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Open AccessEditorial

Editorial to the Special Issue “Human Bodywork: Applications in Health, Disease, and Rehabilitation”

by Redha Taiar

Biology 2023, 12(3), 451; https://doi.org/10.3390/biology12030451 - 15 Mar 2023

Viewed by 1208

Abstract

In this research topic, the question concerning how the human body functions through the musculoskeletal system was addressed [...] Full article

(This article belongs to the Special Issue Human Bodywork: Applications in Health, Disease, and Rehabilitation)

Research

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13 pages, 2753 KiB

Open AccessArticle

Shoulder Surgery Postoperative Immobilization: An International Survey of Shoulder Surgeons

by Michael T. Freehill, Iain R. Murray, Emilio Calvo, Alexandre Lädermann and Uma Srikumaran

Biology 2023, 12(2), 291; https://doi.org/10.3390/biology12020291 - 11 Feb 2023

Cited by 9 | Viewed by 5376

Abstract

Background: There is currently no consensus on immobilization protocols following shoulder surgery. The aim of this study was to establish patterns and types of sling use for various surgical procedures in the United States (US) and Europe, and to identify factors associated with [...] Read more.

Background: There is currently no consensus on immobilization protocols following shoulder surgery. The aim of this study was to establish patterns and types of sling use for various surgical procedures in the United States (US) and Europe, and to identify factors associated with the variations. Methods: An online survey was sent to all members of the American Shoulder and Elbow Society (ASES) and European Society for Surgery of the Shoulder and Elbow (ESSSE). The survey gathered member data, including practice location and years in practice. It also obtained preferences for the type and duration of sling use after the following surgical procedures: arthroscopic Bankart repair, Latarjet, arthroscopic superior/posterosuperior rotator cuff repair (ARCR) of tears <3 cm and >3 cm, anatomic total shoulder arthroplasty (aTSA) and reverse TSA (rTSA), and isolated biceps tenodesis (BT). Relationships between physician location and sling type for each procedure were analyzed using Fisher’s exact tests and post-hoc tests using Bonferroni-adjusted p-values. Relationships looking at years in practice and sling duration preferred were analyzed using Spearman’s correlation tests. Results: In total, 499 surgeons with a median of 15 years of experience (IQR = 9–25) responded, with 54.7% from the US and 45.3% from Europe. US respondents reported higher abduction pillow sling use than European respondents for the following: Bankart repair (62% vs. 15%, p < 0.0001), Latarjet (53% vs. 12%, p < 0.001), ARCR < 3 cm (80% vs. 42%, p < 0.001) and >3 cm (84% vs. 61%, p < 0.001), aTSA (50% vs. 21%, p < 0.001) and rTSA with subscapularis repair (61% vs. 22%, p < 0.001) and without subscapularis repair (57% vs. 17%, p < 0.001), and isolated BT (18% vs. 7%, p = 0.006). European respondents reported higher simple sling use than US respondents for the following: Bankart repair (74% vs. 31%, p < 0.001), Latarjet (78% vs. 44%, p < 0.001), ARCR < 3 cm (50% vs. 17%, p < 0.001) and >3 cm (34% vs. 13%, p < 0.001), and aTSA (69% vs. 41%, p < 0.001) and rTSA with subscapularis repair (70% vs. 35%, p < 0.001) and without subscapularis repair (73% vs. 39%, p < 0.001). Increasing years of experience demonstrated a negative correlation with the duration of sling use after Bankart repair (r = −0.20, p < 0.001), Latarjet (r = −0.25, p < 0.001), ARCR < 3 cm (r = −0.14, p = 0.014) and >3 cm (r = −0.20, p < 0.002), and aTSA (r = −0.37, p < 0.001), and rTSA with subscapularis repair (r = −0.10, p = 0.049) and without subscapularis repair (r = −0.19, p = 0.022. Thus, the more experienced surgeons tended to recommend shorter durations of post-operative sling use. US surgeons reported longer post-operative sling durations for Bankart repair (4.8 vs. 4.1 weeks, p < 0.001), Latarjet (4.6 vs. 3.6 weeks, p < 0.001), ARCR < 3 cm (5.2 vs. 4.5 weeks p < 0.001) and >3 cm (5.9 vs. 5.1 weeks, p < 0.001), aTSA (4.9 vs. 4.3 weeks, p < 0.001), rTSR without subscapularis repair (4.0 vs. 3.6 weeks, p = 0.031), and isolated BT (3.7 vs. 3.3 weeks, p = 0.012) than Europe respondents. No significant differences between regions within the US and Europe were demonstrated. Conclusions: There is considerable variation in the immobilization advocated by surgeons, with geographic location and years of clinical experience influencing patterns of sling use. Future work is required to establish the most clinically beneficial protocols for immobilization following shoulder surgery. Level of Evidence: Level IV. Full article

(This article belongs to the Special Issue Human Bodywork: Applications in Health, Disease, and Rehabilitation)

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16 pages, 2379 KiB

Open AccessArticle

Evolution of Hip Muscles Strength in Femoroacetabular Impingement Patients Treated by Arthroscopy or Surgical Hip Dislocation: A Retrospective Exploratory Study

by Guillaume Servant, François Fourchet, Anthony Pernoud, Hugo Bothorel and Panayiotis Christofilopoulos

Biology 2022, 11(12), 1765; https://doi.org/10.3390/biology11121765 - 6 Dec 2022

Cited by 3 | Viewed by 3047

Abstract

Hip arthroscopy and surgical hip dislocation (SHD) can be adequate surgical options for patients suffering from femoroacetabular impingement (FAI) syndrome, but there is to date no published data on their impact on hip muscles strength. The purpose of this retrospective study was, therefore, [...] Read more.

Hip arthroscopy and surgical hip dislocation (SHD) can be adequate surgical options for patients suffering from femoroacetabular impingement (FAI) syndrome, but there is to date no published data on their impact on hip muscles strength. The purpose of this retrospective study was, therefore, to evaluate it on a consecutive series of 50 FAI patients treated either by arthroscopy (n = 29, aged 27.4 ± 7.5 years, 76% of women) or SHD (n = 21, aged 25.9 ± 6.5 years, 38% of women) at La Tour Hospital between 2020 and 2021. The bilateral isometric strengths of eight hip-related muscles were evaluated before and three months after surgery (halfway through the rehabilitation program). For arthroscopy, a statistically significant (p < 0.05) reduction in hip muscles strength could be noted on the operated hamstrings (1.49 ± 0.43 vs. 1.39 ± 0.38 Nm/kg), flexors (1.88 ± 0.46 vs. 1.73 ± 0.41 Nm/kg), abductors (1.97 ± 0.42 vs. 1.72 ± 0.40 Nm/kg) and external rotators (1.17 ± 0.40 vs. 1.04 ± 0.37 Nm/kg). The abductors were the most affected muscles, with 45% of the patients suffering from a strength reduction ≥15%. The non-operated external rotators were also affected but to a lesser extent (1.21 ± 0.38 vs. 1.10 ± 0.36 Nm/kg). For SHD, a statistically significant strength reduction could be noted on the operated extensors (2.28 ± 0.84 vs. 2.05 ± 0.70 Nm/kg), abductors (1.87 ± 0.49 vs. 1.65 ± 0.41 Nm/kg), quadriceps (2.96 ± 0.92 vs. 2.44 ± 0.89 Nm/kg), external rotators (1.16 ± 0.42 vs. 0.93 ± 0.36 Nm/kg) and internal rotators (1.26 ± 0.38 vs. 0.96 ± 0.30 Nm/kg). The internal rotators were the most affected muscles, with 75% of the patients suffering from a strength reduction ≥15%. To conclude, particular attention should be paid to operated abductors for patients treated by arthroscopy as well as operated internal/external rotators, abductors and quadriceps for those treated by surgical hip dislocation. It reinforces that a rehabilitation method based on isolated muscle reinforcement and functional exercises that goes beyond three postoperative months is needed. Full article

(This article belongs to the Special Issue Human Bodywork: Applications in Health, Disease, and Rehabilitation)

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12 pages, 853 KiB

Open AccessArticle

Effectiveness of a Group-Based Rehabilitation Program Combining Education with Multimodal Exercises in the Treatment of Patients with Nonspecific Chronic Low Back Pain: A Retrospective Uncontrolled Study

by Cristiano Martins, Souheil Sayegh, Antonio Faundez, François Fourchet and Hugo Bothorel

Biology 2022, 11(10), 1508; https://doi.org/10.3390/biology11101508 - 14 Oct 2022

Cited by 5 | Viewed by 3877

Abstract

Currently, there is no consensus on the best rehabilitation program to perform for nonspecific chronic low back pain (NSCLBP). However, multimodal exercises, education, and group-based sessions seem to be beneficial. We, therefore, launched such a treatment program and aimed to evaluate its effectiveness [...] Read more.

Currently, there is no consensus on the best rehabilitation program to perform for nonspecific chronic low back pain (NSCLBP). However, multimodal exercises, education, and group-based sessions seem to be beneficial. We, therefore, launched such a treatment program and aimed to evaluate its effectiveness in improving patient health status. We retrospectively analyzed the records of 23 NSCLB patients who followed the MyBack program at La Tour hospital from 2020 to 2022 (25 sessions, 8 weeks). Patients were evaluated before and after intervention using pain on a visual analog scale (pVAS), Roland–Morris Disability Questionnaire (RMDQ), Pain Catastrophizing Scale (PCS), Tampa Scale of Kinesiophobia (TSK), and the EuroQol-5D-3L (EQ-5D-3L). Responder rates were calculated using minimal clinically important differences. Patients reported a significant reduction (p < 0.05) in the pVAS (5.3 ± 1.2 vs. 3.1 ± 1.6), RMDQ (8.8 ± 3.3 vs. 4.0 ± 3.7), PCS (24.5 ± 9.4 vs. 11.7 ± 7.9) and TSK (41.5 ± 9.2 vs. 32.7 ± 7.0). The EQ-5D-3L also statistically improved (score: 0.59 ± 0.14 vs. 0.73 ± 0.07; and VAS: 54.8 ± 16.8 vs. 67.0 ± 15.2). The responder rates were 78% for the pVAS and PCS, 74% for the RMDQ and TSK, and only 26% for the EQ-5D-3L. The MyBack program combining education with multimodal group exercises led to satisfactory clinical, functional, and psychosocial outcomes. Full article

(This article belongs to the Special Issue Human Bodywork: Applications in Health, Disease, and Rehabilitation)

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14 pages, 654 KiB

Open AccessArticle

Effects of a Multicomponent Exercise Program on Improving Frailty in Post-COVID-19 Older Adults after Intensive Care Units: A Single-Group Retrospective Cohort Study

by Juan Nicolás Cuenca-Zaldivar, Álvaro Monroy Acevedo, Josué Fernández-Carnero, Eleuterio A. Sánchez-Romero, Jorge Hugo Villafañe and Carlos Barragán Carballar

Biology 2022, 11(7), 1084; https://doi.org/10.3390/biology11071084 - 20 Jul 2022

Cited by 26 | Viewed by 4521

Abstract

Background: Older adult patients with post-COVID-19 syndrome present greater physical impairment accompanied by frailty than younger patients, which is why multicomponent exercise programs (MEP) are recommended for their positive effects on improving frailty and physical capacity. The aim of this study was to [...] Read more.

Background: Older adult patients with post-COVID-19 syndrome present greater physical impairment accompanied by frailty than younger patients, which is why multicomponent exercise programs (MEP) are recommended for their positive effects on improving frailty and physical capacity. The aim of this study was to evaluate the effects of a short MEP (Vivifrail; <4 weeks) on improving frailty in post-COVID-19 older adults after intensive care units. Methods: To develop a retrospective cohort study, data were collected from the functional gait training program based on selected Vivifrail MEP in a single-group and applied to patients admitted with a diagnosis of post-COVID-19 functional impairment. The MEP was carried out for 3 weeks, with daily sessions lasting 40 min. Patients included were assessed at the beginning and at the end of the protocol by using the Short Performance Physical Battery (SPPB), the number of falls in the last year, the number of falls with medical attention, the Timed Up and Go (TUG) test, the presence of dementia, the Trunk Control Test (TCT), the Tinetti balance and gait test, Barthel Index, Medical Research Council Sum Score (MRCSS) and handgrip strength dynamometry. Results: The results of this study show statistically significant improvements in physical fitness and frailty with increases in the Short Physical Performance Battery (Z = 9.12, p < 0.001) by means of the MET applied in its short version (<4 weeks) showing even clinically relevant improvements (>2.5 points). Statistically significant improvements were also found in Medical Research Council Sum Score (Z = 12.345, p < 0.001), Barthel Index Score (Z = 12.272, p < 0.001), Trunk Control Test (Z = 12. 36, p < 0.001), Tinetti–POMA (Z = 12.293, p < 0.001) including the balance (Z = 12.11, p < 0.001), gait (Z = 12.164, p < 0.001) subscales and in the hand dynamometry (Z = 12.172, p < 0.001). Conclusions: The selected Vivifrail MEP is effective and safe for improving frailty in post-COVID-19 older adult’s patients. Full article

(This article belongs to the Special Issue Human Bodywork: Applications in Health, Disease, and Rehabilitation)

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16 pages, 4634 KiB

Open AccessArticle

The Influence of Mattress Stiffness on Spinal Curvature and Intervertebral Disc Stress—An Experimental and Computational Study

by Tommy Tung-Ho Hong, Yan Wang, Duo Wai-Chi Wong, Guoxin Zhang, Qitao Tan, Tony Lin-Wei Chen and Ming Zhang

Biology 2022, 11(7), 1030; https://doi.org/10.3390/biology11071030 - 8 Jul 2022

Cited by 13 | Viewed by 7600

Abstract

Sleeping support systems can influence spinal curvature, and the misalignment of the spinal curvature can lead to musculoskeletal problems. Previous sleep studies on craniocervical support focused on pillow variants, but the mattress supporting the pillow has rarely been considered. This study used a [...] Read more.

Sleeping support systems can influence spinal curvature, and the misalignment of the spinal curvature can lead to musculoskeletal problems. Previous sleep studies on craniocervical support focused on pillow variants, but the mattress supporting the pillow has rarely been considered. This study used a cervical pillow and three mattresses of different stiffnesses, namely soft, medium, and hard, with an indentation load deflection of 20, 42, and 120 lbs, respectively. A novel electronic curvature measurement device was adopted to measure the spinal curvature, whereby the intervertebral disc loading was computed using the finite element method. Compared with the medium mattress, the head distance increased by 30.5 ± 15.9 mm, the cervical lordosis distance increased by 26.7 ± 14.9 mm, and intervertebral disc peak loading increased by 49% in the soft mattress environment. Considering that the pillow support may increase when using a soft mattress, a softer or thinner pillow is recommended. The head distance and cervical lordosis distance in the hard mattress environment were close to the medium mattress, but the lumbar lordosis distance reduced by 10.6 ± 6.8 mm. However, no significant increase in intervertebral disc loading was observed, but contact pressure increased significantly, which could cause discomfort and health problems. Full article

(This article belongs to the Special Issue Human Bodywork: Applications in Health, Disease, and Rehabilitation)

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13 pages, 610 KiB

Open AccessArticle

Characteristics of COVID-19 Inpatients in Rehabilitation Units during the First Pandemic Wave: A Cohort Study from a Large Hospital in Champagne Region

by Amandine Rapin, Peter-Joe Noujaim, Redha Taiar, Sandy Carazo-Mendez, Gaetan Deslee, Damien Jolly and François Constant Boyer

Biology 2022, 11(6), 937; https://doi.org/10.3390/biology11060937 - 20 Jun 2022

Cited by 7 | Viewed by 2337

Abstract

Background: Data describing patients hospitalized in medical rehabilitation wards after the acute phase of COVID-19 could help to better understand the rehabilitation needs in the current pandemic situation. Methods: Cohort including all patients with COVID-19 hospitalized in a single, large university [...] Read more.

Background: Data describing patients hospitalized in medical rehabilitation wards after the acute phase of COVID-19 could help to better understand the rehabilitation needs in the current pandemic situation. Methods: Cohort including all patients with COVID-19 hospitalized in a single, large university hospital in Northeast France from 25 February to 30 April 2020. Results: 479 patients were admitted with COVID-19 during the study period, of whom 128 died (26.7%). Among the 351 survivors, 111 were referred to rehabilitation units, including 63 (17.9%) referred to physical and rehabilitation medicine (PRM) units. The median age of patients referred to rehabilitation units was 72 years. Patients who had been in intensive care, or who had had a long hospital stay, required referral to PRM units. Two biomarkers were associated with referral to rehabilitation units, namely, elevated troponin (p = 0.03) and impaired renal function (p = 0.03). Age was associated with referral to PRM units (p = 0.001). Conclusions: Almost one-third of COVID-19 patients required post-acute care, but only one-fifth had access to PRM units. The optimal strategy for post-acute management of COVID-19 patients remains to be determined. The need for rehabilitation wards during a pandemic is a primary concern in enabling the long-term functioning of infected patients. Full article

(This article belongs to the Special Issue Human Bodywork: Applications in Health, Disease, and Rehabilitation)

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10 pages, 310 KiB

Open AccessArticle

Oxidative Stress Biomarkers and Quality of Life Are Contributing Factors of Muscle Pain and Lean Body Mass in Patients with Fibromyalgia

by Jousielle Márcia dos Santos, Ana Cristina Rodrigues Lacerda, Vanessa Gonçalves César Ribeiro, Pedro Henrique Scheidt Figueiredo, Sueli Ferreira Fonseca, Vanessa Kelly da Silva Lage, Henrique Silveira Costa, Vanessa Pereira Lima, Borja Sañudo, Mário Bernardo-Filho, Danúbia da Cunha de Sá Caputo, Vanessa Amaral Mendonça and Redha Taiar

Biology 2022, 11(6), 935; https://doi.org/10.3390/biology11060935 - 19 Jun 2022

Cited by 11 | Viewed by 3286

Abstract

(1) The evidence points to an increase in oxygen reactive species as one of the possible causes of fibromyalgia (FM). In addition, it is plausible that an imbalance in redox markers can be associated with pain amplification and dynapenia in FM patients. The [...] Read more.

(1) The evidence points to an increase in oxygen reactive species as one of the possible causes of fibromyalgia (FM). In addition, it is plausible that an imbalance in redox markers can be associated with pain amplification and dynapenia in FM patients. The aim of our study was to investigate possible factors associated with muscle pain and lean body mass in FM patients. (2) Methods: This was a quantitative, exploratory and cross-sectional study of 47 patients with FM (53.45 + 7.32 years). We evaluated self-perceptions of muscle pain, lean body mass, body composition, quality of life, sleep quality, depression index, muscle performance and oxidative stress biomarkers. (3) Results: We observed that lower blood levels of antioxidants and poor quality of life explained 21% of the greater muscle pain. In addition, high blood levels of oxidative stress, worse muscle performance and poor quality of life explained 27% of the lower lean mass in patients with FM. (4) Conclusions: Larger amounts of lipid peroxidation and reductions in antioxidant levels, in addition to lower muscle performance and poor life quality, are possible independent contributors to greater muscle pain and lower lean body mass in FM patients. Full article

(This article belongs to the Special Issue Human Bodywork: Applications in Health, Disease, and Rehabilitation)

12 pages, 1009 KiB

Open AccessArticle

Acute Effects of Whole-Body Vibration on Resting Metabolic Rate and Substrate Utilisation in Healthy Women

by Marcin Maciejczyk, Marek Bawelski, Magdalena Więcek, Zbigniew Szygula, Michail Lubomirov Michailov, Bibiana Vadašová, Peter Kačúr and Tomasz Pałka

Biology 2022, 11(5), 655; https://doi.org/10.3390/biology11050655 - 24 Apr 2022

Cited by 6 | Viewed by 3296

Abstract

The aim of the study was to determine the acute effects of single-whole-body vibration (WBV) on resting metabolic rate (RMR) and carbohydrate–lipid profile of blood in young, healthy women. The participants, in a randomised controlled crossover study, participated in two trials: WBV and [...] Read more.

The aim of the study was to determine the acute effects of single-whole-body vibration (WBV) on resting metabolic rate (RMR) and carbohydrate–lipid profile of blood in young, healthy women. The participants, in a randomised controlled crossover study, participated in two trials: WBV and a vibration simulation (placebo). The WBV was performed in the prone position and cycloidal-oscillatory vibration was used. The RMR measurement (calorimetry) was performed: before the WBV, during WBV, immediately after the completion of WBV, and 1 h after the completion of WBV. For biochemical analyses, venous blood was collected. During WBV, there was a significant increase in RMR compared to baseline. Immediately after and 1 h following the end of the WBV, RMR was close to baseline levels (p > 0.05). The increased energy expenditure resulted from the increased utilisation of carbohydrates and proteins during the vibration. In the placebo condition, there were no significant changes over time in the level of the studied indices during calorimetry. The WBV had no significant effects on the level of glucose in the blood. The applied vibration did not significantly affect the concentration of the analysed lipid indices, which were within the physiological norms for all measurements. Results indicate the need for further research to establish the physiological mechanisms underlying the observed effects of WBV on resting metabolic rate. Full article

(This article belongs to the Special Issue Human Bodywork: Applications in Health, Disease, and Rehabilitation)

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10 pages, 13062 KiB

Open AccessArticle

Aquatic Therapy versus Standard Rehabilitation after Surgical Rotator Cuff Repair: A Randomized Prospective Study

by Adrien Dufournet, Xue Ling Chong, Adrien Schwitzguébel, Corinne Bernimoulin, Myriam Carvalho, Hugo Bothorel and Alexandre Lädermann

Biology 2022, 11(4), 610; https://doi.org/10.3390/biology11040610 - 17 Apr 2022

Cited by 5 | Viewed by 4757

Abstract

Introduction: Post-operative rehabilitation following rotator cuff tear repair (RCR) is important to promote tendon healing, restore strength, and recover normal function. Aquatic therapy in hot water allows body relaxation, which promotes patient conditioning for efficient rehabilitation. The aim of this study was to [...] Read more.

Introduction: Post-operative rehabilitation following rotator cuff tear repair (RCR) is important to promote tendon healing, restore strength, and recover normal function. Aquatic therapy in hot water allows body relaxation, which promotes patient conditioning for efficient rehabilitation. The aim of this study was to assess whether aquatic therapy is more efficient than standard (land-based) rehabilitation in terms of range of motion (ROM), function, and pain after arthroscopic RCR. Methods: We prospectively randomized 86 patients scheduled for arthroscopic RCR to either aquatic therapy (n = 44) or standard rehabilitation (n = 42) using block sizes of four or six. Patients were evaluated clinically at 1.5, 3, 6, and 24 months and using ultrasound (US) at 6 months. Two-way mixed ANOVA tests were performed to evaluate the effects of rehabilitation type (between-subjects factor) on ROM and patient reported outcome measures (PROMs) over time (within-subjects factor). Post-hoc inter-group comparisons at each time point were also conducted using Wilcoxon rank sum tests or unpaired Student t-tests and adjusted for multiple comparisons using the Bonferroni correction. Results: The two groups did not differ significantly in terms of demographic data or pre-operative characteristics, except for the Single Assessment Numeric Evaluation (SANE) score, which was lower in the aquatic therapy group (37.9 ± 23.6 vs. 55.6 ± 24.9, p = 0.019). The mixed model revealed the absence of interaction effect between the type of rehabilitation and time on PROMs and ROM except on the SANE score (p < 0.001), which was biased by the existing pre-operative difference mentioned above. Furthermore, none of the post-operative outcomes were statistically different between the two groups at 1.5, 3, 6, and 24 months. In addition, no significant difference could be noted regarding tendon healing rate (p = 0.443), complication (p = 0.349), workstop duration (0.585), or patient satisfaction (p = 0.663). Conclusion: Compared to the standard rehabilitation, the aquatic therapy did not yield superior clinical and functional outcomes after arthroscopic RCR when started immediately after the surgery. Full article

(This article belongs to the Special Issue Human Bodywork: Applications in Health, Disease, and Rehabilitation)

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18 pages, 4456 KiB

Open AccessArticle

Optimal Biomechanical Performance in Upper-Limb Gestures Depends on Velocity and Carried Load

by Cristina Brambilla, Matteo Malosio, Gianluigi Reni and Alessandro Scano

Biology 2022, 11(3), 391; https://doi.org/10.3390/biology11030391 - 2 Mar 2022

Cited by 5 | Viewed by 3077

Abstract

In the last few years, there has been increased interest in the preservation of physical and mental health of workers that cooperate with robots in industrial contexts, such as in the framework of the European H2020 Mindbot Project. Since biomechanical analysis contributes to [...] Read more.

In the last few years, there has been increased interest in the preservation of physical and mental health of workers that cooperate with robots in industrial contexts, such as in the framework of the European H2020 Mindbot Project. Since biomechanical analysis contributes to the characterization of the subject interacting with a robotic setup and platform, we tested different speed and loading conditions in a simulated environment to determine upper-limb optimal performance. The simulations were performed starting from laboratory data of people executing upper-limb frontal reaching movements, by scaling the motion law and imposing various carried loads at the hand. The simulated velocity ranged from 20% to 200% of the original natural speed, with step increments of 10%, while the hand loads were 0, 0.5, 1, and 2 kg, simulating carried objects. A 3D inverse kinematic and dynamic model was used to compute upper-limb kinematics and dynamics, including shoulder flexion, shoulder abduction, and elbow flexion. An optimal range of velocities was found in which the expended energy was lower. Interestingly, the optimal speed corresponding to lower exerted torque and energy decreased when the load applied increased. Lastly, we introduced a preliminary movement inefficiency index to evaluate the deviation of the power and expended energy for the shoulder flexion degree of freedom when not coinciding with the minimum energy condition. These results can be useful in human–robot collaboration to design minimum-fatigue collaborative tasks, tune setup parameters and robot behavior, and support physical and mental health for workers. Full article

(This article belongs to the Special Issue Human Bodywork: Applications in Health, Disease, and Rehabilitation)

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11 pages, 1562 KiB

Open AccessArticle

Deadbug Bridging Performance in 6- to 15-Year-Old Competitive Alpine Skiers—A Cross-Sectional Study

by Gerda Strutzenberger, Lynn Ellenberger, Björn Bruhin, Walter O. Frey, Johannes Scherr and Jörg Spörri

Biology 2022, 11(2), 329; https://doi.org/10.3390/biology11020329 - 18 Feb 2022

Cited by 6 | Viewed by 2654

Abstract

In competitive alpine skiing, a superior antirotation and rear-chain stabilization capacity is essential to constantly remain in dynamic equilibrium while skiing and to counteract the ski-specific adverse loading patterns of the back. As such, skiers’ trunk stabilization performance during deadbug bridging (DBB) exercises [...] Read more.

In competitive alpine skiing, a superior antirotation and rear-chain stabilization capacity is essential to constantly remain in dynamic equilibrium while skiing and to counteract the ski-specific adverse loading patterns of the back. As such, skiers’ trunk stabilization performance during deadbug bridging (DBB) exercises has been shown to be associated with both skiing performance and overuse complaints of the lower back in skiers under 16 years of age (U16). However, to date, little is known about the corresponding stabilization abilities in younger skiers, i.e., 6- to 15-year-old skiers. As part of a biomechanical field experiment during a national off-snow fitness competition, a total of 101 youth competitive alpine skiers were tested with respect to their trunk stabilization performance during DDB exercise. The maximum contralateral displacement of the pelvic drop during leg lift (DBB_displacement) was quantified using reflective markers and a motion capture system (Vicon, Oxford, UK). Potential age group and sex differences in DBB_displacement were assessed using analysis of variance (ANOVA) at p < 0.05. Within each subgroup, the associations of DBB_displacement with age, anthropometrics and maturity offset were analysed using Pearson’s correlation (p < 0.05). Female skiers under 15 years of age (U15) showed better DBB performance than male U15 skiers, while there was no sex difference at the under 10-year (U10) level. In female U10 skiers, DBB_displacement was moderately associated with body height, while in all other subgroups, no confounding associations with anthropometrics or biological maturation were found. Biomechanically quantifying DBB performance may be considered a feasible and nonconfounded screening test approach in young skiers older than 6 years. Body height may represent a confounding bias in exclusively the U10 female skier cohort and, therefore, should be considered when interpreting the test results. In summary, this study provided sport-specific normative reference data that may be of equal interest to both researchers and sport practitioners. Full article

(This article belongs to the Special Issue Human Bodywork: Applications in Health, Disease, and Rehabilitation)

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11 pages, 1422 KiB

Open AccessArticle

Correlations between Electro-Diagnostic Findings, the Severity of Initial Infection, and the Rehabilitation Outcomes among COVID-19 Patients

by Sheer Shabat, Zeev Meiner, Jeanna Tsenter, Isabella Schwartz and Sigal Portnoy

Biology 2022, 11(2), 277; https://doi.org/10.3390/biology11020277 - 10 Feb 2022

Cited by 6 | Viewed by 2512

Abstract

Patients with Coronavirus-2019 (COVID-19) manifest many neuromuscular complications. We evaluated the correlations between electromyography and nerve conduction measurements among COVID-19 patients and the severity of the initial infection, as well as the rehabilitation outcomes, and searched for the factors which best predict the [...] Read more.

Patients with Coronavirus-2019 (COVID-19) manifest many neuromuscular complications. We evaluated the correlations between electromyography and nerve conduction measurements among COVID-19 patients and the severity of the initial infection, as well as the rehabilitation outcomes, and searched for the factors which best predict the rehabilitation outcomes. A total of 19 COVID-19 patients (16 men; mean ± SD age 59.1 ± 10.4), with WHO clinical progression scale of 6.8 ± 2.3, received rehabilitation for 3.9 ± 2.5 months. The Functional Independence Measure (FIM), the 10 m walk test, the 6 minute walk test, and grip force were collected before and after the rehabilitation period. Motor Nerve Conduction (MNC), Sensory Nerve Conduction (SNC) and electromyographic abnormalities were measured. All of the MNC measures of the median nerve correlated with the WHO clinical progression scale and duration of acute hospitalization. The MNC and SNC measures correlated with the rehabilitation duration and with FIM at discharge. The MNC distal latency of the median and the peroneal nerves and the MNC velocity of the median and tibial nerves predicted 91.6% of the variance of the motor FIM at discharge. We conclude that nerve conduction measurements, especially in COVID-19 patients with severe illness, are important in order to predict prognosis and rehabilitation outcomes. Full article

(This article belongs to the Special Issue Human Bodywork: Applications in Health, Disease, and Rehabilitation)

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10 pages, 1211 KiB

Open AccessArticle

The Proper Motor Control Model Revealed by Wheelchair Curling Quantification of Elite Athletes

by Xiangdong Wang, Ruijiao Liu, Tian Zhang and Gongbing Shan

Biology 2022, 11(2), 176; https://doi.org/10.3390/biology11020176 - 23 Jan 2022

Cited by 5 | Viewed by 3542

Abstract

Background: Wheelchair users are disadvantaged when it comes to accruing the benefits of physical activities. Hence, promoting various sports is crucial for keeping this population healthy. Since wheelchair curling can be played by individuals from a wide range of ages, strengths, and endurance [...] Read more.

Background: Wheelchair users are disadvantaged when it comes to accruing the benefits of physical activities. Hence, promoting various sports is crucial for keeping this population healthy. Since wheelchair curling can be played by individuals from a wide range of ages, strengths, and endurance levels, it has potential to improve wheelchair users’ well-being. Yet, hardly any motion studies exist. This study aimed to facilitate understanding of optimized control of wheelchair curling for promoting wheelchair users’ participation. Methods: Using motion capture technology, nine national-level athletes were tested. Kinematic parameters related to segment/joint control and their coordination were quantified for both slow and fast curling. Descriptive statistics (means and standard deviations) and correlation analysis were applied for characterizing the skill. Results: (1) Curling control consists of an acceleration phase and a stabilizing delivery phase; (2) the control of trunk, shoulder, and wrist are responsible for accelerating the rock; (3) elbow control is accountable for the accurate delivery of the rock; and (4) during the slow curling, a synchronized effort of trunk, shoulder, and wrist is used for accelerating the rock, while a sequential control among the segment/joints is applied in fast curling. Conclusions: The results supply valuable motor learning markers that could have a significant positive impact on the teaching and learning of wheelchair curling, as such, the findings have great potential for the health promotion of wheelchair users. Full article

(This article belongs to the Special Issue Human Bodywork: Applications in Health, Disease, and Rehabilitation)

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12 pages, 3499 KiB

Open AccessArticle

Effect of Displacement Degree of Distal Chevron Osteotomy on Metatarsal Stress: A Finite Element Method

by Qiaolin Zhang, Yan Zhang, Jialu Huang, Ee Chon Teo and Yaodong Gu

Biology 2022, 11(1), 127; https://doi.org/10.3390/biology11010127 - 13 Jan 2022

Cited by 22 | Viewed by 2563

Abstract

Background: The stress of foot bone can effectively evaluate the functional damage caused by foot deformity and the results of operation. In this study, the finite element method was used to investigate the degree of displacement of distal chevron osteotomy on metatarsal stress [...] Read more.

Background: The stress of foot bone can effectively evaluate the functional damage caused by foot deformity and the results of operation. In this study, the finite element method was used to investigate the degree of displacement of distal chevron osteotomy on metatarsal stress and metatarsophalangeal joint load; Methods: Four finite element models of displacement were established by using the CT images of a patient with moderate hallux valgus (hallux valgus angle and intermetatarsal angle were 26.74° and 14.09°, respectively), and the validity of the model was verified. Each finite element model consisted of bones and various cartilage structures, ligaments, and plantar fascia, as well as encapsulated soft tissue. Except for soft tissue, the material properties of other parts were isotropic linear elastic material, and the encapsulated soft tissue was set as nonlinear hyperelastic material. The mesh was tetrahedral mesh. Link elements were used in ligament and plantar fascia. A ground reaction force with a half-body weight was applied at the bottom of the floor to simulate the ground reaction when standing. The upper surfaces of the encapsulated soft tissue, distal tibia, and distal fibula were fixed. The stress distribution of metatarsals and the stress of cartilage of the first metatarsophalangeal joint were compared and analyzed; Results: Compared with the hallux valgus without osteotomy, the stress of the first metatarsals and second metatarsals of 2–4 mm decreased, and the stress of the interarticular cartilage of the first metatarsophalangeal joint with 4 mm was reduced. In the case of 6 mm, the stress value between the first metatarsal and the first metatarsophalangeal joint increased, and 4 mm was the most suitable distance; Conclusions: Compared with the hallux valgus without osteotomy, the stress of the first metatarsals and second metatarsals of 2–4 mm decreased, and the stress of the interarticular cartilage of the first metatarsophalangeal joint with 4 mm was reduced. In the case of 6 mm, the stress value between the first metatarsal and the first metatarsophalangeal joint increased, and 4 mm was the most suitable distance. For the degree of displacement of the distal chevron osteotomy, the postoperative stability and the stress distribution of metatarsal bone should be considered. Factors such as hallux valgus angle, intermetatarsal angle, patient’s age, body weight, and metatarsal width should be considered comprehensively. The factors affecting osteotomy need to be further explored. The degree of displacement of osteotomy can be evaluated by FE method before the operation, and the most suitable distance can be obtained. Full article

(This article belongs to the Special Issue Human Bodywork: Applications in Health, Disease, and Rehabilitation)

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15 pages, 1433 KiB

Open AccessArticle

The COVID-19 Infection Diffusion in the US and Japan: A Graph-Theoretical Approach

by Mohammad Reza Davahli, Waldemar Karwowski, Krzysztof Fiok, Atsuo Murata, Nabin Sapkota, Farzad V. Farahani, Awad Al-Juaid, Tadeusz Marek and Redha Taiar

Biology 2022, 11(1), 125; https://doi.org/10.3390/biology11010125 - 13 Jan 2022

Cited by 9 | Viewed by 3089

Abstract

Coronavirus disease 2019 (COVID-19) was first discovered in China; within several months, it spread worldwide and became a pandemic. Although the virus has spread throughout the globe, its effects have differed. The pandemic diffusion network dynamics (PDND) approach was proposed to better understand [...] Read more.

Coronavirus disease 2019 (COVID-19) was first discovered in China; within several months, it spread worldwide and became a pandemic. Although the virus has spread throughout the globe, its effects have differed. The pandemic diffusion network dynamics (PDND) approach was proposed to better understand the spreading behavior of COVID-19 in the US and Japan. We used daily confirmed cases of COVID-19 from 5 January 2020 to 31 July 2021, for all states (prefectures) of the US and Japan. By applying the pandemic diffusion network dynamics (PDND) approach to COVID-19 time series data, we developed diffusion graphs for the US and Japan. In these graphs, nodes represent states and prefectures (regions), and edges represent connections between regions based on the synchrony of COVID-19 time series data. To compare the pandemic spreading dynamics in the US and Japan, we used graph theory metrics, which targeted the characterization of COVID-19 bedhavior that could not be explained through linear methods. These metrics included path length, global and local efficiency, clustering coefficient, assortativity, modularity, network density, and degree centrality. Application of the proposed approach resulted in the discovery of mostly minor differences between analyzed countries. In light of these findings, we focused on analyzing the reasons and defining research hypotheses that, upon addressing, could shed more light on the complex phenomena of COVID-19 virus spread and the proposed PDND methodology. Full article

(This article belongs to the Special Issue Human Bodywork: Applications in Health, Disease, and Rehabilitation)

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13 pages, 1449 KiB

Open AccessArticle

Anterior Cruciate Ligament Reconstructed Patients Who Recovered Normal Postural Control Have Dissimilar Brain Activation Patterns Compared to Healthy Controls

by Yong Woo An, Yangmi Kang, Hyung-Pil Jun and Eunwook Chang

Biology 2022, 11(1), 119; https://doi.org/10.3390/biology11010119 - 12 Jan 2022

Cited by 9 | Viewed by 2792

Abstract

Postural control, which is a fundamental functional skill, reflects integration and coordination of sensory information. Damaged anterior cruciate ligament (ACL) may alter neural activation patterns in the brain, despite patients’ surgical reconstruction (ACLR). However, it is unknown whether ACLR patients with normal postural [...] Read more.

Postural control, which is a fundamental functional skill, reflects integration and coordination of sensory information. Damaged anterior cruciate ligament (ACL) may alter neural activation patterns in the brain, despite patients’ surgical reconstruction (ACLR). However, it is unknown whether ACLR patients with normal postural control have persistent neural adaptation in the brain. Therefore, we explored theta (4–8 Hz) and alpha-2 (10–12 Hz) oscillation bands at the prefrontal, premotor/supplementary motor, primary motor, somatosensory, and primary visual cortices, in which electrocortical activation is highly associated with goal-directed decision-making, preparation of movement, motor output, sensory input, and visual processing, respectively, during first 3 s of a single-leg stance at two different task complexities (stable/unstable) between ACLR patients and healthy controls. We observed that ACLR patients showed similar postural control ability to healthy controls, but dissimilar neural activation patterns in the brain. To conclude, we demonstrated that ACLR patients may rely on more neural sources on movement preparation in conjunction with sensory feedback during the early single-leg stance period relative to healthy controls to maintain postural control. This may be a compensatory protective mechanism to accommodate for the altered sensory inputs from the reconstructed knee and task complexity. Our study elucidates the strategically different brain activity utilized by ACLR patients to sustain postural control. Full article

(This article belongs to the Special Issue Human Bodywork: Applications in Health, Disease, and Rehabilitation)

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14 pages, 1413 KiB

Open AccessArticle

Repeatability and Reliability of the Rheumatoid Arthritis Foot Disease Activity Index in Spanish Patients: A Transcultural Adaptation

by Eva María Martínez-Jiménez, Héctor Pereiro-Buceta, Patricia Palomo-López, Emmanuel Navarro-Flores, Ana María Jiménez-Cebrián, Marta Elena Losa-Iglesias, Ricardo Becerro-De-Bengoa-Vallejo and Daniel López-López

Biology 2022, 11(1), 30; https://doi.org/10.3390/biology11010030 - 26 Dec 2021

Cited by 7 | Viewed by 4733

Abstract

Background: The Rheumatoid Arthritis Foot Disease Activity Index (RADAI-F5) questionnaire, based on five questions, is used to assess the severity of rheumatoid arthritis disease in the foot. Nowadays, RADAI-F5 has been validated in different languages; however a Spanish version was lacking. Therefore, the [...] Read more.

Background: The Rheumatoid Arthritis Foot Disease Activity Index (RADAI-F5) questionnaire, based on five questions, is used to assess the severity of rheumatoid arthritis disease in the foot. Nowadays, RADAI-F5 has been validated in different languages; however a Spanish version was lacking. Therefore, the purpose of this research was to translate and validate the Spanish version (RADAI-F5-es). Methods: A cross-cultural translation of the RADAI-F5 questionnaire was performed from English to Spanish. To validate its use, 50 subjects with rheumatoid arthritis who responded to the translated questionnaire two times in an interval of less than 3 months were selected in order to verify the psychometric properties. Results: Excellent agreement between the two versions according to the Cronbach’s α was shown. Five domains with regards to arthritis activity in foot joint tenderness and swelling, foot arthritis pain, general foot health and joint stiffness were added together to obtain the total score. Excellent retest reliability was shown for the total score. Test/retest reliability was excellent for joint stiffness on awakening and foot arthritis pain domains. There were no significant differences among any domains (p > 0.05). There were no statistically significant differences (p = 0.000) for the mean ± standard deviations (SD) between pre- and post-tests (98.09 ± 15.42) [93.75–102.43] and 97.96 ± 13.88 [94.5–101.86] points, respectively). Bland–Altman plots or clinically pertinent variations were not statistically significantly different. Conclusions: The RADAI-F5-es is considered a valid and strong tool with adequate repeatability in the Spanish community. Full article

(This article belongs to the Special Issue Human Bodywork: Applications in Health, Disease, and Rehabilitation)

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12 pages, 3436 KiB

Open AccessArticle

Shoulder Positioning during Superior Capsular Reconstruction: Computational Analysis of Graft Integrity and Shoulder Stability

by Madalena Antunes, Carlos Quental, João Folgado, Clara de Campos Azevedo and Ana Catarina Ângelo

Biology 2021, 10(12), 1263; https://doi.org/10.3390/biology10121263 - 3 Dec 2021

Cited by 3 | Viewed by 2880

Abstract

The shoulder position during fixation of the graft may be a key factor impacting the outcome of arthroscopic superior capsular reconstruction (ASCR) in irreparable rotator cuff tears (IRCTs). However, biomechanical evidence regarding this effect is lacking. The aim of this study was to [...] Read more.

The shoulder position during fixation of the graft may be a key factor impacting the outcome of arthroscopic superior capsular reconstruction (ASCR) in irreparable rotator cuff tears (IRCTs). However, biomechanical evidence regarding this effect is lacking. The aim of this study was to evaluate the influence of the shoulder position during fixation of the graft on shoulder stability and graft tear risk in ASCR. A 3-D musculoskeletal model of the upper limb was modified to account for the fixation of the graft in ASCR, assuming a full-thickness tear of the supraspinatus tendon. The concomitant tenotomy of the long head of the biceps (LHB) tendon was also studied. The biomechanical parameters evaluated included the strain of the graft and the glenohumeral joint reaction force (GH JRF), which were used to evaluate graft integrity and shoulder stability, respectively. Fixation of the graft considering abduction angles greater than 15° resulted in a high risk for graft tearing when the arm was adducted to the side of the trunk. For abduction angles below 15°, the mean shoulder stability improved significantly, ranging between 6% and 20% (p < 0.001), compared with that in the preoperative condition. The concomitant tenotomy of the LHB tendon resulted in loss of stability when compared to ASCR with an intact LHB tendon. The position of the shoulder during fixation of the graft has a significant effect on shoulder stability and graft tear risk after ASCR in IRCTs. This study provides new and important information regarding the role of shoulder positioning during fixation of the graft. Full article

(This article belongs to the Special Issue Human Bodywork: Applications in Health, Disease, and Rehabilitation)

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15 pages, 5972 KiB

Open AccessArticle

Evaluation of the Relationships between Simple Anthropometric Measures and Bioelectrical Impedance Assessment Variables with Multivariate Linear Regression Models to Estimate Body Composition and Fat Distribution in Adults: Preliminary Results

by Danúbia da Cunha de Sá-Caputo, Anelise Sonza, Ana Carolina Coelho-Oliveira, Juliana Pessanha-Freitas, Aline Silva Reis, Arlete Francisca-Santos, Elzi Martins dos Anjos, Laisa Liane Paineiras-Domingos, Thais de Rezende Bessa Guerra, Amanda da Silva Franco, Vinicius Layter Xavier, Claudia Jakelline Barbosa e Silva, Marcia Cristina Moura-Fernandes, Vanessa Amaral Mendonça, Ana Cristina Rodrigues Lacerda, Alessandra da Rocha Pinheiro Mulder, Aderito Seixas, Alessandro Sartorio, Redha Taiar and Mario Bernardo-Filho

Biology 2021, 10(11), 1209; https://doi.org/10.3390/biology10111209 - 19 Nov 2021

Cited by 9 | Viewed by 3730

Abstract

Background: Overweight and obesity are conditions associated with sedentary lifestyle and accumulation of abdominal fat, determining increased mortality, favoring chronic diseases, and increasing cardiovascular risk. Although the evaluation of body composition and fat distribution are highly relevant, the high cost of the gold [...] Read more.

Background: Overweight and obesity are conditions associated with sedentary lifestyle and accumulation of abdominal fat, determining increased mortality, favoring chronic diseases, and increasing cardiovascular risk. Although the evaluation of body composition and fat distribution are highly relevant, the high cost of the gold standard techniques limits their wide utilization. Therefore, the aim of this work was to explore the relationships between simple anthropometric measures and BIA variables using multivariate linear regression models to estimate body composition and fat distribution in adults. Methods: In this cross-sectional study, sixty-eight adult individuals (20 males and 48 females) were subjected to bioelectrical impedance analysis (BIA), anthropometric measurements (waist circumference (WC), neck circumference (NC), mid-arm circumference (MAC)), allowing the calculation of conicity index (C-index), fat mass/fat-free mass (FM/FFM) ratios, body mass index (BMI) and body shape index (ABSI). Statistical analyzes were performed with the R program. Nonparametric Statistical tests were applied to compare the characteristics of participants of the groups (normal weight, overweight and obese). For qualitative variables, the Fisher’s exact test was applied, and for quantitative variables, the paired Wilcoxon signed-rank test. To evaluate the linear association between each pair of variables, the Pearson correlation coefficient was calculated, and Multivariate linear regression models were adjusted using the stepwise variable selection method, with Akaike Information Criterion (p ≤ 0.05). Results: BIA variables with the highest correlations with anthropometric measures were total body water (TBW), body fat percentage (BFP), FM, FFM and FM/FFM. The multiple linear regression analysis showed, in general, that the same variables can be estimated through simple anthropometric measures. Conclusions: The assessment of fat distribution in the body is desirable for the diagnosis and definition of obesity severity. However, the high cost of the instruments (dual energy X-ray absorptiometry, hydrostatic weighing, air displacement plethysmography, computed tomography, magnetic resonance) to assess it, favors the use of BMI in the clinical practice. Nevertheless, BMI does not represent a real fat distribution and body fat percentage. This highlights the relevance of the findings of the current study, since simple anthropometric variables can be used to estimate important BIA variables that are related to fat distribution and body composition. Full article

(This article belongs to the Special Issue Human Bodywork: Applications in Health, Disease, and Rehabilitation)

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12 pages, 1429 KiB

Open AccessArticle

Effect of Customized Insoles on Gait in Post-Stroke Hemiparetic Individuals: A Randomized Controlled Trial

by Jie Wang, Lei Qiao, Long Yu, Yanmin Wang, Redha Taiar, Ying Zhang and Weijie Fu

Biology 2021, 10(11), 1187; https://doi.org/10.3390/biology10111187 - 15 Nov 2021

Cited by 7 | Viewed by 2885

Abstract

Background: Insoles have been widely applied to many diseases, but stroke involves complex problems and there is a paucity of research on the application of insoles in stroke patients. Aim: To evaluate the effect of customized insoles on gait in patients with [...] Read more.

Background: Insoles have been widely applied to many diseases, but stroke involves complex problems and there is a paucity of research on the application of insoles in stroke patients. Aim: To evaluate the effect of customized insoles on gait in patients with hemiplegia. Design: A randomized controlled trial. Setting: Rehabilitation department of a hospital. Population: A total of 50 stroke patients were randomized into an experimental group (n = 25) or a control group (n = 25). Methods: Both groups received conventional gait training, which was conducted five times a week, every 40 min for four weeks and patients in the experimental group were required to wear customized insoles for at least 1 h per day for four weeks. The primary outcome measure was the Tinetti Gait Scale (TGS) and the secondary outcome measures were the plantar pressure test, 6-min walking test (6MWT), lower extremity Fugl–Meyer assessment (FMA-LE), Berg Balance Scale (BBS), and the modified Barthel index (MBI). Results: Compared to the control group, there were significant increases in the experimental group after four weeks (p = 0.014) and at the four week follow-up (p = 0.001) in the change in TGS, weight-bearing on the involved side (p = 0.012) or forefoot (p = 0.028) when standing, weight-bearing on the involved side (p = 0.01 6) or forefoot (p = 0.043) when walking, early stance phase (p = 0.023) and mid stance phase (p = 0.013) on the involved side, FMA-LE (p = 0.029), BBS (p = 0.005), and MBI (p = 0.009), but there were no differences in the late stance phase (p = 0.472) on the involved side when walking or in the 6MWT (p = 0.069). Conclusions: Customized insoles had great efficacy in enhancing gait performance in stroke patients. Full article

(This article belongs to the Special Issue Human Bodywork: Applications in Health, Disease, and Rehabilitation)

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11 pages, 918 KiB

Open AccessArticle

A Cross-Sectional Observation on Maximal Eccentric Hamstring Strength in 7- to 15-Year-Old Competitive Alpine Skiers

by Kirsten Kiers, Lynn Ellenberger, Marie Javet, Björn Bruhin, Walter O. Frey and Jörg Spörri

Biology 2021, 10(11), 1128; https://doi.org/10.3390/biology10111128 - 3 Nov 2021

Cited by 5 | Viewed by 2576

Abstract

Severe knee injuries are common in alpine skiing and the hamstring muscles are known to counteract the anterior tibial displacement that typically accompanies major injury mechanisms. This study aimed to assess the Maximal Eccentric Hamstring Strength (MEHS) of youth competitive alpine skiers during [...] Read more.

Severe knee injuries are common in alpine skiing and the hamstring muscles are known to counteract the anterior tibial displacement that typically accompanies major injury mechanisms. This study aimed to assess the Maximal Eccentric Hamstring Strength (MEHS) of youth competitive alpine skiers during Nordic Hamstring Exercise (NHE) in terms of dependence of sex, age and biological maturation. A total of 246 7- to 15-year-old skiers were tested with respect to their MEHS using an NHE-based measurement device (Vald Performance, Newstead, Australia). Significantly greater absolute MEHS was observed in skiers of the under 15 years (U15) category compared to skiers under 10 years old (U10) (227.9 ± 61.1 N vs. 142.6 ± 28.9 N; p < 0.001), also when grouped by sex. Absolute MEHS was revealed to be lower in U15 females compared to males (213.5 ± 49.0 N vs. 241.9 ± 68.4 N; p = 0.001); in U10 skiers there was no sex difference. For all age groups and sexes, absolute MEHS values were significantly correlated with age and biological maturation (p < 0.001). However, when normalized to body weight such associations disappeared, which is why this is strongly recommended when testing around their growth spurt. Overall, this study established sport-specific normative reference data that may be of interest to researchers and sport practitioners alike. Full article

(This article belongs to the Special Issue Human Bodywork: Applications in Health, Disease, and Rehabilitation)

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9 pages, 274 KiB

Open AccessArticle

Falls in Post-Polio Patients: Prevalence and Risk Factors

by Yonah Ofran, Isabella Schwartz, Sheer Shabat, Martin Seyres, Naama Karniel and Sigal Portnoy

Biology 2021, 10(11), 1110; https://doi.org/10.3390/biology10111110 - 28 Oct 2021

Cited by 4 | Viewed by 3035

Abstract

Individuals with post-polio syndrome (PPS) suffer from falls and secondary damage. Aim: To (i) analyze the correlation between spatio-temporal gait data and fall measures (fear and frequency of falls) and to (ii) test whether the gait parameters are predictors of fall measures in [...] Read more.

Individuals with post-polio syndrome (PPS) suffer from falls and secondary damage. Aim: To (i) analyze the correlation between spatio-temporal gait data and fall measures (fear and frequency of falls) and to (ii) test whether the gait parameters are predictors of fall measures in PPS patients. Methods: Spatio-temporal gait data of 50 individuals with PPS (25 males; age 65.9 ± 8.0) were acquired during gait and while performing the Timed Up-and-Go test. Subjects filled the Activities-specific Balance Confidence Scale (ABC Scale) and reported number of falls during the past year. Results: ABC scores and number of falls correlated with the Timed Up-and-Go, and gait cadence and velocity. The number of falls also correlated with the swing duration symmetry index and the step length variability. Four gait variability parameters explained 33.2% of the variance of the report of falls (p = 0.006). The gait velocity was the best predictor of the ABC score and explained 24.8% of its variance (p = 0.001). Conclusion: Gait variability, easily measured by wearables or pressure-sensing mats, is an important predictor of falls in PPS population. Therefore, gait variability might be an efficient tool before devising a patient-specific fall prevention program for the PPS patient. Full article

(This article belongs to the Special Issue Human Bodywork: Applications in Health, Disease, and Rehabilitation)

12 pages, 1654 KiB

Open AccessArticle

Superiority of Multiple-Joint Space Width over Minimum-Joint Space Width Approach in the Machine Learning for Radiographic Severity and Knee Osteoarthritis Progression

by James Chung-Wai Cheung, Andy Yiu-Chau Tam, Lok-Chun Chan, Ping-Keung Chan and Chunyi Wen

Biology 2021, 10(11), 1107; https://doi.org/10.3390/biology10111107 - 27 Oct 2021

Cited by 27 | Viewed by 4552

Abstract

We compared the prediction efficiency of the multiple-joint space width (JSW) and the minimum-JSW on knee osteoarthritis (KOA) severity and progression by using a deep learning approach. A convolutional neural network (CNN) with ResU-Net architecture was developed for knee X-ray imaging segmentation and [...] Read more.

We compared the prediction efficiency of the multiple-joint space width (JSW) and the minimum-JSW on knee osteoarthritis (KOA) severity and progression by using a deep learning approach. A convolutional neural network (CNN) with ResU-Net architecture was developed for knee X-ray imaging segmentation and has attained a segmentation efficiency of 98.9% intersection over union (IoU) on the distal femur and proximal tibia. Later, by leveraging the image segmentation, the minimum and multiple-JSWs in the tibiofemoral joint were estimated and then validated by radiologist measurements in the Osteoarthritis Initiative (OAI) dataset using Pearson correlation and Bland–Altman plots. The agreement between the CNN-based estimation and radiologist’s measurement of minimum-JSWs reached 0.7801 (p < 0.0001). The estimated JSWs were deployed to predict the radiographic severity and progression of KOA defined by Kellgren-Lawrence (KL) grades using the XGBoost model. The 64-point multiple-JSWs achieved the best performance in predicting KOA progression within 48 months, with the area-under-receiver operating characteristic curve (AUC) of 0.621, outperforming the commonly used minimum-JSW with 0.554 AUC. We provided a fully automated radiographic assessment tool for KOA with comparable performance to the radiologists and showed that the fine-grained measurement of multiple-JSWs yields superior prediction performance for KOA over the minimum-JSW. Full article

(This article belongs to the Special Issue Human Bodywork: Applications in Health, Disease, and Rehabilitation)

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16 pages, 3076 KiB

Open AccessArticle

Gait Characteristics and Fatigue Profiles When Standing on Surfaces with Different Hardness: Gait Analysis and Machine Learning Algorithms

by Zhenghui Lu, Dong Sun, Datao Xu, Xin Li, Julien S. Baker and Yaodong Gu

Biology 2021, 10(11), 1083; https://doi.org/10.3390/biology10111083 - 22 Oct 2021

Cited by 8 | Viewed by 2944

Abstract

Background: Longtime standing may cause fatigue and discomfort in the lower extremities, leading to an increased risk of falls and related musculoskeletal diseases. Therefore, preventive interventions and fatigue detection are crucial. This study aims to explore whether anti-fatigue mats can improve gait parameters [...] Read more.

Background: Longtime standing may cause fatigue and discomfort in the lower extremities, leading to an increased risk of falls and related musculoskeletal diseases. Therefore, preventive interventions and fatigue detection are crucial. This study aims to explore whether anti-fatigue mats can improve gait parameters following long periods of standing and try to use machine learning algorithms to identify the fatigue states of standing workers objectively. Methods: Eighteen healthy young subjects were recruited to stand on anti-fatigue mats and hard ground to work 4 h, including 10 min rest. The portable gait analyzer collected walking speed, stride length, gait frequency, single support time/double support time, swing work, and leg fall intensity. A Paired sample t-test was used to compare the difference of gait parameters without standing intervention and standing on two different hardness planes for 4 h. An independent sample t-test was used to analyze the difference between males and females. The K-nearest neighbor (KNN) classification algorithm was performed, the subject’s gait characteristics were divided into non-fatigued and fatigue groups. The gait parameters selection and the error rate of fatigue detection were analyzed. Results: When gender differences were not considered, the intensity of leg falling after standing on the hard ground for 4 h was significantly lower than prior to the intervention (p < 0.05). When considering the gender, the stride length and leg falling strength of female subjects standing on the ground for 4 h were significantly lower than those before the intervention (p < 0.05), and the leg falling strength after standing on the mat for 4 h was significantly lower than that recorded before the standing intervention (p < 0.05). The leg falling strength of male subjects standing on the ground for 4 h was significantly lower than before the intervention (p < 0.05). After standing on the ground for 4 h, female subjects’ walking speed and stride length were significantly lower than those of male subjects (p < 0.05). In addition, the accuracy of testing gait parameters to predict fatigue was medium (75%). After standing on the mat was divided into fatigue, the correct rate was 38.9%, and when it was divided into the non-intervention state, the correct rate was 44.4%. Conclusion: The results show that the discomfort and fatigue caused by standing for 4 h could lead to the gait parameters variation, especially in females. The use of anti-fatigue mats may improve the negative influence caused by standing for a long period. The results of the KNN classification algorithm showed that gait parameters could be identified after fatigue, and the use of an anti-fatigue mat could improve the negative effect of standing for a long time. The accuracy of the prediction results in this study was moderate. For future studies, researchers need to optimize the algorithm and include more factors to improve the prediction accuracy. Full article

(This article belongs to the Special Issue Human Bodywork: Applications in Health, Disease, and Rehabilitation)

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10 pages, 427 KiB

Open AccessArticle

Facial Hair Decreases Fit Factor of Masks and Respirators in Healthcare Providers

by Borja De-Yñigo-Mojado, Ricardo Becerro-de-Bengoa-Vallejo, Marta Elena Losa-Iglesias, Javier Madera-García, David Rodríguez-Sanz, Cesar Calvo-Lobo, Daniel López-López, María Teresa Angulo-Carrere and Marta San-Antolín

Biology 2021, 10(10), 1031; https://doi.org/10.3390/biology10101031 - 12 Oct 2021

Cited by 3 | Viewed by 2937

Abstract

In response to the current state of the COVID-19 pandemic, healthcare providers are using common surgical masks and filtering respirators in conjunction with the presence of facial hair, which could lead to a large number of particles passing into their respiratory system. The [...] Read more.

In response to the current state of the COVID-19 pandemic, healthcare providers are using common surgical masks and filtering respirators in conjunction with the presence of facial hair, which could lead to a large number of particles passing into their respiratory system. The purpose of this study was to determine the fit factor effectiveness of filtering respirators and surgical masks in bearded versus non-bearded healthcare providers. A controlled randomized clinical trial (NCT04391010) was carried out, analyzing a sample of 63 healthcare providers. The fit factors of surgical masks and FFP3 filtering respirators for healthcare providers with (n = 32) and without (n = 31) facial hair were compared. Fit factors were measured during an exercises protocol in which healthcare providers wore surgical masks and FFP3 filtering respirators. Surgical mask fit factor comparisons did not show significant differences (p > 0.05) between healthcare providers with and without facial hair. In contrast, filtering respirator fit factor comparisons showed statistically significant differences (p < 0.01) between both groups, indicating that healthcare providers with facial hair showed lower fit factor scores, which implies a worse fit factor with respect to healthcare providers without facial hair. The fit factor effectiveness of filtering respirators was reduced in healthcare providers with facial hair. The authors of this paper encourage healthcare providers to trim their beards during filtering respirator use or wear full-mask filtering facepiece respirators, especially during the COVID-19 pandemic. Full article

(This article belongs to the Special Issue Human Bodywork: Applications in Health, Disease, and Rehabilitation)

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13 pages, 2078 KiB

Open AccessArticle

Wearing Cushioning Shoes Reduce Load Rates More Effectively in Post-Fatigue than in Pre-Fatigue during Landings

by Xi Wang, Liqin Deng, Wing-Kai Lam, Yang Yang, Xini Zhang and Weijie Fu

Biology 2021, 10(10), 962; https://doi.org/10.3390/biology10100962 - 26 Sep 2021

Cited by 2 | Viewed by 3963

Abstract

Purpose: this study aimed to investigate the footwear cushioning effects on impact forces and joint kinematics of the lower extremity during bipedal drop landings before and after acute exercise-induced fatigue protocol. Methods: in this case, 15 male collegiate basketball athletes performed drop landings [...] Read more.

Purpose: this study aimed to investigate the footwear cushioning effects on impact forces and joint kinematics of the lower extremity during bipedal drop landings before and after acute exercise-induced fatigue protocol. Methods: in this case, 15 male collegiate basketball athletes performed drop landings from a 60 cm platform wearing highly-cushioned shoes (HS) and less cushioned shoes (control shoes, CS) before and after acute fatigue-inducing exercises (i.e., shuttle run combined with multiple vertical jumps). Force plates and motion capturing systems were synchronised to measure ground reaction forces and kinematic data during drop landings. Maximum jump height was analysed with one-way ANOVA. Two-way repeated measure ANOVAs were performed on each of the tested variables to examine if there was significant main effects of shoe and fatigue as well as the interaction. The significance level was set to 0.05. Results: rearfoot peak impact forces and loading rates significantly reduced when the participants wore HS in pre- and post-fatigue conditions. The peak loading rates in forefoot significantly reduced when HS were worn in post-fatigue. Compared with pre-fatigue, wearing HS contributed to with 24% and 13% reduction in forefoot and rearfoot peak loading rates, respectively, and the occurrence times of first and second peak impact forces and loading rates were much later. In the post-fatigue, a significant increase in the initial contact and minimum angles of the ankle were observed in HS compared with CS. Conclusion: these findings suggest that footwear cushioning can reduce landing-related rearfoot impact forces regardless of fatigue conditions. In a situation where the neuromuscular activity is reduced or absent such as post-fatigue wearing better cushioning shoes show superior attenuation, as indicated by lower forefoot and rearfoot impacts. Full article

(This article belongs to the Special Issue Human Bodywork: Applications in Health, Disease, and Rehabilitation)

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Review

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21 pages, 3142 KiB

Open AccessReview

Efficacy of Exercise-Based Rehabilitation Programs for Improving Muscle Function and Size in People with Hip Osteoarthritis: A Systematic Review with Meta-Analysis

by Zachary P. J. Rostron, Rodney A. Green, Michael Kingsley and Anita Zacharias

Biology 2021, 10(12), 1251; https://doi.org/10.3390/biology10121251 - 30 Nov 2021

Cited by 4 | Viewed by 4282

Abstract

Objective: To determine the effect of exercise-based rehabilitation programs on hip and knee muscle function and size in people with hip osteoarthritis. Methods: Seven databases were systematically searched in order to identify studies that assessed muscle function (strength or power) and size in [...] Read more.

Objective: To determine the effect of exercise-based rehabilitation programs on hip and knee muscle function and size in people with hip osteoarthritis. Methods: Seven databases were systematically searched in order to identify studies that assessed muscle function (strength or power) and size in people with hip osteoarthritis after exercise-based rehabilitation programs. Studies were screened for eligibility and assessed for quality of evidence using the GRADE approach. Data were pooled, and meta-analyses was completed on 7 of the 11 included studies. Results: Six studies reported hip and/or knee function outcomes, and two reported muscle volumes that could be included in meta-analyses. Meta-analyses were conducted for four strength measures (hip abduction, hip extension, hip flexion, and knee extension) and muscle size (quadriceps femoris volume). For hip abduction, there was a low certainty of evidence with a small important effect (effect size = 0.28, 95% CI = 0.01, 0.54) favouring high-intensity resistance interventions compared to control. There were no other comparisons or overall meta-analyses that identified benefits for hip or knee muscle function or size. Conclusion: High-intensity resistance programs may increase hip abduction strength slightly when compared with a control group. No differences were identified in muscle function or size when comparing a high versus a low intensity group. It is unclear whether strength improvements identified in this review are associated with hypertrophy or other neuromuscular factors. Full article

(This article belongs to the Special Issue Human Bodywork: Applications in Health, Disease, and Rehabilitation)

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15 pages, 1489 KiB

Open AccessSystematic Review

Effects of Physical Exercises Alone on the Functional Capacity of Individuals with Obesity and Knee Osteoarthritis: A Systematic Review

by Vanessa Silva Caiado, Aline Cristina Gomes Santos, Eloá Moreira-Marconi, Marcia Cristina Moura-Fernandes, Adérito Seixas, Redha Taiar, Ana Cristina Rodrigues Lacerda, Anelise Sonza, Vanessa Amaral Mendonça, Danúbia Cunha Sá-Caputo and Mario Bernardo-Filho

Biology 2022, 11(10), 1391; https://doi.org/10.3390/biology11101391 - 23 Sep 2022

Cited by 7 | Viewed by 3023

Abstract

The association between obesity and knee osteoarthritis (KOA) is reported in the literature. The inflammatory factors described in obesity associated with mechanical overload on the knee joint lead to KOA development and reduced functional capacity in these individuals. Most physical exercise (PE) protocols [...] Read more.

The association between obesity and knee osteoarthritis (KOA) is reported in the literature. The inflammatory factors described in obesity associated with mechanical overload on the knee joint lead to KOA development and reduced functional capacity in these individuals. Most physical exercise (PE) protocols associate a diet program to improve the functional capacity of individuals with concomitant KOA and obesity. There is a lack of published protocols performing PE alone, which would be without an associated diet program in individuals with both clinical conditions. In this systematic review, the authors summarize the effects of the application of PE alone, describing each protocol and reporting the improvement in the function of people with these clinical conditions. This investigation was conducted according to the PRISMA guidelines and registered in PROSPERO. Five databases (MEDLINE/PubMed, PEDro, Scopus, CINAHL and Web of Science) were used up to July 2022 and ten studies, including 534 participants, met the inclusion criteria. The PEDro scale, Cochrane collaborations and ROBINS-I tools were used to evaluate the methodological quality and risk of bias. It was concluded that PE performed alone seems to provide an improvement in the functional capacity of these individuals even without an associated diet plan in the condition of obesity. Full article

(This article belongs to the Special Issue Human Bodywork: Applications in Health, Disease, and Rehabilitation)

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34 pages, 4150 KiB

Open AccessSystematic Review

Potential of Whole-Body Vibration in Parkinson’s Disease: A Systematic Review and Meta-Analysis of Human and Animal Studies

by Y. Laurisa Arenales Arauz, Gargi Ahuja, Ype P. T. Kamsma, Arjan Kortholt, Eddy A. van der Zee and Marieke J. G. van Heuvelen

Biology 2022, 11(8), 1238; https://doi.org/10.3390/biology11081238 - 19 Aug 2022

Cited by 15 | Viewed by 4293

Abstract

(1) Background: When the severity of Parkinson’s Disease (PD) increases, patients often have difficulties in performing exercises. Whole-Body Vibration (WBV) may be a suitable alternative. This systematic review aims to clarify if WBV shows potential as rehabilitative therapy for PD patients. (2) Methods: [...] Read more.

(1) Background: When the severity of Parkinson’s Disease (PD) increases, patients often have difficulties in performing exercises. Whole-Body Vibration (WBV) may be a suitable alternative. This systematic review aims to clarify if WBV shows potential as rehabilitative therapy for PD patients. (2) Methods: We searched several databases for controlled trials investigating the effects of WBV (1) on PD populations and (2) PD neuropathological mechanisms. We included both human and animal studies and performed meta-analyses. (3) Results: The studies on PD populations (14 studies) show an overall significant, but small, effect in favor of WBV (Hedges’ g = 0.28), for which the effects on stability (Hedges’ g = 0.39) and balance (Hedges’ g = 0.30) are the most prominent. The studies on the neuropathological mechanisms (18 studies) show WBV effects on neuroinflammation (Hedges’ g = –1.12) and several specific WBV effects on neurotransmitter systems, growth factors, neurogenesis, synaptic plasticity and oxidative stress. (4) Conclusions: The effects of WBV on human PD patients remains inconclusive. Nevertheless, WBV protocols with sufficient duration (≥3 weeks), session frequency (≥3 sessions/week) and vibration frequency (≥20 Hz) show potential as a treatment method, especially for motor function. The potential of WBV for PD patients is confirmed by the effects on the neuropathological mechanisms in mostly non-PD populations. We recommend high-quality future studies on both PD patients and PD mouse models to optimize WBV protocols and to examine the neuropathological mechanisms in PD populations. Full article

(This article belongs to the Special Issue Human Bodywork: Applications in Health, Disease, and Rehabilitation)

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14 pages, 942 KiB

Open AccessProtocol

Effectiveness of Whole-Body Vibration Combined with Multicomponent Training on the Risk of Falls and Quality of Life in Elderly Women with Osteoporosis: Study Protocol for a Randomized Controlled Clinical Trial

by Rúbia Rayanne Souto Braz, Shirley Lima Campos, Débora Wanderley Villela, Gabriel Barreto Antonino, Pâmella Karolline Araújo Batista, Marcelo Renato Guerino, François Talles Medeiros Rodrigues, Kennedy Freitas Pereira Alves, João Victor Torres Duarte, Diana de Andrade Silva, Daniel Florentino Lima, Arthur Felipe Freire da Silva, Karla Cybele Vieira de Oliveira, Edy Kattarine Dias dos Santos, Wagner Souza Leite, Larissa Coutinho de Lucena, Ana Paula de Lima Ferreira, Kátia Monte-Silva, Maria das Graças Rodrigues de Araújo and Redha Taiar

Biology 2022, 11(2), 266; https://doi.org/10.3390/biology11020266 - 8 Feb 2022

Cited by 3 | Viewed by 3173

Abstract

Osteoporosis and the risk of falls increase the risk of fractures and events of falls. Prescriptions and programs for different forms of exercise have different impacts on the risk of falls, and exercises from multiple categories of whole-body vibration can be effective. This [...] Read more.

Osteoporosis and the risk of falls increase the risk of fractures and events of falls. Prescriptions and programs for different forms of exercise have different impacts on the risk of falls, and exercises from multiple categories of whole-body vibration can be effective. This study aims to evaluate the effectiveness of whole-body vibration (WBV) protocol combined with multicomponent training (MCT) in elderly women with osteoporosis and their history of falls. Our proposal is a protocol for a randomized clinical trial, divided into two stages: First, development of a protocol for WVB combined with MCT for elderly women with osteoporosis and a history of falls, under the Guidelines of the American College of Sports Medicine, and following the recommendations of the Standard Protocol Items Recommendations for Interventional Trials (SPIRIT), and second, a randomized controlled clinical trial following the Consolidated Standards of Reporting Trials (CONSORT). This trial will have implications for the effectiveness of a vibration protocol combined with multicomponent exercise on the risk of falls and quality of life for older women with osteoporosis. We expect that adding full-body vibration to an exercise protocol will decrease the risk of falls and improve participants’ quality of life, as well as their strength, balance, and functional capacity. Full article

(This article belongs to the Special Issue Human Bodywork: Applications in Health, Disease, and Rehabilitation)

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30 pages, 1991 KiB

Open AccessTutorial

Reporting Guidelines for Whole-Body Vibration Studies in Humans, Animals and Cell Cultures: A Consensus Statement from an International Group of Experts

by Marieke J. G. van Heuvelen, Jörn Rittweger, Stefan Judex, Borja Sañudo, Adérito Seixas, Anselm B. M. Fuermaier, Oliver Tucha, Csaba Nyakas, Pedro J. Marín, Redha Taiar, Christina Stark, Eckhard Schoenau, Danúbia C. Sá-Caputo, Mario Bernardo-Filho and Eddy A. van der Zee

Biology 2021, 10(10), 965; https://doi.org/10.3390/biology10100965 - 27 Sep 2021

Cited by 92 | Viewed by 7363

Abstract

Whole-body vibration (WBV) is an exercise modality or treatment/prophylaxis method in which subjects (humans, animals, or cells) are exposed to mechanical vibrations through a vibrating platform or device. The vibrations are defined by their direction, frequency, magnitude, duration, and the number of daily [...] Read more.

Whole-body vibration (WBV) is an exercise modality or treatment/prophylaxis method in which subjects (humans, animals, or cells) are exposed to mechanical vibrations through a vibrating platform or device. The vibrations are defined by their direction, frequency, magnitude, duration, and the number of daily bouts. Subjects can be exposed while performing exercises, hold postures, sitting, or lying down. Worldwide, WBV has attracted significant attention, and the number of studies is rising. To interpret, compare, and aggregate studies, the correct, complete, and consistent reporting of WBV-specific data (WBV parameters) is critical. Specific reporting guidelines aid in accomplishing this goal. There was a need to expand existing guidelines because of continuous developments in the field of WBV research, including but not limited to new outcome measures regarding brain function and cognition, modified designs of WBV platforms and attachments (e.g., mounting a chair on a platform), and comparisons of animal and cell culture studies with human studies. Based on Delphi studies among experts and using EQUATOR recommendations, we have developed extended reporting guidelines with checklists for human and animal/cell culture research, including information on devices, vibrations, administration, general protocol, and subjects. In addition, we provide explanations and examples of how to report. These new reporting guidelines are specific to WBV variables and do not target research designs in general. Researchers are encouraged to use the new WBV guidelines in addition to general design-specific guidelines. Full article

(This article belongs to the Special Issue Human Bodywork: Applications in Health, Disease, and Rehabilitation)

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