Summary. Measurement of changes in the physiological cycle-to-cycle variability in gait kinematics using the ELLIS approach holds promise as a new tool for quantitative evaluation of gait adaptability. Introduction. Adaptability is arguably one of the most crucial factors of gait function. However, functional limitations in adaptability have not been well documented, presumably due to the inability to accurately measure this aspect. For this purpose, we developed a new method to quantify subtle changes in cycle-to-cycle physiological variability in gait kinematics; a technique designated as the entropy of leg-linkage inertial signals (ELLIS) analysis. A previous study (Tochigi et al., JOR 2012) found that the ELLIS outputs in an asymptomatic cohort) became lower with greater age, and that subjects with symptomatic knee osteoarthritis exhibited lower values compared to age-matched asymptomatic subjects. In addition, highly consistent speed-dependent increases in ELLIS outputs (in the asymptomatic subjects) were also documented. This speed-dependency is consistent with the fact that stable walking at a faster pace places higher demands on the neuromuscular control systems. Complex interactions across multiple controlling factors presumably increase perturbations to gait kinematics within the “normal” range (i.e., increase in physiological variability). To advance understanding of the degree of speed dependence, the present study aimed to test whether or not the ELLIS outputs would linearly increase with increase in walking speed. Methods. Six asymptomatic adult individuals (all males, age 24 – 47) were recruited and completed an institutionally approved consent process. No subjects had lower limb symptoms, histories of major lower limb pathology in the prior year, or systemic conditions that might affect gait (e.g., neurological or cardiovascular impairments). For leg kinematics measurement, each subject wore a portable wireless inertial monitor, which was strapped to the lateral aspect of the left or right calf, just above the ankle. Self-selected gait speed was determined during a timed corridor walk. Data during a treadmill walk were collected at 60%, 80%, 100%, 120% and 140% of the individuals’ self-selected pace, in a randomised order. The kinematic data collected were six channels of synchronised signals (sampling rate: 150Hz), including tri-axial rotational rate and tri-axial acceleration data. For each of these two 3-D kinematic datasets, entropy was measured individually using a non-linear measure designated as Sample Entropy (SampEn). These outputs were plotted for the relationship with relative speed change, and the correlation between entropy and relative speed change was tested using the Pearson's linear regression model. Results. The SampEn values of the rotational rate data exhibited high positive correlation with relative speed changes, as indicated by the correlation coefficients (r) > 0.95 in all subjects, while those for the acceleration data exhibited modest correlation (r: 0.66 to 0.99). Conclusion. These data support the hypothesised speed-dependent linear increase of ELLIS outputs. Assuming the sensitivity of this speed-dependent change is associated with the integrity of gait adaptability, this approach may be capable of quantifying decrease of gait adaptability in various pathological conditions. This gait analysis technique does not require elaborate laboratory equipment, permitting data collection at a variety of non-specialised settings, such as private clinics and community-based settings. The ELLIS approach holds promise as a new convenient diagnostic tool

Summary. Bi-plane Image matching method is very useful technique to evaluate the loaded 3D motion of each cervical level. Introduction. Cervical orthoses are commonly used to regulate the motion of cervical spines for conservative treatment of injuries and for post-operative immobilization. Previous studies have reported the efficacy of orthoses for 2D flex-extension or 3D motions of the entire cervical spine. However, the ability of cervical orthoses to reduce motion might be different at each intervertebral level and for different types of motion (flexion-extension, rotation, lateral bending). The effectiveness of immobilizing orthoses at each cervical intervertebral level for 3D motions has not been reported. The purpose of this study is to evaluate the effectiveness of the Philadelphia collar to each level of cervical spines with 3D motion analysis under loading condition. Patients & Methods. Patient Sample: Four asymptomatic volunteer subjects were recruited and provided informed consent. Approval of the experimental design by the institutional review board was obtained. These 4 individuals were without any history of cervical diseases or procedures. The presence of any symptoms, spinal disorders and anatomical abnormalities in fluoroscopic images or CT was a criterion of exclusion from this study. Outcome Measures: To evaluate the efficacy of the Philadelphia collar, ANOVA was used to compare the range of motion with and without collar at the C3/4, C4/5, C5/6 and C6/7 intervertebral levels for each motion. The level of statistical significance was set at p<0.05. When a statistical difference was detected, post hoc Tukey tests were performed. Methods. Three-dimensional models of the C3-C7 vertebrae were developed from CT scans of each subject using commercial software. Two fluoroscopy systems were positioned to acquire orthogonal images of the cervical spine. The subject was seated within the view of the dual fluoroscopic imaging system. Pairs of images were taken in each of 7 positions: neutral posture, maximum flexion and extension, maximum left and right lateral bending, and maximum left and right rotation. The images and 3D vertebral models were imported into biplane 2D-3D registration software, where the vertebral models were projected onto the pair of digitised images and the 3D bone pose was adjusted to match its radiographic projection in each image. Relative motions between each vertebral body were calculated from body-fixed coordinate systems using a flexion-lateral bending-axial rotation Cardan angle sequence. Results. Flexion range was significantly reduced with the collar at each cervical level. Extension range was significantly reduced at the C3/4 level. Rotation and lateral bending were reduced for C3/4, C4/5, C5/6 levels with the collar. Discussion/Conclusion. The Philadelphia Collar significantly reduces cervical motion at C3/4, C4/5 and C5/6 levels in almost all motions (except for extension). At the C6/7 level, this type of collar has limited effectiveness reducing cervical motion. We used 3D radiographic measurements to quantify the effectiveness of the Philadelphia collar for reducing cervical motion. Bi-plane 2D-3D registration method is useful technique to evaluate 3D motion of cervical spines

In an osteological collection of 3100 specimens, 70 were found with unilateral clavicular fractures which were matched with 70 randomly selected normal specimens. This formed the basis of a study of the incidence of arthritis of the acromioclavicular joint and the effect of clavicular fracture on the development of arthritis in the ipsilateral acromioclavicular joint. This was graded visually on a severity scale of 0 to 3. The incidence of moderate to severe arthritis of the acromioclavicular joint in normal specimens was 77% (100 specimens). In those with a clavicular fracture, 66 of 70 (94%) had arthritis of the acromioclavicular joint, compared to 63 of 70 (90%) on the non-injured contralateral side (p = 0.35).

Clavicles with shortening of 15 mm or less had no difference in the incidence of arthritis compared to those with shortening greater than 15 mm (p = 0.25). The location of the fracture had no effect on the development of arthritis.