Cervical Joint Position Sense in Individuals With Type 2 Diabetes and Its Correlations With Glycated Hemoglobin Levels: A Cross-Sectional Study

ObjectiveThis study aimed to compare cervical joint position sense (JPS) between individuals with type 2 diabetes (T2D) and healthy individuals and to assess the correlation between glycated hemoglobin (HbA1c) values and cervical JPS in individuals with T2D.MethodsNinety-seven individuals with T2D (mean age: 59.0 ± 6.8 years; men = 63 [67.02%], women = 34 [32.98%], and 117 healthy individuals without T2D (mean age: 57.3 ± 6.9 years; men = 70 [79.80%], women = 44 [20.20%]) were recruited into this study. Cervical JPS was evaluated using a cervical range of motion device in cervical flexion, extension, and rotation in left and right directions. Participants were required to relocate their heads actively to a predefined target position with eyes closed, and their reposition accuracy was measured in degrees as joint reposition error (JRE). The HbA1c test was performed on all participants with T2D to determine their average blood sugar level over the previous 2 to 3 months. Cervical JREs were compared and correlated with HbA1c values.ResultsThe participants with T2D showed significantly larger cervical JREs in all directions compared with the healthy group (flexion: d = 1.23, P < .001; extension: d = 1.85, P < .001; left rotation: d = 1.70, P < .001; right rotation: d = 2.60, P < .001). Pearson correlation coefficient (r) showed significant moderate positive association between HbA1c and cervical JREs in flexion (r = 0.41, P = .001), extension (r = 0.48, P < .001), left rotation (r = 0.38, P < .001), and right rotation (r = 0.37, P < .001) in participants with T2D.ConclusionThe magnitude of cervical JPS impairment was significant in individuals with T2D. In addition, HbA1c levels showed a significant negative correlation with cervical JPS.     

Immediate Effect of Lumbosacral Orthosis and Abdominal Drawing-In Maneuver on Postural Control in Adults With Nonspecific Chronic Low Back Pain

ObjectiveThe purpose of this study was to examine the immediate effects of lumbosacral orthosis and the abdominal drawing-in maneuver on the trunk postural control of adults with chronic low back pain compared with asymptomatic controls during 1-legged and semi-tandem stances.MethodsAn experimental and comparative study (cross-sectional design) was conducted in a laboratory setting. Twenty adults with chronic low back pain and 20 asymptomatic controls randomly performed 2 postural balance tasks over a force platform, considering 3 experimental conditions: (1) natural posture (baseline-control), (2) lumbosacral orthosis, and (3) abdominal drawing-in maneuver. Linear variables (mean amplitude, ellipse area, and sway velocity) derived from the center of pressure were computed, and 2-way analysis of variance (group × condition) for repeated measures were conducted.ResultsNo group × condition interactions (.139 ≤ P ≤.938) were detected in any center of pressure parameters. No condition effect was detected, but a group effect (P = .042) was observed for 1 center of pressure parameter. The chronic low back pain group presented with a lower mean anteroposterior center of pressure amplitude than asymptomatic controls (? = 0.31 ± 0.66 cm [95% confidence interval, 0.05-0.56], P = .019) during the semi-tandem stance balance task.ConclusionNeither lumbosacral orthosis nor the abdominal drawing-in maneuver showed immediate improvement in trunk postural control in any group. Thus, clinicians should not expect immediate benefits or improvements yielded by lumbosacral orthosis or the abdominal drawing-in maneuver when patients with chronic low back pain undergo these interventions.     

Effects of Valsalva Maneuver on Pain and Vasovagal Reaction During the Removing of Femoral Arterial Sheath After Percutaneous Coronary Intervention: A Randomized Controlled Trial

PurposeThe objective of this study was to investigate the effects of the Valsalva maneuver on pain and vasovagal reactions during femoral arterial sheath removal in patients undergoing percutaneous coronary intervention.DesignThis study was a randomized controlled trial.MethodsIn this study, 60 patients undergoing elective coronary angioplasty were randomly assigned to the intervention and control groups. After angioplasty, the patients in the intervention group performed the Valsalva maneuver (20-30 mm Hg) for 10 seconds during the sheath removal. Conversely, in the control group, no inspiratory pressure was applied. Before and immediately after the sheath removal, the patients’ pain, vital signs, and vasovagal reactions were measured.FindingsThe primary characteristics of the patients were similar in the two groups. The patients in the intervention group had significantly lower pain scores during femoral sheath removal compared to the control group (2.33 ± 1.56 vs 5.56 ± 3.08, P < .001). The Valsalva maneuver during femoral sheath removal decreased the patients’ heart rate in the intervention group compared to the control group (78.26 ± 12.37 vs 85.46 ± 11.79, P < .001); however, blood pressure and vasovagal reactions were not significantly different.ConclusionsThis study showed that the Valsalva maneuver during femoral arterial sheath removal can reduce the pain severity score, without increasing the incidence of vasovagal reactions.     

Origin of neck pain and direction of movement influence dynamic cervical joint motion and pressure pain sensitivity

BackgroundPatients with neck pain normally showed alterations in cervical motion and pressure pain sensitivity. Cervical joints show scattered motions opposite to (anti-directional) the primary motion direction (pro-directional) during dynamic cervical flexion and extension. This study aimed to assess dynamic cervical joint motion and pressure pain sensitivity when pain originated from different cervical muscles which may have clinical relevance in diagnosis of impairments related with neck pain.MethodsFluoroscopic video recordings of cervical flexion and extension were collected from fifteen healthy subjects before and during hypertonic saline-induced pain in right multifidus and trapezius muscles. Cervical flexion and extension motions were divided into 10 epochs with respect to time. Pro-directional, anti-directional, and total joint motion were extracted across epochs as well as joint motion variability. Pressure pain thresholds (PPTs) were assessed bilaterally over C2/C3 and C5/C6 facet joints.FindingsCompared with baseline: 1) Multifidus muscle pain increased the C3/C4 anti-directional motion (P < 0.01), decreased the C6/C7 anti-directional motion (P < 0.05) during extension, and redistributed total joint motion between joints and between half ranges during flexion (P < 0.05). 2) Trapezius muscle pain decreased pro-directional motion (P < 0.05), anti-directional motion (P < 0.05), and joint motion variability (P < 0.05) during extension. 3) Trapezius and multifidus muscle pain increased the PPTs bilaterally over C2/C3 and on the left side of C5/C6 facet joints (P < 0.05).InterpretationThe direction of motion influenced the effects of experimental muscle pain on dynamic cervical joint kinematics, and deep muscle pain showed local effects on individual joints while superficial muscle pain showed global effects spread to all joints.     

Control of Linear Head and Trunk Acceleration During Gait After Unilateral Vestibular Deficits

ObjectiveTo use clinically available inertial measurement units to quantify the control of linear accelerations at the head and trunk during gait in different sensory conditions in individuals with unilateral vestibular loss.DesignObservational study.SettingOutpatient research laboratory.ParticipantsIndividuals (n=13; mean age, 47.6±13.7y; 69% women) 6 weeks after vestibular schwannoma resection surgery and vestibular healthy participants (n=16; mean age, 29.7±5.9y; 56% women).InterventionNot applicable.Main Outcome MeasuresWalking speed normalized, root mean square values of cranial-caudal, medial-lateral, and anterior-posterior directed linear accelerations at the head and the trunk while walking in 2 visual sensory conditions (eyes open and eyes closed).ResultsLinear mixed models for each root mean square value were fit on the effects of group, condition, and group by condition. The group by condition effect was used to examine the primary hypothesis that individuals with vestibular loss would experience greater change in triplanar root mean square values at the head and trunk from the eyes open to eyes closed condition compared with the vestibular healthy group. The group by condition effect was found to be significant at the head in the cranial-caudal (β=0.39; P=.002), medial-lateral (β=0.41; P<.001), and anterior-posterior (β=0.43; P<.001) directions. The group by condition effect was also significant in the cranial-caudal (β=0.39; P=.002), medial-lateral (β=0.39; P<.001), and anterior-posterior (β=0.23; P=.002) directions at the trunk.ConclusionsParticipants who underwent vestibular schwannoma resection were more impaired in their ability to control accelerations at the head and trunk without visual sensory information than vestibular healthy participants. These impairments were detectable using clinically available inertial measurement units.     

The Acute Effects of Manual and Instrument-Assisted Cervical Spine Manipulation on Pressure Pain Threshold,Pressure Pain Perception,and Muscle-Related Variables in Asymptomatic Subjects: A Randomized Controlled Trial

ObjectiveThe purpose of this study was to compare the immediate effects in asymptomatic participants of manual and instrument-assisted cervical manipulation on pressure pain thresholds, pressure pain perception, and muscle mechanical properties (tone, stiffness, and elasticity) over muscles anatomically related and unrelated to the manipulated level.MethodsFifty-nine asymptomatic participants (34 women and 25 men; age [mean ± standard deviation] = 21.1 ± 1.6 years) were randomly assigned to 4 groups in a double-blind, randomized, placebo-controlled trial. Two groups received cervical (C3/C4) manipulation, 1 manual and the other instrument-assisted; the third group received a sham manipulation; and the fourth group served as the control. Bilateral pressure pain threshold, pressure pain perception, muscle tone, stiffness, and elasticity in the upper trapezius and biceps brachii were evaluated before and immediately after the interventions.ResultsAt baseline, there were no differences among the groups on any variable. After the interventions, a significant increase in pressure pain threshold was observed with both manual and instrument-assisted manipulation at local and distal sites (P < .05), whereas no changes were observed in either the control or the placebo group. The perception of pain pressure did not change significantly in any group. The interventions did not promote any statistically significant differences in muscle tone, elasticity, or stiffness at any site (local or distal).ConclusionCervical (C3/C4) manual and instrument-assisted manipulations produced an increase in pressure pain threshold bilaterally and over muscles related and unrelated to the vertebral segment, but had no effect on muscle tone, elasticity, or stiffness.     

难治性癔球症患者食管压力特征及血清脑肠肽水平的变化

目的探讨难治性癔球症(RG)与非难治性癔球症(NRG)患者食管运动功能尤其是食管上括约肌(UES)压力及血清脑肠肽水平的变化特征。 方法采用高分辨食管测压系统(HRM)对癔球症患者行食管测压并留取空腹静脉血,检测血清脑肠肽水平,对比难治性癔球症患者和非难治性癔球症患者食管测压结果及血清脑肠肽水平差异。 结果RG患者的UES静息压显著高于NRG患者[(94.97±42.08)mmHg,(73.91±23.47) mmHg,t＝2.359,P<0.05)](1 mmHg＝0.133 kPa);RG患者与NRG患者UES残余压[(12.44±8.31)mmHg,(12.66±8.12)mmHg]、UES长度[(22.72±10.13)mm,(19.71±7.85)mm]、收缩前速度(CFV)[(5.47±1.39)cm/s,(5.24±1.40)cm/s]、收缩延迟时间(DL)[(6.59±1.29)s,(6.78±1.10)s]、食管下括约肌(LES)静息压[(22.63±10.17)mmHg,(19.56±7.63)mmHg]比较,均差异无统计学意义(t＝0.528,0.471,0.725,0.736,0.486;P>0.05);NRG患者的血清神经肽Y(NPY)水平较RG患者低[(626.26±16.60)ng/L,(641.35±17.45)ng/L,t＝2.528,P<0.05];RG患者血清P物质(SP)水平高于NRG患者[(2386.96±372.68)ng/L,(1607.77±345.91)ng/L,t＝3.728,P<0.05)];NRG患者与RG患者两者血清中降钙素基因相关肽(CGRP)水平无统计学差异[(236.17±76.85)ng/L,(229.35±57.52)ng/L,t＝0.752,P>0.05)]。 结论相对于NRG患者,RG患者具有更高的UES静息压和较高水平的血清P物质含量以及较低水平的血清神经肽Y含量。     

The Effectiveness of Hollowing and Bracing Strategies With Lumbar Stabilization Exercise in Older Adult Women With Nonspecific Low Back Pain: A Quasi-Experimental Study on a Community-based Rehabilitation

Objective

The purpose of this study was to explore the therapeutic effectiveness of hollowing lumbar stabilization exercise (HLSE) and bracing lumbar stabilization exercise (BLSE) for older adult women with nonspecific low back pain (NSLBP) in community welfare centers.

Recurrent neck pain patients exhibit altered joint motion pattern during cervical flexion and extension movements

BackgroundImpaired sensorimotor ability has been demonstrated in recurrent neck pain patients. It is however not clear if cervical joint motion and pressure pain sensitivity in recurrent neck pain patients are different from asymptomatic controls.MethodsCervical flexion and extension motions were examined by video-fluoroscopy and pressure pain thresholds were assessed bilaterally over C2/C3, C5/C6 facet joints and right tibialis anterior in eighteen recurrent neck pain patients and eighteen healthy subjects. Individual joint motion was analyzed by dividing fluoroscopic videos into 10 epochs. The motion opposite to the primary direction (anti-directional motion) and motion along with the primary direction (pro-directional motion) of each joint were extracted across epochs. Total joint motion was the sum of anti-directional and pro-directional motions. Joint motion variability was represented by the variance of joint motions across epochs.FindingsCompared to controls, recurrent neck pain patients showed: 1) decreased anti-directional motion at C2/C3 and C3/C4 (P < 0.05) and increased anti-directional motion at C5/C6 and C6/C7 (P < 0.05) during extension motion. 2) Increased overall anti-direction motion during flexion motion (P < 0.05). 3) Lower joint motion variability at C3/C4 during extension motion (P < 0.05).InterpretationRecurrent neck pain patients showed a redistribution of anti-directional motion between the middle cervical spine and the lower cervical spine during cervical extension and increased overall anti-directional motion during cervical flexion compared with healthy controls. The anti-directional motion was more sensitive to neck pain compared to other cervical joint motion parameters in the present study.     

Effect of Increasing Obstacle Distances Task on Postural Stability Variables During Gait Initiation in Older Nonfallers and Fallers

ObjectiveTo compare the scaling of the postural stability variables between older nonfallers and fallers during gait initiation (GI) while stepping over increasing obstacle distances.DesignCross-sectional study.SettingUniversity research laboratory.ParticipantsA sample of participants (N=24) divided into 2 groups: older nonfallers (n=12) and older fallers (n=12). Participants had no known neurologic, musculoskeletal, or cardiovascular conditions that could have affected their walking, and all were independent walkers. All the participants had an adequate cognitive function to participate as indicated by a score of more than 24 on the Mini-Mental State Examination.InterventionsNot applicable.Main Outcome MeasuresThe primary dependent variables were peak anterior-posterior (AP) center of mass (CoM)-center of pressure (CoP) separation during anticipatory postural adjustments (APAs), AP CoM-CoP separation at the toe-off, and peak AP CoM-CoP separation during the swing. Secondary dependent variables were AP trunk angle during GI. Within- and between-repeated measures analysis of variance was used to compare means between groups across different task conditions for all the dependent variables.ResultsThere was a main effect of group for peak AP CoM-CoP separation during APA (P=.018), an interaction effect between group and condition for AP CoM-CoP separation at toe-off (P=.009), and a main effect of condition for peak AP CoM-CoP separation during the swing (P<.001). We also found a main effect of group for peak AP trunk angle during the swing (P=.028).ConclusionsFor GI while stepping over increasing obstacle distances, older fallers adopt a more conservative strategy of AP CoM-CoP separation than nonfallers prior to toe-off and demonstrate increased peak AP trunk lean during the swing. AP CoM-CoP separation prior to toe-off during the GI task may be a critical marker to identify fallers and warrants additional investigation.     

Muscle endurance and cervical electromyographic activity during submaximal efforts in women with and without migraine

BackgroundDespite previous reports supporting cervical muscle weakness and altered motor control in migraine, the endurance under standardized submaximal loads has not been investigated. Therefore, this study aimed to assess the endurance and muscle activity of the cervical musculature during submaximal isometric contractions in women with migraine and those without headache.MethodsCervical muscle endurance tests were performed for flexors and extensors at 25%, 50%, and 75% of the output force during maximal isometric contraction using the Multi-Cervical Rehabilitation Unit with customized biofeedback. Initial values and relative rates of changes in root mean square and median frequency were calculated using cervical muscle superficial electromyography.FindingsWomen with chronic migraine presented significantly shorter flexor endurance time in all load tests than controls (25%, P = .001, 50%, P = .005; 75%, P = .013), while episodic migraine only differed from controls at 75% (P = .018). The frequency of neck pain and/or pain referred to the head after the endurance test was up 12% in the control group, 40% in the episodic migraine group and 68% of the chronic migraine group. Few differences between groups were observed in the electromyographic variables and none of them was related to a worse performance in the endurance tests.InterpretationCervical flexor endurance was reduced in women with chronic migraine when independent of the load, whereas it was reduced to 75% of the maximal force in those with episodic migraine. No difference in the electromyographic variables could be related to this reduced flexor endurance. Also, no differences were detected in extensors endurance.     

Cognitive Behavioral Therapy With Stabilization Exercises Affects Transverse Abdominis Muscle Thickness in Patients With Chronic Low Back Pain: A Double-Blinded Randomized Trial Study

ObjectiveNonspecific chronic low back pain (NCLBP) is a major public health and global socioeconomic burden with a variety of symptoms, such as fear-avoidance behaviors. This study aimed to evaluate the effect of cognitive behavioral therapy (CBT) associated with stabilization exercise (SE) on thickness of transverse abdominis (TrA) muscle in patients with NCLBP.MethodsForty patients with NCLBP were randomly assigned into experimental CBT associated with SE (n = 20) and control groups without SE (n = 20). Transverse abdominis muscle thickness was assessed during abdominal drawing in maneuver (ADIM) and active straight leg raise (ASLR) of the right lower limb using ultrasound imaging. Fear-avoidance belief and disability were evaluated using a fear-avoidance belief questionnaire (FABQ) and a Roland-Morris disability questionnaire (RMDQ) before and after intervention.ResultsMixed-model analysis of variance indicated that the effect of time was significant for the right and left TrA contraction thickness during ADIM and left TrA contraction thickness during ASLR (P < .05). However, the experimental group exhibited higher right and left TrA muscle thickness compared with the control group during ADIM (P = .001). Moreover, there were no significant differences between groups in the thickness of TrA muscle during ASLR (P > .05). The effect of time was significant for FABQ (P = .02) and RMDQ (P = .01); however, the effect of group was significant for the FABQ after intervention (P = .04).ConclusionsStabilization exercise associated with CBT is more effective than SE alone in improving fear avoidance belief and in increasing the thickness of the TrA muscle during ADIM task.     

Structural damage and motion rhythm of the spine and hip during trunk lateral bending in ankylosing spondylitis patients with mild to moderate radiographic signs

BackgroundAnkylosing spondylitis causes structural damage and motion restriction in spine. The study was designed to assess structural damage and incoordination pattern between the spine and hip during trunk lateral bending in ankylosing spondylitis.MethodsTwenty-three healthy adults and 39 adults with ankylosing spondylitis were recruited from a tertiary care medical centre. Patients with ankylosing spondylitis were divided into two subgroups: sacroiliitis or lumbar-level syndesmophytes (n = 27) and thoracic or cervical-level syndesmophytes (n = 12). An inertia motion system was used to record three-dimensional kinematic data during trunk lateral bending.FindingsSignificant differences were observed in lumbar spine syndesmophyte scores, sacroiliitis severity and Bath Ankylosing Spondylitis Metrology Index between the subgroups. The cervical supraspinous ligaments thickness revealed difference between the ankylosing spondylitis and control group, but the Glasgow Ultrasound Enthesitis Scoring System did not revealed difference. Motion analysis revealed that the ankylosing spondylitis group had a larger hip, cervical rotation and smaller lumbar-hip rhythm than the control group; however, the other motions of the spine and hip were smaller. The sacroiliitis or lumbar-level syndesmophytes group had the largest thoracic rotation among the three groups.InterpretationThe different lumbar-hip rhythm between ankylosing spondylitis patients depends on syndesmophyte formation levels. Cervical rotation, the Schober test, the chest expansion test, and lumbar–hip rhythm can indicate the levels of bone damage in ankylosing spondylitis. Clinical examination of ankylosing spondylitis should include kinematic measures of both the spine and hips in the early disease stage.     

Effectiveness of manual physical therapy in the treatment of cervical radiculopathy: a systematic review

Abstract

Study design: Systematic review of randomized clinical trials.

Objective: Review of current literature regarding the effectiveness of manual therapy in the treatment of cervical radiculopathy.

Background: Cervical radiculopathy (CR) is a clinical condition frequently encountered in the physical therapy clinic. Cervical radiculopathy is a result of space occupying lesions in the cervical spine: either cervical disc herniations, spondylosis, or osteophytosis. These affect the pain generators of bony and ligamentous tissues, producing radicular symptoms (i.e. pain, numbness, weakness, paresthesia) observed in the upper extremity of patients with cervical nerve root pathology. Cervical radiculopathy has a reported annual incidence of 83·2 per 100?000 and an increased prevalence in the fifth decade of life among the general population.

Results: Medline and CINAHL via EBSCO, Cochrane Library, and Google Scholar were used to retrieve the randomized clinical trial studies for this review between the years of 1995 and February of 2011. Four studies met inclusion criteria and were considered to be high quality (PEDro scores of ?5). Manual therapy techniques included muscle energy techniques, non-thrust/thrust manipulation/mobilization of the cervical and/or thoracic spine, soft-tissue mobilization, and neural mobilization. In each study, manual therapy was either a stand-alone intervention or part of a multimodal approach which included therapeutic exercise and often some form of cervical traction. Although no clear cause and effect relationship can be established between improvement in radicular symptoms and manual therapy, results are generally promising.

Conclusion: Although a definitive treatment progression for treating CR has not been developed a general consensus exists within the literature that using manual therapy techniques in conjunction with therapeutic exercise is effective in regard to increasing function, as well as AROM, while decreasing levels of pain and disability. High quality RCTs featuring control groups are necessary to establish clear and effective protocols in the treatment of CR.     

Tactile Perception of Pressure and Volitional Thrust Intensity Modulate Spinal Manipulation Dose Characteristics

ObjectiveThe purpose of this study was to examine clinicians’ ability to modulate spinal manipulation (SM) thrust characteristics based on their tactile perception of pressure and volitional intensity.MethodsIn a cross-sectional, within-participants design, 13 doctors of chiropractic delivered SM thrusts of perceived least, appropriate, or greatest intensity of their perceived safe output level for an SM thrust on low-fidelity thoracic spine models of 4 different pressure levels. The participants performed SM over the course of 96 trials in a randomized order on combinations of thrust intensity and pressure. Dependent variables included normalized preload force, thrust force, thrust duration, peak acceleration, time to peak acceleration, and displacement. For all dependent measures, 2-factor within-participants analysis of variance models with repeated measures on both factors were performed.ResultsPreload force increased with intensity (F_2,24 = 9.72; P < .001) and model pressure (F_3,36 = 4.27; P = .011). Participants modulated thrust force and displacement as each also increased with intensity escalation (F_2,24 = 22.53, P < .001; F_2,18 = 45.20, P < .001). The highest accelerations were observed during the greatest intensity. Increased thrust force was delivered at higher model pressures (F_3,36 = 6.43; P < .001). A significant interaction demonstrated that as volitional thrust intensity increased, greater displacement was attained, particularly on low pressure models (F_6,54 = 11.06; P < .001). Thrust duration and time to peak acceleration yielded no significant differences.ConclusionSpinal manipulation thrust dosage was modulated by the chiropractors’ tactile perception of pressure and volitional intensity.     

A Comparison of Three Cervical Immobilization Devices

Objective. Prehospital cervical spinal cord injuries (SCIs) are rare but potentially catastrophic. Although spinal immobilization is resource-intensive, emergency medical services (EMS) personnel commonly immobilize trauma patients to prevent exacerbation of unrecognized SCI during transport. We compared the stabilization properties of a novel rigid, cervical immobilization collar (XCollar) with those of one-piece andtwo-piece rigid collars commonly used in the prehospital setting. Methods. This was a prospective laboratory study of healthy adult volunteers to determine total cervical motion in the horizontal, coronal, andsagittal planes in both seated andsupine positions. Goniometric techniques were used to measure head andneck movement after marking anatomic landmarks. Ranges of motion were compared with a one-way analysis of variance (ANOVA). A Bonferroni correction was applied for multiple comparisons, setting significance at p ≤ 0.004. Results. Twenty-five subjects (11 men; 14 women) completed the study. The subject pool represented a wide range of morphometrics. For most measurements, the XCollar permitted 10–15 millimeters of movement when applied without manual cervical stabilization. This was less than the movement permitted by both comparison collars. On average, the XCollar permitted less than 10 millimeters of movement in the sagittal andhorizontal planes when the subject was in the seated position. Conclusions. The XCollar provided superior cervical stabilization without augmentation by manual stabilization in healthy adult volunteers in both the seated andsupine positions when compared with other one-piece andtwo-piece rigid cervical collars. Although maximal stabilization was achieved only after the subjects were secured to a long spine board with a cervical immobilization device, the XCollar can provide an acceptable alternative to manual cervical stabilization in situations where the number of patients exceeds the number of EMS providers available to provide care.     

Changes in Spinal Height After Manual Axial Traction or Side Lying: A Clinical Measure of Intervertebral Disc Hydration Using Stadiometry

ObjectivesThe purpose of this study was to determine the immediate effects of a manual therapy technique consisting of axial traction compared with side lying on increased spine height after sustained loading.MethodsTwenty-one asymptomatic participants were included. Participants either received manual therapy technique consisting of manual axial traction force for 2 consecutive rounds of 3 minutes or sustained side lying for 10 minutes. Spine height was measured using a commercially available stadiometer. Spinal height change was determined from measurements taken after loaded walking and measurements taken after manual therapy. A paired t test was performed to determine if a manual therapy technique consisting of axial traction increased spinal height after a period of spinal loading.ResultsA significant increase in height was found after both manual therapy technique and sustained side lying (P < .0001). The mean height gain was 8.60 mm using 3-dimensional axial separation.ConclusionThis study is an initial attempt at evaluating the biomechanical effects of manual therapy technique consisting of axial traction. Both manual axial traction force and sustained side-lying position were equally effective for short-term change in spine height after a loaded walking protocol among healthy asymptomatic individuals. This study protocol may help to inform future studies that evaluate spine height after loading.     

LUCAS compared to manual cardiopulmonary resuscitation is more effective during helicopter rescue—a prospective,randomized, cross-over manikin study

Objective

High-quality chest-compressions are of paramount importance for survival and good neurological outcome after cardiac arrest. However, even healthcare professionals have difficulty performing effective chest-compressions, and quality may be further reduced during transport. We compared a mechanical chest-compression device (Lund University Cardiac Assist System [LUCAS]; Jolife, Lund, Sweden) and manual chest-compressions in a simulated cardiopulmonary resuscitation scenario during helicopter rescue.

Methods

Twenty-five advanced life support–certified paramedics were enrolled for this prospective, randomized, crossover study. A modified Resusci Anne manikin was employed. Thirty minutes of training was allotted to both LUCAS and manual cardiopulmonary resuscitation (CPR). Thereafter, every candidate performed the same scenario twice, once with LUCAS and once with manual CPR. The primary outcome measure was the percentage of correct chest-compressions relative to total chest-compressions.

Results

LUCAS compared to manual chest-compressions were more frequently correct (99% vs 59%, P < .001) and were more often performed correctly regarding depth (99% vs 79%, P < .001), pressure point (100% vs 79%, P < .001) and pressure release (100% vs 97%, P = .001). Hands-off time was shorter in the LUCAS than in the manual group (46 vs 130 seconds, P < .001). Time until first defibrillation was longer in the LUCAS group (112 vs 49 seconds, P < .001).

Conclusions

During this simulated cardiac arrest scenario in helicopter rescue LUCAS compared to manual chest-compressions increased CPR quality and reduced hands-off time, but prolonged the time interval to the first defibrillation. Further clinical trials are warranted to confirm potential benefits of LUCAS CPR in helicopter rescue.