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Biomedical subjects

J J Triano

Publications and source records attributed to J J Triano.

33 records · Page 2Linked to original sources
PubMed1989

Sensitivity study of H-reflex alterations in idiopathic low back pain patients vs. a healthy population.

Twenty-seven male and 12 female healthy volunteers were tested twice with 2-7 days separation. Hoffman (H) reflexes and muscle (M) activation waves were obtained from the posterior tibial nerves bilaterally. Results were compared to those obtained from patients presenting with a complaint of low back and/or leg pain, without compressive neuropathy. M, F, H latencies and H/Mmax ratio were recorded. H/M ratio and latency comparisons were not significantly different in the control group left to right or test to test. For the low back pain group, 10-14 days following the initial evaluation, each subject returned for a follow-up test. During the interim, the patient was followed conservatively using manipulation and home care. Analysis of variance (ANOVA) testing of ratio values demonstrated a difference in overall mean values (p greater than 0.001) for comparisons between the control (mean = 0.367), pretest (mean = 0.695), and posttest (mean = 0.558) values. Sensitivity in discriminating acute low back pain subjects from healthy controls was tested by determining the distance between mean H/M values for the probability curves of each population, with an arbitrary cutoff value of 0.6 as the upper limit normal. Sensitivity distance was 2.29 with a likelihood ratio of 3.04. This suggests that an H/Mmax ratio greater than or equal to 0.6 will correctly identify two of three patients with idiopathic low back pain.

Adult↗
PubMed1987

Patient monitoring in the conservative management of cervical radiculopathy.

With increasing frequency, concern is being raised by nonmanipulating health professionals over the use of manual procedures in the cervical spine. With respect to treatment of radicular syndromes secondary to discogenic spondylosis, the potential for occasional iatrogenic complications must be an "a priori" consideration. Illustrated with the data from case presentation, conservative therapeutic management utilizing electrodiagnostic monitoring in questionable cases is discussed. Anecdotal improvement in median nerve F-wave function following conservative treatment including spinal manipulation is presented.

Cervical Vertebrae↗
PubMed1985

Myoelectric paraspinal response to spinal loads: potential for monitoring low back pain.

LBP evaluation has been hampered by the subjectivity of available clinical procedures and the paucity of factual information about spinal dysfunction. Objective indices of spinal pathomechanics would assist the clinician to prescribe and evaluate appropriate treatment. This project assesses paraspinal myoelectric symmetry as a potential objective measure of low back performance. A preliminary group (N = 39) of symptomatic subjects was prospectively tested to choose parameters for the blinded experiment to follow. The experimental group of volunteers (N = 37) were electromyographically monitored while the subjects performed selected postural tasks which did not produce pain. Results were compared to orthopedic tests and history. Four arbitrary myoelectric classifications were defined for subject grouping and comparison: subjects with symmetrical paraspinal task performance, occasional (less than 4 tasks) asymmetry, low amplitude response for quasi-static loads, and large amplitude asymmetry (greater than 4 tasks). Eighty percent of subjects with significant asymmetry of muscle action had recent LBP history. Isolated task testing is inconclusive as a clinical parameter. However, observation of performance of a series of tasks may be useful in clinical diagnosis and monitoring of function in low back pain.

Abdominal Muscles↗
PubMed1983

Objective electromyographic evidence for use and effects of lift therapy.

Thirty nine subjects with chronic low back complaints which were unresponsive to other conservative therapies were tested by postural loading electromyography (EMG) to assess their possible response to lift therapy. Of the 35 subjects included in the study, seven (20%) showed no alteration of their muscular asymmetry during stance with either heel of ischial supports placed unilaterally; 18 (51%) of the remaining 28 subjects demonstrated a balancing of the paraspinal activity as a result of the use of heel lifts, while all 28 (80%) were balanced by an ischial support. It was concluded that lift placement by EMG criteria is more accurate than customary radiographic methods of assessing pelvic tilt and/or sacral unleveling. Further study of EMG lift placement, as well as other possible applications, is warranted.

Back Pain↗
PubMedDate not supplied

Biomechanics of spinal manipulative therapy.

BACKGROUND CONTEXT: Modern scientific investigations into spinal manipulative therapy (SMT) began in 1975. Conditions often treated include acute and chronic low back pain, radicular pain, neck pain, and some forms of headache. The field of spinal manipulation has often been treated by the literature, incorrectly, as being homogeneous. Much of the confusion regarding this form of treatment can be traced to the ambiguity surrounding the procedures themselves. This report summarizes the clinical biomechanics of SMT and evidence for its associated manipulable lesion is reviewed. Finally, a classification system based on biomechanics is proposed that may facilitate more detailed research in the future. PURPOSE: A categorization system for SMT was sought that would be more objective than is clinically available. Such a system may serve as a means to strengthen future studies, determine operating principles, applicability, treatment effectiveness, and nature of the manipulable lesion. STUDY DESIGN: Literature synthesis. METHODS: A search of the indexed biomechanical and medical literature as well as a hand search of published works was conducted. The criteria for article selection consisted of studies that included measurements of mechanical characteristics of treatment techniques used under the general headings of SMT or manual therapy. A second set of studies was identified that explored the biomechanics of buckling behavior of vertebral segments as a model of the manipulable lesion. Quantitative characteristics of SMT were extracted and grouped to form a basis for classification. RESULTS: A total of 31 articles were identified that contained quantitative data on the biomechanical properties of SMT methods. An additional seven studies were found that quantified spinal buckling behavior. Common features of SMT procedures lead to a matrix that biomechanically characterizes the types of procedures in use. Buckling behavior was compared qualitatively with clinical observations to form a plausible and evidence-based hypothesis of the manipulable lesion. CONCLUSIONS: There currently are a number of named systems of manual procedures. No current triage system is available that predicts which patient has the greater likelihood of benefiting from manual treatment or the procedure type. The biomechanical parameters of SMT form a systematic characterization of manual procedures. Such a system may be used in future studies to test hypotheses of treatment effect from quantitatively defined procedures.

Biomechanical Phenomena↗
PubMedDate not supplied

Correlation of objective measure of trunk motion and muscle function with low-back disability ratings.

A study was undertaken to examine relations among some objective and subjective measures of low-back-related disability in a group of 41 low-back pain patients and in seven pain-free control subjects. Subjective measures of disability were obtained by Oswestry patient questionnaires. Oswestry disability score related significantly (P less than 0.001) to presence or absence of relaxation in back muscles during flexion. Mean trunk strength ratios were inversely related to disability score (P less than .05), and trunk mobility was meaningfully reduced (P less than .01). Despite loss of motion, a large enough excursion was observed to predict presence of back muscle relaxation. These findings imply that myoelectric signal levels, trunk strength ratios, and ranges of trunk motion may be used as objective indicators of low-back pain disability.

Activities of Daily Living↗
PubMedDate not supplied

Biomechanical performance of spinal manipulation therapy by newly trained vs. practicing providers: does experience transfer to unfamiliar procedures?

OBJECTIVE: To examine the differences in predefined biomechanical parameters of spinal manipulation using a single method common to the training of both novice and expert manipulators. DESIGN: Analytic Cohort Study. PARTICIPANTS: Fifteen novice manipulators and fifteen experienced physicians provided 2 applications of spinal manipulation therapy (SMT) to 15 healthy, male student volunteers. Assignment of volunteers was randomized, and the order of the first interaction with the manipulators was determined by coin toss and then inverted for the second. INTERVENTION: The bilateral transverse-thenar thoracic maneuver was selected from the diversified system of treatment to be used as the test procedure. Selection was guided by mechanical simplicity. SMT was applied at the physician's discretion to the region of T3-T10. Standard informed consent procedures were followed. MAIN OUTCOME MEASURES: Preload force, rise rate of thrust and thrust force were selected as prospective primary outcome measures. Secondary descriptive measures included impulse, rise time, downward incisural point (DIP), fall time, total force, force components and direction cosines. RESULTS: Both novice and experienced manipulators were familiar with the transverse-thenar procedure, but only three of the experienced manipulators professed common use of it. Mean values for primary outcomes were all higher for the experienced participants; however, no statistically significant differences were found. DISCUSSION: Differences are presumed to exist between novice and experienced manipulators, as evidenced by measurement of arbitrarily selected thoracic and lumbar SMT. However, no systematic differences were found when the manipulators have a similar lack of practice experience specific to the test procedure. These results suggest the importance of regular use in developing skill of performance.

Biomechanical Phenomena↗
PubMedDate not supplied

Motions of the head and thorax during neck manipulations.

OBJECTIVE: The purpose of this study was to determine the amplitudes and variations of preload positioning and displacements of the head and thorax during spinal manipulative therapy (SMT) applied to C2. DESIGN: This experimental study measured the biomechanics of SMT applied to C2. SETTING: Biomechanics Laboratory, Mechanical Engineering and Applied Mechanics, University of Michigan and Spinal Ergonomics and Joint Research Laboratory, National College of Chiropractic. PARTICIPANTS: Eighteen healthy volunteers from the University of Michigan and the National College of Chiropractic were manipulated by a total of eight experienced chiropractic physicians licensed in the state in which they participated. INTERVENTION: Sixty-six Direct Break (DB) and twenty-three Rotary Break (RB) diversified procedures were administered to C2. Randomization of the DB was made on two variables, direction and intended load intensities. The RB was administered only from the right by each physician. MAIN OUTCOME MEASURES: Linear and angular displacement time histories for the head and thorax mass centers were monitored during the preload setup of each procedure and the dynamic delivery of the treatment procedures. CONCLUSIONS: DB procedures were found to have sagittally symmetric positioning and displacements as a function of intended direction of the procedure. Both DB and RB methods consisted of preload positioning with head flexion. RB rotation and lateral bending preload positions approached the maximal voluntary ranges of motion for the upper cervical spine. Variations among procedures by one manipulator were approximately the same as for variations among manipulators. Data indicates that SMT procedures can be successfully modified to control amplitude and direction of body segment displacements that arise.

Adult↗
PubMedDate not supplied

Electrodiagnostic testing in back and extremity pain.

OBJECTIVE: The usefulness of electrodiagnostic testing by the primary care provider is shown in two cases of suspected compression-type neural lesions of the lumbar spine. CLINICAL FEATURES: A 54-yr-old female with acute lumbar spine pain that radiated into the hip and a 26-yr-old male with sharp gluteal pain that radiated into the thigh and ankle were admitted into an inpatient care facility for intensive therapy. Plain film radiographs were obtained initially. In addition, electrodiagnostic testing was performed to evaluate the L5 and S1 nerve roots, which suggested compressive-type lesions. Non-enhanced CT of the lumbar spine was performed and revealed central disk herniation or protrusion in each case. INTERVENTION AND OUTCOME: One patient exhibiting central compression signs of bladder dysfunction was referred for medical intervention. The remaining patient received flexion-distraction type of chiropractic manipulation with physiologic therapeutics and was discharged to outpatient care after 16 days. CONCLUSIONS: Electrodiagnostic testing can provide the primary care provider the data needed to make an informed decision regarding advanced imaging studies and to institute appropriate therapy or to intelligently refer a patient for follow-up.

Adult↗