Este estudo teve como objetivo implementar um modelo biomecânico, de segmentos articulados, associado à solução inversa que permita a análise em três dimensões das forças de reação proximais e momentos proximais resultantes para diferentes gestos do membro superior. O modelo implementado é composto por cinco segmentos rígidos (mão, antebraço, braço, escápula e tronco) conectados. A resolução das equações de movimento de Newton-Euler é feita através da solução inversa. Para registro cinemático foram utilizadas cinco câmeras digitais, com freqüência de amostragem de 50 campos/seg. O modelo implementado foi avaliado de quatro formas: estimativa da acurácia da medida tridimensional obtida pela cinemetria, comparação quantitativa e qualitativa dos resultados parciais oferecidos pelo modelo implementado com resultados obtidos por instrumentos de mensuração direta (eletrogoniômetro e eletromiografia) e cálculo da propagação do erro nos valores de força de reação resultante e momento proximal líquido. Os resultados sugerem que o modelo apresenta resultados coerentes. A acurácia do sistema de videogrametria estimada foi, em média, de 1,7 (± 1,5) mm. As medidas angulares da cinemetria e eletrogoniometria divergiram em até 36°. O erro propagado no cálculo da força de reação proximal pode chegar até 25% e até 100% no cálculo do momento proximal. O sinal eletromiográfico e o momento proximal apresentaram sincronismo temporal. O modelo foi capaz de avaliar as forças de reação proximal resultantes e momentos proximais líquidos nos diferentes gestos. / The goal of this study was to implement a link segments biomechanical model, associate to the inverse solution for three dimensions analysis of proximal reaction force and proximal net moments during upper limb movement. The implemented model is composed by five connected rigid segments (hand, forearm, arm, scapula and trunk). The resolution of Newton-Euler movement equations is done through the inverse solution. For kinematics acquisition five digital cameras were used, with a frequency sample of 50 fields/sec. The implemented model was evaluated in four ways: accuracy estimation of the three-dimensional measurements, quantitative and qualitative comparison of the partial results offered by the implemented model with results obtained by instruments of direct measurements (electrogoniometer and electromyography) and calculation of the error propagation in proximal reaction force and proximal net moment values. The results suggest that the model presents coherent results. The estimated accuracy videogrammetry system was, on average, of 1.7 (± 1.5) mm. The joint angular values obtained by kinematics system and electrogoniometer diverged in 36°. The error propagation in proximal reaction force values can arrive up to 25% and up to 100% for proximal net moment. The electromyographic sign and the proximal moment presented temporary synchronism. The model was able to evaluate the proximal reaction force and proximal net moment during upper limb movement.

Author's name: Bc. Sára Miczová Supervisor:: Mgr. Miriama Dědková, DiS Opponent: Thesis title: Occupational therapy practise guidelines in patients with functional upper limb impairment after stroke in subacute phase To be able to provide occupational therapy intervention of high quality the occupatioal therpaists should rely on relevant standards of clinical care and clinical guidelines. (Švestková, 2018). Occupational therapists as well as other members of the interdisciplinar team provide professional care to the patients recovering from stroke. Those patients often have to deal with upper limb impairment which leads to decrese of quality of life. Relevant studies focused on this topic were searched via key words in PubMed, Web of Science and OVID Evidence Based Medicine Reviews databasis. The criterias of selection were: public access to the content, english language which were mainly focused on stroke patients rehabilitation. The suggestion of guideline was created based on methods accepted by department. The occupational therapist as well as physiotherapeutist of early rehabilitation were included in the process of creating the guideline using the GRADE programme for it. Only 48 out of 4054 studies were used, these were divided into two cathegories, one being the cathegory of assessment, the...

Ballistic shields are supported by a user’s arm, placing the upper extremity at close proximity to the back-face of the shield. Although ballistic shields must pass a protective standard that outlines projectile (bullet) penetration; there is no standard that stipulates the amount of acceptable deformation when ballistic shields stop or deflect projectiles. There are no injury criteria developed for the high-rate, short duration and focal loading that is typical of shield back-face deformation from these events. In this research, an anthropomorphic test device (ATD) was modified to allow for additional instrumentation capable of measuring these loads. It was then used in a ballistic testing facility to quantify loading at the hand, wrist, forearm, and elbow. A lightweight projectile was created that matched the shape and stiffness of the deforming ballistic shield and impacts within 5% of the peak force measured in the ballistic testing facility were applied with it to post-mortem human subjects (PMHS) until failure. Eight 50th percentile male PMHS pairs were segmented at the mid-humerus and impacted to failure to determine the fracture threshold of the hand, wrist, forearm, and elbow, confirmed by x-ray imaging. The peak force required to generate fracture varied significantly among anatomical location, indicating boundary conditions influence failure threshold. Further, these injury criteria were substantially different than previously reported criteria for other loading events (e.g., automotive), highlighting the importance of developing injury criteria specific for the intended application. An existing finite element human body model designed for automotive impacts was also assessed for its applicability to predict injury in these high-rate loading scenarios, and performed well for peak force, but not for the force-time curve shape. This is the first study of its kind to assess injury risk resulting from shield behind armour blunt trauma, and results from this work will inform a protective standard to assess ballistic shields. / Thesis / Doctor of Philosophy (PhD) / Ballistic shields used by defence personnel are designed to stop incoming bullets by deflecting or absorbing them. In the process, the back-face of the shield undergoes a rapid deformation that can potentially cause an upper extremity injury to users, an injury mechanism termed behind shield blunt trauma. This work aimed to quantify the injury risk that this mechanism poses at four locations along the upper extremity: the hand, wrist, forearm, and elbow. This was conducted by modifying and employing a crash test dummy upper extremity and measuring loads applied to the upper extremity in a ballistic testing range. Assessment of whether these loads caused injury was conducted using cadaveric specimens and testing them to failure. An existing finite element human body model was also assessed for its applicability to predict injury in these high-rate loading scenarios. Results from this work will inform a protective standard to assess ballistic shields.

Joint kinematics of upper extremity (UE) impairments in a pediatric population are often difficult to examine using marker-based motion capture. As a result of the cost and availability of tools such as marker-based motion capture in clinical settings, clinicians use functional tasks to examine improvement in movement quality. However, some of these tasks, such as the Box and Block test (BBT), which is examined in this study, rely on scoring to assess motor improvement. This scoring method can be misleading due to the possibility of movement compensation to improve scores. Therefore, finding kinematic correlations that can lead to improved BBT scores could improve the quality of functional assessments by providing discrete measures for clinicians. Understanding human motion using marker-based motion capture has been the accepted standard in biomechanics. However, it is not without its drawbacks, especially in upper extremity examination due to complex anatomical positioning. The introduction of markerless motion capture software could drastically alter how human biomechanics is analyzed in various settings. Additionally, avoiding possible errors due to clothing and skin movement could greatly improve reported results. Therefore, examining similarities in UE joint kinematics between accepted marker-based and markerless software could introduce markerless motion capture as a method for examining complex kinematics. This study aims to examine UE joint kinematics in a typically developing pediatric population while they complete the BBT, as well as validate Theia3D (Theia Markerless Inc., Kingston, ON, Canada). Marker-based motion capture was used to capture UE kinematics during the BBT. This study was performed on typically developing children aged 7, 9, and 11. Average and peak joint angles were determined, as well as hand segment velocity and path length. Significant correlations to BBT scores were found in peak shoulder flexion (FLEX) angle (r = -0.556, p-value = 0.009), peak (r = -0.479, p-value = 0.028), and average (ρ = -0.535, p-value = 0.012) wrist extension (EXT) angle, average mediolateral (ML) hand segment velocity (r = 0.494, p-value = 0.023), and path length (r = -0.522, p-value = 0.015). Additionally, significant differences between BBT scores (p-value = 0.005), peak shoulder FLEX (p-value = 0.024), and peak shoulder abduction (ABD) angle (p-value = 0.022) were found between the 7- and 11-year-old age groups. Peak elbow FLEX angle was significantly different (p-value = 0.049) between 9- and 11-year-old age groups. These results show that the BBT score could be related to the shoulder and wrist angle, as well as hand segment velocity and path length for typically developing children. Furthermore, root mean square deviation (RMSD) values less than 6° existed in all joint angles. Intraclass correlation coefficients (ICCs) greater than 0.75 were found in shoulder ABD (ICC = 0.79), forearm pronation (ICC = 0.81), wrist EXT (ICC = 0.75), and radial deviation (ICC = 0.87). Additionally, validation results between the marker-based and markerless systems show that there are differences in pose estimations and joint calculations based on rotation sequences. Overall, UE joint kinematics are shown to have correlations to BBT scores, so scores alone may not be indicative of movement quality in other patient populations. Markerless motion capture shows many benefits, however, it should be noted that, due to the complexity of upper extremity motion analysis, understanding what joint rotation sequences align the best with task-specific motions is important. / Master of Science / Human motion is commonly analyzed using marker-based motion capture, which consists of fitting participants with retroreflective markers that can be seen by specialized cameras. However, due to equipment costs, difficult implementation, and the occurrence of markers shifting on skin or being concealed by clothing, markerless motion capture is beginning to be introduced into biomechanics research and could be used in hospitals, clinical settings, and for outdoor examination due to its versatility. The software uses machine learning software that can determine skin landmarks in videos from several cameras to develop a 3D skeleton. Markerless motion capture could be beneficial in examining patients with neuromotor disorders or injuries due to being able to capture abnormal or quick movement which often accompanies many neurological disorders that affect motor function. Additionally, observing movement in children is a challenge due to markers being too close together on smaller limbs. Due to cost and obtainability, clinicians tend to use functional tests to examine improvements in motor function by a scoring system relevant to the specific test, such as the Box and Block test (BBT) which will be used in this study. However, there is the possibility of the patient's ability to adapt to the test to improve their score without improving general motor function. Therefore, it is important to find a relationship between upper limb movement and BBT scores. This study aims to find correlations between upper limb movement and Box and Block test scores as well as differences between 7-, 9-, and 11-year-old age groups and compare marker-based motion capture and the Theia3D (Theia Markerless Inc., Kingston, ON, Canada) markerless motion capture software. Joint assessment is completed with motion capture, which uses reflective markers on specific landmarks on the skin surface. Markerless motion capture is collected simultaneously with marker-based motion capture to assess similarities. The entire procedure was also completed 2 times within 1 visit. The results showed meaningful comparisons between the BBT scores and shoulder and wrist angle, and hand velocity. BBT scores and shoulder angles were shown to be different between the 7- and 11-year-old age groups. Elbow angles were shown to be different between the 9- and 11-year-old age groups. Additionally, comparisons between the marker-based and markerless results showed that all resulting joint angle data captured by each system were similar. Markerless measurement comparisons showed similarities between both sessions as well. These results show that there are ways to provide discrete measurements in clinical settings to examine movement quality. Comparisons between both motion analysis systems show the need to determine task-specific analyses to obtain meaningful results concerning the upper limbs, due to the inherent joint complexity and differing methods of completing the same task.

As principais desordens dos membros superiores e cervical (CANS - Complaints of arms, neck and shoulders) podem ser definidas como queixas musculoesqueléticas nas regiões de membro superior, ombro e pescoço não atribuídas a trauma agudo ou a desordens sistêmicas. Essas desordens são comuns entre trabalhadores usuários de computador. O Maastricht Upper Extremity Questionnaire (MUEQ) é uma das poucas ferramentas existentes na literatura para avaliação de risco ergonômico e psicossocial em trabalhadores, além da vantagem de ser específico para usuários de computador, porém não está validado no português-brasileiro. O objetivo deste trabalho foi realizar a adaptação transcultural para o português-brasileiro e validação do MUEQ em trabalhadores de escritório usuários de computador e verificar a prevalência das CANS na amostra recrutada. A tradução e adaptação transcultural seguiram as diretrizes do Consensus-based Standards for the selection of health status Measurement Instruments nos estágios: tradução, síntese, retrotradução, revisão pelo comitê de especialistas e pré-teste. Na etapa do teste da versão pré-final, foram aplicados 55 questionários em trabalhadores usuários de computador, que relataram dificuldades de compreensão abaixo do valor estipulado de 20%, não sendo necessária a reformulação da ferramenta. Para testar a confiabilidade, outros 50 sujeitos preencheram o questionário, em dois momentos, com nível de reprodutibilidade considerado excelente (ICC>0,75). A amostra para a análise da consistência interna e análise fatorial do questionário contou com 386 trabalhadores usuários de computador de mesa entre 18 e 60 anos. Para a consistência interna foram observados valores de de Cronbach maiores que 0,7 para todos os domínios. Na análise fatorial os domínios/subdomínios apresentaram valores de eigenvalue superiores a 1 e os valores de variância explicada acumulada dos fatores de cada domínio variou entre 40% e 60%. A prevalência das CANS nos últimos três meses por pelo menos uma semana foi de 73,32% (IC=0,69-0,77) na amostra total (n=283) e 82% (IC=0,76-0,87) das mulheres e 62% (IC=0,55-0,69) dos homens relataram alguma das CANS. Os domínios foram mantidos iguais à versão original do MUEQ. A queixa musculoesquelética mais observada foi a dor no pescoço (51%). A partir deste trabalho disponibilizou-se um instrumento abrangente e confiável para a avaliação ergonômica e psicossocial relacionado às queixas em cervical e membro superior em trabalhadores usuários de computador brasileiros e foi observada alta prevalência de CANS na população observada. / Complaints of the Arm, Neck and Shoulder (CANS) have a multifactorial etiology, and, therefore, its assessment should take into consideration work-related ergonomic and psychosocial aspects. The Maastricht Upper Extremity Questionnaire (MUEQ) is among the few specific tools available to evaluate the nature and occurrence of CANS in computer office workers. The purpose of the present study was to perform the cross-cultural adaptation of the MUEQ to Brazilian Portuguese and verify the psychometric properties of the MUEQ-Br in Brazilian computer office workers and to assess the prevalence of CANS in a sample of Brazilian computer office workers. The translation and cultural adaptation followed the guidelines of the Consensus-based Standards for the selection of health status Measurement Instruments in six stages: translation, synthesis, back translation, review by the expert committee, pre-test and submission of documents to the committee. In the test of pre-final version, 55 questionnaires were administered to computer workers who reported difficulties in understanding below the stipulated 20%, without the need for redesign of the tool. The pre-final version test counted on the participation of 55 computer office workers. For reproducibility, it was considered a sample of 50 workers who answered the questionnaire twice with a one-week interval. A sample comprised by 386 (37.44 years, Confidence Interval (CI) 95%:36.50-38.38, 216 women and 170 men) workers from the University of São Paulo at Ribeirão Preto campus to validate the structure of the questionnaire, verify internal consistency and CANS prevalence. Intraclass Correlation Coefficient (ICC) was used for the statistical analysis of reproducibility, Cronbachs Alpha for Internal Consistency, and the Principal Component Analysis method for Exploratory Factor Analysis. The psychometric properties of the MUEQ were assessed using exploratory factor analysis, which revealed 14 factors. The calculation of internal consistency, reproducibility and cross validation provided evidence of reliability and lack of redundancy. It was verified ICC values greater than 0.75 and cronbachs alpha greater than 0.7. Factor analysis was conducted for every section of the questionnaire and 14 factors were found, two for each section accounting for approximately 40 to 60% of the variance. The prevalence rate of CANS indicated that 73% (IC=0,69-0,77) of the respondents reported at least one complaint in the arm, neck and/or shoulder in the total sample (n=283), 82% (IC=0,76-0,87) of the women and 62% IC=0,55-0,69) of the men. The highest prevalence rates were found for neck symptoms (51%). The MUEQ-Br demonstrated to be a valid tool for the assessment of risk factors related to pain in the upper extremity among Brazilian computer office workers.

Patient reported outcome (PRO) measurement of disability is integral to a patient-centered approach to health care and gauging the biopsychosocial impact of health conditions from the patient's perspective. This thesis investigates disability after proximal humerus, elbow and distal radius fractures; conditions that constitute a major burden in musculoskeletal health care and a substantial impact on health-related quality of life (HrQoL). Disability is defined by the World Health Organisation (WHO) International Classification of Disability, Functioning and Health (ICF) as ‘a multi-dimensional construct involving a dynamic interaction between impairment, activity limitations and participation restrictions, that are influenced by contextual factors'. This international, consensus-based framework acts as a guide for the application of outcome measures in performing scientific research. The WHO ICF also considers other patient perspectives on health and health care systems, including patient experience and patient activation within the contextual factors component. Patient experience encompasses aspects such as satisfaction, expectation management and confidence with care, and is measured using a variety of scales and questionnaires. Patient activation relates to 'the knowledge, skills and confidence a person has in managing their own health and health care'. This concept is quantified using patient activation measures (PAMs). The overarching goal of this thesis is to identify the most influential factors predicting disability after proximal humerus, elbow and distal radius fractures. This work also aimed to define the relationship between disability, experience and activation to inform the development of a patient-centred approach to managing these challenging injuries. The first systematic review highlights the dominance of psychosocial factors in influencing disability associated with a range of upper extremity conditions. Few studies have assessed this relationship in specific trauma populations. The second review underlines the paucity of upper extremity PRO measures incorporating fracture populations in their original development. It also reports the highly variable quality of initial studies introducing these measures. The final review demonstrates the superior measurement properties of computer adaptive tests (CATs), a contemporary form of PRO measurement, over fixed-scale instruments. Few studies apply CATs in trauma and few have been performed outside the U.S. These reviews collectively informed the selection of PRO measures for the experimental studies in this thesis. Firstly, a pilot study establishes a methodology for addressing the key objectives and the feasibility of using a web-based platform for measuring patient outcomes. Strong correlation between PROMIS Physical function CAT, a computer adaptive measure of physical function, and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), a region-specific, fixed scale is observed. The core experiment (n=734) expands upon this work and demonstrates correlations between a range of generic and region-specific measures in an upper extremity trauma population. Disability is shown to correlate with satisfaction, and the strength of this correlation increases over time. Applying PRO measures of disability in populations with shoulder, elbow and wrist fractures show that self-efficacy (i.e. coping ability) within 6 weeks of injury was the strongest predictor of medium-term disability at 6-9 months. In proximal humerus and elbow fractures, kinesiophobia (i.e. fear of movement) within a week of injury was also a strong predictor of disability. The final study concludes that greater patient activation is associated with greater health-related and experiential outcomes. However, psychosocial factors including self-efficacy, superseded activation in predicting disability and satisfaction. This thesis contributes evidence for musculoskeletal health care professionals (HCPs) to consider specific psychosocial factors, such as coping abilities, and patient activation early in the recovery process to improve disability following these injuries.

As principais desordens dos membros superiores e cervical (CANS - Complaints of arms, neck and shoulders) podem ser definidas como queixas musculoesqueléticas nas regiões de membro superior, ombro e pescoço não atribuídas a trauma agudo ou a desordens sistêmicas. Essas desordens são comuns entre trabalhadores usuários de computador. O Maastricht Upper Extremity Questionnaire (MUEQ) é uma das poucas ferramentas existentes na literatura para avaliação de risco ergonômico e psicossocial em trabalhadores, além da vantagem de ser específico para usuários de computador, porém não está validado no português-brasileiro. O objetivo deste trabalho foi realizar a adaptação transcultural para o português-brasileiro e validação do MUEQ em trabalhadores de escritório usuários de computador e verificar a prevalência das CANS na amostra recrutada. A tradução e adaptação transcultural seguiram as diretrizes do Consensus-based Standards for the selection of health status Measurement Instruments nos estágios: tradução, síntese, retrotradução, revisão pelo comitê de especialistas e pré-teste. Na etapa do teste da versão pré-final, foram aplicados 55 questionários em trabalhadores usuários de computador, que relataram dificuldades de compreensão abaixo do valor estipulado de 20%, não sendo necessária a reformulação da ferramenta. Para testar a confiabilidade, outros 50 sujeitos preencheram o questionário, em dois momentos, com nível de reprodutibilidade considerado excelente (ICC>0,75). A amostra para a análise da consistência interna e análise fatorial do questionário contou com 386 trabalhadores usuários de computador de mesa entre 18 e 60 anos. Para a consistência interna foram observados valores de de Cronbach maiores que 0,7 para todos os domínios. Na análise fatorial os domínios/subdomínios apresentaram valores de eigenvalue superiores a 1 e os valores de variância explicada acumulada dos fatores de cada domínio variou entre 40% e 60%. A prevalência das CANS nos últimos três meses por pelo menos uma semana foi de 73,32% (IC=0,69-0,77) na amostra total (n=283) e 82% (IC=0,76-0,87) das mulheres e 62% (IC=0,55-0,69) dos homens relataram alguma das CANS. Os domínios foram mantidos iguais à versão original do MUEQ. A queixa musculoesquelética mais observada foi a dor no pescoço (51%). A partir deste trabalho disponibilizou-se um instrumento abrangente e confiável para a avaliação ergonômica e psicossocial relacionado às queixas em cervical e membro superior em trabalhadores usuários de computador brasileiros e foi observada alta prevalência de CANS na população observada. / Complaints of the Arm, Neck and Shoulder (CANS) have a multifactorial etiology, and, therefore, its assessment should take into consideration work-related ergonomic and psychosocial aspects. The Maastricht Upper Extremity Questionnaire (MUEQ) is among the few specific tools available to evaluate the nature and occurrence of CANS in computer office workers. The purpose of the present study was to perform the cross-cultural adaptation of the MUEQ to Brazilian Portuguese and verify the psychometric properties of the MUEQ-Br in Brazilian computer office workers and to assess the prevalence of CANS in a sample of Brazilian computer office workers. The translation and cultural adaptation followed the guidelines of the Consensus-based Standards for the selection of health status Measurement Instruments in six stages: translation, synthesis, back translation, review by the expert committee, pre-test and submission of documents to the committee. In the test of pre-final version, 55 questionnaires were administered to computer workers who reported difficulties in understanding below the stipulated 20%, without the need for redesign of the tool. The pre-final version test counted on the participation of 55 computer office workers. For reproducibility, it was considered a sample of 50 workers who answered the questionnaire twice with a one-week interval. A sample comprised by 386 (37.44 years, Confidence Interval (CI) 95%:36.50-38.38, 216 women and 170 men) workers from the University of São Paulo at Ribeirão Preto campus to validate the structure of the questionnaire, verify internal consistency and CANS prevalence. Intraclass Correlation Coefficient (ICC) was used for the statistical analysis of reproducibility, Cronbachs Alpha for Internal Consistency, and the Principal Component Analysis method for Exploratory Factor Analysis. The psychometric properties of the MUEQ were assessed using exploratory factor analysis, which revealed 14 factors. The calculation of internal consistency, reproducibility and cross validation provided evidence of reliability and lack of redundancy. It was verified ICC values greater than 0.75 and cronbachs alpha greater than 0.7. Factor analysis was conducted for every section of the questionnaire and 14 factors were found, two for each section accounting for approximately 40 to 60% of the variance. The prevalence rate of CANS indicated that 73% (IC=0,69-0,77) of the respondents reported at least one complaint in the arm, neck and/or shoulder in the total sample (n=283), 82% (IC=0,76-0,87) of the women and 62% IC=0,55-0,69) of the men. The highest prevalence rates were found for neck symptoms (51%). The MUEQ-Br demonstrated to be a valid tool for the assessment of risk factors related to pain in the upper extremity among Brazilian computer office workers.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Abstract available in the Medicine and Sciences in Sports and Exercise.

Introduction: Baseball pitching is considered one of the most intense aspects within the game of baseball, as well as the most complicated dynamic throwing task in all of sports. The biomechanics of pitching have been heavily investigated in an attempt to identify optimal pitching mechanics in terms of pitching performance. Previous quantified upper body kinetics research has concluded that improved muscle strength is needed in attempting to achieve adequate upper body kinetics and efficient pitching performances. Therefore, it is the purpose of this research study to compare the lower extremity muscle and upper extremity muscle activation patterns and kinematic variables associated with the curveball pitch and the fastball pitch when pitching from the wind-up and stretch position. Methods: Twelve skilled (competed at the NCAA collegiate level) baseball pitchers volunteered to be research subjects for this study. The participants were fitted with six surface electromyography (EMG) bipolar electrodes (Delsys Inc., Boston, Massachusetts) on the stride leg biceps femoris, medial gastrocnemius, ipsilateral side (throwing arm side) lower trapezius, upper trapezius, triceps brachii and biceps brachii. Each participant underwent maximum voluntary isometric contraction (MVIC) testing and then performed a pitching analysis. All EMG variables of interest were normalized using MVIC data and then compared between pitching types and pitch delivery. Shoulder rotation, shoulder abduction, elbow flexion and extension, elbow angular velocity and pelvis rotation were determined using motion capture (Motion Analysis Corp., Santa Rosa, SA) and Visual 3D software (C-Motion Inc., Germantown, MD). Paired t-tests and factorial analyses were performed using SPSS (p ≤ 0.05). Results and Discussion: Significant differences in the peak and mean muscle activity for the fastball and curveball pitched from wind-up and stretch position were observed. Significant differences in the kinematic variables between the fastball and curveball from the wind- up and stretch were also observed. These findings suggest that upper and lower muscle activity could be associated with enhanced pitching technique and pitching performance. Pitching kinematic differences associated with the diverse pitch types as well as the multiple pitch deliveries may impact the overall “wear and tear” on a pitcher’s health and pitching arm. Conclusions: Many differences were found, between both the pitching type and the pitching delivery as well as the kinematic variables. These findings suggest that upper and lower muscle activity could be associated with enhanced pitching technique and pitching performance to keep a baseball pitcher healthy and on the pitching mound longer into the season, decreasing the rate of injury. Shoulder rotation and pelvis rotation, as well as the elbow angular velocity and elbow flexion-extension, have an impact on the pitcher’s ability to stay off the disabled list and in the game longer. Determining pitch types along with delivery types that enhance the pitcher’s ability to stay active without injury will provide a way to make the game of baseball safer for the future generation of all stars.