Medicine in motion Laboratory

Overview
The evolution and development of human species is relying upon motion thus, an understanding of the human body in health and disease requires the appreciation of the mechanisms which are essential for movement. Due to the complexity of the human body, these mechanisms involve among others, the use of energy systems, musculoskeletal mechanics and physiology. What is interesting though, is that in order to provide the means for enhancing those mechanisms, motion must also be present. However, one of the most important challenges faced globally today is the rise in inactivity levels, despite all the health benefits associated with it. The benefits of motion are scientifically proven and widely linked with disease prevention, treatment and improved function, therefore the link between medicine and motion is multifaced. A deep understanding of human motion provides the means for a better appreciation of medicine, as specialist knowledge can be applied or prescribed for the treatment of patients. Behavioral factors such as sedentary lifestyle can impact upon health and all-cause mortality across the age spectrum. There are scientific evidence of the benefits of physical activity in children as their bone health and weight is improved, in addition to their cognitive function. In adults, the evidence are also apparent. Health disorders such cardiometabolic conditions, cancer, brain health and weight status can be prevented, improved or maintained, while in older adults’ physical function can be improved and the risk of falls can be reduced. In addition, medicine can also be directly related to movement, as application of interventions or diagnostics aiming to treat or manage specific conditions, which have a direct impact upon human motion, can bring about changes in the quality of life. People suffering from chronic diseases, such as arthritis or multiple sclerosis can benefit by the combined knowledge and application of medicine and motion through the application of interventions directly aiming to target specific movement patterns, or improve daily living. This can be apparent as pain can be managed and gait patterns can be enhanced. For medicine in motion laboratory, the aim is to link movement with medicine by focusing on the prevention and improvement of medical conditions, while aiming to innovate on the improvement of daily living and health promotion via motion.

Clinical Biomechanics

Clinical biomechanics bridges the gap between biomechanical principles in the clinical context. Injuries in the musculoskeletal system or pathological conditions, such as osteoporosis or arthritis, may impose changes on the mechanics of the human body which could lead to degradation, instability or disability of movement (Lu and Chang, 2012). Through the knowledge, understanding and appreciation of the mechanics of human body, the underlying causes of clinical conditions can be identified, and treatment plans can be established in order to elucidate the causes of dysfunction and improve daily living. In addition, recommendations and corrective adjustments can be made on patterns affecting movement, and treatment plans can be established to improve motion. Advances in the application of clinical biomechanics, such as gait analysis and postural control has been shown to predict the development of certain conditions, as dementia and Alzheimer’s, years before the clinical diagnosis. Thus, knowledge in the field becomes essential in order to gain a deeper understanding of the role of biomechanics in acute and chronic conditions.

Key areas: Clinical interventions on gait, posture and balance, neurological conditions and clinical biomechanics, diabetic foot, sport biomechanics and injuries, gait dysfunction, mechanical principles for the management of pathology of human movement, mechanics of muscle, tendon and bone, clinical movement analysis.

Footwear Biomechanics

The evolvement of humans begun through barefoot walking however, the use of footwear is nowadays a necessity for most. The advancement of footwear structure and function has been shown to provide therapeutic, orthopedic benefits and functional improvement in patients and athletes. Multinational cooperation’s continuously invest in research and innovation of new footwear which can treat disorders, boost performance, decrease fatigue, correct posture or prevent damage to the feet. In addition, new technological improvements may allow even further innovation on footwear. Currently, there is ongoing research aiming to implement smart technology in footwear such as pressure sensors to provide detection of body weight distribution throughout gait cycle to the detection of falls, or the assistance of footwear to visually impaired people. Thus, footwear biomechanics can provide all the necessary knowledge of the lower limbs in terms of mechanics, anatomy and pathophysiology specifically aimed in the application of footwear.

Key areas: Therapeutic footwear, Athletic footwear, Orthotics, interventions on footwear biomechanics, computer modelling of foot related pathologies for the enhancement of clinical pathologies, influence of footwear on human movement, influence of footwear on performance, the role of footwear in the prevention and treatment of clinical conditions.

Podology

Podology is a field aiming to explore the study and care of the foot. The objective of a podologist is to relieve pain and treat foot related infections. This includes assessment, diagnosis and treatment of issues associated with feet such as deformities, injuries and fractures. Furthermore, podologists have an extended understanding of foot related complications such as athlete’s foot, fungal nail infections, ingrown toenails, calluses, verrucas, blisters, gout and dry or cracked heels. Knowledge of podology requires an understanding of clinical science, anatomy, biomechanics and dermatology. The application of knowledge can improve the mobility of lower extremities and performance.
Key Areas: Diabetic foot, footcare, podology and long-term conditions, treatment of foot related complications
Clinical exercise physiology
The beneficial effects of exercise in the prevention and treatment of clinical conditions has been widely documented. Exercise has a positive impact and can improve overall health and fitness, while it can also reduce the onset of chronic conditions, such as cardiovascular, neuromuscular and metabolic diseases. As an example, it has been shown that participation in physical activity has a strong association with reduced recurrence and mortality among breast cancer patients (Cannioto et al., 2020) while 1 f the 5 major risk factors for cardiovascular disease is sedentary lifestyle (Myers, 2020). In addition, knowledge of exercise physiology can be applied in the clinical setting and used for health assessment, treatment or management of mental and health-related conditions, which can be achieved thought the design and prescription of exercise interventions and training plans.

Key areas: Exercise prescription, exercise and mental health, neurological conditions and exercise prescription, cardiopulmonary conditions and exercise prescription, strategies to improve health through exercise, applied clinical exercise physiology

Nutritional science

Humans are in constant need for energy, in order to be able to perform essential metabolic functions and maintain active. As nutrition provides energy though the consumption of carbohydrates, fats, proteins as well as other organic compounds, its role becomes essential in health, disease and performance. The metabolic demands for nutritional needs and requirements vary between populations. As an example, athletes of specific sports require specific diet to maintain or enhance their performance levels, while people suffering from pathological conditions may also need to adapt their dietary habits. Furthermore, the global pandemic of obesity is currently affecting over 300 million adults according to World Health Organization (WHO, 2020), which demonstrates the need for immediate actions to be taken.

Key areas: Clinical nutrition, obesity, exercise nutrition, physiology and nutrition, nutrition in the prevention of disease.

Occupational Therapy

Occupational therapy aims to promote health and wellness by providing the means to engage in daily activities which are necessary for daily living. In addition, occupational therapy provides independence in engaging in occupations. As such, occupational therapists work with patients across the range of the population, such as children with special needs, elderly, people suffering from dementia and rehabilitation after surgeries or stroke. The occupational therapists can also provide the means to improve health on multiple levels including physical, cognitive and sensory issues aiming patients to regain independence in all aspects of their life and daily living. This includes self-care, ability to be actively involved in work or education, engagement in playing and leisure activities, social participation, maximising functionality and independence. Due to the above, occupational therapists have a range of knowledge in the areas of anatomy, mental health, learning disabilities, physiology, psychology and sociology.

Key areas: Dementia prevention and care, rehabilitation after stroke, management of arthritis, geriatric management, interventions for children in the autistic spectrum, Parkinson’s disease, movement therapy for children and adults, management of children with disabilities, chronic pain management, improved quality of life for older adults, improvement of fine and gross motor skills in children.

Selected bibliography
– Baltadjieva, R., Giladi, N., Gruendlinger, L., Peretz, C. & Hausdorff, J. M. Marked alterations in the gait timing and rhythmicity of patients with de novo Parkinson’s disease. European Journal of Neuroscience 24, 1815–1820 (2006).

– Baydal-Bertomeu, J., Puigcerver, S., Arroyo-Gómez, N., González, J., Gomez, J., Perez-Fernandez, M. and Sempere-Tortosa, J., 2015. New methodology based on PCA to analyse different pressure contact treads. Footwear Science, 7(sup1), pp.S70-S72.

– Cannioto, R., Hutson, A., Dighe, S., McCann, W., McCann, S., Zirpoli, G., Barlow, W., Kelly, K., DeNysschen, C., Hershman, D., Unger, J., Moore, H., Stewart, J., Isaacs, C., Hobday, T., Salim, M., Hortobagyi, G., Gralow, J., Albain, K., Budd, G. and Ambrosone, C., 2020. Physical Activity Before, During, and After Chemotherapy for High-Risk Breast Cancer: Relationships With Survival. JNCI: Journal of the National Cancer Institute,

– Cunningham, C., O’ Sullivan, R., Caserotti, P. and Tully, M., 2020. Consequences of physical inactivity in older adults: A systematic review of reviews and meta‐analyses. Scandinavian Journal of Medicine & Science in Sports, 30(5), pp.816-827.

– Giladi, N., Horak, F. B. & Hausdorff, J. M. Classification of gait disturbances: Distinguishing between continuous and episodic changes. Movement Disorders 28, 1469–1473 (2013).

– Horst, F., Lapuschkin, S., Samek, W., Müller, K. and Schöllhorn, W., 2019. Explaining the unique nature of individual gait patterns with deep learning. Scientific Reports, 9(1).

– Lippi, G. and Sanchis-Gomar, F., 2020. An Estimation of the Worldwide Epidemiologic Burden of Physical Inactivity-Related Ischemic Heart Disease. Cardiovascular Drugs and Therapy, 34(1), pp.133-137.

– Lu, T. and Chang, C., 2012. Biomechanics of human movement and its clinical applications. The Kaohsiung Journal of Medical Sciences, 28(2), pp.S13-S25.

– Myers, J., 2020. Exercise And Cardiovascular Health. Circularion. 107(1), pp. e2-e5

– McKay, M. J. et al. 1000 norms project: Protocol of a cross-sectional study cataloging human variation. Physiotherapy 102, 50–56 (2016).

– Montanini, L., Del Campo, A., Perla, D., Spinsante, S. and Gambi, E., 2018. A Footwear-Based Methodology for Fall Detection. IEEE Sensors Journal, 18(3), pp.1233-1242.

– Sallis, R., 2008. Exercise is medicine and physicians need to prescribe it!. British Journal of Sports Medicine, 43(1), pp.3-4.

– Verghese, J. et al. Abnormality of gait as a predictor of non-Alzheimer’s dementia. New England Journal of Medicine 347, 1761–1768 (2002).

– Who.int. 2020. WHO | Controlling The Global Obesity Epidemic. [online] Available at: <https://www.who.int/nutrition/topics/obesity/en/> [Accessed 28 October 2020].

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