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Title: Developing a methodology to perform measurements of the multi-spinal regions and lumbar-hip complex kinematics during dominant daily tasks
Author: Alqhtani, Raee
ISNI:       0000 0004 6349 2540
Awarding Body: Cardiff University
Current Institution: Cardiff University
Date of Award: 2016
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Introduction: Quantitative data of spinal range of motion in vivo is essential to improve clinicians’ understanding of spinal pathologies, procedure of assessment and treatment. Accurate knowledge of physiological movement of lumbar spine regions, hip and the behaviour of each regional movement is important. Spine and hip motion play an essential role in daily functional activities, such as self-caring or performing occupational duties. Measuring the regional breakdown of spinal motion in three planes and describing the relative motion of different regions of the thoracolumbar (TL) spine can provide useful clinical information, which can be used in clinical procedure for spinal assessment. The relationship between the forward flexion (i.e. cardinal motion) and more functional tasks, such as lifting, stand-to-sit and sit-to-stand, as well as dividing the lumbar spine into more than one region, relative to the hip during these tasks, have not yet been established. Measuring the regional breakdown of spinal motions in three planes, as well as the relationship between lumbar spine and hip in sagittal plane, requires a multi-regional analysis system. Aims and objectives: The fundamental aim was to explore range of motion and velocity magnitudes in flexion, extension lifting, stand-to-sit and sit-to-stand tasks, using three lumbar regions relative to the hip, and to determine correlations and differences between flexion and other dominant functional tasks. An objective was to obtain an appropriate measurement system that is capable of measuring dynamic movement in ‘real time’ and examine its validity against a “gold standard” system and its reliability, by measuring the range of motion of multi-spinal regions. Also, to demonstrate the relative contribution of five regions from within the thoracolumbar and head-cervical regions in 3D. Methods: The selected system (tri-axial accelerometer sensors-(3A sensors)) was validated against a “gold standard” system (roll table (RT)) to demonstrate a correlation and root mean square errors (RMSEs) between the two devices. Reliability of the 3A sensors and the contribution of multi-spinal regions was assessed on 18 healthy participants. Two protocols were applied: in protocol one, two sensors were placed on the forehead and T1, to measure cervical ROM; in protocol two, six sensors were placed on the spinous processes of T1, T4, T8, T12, L3 and S1 to measure thoraco-lumbar regional range of motion. It also divided the lumbar spine as one single joint (S1 to T12) and as two regions (the upper (T12-L3) and lower (L3-S1)) and hip region. Data was gathered from 53 participants using four sensors attached to the skin over the S1, L3, T12 and lateral thigh. Two different statistical analyses were applied: one for analysing each particular region’s contribution, relative to the hip; and another to analyse the correlation between the kinematic profiles of flexion and three sagittally dominant functional tasks (lifting, stand-to-sit and sit-to-stand). Results: Validation of 3A accelerometer sensors system against the roll table revealed a strong correlation between the two systems average (ICC=.998 (95% CI=.993-.999)) and an acceptable rate of errors ranged from (2.54º (0.70%) to 5.01º (1.39%)). It also demonstrated the reliability of this system, when the ICC values for all regions were high with relatively small errors associated with a novel multi-regional clinical spinal motion system. The ICC values for all regions were found to be high, ranging from .88 and .99 with 95% CI ranged from .62 to .99 while errors values ranged from 0.4 to 5.2°. The additional movement information, gathered from a multi-regional breakdown, adds insight into the relative contributions to spinal movement. Significant differences existed between ROM of LLS and ULS across all movements (p < 0.05). A significant difference also existed between ULS-hip and LLS-hip ratio for the majority of tasks (p < 0.05), and between ULS and LLS velocity for the majority of tasks (p < 0.05). The findings from the lumbar spine as one region, underestimates the contribution of the lower lumbar and overestimates the contribution of the upper lumbar spine. Strong correlations for ROM are reported between forward flexion tasks and lifting for the LL spine (r = 0.83) and all regions during stand-to-sit and sit-to-stand (r = 0.70-0.73). No tasks were strongly correlated for velocity (r = 0.03-0.55). Conclusion: The validity and reliability of the accelerometer sensors system is evidence of its ability to measure spinal movement. Since it is inexpensive, small, portable and relatively easy to use, it could be a preferable system for clinical application. The data, from multi-spinal regions, provides a novel method for practitioners to focus on a greater number of regions, rather than measuring only the three main areas of the spine (cervical, thoracic and lumbar). Investigating the lumbar spine as only one region risks missing out important kinematic detail. Further, the methodology provides the potential to measure functionally unique kinematics from more complex functional tasks, rather than generalised findings from clinical assessments of simple flexion.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available