An Integer Programming Model for Optimizing Shoulder Rehabilitation

Strength restoration is one goal of shoulder rehabilitation following rotator cuff repair surgery. However, the time spent in a physical rehabilitation setting is limited. The objective of this study was to develop a novel mathematical formulation for determining the optimal shoulder rehabilitation...

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Published in:	Annals of biomedical engineering Vol. 36; no. 7; pp. 1242 - 1253
Main Authors:	Gatti, Christopher J., Scibek, Jason, Svintsitski, Oleg, Carpenter, James E., Hughes, Richard E.
Format:	Journal Article
Language:	English
Published:	Boston Springer US 01.07.2008 Springer Nature B.V
Subjects:	Biochemistry Biological and Medical Physics Biomedical and Life Sciences Biomedical Engineering and Bioengineering Biomedicine Biophysics Classical Mechanics Computer Simulation Exercise Therapy - methods Humans Models, Biological Objective function Physical Fitness Rotator Cuff - physiopathology Rotator Cuff Injuries Tendon Injuries - physiopathology Tendon Injuries - rehabilitation Therapy, Computer-Assisted - methods Treatment Outcome Integer programming Computer model Rehabilitation Shoulder Optimization
ISSN:	0090-6964, 1573-9686, 1573-9686, 1521-6047
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Abstract	Strength restoration is one goal of shoulder rehabilitation following rotator cuff repair surgery. However, the time spent in a physical rehabilitation setting is limited. The objective of this study was to develop a novel mathematical formulation for determining the optimal shoulder rehabilitation exercise protocol to restore normal shoulder strength given a time-constrained rehabilitation session. Strength gain was modeled using a linear dose–response function and biomechanical parameters of the shoulder musculature. Two different objective functions were tested: (1) one based on a least squares support vector machine using healthy and pathologic shoulder strengths (normative objective function), and (2) one which seeks to match the strength of the contralateral shoulder (contralateral objective function). The normative objective function was subject-independent and the optimal protocol consisted of four sets each of adduction and external rotation. The contralateral objective function was subject-specific and the typical optimal protocol consisted of various set combinations of abduction and internal and external rotation. These results are only partially consistent with current practice. Improvement of the current model is dependent on a better understanding of strength training adaptation and shoulder rehabilitation.
AbstractList	Strength restoration is one goal of shoulder rehabilitation following rotator cuff repair surgery. However, the time spent in a physical rehabilitation setting is limited. The objective of this study was to develop a novel mathematical formulation for determining the optimal shoulder rehabilitation exercise protocol to restore normal shoulder strength given a time-constrained rehabilitation session. Strength gain was modeled using a linear dose-response function and biomechanical parameters of the shoulder musculature. Two different objective functions were tested: (1) one based on a least squares support vector machine using healthy and pathologic shoulder strengths (normative objective function), and (2) one which seeks to match the strength of the contralateral shoulder (contralateral objective function). The normative objective function was subject-independent and the optimal protocol consisted of four sets each of adduction and external rotation. The contralateral objective function was subject-specific and the typical optimal protocol consisted of various set combinations of abduction and internal and external rotation. These results are only partially consistent with current practice. Improvement of the current model is dependent on a better understanding of strength training adaptation and shoulder rehabilitation. Strength restoration is one goal of shoulder rehabilitation following rotator cuff repair surgery. However, the time spent in a physical rehabilitation setting is limited. The objective of this study was to develop a novel mathematical formulation for determining the optimal shoulder rehabilitation exercise protocol to restore normal shoulder strength given a time-constrained rehabilitation session. Strength gain was modeled using a linear dose-response function and biomechanical parameters of the shoulder musculature. Two different objective functions were tested: (1) one based on a least squares support vector machine using healthy and pathologic shoulder strengths (normative objective function), and (2) one which seeks to match the strength of the contralateral shoulder (contralateral objective function). The normative objective function was subject-independent and the optimal protocol consisted of four sets each of adduction and external rotation. The contralateral objective function was subject-specific and the typical optimal protocol consisted of various set combinations of abduction and internal and external rotation. These results are only partially consistent with current practice. Improvement of the current model is dependent on a better understanding of strength training adaptation and shoulder rehabilitation.Strength restoration is one goal of shoulder rehabilitation following rotator cuff repair surgery. However, the time spent in a physical rehabilitation setting is limited. The objective of this study was to develop a novel mathematical formulation for determining the optimal shoulder rehabilitation exercise protocol to restore normal shoulder strength given a time-constrained rehabilitation session. Strength gain was modeled using a linear dose-response function and biomechanical parameters of the shoulder musculature. Two different objective functions were tested: (1) one based on a least squares support vector machine using healthy and pathologic shoulder strengths (normative objective function), and (2) one which seeks to match the strength of the contralateral shoulder (contralateral objective function). The normative objective function was subject-independent and the optimal protocol consisted of four sets each of adduction and external rotation. The contralateral objective function was subject-specific and the typical optimal protocol consisted of various set combinations of abduction and internal and external rotation. These results are only partially consistent with current practice. Improvement of the current model is dependent on a better understanding of strength training adaptation and shoulder rehabilitation.
Author	Gatti, Christopher J. Svintsitski, Oleg Scibek, Jason Hughes, Richard E. Carpenter, James E.
AuthorAffiliation	1 Laboratory for Optimization and Computation in Orthopaedic Surgery, University of Michigan, Ann Arbor, MI 48109-2200, USA 2 Department of Athletic Training, Duquesne University, Pittsburgh, PA 15282, USA
AuthorAffiliation_xml	– name: 1 Laboratory for Optimization and Computation in Orthopaedic Surgery, University of Michigan, Ann Arbor, MI 48109-2200, USA – name: 2 Department of Athletic Training, Duquesne University, Pittsburgh, PA 15282, USA
Author_xml	– sequence: 1 givenname: Christopher J. surname: Gatti fullname: Gatti, Christopher J. organization: Laboratory for Optimization and Computation in Orthopaedic Surgery, University of Michigan – sequence: 2 givenname: Jason surname: Scibek fullname: Scibek, Jason organization: Department of Athletic Training, Duquesne University – sequence: 3 givenname: Oleg surname: Svintsitski fullname: Svintsitski, Oleg organization: Laboratory for Optimization and Computation in Orthopaedic Surgery, University of Michigan – sequence: 4 givenname: James E. surname: Carpenter fullname: Carpenter, James E. organization: Laboratory for Optimization and Computation in Orthopaedic Surgery, University of Michigan – sequence: 5 givenname: Richard E. surname: Hughes fullname: Hughes, Richard E. email: rehughes@umich.edu organization: Laboratory for Optimization and Computation in Orthopaedic Surgery, University of Michigan
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Snippet	Strength restoration is one goal of shoulder rehabilitation following rotator cuff repair surgery. However, the time spent in a physical rehabilitation setting...
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SubjectTerms	Biochemistry Biological and Medical Physics Biomedical and Life Sciences Biomedical Engineering and Bioengineering Biomedicine Biophysics Classical Mechanics Computer Simulation Exercise Therapy - methods Humans Models, Biological Objective function Physical Fitness Rotator Cuff - physiopathology Rotator Cuff Injuries Tendon Injuries - physiopathology Tendon Injuries - rehabilitation Therapy, Computer-Assisted - methods Treatment Outcome
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Title	An Integer Programming Model for Optimizing Shoulder Rehabilitation
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