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[Purpose] To verify the effects of the differences in the post-learning period on the accuracy and self-efficacy of measuring the range of passive flexion of the knee and elbow of students. [Participants and Methods] Thirty-six physical therapy students were classified into three groups (short-term, medium-term, and long-term) based on the interval since learning to measure the range of motion. Participants were asked to self-evaluate their efficacy in appropriately measuring the range of motion for knee and elbow flexion using a 10-point Likert scale. Subsequently, the flexion range of the left knee and elbow was measured using a universal goniometer and compared to the measurements obtained using an electronic accelerometer. [Results] Absolute errors in measuring knee flexion were significantly smaller in the medium- and long-term groups than in the short-term group. No other significant main effects or correlations were observed. [Conclusion] Although the accuracy of measuring the range of motion by students improved while they were in school, it did not improve sufficiently based on the joint being assessed. Furthermore, the post-learning period did not affect a student's self-efficacy for measuring the range of motion and did not reflect its accuracy.

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The healthcare industry requires the integration of digital technologies, such as Artificial Intelligence (AI) and the Internet of Things (IoT), to their full potential, particularly during this challenging time and the recent outbreak of the COVID-19 pandemic, which resulted in the disruptions in healthcare delivery, service operations, and shortage of healthcare personnel. However, every opportunity has barriers and bumps, and when it comes to IoT healthcare, data privacy is one of the main growing issues. Despite the recent advances in the development of IoT healthcare architectures, most of them are invasive for the data subjects. In this context, the broad applications of AI in the IoT domain have also been hindered by emerging strict legal and ethical requirements to protect individual privacy. Camera-based solutions that monitor human subjects in everyday settings, e.g., for Online Range of Motion (ROM) detection, are making this problem even worse. One actively practiced branch of such solutions is telerehabilitation, which provides remote solutions for the physically impaired to regain their strength and get back to their normal daily routines. The process usually involves transmitting video/images from the patient performing rehabilitation exercises and applying Machine Learning (ML) techniques to extract meaningful information to help therapists devise further treatment plans. Thereby, real-time measurement and assessment of rehabilitation exercises in a reliable, accurate, and Privacy-Preserving manner is imperative. To address the privacy issue of existing solutions, this paper proposes a holistic Privacy-Preserving (PP) hierarchical IoT solution that simultaneously addresses the utilization of AI-driven IoT and the demands for data protection. Furthermore, the efficiency of the proposed architecture is demonstrated by a novel machine learning-based system that allows immediate assessment and extraction of ROM as the critical information for analyzing the progress of patients.

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Joint movements are the key factor for the mobility of the people during daily activities. The evaluation of the joint movements is determined by the range of motion (ROM) parameters. The ROM might change due to age, gender, and some diseases. Therefore, it is essential to measure ROM accurately and compare it with the normal values of the healthy people. In this study, a low-cost, wireless, and wearable electrogoniometer was designed for highly precise and accurate measurements. The stability of the measurements is guaranteed with the quaternion based Kalman filter. The measurements of the developed system are compared with the traditional goniometer. The concordance correlation coefficient is calculated as a similarity metric, and the result is obtained as 1. In addition, a GUI was prepared to present 3D visualization of the movements in real-time with the ROM measurements and give visual feedback to the physiotherapists during physical examinations and to the patient during the home therapy sessions. The measurements also can be recorded using the GUI for retrospective analysis.

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[Purpose] The aims of this study were to evaluate the type and extent of error in the measurement of range of motion and to evaluate the effect of evaluators' proficiency level on measurement error. [Subjects and Methods] The participants were 45 university students, in different years of their physical therapy education, and 21 physical therapists, with up to three years of clinical experience in a general hospital. Range of motion of right knee flexion was measured using a universal goniometer. An electrogoniometer attached to the right knee and hidden from the view of the participants was used as the criterion to evaluate error in measurement using the universal goniometer. The type and magnitude of error were evaluated using the Bland-Altman method. [Results] Measurements with the universal goniometer were not influenced by systematic bias. The extent of random error in measurement decreased as the level of proficiency and clinical experience increased. [Conclusion] Measurements of range of motion obtained using a universal goniometer are influenced by random errors, with the extent of error being a factor of proficiency. Therefore, increasing the amount of practice would be an effective strategy for improving the accuracy of range of motion measurements.

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Effectiveness of postural control techniques to compensate for oropharyngeal dysphagia have been recommended and used by several clinicians. However, the inter-rater reliability of these techniques is not well understood. The purpose of this study was to clarify the ambiguity of postural control techniques using statistical analyses. A total of 50 clinicians involved in dysphagia treatment participated in this study, where a healthy male served as the simulated patient. The following clinically used postures were measured by two investigators on two separate days: chin down, right/left incline, and right/left rotation. Postural angles were measured twice by two investigators on each day. Data obtained for the angle of each posture were visually displayed. Data from both investigators were assessed for each posture using the Youden plot, which analyzes data variability for systematic errors and accidental errors separately. The correlation coefficient for examining the measurement error between investigators was calculated. The results showed considerable variation between clinicians regarding the postures used, and significant differences were noted each day. The correlation coefficient for a total of four measurements was more often lower on Day 2 than that on Day 1. The details of the instructions provided by clinicians were not fixed, and the same specified posture was not reproduced even when instructions were provided to the same subject. These findings suggest poor inter-rater reliability because of the variability of selected postures when using statistical analyses. Therefore, standardized postures need to be developed that can be easily measured and reproduced.

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PURPOSE: This study examined the cervical spine range of motion (ROM) resulting from whiplash-type hyperextension and hyperflexion type ligamentous injuries, and sought to improve the accuracy of specific diagnosis of these injuries. METHODS: The study was accomplished by measurement of ROM throughout axial rotation, lateral bending, and flexion and extension, using a validated finite element model of the cervical spine that was modified to simulate hyperextension and/or hyperflexion injuries. RESULTS: It was found that the kinematic difference between hyperextension and hyperflexion injuries was minimal throughout the combined flexion and extension ROM measurement that is commonly used for clinical diagnosis of cervical ligamentous injury. However, the two injuries demonstrated substantially different ROM under axial rotation and lateral bending. CONCLUSIONS: It is recommended that other bending axes beyond flexion and extension are incorporated into clinical diagnosis of cervical ligamentous injury.

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BACKGROUND: Shoulder range of motion (ROM) and strength measurements are imperative in the clinical assessment of the patient's status and progression over time. The method and type of assessment varies among clinicians and institutions. No comprehensive study to date has examined the reliability of a variety of procedures based on different testing equipment and specific patient or shoulder position. The purpose of this study was to establish absolute and relative reliability for several procedures measuring the rotational shoulder ROM and strength into internal (IR) and external (ER) rotation strength. METHODS: Thirty healthy individuals (15 male, 15 female), with a mean age of 22.1 ± 1.4 years, were examined by 2 examiners who measured ROM with a goniometer and inclinometer and isometric strength with a hand-held dynamometer (HHD) in different patient and shoulder positions. Relative reliability was determined by intraclass correlation coefficients (ICC). Absolute reliability was quantified by standard error of measurement (SEM) and minimal detectable change (MDC). Systematic differences across trials or between testers, as well as differences among similar measurements under different testing circumstances, were analyzed with dependent t tests or repeated-measures analysis of variance in case of 2 or more than 2 conditions, respectively. RESULTS: Reliability was good to excellent for IR and ER ROM and isometric strength measurements, regardless of patient or shoulder position or equipment used (ICC, 0.85-0.99). For some of the measurements, systematic differences were found across trials or between testers. The patient's position and the equipment used resulted in different outcome measures. CONCLUSIONS: All procedures examined showed acceptable reliability for clinical use. However, patient position and equipment might influence the results.

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