Context: Since learning guitar and playing it requires repetitive use of muscles, very often with... more Context: Since learning guitar and playing it requires repetitive use of muscles, very often with poor posture, guitarists are at an increased risk of nerve or musculoskeletal damage. As playing is the work of musicians, playing-related musculoskeletal disorders (PRMDs) are an appropriate music-specific derivative of work-related musculoskeletal disorder. Since learning guitar and playing it requires repetitive use of muscles, very often with poor posture, guitarists are at an increased risk of musculoskeletal disorder. Aim: To estimate the prevalence of playing related musculoskeletal disorder among non-professional guitar players. Methodology: it was a cross-sectional study done on non-professional guitar players in the age group of 18-30 years. Modified Nordic Questionnaire was used to screen for the symptoms and a self prepared validated questionnaire was used to take the details of playing related activities. Statistical analysis: Results were analyzed using descriptive statist...
To best establish appropriate treatment aims and treatment strategies in the rehabilitation of th... more To best establish appropriate treatment aims and treatment strategies in the rehabilitation of the patient having undergone reconstructive surgery, the therapist must understand the general principles underpinning the reconstructive procedure/s performed by the surgeon. The therapist then applies his/her knowledge of anatomy and biomechanics during assessment of the patient and must consider possible contraindications of routine treatment techniques that may compromise the reconstruction. Communication with the surgeon and the patient is essential so that treatment goals are understood, agreed and ultimately achieved.
for evaluation of in-hand manipulation skills for children and establish its validity, reliabilit... more for evaluation of in-hand manipulation skills for children and establish its validity, reliability and responsiveness. Methods: Based on literature and expert opinion test items were pooled and was given for content validity to 10 Occupational therapists and 5 Physiotherapists. After establishing content validity it was administered to 15 typically developing children and there performance was videotaped. For interrater reliability three therapists scored children on the test by observing there videotaped performance and for intrarater reliability 1st rater again watched same video after 1 week. To establish internal consistency test was administered to 143 typically developing children between the age of 2 years 6 months to 9 years 6 months. To investigate responsiveness of the test 15 children with hand dysfunction were identified and test was administered to them. They were given supervised intervention specific to rehabilitate in-hand manipulation skills for 15 days and test was re-administered at the end of 15 days. Results: Five therapist completed content validation and it was analyzed qualitatively. None of the items were considered invalid by more than 50% of the responders. Suggestionswere incorporatedwhich consisted solely of instructions for scoring and test administration. Internal consistency was determined using Cronbach’s alpha. All the subscales and complete scale showed excellent internal consistency. (Translation subscale a 5 .95, shift subscale a 5.93, rotation subscale a 5.90, complete scale a 5.95). Both inter-rater and intra-rater reliability was good for the complete scale with an ICC of .977 and .967 respectively. There was significant improvement in pre-post intervention scores of children with hand dysfunction in all type of skills except translation. (Translation subscale p 5 0.073, shift subscale p 5 0.025, rotation subscale p 5 0.004, complete scale p 5 0.011). Conclusions: Test of In Hand Manipulation Skills (TIMS) is a valid, reliable, sensitive, easy to administer, cost effective versatile tool. Relevance: Test of In-Hand Manipulation Skills (TIMS) can be used by hand therapists for precise assessment of in-hand manipulation skills and it will assist them in measuring treatment outcome in children with hand dysfunction. Hand therapist can explore its effectiveness to detect hand dysfunction in adults.
Introduction: Rett syndrome is a rare neurodevelopmental disorder that affects mainly girls. Afte... more Introduction: Rett syndrome is a rare neurodevelopmental disorder that affects mainly girls. After relatively normal early development, there is a period of developmental regression during which hand function is lost. Hand function is affected by additional impairments of dyspraxia and hand stereotypies. Methods: We conducted a review of hand function and stereotypies in Rett syndrome and developed a toolkit for their assessment and treatment. Results: The current literature on the management of hand function in Rett syndrome is limited by both the number of peer-reviewed papers and sample sizes within each study. We have suggested assessment and treatment strategies based on available literature, clinical experience, and grounded in theories of motor control and motor learning. Conclusions: Multicentre studies are needed to better determine the evidence base for treatments. In the meantime, clinical needs can be addressed by supplementing the evidence base with an understanding of the complexities of Rett syndrome, theories of motor control and motor learning, information from environmental enrichment studies conducted on animals, and clinical experience from working with other similarly affected populations.
This case study outlines the surgical and physiotherapy management of a delayed extensor tendon r... more This case study outlines the surgical and physiotherapy management of a delayed extensor tendon reconstruction of the right hand in zones III–VIII
1. Mobile touch screen device use by children is an emerging ergonomics issue Mobile touch screen... more 1. Mobile touch screen device use by children is an emerging ergonomics issue Mobile touch screen devices (MTSD), such as tablet computers and smart phones, are rapidly becoming accessible to children. Over 90% of Australians aged 18-34 years (common age for parents of young children) were using a MTSD to access the internet in 2014, 1 suggesting most young children have access to these devices in families. Recent USA data show access to MTSD in families with 0-8 year old children rose rapidly from 52% in 2011 to 75% in 2013. 2 Preliminary data from Australia show that in 2014, 63.7% of 0-5 year old children had used a tablet computer and 45.6% had used a mobile phone. Notably, 48% had used a tablet computer for more than 30 minutes on weekdays and 24% for more than 30 minutes on weekends. This growing MTSD use has likely musculoskeletal implications for children as previous generations of technology have been shown to have musculoskeletal implications. In 2000, we published a study...
Objectives Complex regional pain syndrome (CRPS) is a persistent pain condition which is often mi... more Objectives Complex regional pain syndrome (CRPS) is a persistent pain condition which is often misunderstood and poorly managed. Qualitative studies are needed to explore the lived experience of the condition and to better understand patient perspectives on their management experiences and needs. The aim of this study was to explore the lived experience of CRPS in Australia, including exploration of their perceptions of care and advice received from healthcare professionals. Methods A qualitative study with individual in-depth semi-structured, face-to-face interviews was performed (n=15, 80% female, average time elapsed since diagnosis 3.8 years). Qualitative data were analysed using an inductive thematic analysis approach. Results Four main themes with associated subthemes were identified, representing the participants’ journey: (1) Life Changing Impact of CRPS (Subthemes: Impact on self, Impact on others); (2) Variable Experiences of Care (Subthemes: Helpful experiences of care, U...
PURPOSE: Music research has investigated the prevalence of playing-related musculoskeletal proble... more PURPOSE: Music research has investigated the prevalence of playing-related musculoskeletal problems in adults and children, but the prevalence in adolescents has not been established. String instrumentalists report high problem rates, though it is unclear whether rates vary between upper and lower strings in adolescent instrumentalists. Further, there is limited evidence for the association between physical characteristics and playing problems in this group of musicians. METHODS: Seventy-six adolescent string musicians from the West Australian Youth Orchestras were surveyed. Their experience of playing problems, both symptoms (PRMS) and disorders (PRMD), within the last month and measurements of body mass index, hand span, and joint mobility (Beighton scale) were obtained. Prevalence rates were calculated and compared between upper and lower string instrumentalists using a chi-squared test. Logistic regression examined the association of physical measures with playing problems, adju...
Young children (ages 3 to 5) are using mobile touchscreen technology, including tablet computers,... more Young children (ages 3 to 5) are using mobile touchscreen technology, including tablet computers, yet little is known on the potential musculoskeletal and physical activity implications of its use. This withinsubject laboratory study (n ¼ 10) examined head, trunk and arm postures, upper trapezius muscle activity, and total body and upper limb physical activity during playing with tablets compared to during TV watching and playing with non-screen toys. Overall, this study found that during tablet play children had greater mean head, trunk and upper arm angles compared to both TV watching and toy play. Conversely, compared to toy play, children playing with tablets had lesser trunk, upper arm and elbow postural variation, lesser trapezius activity, more time sitting and lesser physical activity. Thus, to minimize potential musculoskeletal and sedentary risks, non-screen toy play should be encouraged and education and guidelines provided for parents and caretakers to support wise use of tablets.
There is evidence supporting the social and cognitive benefits of music education. However aspect... more There is evidence supporting the social and cognitive benefits of music education. However aspects of music practice, such as an increase in frequency and intensity of practice, are associated with playing-related musculoskeletal problems in adult musicians, though with limited evidence in children. The aim of this study was to describe the music practice of child instrumentalists and determine their associations with playing-related musculoskeletal problems (PRMP), accounting for gender and age. A total of 731 children learning musical instruments (460 females) ranging in age from 7 – 17 years were surveyed; music experience, music practice and intrinsic factors (e.g. the experience of butterflies in stomach before a concert/exam) were investigated. Logistic regression evaluated the independent association of these potential correlates with PRMP. Music experience (number of years playing main instrument) was significantly negatively associated with PRMP (OR 0.88, p = .003). Pattern...
Playing-related musculoskeletal problems (PRMP) are common in adult musicians. The limited availa... more Playing-related musculoskeletal problems (PRMP) are common in adult musicians. The limited available evidence suggests PRMP are common in children and adolescents and that risk factors may be similar. The aim of this study was to determine the prevalence of PRMP in children and adolescents and their associations with female gender, age and instrument exposure. The study surveyed 731 children learning musical instruments (460 females) ranging in age from 7—17 years. Lifetime symptoms, monthly symptoms and monthly disorders (the inability to play an instrument as usual) were examined. Logistic regression evaluated the independent association of these potential risk factors with PRMP prevalences. A total of 67% students reported PRM symptoms at some point, 56% reported PRM symptoms within the last month and 30% reported an inability to play as usual within the last month. Female gender was significantly associated with PRMP (OR 1.38—1.56, p = 0.004—0.046), as was age (OR 1.19—0.23, p &...
Objective To examine effectiveness of a physiotherapy-specific, web-based e-learning platform, &q... more Objective To examine effectiveness of a physiotherapy-specific, web-based e-learning platform, "RAP-eL", in best-practice management of rheumatoid arthritis (RA) using a single-blind, randomized controlled trial (RCT) and prospective cohort study. Methods Australian-registered physiotherapists were electronically randomized into intervention and control groups. The intervention group accessed RAP-eL over four weeks. Change in self-reported confidence in knowledge and skills was compared between groups at the end of the RCT using linear regression conditioned for baseline scores by a blinded assessor, using intention to treat analysis. Secondary outcomes included physiotherapists' satisfaction with RA management and responses to RA-relevant clinical statements and practice-relevant vignettes. Retention was evaluated in a cohort study 8 weeks after the RCT. Results Eighty physiotherapists were randomised into the intervention and 79 into the control groups. Fifty-six and...
Physiotherapy co-management of rheumatoid arthritis: Identification of red flags, significance to... more Physiotherapy co-management of rheumatoid arthritis: Identification of red flags, significance to clinical practice and management pathways.
The science of our craft may require us to use numbers for an objective record of motions, but th... more The science of our craft may require us to use numbers for an objective record of motions, but the art of our profession permits us to use the facitities of language to describe the ability of the parts to function in the activities of daHy l;v;ng-work and play. Us;ng both numbers and words, we then can record In a most clear manner the almost infinite motions of this part, this marvellous mechanism of exquisite design and delicate sensibility
Context: Since learning guitar and playing it requires repetitive use of muscles, very often with... more Context: Since learning guitar and playing it requires repetitive use of muscles, very often with poor posture, guitarists are at an increased risk of nerve or musculoskeletal damage. As playing is the work of musicians, playing-related musculoskeletal disorders (PRMDs) are an appropriate music-specific derivative of work-related musculoskeletal disorder. Since learning guitar and playing it requires repetitive use of muscles, very often with poor posture, guitarists are at an increased risk of musculoskeletal disorder. Aim: To estimate the prevalence of playing related musculoskeletal disorder among non-professional guitar players. Methodology: it was a cross-sectional study done on non-professional guitar players in the age group of 18-30 years. Modified Nordic Questionnaire was used to screen for the symptoms and a self prepared validated questionnaire was used to take the details of playing related activities. Statistical analysis: Results were analyzed using descriptive statist...
To best establish appropriate treatment aims and treatment strategies in the rehabilitation of th... more To best establish appropriate treatment aims and treatment strategies in the rehabilitation of the patient having undergone reconstructive surgery, the therapist must understand the general principles underpinning the reconstructive procedure/s performed by the surgeon. The therapist then applies his/her knowledge of anatomy and biomechanics during assessment of the patient and must consider possible contraindications of routine treatment techniques that may compromise the reconstruction. Communication with the surgeon and the patient is essential so that treatment goals are understood, agreed and ultimately achieved.
for evaluation of in-hand manipulation skills for children and establish its validity, reliabilit... more for evaluation of in-hand manipulation skills for children and establish its validity, reliability and responsiveness. Methods: Based on literature and expert opinion test items were pooled and was given for content validity to 10 Occupational therapists and 5 Physiotherapists. After establishing content validity it was administered to 15 typically developing children and there performance was videotaped. For interrater reliability three therapists scored children on the test by observing there videotaped performance and for intrarater reliability 1st rater again watched same video after 1 week. To establish internal consistency test was administered to 143 typically developing children between the age of 2 years 6 months to 9 years 6 months. To investigate responsiveness of the test 15 children with hand dysfunction were identified and test was administered to them. They were given supervised intervention specific to rehabilitate in-hand manipulation skills for 15 days and test was re-administered at the end of 15 days. Results: Five therapist completed content validation and it was analyzed qualitatively. None of the items were considered invalid by more than 50% of the responders. Suggestionswere incorporatedwhich consisted solely of instructions for scoring and test administration. Internal consistency was determined using Cronbach’s alpha. All the subscales and complete scale showed excellent internal consistency. (Translation subscale a 5 .95, shift subscale a 5.93, rotation subscale a 5.90, complete scale a 5.95). Both inter-rater and intra-rater reliability was good for the complete scale with an ICC of .977 and .967 respectively. There was significant improvement in pre-post intervention scores of children with hand dysfunction in all type of skills except translation. (Translation subscale p 5 0.073, shift subscale p 5 0.025, rotation subscale p 5 0.004, complete scale p 5 0.011). Conclusions: Test of In Hand Manipulation Skills (TIMS) is a valid, reliable, sensitive, easy to administer, cost effective versatile tool. Relevance: Test of In-Hand Manipulation Skills (TIMS) can be used by hand therapists for precise assessment of in-hand manipulation skills and it will assist them in measuring treatment outcome in children with hand dysfunction. Hand therapist can explore its effectiveness to detect hand dysfunction in adults.
Introduction: Rett syndrome is a rare neurodevelopmental disorder that affects mainly girls. Afte... more Introduction: Rett syndrome is a rare neurodevelopmental disorder that affects mainly girls. After relatively normal early development, there is a period of developmental regression during which hand function is lost. Hand function is affected by additional impairments of dyspraxia and hand stereotypies. Methods: We conducted a review of hand function and stereotypies in Rett syndrome and developed a toolkit for their assessment and treatment. Results: The current literature on the management of hand function in Rett syndrome is limited by both the number of peer-reviewed papers and sample sizes within each study. We have suggested assessment and treatment strategies based on available literature, clinical experience, and grounded in theories of motor control and motor learning. Conclusions: Multicentre studies are needed to better determine the evidence base for treatments. In the meantime, clinical needs can be addressed by supplementing the evidence base with an understanding of the complexities of Rett syndrome, theories of motor control and motor learning, information from environmental enrichment studies conducted on animals, and clinical experience from working with other similarly affected populations.
This case study outlines the surgical and physiotherapy management of a delayed extensor tendon r... more This case study outlines the surgical and physiotherapy management of a delayed extensor tendon reconstruction of the right hand in zones III–VIII
1. Mobile touch screen device use by children is an emerging ergonomics issue Mobile touch screen... more 1. Mobile touch screen device use by children is an emerging ergonomics issue Mobile touch screen devices (MTSD), such as tablet computers and smart phones, are rapidly becoming accessible to children. Over 90% of Australians aged 18-34 years (common age for parents of young children) were using a MTSD to access the internet in 2014, 1 suggesting most young children have access to these devices in families. Recent USA data show access to MTSD in families with 0-8 year old children rose rapidly from 52% in 2011 to 75% in 2013. 2 Preliminary data from Australia show that in 2014, 63.7% of 0-5 year old children had used a tablet computer and 45.6% had used a mobile phone. Notably, 48% had used a tablet computer for more than 30 minutes on weekdays and 24% for more than 30 minutes on weekends. This growing MTSD use has likely musculoskeletal implications for children as previous generations of technology have been shown to have musculoskeletal implications. In 2000, we published a study...
Objectives Complex regional pain syndrome (CRPS) is a persistent pain condition which is often mi... more Objectives Complex regional pain syndrome (CRPS) is a persistent pain condition which is often misunderstood and poorly managed. Qualitative studies are needed to explore the lived experience of the condition and to better understand patient perspectives on their management experiences and needs. The aim of this study was to explore the lived experience of CRPS in Australia, including exploration of their perceptions of care and advice received from healthcare professionals. Methods A qualitative study with individual in-depth semi-structured, face-to-face interviews was performed (n=15, 80% female, average time elapsed since diagnosis 3.8 years). Qualitative data were analysed using an inductive thematic analysis approach. Results Four main themes with associated subthemes were identified, representing the participants’ journey: (1) Life Changing Impact of CRPS (Subthemes: Impact on self, Impact on others); (2) Variable Experiences of Care (Subthemes: Helpful experiences of care, U...
PURPOSE: Music research has investigated the prevalence of playing-related musculoskeletal proble... more PURPOSE: Music research has investigated the prevalence of playing-related musculoskeletal problems in adults and children, but the prevalence in adolescents has not been established. String instrumentalists report high problem rates, though it is unclear whether rates vary between upper and lower strings in adolescent instrumentalists. Further, there is limited evidence for the association between physical characteristics and playing problems in this group of musicians. METHODS: Seventy-six adolescent string musicians from the West Australian Youth Orchestras were surveyed. Their experience of playing problems, both symptoms (PRMS) and disorders (PRMD), within the last month and measurements of body mass index, hand span, and joint mobility (Beighton scale) were obtained. Prevalence rates were calculated and compared between upper and lower string instrumentalists using a chi-squared test. Logistic regression examined the association of physical measures with playing problems, adju...
Young children (ages 3 to 5) are using mobile touchscreen technology, including tablet computers,... more Young children (ages 3 to 5) are using mobile touchscreen technology, including tablet computers, yet little is known on the potential musculoskeletal and physical activity implications of its use. This withinsubject laboratory study (n ¼ 10) examined head, trunk and arm postures, upper trapezius muscle activity, and total body and upper limb physical activity during playing with tablets compared to during TV watching and playing with non-screen toys. Overall, this study found that during tablet play children had greater mean head, trunk and upper arm angles compared to both TV watching and toy play. Conversely, compared to toy play, children playing with tablets had lesser trunk, upper arm and elbow postural variation, lesser trapezius activity, more time sitting and lesser physical activity. Thus, to minimize potential musculoskeletal and sedentary risks, non-screen toy play should be encouraged and education and guidelines provided for parents and caretakers to support wise use of tablets.
There is evidence supporting the social and cognitive benefits of music education. However aspect... more There is evidence supporting the social and cognitive benefits of music education. However aspects of music practice, such as an increase in frequency and intensity of practice, are associated with playing-related musculoskeletal problems in adult musicians, though with limited evidence in children. The aim of this study was to describe the music practice of child instrumentalists and determine their associations with playing-related musculoskeletal problems (PRMP), accounting for gender and age. A total of 731 children learning musical instruments (460 females) ranging in age from 7 – 17 years were surveyed; music experience, music practice and intrinsic factors (e.g. the experience of butterflies in stomach before a concert/exam) were investigated. Logistic regression evaluated the independent association of these potential correlates with PRMP. Music experience (number of years playing main instrument) was significantly negatively associated with PRMP (OR 0.88, p = .003). Pattern...
Playing-related musculoskeletal problems (PRMP) are common in adult musicians. The limited availa... more Playing-related musculoskeletal problems (PRMP) are common in adult musicians. The limited available evidence suggests PRMP are common in children and adolescents and that risk factors may be similar. The aim of this study was to determine the prevalence of PRMP in children and adolescents and their associations with female gender, age and instrument exposure. The study surveyed 731 children learning musical instruments (460 females) ranging in age from 7—17 years. Lifetime symptoms, monthly symptoms and monthly disorders (the inability to play an instrument as usual) were examined. Logistic regression evaluated the independent association of these potential risk factors with PRMP prevalences. A total of 67% students reported PRM symptoms at some point, 56% reported PRM symptoms within the last month and 30% reported an inability to play as usual within the last month. Female gender was significantly associated with PRMP (OR 1.38—1.56, p = 0.004—0.046), as was age (OR 1.19—0.23, p &...
Objective To examine effectiveness of a physiotherapy-specific, web-based e-learning platform, &q... more Objective To examine effectiveness of a physiotherapy-specific, web-based e-learning platform, "RAP-eL", in best-practice management of rheumatoid arthritis (RA) using a single-blind, randomized controlled trial (RCT) and prospective cohort study. Methods Australian-registered physiotherapists were electronically randomized into intervention and control groups. The intervention group accessed RAP-eL over four weeks. Change in self-reported confidence in knowledge and skills was compared between groups at the end of the RCT using linear regression conditioned for baseline scores by a blinded assessor, using intention to treat analysis. Secondary outcomes included physiotherapists' satisfaction with RA management and responses to RA-relevant clinical statements and practice-relevant vignettes. Retention was evaluated in a cohort study 8 weeks after the RCT. Results Eighty physiotherapists were randomised into the intervention and 79 into the control groups. Fifty-six and...
Physiotherapy co-management of rheumatoid arthritis: Identification of red flags, significance to... more Physiotherapy co-management of rheumatoid arthritis: Identification of red flags, significance to clinical practice and management pathways.
The science of our craft may require us to use numbers for an objective record of motions, but th... more The science of our craft may require us to use numbers for an objective record of motions, but the art of our profession permits us to use the facitities of language to describe the ability of the parts to function in the activities of daHy l;v;ng-work and play. Us;ng both numbers and words, we then can record In a most clear manner the almost infinite motions of this part, this marvellous mechanism of exquisite design and delicate sensibility
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Papers by Sonia Ranelli