Medical and Biological Sciences XXVI/2 - Collegium Medicum ...

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30 Magdalena Hagner-Derengowska et. al. move patient’s limb in passive way without patients’ relaxation and confidence to the therapist [1,2,8]. But all objections mentioned above concern mainly problem with determination of accuracy of the testing and interrater reliability. In both cases problem with objective evaluation of true value of measured characteristic and possibility of its changes between the tests makes such research hard to perform. Focusing on intrarater repeatability and limiting number of test movement repetition authors hoped to avoid majority of threats mentioned above. What is the outcome of obtained results? However, it is important to clearly mark what the come of these results is. We know that a skilled, experienced therapist could test first muscle resistance in passive movement in very repeatable way – so he feels the mechanical resistance in almost the same muscle length in every trial. But we do not know if the result obtained by the therapist is the true result. This implicates that the therapist could use that kind of examination as a reference point in different therapeutic techniques, what gives him good repeatability of performing them. But obtained results could not prove that it is the best way to do them, as we do not know if the points that therapist feels is the right one. However, the good repeatability of performing therapeutic techniques gives strong basis for research which assesses clinical outcomes of therapy. The last application is using the manual test of muscle first mechanical resistance as a test performed during therapy session to assess immediate effect of performed treatment technique. Obtained results show that such manual testing of tissue resistance could be valuable for medical purposes, if joint spatial position or muscle length is measured and recorded in more traditional or sophisticated way. It was not a goal of this paper to evaluate therapist’s possibility to differentiation different joint position during manual testing. That would require tests including assessment of not only proprioceptive skills, but also capabilities of memory related to movement task. Because in this paper such examination was not performed, that, based on obtained results, could not be stated whether a therapist is or is not able to use such manual testing without additional equipment or not. CONCLUSIONS On the basis of obtained results following conclusions could be made: 1. Manual testing of muscle first mechanical resistance during passive movement is characterized by very high intrarater repeatability when performing by an experience of therapist. It makes this suitable for clinical use as a test and in treatment techniques as a reference point. 2. The high intrarater repeatability allows comparison of the obtained results between tests when another instrumentation is used for recording ankle position or muscle length. 3. In this paper the possibility of differentiation of two different positions was not assessed, so it is not known, based on described results, if a therapist is able to differentiate changes after therapy concerning position when first manual resistance occurs without additional equipment. 4. Accuracy of manual testing was not the subject of this work so it can not be assessed based on obtained results. However, research in that direction could be very interesting and valuable, although not easy. REFERENCES 1. Kaltenborn FM „Kręgosłup. Badanie manualne i mobilizacja.“ Wydawnictwo Rolewski, Toruń, 1998. 2. Lewit K „Terapia manualna w rehabilitacji chorób narządu ruchu” III wyd. ZL Natura, 2001 3. Maitland G.D “Vertebral Manipulation” 6th Edition, Butterworths, London 2001 4. Lisowski J, Hagner W “Terapeutyczna moc rozciągania mięśni. Ćwiczenia w procesie autoterapii I profilaktyki najczęstszych dolegliwości I dysfunkcji narządu ruchu” Remedium, Włocławek 2005 5. Cyriax JH., Cyriax PJ “Cyriax’s Illustrated Manual of Orthopaedic Medicine” Butterworth-Heinemann Ltd, Oxford 1993. 6. Magee DJ .Orthopedic Physical Assessment. Wyd IV. Pennsylvania, Philadelphia: Elsevier Sciences; 2002. 7. Kaltenborn FM „Manualne mobilizacje stawów kończyn.“ Wydawnictwo Rolewski, Toruń, 1996 8. Myers WT "Anatomy Trains" I ed. Churchill Livingstone, 2001 9. Kase K, Wallis J, Kase T "Clinical therapeutic applications of the Kinesiotaping Method", KinesioTaping Association, 2003. 10. Rakowski A “Kręgosłup w stresie. Jak pokonać ból i jego przyczyny” III wyd, Gdańskie Wydawnictwo Psychologiczne, Gdańsk 2001.
Intrarater repeatability of manual testing of first muscle movement resistance 31 11. Kaltenborn FM, Kaltenborn TB, Vollowitz E “Manual Mobilization of the Joints, Vol.III. Traction- Manipulation of the Extremities and Spine: Basic Thrust Techniques” Norli, 2008. 12. Triano JJ (2001) Biomechanics of spinal manipulative therapy, The Spinal Journal vol. 1, Pp.121-130. 13. Błaszczyk JW „Biomechanika Kliniczna” Wydawnictwo Lekarskie PZWL; Warszawa 2004. 14. Bober T, Zawadzki J „Biomechanika układu ruchu człowieka” Wyd. 2. Wydawnictwo BK, Wrocław 2003 15. Dylewski M, Rzepka R (2009) “Możliwości obiektywnej oceny postawy ciała z wykorzystaniem czynnych i biernych markerów.” W: Nowotny J. (red.): Wady postawy ciała u dzieci i młodzieży. Wydawnictwo Wyższej Szkoły Administracji w Bielsku-Białej, Bielsko- Biała, 75-84. 16. Chateau H, Girard D, Degueurce C, Denoix J-M (2003) „Methodological considerations for using a kinematic analysis system based on ultrasonic triangulation” ITBM- RBM Volume 24, Issue 2, Pages 69-78. 17. “WinData 2x for Windows. Operating instructions” ZEBRIS MEDICAL Gmbh Isny im Allgau, 2006. 18. Będziński R „Biomechanika Inżynierska. Zagadnienia wybrane” Oficyna Wydawnicza Politechniki Wrocławskiej, Wrocław 1997. 19. Brumagne S, Cordo P, Lysens S, Verschueren S, Swinnen S. (2000) The role of paraspinal muscle spindles in lumbosacral position sense in individuals with and without low back pain. Spine;25(8):989-94. 20. Cholewicki J, van Diee¨n JH, Arsenault AB (2003) Muscle function and dysfunction in the spine. J Electromyogr Kinesiol 13:303-304. Address for correspondence: doc. dr hab. Magdalena Hagner-Derengowska Katedra i Klinika Rehabilitacji UMK w Toruniu Collegium Medicum im. L. Rydygiera ul. M. Curie Skłodowskiej 9 85-094 Bydgoszcz Received: 15.11.2011 Accepted for publication: 14.02.2012
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