Fig 8 - uploaded by Andrew Busch
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Arm lifting test. A. Optimal pattern. Ribcage in neutral position, thoracolumbar junction stable, symmetrical expansion of abdominal wall. B. Pathological stereotype. Chest elevation, thoracolumbar instability, hyperlordosis of the lumbar spine.
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BACKGROUND: The evaluation of postural trunk muscle function is a critical component of clinical assessment in patients with musculoskeletal pain and dysfunction. Postural activation of the trunk muscles has been evaluated by various methods. This study evaluates the correlation between subjective assessment of postural trunk muscle function with a...
Context in source publication
Context 1
... lift up right leg (approximately 10 to 20 cm) above the ground. Participant breathed naturally while maintaining this position. The activity of the latero-dorsal sections of abdominal wall was assessed bilaterally by palpation (as in diaphragm test). Then, any spinal and pelvic movements were assessed by visual inspection. 5. Arm lifting test. (Fig. 8) The participant lifted a dumbbell that corresponded to 20% of the body weight. Elbows were flexed to 90 • and participant breathed naturally in this position. The assessor palpated bilaterally the abdominal wall activation first in trigonum lumbale, then above the groin. Spinal or pelvic movements were assessed visually.) All DNS tests ...
Citations
... The DNS diaphragm test and its variation, the intra-abdominal pressure regulation test (IAPRT) (Kobesova et al., 2020a) assess an individual's capability to voluntarily activate the diaphragm in coordination with abdominal wall. The reliability of DNS tests was previously studied by Jacisko et al. (2021) on a cohort of 25 asymptomatic individuals reporting moderate reliability both in palpation and observation measures for the diaphragm test and IAPRT when performed by certified DNS instructors. The primary outcome of this study was intended to determine the inter-rater reliability of the diaphragm test and IAPRT between physiotherapists, one DNS-trained (experienced) and the other with minimal training in the DNS testing procedures (novice), among non-specific low back pain (LBP) and neck pain participants. ...
... At the time of this writing, very few studies have evaluated the reliability of DNS tests. Jacisko et al. (2021) investigated the correlation between clinical DNS postural examinations and instrumental examination. The patient was examined by two experienced therapists (licensed DNS instructors) performing five DNS functional tests and by the DNS Brace device. ...
... The DNS diaphragm test and its variation, the intra-abdominal pressure regulation test (IAPRT) (Kobesova et al., 2020a) assess an individual's capability to voluntarily activate the diaphragm in coordination with abdominal wall. The reliability of DNS tests was previously studied by Jacisko et al. (2021) on a cohort of 25 asymptomatic individuals reporting moderate reliability both in palpation and observation measures for the diaphragm test and IAPRT when performed by certified DNS instructors. The primary outcome of this study was intended to determine the inter-rater reliability of the diaphragm test and IAPRT between physiotherapists, one DNS-trained (experienced) and the other with minimal training in the DNS testing procedures (novice), among non-specific low back pain (LBP) and neck pain participants. ...
... At the time of this writing, very few studies have evaluated the reliability of DNS tests. Jacisko et al. (2021) investigated the correlation between clinical DNS postural examinations and instrumental examination. The patient was examined by two experienced therapists (licensed DNS instructors) performing five DNS functional tests and by the DNS Brace device. ...
... In our current research, the experienced therapist was trained by DNS expert instructors and the novice was trained by experienced, non-expert DNS clinicians. Therefore, we presume that reliability might further improve if the tests were conducted by two therapists who were trained by DNS expert instructors, or perhaps by the instructors themselves as indicated by Jacisko et al. (2021). The work of Cha et al. (2017) monitored the reliability of the "DNS heel sliding test". ...
Background: The Dynamic Neuromuscular Stabilization (DNS) diaphragm test and intra-abdominal pressure regulation test (IAPRT) are qualitative clinical tests that assess postural stability provided by the diaphragm. Objective: Evaluate the inter-rater reliability of the diaphragm test and IAPRT between an experienced and novice DNS clinician among individuals with non-specific low back pain (LBP) and neck pain. Methods: Forty-five participants with non-specific LBP and/or neck pain were assessed by an experienced and novice DNS physiotherapist in the diaphragm test and IAPRT, and scored on a visual analog scale (VAS) according to five different criteria. Results: Moderate reliability was noted when assessing LBP and neck pain patients in the diaphragm test and IAPRT (p < 0.001). Moderate reliability also existed when assessing only LBP (p < 0.001) or neck pain (p = 0.002, p = 0.009) independently. Patients with lower pain (NPRS score of 5 or <) demonstrated lower intra-class correlation coefficients, yet still moderate reliability in the diaphragm test (p = 0.004) and IAPRT (p = 0.001). Patients with higher pain (NPRS score of 6 or >) demonstrated greater intra-class correlation coefficients, with the diaphragm test resulting in good reliability (p < 0.001). Conclusions: The diaphragm test and IAPRT demonstrate moderate reliability between an experienced and novice DNS clinician when evaluating LBP and neck pain patients, with a greater degree of reliability noted in patients suffering from higher reported pain.
... Posuzování segmentů těla je v porovnání s přístrojovým měřením nepřesné, což se potvrdilo ve screeningu statických pozic i pohybů (Falk et al., 2021;Whelan et al., 2019). Významné rozdíly ve screeningu také mezi experty na DNS a přístrojovým měřením uvádí Jacisko et al. (2021). U jednoho experta byla korelace r=0,303-0,580, u druhého byl silný vztah zjištěn pouze ve dvou z pěti případů. ...
... It has recently been shown that IAP can be predicted from AWT through the use of a capaciative force sensor (Novak et al., 2021a,b). Since IAP correlates with the AWT (Jacisko et al., 2021;Novak et al., 2021a,b), it is possible to understand changes in IAP indirectly by monitoring AWT using capacitive force sensors. For such purposes, devices called the DNS Brace (Jacisko et al., 2021;Novak et al., 2021a,b) and Ohmbelt (Novak et al., 2021a,b) have been used. ...
... Since IAP correlates with the AWT (Jacisko et al., 2021;Novak et al., 2021a,b), it is possible to understand changes in IAP indirectly by monitoring AWT using capacitive force sensors. For such purposes, devices called the DNS Brace (Jacisko et al., 2021;Novak et al., 2021a,b) and Ohmbelt (Novak et al., 2021a,b) have been used. ...
... Activation of the abdominal wall and the amount of IAP is posture and task specific (Arjmand and Shirazi-Adl, 2006;Jacisko et al., 2021;Novak et al., 2021Novak et al., , 2021Novak et al., , 2021. Therefore in attempt to further understand the impact of different postural positions on AWT (and subsequent regulation of IAP), this study investigated which positions exhibit the greatest effect on AWT, and determine if AWT can be increased with the instruction according to Dynamic Neuromuscular Stabilization (DNS) principles (Kobesova et al., 2016(Kobesova et al., , 2020. ...
Background
Intra-abdominal pressure (IAP) is an important mechanism stabilizing the spine and trunk. IAP regulation depends on the coordination of abdominal muscles, diaphragm and pelvic floor muscles.
Objective
To determine the differences in abdominal wall tension (AWT) of various postural positions, first without any correction, then after verbal and manual instructions according to Dynamic Neuromuscular Stabilization (DNS) principles.
Methods
In a cross-sectional observational study, thirty healthy individuals (mean age = 22.73 ± 1.91 years) were fitted with two Ohmbelt sensors contralaterally above the inguinal ligament and in the upper lumbar triangle. AWT was measured during five postural positions: sitting, supine with legs raised, squat, bear and hang position. First, spontaneous AWT was measured, then again after manual and verbal instructions following DNS principles.
Results
AWT increased significantly with DNS instructions compared to spontaneous activation. Both sensors recorded significant increases (p < 0.01; Cohen's d = −1.13 to −2.06) in all observed postural situations. The increase in activity occurred simultaneously on both sensors, with no significant differences noted in pressure increases between the sensors. The greatest activation for both sensors occurred in the bear position. Significant increases in activity were identified for both sensors in the supine leg raise position and in the bear position compared to spontaneous activation in sitting (p < .001). There were no statistically significant differences (for both sensors) between women and men in any position.
Conclusion
The amount of AWT significantly increases after verbal and manual instructions according to DNS. The greatest abdominal wall activation was achieved in the bear position.
... As the abdominal wall expands, the IAP increases, which is monitored through the pressure sensor and the pressure value is transmitted via a tube to the digital sensor. The brace sensors measure the pressure exerted by the abdominal wall in kilopascals (kPa) and transfer the data via Bluetooth to a smart-phone or computer so the data can be statistically processed and graphically displayed (52). ...
... Clinicians use their fingers to palpate the quality and symmetry of abdominal wall during client's activation. Further description of clinical tests can be found elsewhere (52,54,55). ...
... Clinical examination consisted of three tests according to DNS examination protocol, i.e. resting breathing, loaded breathing and the diaphragm test (52,54). All three tests showed that the patient was not able to sufficiently activate the dorsolateral parts of the abdominal wall, lacked lateral expansion of the lower part of the thorax, there was cranial migration of the ribs and the thoracic spine became kyphotic during DNS testing. ...
Intra-abdominal pressure is a hydraulic pressure within the abdominal cavity. Previous studies confirmed its direct association with both spinal stability and spinal unloading. The literature review part of the paper summarizes intra-abdominal pressure physiology and pathophysiology and explains the underlying mechanisms of Intra-abdominal pressure regulation and its effects on the human body, especially spinal stability. Current methods of invasive and non-invasive intra-abdominal pressure measurement are described in detail. Second part of a paper presents a case report of a competitive athlete suffering from low back pain. The functional assessment and treatment focused on quality of patient’s trunk stabilization. Training following principles of Dynamic Neuromuscular Stabilization resulted in better ability to activate abdominal wall muscles which is a critical mechanism of Intra-abdominal pressure regulation and in this case caused significant low back pain reduction. The effect of the therapy was evaluated by DNS Brace which measures activity of the abdominal wall, thus Intra-abdominal pressure indirectly, along with clinical Dynamic Neuromuscular Stabilization assessment tests.
https://doi.org/10.24040/sjss.2021.7.2.3-18
... The values recorded in kilopascals (kPa) are transferred via Bluetooth, stored and graphically displayed in a smart-phone device. More details about the brace can be found elsewhere (Jacisko et al., 2020). The brace sensors measure the pressure exerted by the abdominal wall in kilopascals (kPa) (Figs. 2. B,3. ...
Background: The abdominal muscles play an important respiratory and stabilization role, and in coordination
with other muscles regulate the intra-abdominal pressure stabilizing the spine. The evaluation of postural trunk
muscle function is critical in clinical assessments of patients with musculoskeletal pain and dysfunction. This
study evaluates the relationship between intra-abdominal pressure measured as anorectal pressure with objective
abdominal wall tension recorded by mechanical-pneumatic-electronic sensors.
Methods: In a cross-sectional observational study, thirty-one asymptomatic participants (mean age = 26.77 ±
3.01 years) underwent testing to measure intra-abdominal pressure via anorectal manometry, along with
abdominal wall tension measured by sensors attached to a trunk brace (DNS Brace). They were evaluated in five
different standing postural-respiratory situations: resting breathing, Valsalva maneuver, Müller’s maneuver,
instructed breathing, loaded breathing when holding a dumbbell.
Findings: Strong correlations were demonstrated between anorectal manometry and DNS Brace measurements in
all scenarios; and DNS Brace values significantly predicted intra-abdominal pressure values for all scenarios:
resting breathing (r = 0.735, r2 = 0.541, p < 0.001), Valsalva maneuver (r = 0.836, r2 = 0.699, p < 0.001),
Müller’s maneuver (r = 0.651, r2 = 0.423, p < 0.001), instructed breathing (r = 0.708, r2 = 0.501, p < 0.001),
and loaded breathing (r = 0.921, r2 = 0.848, p < 0.001).
Interpretation: Intra-abdominal pressure is strongly correlated with, and predicted by abdominal wall tension
monitored above the inguinal ligament and in the area of superior trigonum lumbale. This study demonstrates
that intra-abdominal pressure can be evaluated indirectly by monitoring the abdominal wall tension.
Coronary rotational atherectomy (CRA) is a kind of percutaneous coronary intervention, which removes calcified tissue through the grinding tool at high speed. But excessive grinding force during CRA is prone to occurrence of complications. For this purpose, based on PVDF film, a pressure sensor integrated into grinding tool was fabricated, which can measure grinding force in real time. In operation, there is a deformation in PVDF sensor when collides with vascular/ calcified tissue, and feedback the charge signals. A fabricated model was used to test the sensor, which shows that the sensitivity of sensor reaches 1049mV/N, and the response and recovery time are 2.240ms and 1.320ms respectively. The experimental results show that the sensor could accurately distinguish whether the tool collide with vessels/ calcified tissue and measure real-time grinding force. The fabricated sensor has great significance in reducing the complications caused by excessive grinding force.
Objectives:
The diaphragm changes position and respiratory excursions during postural loading. However, it is unclear how it reacts to lifting a load while breath-holding or breathing with simultaneous voluntary contraction of the abdominal muscles (VCAM). This study analyzed diaphragm motion in healthy individuals during various postural-respiratory situations.
Methods:
31 healthy participants underwent examination of the diaphragm using M-mode ultrasonography, spirometry, and abdominal wall tension (AWT) measurements. All recordings were performed simultaneously during three consecutive scenarios, i.e., 1. Lifting a load without breathing; 2. Lifting a load and breathing naturally; 3. Lifting a load and breathing with simultaneous VCAM.
Results:
Using paired-samples t-tests, lifting a load without breathing displaced the diaphragm's expiratory position more caudally (P < .001), with no change noted in the inspiratory position (P = .373). During lifting a load breathing naturally, caudal displacement of the diaphragm's inspiratory position was presented (P < .001), with no change noted in the expiratory position (P = 0.20) compared to tidal breathing. Total diaphragm excursion was greater when loaded (P = .002). Lifting a load and breathing with VCAM demonstrated no significant changes in diaphragm position for inspiration, expiration, or total excursion compared to natural loaded breathing. For all scenarios, AWT measures were greater when lifting a load (P < .001).
Conclusion:
In healthy individuals, caudal displacement and greater excursions of the diaphragm occurred when lifting a load. The postural function of the diaphragm is independent of its respiratory activity and is not reduced by the increase in AWT.
