FysioFons

Last week all the osteoarthritis researchers in the world were in Amsterdam for a yearly OARSI congress. A lot of Dutch physiotherapy researchers presented their findings this year too and attention was given to the importance of physiotherapy in the treatment of osteoarthritis. Jesper Knoop researcher by Reade and policy maker by the KNGF was in attendance in Amsterdam. He listed out the most interesting results about knee osteoarthritis.

Physiotherapy with early osteoarthritis:

A lot of patients with knee osteoarthritis are treated only after several structural changes are already noticeable in an x-ray of the joint. This is done even though it is increasingly clear that osteoarthritis may be reversible: with physio-therapeutic treatment at an earlier stage addressing muscle strengthening exercise therapy. Therefore, it is necessary to identify the patient as soon as possible; when there is minimal damage to the joint. For example, with the KOOS questionnaire, a knee evaluation and a muscle strength test, people with a functional limitation can be identified and treated earlier. In the Netherlands research even shows that osteoarthritis can be avoided with exercise therapy in combination with weight loss.

The most optimal content in exercise therapy:

Although there is already irrefutable evidence that exercise therapy is effective for knee osteoarthritis, a lot of research is now being carried out with regards to the most optimal form of exercise. The addition of telephone consultations to the supervised sessions had no additional value, according to research from Australia. According to an English study, exercise therapy consisting of 4 sessions (though cheaper) was almost as effective as 6 or 10 sessions for  people with knee pain. Hereby however, it is to noted that the intensity of the exercise programs was rather low and perhaps this led to the lack of noticeable difference. The Dutch DO-IT program (subsidized by KNGF) was also presented. This program proves that specific adapted supervised exercise therapy is also very effective for patients with knee osteoarthritis and a co-morbidity such as DM2 or COPD.

Better selection of candidates for operation:

It is known that a joint replacement operation in patients with knee osteoarthritis often leads to fewer complaints. However, recent research also shows that a significant amount (20% - 40%) do not get better nor do they get worse after an operation. A great number of these patients are those that had relatively fewer complaints before the operation. If a surgeon would only operate the most serious group (where the complaints do not get better after conservative treatment) then the average treatment effects would be a lot better, with an additional reduction in the total treatment cost.

More information at:http://2016.oarsi.org/

This study focuses on the main muscles in the lower extremity: gluteus maximus; gluteus medius; iliopsoas (iliacus and psoas); hamstrings (semitendinosus, semimembranosus, and biceps femoris long head); rectus femoris; vasti (vastus medialis, lateralis, and intermedius); tibialis anterior; plantarflexors (gastrocnemius medialis, lateralis, and soleus combined); gastrocnemius (medialis and lateralis combined); and soleus

What extent of muscle weakness can be tolerated before there is limitation in normal daily activities?

Up to 40% decrease in strength could be tolerated AFTER which normal gait couldn’t be carried out.This also depends on the initial strength.

Which muscles are the most necessary for a normal gait? Can different muscle groups tolerate a different amount of weakness?

Weakness of plantarflexors, hip abductors, and hip flexors affected the gait most, since weakness in these muscles could be tolerated only to a limited extent, and resulted in a large increase in total muscle cost.

With muscle weakness, what are the compensatory mechanisms related to gait and how effective are they?

Compensations for weakness of individual muscles included activating the weak muscle more and/or activating other muscles. With all muscles weakened at the same time; there was an increased activation rate for all muscles. With weakening of individual muscles, the specific muscle produced less force leading to the other muscles compensating.

The observed compensations were generally inefficient, why?

They generated unbalanced joint moments that required compensatory activation in other muscles. As a result, weakness of individual muscles led to changes in activation pattern and forces of many other muscles throughout the leg.

What result does muscular weakness have on the body when carrying out ADL activities?

Compensations caused due to muscle weakness led to increased muscle cost. Total muscle cost (tmc) over the gait cycle a) increased with the severity of weakness b) showed a significant variability depending on the muscle being weakened.

Total muscle cost increased most with weakness of: plantarflexors, gluteus medius, and iliopsoas.

Little change in total muscle cost was seen with weakness in: gluteus maximus and vasti.

Due to this extra cost there could be a downward spiral of muscle weakness due to fatigue and damage.

Things I found particularly strange/ What I took out of this study:

“Most individual muscles/muscle groups could be weakened by approximately 80%, or could even be totally removed, while still allowing normal gait kinematics. “

“Since weakness is not well tolerated in the plantarflexors, hip abductors, and hip flexors, it may be most useful to target these muscles with strength training programs. In contrast, strength training of hip or knee extensors, although commonly performed, may merely enhance their already significant excess strength capacity. “

Article: http://www.gaitposture.com/article/S0966-6362%2812%2900039-2/fulltext

Shaping bones and joints ideally to match the patients connected to the persons own nerves and muscles.

Form follows function: eg: strength in the bones of the forearm or digits, flexibility in the joints, power in whatever artificial muscle will drive the function of grasp. So which function has to be aided.

Necessary cooperation between the design side and the operational side with regards to satisfactory syncing of the prosthetic.

“Rather than patenting and licensing the technology for profit, however, Richard and Ivan made the design freely available. Now over 200 people around the world have been fitted with a prosthetic they could never otherwise have afforded. Richard went on to set up his company, Robohand, and their 3D printable prosthetics now include Robofinger, Roboarm and Roboleg.“

Two low cost 3d printing materials ABS (acrylonitrile-butadiene-styrene) and PLA (polylactic acid)

fdm = fused deposition modeling.

3d printed files are saved in the stl format. A designed 2d image is then extruded: volume is added to it. The word extrude means to force out, taking this into 3D printing context that would be to force out volume into the 2D picture.

In the quest to replace a lost limb 3d scanning and printing offers a perfect solution; providing a lasting robust limb.