Objective Assessment of Joint Stiffness: A Clinically Oriented Hardware and Software Device With an Application to the Shoulder Joint.

Objective Assessment of Joint Stiffness: A Clinically Oriented Hardware and Software Device with an Application to the Shoulder Joint.

J Nov Physiother. 2012 Aug 30; 2(7):
McQuade K, Price R, Liu N, Ciol MA

Examination of articular joints is largely based on subjective assessment of the “end-feel” of the joint in response to manually applied forces at different joint orientations. This technical report aims to describe the development of an objective method to examine joints in general, with specific application to the shoulder, and suitable for clinical use. We adapted existing hardware and developed laptop-based software to objectively record the force/displacement behavior of the glenohumeral joint during three common manual joint examination tests with the arm in six positions. An electromagnetic tracking system recorded three-dimensional positions of sensors attached to a clinician examiner and a patient. A hand-held force transducer recorded manually applied translational forces. The force and joint displacement were time-synchronized and the joint stiffness was calculated as a quantitative representation of the joint “end-feel.” A methodology and specific system checks were developed to enhance clinical testing reproducibility and precision. The device and testing protocol were tested on 31 subjects (15 with healthy shoulders, and 16 with a variety of shoulder impairments). Results describe the stiffness responses, and demonstrate the feasibility of using the device and methods in clinical settings. HubMed – rehab


Hemispatial neglect: computer-based testing allows more sensitive quantification of attentional disorders and recovery and might lead to better evaluation of rehabilitation.

Front Hum Neurosci. 2013; 7: 162
Bonato M, Deouell LY

HubMed – rehab


What Makes Transcutaneous Electrical Nerve Stimulation Work? Making Sense of the Mixed Results in the Clinical Literature.

Phys Ther. 2013 May 2;
Sluka KA, Bjordal JM, Marchand S, Rakel BA

Transcutaneous electrical nerve stimulation (TENS) is a non-pharmacological treatment for control of pain. It has come under much scrutiny lately with the Center for Medicare Services rendering a recent decision stating that “TENS is not reasonable and necessary for the treatment of CLBP [chronic low back pain]”.When reading and analyzing the existing literature for which systematic reviews show that TENS is inconclusive or ineffective, it is clear that a number of variables related to TENS application have not been considered. While many of the trials were designed with the highest of standards, recent evidence suggests that factors related to TENS application need to be considered in an assessment of efficacy. These factors include, dosing of TENS, negative interactions with long-term opioid use, the population and outcome assessed, timing of outcome measurement and comparison groups. The purpose of this perspective is to highlight and interpret recent evidence to help improve the design of clinical trials and the efficacy of TENS in the clinical setting. HubMed – rehab