Table Of Content. l '
CERVICAL SPINE MOTION DURING PATIENT TRANSFER ONTO A LONG SPINE
BOARD
LAURIE ANN MARIA AUGUSTIN
A THESIS SUBMITTED TO THE FACULTY OF GRADUATE STUDIES IN PARTIAL
FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF
MASTER OF SCIENCE
GRADUATE PROGRAM IN KINESIOLOGY AND HEALTH SCIENCE
YORK UNIVERSITY
TORONTO, ONTARIO
AUGUST2013
©LAURIE AUGUSTIN, 2013
Abstract
The initial management stages of a suspected spinal cord injury are crucial. Currently
there is a void in the literature with regards to the proper timing of neck realignment for prone
patient transfer methods. The purpose of this study was to determine if the timing of neck
realignment and/or the size of the victim will have an influence the amount of cervical spine
motion during the prone log roll technique. A team of five Athletic Therapists performed 18 log
rolls (9 on two trained "victims"), randomly correcting neck realignment AFTER and DURING
the roll as well as the timing of their choice, for both supine and prone conditions. Motion of the
cervical spine was collected using accelerometers and electromyography (EMG) was used to
collect muscle activity of neck stabilizers. Comparisons were made for range, additional motion,
theoretical minimal required motion and maximum EMG values. There were no significant
differences found for the timing of neck realignment for motion and muscle activation, but there
were significant differences found between male and female victims for both motion and muscle
activation. These findings will help enhance knowledge of transfer techniques as well as help
develop proper training techniques for primary stage management personnel.
ii
Dedication
I would like to dedicate this thesis to my family for supporting me through all of my
educational endeavours. I would especially like to thank my loving husband Matt and my son
Jakob, who have inspired me and encouraged me to strive for greatness.
iii
Acknowledgments
I would to start by thanking my advisor Dr. Janessa Drake for all of her guidance and enthusiasm
throughout this whole process. I would also like to thank my mentor Dr. Frances Flint for
helping me to realize my potential in the field of Athletic Therapy. Finally, I would like to
especially thank Graham Mayberry for putting up with my constant demands and keeping a
smile on his face the whole time I had the opportunity to work with him. It was an absolute
pleasure.
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Table of Contents
Abstract .................................................................................................................................. ii
Dedication ............................................................................................................................. iii
Acknowledgements ............................................................................................................... iv
Table of Contents ................................................................................................................... v
. fp· ...
List o 1gures ..................................................................................................................... v111
List of Tables ........................................................................................................................ xi
Abbreviations ...................................................................................................................... xiii
I. Scope of Thesis .................................................................................................................. I
I. I Research Questions ..................................................................................................... 2
1.2 Hypotheses .................................................................................................................. 3
2. Literature Review .............................................................................................................. 4
2.I Anatomy ...................................................................................................................... 4
2. I. I Vertebral Column ................................................................................................ 4
2. I .2 Soft Tissue of the Cervical Spine ........................................................................ 6
2. I .3 Spinal Canal and Spinal Cord ........................................................................... I 0
2. I .4 Anatomy Summary. ........................................................................................... I 1
2.2 Mechanisms and Classifications of Cervical Spine Injury ....................................... 12
2.2. I Axial Loading Injuries ....................................................................................... I 5
2.2.2 Hyperflexion and Hyperextension Injuries ....................................................... I 6
2.2.3 Lateral Flexion and Rotation Injuries ................................................................ I 7
2.2.4 Mechanisms and Classifications of Cervical Spine Injury Summary ............... I 8
2.3 Current Patient Transfer Methods ............................................................................. I 8
v
2.3 .1 Patient Transfer Methods Summary .................................................................. 23
2.4 Methodology Literature ............................................................................................ 24
2.4.1 Kinematics ......................................................................................................... 24
2.4.1.1 Optoelectric Motion Analysis Systems ..................................................... 24
2.4.1.2 Inertial Measurement Units ....................................................................... 25
2.4.1.3 Kinematics Summary ................................................................................ 27
2.4.2 Electromyography ............................................................................................. 27
2.4.2.1 Electromyography Summary ..................................................................... 31
3. Introduction ...................................................................................................................... 32
4 Methodology ..................................................................................................................... 34
4.1 Participants ........................................................................................................... 34
4.2 Instrumentation ..................................................................................................... 35
4.2.1Kinematics .................................................................................................... 35
4.2.2 Electromyography ........................................................................................ 3 7
4.3 Calibration ............................................................................................................ 38
4.3.1 Kinematics .................................................................................................... 38
4.3.2 Electromyography ........................................................................................ 34
4.4 Data Collection Procedures .................................................................................. 40
4.4.1 Pre-collection ................................................................................................ 40
4.4.2 Trials ............................................................................................................. 40
4.5 Data Processing .................................................................................................... 41
4.5.1 Kinematics ...................................................................................................... 41
4.5.2 Electromyography ............................................................................................. 41
vi
4.5.3 Statistical analysis ............................................................................................. 42
4.5.3.1 Kinematics .................................................................................................. 42
4.5.3.2 Electromyography ...................................................................................... 43
5 Results ............................................................................................................................... 44
5.1 General Results ..................................................................................................... 44
5.2 Specific Results ................................................................................................... 44
5.2.1 Kinematics .................................................................................................... 44
5.2.2 Electromyography ........................................................................................ 53
5.3 Reference postures ............................................................................................... 57
6. Discussion ........................................................................................................................ 61
6.1 Hypotheses revisited ............................................................................................. 61
6.2 Kinematics ............................................................................................................ 63
6.3 Electromyography ................................................................................................ 67
6.4 Reference Postures ............................................................................................... 68
7. Limitations ...................................................................................................................... 70
8. Knowledge Generated and Future Directions .................................................................. 72
9. Conclusion ....................................................................................................................... 74
10. References ...................................................................................................................... 75
Appendix A: Study Q & As ........................................................................................... lxxxxi
Appendix B: Permission to use Copyright Material from Arcturus Publishing ............ lxxxiv
Appendix C: Permission to use Copyright Material from Springer ............................. lxxxvii
Appendix D: Permission to use Copyright Material from Wolters Kluwer Health ........... xcii
Appendix E: Permission to use Copyright Material from XS ens ..................................... xcvi
vii
List of Figures
Figure 2.1.1.1: Typical characteristics of a cervical vertebra (From Gray, H.
(2008). Anatomy descriptive and surgical. (Second ed., p. 8). London,
England: Arcturus). Adapted with permission from Arcturus: [Anatomy
Descriptive and surgical] (See Appendix B), copyright (2008) ........................... 5
Figure 2.1.2.2: Lateral view ofligaments of the cervical spine up to C3 (From
Gray, H. (2008). Anatomy descriptive and surgical. (Second ed., p.
126). London, England: Arcturus). Adapted with permission from
Arcturus: [Anatomy Descriptive and surgical] (See Appendix B),
copyright (2008) .................................................................................................... 8
Figure 2.1.2.3: Musculature of the cervical spine (lateral view) (From Gray, H.
(2008). Anatomy descriptive and surgical. (Second ed., p. 180)~
London, England: Arcturus). Adapted with permission from Arcturus:
[Anatomy Descriptive and surgical] (See Appendix B), copyright
(2008) .................................................................................................................. 10
Figure 2.2.4: The buckling effect of the spine. A) The spine acts as a solid
column at 30° of flexion. B) and C) As axial compressive loads are
applied the spine begins to buckle resulting in injury (D and E) (From
Chao, S., Pacella, M. J., & Torg, J. S. (2010). Sports Medicine, 40(1),
viii
59-75, p. 61, Fig. 1). Adapted with permission from Springer: [Sports
Medicine] (See Appendix C), copyright (2010) .................................................. 14
Figure 2.3.5: The log roll manoeuver from a prone starting position. Top Starting
position for log roll. Middle Transition roll onto the spine board Bottom
Final supine position ........................................................................................... 21
Figure 2.3.6: The lift-and-slide technique (From Del Rossi, G., Horodyski, M.,
Heffernan, T. P., Powers, M. E., Siders, R., and Brunt, D. (2004). Spine,
29(7), E 134-8, E 135, Fig. 2). Adapted with permission from
Lippincott Williams and Wilkins/Wolters Kluwer Health: [Spine] (See
Appendix D), copyright (2004) .......................................................................... 22
Figure 4.2.1.7: XSens® System including the XBus Master (bottom right) and
MTxTM motion sensors (top) .............................................................................. 36
Figure 4.2.1.8: Sensor coordinate system for MTx™ sensors (Mti and Mtx User
Manual (2008), p. 8, Fig. I). Adapted with permission from XS ens
[MTx and Mti User Manual] (See Appendix E), copyright (2008) .................... 37
Figure 4.5.2.9: Photograph of the Biometrics Ltd. Datalog© system, includi02g
EMG sensors and ground electrode .................................................................... 42
ix
Figure 5.2.1.10: Example of kinematic motion {0 of the forehead over the trial
)
length (s) for the AFTER condition, female model ........................................... 48
Figure 5.2.1.11: Example of kinematic motion {0 of the forehead over the trial
)
length (s) for the DURING condition, female model.. ........................................ 49
Figure 5.2.1.12: Example of kinematic motion {0 of the forehead over the trial
)
length (s) for the DURING condition, female model.. ....................................... 49
Figure 5.2.2.13: Comparison of peak EMG amplitude (%MVC) across left and
right sternocleidomastoid, erector spinae and upper trapezius sensors of both
male and female model ...................................................................................... 54
Figure 5.2.2.14 Time to peak amplitude between male and female models by side
(%of total trial length) ....................................................................................... 55
Figure 5.3.15: Example of kinematic motion (0 (x axis) of the forehead sensor,
)
female model over time ( s) (y axis) for reference posture 2 (left lateral
rotation) ............................................................................................................... 60
x
Description:Figure 2.2.4 The buckling effect of the spine. A) The spine acts as a solid column at 30° of flexion. B) and C) As axial compressive loads are applied
