Mehdi Hassanpour; Sayed Ali Hoseini; Shahram Aboutaleb; Mahdi Rahgozar; Zohre Sarafraz
1. Dept. of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.Background: Bilateral activity is a rehabilitation method for cerebral vascular accident (CVA) patients with proven efficacy. This study investigated the effects of bilateral activities on the affected side upper limb functions in CVA patients.Methods: In this empirical study, 21 CVA patients were assigned into case and control groups. During 8 weeks interventions the case group received b...
Full Text Available 1. Dept. of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.Background: Bilateral activity is a rehabilitation method for cerebral vascular accident (CVA patients with proven efficacy. This study investigated the effects of bilateral activities on the affected side upper limb functions in CVA patients.Methods: In this empirical study, 21 CVA patients were assigned into case and control groups. During 8 weeks interventions the case group received bilateral activities in addition to routine treatment, which performed in both groups. Upper limb function was measured using both Fugl- Meyer and Wolf tests at the beginning and end of the 8 week of the study. Data was analyzed using Chi–Square independent and paired sample T-tests.Results: In the case group, function time and sensory motor score were increased significantly after the intervention (p=0.023 and p-0.002 respectively. There was no significant difference between the case and control groups before and after intervention. Significant difference was not seen either in case or in control group in the motor function scores during the study period.Conclusion: Performing bilateral activities could not lead to significant upper limb function improvement. Due to the small sample size and the long time passed after CVA occurring in our study, it seems that more investigations in this filed is necessary.
Juha M. Hijmans, PhD
Full Text Available This study aimed to determine the effectiveness of a bilateral, self-supported, upper-limb rehabilitation intervention using a movement-based game controller for people with chronic stroke. Fourteen participants received a control treatment, followed by a washout period, and then the intervention. The intervention comprised playing computer games with the CyWee Z (CyWee Group Ltd; Taipei, Taiwan, a movement-based game controller similar to the Nintendo Wii remote. The CyWee Z was incorporated into a handlebar, making bilateral exercises possible by allowing the unaffected side to support and assist the affected side. The intervention lasted for 8 to 10 sessions of 45 to 60 minutes over a period of 2.5 weeks. The Fugl-Meyer Assessment upper-limb section (FMA-UL was used as the primary outcome. The Wolf Motor Function Test and the Disabilities of Arm, Shoulder, and Hand outcome measure were used as secondary outcomes. Postintervention, motor performance as measured by the FMA-UL was significantly improved compared with all preintervention assessments (p < 0.001, whereas no changes were found on both secondary outcomes. It can be concluded from this pilot study that upper-limb motor performance of adults with chronic stroke improves with repetitive, game-assisted, self-supported bilateral exercises.
Simkins, Matt; Kim, Hyuchul; Abrams, Gary; Byl, Nancy; Rosen, Jacob
Stroke is the leading cause of long-term neurological disability and the principle reason for seeking rehabilitative services in the US. Learning based rehabilitation training enables independent mobility in the majority of patients post stroke, however, restoration of fine manipulation, motor function and task specific functions of the hemiplegic arm and hand is noted in fewer than 15% of the stroke patients. Brain plasticity is the innate mechanism enabling the recovery of motor skills through neurological reorganization of the brain as a response to limbs' manipulation. The objective of this research was to evaluate the therapeutic efficacy for the upper limbs with a dual arm exoskeleton system (EXO-UL7) using three different modalities: bilateral mirror image with symmetric movements of both arms, unilateral movement of the affected arm and standard care. Five hemiparetic subjects were randomly assigned to each therapy modality. An upper limb exoskeleton was used to provide bilateral and unilateral treatments. Standard care was provided by a licensed physical therapist. Subjects were evaluated before and after the interventions using 13 different clinical measures. Following these treatments all of the subjects demonstrated significant improved of their fine motor control and gross control across all the treatment modalities. Subjects exhibited significant improvements in range of motion of the shoulder, and improved muscle strength for bilateral training and standard care, but not for unilateral training. In conclusion, a synergetic approach in which robotic treatments (unilateral and bilateral depending on the level of the motor control) are supplemented by the standard of care may maximize the outcome of the motor control recover following stroke. PMID:24187321
Sheng, Bo; Zhang, Yanxin; Meng, Wei; Deng, Chao; Xie, Shengquan
Robot-assisted bilateral upper-limb training grows abundantly for stroke rehabilitation in recent years and an increasing number of devices and robots have been developed. This paper aims to provide a systematic overview and evaluation of existing bilateral upper-limb rehabilitation devices and robots based on their mechanisms and clinical-outcomes. Most of the articles studied here were searched from nine online databases and the China National Knowledge Infrastructure (CNKI) from year 1993 to 2015. Devices and robots were categorized as end-effectors, exoskeletons and industrial robots. Totally ten end-effectors, one exoskeleton and one industrial robot were evaluated in terms of their mechanical characteristics, degrees of freedom (DOF), supported control modes, clinical applicability and outcomes. Preliminary clinical results of these studies showed that all participants could gain certain improvements in terms of range of motion, strength or physical function after training. Only four studies supported that bilateral training was better than unilateral training. However, most of clinical results cannot definitely verify the effectiveness of mechanisms and clinical protocols used in robotic therapies. To explore the actual value of these robots and devices, further research on ingenious mechanisms, dose-matched clinical protocols and universal evaluation criteria should be conducted in the future. PMID:27117423
The booklet discusses sports adaptations for unilateral and bilateral upper limb amputees. Designs for adapted equipment are illustrated and information on adaptations are described for archery (including an archery release aid and a stationary bow holder); badminton (serving tray); baseball/softball (adaptations for catching, throwing, and…
Bilateral PPG signals have been used for comparative study of two groups of healthy (free from any cardiovascular risk factors) and diabetic (as cardiovascular disease risk group) subjects in the age-matched range 40–50 years. The peripheral blood pulsations were recorded simultaneously from right and left index fingers for 90 s. Pulses have been modeled with the ARX440 model in the interval of 300 sample points with 100 sample points overlap between segments. Model parameters of three segments based on the highest fitness (higher than 80%) of modeled segments were retained for each subject. Subsequently, principal component analysis (PCA) was applied to the parameters of retained segments to eliminate the existing correlation among parameters and provide uncorrelated variables. The first principal component (contains 78.2% variance of data) was significantly greater in diabetic than in control groups (P < 0.0001, 0.74 ± 2.01 versus −0.53 ± 1.66). In addition the seventh principal component, which contains 0.02% of the data variance, was significantly lower in diabetic than in control groups (P < 0.05, −0.007 ± 0.03 versus 0.005 ± 0.03). Finally, linear discrimination analysis (LDA) was used to classify the subjects. The classification was done using the robust leaving-one-subject-out method. LDA could classify the subjects with 71.7% sensitivity and 70.2% specificity while the male subjects resulted in a highly acceptable result for the sensitivity (81%). The present study showed that PPG signals can be used for vascular function assessment and may find further application for detection of vascular changes before onset of clinical diseases
Hong-wei Min, MD; Ke-min Liu, MD; Xin-zuo Han, MD; Rui Gu, MD
The management of heterotopic ossification (HO) is controversial. Although some reports have investigated assessment and surgical resection techniques for HO affecting one or more joints, the cases of multijoint stiffness secondary to HO are rare. This article describes a rare case of HO affecting both upper limbs of a 32-year-old man that severely interfered with activities of daily living. We present the rehabilitation management of this case and the functional outcome 1 to 2 yr after excis...
Hong-wei Min, MD
Full Text Available The management of heterotopic ossification (HO is controversial. Although some reports have investigated assessment and surgical resection techniques for HO affecting one or more joints, the cases of multijoint stiffness secondary to HO are rare. This article describes a rare case of HO affecting both upper limbs of a 32-year-old man that severely interfered with activities of daily living. We present the rehabilitation management of this case and the functional outcome 1 to 2 yr after excision of the ossific masses.
Full Text Available : Diabetic myonecrosis, one of the complications of chronic, inadequately controlled diabetes mellitus is seen more commonly in lower extremities and in females. We report a case of diabetic myonecrosis in upper extremities, an underreported complication of diabetes in a male from a tertiary care hospital in Mumbai. Diabetic myonecrosis usually responds to conservative management, but the long-term prognosis of the condition is poor. Identification and correct diagnosis of diabetic myonecrosis is important to avoid wrong treatment which could result in unnecessary complications.
Stoykov, Mary Ellen; Corcos, Daniel M
Upper extremity hemiparesis is the most common post-stroke disability. Longitudinal studies have indicated that 30-66% of stroke survivors do not have full arm function 6 months post-stroke. The current gold standard for treatment of mild post-stroke upper limb impairment is constraint-induced therapy but, because of the inclusion criteria, alternative treatments are needed which target more impaired subjects. Bilateral arm training has been investigated as a potential rehabilitation intervention. Bilateral arm training encompasses a number of methods including: (1) bilateral isokinematic training; (2) mirror therapy using bilateral training; (3) device-driven bilateral training; and (4) bilateral motor priming. Neural mechanisms mediating bilateral training are first reviewed. The key bilateral training studies that have demonstrated evidence of efficacy will then be discussed. Finally, conclusions are drawn concerning clinical implications based on the reviewed literature. PMID:19517519
Lacoux, Philippe A; Crombie, Iain K; MacRae, William A
Data on 40 upper limb amputees (11 bilateral) with regard to stump pain, phantom sensation and phantom pain is presented. All the patients lost their limbs as a result of violent injuries intended to terrorise the population and were assessed 10-48 months after the injury. All amputees reported stump pain in the month prior to interview and ten of the 11 bilateral amputees had bilateral pain. Phantom sensation was common (92.5%), but phantom pain was only present in 32.5% of amputees. Problem...
Tung, Monica L; Murphy, Ian C; Griffin, Sarah C; Alphonso, Aimee L.; Hussey-Anderson, Lindsey; Hughes, Katie E; Weeks, Sharon R; Merritt, Victoria; Yetto, Joseph M; Pasquina, Paul F.; Tsao, Jack W.
Background Mirror therapy has been demonstrated to reduce phantom limb pain (PLP) experienced by unilateral limb amputees. Research suggests that the visual feedback of observing a limb moving in the mirror is critical for therapeutic efficacy. Objective Since mirror therapy is not an option for bilateral lower limb amputees, the purpose of this study was to determine if direct observation of another person’s limbs could be used to relieve PLP. Methods We randomly assigned 20 bilateral lower ...
Ravi Gupta; Vivekananda Lahan; Deepak Goel
Restless legs syndrome (RLS) rarely affects the upper limb during the initial course of disease. We present a patient who complained of symptoms suggesting RLS in the right upper limb as the sole manifestation of illness. Bilateral cervical ribs and depression were co-incidental findings. Patient responded well to dopaminergic therapy.
Hypoplasia affecting both hind limbs was observed in a neonatal foal. Scintigraphy aided in establishing diagnosis and prognosis. Radiography revealed an abnormally shaped middle phalanx and lack of the distalphalanx and navicular bone in the right hind limb, with an abnormally shaped distal phalanx and navicular bone in the left hind limb. Scintigraphic findings were closely correlated with the radiographic findings. Radiographic and scintigraphic findings were confirmed at postmortem examination
Michele A. Raya, PhD, PT, SCS, ATC
Full Text Available The Amputee Mobility Predictor (AMP is an outcome measure designed to assess mobility and functional capabilities for people with unilateral lower-limb amputation. No comparable measure exists for those with bilateral lower-limb amputation (BLLA. The purpose of this study was to examine the utility of the AMP-Bilateral (AMP-B to measure the ability to perform functional tasks related to participation in advanced skill activities in those with BLLA and to determine whether AMP-B scores correlated with 6-minute walk test (6MWT performance. Twenty-six male servicemembers (SMs completed the study: 12 with bilateral transtibial amputation (BTTA, 7 with bilateral transfemoral amputation (BTFA, and 7 with combination transtibial and transfemoral amputation (TTA/TFA. Significant differences existed between the AMP-B scores (p < 0.001, AMP scores (p < 0.001, and 6MWT distance (p < 0.05 for SMs with BTTA and TTA/TFA and SMs with BTTA and BTFA but not between those with BTFA and TTA/TFA. Scoring of five AMP items was modified because they necessitate at least one intact knee joint to generate the necessary torque requirements to perform the activity without upper-limb assistance. Minor modifications in scoring of the AMP do not alter total score and allow clinicians to determine the mobility and functional capabilities of SMs with BTFA and TFA/TTA.
Bach, Per Ferdinand
In the last couple of years The Institute of Cybernetics at NTNU, Norway, has based its research on the SVEN work carried out in Sweden in the late 1970’s. The SVEN hand was an on/off-controlled upper limb prosthesis based on electromyographic (EMG) signals. This master thesis is a part of the renewed and continuing research. This study will try to identify signal features that are beneficial in a proportional control of a multi-function upper limb prosthesis. The intent is to identify a set ...
Leung, Anderson S M; Fok, Margaret W M; Fung, Boris K K
Venous thromboembolism in hand surgery is rare. There is no report in the literature on postoperative mortality from venous thromboembolism following microsurgery in upper limbs. We report the case of a 56-year-old Chinese man who died from pulmonary embolism as a result of bilateral lower-limb deep vein thrombosis following prolonged surgery under general anaesthesia after replantation of a finger. This case raises awareness of the need for precautions against venous thromboembolism following prolonged microsurgery and identification of high-risk patients. PMID:26045073
Teo, Harvey E.L.; Peh, Wilfred C.G. [KK Women' s and Children' s Hospital, Department of Diagnostic Imaging, Singapore (Singapore); Chan, Mei-Yoke [KK Women' s and Children' s Hospital, Department of Paediatric Medicine, Singapore (Singapore); Walford, Norman [Tan Tock Seng Hospital, Department of Pathology, Singapore (Singapore)
The imaging features of extensive lipofibromatosis presenting in a 1-day-old female infant are reported. This lesion involved her entire right upper limb, extending from the axilla to the palm of the hand. Radiographs showed marked deformity and thinning of all the right upper-limb bones due to pressure effect of soft-tissue enlargement, especially affecting the distal humerus and proximal forearm bones. Magnetic resonance imaging showed a huge soft-tissue mass infiltrating most of the muscles of the entire upper limb, with bony erosion. The mass was largely T1-isointense, moderately T2-hyperintense and showed marked enhancement. There were intra-lesional signal changes consistent with fatty elements. A lesion debulking procedure was performed and the histology was that of lipofibromatosis. The limb was found to be non-viable after the procedure and a subsequent above-elbow amputation was performed. Although the resection margins were not clear, she had no further recurrence over a subsequent 3-year follow-up period. (orig.)
Churchill, Steven E; Holliday, Trenton W; Carlson, Kristian J; Jashashvili, Tea; Macias, Marisa E; Mathews, Sandra; Sparling, Tawnee L; Schmid, Peter; de Ruiter, Darryl J; Berger, Lee R
The evolution of the human upper limb involved a change in function from its use for both locomotion and prehension (as in apes) to a predominantly prehensile and manipulative role. Well-preserved forelimb remains of 1.98-million-year-old Australopithecus sediba from Malapa, South Africa, contribute to our understanding of this evolutionary transition. Whereas other aspects of their postcranial anatomy evince mosaic combinations of primitive (australopith-like) and derived (Homo-like) features, the upper limbs (excluding the hand and wrist) of the Malapa hominins are predominantly primitive and suggest the retention of substantial climbing and suspensory ability. The use of the forelimb primarily for prehension and manipulation appears to arise later, likely with the emergence of Homo erectus. PMID:23580536
Ruddy, Kathy L; Jaspers, Ellen; Keller, Martin; Wenderoth, Nicole
Somatosensory information from the limbs reaches the contralateral Primary Sensory Cortex (S1) with a delay of 23ms for finger, and 40ms for leg (somatosensory N20/N40). Upon arrival of this input in the cortex, motor evoked potentials (MEPs) elicited by Transcranial Magnetic Stimulation (TMS) are momentarily inhibited. This phenomenon is called 'short latency afferent inhibition (SAI)' and can be used as a tool for investigating sensorimotor interactions in the brain. We used SAI to investigate the process of sensorimotor integration in the hemisphere ipsilateral to the stimulated limb. We hypothesized that ipsilateral SAI would occur with a delay following the onset of contralateral SAI, to allow for transcallosal conduction of the signal. We electrically stimulated the limb either contralateral or ipsilateral to the hemisphere receiving TMS, using a range of different interstimulus intervals (ISI). We tested the First Dorsal Interosseous (FDI) muscle in the hand, and Tibialis Anterior (TA) in the lower leg, in three separate experiments. Ipsilateral SAI was elicited in the upper limb (FDI) at all ISIs that were greater than N20+18ms (all pintegration. PMID:27425210
Full Text Available Paralysis causes loss of muscle function and loss of feeling in the affected area. The main problem faced by the patients after paralysis is muscle atrophy caused due to non-functionality of the stump. Orthotics is an orthopedic device which supports the function of the arm, leg or torso. This paper deals with the design of an upper limb orthotic device which has a hollow shell/ braces structure and can be used by paralyzed patients to bring about simple hand movements independently by the patient.
Desmond, Deirdre M.; MacLachlan, Malcolm
This study aims to describe the prevalence and characteristics of phantom limb pain and residual limb pain after upper limb amputation. One-hundred and forty-one participants (139 males; mean age 74.8 years; mean time since amputation 50.1 years) completed a self-report questionnaire assessing residual and phantom limb pain experience. Prevalence…
Purpose. - To study the frequency and risk factors for upper limb lymphedema through a series of patients treated for breast cancer. Patients and methods. - It is a retrospective study about 222 patients treated for breast cancer during the period between February 1993 and December 2003 in Sfax hospitals. Average age was 51 years (27-92 years). Tumour was T2 in 59% of cases. All patients had surgery with lymph node dissection. Infiltrating ductal carcinoma was the most frequent histological type (80% of cases), with predominant SBR II grade (62%). The mean number of removed lymph nodes was 12 (2-33). Axillary lymph node metastasis was detected in 124 patients. Radiotherapy was delivered in 200 patients, including axillary irradiation in 30 cases. The mean follow-up was 68 months (12-120). Results. - Lymphedema appeared in 23% of cases (51 patients), 14 months after surgery (mean period). Lymphedema affected the brachium in 17% of cases, the forearm in 12% of cases and all upper limb in 71% of cases. Fifty percent of patients had rehabilitation. However, improvement of lymphedema was obtained in 18 cases. Parameters predicting lymphedema were studied. Significant risk factors were obesity, infection and a number of removed lymph node above 10. The type of surgery, axillary irradiation and shoulder abduction deficit did not predict lymphedema. Conclusion. - Lymphedema of the arm is a frequent consequence of breast cancer treatment. The risk of lymphedema is correlated with obesity, infection and a number of removed lymph node above 10. (authors)
Full Text Available Radiogrammetry is radiological method of bone mineral density quantification. Besides giving an insight in diagnostics and evolution of metabolic bone disorders (osteoporosis, osteomalacia, osteitis deformans- Paget's disease, it can also explain some specific biomechanical characteristics of bone structures. The aim of this study is to evaluate the significance and perspectives of radiogrammetry as a scientific model for further inquiry of skeletal system. The work demonstrates mathematical parameters (Ca-Cortical area, CI- Cortical index, GI- Garn's index, ESI- Exton Smith's index of upper limb long bones (humerus, radius, ulna. Two standard radiological projections of bones were taken: antero-posterior (AP and latero-lateral (LL. Correlation with metacarpal and lower limb bones was also performed. The value of the cortical area of humerus is significantly higher comparing with the two other examined bones (Xmean 2,2443 cm2, p < 0.01. Radial bone has the highest values of the relational mathematical parameters, which implicates its higher strength by volumetric unit concerning humerus and ulna. Despite the development of contemporary osteometric procedures (ultrasound densitometry, dual X-ray absorptiometry, digital X-ray radiogrammetry, the classical radiogrammetry sustains its important role in diagnostics of metabolic bone disorders and it can be successfully used for biomechanical inquiry of skeletal system.
Fry, H J; Rowley, G L
Two British secondary schools (one a specialist music school) were surveyed to assess the prevalence of upper limb pain among specialist music students compared with students in a regular school setting. Female students tended to report pain more often than male students, but for both significantly higher prevalence was found in the music school. Pain in the regular school was most often attributed to writing, whereas in the music school it was associated with the playing of all instruments, but most particularly with cello, clarinet, and flute. Music students reported long hours of practice, but it appeared that the intensity of practice may be more important as a determinant of pain than the total hours spent practising. The results of the study are in substantial agreement with those previously published from Australia and North America. On the balance of probabilities the pain is due to overuse syndrome, which is very common in musicians and well known in writers. PMID:2619360
Desmond, Deirdre M.; MacLachlan, Malcolm
This study aims to describe the prevalence and characteristics of phantom limb pain and residual limb pain following upper limb amputation. Methods: One-hundred and forty-one participants (139 males; mean age 74.8 years; mean time since amputation 50.1 years) completed a self-report questionnaire assessing residual and phantom limb pain experience. Results: Prevalence of phantom limb pain during the week preceding assessment was 42.6% (60/141). Prevalence of residual limb pain was 43.3% (61/1...
Rogowski, Isabelle; Creveaux, Thomas; Genevois, Cyril; Klouche, Shahnaz; Rahme, Michel; Hardy, Philippe
The purpose of this study was to examine the relationship between the upper limb anthropometric dimensions and a history of dominant upper limb injury in tennis players. Dominant and non-dominant wrist, forearm, elbow and arm circumferences, along with a history of dominant upper limb injuries, were assessed in 147 male and female players, assigned to four groups based on location of injury: wrist (n = 9), elbow (n = 25), shoulder (n = 14) and healthy players (n = 99). From anthropometric dimensions, bilateral differences in circumferences and in proportions were calculated. The wrist group presented a significant bilateral difference in arm circumference, and asymmetrical bilateral proportions between wrist and forearm, as well as between elbow and arm, compared to the healthy group (6.6 ± 3.1% vs. 4.9 ± 4.0%, P < 0.01; -3.6 ± 3.0% vs. -0.9 ± 2.9%, P < 0.05; and -2.2 ± 2.2% vs. 0.1 ± 3.4%, P < 0.05, respectively). The elbow group displayed asymmetrical bilateral proportions between forearm and arm compared to the healthy group (-0.4 ± 4.3% vs. 1.5 ± 4.0%, P < 0.01). The shoulder group showed significant bilateral difference in elbow circumference, and asymmetrical bilateral proportions between forearm and elbow when compared to the healthy group (5.8 ± 4.7% vs. 3.1 ± 4.8%, P < 0.05 and -1.7 ± 4.5% vs. 1.4 ± 4.3%, P < 0.01, respectively). These findings suggest that players with a history of injury at the upper limb joint present altered dominant upper limb proportions in comparison with the non-dominant side, and such asymmetrical proportions would appear to be specific to the location of injury. Further studies are needed to confirm the link between location of tennis injury and asymmetry in upper limb proportions using high-tech measurements in symptomatic tennis players. PMID:25881663
Full Text Available Abstract Introduction Replantation of a limb to the contralateral stump after bilateral traumatic amputations is rare. To the best of our knowledge, there are only a few reports of crossover lower limb replantation in the literature. Case presentation We treated a 37-year-old Chinese woman with bilateral lower limb crush injuries sustained in a traffic accident. Her lower limb injuries were at different anatomic levels. We performed emergency bilateral amputations followed by crossover replantation. Five years later, the woman had recovered well, and had perfect movement and stability in her replanted leg. After reviewing the literature, we thought that presentation of our patient’s case might provide useful information for clinicians. Conclusions Crossover replantation should be considered when evaluating a patient with bilateral lower limb injuries, thus allowing the patient to touch the ground and stand using their own foot.
Restuccia, D; Valeriani, M.; Di Lazzaro, V; Tonali, P.; Mauguière, F
Radial, median, and ulnar nerve somatosensory evoked potentials (SEPs) were recorded, with non-cephalic reference montage, in 38 patients with clinical signs of cervical myelopathy and MRI evidence of spondylotic compression of the cervical cord. Upper limb SEPs are useful in spondylotic myelopathy because SEPs were abnormal in all patients for at least one of the stimulated nerves and SEP abnormalities were bilateral in all patients but one. Reduction of the amplitude of the N13 potential in...
Farina, Dario; Amsüss, Sebastian
Despite progress in research and media attention on active upper limb prostheses, presently the most common commercial upper limb prosthetic devices are not fundamentally different from solutions offered almost one century ago. Limited information transfer for both control and sensory-motor integration and challenges in socket technology have been major obstacles. By analysing the present state-of-the-art and academic achievements, we provide our opinion on the future of upper limb prostheses. We believe that surgical procedures for muscle reinnervation and osseointegration will become increasingly clinically relevant; muscle electrical signals will remain the main clinical means for prosthetic control; and chronic electrode implants, first in muscles (control), then in nerves (sensory feedback), will become viable clinical solutions. After decades of suspended clinically relevant progress, it is foreseeable that a new generation of upper limb prostheses will enter the market in the near future based on such advances, thereby offering substantial clinical benefit for patients. PMID:26924191
Harrington, J. M.; Carter, J T; Birrell, L.; Gompertz, D
OBJECTIVES: To establish consensus case definitions for several common work related upper limb pain syndromes for use in surveillance or studies of the aetiology of these conditions. METHODS: A group of healthcare professionals from the disciplines interested in the prevention and management of upper limb disorders were recruited for a Delphi exercise. A questionnaire was used to establish case definitions from the participants, followed by a consensus conference involving the core grou...
Subin,; Rao Vaishali; Prem V; Sahoo
Objectives: To study the effect of unsupported upper limb and lower limb exercise training and their combined influence on the exercise performance and health-related quality of life in COPD patients. Materials and Methods: Thirty patients were randomly assigned to one of the three groups, through block randomization. Of the three groups, group A received upper limb training, group B received lower limb training, and group C received both upper and lower limb training. Patients in group A,...
Ryan R. Bailey, MSOT, OTR/L
Full Text Available The goal of physical rehabilitation following upper-limb (UL impairment is functional restoration of the UL for use in daily activities. Because capacity for UL function may not translate into real-world activity, it is important that assessment of real-world UL activity be used in conjunction with clinical measures of capacity. Accelerometry can be used to quantify duration of UL activity outside of the clinic. The purpose of this study was to characterize hours of UL activity and potential modifying factors of UL activity (sedentary activity, cognitive impairment, depressive symptomatology, additive effects of comorbidities, cohabitation status, and age. Seventy-four community-dwelling adults wore accelerometers on bilateral wrists for 25 h and provided information on modifying factors. Mean time of dominant UL activity was 9.1 +/– 1.9 h, and the ratio of activity between the nondominant and dominant ULs was 0.95 +/– 0.06 h. Decreased hours of dominant UL activity was associated with increased time spent in sedentary activity. No other factors were associated with hours of dominant UL activity. These data can be used to help clinicians establish outcome goals for patients given preimpairment level of sedentary activity and to track progress during rehabilitation of the ULs.
McDonnell, J G
We report the successful use of a stellate ganglion block as part of a multi-modal postoperative analgesic regimen. Four patients scheduled for orthopaedic surgery following upper limb trauma underwent blockade of the stellate ganglion pre-operatively under ultrasound guidance. Patients reported excellent postoperative analgesia, with postoperative VAS pain scores between 0 and 2, and consumption of morphine in the first 24 h ranging from 0 to 14 mg. While these are preliminary findings, and must be confirmed in a clinical trial, they highlight the potential for stellate ganglion blockade to provide analgesia following major upper limb surgery.
Jepsen, Jørgen Riis
A previous review of historical descriptions and theories about the character and pathogenesis of writer’s cramp and other comparable chronic upper limb “overuse” work-related pain syndromes has indicated that somatic dysfunctions explain symptoms and findings. The first case studies and case...... series suggested that these conditions were caused by pathology affecting the peripheral nerves. The general perception gradually changed, however, with symptoms becoming attributed to central nervous system dysfunction and ultimately to represent a psychiatric condition. Work-related upper limb......” conditions that have occurred sporadically and epidemically, and reviews interpretations from the nineteenth century that relate symptoms to psychogenic conditions....
Zlatka Borisova Stoyneva
Full Text Available In this study the complex interrelationship between physical factors, job stress, lifestyle and genetic factors on symptoms of work-related musculoskeletal disorders of the upper limbs is demonstrated by a case report and discussion of the literature. A 58 year old woman with long lasting complaints of the upper limbs with increasing intensity and duration, generalisation, combined with skin thickness, Raynaud’s phenomenon, joint disorders, arterial and pulmonary hypertension, metabolic lipid dysfunctions is presented. Occupational history proves continuous duration of service at a job with occupational physical static load with numerous repetitive monotonous systematic motions of fingers and hands as a weaver of Persian rugs followed by work at an automated loom and variable labour activities. Though the complaints dated since the time she was a manual weaver, the manifestations of generalized joint degenerative changes, system sclerosis with Raynaud’s phenomenon with similar upper extremities signs and symptoms discount upper limbs musculoskeletal disorder as caused only or mainly by occupational risk factors. The main principles and criteria for occupational diagnosis of musculoskeletal upper limb disorders and legislative requirements for their reglamentation are discussed.
Laursen, Lise H; Sjøgaard, Gisela; Hagert, C G;
BACKGROUND: Upper limb disorders (ULDs) are common, and so are the difficulties in specific diagnoses of these disorders. Prior studies have shed light on the nerves in the diagnostic approach beside disorders related to muscles, tendons and joints (MCDs). OBJECTIVE: The study aimed to compare th...
Gaggioli, Andrea; Amoresano, Amedeo; Gruppioni, Emanuele; Verni, Gennaro; Riva, Giuseppe
At least 90% of individuals of limb amputees experience phantom limb pain (PLP). Recent clinical research suggests that providing patients with the mirror image representation of the amputated limb may alleviate PLP. However, mirror therapy cannot be used with bilateral amputees, as visual feedback is dependent on the movement of the intact limb. To overcome this limitation, we designed a novel myoelectric-controlled virtual reality (VR) system for the treatment of phantom limb pain in trans-radial upper extremity amputees. The proposed system allows the patient to directly control the virtual limb by recognizing stump muscle patterns recorded with EMG sensors. The hypothesis behind this strategy is that the VR image of the amputated limb induces better limb imagery than the reflected image of their intact limb and, therefore, is more effective in reducing PLP. A research protocol to test this hypothesis is described. PMID:20543301
Full Text Available The loss of all or part of the arm is a catastrophic event for a patient and a significant challenge to rehabilitation professionals and prosthetic engineers. The large, upper extremity amputee population in India has, historically, been poorly served, with most having no access to support or being provided with ineffective prostheses. In recent years, the arrival of organisations like Otto Bock has made high quality service standards and devices accessible to more amputees. This review attempts to provide surgeons and other medical professionals with an overview of the multidisciplinary, multistage rehabilitation process and the solution options available. With worldwide upper extremity prosthesis rejection rates at significant levels, the review also describes some of the factors which influence the outcome. This is particularly relevant in the Indian context where the service can involve high cost investments. It is the responsibility of all contributing professionals to guide vulnerable patients through the process and try to maximise the benefit that can be obtained within the resources available.
Craig A. Peters
Full Text Available A 16-year-old girl presented with bilateral back pain caused by bilateral upper pole ureteropelvic junction obstructions; an extremely rare phenomenon. Bilateral robotically assisted upper pole pyeloplasties were preformed at the same setting with an excellent clinical response. Although rare, upper pole ureteropelvic junction obstruction is a defined entity that urologists should be aware of.
Full Text Available Vascular anomalies of the upper extremity are a surgical challenge to the hand surgeons. The treatment modality varies with respect to the presentation, extent of the lesion, progression and their complications. Based on our experience in treating patients with vascular malformations, a protocol has been formulated for their management, which we have found to be very useful and successful. With the use of the tumescent technique and good planning, haemangiomas are best excised in infancy or early childhood. Investigations like contrast computed tomography and magnetic resonance imaging have been found to be a useful tool in the diagnosis and planning of surgery for venous malformations. Embolisation seems to be a safe option in arteriovenous malformations.
Full Text Available Extra-abdominal desmoid tumors preferentially affect the shoulders, arms, backs, buttocks, and thighs of young adults. Multicentric occurrence is rather rare but seems to be another distinctive feature of extra-abdominal desmoid tumors. In this article we report a rare case of multicentric extra-abdominal desmoid tumors arising in bilateral lower limbs.
Aasef G Shaikh
Full Text Available Ataxia-telangiectasia is known for cerebellar degeneration, but clinical descriptions of abnormal tone, posture, and movements suggest involvement of the network between cerebellum and basal ganglia. We quantitatively assessed the nature of upper-limb movement disorders in ataxia-telangiectasia. We used a three-axis accelerometer to assess the natural history and severity of abnormal upper-limb movements in 80 ataxia-telangiectasia and 19 healthy subjects. Recordings were made during goal-directed movements of upper limb (kinetic task, while arms were outstretched (postural task, and at rest. Almost all ataxia-telangiectasia subjects (79/80 had abnormal involuntary movements, such as rhythmic oscillations (tremor, slow drifts (dystonia or athetosis, and isolated rapid movements (dystonic jerks or myoclonus. All patients with involuntary movements had both kinetic and postural tremor, while 48 (61% also had resting tremor. The tremor was present in transient episodes lasting several seconds during two-minute recording sessions of all three conditions. Percent time during which episodic tremor was present was greater for postural and kinetic tasks compared to rest. Resting tremor had higher frequency but smaller amplitude than postural and kinetic tremor. Rapid non-rhythmic movements were minimal during rest, but were triggered during sustained arm postures and goal directed arm movements suggesting they are best considered a form of dystonic jerks or action myoclonus. Advancing age did not correlate with the severity of involuntary limb movements. Abnormal upper-limb movements in ataxia-telangiectasia feature classic cerebellar impairment, but also suggest involvement of the network between the cerebellum and basal ganglia.
Ferris Daniel P
Full Text Available Abstract Background When humans perform rhythmic upper and lower limb locomotor-like movements, there is an excitatory effect of upper limb exertion on lower limb muscle recruitment. To investigate potential neural mechanisms for this behavioral observation, we developed computer simulations modeling interlimb neural pathways among central pattern generators. We hypothesized that enhancement of muscle recruitment from interlimb spinal mechanisms was not sufficient to explain muscle enhancement levels observed in experimental data. Methods We used Matsuoka oscillators for the central pattern generators (CPG and determined parameters that enhanced amplitudes of rhythmic steady state bursts. Potential mechanisms for output enhancement were excitatory and inhibitory sensory feedback gains, excitatory and inhibitory interlimb coupling gains, and coupling geometry. We first simulated the simplest case, a single CPG, and then expanded the model to have two CPGs and lastly four CPGs. In the two and four CPG models, the lower limb CPGs did not receive supraspinal input such that the only mechanisms available for enhancing output were interlimb coupling gains and sensory feedback gains. Results In a two-CPG model with inhibitory sensory feedback gains, only excitatory gains of ipsilateral flexor-extensor/extensor-flexor coupling produced reciprocal upper-lower limb bursts and enhanced output up to 26%. In a two-CPG model with excitatory sensory feedback gains, excitatory gains of contralateral flexor-flexor/extensor-extensor coupling produced reciprocal upper-lower limb bursts and enhanced output up to 100%. However, within a given excitatory sensory feedback gain, enhancement due to excitatory interlimb gains could only reach levels up to 20%. Interconnecting four CPGs to have ipsilateral flexor-extensor/extensor-flexor coupling, contralateral flexor-flexor/extensor-extensor coupling, and bilateral flexor-extensor/extensor-flexor coupling could enhance
Huang, Shuai; Luo, Chun; Ye, Shiwei; Liu, Fei; Xie, Bin; Wang, Caifeng; Yang, Li; Huang, Zhen; Wu, Jiankang
There has been an urgent need for an effective and efficient upper limb rehabilitation method for poststroke patients. We present a Micro-Sensor-based Upper Limb rehabilitation System for poststroke patients. The wearable motion capture units are attached to upper limb segments embedded in the fabric of garments. The body segment orientation…
Our objective was to evaluate the usefulness of computer-assisted preoperative simulation of malunited fractures in the upper limb. Ten patients with malunited fractures underwent multislice computed tomography of both upper limbs with reconstruction of three-dimensional bone models using three-dimensional (3D) software. Preoperative simulation was comprised of four main procedures: performance of virtual corrective osteotomy, matching of reposition with a mirror-image model of the unaffected side, creating new data for the bone defect, and machining of an hydroxyapatite block as bone graft. In addition, we used full-sized three-dimensional virtual reality modeling with a rapid prototyping molding device, and performed preoperative rehearsals of osteotomies using plaster models. All patients tolerated the surgical procedure well. This technique permits the surgeon to recognize and correct three-dimensional deformities of malunited fracture with both accuracy and precision. (author)
Gebouský, Petr; Kárný, Miroslav; Křížová, H.; Wald, M.
Roč. 39, č. 1 (2009), s. 1-7. ISSN 0010-4825 R&D Projects: GA MŠk 1M0572; GA MŠk 2C06001 Institutional research plan: CEZ:AV0Z10750506 Keywords : Quantitative lymphoscintigraphy * Secondary lymphedema of upper limbs * Staging * Bayesian evaluation * Probabilistic mixtures Subject RIV: BB - Applied Statistics, Operational Research Impact factor: 1.269, year: 2009 http://library.utia.cas.cz/separaty/2009/AS/karny-0320214.pdf
Ryan R. Bailey, MSOT, OTR/L; Catherine E. Lang, PT, PhD
The goal of physical rehabilitation following upper-limb (UL) impairment is functional restoration of the UL for use in daily activities. Because capacity for UL function may not translate into real-world activity, it is important that assessment of real-world UL activity be used in conjunction with clinical measures of capacity. Accelerometry can be used to quantify duration of UL activity outside of the clinic. The purpose of this study was to characterize hours of UL activity and potential...
Full Text Available Kimura disease is a rare chronic inflammatory disease of unknown etiology. The disease typically presents in young Asian males with single or multiple slowly progressing painless subcutaneous lumps in the head and neck region; regional lymphadenopathy is commonly accompanied. The disease is associated with peripheral blood eosinophilia and elevated serum immunoglobulin E levels. This gives an important clinical clue to the diagnosis and implies a possible immune-mediated pathophysiology. Although the disease commonly affects the head and neck region, it may also affect the extremities, axilla, groin, and abdomen. Upper limb involvement in Kimura’s disease is rare and few cases have been reported in the literature. We describe the case of a man who presented with a history of progressive upper limb swelling. He was diagnosed with Kimura’s disease based on concordant clinical, laboratory, radiological, and histopathological grounds. Although rare in the upper limb, the possibility of Kimura’s disease has to be considered in young males presenting with painless swelling in the medial epitrochlear region with compatible imaging appearance, particularly if associated with lymph node enlargement and increased blood eosinophils. Characteristic imaging findings of Kimura’s disease of the upper limb include specific location along the neuro-lymphovascular structures, the absence of necrosis or calcification, mutliple flow voids representing vascular structures, a varying amount of edema of subcutaneous fat plane overlying the lesion; displacement of adjacent muscles; and neurovascular structures without signs of direct invasion. Clinicians should be aware of this distinct entity in order to avoid misdiagnosis and to tailor appropriate management.
Tyrrell, P.; Rossor, M
Ten patients with gegenhalten of the upper limb of mixed aetiology were studied, in nine of whom an association with dyspraxia was found. In four of the patients, the rigidity became more pronounced after the instruction to relax, and only one patient showed improvement after this instruction. In these patients, the resistance to movement, evident as gegenhalten, may be a direct consequence of the dyspraxia.
Tyrrell, P; Rossor, M
Ten patients with gegenhalten of the upper limb of mixed aetiology were studied, in nine of whom an association with dyspraxia was found. In four of the patients, the rigidity became more pronounced after the instruction to relax, and only one patient showed improvement after this instruction. In these patients, the resistance to movement, evident as gegenhalten, may be a direct consequence of the dyspraxia. PMID:3204407
Cassileth, Barrie R.; Van Zee, Kimberly J.; Yeung, K. Simon; Coleton, Marci I.; Cohen, Sara; Chan, Yi H; Andrew J Vickers; Sjoberg, Daniel D.; Hudis, Clifford A.
BACKGROUND Current treatments for lymphedema after breast cancer treatment are expensive and require ongoing intervention. Clinical experience and our preliminary published results suggest that acupuncture is safe and potentially useful. This study evaluates the safety and potential efficacy of acupuncture on upper-limb circumference in women with lymphedema. METHODS Women with a clinical diagnosis of breast cancer−related lymphedema (BCRL) for 0.5-5 years and with affected arm circumference ...
Cordella, Francesca; Ciancio, Anna Lisa; Sacchetti, Rinaldo; Davalli, Angelo; Cutti, Andrea Giovanni; Guglielmelli, Eugenio; Zollo, Loredana
The loss of one hand can significantly affect the level of autonomy and the capability of performing daily living, working and social activities. The current prosthetic solutions contribute in a poor way to overcome these problems due to limitations in the interfaces adopted for controlling the prosthesis and to the lack of force or tactile feedback, thus limiting hand grasp capabilities. This paper presents a literature review on needs analysis of upper limb prosthesis users, and points out ...
Thoracodorsal artery perforator flap (TAP) is a feasible option to reconstruct defects in upper limb where only skin and subcutaneous tissue is required. Methods: This case series was carried out at department of Plastic and Reconstructive Surgery Combined Military Hospital Rawalpindi. A total of 5 patients with upper limb defects were reconstructed with thoracodorsal artery musculocutaneous perforator flaps. Among them, 3 were pedicled and two free TAP flaps. All flaps except one pedicled flap were raised on a single perforator pedicle. Recipient sites were one axilla, two shoulder regions and two hands. The soft tissue defects in the patients had resulted from burns, trauma, wide local excision of synovial sarcoma and surgery for hidradenitis suppurativa. Preoperative hand held Doppler ultrasound was used to locate and mark the perforator. Results: All flaps survived without significant complications. All flaps were hyperemic in the immediate postoperative period. We designed and raised all the five flaps on eccentrically placed perforators. All the raised perforators originated from the descending branch of the thoracodorsal artery. The donor sites were closed primarily with linear scars in all cases except one, in which partial closure was accomplished with split thickness skin grafting (STSG). Conclusion: The thoracodorsal artery perforator flap has great potential for reconstructing large, relatively shallow, defects of upper limb because of its suitable skin quality, texture and appropriate thickness, as well as hidden donor site, a reliable pedicle and sparing of muscle unit. (author)
Full Text Available Erysipelas of upper limb is a well-known complication following breast cancer therapy, but few cases are reported in the literature. We undertook a 5-year retrospective study at the Department I of Infectious Diseases. For each patient we recorded the age, past medical history, clinical findings, laboratory parameters, treatment, outcome and recommended prophylaxis. From 145 erysipelas identified, 12 cases were erysipelas of upper limb. All patients had a breast surgery and lymphadectomy. The erysipelas appeared with an average of 5.5 years after cancer treatment. Associated pathology: obesity (5 cases, diabetes (6 cases and thrombophlebitis (1 case. Lymphedema was noticed in 9 patients and the site of involvement was the homolateral upper limb of the treated breast. The diagnosis of erysipelas was essentially clinical. The clinical aspect was an inflammatory plaque with raised edges in 7 cases, blisters, cellulitis and purpura in one case, respectively. The portal of entry was not found in 6 cases. Laboratory parameters: increased leucocytes with predominance of neutrophils (4; normal white count (5 and leucopenia (3; the erythrocyte sedimentation rate and fibrinogen elevated in 5 cases; CRP levels elevated in 8 cases. The most commonly used antibiotic was penicillin G intravenous route of administration. The outcome was favorable for all the patients. At discharge, prophylactic treatment was recommended for all the patients. In three of our patient, despite the prophylaxis, recurrences occurred with a frequency of 3-6 episodes in 5 years. All these patients displayed an immune suppressive status with decreased CD4+.
Lin Zhu; Lin Liu; Weiqun Song
BACKGROUND:The main aim of rehabilitation is to ameliorate motor function and use the damaged limbs in the activities of daily living.Several factors are needed in the self-recovery of the patients,and the most important one is to reduce spasm.Some mechanical repetitive movements can affect and change the excitability of motor neurons.OBJECTIVE:To observe the effect of repetitive training on ameliorating spasm of upper limbs of hemiplegic patients.DESIGN:A self-controlled observation before and after training.SETTING:Department of Rehabilitation,Xuanwu Hospital of Capital Medical University.PARTICI PANTS: Seven hemiplegic patients induced by brain injury were selected from the Department of Rehabilitation,Xuanwu Hospital,Capital Medical University from March to June in 2005.Inclusive criteria:①Agreed and able to participate in the 30-minute training of hand function; ②Without disturbance of understanding.The patients with aphasia or apraxia,manifestation of shoulder pain,and severe neurological or mental defects.For the 7 patients,the Rivermead motor assessment(RMA)scores ranged 0-10 points,the Rivermead mobility index(RMI)ranged 1-3,and modified Ashworth scale(MAS)was grade 2-4.Their horizontal extension of shoulder joint was 0°-30°,anteflextion was 0°-50°,internal rotation was 50°-90°,external rotation was 0°-10°:and the elbow joint could extend for 15°-135°.METHODS:The viva 2 serial MOTOmed exerciser(Reck Company,Germany)was used.There were three phases of A-B-A.①The phase A lasted for 1 week.The patient sat on a chair facting to the MOTOmed screen.and did the circumduction of upper limbs forwardly,30 minutes a day and 5 days a week.②The phase B lasted for 3 weeks.The training consisted of forward circumduction of upper limbs for 15 minutes.followed by backward ones for 15 minutes and 5-minute rest.③The training in the phase A was performed again for 2 weeks.The extensions of upper limbs were recorded at phase A,the extension and flexion of
Fernando Max Lima
Full Text Available This study aimed to identify useful electronic grip dynamometry parameters to track differences between trained (TR and untrained (UT participants, and between dominant (DO and non-dominant (ND limbs as a consequence of upper limbs muscle fatigue following 10 RM tests of the brachial biceps. This experimental study with transversal design involved 18 young adult males, of whom 9 were untrained and 9 were experienced in resistance training.Isometric grip force was evaluated (30 seconds long previous and after 10RM tests by means of a G200 Model grip dynamometer with precision load cell (Biometrics(r. Significant differences between initial and final measurements were found only for trained participants: Peak force for TR-DO (67.1 vs 55.5 kgf, p = .0277; Raw average for TR-DO (46.96 vs 42.22 kgf, p = .0464, and for TR-ND (40.34 vs 36.13 kgf, p = .0277. Electronic grip dynamometry efficiently identified upper limbs fatigue in trained participants, being raw average measurements the best parameter.
Pratiksha Tilak Rao
Full Text Available Aims: Response time (RT, that is, the time taken to respond is known to be delayed in children with Down syndrome (DS. We performed a pilot study to evaluate whether bilateral limb training can be used to train RT, in children with DS. Settings and Design: 10 children with DS (5 males were recruited from a special school in a suburban region using convenience sampling. Subjects and Methods: Response time was measured using an indigenously developed RT Analyzer, before and after intervention, from right and left hand. Structured bilateral limb training was given for a period of 4 weeks, using low-cost, locally available materials, in community settings. Statistical Analysis Used: The Wilcoxon signed ranks test was used for statistical analysis. Results: Significant improvements in RT following 4 weeks of intervention were seen in the left hand (P = 0.006 but not in the right hand (P = 0.104. Conclusions: Response time can be trained in children with DS using 4 weeks of bilateral limb training activities using low-cost, locally available materials.
Full Text Available The paper is devoted to a survey on the state of the art of elements and parts for the upper limb rehabilitation. As a matter of fact, the use of technological, and specifically of robotic, devices is entering in the habits of clinical approaches, due to their ability to work efficiently and to be able to obtain, at least, the same rehabilitation results of manual therapy. At the same time, the therapists can change his/her role in rehabilitation activity from a physical contribution to an intellectual/motivational one.
Yan Kun; Chernev Ivan; Wilcher Delia G
Abstract Introduction Phantom limb sensation and phantom limb pain is a very common issue after amputations. In recent years there has been accumulating data implicating 'mirror visual feedback' or 'mirror therapy' as helpful in the treatment of phantom limb sensation and phantom limb pain. Case presentation We present the case of a 24-year-old Caucasian man, a left upper limb amputee, treated with mirror visual feedback combined with auditory feedback with improved pain relief. Conclusion Th...
Cordella, Francesca; Ciancio, Anna Lisa; Sacchetti, Rinaldo; Davalli, Angelo; Cutti, Andrea Giovanni; Guglielmelli, Eugenio; Zollo, Loredana
Cordella, Francesca; Ciancio, Anna Lisa; Sacchetti, Rinaldo; Davalli, Angelo; Cutti, Andrea Giovanni; Guglielmelli, Eugenio; Zollo, Loredana
This paper provides an initial debate on the use of eponyms used in trauma imaging. This is followed by a review of common and interesting eponyms associated with upper limb trauma. The origin of these eponyms, which are still used in clinical practice, is often unclear or not actually attributed to the originator of the fracture type. Trauma eponyms are considered within this paper from the distal to the proximal aspect of the upper limb. A brief biography of famous eponymous surgeons gives insight and background to their work and professional achievements. Each fracture is then described briefly, supported by the relevant image and a concise summary of a radiological report. Since accuracy and conciseness are essential elements of any medical communication, the use of terms that are well understood further facilitate clarity. For this reason some knowledge of the originator and a full description of the eponymic fracture, plus its etymology, is still an essential part of clinical and radiographic teaching. This paper also argues that the radiographic report should always describe soft tissue and bony injuries with the concise use of standard anatomic radiographic terminology.
Wosnitzka, M; Papenhoff, M; Reinersmann, A; Maier, C
This case study is the first to report successful treatment of bilateral phantom limb pain (PLP) in a patient with bilateral thigh amputation and inefficacious medical treatment using a protocol of graded interventions including mirror therapy (MT). MT is a common treatment for PLP but requires the induction of a visual illusion of an intact limb in the mirror, usually achieved by mirroring the healthy extremity. Here, we illustrate how application of a unilateral prosthesis sufficed to induce the necessary illusion. After sequential imagery, then lateralization training, which alleviated pain attacks, the patient received a further 3-week treatment of mirror treatment. Pain intensity was reduced by more than 85 %; the number of attacks were decreased by more than 90% per day. The analgesic efficacy lasted until the unexpected death of the patient several months later. This case illustrates the mechanisms of MT through overcoming the sensory incongruences underlying the distorted body schema and its efficacy in patients with bilateral amputation. PMID:25392090
Wu, Guojun; Xu, Hao; Zhou, Wenhong; Yuan, Xianshun; Yang, Zhe; Yang, Qing; Ding, Feng; Meng, Zhigang; Liang, Weili; Geng, Chong; Gao, Ling; Tian, Xingsong
Objective: This study is to establish the rhesus monkey model of lymphedema in the upper limbs, and assess the suitability of this model. Methods: An animal model of lymphedema was established by the combined irradiation and surgical techniques in the upper limbs of these rhesus monkeys. Physical examination, high-resolution MR lymphangiography, bioelectrical impedance analysis (BIA), and immunohistochemical staining were performed to determine the severity of the edema in the upper limbs of ...
Moon, Hyo-Bin; Park, Seung-Jae; Kim, Al-Chan; Jang, Jee-Hun
The purpose of this study was to identify the characteristics of muscular strength in upper limb and to present the preliminary information for development of sports injury prevention program and exercise rehabilitation program in wheelchair tennis players. Participants were 12 male wheelchair tennis players. Muscular strength was measured in shoulder and elbow joints with isokinetic dynamometer. Ipsilateral (IR) and bilateral (BR) balance ratio were calculated with isokinetic strength at 60°/sec. As a result, extension strength (ES) was significantly higher than flexion strength (FS) (Ptennis players. It is suggested that flexor strengthening program in nondominant shoulder joint, extensor strengthening program in both elbow joint, and flexor strengthening program in non-dominant elbow joint should be introduced for male wheelchair tennis players. PMID:24278887
Dreyfuss, Daniel; Elbaz, Avi; Mor, Amit; Segal, Ganit; Calif, Edward
Casting of the arm may interfere with normal walking patterns because of additional load of the cast or prevention of arm swing. This study aimed to determine the effect of applying various casts on temporospatial walking parameters, including gait velocity and cadence, step length, and single limb support. A computerized gait system was used to assess these variables for 23 healthy individuals in four walking modes: normal walking, with a cast above the elbow and a sling, and with a cast below the elbow, with and without a sling. Thirteen participants had their dominant hand casted and 10 had their nondominant hand casted. On average, casted participants took significantly smaller steps with the leg on the casted side and spent less time supported on the casted side. The least changes were noted with the arm in a cast below the elbow and no sling, and the greatest changes were noted with the arm in a cast above the elbow and in a sling. This difference was heightened when the dominant hand was casted and lessened when the nondominant hand was casted. No differences were found in walking velocity or cadence between the walking modes. Casting of the upper limb has significant effects on gait, which should be taken into consideration, especially in individuals with previous gait abnormalities. PMID:26855024
Consistent with the Committee on Publication Ethics guidelines, we the above authors are initiating the retraction of our paper: Young DA, Blake DF, Brown LH: Transcutaneous oximetry measurement: normal values for the upper limb. Diving Hyperb Med. 2012;42(4):208-213. We wish to make the following statement: "The authors voluntarily retract this article after discovering a critical error associated with the instrumentation used in the study, namely the fitting of incorrect sensor membranes on the electrodes of the transcutaneous oximetry device used in the study. This resulted in transcutaneous oxygen tension (PtcO₂) measurements that were consistently lower than those that would have been recorded with the correct electrode membranes in place. We recently confirmed this by comparing the two membrane types once we discovered the error. We are in the process of replicating our work using the correct PtcO₂ specific membranes." PMID:27044465
Pathak, Yagna; Johnson, Michelle
Robot therapy has emerged in the last few decades as a tool to help patients with neurological injuries relearn motor tasks and improve their quality of life. The main goal of this study was to develop a simple model of the human arm for children affected with cerebral palsy (CP). The Simulink based model presented here shows a comparison for children with and without disabilities (ages 6-15) with normal and reduced range of motion in the upper limb. The model incorporates kinematic and dynamic considerations required for activities of daily living. The simulation was conducted using Matlab/Simulink and will eventually be integrated with a robotic counterpart to develop a physical robot that will provide assistance in activities of daily life (ADLs) to children with CP while also aiming to improve motor recovery. PMID:23366294
Andersen, L V; Mortensen, L S; Lindholt, Jes S.; Faergeman, O; Henneberg, Eskild Winther; Frost, L
We investigated the incidence of thrombo-embolectomy in upper-limb and prognosis with respect to arm amputation, stroke and death.......We investigated the incidence of thrombo-embolectomy in upper-limb and prognosis with respect to arm amputation, stroke and death....
Lynsay R. Whelan; Wagner, Nathan
While over 1.5 million individuals are living with limb loss in the United States (Ziegler-Graham et al., 2008), only 10% of these individuals have a loss that affects an upper limb. Coincident with the relatively low incidence of upper limb loss, is a shortage of the community-based prosthetic rehabilitation experts that can help prosthetic users to more fully integrate their devices into their daily routines. This article describes how expert prosthetists and occupational therapists at Touc...
Non-melanomatous skin cancers represent 80% of all newly diagnosed cancers in Australia with basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) being the most common. A previously healthy 71-year-old woman presented with widespread and tender superficial skin cancers on the lower bilateral limbs. External beam radiation therapy through the use of intensity-modulated radiation therapy (IMRT) was employed as the treatment modality of choice as this technique provides conformal dose distribution to a three-dimensional treatment volume while reducing toxicity to surrounding tissues. The patient was prescribed a dose of 60 Gy to the planning target volume (PTV) with 1.0 cm bolus over the ventral surface of each limb. The beam arrangement consisted of six treatment fields that avoided entry and exit through the contralateral limb. The treatment plans met the International Commission on Radiation Units and Measurements (ICRU) guidelines and produced highly conformal dosimetric results. Skin toxicity was measured against the National Cancer Institute: Common Terminology Criteria for Adverse Events (NCI: CTCAE) version 3. A well-tolerated treatment was delivered with excellent results given the initial extent of the disease. This case study has demonstrated the feasibility and effectiveness of IMRT for skin cancers as an alternative to surgery and traditional superficial radiation therapy, utilising a complex PTV of the extremities for patients with similar presentations
Fitzgerald, Emma, E-mail: firstname.lastname@example.org; Miles, Wesley; Fenton, Paul; Frantzis, Jim [Radiation Oncology, Epworth HealthCare, Victoria (Australia)
Non-melanomatous skin cancers represent 80% of all newly diagnosed cancers in Australia with basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) being the most common. A previously healthy 71-year-old woman presented with widespread and tender superficial skin cancers on the lower bilateral limbs. External beam radiation therapy through the use of intensity-modulated radiation therapy (IMRT) was employed as the treatment modality of choice as this technique provides conformal dose distribution to a three-dimensional treatment volume while reducing toxicity to surrounding tissues. The patient was prescribed a dose of 60 Gy to the planning target volume (PTV) with 1.0 cm bolus over the ventral surface of each limb. The beam arrangement consisted of six treatment fields that avoided entry and exit through the contralateral limb. The treatment plans met the International Commission on Radiation Units and Measurements (ICRU) guidelines and produced highly conformal dosimetric results. Skin toxicity was measured against the National Cancer Institute: Common Terminology Criteria for Adverse Events (NCI: CTCAE) version 3. A well-tolerated treatment was delivered with excellent results given the initial extent of the disease. This case study has demonstrated the feasibility and effectiveness of IMRT for skin cancers as an alternative to surgery and traditional superficial radiation therapy, utilising a complex PTV of the extremities for patients with similar presentations.
Perera M M N; Nanayakkarawasam P P; Katulanda P
Background: Burn is an injury cause destruction of skin and underling tissue. Post burns complications are severe. Objective of this study is to identify the effects on the Active Range of Motion (AROM) of upper limb/s, hand functions and Activities of Daily Living (ADL) who attend the physical therapy department of burns unit. Methodology: It was a descriptive cross sectional study carried out at out-patient physical therapy department of burns unit of National Hospital of SriLanka (NHS...
Shalev, S.A.; Dar, H.; Barel, H.; Borochowitz, Z. [Bnai Zion Medical Center, Haifa (Israel)
We read with interest the report of Cormier-Daire et al. in a recent issue of the journal, describing upper limb malformations in DiGeorge syndrome. We observed a family with this group of rare clinical expression of chromosome 22q11 deletions. The proposita was examined in our clinic when she was 4 years old. She was mildly mentally retarded. Clinical evaluation showed normal growth, long thin nose with squared tip, nasal speech, and abundant scalp hair and no cardiac anomalies. The girl was accompanied by her mother. Facial similarities were noted between the two. The mother reported to be treated with oral calcium due to hypoparathyroidism, diagnosed several years ago. Clinical evaluation showed wide flat face, short stature, mild mental retardation, slight hypertelorism, peculiar nose similar to her daughter`s, and nasal speech. No cardiac anomalies were found. Recently, a brother was born. Clinical examination documented large ventriculo-septal defect, retrognathia, narrow palpebral fissures, and long thin nose with squared tip. 1 ref.
Premalatha, G D; Noor Hassim, I
A total of 323 workers from 5 different occupational groups in the telecommunication industry were studied in this cross sectional study, which sought to determine the prevalence of Work Related Upper Limb Disorders (WRULD) in 5 occupational groups; operators using the Video Display Terminals, switchboard operators, clerks, data entry processors and the supervisors. WRULD was also studied with regard to factors such as sex, race, height, age, stress and the discomfort perceived due to the work station design. The possibility of WRULD was determined from a self-administered questionnaire and confirmed by history and physical examination. Psychological stress and the discomfort due to the workstation were measured from the questionnaire. The overall prevalence was found to be 31.2% and the prevalence among the various occupations differed with it being the highest in the switchboard operators and data processors and the lowest in the supervisors. The older workers and the female workers were found to have higher prevalences of WRULD. It was also found that a higher stress score and a higher score of discomfort perceived at the work station were associated with higher prevalences of WRULD. PMID:10972037
Moscato, T A; Orlandini, D
Since pre-history until modern times, the ever more refined use of the hand has been fundamental to the progress of mankind. The list of functions of this incredible part of the body would fill several pages and show its fundamental importance in all our actions; in fact, there is very little that humans do that does not involve the use of the hands. The hand offers points for unlimited dissertation and is the executive organ par excellence, carrying out directly or participating in almost all our actions; it is an organ for communication and an instrument of well-being as well as being the main site of one of the five senses: touch. On this background, attention will be focused on the importance that the hand plays in daily life and, particularly, on the difficulties inevitably faced by people who are forced to live without a hand, even if replaced by an orthopaedic prosthesis. This is the sense of occupational therapy in the context of upper limb amputees. PMID:21438258
Full Text Available Stroke is a leading cause of disability worldwide. In this paper, a novel robot‐assisted rehabilitation system based on motor imagery electroencephalography (EEG is developed for regular training of neurological rehabilitation for upper limb stroke patients. Firstly, three‐dimensional animation was used to guide the patient image the upper limb movement and EEG signals were acquired by EEG amplifier. Secondly, eigenvectors were extracted by harmonic wavelet transform (HWT and linear discriminant analysis (LDA classifier was utilized to classify the pattern of the left and right upper limb motor imagery EEG signals. Finally, PC triggered the upper limb rehabilitation robot to perform motor therapy and gave the virtual feedback. Using this robot‐assisted upper limb rehabilitation system, the patientʹs EEG of upper limb movement imagination is translated to control rehabilitation robot directly. Consequently, the proposed rehabilitation system can fully explore the patientʹs motivation and attention and directly facilitate upper limb post‐stroke rehabilitation therapy. Experimental results on unimpaired participants were presented to demonstrate the feasibility of the rehabilitation system. Combining robot‐assisted training with motor imagery‐ based BCI will make future rehabilitation therapy more effective. Clinical testing is still required for further proving this assumption.
Ponsen, Mirthe M; Daffertshofer, Andreas; Wolters, Erik Ch; Beek, Peter J; Berendse, Henk W
The aim of the present study was to evaluate complex upper limb motor function in newly diagnosed, untreated Parkinson's disease (PD) patients. Four different unimanual upper limb motor tasks were applied to 13 newly diagnosed, untreated PD patients and 13 age- and sex-matched controls. In a handwriting task, PD patients had significantly reduced sentence length and writing velocity, and decreasing letter height in the course of writing. Furthermore, PD patients performed an aiming task slower with than without target, and showed increased transposition in a pointing task. The results of this study extend previous observations of impaired complex upper limb movements to newly diagnosed, untreated PD patients. PMID:17913560
Full Text Available Hand and upper limb traumatic injuries are common presenting pathology in the emergency department. Extensive trauma patients approach is standardized and internationally accepted guidelines are followed. The care for the traumatic injury is secondary to the patient’s general status stabilization. After debridement, lesions inventory is made and priority is established according to their gravity. Flap surgery is a ubiquitous strategy in soft tissue reconstruction. Extensive soft tissue defects, especially over exposed bones, joints, vessels and nerves, need immediate coverage with well-vascularized tissues. Besides the obvious reason for saving critical anatomical structure, is the only way to maximize the chances for functional recovery. One-stage reconstruction, even for complex defects, is possible due to flaps versatility. Composite tissue transfer, including two three or more types of tissues, can successfully address combined bone, muscle, vessels, nerves or skin loss. The best example is the subscapular system, which offers no less than 5 different tissues and wide combinations of flaps. Even if the procedure per se involves large human, technical and financial resources, on a long term it was proved to be cost-effective, in reducing number of operations, hospital stay and rehabilitation time. Muscle flaps share first place in soft tissue reconstruction with the fasciocutaneous flaps. Yet, in functional reconstruction or in combined defects in need for composite flaps, nothing can beat the muscle flaps. In our hands, muscles flaps and the omentum are the workhorse for soft tissue and/or combined defects reconstruction. Pedicled latissimus dorsi can cover tissue defects from shoulder down to the elbow, but also reconstruct the function of shoulder muscles or totally or partially biceps or triceps loss, with minimal or no donor-site functional deficit. Whenever defects are more distal, free flap transfers are needed for optimal
Mirbagheri Mehdi M
Full Text Available Abstract Background While upper-extremity movement in individuals with neurological disorders such as stroke and spinal cord injury (SCI has been studied for many years, the effects of spasticity on arm movement have been poorly quantified. The present study is designed to characterize the nature of impaired arm movements associated with spasticity in these two clinical populations. By comparing impaired voluntary movements between these two groups, we will gain a greater understanding of the effects of the type of spasticity on these movements and, potentially a better understanding of the underlying impairment mechanisms. Methods We characterized the kinematics and kinetics of rapid arm movement in SCI and neurologically intact subjects and in both the paretic and non-paretic limbs in stroke subjects. The kinematics of rapid elbow extension over the entire range of motion were quantified by measuring movement trajectory and its derivatives; i.e. movement velocity and acceleration. The kinetics were quantified by measuring maximum isometric voluntary contractions of elbow flexors and extensors. The movement smoothness was estimated using two different computational techniques. Results Most kinematic and kinetic and movement smoothness parameters changed significantly in paretic as compared to normal arms in stroke subjects (p Conclusion The findings suggest that although the cause and location of injury are different in spastic stroke and SCI subjects, the impairments in arm voluntary movement were similar in the two spastic groups. Our results also suggest that the non-paretic arm in stroke subjects was not distinguishable from the normal, and might therefore be used as an appropriate control for studying movement of the paretic arm.
McClanahan, Barbara S; Harmon-Clayton, Karen; Ward, Kenneth D; Klesges, Robert C; Vukadinovich, Christopher M; Cantler, Edwin D
This cross-sectional study investigated the effects of participation in various sports on side-to-side (contralateral) differences in bone mineral density (BMD) of the upper and lower limbs. The BMD of the arms and legs was measured using dual energy X-ray absorptiometry. The subjects were 184 collegiate athletes, both men and women, who participated in NCAA Division I-A baseball, basketball, football, golf, soccer, tennis, cross-country, indoor/outdoor track, and volleyball. Results revealed greater BMD of the right arms compared with the left arms for all teams, with the most pronounced differences observed in men's and women's tennis and men's baseball. Differences in the lower limbs were less common. No significant differences in lower limb BMD were found in the women. In men, differences in lower limb BMD were found in the football and tennis teams, with the nondominant leg having greater bone mass. Recognition of contralateral differences in bone density may be of particular interest to strength and conditioning professionals as they consider the need to include bilateral and unilateral training programs in an effort to maximize performance and minimize stress-related injuries. PMID:12423190
Entrapment neuropathies, particularly those affecting upper limbs, are common reasons for referral for nerve conduction studies (NCS). However, concordance between clinical findings and NCS findings, especially in patients being considered for intervention including decompressive surgery, has not been assessed.
Liu, Ting; Jensen, Jody L.
Bilateral asymmetry, a form of limb laterality in the context of moving two limbs, emerges in childhood. Children and adults show lateral preference in tasks that involve the upper and lower limbs. The importance of research in limb laterality is the insight it could provide about lateralized functions of the cerebral hemispheres. Analyzing…
Introduction: Prostheses for upper-limb amputees are currently controlled by either myoelectric or peripheral neural signals. Performance and dexterity of these devices is still limited, particularly when it comes to controlling hand function. Movement-related brain activity might serve as a complementary bio-signal for motor control of hand prosthesis. Methods: We introduced a methodology to implant a cortical interface without direct exposure of the brain surface in an upper-limb amputee. T...
Pérez-Mármol, Jose Manuel; García-Ríos, Mª Carmen; Barrero-Hernandez, Francisco J.; Molina-Torres, Guadalupe; Brown, Ted; Aguilar-Ferrándiz, María Encarnación
Background Upper limb apraxia is a common disorder associated with stroke that can reduce patients’ independence levels in activities of daily living and increase levels of disability. Traditional rehabilitation programs designed to promote the recovery of upper limb function have mainly focused on restorative or compensatory approaches. However, no previous studies have been completed that evaluate a combined intervention method approach, where patients concurrently receive cognitive trainin...
Fenga, C; Rapisarda, V; Valentino, M; Cacciola, A; Deboli, R; Calvo, A; Germanò, D
Vibration exposure of the hand-arm system is associated with an increased risk of upper-limb vascular, neurological and musculoskeletal lesions, or hand-arm vibration syndrome (HAVS). The prevalence of occupational HAVS and upper-limb disorders was studied among 278 Forestry Service workers in Sicily and Calabria. Subjects who used chain-saws (18 weeks/year) had a greater prevalence of peripheral sensory-neural disturbances (28%), upper-limb musculoskeletal disorders (33%) and carpal tunnel syndrome (19%) compared with 260 manual workers from the same Corps not exposed to hand-transmitted vibration. Raynaud's phenomenon was comparable in exposed and control subjects (5.3% vs. 4.7%.) Upper-limb neuropathies were significantly associated with energy-equivalent frequency-weighted acceleration; exposure duration; and cumulative vibration dose (m2/s4h). The variable "years of work with vibrating tools" was strongly associated with peripheral neuropathies; carpal tunnel syndrome; and upper-limb musculotendinous syndromes. Data suggest that in Sicily and Calabria, where the climate is milder than in other areas of Italy, forestry work with hand-held vibrating tools does not entail a greater prevalence of peripheral vascular disorders (Raynaud's phenomenon), while the prevalence of occupational upper-limb neurological and musculoskeletal disorders, in which combined ergonomic and mechanical risk factors have a large pathogenic role, is significantly increased. PMID:18409849
Lynsay R. Whelan; Nathan Wagner
While over 1.5 million individuals are living with limb loss in the United States (Ziegler-Graham et al., 2008), only 10% of these individuals have a loss that affects an upper limb. Coincident with the relatively low incidence of upper limb loss, is a shortage of the community-based prosthetic rehabilitation experts that can help prosthetic users to more fully integrate their devices into their daily routines. This article describes how expert prosthetists and occupational therapis...
Lyu, Yuanyuan; Guo, Xiaoli; Bekrater-Bodmann, Robin; Flor, Herta; Tong, Shanbao
A potential contributor to impaired motor imagery in amputees is an alteration of the body schema as a result of the presence of a phantom limb. However, the nature of the relationship between motor imagery and phantom experiences remains unknown. In this study, the influence of phantom limb perception on motor imagery was investigated using a hand mental rotation task by means of behavioral and electrophysiological measures. Compared with healthy controls, significantly prolonged response time for both the intact and missing hand were observed specifically in amputees who perceived a phantom limb during the task but not in amputees without phantom limb perception. Event-related desynchronization of EEG in the beta band (beta-ERD) in central and parietal areas showed an angular disparity specifically in amputees with phantom limb perception, with its source localized in the right inferior parietal lobule. The response time as well as the beta-ERD values were significantly positively correlated with phantom vividness. Our results suggest that phantom limb perception during the task is an important interferential factor for motor imagery after amputation and the interference might be related to a change of the body representation resulting from an unnatural posture of the phantom limb. PMID:26879749
Yuanyuan Lyu; Xiaoli Guo; Robin Bekrater-Bodmann; Herta Flor; Shanbao Tong
A potential contributor to impaired motor imagery in amputees is an alteration of the body schema as a result of the presence of a phantom limb. However, the nature of the relationship between motor imagery and phantom experiences remains unknown. In this study, the influence of phantom limb perception on motor imagery was investigated using a hand mental rotation task by means of behavioral and electrophysiological measures. Compared with healthy controls, significantly prolonged response ti...
Cassar, Kevin; Camilleri, Kenneth P.; De Raffaele, Clifford; Mizzi, Stephen; Cristina, Stefania
Objectives. To collect normative baseline data and identify any significant differences between hand and foot thermographic distribution patterns in a healthy adult population. Design. A single-centre, randomized, prospective study. Methods. Thermographic data was acquired using a FLIR camera for the data acquisition of both plantar and dorsal aspects of the feet, volar aspects of the hands, and anterior aspects of the lower limbs under controlled climate conditions. Results. There is general symmetry in skin temperature between the same regions in contralateral limbs, in terms of both magnitude and pattern. There was also minimal intersubject temperature variation with a consistent temperature pattern in toes and fingers. The thumb is the warmest digit with the temperature falling gradually between the 2nd and the 5th fingers. The big toe and the 5th toe are the warmest digits with the 2nd to the 4th toes being cooler. Conclusion. Measurement of skin temperature of the limbs using a thermal camera is feasible and reproducible. Temperature patterns in fingers and toes are consistent with similar temperatures in contralateral limbs in healthy subjects. This study provides the basis for further research to assess the clinical usefulness of thermography in the diagnosis of vascular insufficiency. PMID:25648145
Dim, EM; Amanari, OC; Nottidge, TE; Inyang, UC; Nwashindi, A
Abstract The human body conducts electricity very well. Direct contact with electric current can be lethal. The passage of electric current through the body is capable of producing a wide spectrum of injuries, including serious damage to the heart, brain, skin and muscles. Naked high-voltage electric cables negligently abandoned in residential, commercial and industrial areas are a recipe for disaster. This is a case report of a 5-year girl child who had bilateral lower limb gangrene followin...
Full Text Available 【Abstract】Fall from height is a common cause of unintentional injuries in children and accounts for 6% of all trauma-related childhood deaths, usually from head injury. We report a case of a 2-year-old child with multiple fractures of the bilateral lower limbs due to this reason. A child fell from a height of around 15 feet after toppling from a alcony. He developed multiple fractures involving the right femoral shaft, right distal femoral epiphysis (Salter Harris type 2, right distal metaphysis of the tibia and fi bula, and undisplaced Salter Harris type 2 epiphyseal injury of the left distal tibia. There were no head, abdominal or spinal injuries. The patient was taken into emergency operation theatre after initial management which consisted of intravenous fl uids, blood transfusion, and splintage of both lower limbs. Fracture of the femoral shaft was treated by closed reduction and fixation using two titanium elastic nails. Distal femoral physeal injury required open eduction and fixation with K wires. Distal tibia fractures were closely reduced and managed nonoperatively in both the lower limbs. All the fractures united in four weeks. At the last follow-up, the child had no disability and was able to perform daily ctivities comfortably. We also proposed the unique mechanism of injury in this report. Key words: Multiple bilateral lower limb fractures; Fall; Child
Full Text Available New motor rehabilitation therapies include virtual reality (VR and robotic technologies. In limb rehabilitation, limb posture is required to (1 provide a limb realistic representation in VR games and (2 assess the patient improvement. When exoskeleton devices are used in the therapy, the measurements of their joint angles cannot be directly used to represent the posture of the patient limb, since the human and exoskeleton kinematic models differ. In response to this shortcoming, we propose a method to estimate the posture of the human limb attached to the exoskeleton. We use the exoskeleton joint angles measurements and the constraints of the exoskeleton on the limb to estimate the human limb joints angles. This paper presents (a the mathematical formulation and solution to the problem, (b the implementation of the proposed solution on a commercial exoskeleton system for the upper limb rehabilitation, (c its integration into a rehabilitation VR game platform, and (d the quantitative assessment of the method during elbow and wrist analytic training. Results show that this method properly estimates the limb posture to (i animate avatars that represent the patient in VR games and (ii obtain kinematic data for the patient assessment during elbow and wrist analytic rehabilitation.
Wu, Tzong-Ming; Chen, Dar-Zen
Resistance training is a popular form of exercise recommended by national health organizations, such as the American College of Sports Medicine (ACSM) and the American Heart Association (AHA). This form of training is available for most populations. A compact design of upper limb exoskeleton mechanism for homebased resistance training using a spring-loaded upper limb exoskeleton with a three degree-of-freedom shoulder joint and a one degree-of-freedom elbow joint allows a patient or a healthy individual to move the upper limb with multiple joints in different planes. It can continuously increase the resistance by adjusting the spring length to train additional muscle groups and reduce the number of potential injuries to upper limb joints caused by the mass moment of inertia of the training equipment. The aim of this research is to perform a preliminary evaluation of the designed function by adopting an appropriate motion analysis system and experimental design to verify our prototype of the exoskeleton and determine the optimal configuration of the spring-loaded upper limb exoskeleton.
Human motion capture technologies are widely used in interactive game and learning, animation, film special effects, health care, and navigation. Because of the agility, upper limb motion estimation is the most difficult problem in human motion capture. Traditional methods always assume that the movements of upper arm and forearm are independent and then estimate their movements separately; therefore, the estimated motion are always with serious distortion. In this paper, we propose a novel ubiquitous upper...
Full Text Available Abstract Introduction Phantom limb sensation and phantom limb pain is a very common issue after amputations. In recent years there has been accumulating data implicating 'mirror visual feedback' or 'mirror therapy' as helpful in the treatment of phantom limb sensation and phantom limb pain. Case presentation We present the case of a 24-year-old Caucasian man, a left upper limb amputee, treated with mirror visual feedback combined with auditory feedback with improved pain relief. Conclusion This case may suggest that auditory feedback might enhance the effectiveness of mirror visual feedback and serve as a valuable addition to the complex multi-sensory processing of body perception in patients who are amputees.
Kooijman, CM; Dijkstra, PU; Geertzen, JHB; Elzinga, A; Van Der Schans, CP
Phantom pain in subjects with an amputated limb is a well-known problem. However, estimates of the prevalence of phantom pain differ considerably in the literature. Various factors associated with phantom pain have been described including pain before the amputation, gender, dominance, and time elapsed since the amputation. The purposes of this study were to determine prevalence and factors associated with phantom pain and phantom sensations in upper limb amputees in The Netherlands. Addition...
Lott, Mary E. J.; Hogeman, Cynthia; Herr, Michael; Bhagat, Monica; Kunselman, Allen; Sinoway, Lawrence I.
The purpose of this study was to examine upper and lower limb vasoconstrictor responses to changes in transmural pressure in humans. Brachial and femoral blood mean blood velocity (MBV) and vessel diameter (Doppler ultrasound) were measured in 20 supine healthy subjects (10 men and 10 women; 27 ± 1 yr; mean ± SE) during four levels of limb suction at −25, −50, −75, and −100 mmHg, respectively. Limb suction led to an initial rise in MBV followed by a rapid fall in flow velocity to a level belo...
Elke Heremans; Evelien Nackaerts; Griet Vervoort; Sarah Vercruysse; Sanne Broeder; Carolien Strouwen; Stephan P Swinnen; Alice Nieuwboer
Background Recent studies show that besides freezing of gait (FOG), many people with Parkinson's disease (PD) also suffer from freezing in the upper limbs (FOUL). Up to now, it is unclear which task constraints provoke and explain upper limb freezing. Objective To investigate whether upper limb freezing and other kinematic abnormalities during writing are provoked by (i) gradual changes in amplitude or by (ii) sustained amplitude generation in patients with and without freezing of gait. Metho...
Full Text Available Purpose: In order to estimate clinical effects of acupotomy and venesection in a patient with peripheral neuropathy and upper limb lymphedema following breast cancer surgery. Methods: From 17th August, 2009 to 29th August 2009, 1 female patient with peripheral neuropathy and upper limb lymphedema following breast cancer surgery was treated with general oriental medicine therapy(acupuncture, moxibustion, cupping, physical therapy, herbal medication and acupotomy with venesection. Results: The patient's chief complaints- Lt hand numbness, Lt arm edema, Lt. wrist flexion limitation - were notably improved. Conclusions : This study demonstrates that oriental medical treatment with acupotomy and venesection therapy has significant effect in improving symptoms of peripheral neuropathy and upper limb lymphedema following breast cancer surgery, as though we had not wide experience in this treatment, more research is needed.
Lynsay R. Whelan
Full Text Available While over 1.5 million individuals are living with limb loss in the United States (Ziegler-Graham et al., 2008, only 10% of these individuals have a loss that affects an upper limb. Coincident with the relatively low incidence of upper limb loss, is a shortage of the community-based prosthetic rehabilitation experts that can help prosthetic users to more fully integrate their devices into their daily routines. This article describes how expert prosthetists and occupational therapists at Touch Bionics, a manufacturer of advanced upper limb prosthetic devices, employ Voice over the Internet Protocol (VoIP videoconferencing software telehealth technologies to engage in remote consultation with users of prosthetic devices and/or their local practitioners. The Touch Bionics staff provide follow-up expertise to local prosthetists, occupational therapists, and other health professionals. Contrasted with prior telephone-based consultations, the video-enabled approach provides enhanced capabilities to benefit persons with upper limb loss. Currently, the opportunities for Touch Bionics occupational therapists to fully engage in patient-based services delivered through telehealth technologies are significantly reduced by their need to obtain and maintain professional licenses in multiple states.
Whelan, Lynsay R; Wagner, Nathan
While over 1.5 million individuals are living with limb loss in the United States (Ziegler-Graham et al., 2008), only 10% of these individuals have a loss that affects an upper limb. Coincident with the relatively low incidence of upper limb loss, is a shortage of the community-based prosthetic rehabilitation experts that can help prosthetic users to more fully integrate their devices into their daily routines. This article describes how expert prosthetists and occupational therapists at Touch Bionics, a manufacturer of advanced upper limb prosthetic devices, employ Voice over the Internet Protocol (VoIP) videoconferencing software telehealth technologies to engage in remote consultation with users of prosthetic devices and/or their local practitioners. The Touch Bionics staff provide follow-up expertise to local prosthetists, occupational therapists, and other health professionals. Contrasted with prior telephone-based consultations, the video-enabled approach provides enhanced capabilities to benefit persons with upper limb loss. Currently, the opportunities for Touch Bionics occupational therapists to fully engage in patient-based services delivered through telehealth technologies are significantly reduced by their need to obtain and maintain professional licenses in multiple states. PMID:25945186
Ackerley, Suzanne J; Byblow, Winston D; Barber, P Alan; MacDonald, Hayley; McIntyre-Robinson, Andrew; Stinear, Cathy M
Background Recovery of upper limb function is important for regaining independence after stroke.Objective To test the effects of priming upper limb physical therapy with intermittent theta burst stimulation (iTBS), a form of noninvasive brain stimulation.Methods Eighteen adults with first-ever chronic monohemispheric subcortical stroke participated in this randomized, controlled, triple-blinded trial. Intervention consisted of priming with real or sham iTBS to the ipsilesional primary motor cortex immediately before 45 minutes of upper limb physical therapy, daily for 10 days. Changes in upper limb function (Action Research Arm Test [ARAT]), upper limb impairment (Fugl-Meyer Scale), and corticomotor excitability, were assessed before, during, and immediately, 1 month and 3 months after the intervention. Functional magnetic resonance images were acquired before and at one month after the intervention.Results Improvements in ARAT were observed after the intervention period when therapy was primed with real iTBS, but not sham, and were maintained at 1 month. These improvements were not apparent halfway through the intervention, indicating a dose effect. Improvements in ARAT at 1 month were related to balancing of corticomotor excitability and an increase in ipsilesional premotor cortex activation during paretic hand grip.Conclusions Two weeks of iTBS-primed therapy improves upper limb function at the chronic stage of stroke, for at least 1 month postintervention, whereas therapy alone may not be sufficient to alter function. This indicates a potential role for iTBS as an adjuvant to therapy delivered at the chronic stage. PMID:26180053
Stephen, Christopher; Munnoch, David Alexander
A 40-year-old woman underwent an elective thyroidectomy for a non-toxic, multinodular goitre. In the early postoperative period, the patient developed a significant unilateral swelling of the right upper limb, which was subsequently confirmed to be lymphoedema. This was eventually treated successfully using liposuction and compression garment therapies. We report the case due to its rarity and present a possible explanation for such an unexpected complication based on known anatomical variations of lymphatic drainage of the upper limb. PMID:27090542
Full Text Available This case study demonstrates the change of sensory cortical representations of the residual parts of the arm in an individual who underwent a trans-humeral amputation and subsequent targeted reinnervation (TR. As a relatively new surgical technique, TR restores a direct neural connection from amputated sensorimotor nerves to specific target muscles. This method has been successfully applied to upper-limb and lower-limb amputees, and has shown effectiveness in regaining control signals via the newly re-innervated muscles. Correspondingly, recent study results have shown that motor representations for the missing limb move closer to their original locations following TR. Besides regaining motor control signals, TR also restores the sensation in the re-innervated skin areas. We therefore hypothesize that TR causes analogous cortical sensory remapping that may return closer to their original locations. In order to test this hypothesis, cortical activity in response to sensory-level electrical stimulation in different parts of the arm was studied longitudinally in one amputated individual before and up to 2 years after TR. Our results showed that 1 before TR, the cortical response to sensory electrical stimulation in the residual limb showed a diffuse bilateral pattern without a clear focus in either the time or spatial domain; and 2 2 years after TR, the sensory map of the reinnervated median nerve reorganized, showing predominant activity over the contralateral S1 hand area as well as moderate activity over the ipsilateral S1. Therefore, this work provides new evidence for long-term sensory cortical plasticity in the human brain after TR.
Cacho, Enio Walker Azevedo; de Oliveira, Roberta; Ortolan, Rodrigo L.; Varoto, Renato; Cliquet, Alberto
The aim of this study was to correlate clinical and functional evaluations with kinematic variables of upper limp reach-to-grasp movement in patients with tetraplegia. Twenty chronic patients were selected to perform reach-to-grasp kinematic assessment using a target placed at a distance equal to the arm's length. Kinematic variables (hand peak…
De Graaf, J B; Jarrassé, N; Nicol, C; Touillet, A; Coyle, T; Maynard, L; Martinet, N; Paysant, J
After limb amputation, patients often wake up with a vivid perception of the presence of the missing limb, called "phantom limb". Phantom limbs have mostly been studied with respect to pain sensation. But patients can experience many other phantom sensations, including voluntary movements. The goal of the present study was to quantify phantom movement kinematics and relate these to intact limb kinematics and to the time elapsed since amputation. Six upper arm and two forearm amputees with various delays since amputation (6months to 32years) performed phantom finger, hand and wrist movements at self-chosen comfortable velocities. The kinematics of the phantom movements was indirectly obtained via the intact limb that synchronously mimicked the phantom limb movements, using a Cyberglove® for measuring finger movements and an inertial measurement unit for wrist movements. Results show that the execution of phantom movements is perceived as "natural" but effortful. The types of phantom movements that can be performed are variable between the patients but they could all perform thumb flexion/extension and global hand opening/closure. Finger extension movements appeared to be 24% faster than finger flexion movements. Neither the number of types of phantom movements that can be executed nor the kinematic characteristics were related to the elapsed time since amputation, highlighting the persistence of post-amputation neural adaptation. We hypothesize that the perceived slowness of phantom movements is related to altered proprioceptive feedback that cannot be recalibrated by lack of visual feedback during phantom movement execution. PMID:26556065
Peripheral nerve entrapment occurs at specific anatomic locations. Familiarity with the anatomy and the magnetic resonance imaging (MRI) features of nerve entrapment syndromes is important for accurate diagnosis and early treatment of entrapment neuropathies. The purpose of this paper is to illustrate the normal anatomy of peripheral nerves in the upper and lower limbs and to review the MRI features of common disorders affecting the peripheral nerves, both compressive/entrapment and non compressive, involving the supra scapular nerve, the axillary nerve, the radial nerve, the ulnar nerve, and the median verve in the upper limb and the sciatic nerve, the common peroneal nerve, the tibial nerve, and the interdigital nerves in the lower limb
Kwakkel, G.; Meskers, C.G.M.; Van Wegen, E.E.; Lankhorst, G.J.; Geurts, A.C.H.; Van Kuijk, A.A.; Lindeman, E.; Visser-Meily, A.; Vlugt, E.; Arendzen, J.H.
Main claims of the literature are that functional recovery of the paretic upper limb is mainly defined within the first month post stroke and that rehabilitation services should preferably be applied intensively and in a task-oriented way within this particular time window. EXplaining PLastICITy aft
Ángel Gil-Agudo; Ana de los Reyes-Guzmn; Iris Dimbwadyo-Terrer; Benito Peasco-Martn; Alberto Bernal-Sahn; Patricia Lpez-Monteagudo; Antonio del Ama-Espinosa; Jos Luis Pons
Upper limb function impairment is one of the most common sequelae of central nervous system in-jury, especial y in stroke patients and when spinal cord injury produces tetraplegia. Conventional assessment methods cannot provide objective evaluation of patient performance and the effec-tiveness of therapies. The most common assessment tools are based on rating scales, which are inefficient when measuring smal changes and can yield subjective bias. In this study, we designed an inertial sensor-based monitoring system composed of five sensors to measure and analyze the complex movements of the upper limbs, which are common in activities of daily living. We devel-oped a kinematic model with nine degrees of freedom to analyze upper limb and head movements in three dimensions. This system was then validated using a commercial optoelectronic system. These findings suggest that an inertial sensor-based motion tracking system can be used in patients who have upper limb impairment through data integration with a virtual reality-based neurorehabilitation system.
Jacqueline S. Hebert, MD, FRCPC
Full Text Available Motion analysis is an important tool for examining upper-limb function. Based on previous work demonstrating a modified Box and Blocks (BB test with motion capture to assess prosthetic performance, we collected data in 16 nondisabled participants to establish normative kinematics for this test. Four motions of the modified BB test were analyzed to establish kinematic data for upper-limb and trunk motion. The test was repeated for right and left arms in standing and seated positions. Data were compared using a nonparametric Friedman test. No differences were found between right- and left-hand performance other than for task completion time. Small but significant differences were found for standing and seated performance, with slightly greater ranges in standing for axial trunk rotation, medial-lateral sternum displacement, and anterior-posterior hand displacement. The kinematic trajectories, however, were very consistent. The consistency in our nondisabled data suggests that normative kinematic trajectories can be defined for this task. This motion capture procedure may add to the understanding of movement in upper-limb impairment and may be useful for measuring the effect of interventions to improve upper-limb function.
Sequential angioscintigraphy using sup(99m)Tc was performed in patients to evaluate its usefulness in the measurement of deep vein circulation of the upper limb. It proved to provide very good informations about established deep-vein thrombosis and about intermittent venous compression. Several examples are discussed
Bernaards, C.M.; Ariëns, G.A.M.; Simons, M.; Knol, D.L.; Hildebrandt, V.H.
Introduction: The goal of this study was to assess the effectiveness of a group-based interactive work style intervention in improving work style behavior. Methods: Computer workers with neck and upper limb symptoms were randomised into the work style group (WS, N = 152), the work style and physical
Heuvel, S.G. van den; Beek, A.J. van der; Blatter, B.M.; Bonger, P.M.
Examination of the influence of physical exposure at work on neck and upper limb symptoms in office workers. Data were used from a prospective cohort study with a follow-up period of 3 years. Independent variables were physical exposure at work, observed and self-reported. Outcome measures were neck
Pollard Henry P
Full Text Available Abstract Background Golf is a popular past time that provides exercise with social interaction. However, as with all sports and activities, injury may occur. Many golf-related injuries occur in the upper limb, yet little research on the potential mechanisms of these injuries has been conducted. Objective To review the current literature on golf-related upper limb injuries and report on potential causes of injury as it relates to the golf swing. Discussion An overview of the golf swing is described in terms of its potential to cause the frequently noted injuries. Most injuries occur at impact when the golf club hits the ball. This paper concludes that more research into golf-related upper limb injuries is required to develop a thorough understanding of how injuries occur. Types of research include epidemiology studies, kinematic swing analysis and electromyographic studies of the upper limb during golf. By conducting such research, preventative measures maybe developed to reduce golf related injury.
Narendra kumar; Neelam Dogra
We present a case report where thoracic paravertebral block and brachial plexus block were used in a sick elderly patient with poor cardiopulmonary reserve, to cover a post traumatic raw area of the upper limb by raising flap from lateral abdominal wall. The residual raw area of abdomen was then covered with the split skin graft taken from thigh.
Ahmed, Altayeb Abdalla
Sex estimation is the first biological attribute needed for personal identification from mutilated and amputated limbs or body parts in medical-legal autopsies. Populations have different sizes and proportions that affect the anthropometric assessment of sex. Relatively few published works assess the accuracy of sex estimation from soft tissue measurements of upper limb parts, except for the hand and its components, but these studies involve a limited range of global populations. The current study aimed to assess the degree of sexual dimorphism in upper limb measurements and the accuracy of using these measurements for sex estimation in a contemporary adult Sudanese population. The upper arm length, ulnar length, wrist breadth, hand length, and hand breadth of 240 right-handed Sudanese subjects (120 males and 120 females) aged between 25 and 30 years were measured by international anthropometric standards. Demarking points, sexual dimorphism indices and discriminant functions were developed from 200 subjects (100 males and 100 females) who composed the study group. All variables were sexually dimorphic. The ulnar length, wrist breadth and hand breadth significantly contributed to sex estimation. Forearm dimensions showed a higher accuracy for sex estimation than hand dimensions. Cross-validated sex classification accuracy ranged between 78.5% and 89.5%. The reliability of these standards was assessed in a test sample of 20 males and 20 females, and the results showed accuracy between 77.5% and 90%. This study provides new forensic standards for sex estimation from upper limb measurements of Sudanese adults. PMID:24237816
Su, D; Yao, Q
Sirenomelia sequence is a rare lethal pattern of congenital anomalies characterized by fusion of the legs and a variable combination of visceral abnormalities. Some cases accompanied with rare malformations have been reported. In this article, the authors report a case of sirenomelia with upper limb malformations and a review of the literature. PMID:26411229
Barraza Madrigal, José Antonio; Cardiel, Eladio; Rogeli, Pablo; Leija Salas, Lorenzo; Muñoz Guerrero, Roberto
The aim of this study is to assess the suitability of a micro-processing unit of motion analysis (MPUMA), for monitoring, reproducing, and tracking upper limb movements. The MPUMA is based on an inertial measurement unit, a 16-bit digital signal controller and a customized algorithm. To validate the performance of the system, simultaneous recordings of the angular trajectory were performed with a video-based motion analysis system. A test of the flexo-extension of the shoulder joint during the active elevation in a complete range of 120º of the upper limb was carried out in 10 healthy volunteers. Additional tests were carried out to assess MPUMA performance during upper limb tracking. The first, a 3D motion reconstruction of three movements of the shoulder joint (flexo-extension, abduction-adduction, horizontal internal-external rotation), and the second, an upper limb tracking online during the execution of three movements of the shoulder joint followed by a continuous random movement without any restrictions by using a virtual model and a mechatronic device of the shoulder joint. Experimental results demonstrated that the MPUMA measured joint angles that are close to those from a motion-capture system with orientation RMS errors less than 3º. PMID:27185034
Peter, Orsolya; Fazekas, Gabor; Zsiga, Katalin; Denes, Zoltan
Robot-mediated physiotherapy provides a new possibility for improving the outcome of rehabilitation of patients who are recovering from stroke. This study is a review of robot-supported upper limb physiotherapy focusing on the shoulder, elbow, and wrist. A literature search was carried out in PubMed, OVID, and EBSCO for clinical trials with robots…
Kuipers, K.; Burger, L.; Copley, J.
Aim: To determine if a Clinical Reasoning Protocol assisted occupational therapists to consistently choose casting as an intervention in the context of moderate/severe upper limb hypertonia and possible contracture.Methods: Sixty-four intervention decisions (including strength/movement training, spl
WANG Jian; SHI Yu-qian; WU Zhi-yong
Cutaneous metastasis from colorectal carcinoma is uncommon, occurring in less than 4% of the whole patients.' The most frequently involved are incision scar or abdominal skin,24 while cutaneous metastasis to neck and chest is very rare. We hereby report a case of synchronous, postoperative cutaneous metastasis from colorectal carcinoma to neck, upper limb and chest skin, which were confirmed by biopsy.
Eliane Cristina Coelho de Oliveira Correia
Full Text Available To assess the frequency of upper limb injuries in the only emergency medical service inParanaiba, State of Mato Grosso do Sul. Methods: Retrospective study with data collection from medical recordsof patients assisted with upper limb injuries in “Santa Casa de Misericordia” Hospital, the only hospital in the cityto provide emergency care, in 2008. Variables of interest such as gender and type of injury were collected basedon the International Code of Diseases (ICD 10. Results: There were 314 cases of upper limb injury in 2008and men were the most affected with 211 cases (67.2%. The wrist was the most affected segment with 64 cases(20.4%, followed by the shoulder with 55 cases (17.5% and the hand with 50 cases (15.9%. Interventions andsurgeries involving bone portion were the most frequent - 225 (71.7%, followed by tendon - 19 (6.1% and neural - 16 (5.1%; 35 patients (11.1% underwent multiple operations. Osteosyntheses - 94 (29.9%, fractures- 48 (15.3%, and reduction - 46 (14.6% were the most frequent interventions, followed by 26 dislocations(8.3% and 14 tenorrhaphies (4.5%. Conclusion: The involvement of the upper limbs, especially bone lesions,is frequent. The segments most affected by injuries are men’s wrists and shoulders.
Andres F. Ruiz
Full Text Available One of the approaches to study the human motor system, and specifically the motor strategies implied during postural tasks of the upper limbs, is to manipulate the mechanical conditions of each joint of the upper limbs independently. At the same time, it is essential to pick up biomechanical signals and bio-potentials generated while the human motor system adapts to the new condition. The aim of this paper is two-fold: first, to describe the design, development and validation of an experimental platform designed to modify or perturb the mechanics of human movement, and simultaneously acquire, process, display and quantify bioelectric and biomechanical signals; second, to characterise the dynamics of the elbow joint during postural control. A main goal of the study was to determine the feasibility of estimating human elbow joint dynamics using EMG-data during maintained posture. In particular, the experimental robotic platform provides data to correlate electromyographic (EMG activity, kinetics and kinematics information from the upper limb motion. The platform aims consists of an upper limb powered exoskeleton, an EMG acquisition module, a control unit and a software system. Important concerns of the platform such as dependability and safety were addressed in the development. The platform was evaluated with 4 subjects to identify, using system identification methods, the human joint dynamics, i.e. visco-elasticity. Results obtained in simulations and experimental phase are introduced.
Verschuren, J.E.A.; Geertzen, J.H.B.; Enzlin, P.; Dijkstra, P. U.; Dekker, R.; Van Der Sluis, C.K.
The purpose of this paper is to analyze whether professionals who work with people with an upper limb deficiency (ULD) received questions about sexuality from their patients and whether they addressed sexuality themselves, and to analyze their knowledge and comfort level, approach and attitudes towa
Bouwsema, Hanneke; van der Sluis, Corry K.; Bongers, Raoul M.
Objective: To determine which Order of presentation of practice tasks had the highest effect oil using an upper-limb prosthetic simulator. Design: A cohort analytic Study. Setting: University laboratory. Participants: Healthy, able-bodied participants (N=72) randomly assigned to I Of 8 groups, each
Jaspers, Ellen; Byblow, Winston D.; Feys, Hilde; Wenderoth, Nicole
Children with unilateral cerebral palsy (CP) typically present with largely divergent upper limb sensorimotor deficits and individual differences in response to upper limb rehabilitation. This review summarizes how early brain damage can cause dramatic deviations from the normal anatomy of sensory and motor tracts, resulting in unique “wiring patterns” of the sensorimotor system in CP. Based on the existing literature, we suggest that corticospinal tract (CST) anatomy and integrity constrains sensorimotor function of the upper limb and potentially also the response to treatment. However, it is not possible to infer CST (re)organization from clinical presentation alone and conventional biomarkers, such as time of insult, location, and lesion extent seem to have limited clinical utility. Here, we propose a theoretical framework based on a detailed examination of the motor system using behavioral, neurophysiological, and magnetic resonance imaging measures, akin to those used to predict potential for upper limb recovery of adults after stroke. This theoretical framework might prove useful because it provides testable hypotheses for future research with the goal to develop and validate a clinical assessment flowchart to categorize children with unilateral CP. PMID:26779464
Blatter, B.M.; Bongers, P.M.; Witte, H. de
In this study on prevalence and risk factors for work related neck or upper limb symptoms in the Belgian working population, the researchers have found an overall prevalence of work and upper limb symptoms occurring in the past 12 months of 39%. High risk occupations for neck and shoulder symptoms w
Induction of therapeutic angiogenesis by autologous bone marrow mononuclear cell transplantation has been identified as a potential new option in patients with advanced lower-limb ischemia. There is little evidence of the benefit of intra-arterial cell application in upper-limb critical ischemia. We describe a patient with upper-extremity critical limb ischemia with digital gangrene resulting from hypothenar hammer syndrome successfully treated by intra-arterial autologous bone marrow mononuclear cell transplantation.
Perera M M N
Full Text Available Background: Burn is an injury cause destruction of skin and underling tissue. Post burns complications are severe. Objective of this study is to identify the effects on the Active Range of Motion (AROM of upper limb/s, hand functions and Activities of Daily Living (ADL who attend the physical therapy department of burns unit. Methodology: It was a descriptive cross sectional study carried out at out-patient physical therapy department of burns unit of National Hospital of SriLanka (NHSL. Fifty subjects recruited into the study. Interviewer assisted self administered questionnaire Disabilities of Arm, Shoulder,Hand Questionnaire (DASH, AROM of nine movements of shoulder and elbow joints and hand function assessment Signals of Functional, Impairements of hand (SOFI was used to collect data. Results: Study results showed that Flame burns were the most common burn type and majority of the victims were females. Study population had affected AROM in almost all the movements at the joint, which had affected to the ADL significantly. “Keeping an object shelf above head” and “engaging in heavy work”, showed significant correlation with movements of shoulder. SOFI score for the right hand showed significant correlation with selected Activities of Daily Living (ADL (“writing”,” using knife to cut food” opening a jar” etc ;. Conclusion: patient with burn injury including upper limb joints may encounter disabilities. Even though it is mild AROM restrictions at a joint, This restriction affects to persons’ independency in ADL s. This emphasizes the need of intensive medical care as well as long term physical therapy rehabilitation programme for burns patients. Limitations: Each subject’s AROM was not measured at their discharge which was already stated to be a limitation.
Full Text Available H-reflex is a valuable electrophysiological technique for assessing nerve conduction through entire length of afferent and efferent pathways, especially nerve roots and proximal segments of peripheral nerves. The aim of this study was to investigate the relation between normal values of flexor carpi radialis (FCR H-reflex latency, upper limb length and age in normal subjects, and to determine whether there is any regression equation between them.By considering the criteria of inclusion and exclusion, 120 upper limbs of 69 normal volunteers (68 hands of 39 men and 52 hands of 30 women with the mean age of 39.8 ± 11.2 years participated in this study. FCR H-reflex was obtained by standard electrodiagnostic techniques, and its onset latency was recorded. Upper limb length and arm length were measured in defined position. The degree of association between these variables was determined with Pearson correlation and linear regression was used for obtaining the proposed relations.Mean FCR H-reflex latency was found to be 15.88 ± 1.27 ms. There was a direct linear correlation between FCR H-reflex latency and upper limb length (r = 0.647 and also arm length (r = 0.574, but there was no significant correlation between age and FCR H-reflex latency (P = 0.260. Finally, based on our findings, we tried to formulate these relations by statistical methods.We found that upper limb length and arm length are good predictive values for estimation of normal FCR H-reflex latency but age, in the range of 20-60 years old, has no correlation with its latency. This estimation could have practical indications in pathologic conditions.
Dhillon Mandeep S
Full Text Available Abstract Introduction Cricket is the most popular sport in India, and is gaining in importance in all south-east Asian countries. The purpose of this study was to prospectively investigate the incidence, nature, and site of acute upper limb injuries sustained by professional cricketers of north India over a period of one year. Material & methods 95 cricket players (mean age 18.9 years were prospectively evaluated for nature and incidence of upper limb injuries from 1st November 2008 to 31st October 2009. For the purpose of comparison the calculated injury incidence included injuries sustained during match as well as practice. Injuries were also grouped according to the type of cricket activities such as batting or fielding. Results Out of 95 players evaluated, 24 were bowlers, 19 were batsmen, 8 were wicket keepers and the other 44 cricketers declared themselves as all rounders. There were a total of 16 upper limb injuries in 16 (16.8% players. The majority of injuries (10/16 occurred while fielding. Out of 16 injuries, 11 were seen in hand, 3 were observed in elbow, while 2 patients suffered from shoulder problem. Twelve were acute injuries while 4 were classified as repetitive stress injuries (RSI. Conclusion The incidence of upper limb injuries in cricketers at the professional and semi-professional level is significant, causing them to miss matches or practice for a significant number of days. This is the first study of Indian cricketers which documents the high incidence of upper limb injuries. The study highlights the importance of injury surveillance for Indian cricket. It is a concern which needs to be addressed by the players, coaches, teachers, administrators and medical personnel involved with cricket.
Gilliaux, Maxime; Dierckx, Floriane; Vanden Berghe, Lola; Lejeune, Thierry M; Sapin, Julien; Dehez, Bruno; Stoquart, Gaëtan; Detrembleur, Christine
The use of kinematics is recommended to quantitatively evaluate upper limb movements. The aims of this study were to determine the age effects on upper limb kinematics and establish norms in healthy children. Ninety-three healthy children, aged 3-12 years, participated in this study. Twenty-eight kinematic indices were computed from four tasks. Each task was performed with the REAplan, a distal effector robotic device that allows upper limb displacements in the horizontal plane. Twenty-four of the 28 indices showed an improvement during childhood. Indeed, older children showed better upper limb movements. This study was the first to use a robotic device to show the age effects on upper limb kinematics and establish norms in healthy children. PMID:25413362
Brown, Tyler N; Palmieri-Smith, Riann M; McLean, Scott G
Potentially valuable anterior cruciate ligament (ACL) injury prevention strategies are lengthy, limiting training success. Shorter protocols that achieve beneficial biomechanical adaptations may improve training effectiveness. This study examined whether core stability/balance and plyometric training can modify female landing biomechanics compared with the standard neuromuscular and no training models. Forty-three females had lower limb biomechanics analyzed during unilateral and bilateral landings immediately before and after a 6-week neuromuscular or no training programs. Sagittal and frontal plane hip and knee kinematics and kinetics were submitted to 3-way repeated-measures analyses of variance to test for the main and interaction effects of training group, landing type, and testing time. Greater peak knee flexion was evident in the standard neuromuscular group following training, during both bilateral (p = 0.027) and unilateral landings (p = 0.076 and d = 0.633). The plyometric group demonstrated reduced hip adduction (p = 0.010) and greater knee flexion (p = 0.065 and d = 0.564) during bilateral landings following training. The control group had significant reduction in peak stance knee abduction moment (p = 0.003) posttraining as compared with pretraining. The current outcomes suggest that significant biomechanical changes are possible by an isolated plyometric training component. The benefits, however, may not be evident across all landing types, seemingly limited to simplistic, bilateral landings. Integrated training protocols may still be the most effective training model, currently improving knee flexion posture during both bilateral and unilateral landings following training. Future prevention efforts should implement integrated training protocols that include plyometric exercises to reduce ACL injury risk of female athletes. PMID:24714537
Basant Repswal; Anuj Jain; Sunil Gupta; Aditya Aggarwal; Tushar Kohli; Devendra Pathrot
Fall from height is a common cause of unintentional injuries in children and accounts for 6％ of all trauma-related childhood deaths,usually from head injury.We report a case of a 2-year-old child with multiple fractures of the bilateral lower limbs due to this reason.A child fell from a height of around 15 feet after toppling from a balcony.He developed multiple fractures involving the right femoral shaft,right distal femoral epiphysis (Salter Harris type 2),right distal metaphysis of the tibia and fibula,and undisplaced Salter Harris type 2 epiphyseal injury of the left distal tibia.There were no head,abdominal or spinal injuries.The patient was taken into emergency operation theatre after initial management which consisted of intravenous fluids,blood transfusion,and splintage of both lower limbs.Fracture of the femoral shaft was treated by closed reduction and fixation using two titanium elastic nails.Distal femoral physeal injury required open reduction and fixation with K wires.Distal tibia fractures were closely reduced and managed nonoperatively in both the lower limbs.All the fractures united in four weeks.At the last follow-up,the child had no disability and was able to perform daily activities comfortably.We also proposed the unique mechanism of injury in this report.
Repswal, Basant; Jain, Anuj; Gupta, Sunil; Aggarwal, Aditya; Kohli, Tushar; Pathrot, Devendra
Fall from height is a common cause of unintentional injuries in children and accounts for 6% of all trauma-related childhood deaths, usually from head injury. We report a case of a 2-year-old child with multiple fractures of the bilateral lower limbs due to this reason. A child fell from a height of around 15 feet after toppling from a balcony. He developed multiple fractures involving the right femoral shaft, right distal femoral epiphysis (Salter Harris type 2), right distal metaphysis of the tibia and fibula, and undisplaced Salter Harris type 2 epiphyseal injury of the left distal tibia. There were no head, abdominal or spinal injuries. The patient was taken into emergency operation theatre after initial management which consisted of intravenous fluids, blood transfusion, and splintage of both lower limbs. Fracture of the femoral shaft was treated by closed reduction and fixation using two titanium elastic nails. Distal femoral physeal injury required open reduction and fixation with K wires. Distal tibia fractures were closely reduced and managed nonoperatively in both the lower limbs. All the fractures united in four weeks. At the last follow-up, the child had no disability and was able to perform daily activities comfortably. We also proposed the unique mechanism of injury in this report. PMID:25293902
Full Text Available Upper extremity surgery is commonly performed under regional anesthesia. The advent of ultrasonography has made performing upper extremity nerve blocks relatively easy with a high degree of reliability. The proximal approaches to brachial plexus block such as supraclavicular plexus block, infraclavicular plexus block, or the axillary block are favored for the most surgical procedures of distal upper extremity. Ultrasound guidance has however made distal nerve blocks of the upper limb a technically feasible, safe and efficacious option. In recent years, there has thus been a resurgence of distal peripheral nerve blocks to facilitate hand and wrist surgery. In this article, we review the technical aspects of performing the distal blocks of the upper extremity and highlight some of the clinical aspects of their usage.
Demian, Atef D; Wahba, Ashraf M; Atia, Emad M; Hussein, Sami H
This randomized study was designed to compare the effectiveness of bilateral interpleural analgesia with lumbar epidural analgesia, on postoperative pain relief in upper abdominal surgery. The studied patients were randomely allocated into either interpleural group "IP" (n = 15) or epidural group "EP" (n = 15). In "IP" group, preanesthetic bilateral interpleural block was done using a mixture of bupivacaine 0.5% (0.8 mg/kg) and 2 mg morphine diluted to 50 ml saline for each side. In "EP" group, the same mixture-diluted in 20 ml saline-was injected in the epidural space (L2-3). The general anesthetic technique was the same in both groups. Hemodynamic, gasometric, verbal pain score (VPS) values and complications were compared in both techniques. Heart rate (HR) and mean arterial pressure (MAP) readings were in the accepted normal range in the perioperative period although significant lower readings were detected in "EP" group. No significant differences were displayed in blood gasometric variables between the two groups. There were considerable level of analgesia in both groups in the postoperative period although "EP" analgesia was superior to "IP". More pain free patients (9 versus 4) and significant lower consumption of nalbuphine were detected in "EP" group. The results of this study indicate that bilateral "IP" analgesia may offer a satisfactory analgesia for upper abdominal surgery when the use of other analgesic techniques may be contraindicated. PMID:14740589
Zohreh Ganjparvar; Batool Mousavi; Mehdi Masumi; Mohammadreza Soroush; Ali Montazeri
Background: Providing care to a disable relative at home exposes the caregiver to a potentially higher risk of physical and mental problems. We measured health-related quality of life (HRQOL) and its determinants among the caregivers of the Iranian survivors of the Iran-Iraq war (1980–1988) with bilateral lower-limb amputation. Methods: Data were collected from 464 individuals comprising war-related bilateral lower-limb amputees (n=232) and their caregivers (n=232) in January 2015 in Shira...
Meugnot, Aurore; Agbangla, Nounagnon Frutueux; Toussaint, Lucette
In the present experiment, we examined whether short-term upper-limb immobilization would selectively affect the representation of the immobilized limb (using a hand laterality task) or whether the effect of immobilization would extend to another body part (using a foot laterality task). A rigid splint placed on the participants' left hand was used for immobilization. A control group did not undergo the immobilization procedure. We compared the participants' performances on the hand and foot laterality tasks before (T1) and after (T2) a 48-hour delay, corresponding to the immobilization period. For controls, response time analysis indicated a benefit of task repetition for the recognition of both hand and foot images. For the immobilized group, a slowdown of performance appeared in T2 for hand images, but not for foot images. The reduced benefit of task repetition following left-hand immobilization appeared for both the immobilized and non-immobilized hand images. These findings revealed that the general cognitive representation of upper-limb movements is affected by the decrease in input/output signal processing due to the left-hand immobilization, while the cognitive representation of lower-limb movements is not. PMID:26642973
Morita, Yoshifumi; Hirose, Akinori; Uno, Takashi; Uchid, Masaki; Ukai, Hiroyuki; Matsui, Nobuyuki
In this paper we propose a new rehabilitation training support system for upper limbs. The proposed system enables therapists to quantitatively evaluate the therapeutic effect of upper limb motor function during training, to easily change the load of resistance of training and to easily develop a new training program suitable for the subjects. For this purpose we develop control algorithms of training programs in the 3D force display robot. The 3D force display robot has parallel link mechanism with three motors. The control algorithm simulating sanding training is developed for the 3D force display robot. Moreover the teaching/training function algorithm is developed. It enables the therapists to easily make training trajectory suitable for subject's condition. The effectiveness of the developed control algorithms is verified by experiments.
Pellegrino, L; Stranieri, G; Tiragallo, E; Tacchino, A; Brichetto, G; Coscia, M; Casadio, M
The goal of this study was to investigate the movement and muscle activity of the upper limb during common activities of daily life in people with Multiple Sclerosis (PwMS) with low and mild-moderate level of upper limb impairments. We found significant changes in muscles activity in PwMS compared to healthy subjects when holding and lifting objects used in everyday life. These differences were particularly remarkable in subjects with moderate level of impairment, in which the disease affected also movement smoothness. Remarkably, the smoothness of the movement during the interaction with common objects of daily activities highly correlated with the subjects' ability measured with the Abilhand scale. PMID:26737895
Full Text Available Abstract Background We studied whether the twelve-month use of a standard computer would induce complaints of upper limb pain or functional limitations in older novice computer users. Methods Participants between 64 and 76 of age were randomly assigned to an Intervention group (n = 62, whose members received a personal computer and fast Internet access at their homes, or a No Intervention control group (n = 61, whose members refrained from computer use during the twelve month study period. Results Difference scores between baseline and twelve months assessments on both complaint (SFS and functional health scales (SF-36 did not differ between groups (all p > .05. Conclusion Prolonged, self-paced use of a standard computer interface does not put older persons at a risk of upper limb complaints or reduce functional health in older adults.
Sundstrup, Emil; Jakobsen, Markus D; Brandt, Mikkel;
leg (p < 0.01), and reported impaired work ability index score and general health along with higher work disability and fear avoidance compared with controls (all p < 0.0001). No differences were observed between the groups in regard to age, BMI, physical activity level, job position and duration of...... slaughterhouse work (all p > 0.4). CONCLUSIONS: Chronic upper limb pain was paralleled by reduced neuromuscular function of the shoulder and hand along with impaired work ability, work disability and general health. Future studies on chronic pain management at the workplace should carefully consider the......BACKGROUND: Knowledge of factors associated with chronic pain is necessary for preventive strategies. The present study investigates biopsychosocial differences, with specific focus on rate of force development (RFD) and work ability, between workers with and without chronic upper limb pain...
Full Text Available Movement disorders are frequently associated with sensory abnormalities. In particular, proprioceptive deficits have been largely documented in both hypokinetic (Parkinson’s disease and hyperkinetic conditions (dystonia suggesting a possible role in their pathophysiology. Proprioceptive feedback is a fundamental component of sensorimotor integration allowing effective planning and execution of voluntary movements. Rehabilitation has become an essential element in the management of patients with movement disorders and there is a strong rationale to include proprioceptive training in rehabilitation protocols focused on mobility problems of the upper limbs. Proprioceptive training is aimed at improving the integration of proprioceptive signals using task intrinsic or augmented feedback. This perspective article reviews the available evidences on the effects of proprioceptive stimulation in improving upper limb mobility in patients with movement disorders and highlights the emerging innovative approaches targeted to maximizing the benefits of exercise by means of enhanced proprioception.
Objective: To investigate and compare the activation patterns of stroke patients with upper-limb paralysis using functional MRI before and after treatment with constraint-induced movement therapy (CIMT) so as to explore the mechanism of CIMT. Methods: Six patients in chronic stage of brain infarction who have functional disturbance in right upper-limb and 9 normal controls were entered into the study. All of the patients were asked to perform the thumb-to-index finger tapping task and underwent functional MRI before and two weeks after CIMT. The controls underwent fMRI of same protocol once. The patients' upper-limb function scores before and after CIMT were analyzed with SPSS 11.5 by paired t test. The fMRI data were analyzed with analysis of functional neurolmages (AFNI) software. The percentage of blood oxygenation level dependent (BOLD) signal change for the normal control was analyzed by one-sample t test to indentify the activated brain regions. The percentage change of BOLD signal for the patients before and after CIMT was compared to control's data by independent-samples t test. The percentage change of BOLD signal for the patients before and after CIMT was analyzed by paired-samples t test. The significant difference level was set P<0.05. Results: The fMRI showed the patients' activated brain regions before CIMT were similar to that of the controls', while the activation level was lower. There were wide areas activated to compensate the impaired function especially for the fight upper-limb. Before CIMT, the patients' score for fight upper-limb on the action research arm test was 27±4. After CIMT, the patients' score was 40±3, and the difference was significant (t=14.626, P<0.05), which indicated the improved function. These subjects also displayed cortical reorganization after CIMT on fMRI. The areas responsible for the right hand movement showed increased activation and the activation level at bilateral corpora striata thalami, and cerebella increased
Cuesta Vargas, Antonio; Roldan Jimenez, Cristina; Bennett, Paul
Background: In recent years, there have been investigations concerning upper-limbs kinematics by various devices. The latest generation of smartphones often includes inertial sensors with subunits which can detect inertial kinematics. The use of smartphones is presented as a convenient and portable analysis method for studying kinematics in terms of angular mobility and linear acceleration Objective: The aim of this study was to study humerus kinematics through six physical properties that...
This paper presents the design of ABLE, an anthropomorphic upper limb exoskeleton integrally actuated by highly reversible ball-screw and cable (SCS standing for Screw-and-Cable-System) allowing true joint torque control without force sensor. Their unique kinematics allows their integration in the structure thanks to dedicated mechanical innovations such as the shoulder articulation and the forearm-wrist. The result is an anthropomorphic, lightweight, open architecture which avoids imprisonin...
Kuys, Suzanne S.; Tara Edwards; Morris, Norman R.
Mirror therapy is a promising therapy with some benefit for motor recovery in people with chronic hemiparesis. However, there has been little investigation on the effect on upper limb sensory impairments, activity limitations, and participation restrictions. A within-subject, repeated-measures study with 12 people with chronic hemiparesis was conducted. Participants underwent a thirty minute sensorimotor mirror therapy home-based exercise program, conducted three times per week for six weeks....
Saeid Khosrawi; Parisa Taheri; Seyed Hasan Hashemi
Background: H-reflex is a valuable electrophysiological technique for assessing nerve conduction through entire length of afferent and efferent pathways, especially nerve roots and proximal segments of peripheral nerves. The aim of this study was to investigate the relation between normal values of flexor carpi radialis (FCR) H-reflex latency, upper limb length and age in normal subjects, and to determine whether there is any regression equation between them. Methods: By considering the crite...
Full Text Available INTRODUCTION: Upper limb exercises are frequently used in respiratory physiotherapy, with UL elevation and controlled inspiratory timing. However, the use of expiration during upper limb elevation appears to be a strategy that could minimize the action of accessory muscles in patients with chronic obstructive pulmonary disease. In this context, little is known about the synchrony of upper limb (UL movements associated with breathing. The aim of this study was to investigate the respiratory pattern of chronic obstructive pulmonary disease patients during different UL exercises associated with respiratory exercises. METHODS: Fifteen chronic obstructive pulmonary disease patients participated in this study. Respiratory pattern analysis by inductance plethysmography was performed during four types of upper limb exercises, two shoulder flexion-extension (one associated with inspiratory time during the concentric phase and the other associated with expiratory time and two shoulder abduction-adduction (same timing as above. Statistical analysis was performed by the Kolmogorov-Smirnov test and ANOVA with Tukey tests (p< 0.05. RESULTS: The thoracoabdominal coordination measurements increased in the two exercises using both inspiration during shoulder flexion (PhRIB: 172%; PhREB: 131%; PhRTB: 142% and PhAng: 238% as well as in shoulder horizontal abduction (PhRIB: 145%; PhREB: 109%; PhRTB: 130% and PhAng: 229%, differing from the exercises with expiration at the time of shoulder flexion and horizontal abduction. CONCLUSION: The exercises performed with inverted respiratory time produced less asynchrony and can be used as important strategies during physical exercise programs in these patients.
Ferreira, Dulce; Mendes, Eugénia; Noronha, Bruno; Preto, Leonel; Novo, André
Pulmonary rehabilitation in COPD exacerbation has several advantages such as reduction of hospital readmission and mortality, the considerable increase of quality of life and functional improvement translated into a better outcome in the 6 min walking test. Upper limbs exercise is recommended in pulmonary rehabilitation guidelines because it reduces stress, decreases dyspnea and dynamic hyperinflation and improves functional capacity with impact on daily living activities. This study aimed to...
Santisteban, Leire; Térémetz, Maxime; Bleton, Jean-Pierre; Baron, Jean-Claude; Maier, Marc A.; Lindberg, Påvel G.
Background Establishing which upper limb outcome measures are most commonly used in stroke studies may help in improving consensus among scientists and clinicians. Objective In this study we aimed to identify the most commonly used upper limb outcome measures in intervention studies after stroke and to describe domains covered according to ICF, how measures are combined, and how their use varies geographically and over time. Methods Pubmed, CinHAL, and PeDRO databases were searched for upper limb intervention studies in stroke according to PRISMA guidelines and477 studies were included. Results In studies 48different outcome measures were found. Only 15 of these outcome measures were used in more than 5% of the studies. The Fugl-Meyer Test (FMT)was the most commonly used measure (in 36% of studies). Commonly used measures covered ICF domains of body function and activity to varying extents. Most studies (72%) combined multiple outcome measures: the FMT was often combined with the Motor Activity Log (MAL), the Wolf Motor Function Test and the Action Research Arm Test, but infrequently combined with the Motor Assessment Scale or the Nine Hole Peg Test. Key components of manual dexterity such as selective finger movements were rarely measured. Frequency of use increased over a twelve-year period for the FMT and for assessments of kinematics, whereas other measures, such as the MAL and the Jebsen Taylor Hand Test showed decreased use over time. Use varied largely between countries showing low international consensus. Conclusions The results showed a large diversity of outcome measures used across studies. However, a growing number of studies used the FMT, a neurological test with good psychometric properties. For thorough assessment the FMT needs to be combined with functional measures. These findings illustrate the need for strategies to build international consensus on appropriate outcome measures for upper limb function after stroke. PMID:27152853
Pezarat, P.; Cabri, J; O Fernandes; de Sousa, J P
Purpose: The identification of neuromuscular patterns is an important cue for the management of muscular development, skill improve- ment and injury prevention. The main purpose of the present study was to characterize muscular coordination patterns in the dominant upper limb in the different phases of golf swing in experienced golfers. Methods: Three low-handicap golfers (handicap lower than five) performed six full swing movements with a pitch iron. Surface electro- myography (EMG) was...
Linda Resnik, PT, PhD
The purposes of this article are to describe usability testing and introduce designs and methods of usability testing research as it relates to upper-limb prosthetics. This article defines usability, describes usability research, discusses research approaches to and designs for usability testing, and highlights a variety of methodological considerations, including sampling, sample size requirements, and usability metrics. Usability testing is compared with other types of study designs used in...
Pang, Muye; Guo, Shuxiang; Huang, Qiang; Ishihara, Hidenori; Hirata, Hideyuki
This paper presents a quantitative representation method for the upper-limb elbow joint angle using only electromyography (EMG) signals for continuous elbow joint voluntary flexion and extension in the sagittal plane. The dynamics relation between the musculotendon force exerted by the biceps brachii muscle and the elbow joint angle is developed for a modified musculoskeletal model. Based on the dynamics model, a quadratic-like quantitative relationship between EMG signals and the elbow joint...
Thromboangiitis obliterans (Buerger's disease) is a rare, non-atherosclerotic, segmental, inflammatory vasculitis that most commonly involves small and medium-sized arteries, veins and nerves of the extremities and affects tobacco smokers between the ages of 25 and 45 years. The manifestations of Buerger's disease can be extremely variable and, therefore, awareness of the condition is important for both general and musculoskeletal radiologists. This paper presents the radiological appearance of the sequelae of Buerger's disease involving the upper and lower limbs.
Mountrakis, Constantine; Manolis, Sotiris K.
Entheseal changes are potentially useful tools through which the daily activity patterns of individuals within a population may be interpreted through the perspective of a biocultural framework. Studying these patterns in Mycenaean Athens may assist in comprehending intensity of daily behavior of males and females. The upper limb bones of thirty four individuals from the skeletal collection of the Athenian Agora were studied in order to ascertain sex- and age-based differences in entheseal ch...
Joel C. Perry, PhD
Full Text Available Numerous haptic devices have been developed for upper-limb neurorehabilitation, but their widespread use has been largely impeded because of complexity and cost. Here, we describe a variable structure pantograph mechanism combined with a spring suspension system that produces a versatile rehabilitation robot, called Universal Haptic Pantograph, for movement training of the shoulder, elbow, and wrist. The variable structure is a 5-degree-of-freedom (DOF mechanism composed of 7 joints, 11 joint axes, and 3 configurable joint locks that reduce the number of system DOFs to between 0 and 3. The resulting device has eight operational modes: Arm, Wrist, ISO (isometric 1, ISO 2, Reach, Lift 1, Lift 2, and Steer. The combination of available work spaces (reachable areas shows a high suitability for movement training of most upper-limb activities of daily living. The mechanism, driven by series elastic actuators, performs similarly in all operational modes, with a single control scheme and set of gains. Thus, a single device with minimal setup changes can be used to treat a variety of upper-limb impairments that commonly afflict veterans with stroke, traumatic brain injury, or other direct trauma to the arm. With appropriately selected design parameters, the developed multimode haptic device significantly reduces the costs of robotic hardware for full-arm rehabilitation while performing similarly to that of single-mode haptic devices. We conducted case studies with three patients with stroke who underwent clinical training using the developed mechanism in Arm, Wrist, and/or Reach operational modes. We assessed outcomes using Fugl-Meyer Motor Assessment and Wolf Motor Function Test scores showing that upper-limb ability improved significantly following training sessions.
A clinical case of polydactyly in fore limbs of a Holstein Friesian calf was radiographically and ultrasonographically examined and thus was surgically treated by amputation of the first right digit and of the first left digit, the latter present in a vestigial form. Furthermore, a ocular dermoid cyst was removed in the same animal
Full Text Available Standard upper-limb motor function impairment assessments, such as the Fugl-Meyer Assessment (FMA, are a critical aspect of rehabilitation after neurological disorders. These assessments typically take a long time (about 30 min for the FMA for a clinician to perform on a patient, which is a severe burden in a clinical environment. In this paper, we propose a framework for automating upper-limb motor assessments that uses low-cost sensors to collect movement data. The sensor data is then processed through a machine learning algorithm to determine a score for a patient’s upper-limb functionality. To demonstrate the feasibility of the proposed approach, we implemented a system based on the proposed framework that can automate most of the FMA. Our experiment shows that the system provides similar FMA scores to clinician scores, and reduces the time spent evaluating each patient by 82%. Moreover, the proposed framework can be used to implement customized tests or tests specified in other existing standard assessment methods.
Full Text Available Introduction: Prostheses for upper-limb amputees are currently controlled by either myoelectric or peripheral neural signals. Performance and dexterity of these devices is still limited, particularly when it comes to controlling hand function. Movement-related brain activity might serve as a complementary bio-signal for motor control of hand prosthesis. Methods: We introduced a methodology to implant a cortical interface without direct exposure of the brain surface in an upper-limb amputee. This bi-directional interface enabled us to explore the cortical physiology following long-term transhumeral amputation. In addition, we investigated neurofeedback of electrocorticographic brain activity related to the patient’s motor imagery to open his missing hand, i.e. phantom hand movement, for real-time control of a virtual hand prosthesis.Results: Both event-related brain potentials and cortical stimulation revealed mutually overlapping cortical representations of the phantom hand. Phantom hand movements could be robustly classified and the patient required only three training sessions to gain reliable control of the virtual hand prosthesis in an online closed-loop paradigm that discriminated between hand opening and rest. Conclusion: Epidural implants may constitute a powerful and safe alternative communication pathway between the brain and external devices for upper-limb amputees, thereby facilitating the integrated use of different signal sources for more intuitive and specific control of multi-functional devices in clinical use.
Dermitzakis, Konstantinos; Arieta, Alejandro Hernandez; Pfeifer, Rolf
One of the significant challenges in the upper-limb-prosthetics research field is to identify appropriate interfaces that utilize the full potential of current state-of-the-art neuroprostheses. As the new generation of such prostheses paces towards approximating the human physiological performance in terms of movement dexterity and sensory feedback, it is clear that current non-invasive interfaces are still severely limited. Surface electromyography, the interface ubiquitously used in the field, is riddled with several shortcomings. Gesture recognition, an interface pervasively used in wearables and mobile devices, shows a strong potential as a non-invasive upper-limb prosthetic interface. This study aims at showcasing its potential in the field by using gyroscope sensors. To this end, we (1) explore the viability of Dynamic Time Warping as a classification method for upper-limb prosthetics and (2) look for appropriate sensor locations on the body. Results indicate an optimal classification rate of 97.53%, σ = 8.74 using a sensor located proximal to the endpoint performing a gesture. PMID:22255345
Full Text Available Injuries to upper limb has been on the increase and is invariably associated with significant soft tissue loss requiring a flap cover. Local tissue may not be available for cover in a majority of situations, necessitating import of tissue from a distant source. We have utilized the thoraco-umbilical flap taken from the trunk for this purpose. This flap is based on the perforators of the deep inferior epigastric artery that are maximally centred on the periumbilical region.This flap was used in 83 patients. The patients were observed for at least 3 weeks and any flap or donor site complications were recorded. The patients were again followed up at 3 months interval and the donor site scar was assessed. The flaps survived in 81 patients; there was marginal flap necrosis in five patients and partial flap necrosis in two patients. None of these patients required any additional procedure for coverage. The flap is technically easy to plan, almost effortless to drape around upper limb defects, with no significant donor site morbidity and also the post operative immobilization was fairly comfortable. The thoraco-umbilical flap thus is a very useful technique for coverage of the upper limb and is recommended as a first line flap for this purpose.
Full Text Available Abstract Background In a sample of patients in clinical occupational medicine we have demonstrated that an upper limb neurological examination can reliably identify patterns of findings suggesting upper limb focal neuropathies. This further study aimed at approaching the diagnostic accuracy of the examination. Methods 82 limbs were semi-quantitatively assessed by two blinded examiners (strength in 14 individual muscles, sensibility in 7 homonymous territories, and mechanosensitivity at 10 locations along nerves. Based on the topography of nerves and their muscular and sensory innervation we defined 10 neurological patterns each suggesting a localized nerve affliction. Information on complaints (pain, weakness and/or numbness/tingling collected by others served as a reference for comparison. The relation between the presence of pattern(s and complaints was assessed by κ-statistics. Sensitivity, specificity, and positive/negative predictive values were calculated, and pre-test odds were compared to post-test probability. Results The two examiners identified pattern(s suggesting focal neuropathy in 34/36 out of 38 symptomatic limbs, respectively (κ = 0.70/0.75, with agreement in 28 limbs. Out of 44 non-symptomatic limbs the examiners agreed on absence of any pattern in 38 limbs. With concordance between the examiners with regard to the presence or absence of any pattern, the sensitivity, specificity, positive and negative predictive values were 0.73, 0.86, 0.93 and 0.90, respectively. While the pre-test odds for a limb to be symptomatic amounted to 0.46 the post-test probability was 0.81. For each examiner the post-test probability was 0.87 and 0.88, respectively. Conclusion The improved diagnostic confidence is an indication of one aspect of construct validity of the physical examination. For determination of clinical feasibility of the examination further studies are required, most importantly 1 studies of validity by means of comparison with
Full Text Available Abstract Background The ergotamine tartrate associated with certain categories of drugs can lead to critical ischemia of the extremities. Discontinuation of taking ergotamine is usually sufficient for the total regression of ischemia, but in some cases it could be necessary thrombolytic and anticoagulant therapy to avoid amputation. Case report A woman of 62 years presented with a severe pain left forearm appeared 10 days ago, with a worsening trend. The same symptoms appeared after 5 days also in the right forearm. Physical examination showed the right arm slightly hypothermic, with radial reduced pulse in presence of reduced sensitivity. The left arm was frankly hypothermic, pulse less on radial and with an ulnar humeral reduced pulse, associated to a decreased sensitivity and motility. Clinical history shows a chronic headache for which the patient took a daily basis for years Cafergot suppository (equivalent to 3.2 mg of ergotamine. From about ten days had begun therapy with itraconazole for vaginal candidiasis. The Color-Doppler ultrasound shown arterial thrombosis of the upper limbs (humeral and radial bilateral, with minimal residual flow to the right and no signal on the humeral and radial left artery. Results Angiography revealed progressive reduction in size of the axillary artery and right humeral artery stenosis with right segmental occlusions and multiple hypertrophic collateral circulations at the elbow joint. At the level of the right forearm was recognizable only the radial artery, decreased in size. Does not recognize the ulnar, interosseous artery was thin. To the left showed progressive reduction in size of the distal subclavian and humeral artery, determined by multiple segmental steno-occlusion with collateral vessels serving only a thin hypotrophic interosseous artery. Arteriographic findings were compatible with systemic drug-induced disease. The immediate implementation of thrombolysis, continued for 26 hours, with
Cascella, Marco; Viscardi, Daniela; Bifulco, Francesca; Cuomo, Arturo
It is well known that deep vein thrombosis of the upper extremities is linked to high morbidity/mortality, resulting in 12-20% of all documented pulmonary embolism; however, there are few data about thromboembolism originating from a vein and/or a branch of a superficial vein of the upper extremities. Pulmonary embolism secondary to upper limb superficial vein thrombosis (not combined with upper extremities deep vein thrombosis) is a very rare clinical manifestation with few cases reported in the literature. We report a rare case of thrombophlebitis in departure from a superficial branch of the cephalic vein of the right arm, complicated by cardiac arrest secondary to a massive pulmonary embolism in a patient who underwent major surgery for ovarian cancer. We discuss on the numerous thrombotic risk factors, triggering a cascade of reactions and resulting in a potential fatal clinical manifestation. PMID:26985256
Velstra, Inge-Marie; Bolliger, Marc; Krebs, Jörg; Rietman, Johan S; Curt, Armin
Objective To determine which single or combined upper limb muscles as defined by the International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI); upper extremity motor score (UEMS) and the Graded Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP), best predict upper limb function and independence in activities of daily living (ADLs) and to assess the predictive value of qualitative grasp movements (QlG) on upper limb function in individuals with acute tetraplegia.Method As part of a Europe-wide, prospective, longitudinal, multicenter study ISNCSCI, GRASSP, and Spinal Cord Independence Measure (SCIM III) scores were recorded at 1 and 6 months after SCI. For prediction of upper limb function and ADLs, a logistic regression model and unbiased recursive partitioning conditional inference tree (URP-CTREE) were used.Results Logistic regression and URP-CTREE revealed that a combination of ISNCSCI and GRASSP muscles (to a maximum of 4) demonstrated the best prediction (specificity and sensitivity ranged from 81.8% to 96.0%) of upper limb function and identified homogenous outcome cohorts at 6 months. The URP-CTREE model with the QlG predictors for upper limb function showed similar results.Conclusion Prediction of upper limb function can be achieved through a combination of defined, specific upper limb muscles assessed in the ISNCSCI and GRASSP. A combination of a limited number of proximal and distal muscles along with an assessment of grasping movements can be applied for clinical decision making for rehabilitation interventions and clinical trials. PMID:26156192
Quental, C; Folgado, J; Ambrósio, J; Monteiro, J
The reverse shoulder replacement, recommended for the treatment of several shoulder pathologies such as cuff tear arthropathy and fractures in elderly people, changes the biomechanics of the shoulder when compared to the normal anatomy. Although several musculoskeletal models of the upper limb have been presented to study the shoulder joint, only a few of them focus on the biomechanics of the reverse shoulder. This work presents a biomechanical model of the upper limb, including a reverse shoulder prosthesis, to evaluate the impact of the variation of the joint geometry and position on the biomechanical function of the shoulder. The biomechanical model of the reverse shoulder is based on a musculoskeletal model of the upper limb, which is modified to account for the properties of the DELTA® reverse prosthesis. Considering two biomechanical models, which simulate the anatomical and reverse shoulder joints, the changes in muscle lengths, muscle moment arms, and muscle and joint reaction forces are evaluated. The muscle force sharing problem is solved for motions of unloaded abduction in the coronal plane and unloaded anterior flexion in the sagittal plane, acquired using video-imaging, through the minimization of an objective function related to muscle metabolic energy consumption. After the replacement of the shoulder joint, significant changes in the length of the pectoralis major, latissimus dorsi, deltoid, teres major, teres minor, coracobrachialis, and biceps brachii muscles are observed for a reference position considered for the upper limb. The shortening of the teres major and teres minor is the most critical since they become unable to produce active force in this position. Substantial changes of muscle moment arms are also observed, which are consistent with the literature. As expected, there is a significant increase of the deltoid moment arms and more fibers are able to elevate the arm. The solutions to the muscle force sharing problem support the
Alex J Street; Magee, Wendy L.; Helen eOdell-Miller; Andrew eBateman; Jörg Christfried Fachner
Background: Impairment of upper limb function following stroke is more common than lower limb impairment and is also more resistant to treatment. Several lab-based studies with stroke patients have produced statistically significant gains in upper limb function when using musical instrument playing and techniques where rhythm acts as an external time-keeper for the priming and timing of upper limb movements. Methods: For this feasibility study a small sample size of 14 participants (3–60 m...
Aytekin, Ebru; Dogan, Yasemin Pekin; Okur, Sibel Caglar; Burnaz, Ozer; Caglar, Nil Sayiner
[Purpose] Paget-Schroetter syndrome (PSS) is an uncommon deep vein thrombosis of the axillary and subclavian veins which may occur spontaneously, but is usually caused by excessive upper limb activity. PSS is clinically similar to other upper limb musculoskeletal disorders and soft tissue infections, and this may lead to delay in correct diagnosis in its early stages. The aim of our case report is to discuss this rare condition with reference to the available literature. [Subjects and Methods...
Stephanie L. Carey, PhD
Full Text Available The choice of a myoelectric or body-powered upper-limb prosthesis can be determined using factors including control, function, feedback, cosmesis, and rejection. Although body-powered and myoelectric control strategies offer unique functions, many prosthesis users must choose one. A systematic review was conducted to determine differences between myoelectric and body-powered prostheses to inform evidence-based clinical practice regarding prescription of these devices and training of users. A search of 9 databases identified 462 unique publications. Ultimately, 31 of them were included and 11 empirical evidence statements were developed. Conflicting evidence has been found in terms of the relative functional performance of body-powered and myoelectric prostheses. Body-powered prostheses have been shown to have advantages in durability, training time, frequency of adjustment, maintenance, and feedback; however, they could still benefit from improvements of control. Myoelectric prostheses have been shown to improve cosmesis and phantom-limb pain and are more accepted for light-intensity work. Currently, evidence is insufficient to conclude that either system provides a significant general advantage. Prosthetic selection should be based on a patient's individual needs and include personal preferences, prosthetic experience, and functional needs. This work demonstrates that there is a lack of empirical evidence regarding functional differences in upper-limb prostheses.
Carey, Stephanie L; Lura, Derek J; Highsmith, M Jason
The choice of a myoelectric or body-powered upper-limb prosthesis can be determined using factors including control, function, feedback, cosmesis, and rejection. Although body-powered and myoelectric control strategies offer unique functions, many prosthesis users must choose one. A systematic review was conducted to determine differences between myoelectric and body-powered prostheses to inform evidence-based clinical practice regarding prescription of these devices and training of users. A search of 9 databases identified 462 unique publications. Ultimately, 31 of them were included and 11 empirical evidence statements were developed. Conflicting evidence has been found in terms of the relative functional performance of body-powered and myoelectric prostheses. Body-powered prostheses have been shown to have advantages in durability, training time, frequency of adjustment, maintenance, and feedback; however, they could still benefit from improvements of control. Myoelectric prostheses have been shown to improve cosmesis and phantom-limb pain and are more accepted for light=intensity work. Currently, evidence is insufficient to conclude that either system provides a significant general advantage. Prosthetic selection should be based on a patient's individual needs and include personal preferences, prosthetic experience, and functional needs. This work demonstrates that there is a lack of empirical evidence regarding functional differences in upper-limb prostheses. PMID:26230500
Tarkka Ina M.
Full Text Available Stroke has a major impact in the total cost of healthcare in the Western world as stroke is the most common cause of long-term disability . In attempts to enhance motor recovery after stroke effective treatment strategies have been developed in recent years. Appropriate evaluation of the intervention programs requires comprehensive and accurate assessment of the residual abnormal function. In the present study we compare two well-known clinical functional scoring tests developed for the assessment of hemiparetic upper limb function due to stroke and navigated transcranial magnetic stimulation (nTMS, which measures involuntary target muscle response to cortical stimulation. The aim is to investigate the equivalence of these methods and thus add objective evidence of the limb function to strengthen evidence-based practice. In addition to functional tests, four muscles of both arms were studied in twenty chronic stroke patients. Those patients without motor evoked potentials (MEP to nTMS in the affected upper limb had significantly lower total score in Action Research Arm Test and Wolf Motor Function Test and longer performance time than those patients with MEP. Patients, in whom MEP in each of the four target muscles was elicitable, had better than average scores in clinical functional tests while patients, in whom no MEP was elicitable in any target muscle, had worse than average scores. Transcranial magnetic stimulation adds crucial information when clinical assessment based on voluntary activation by command is challenging, e.g. in patients suffering from cognitive deficits.
Filgueiras, Ernesto; Rebelo, Francisco; da Silva, Moreira
Generally, the studies assess the upper limbs postures during the work with Visual Display Terminal - VDT through the measurement of the angles formed by the segments or through the relation with the pre-defined anatomical postures (e.g., flexion, extension, abduction). However, few studies were found in the literature which had focused in the measurement of the upper limbs support during a real situation of work with VDT and in the definition of analysis categories for this kind of behavior. The main objective of this study was to measure, in a real situation and using a systematic observation method through video analysis, the main kinds of support for the upper limbs. The analysis was done considering 480 work hours of 30 office workers. Data were collected using a methodology proposed by Rebelo, Filgueiras & Soares  and related with the work organization and workspace conditions, the participants had: a) minimum of eight hours daily of work; b) similar activities, characterized as office work; c) same furniture and equipment; and, d) computers with the same hardware, software and peripherals. Results were analyzed 46554 dynamic events, considering only the fourteen Interaction Categories - ICs, for upper limps support. In this way, percentage was computed, considering the total number of occurrence, for the Right arm is: arm support (0.06%); forearm support (31,8%); elbow support (31,92%); hand support (7,41%); multiple supports (12,32%) and without support 16,41%- For the Left arm the results is: forearm support (0,11%); arm support (53,69%); elbow support (8,70%); hand support (7,97%); multiple supports (8,43%) e without support (21,11%). This systemic and ecological approach was obtained through a method which enables experimental Biomechanics and Physiology methods to develop more efficient functional requirements and recommendations for the work with VDTs. PMID:22316800
Barbieri, P G; Colombini, D; Rocco, A; Custureri, F; Paderno, G
A group of 59 female workers in the sewing and upholstery departments of a factory manufacturing automobile seats underwent clinical and instrumental tests following reports of several cases of suspected carpal tunnel syndrome. A risk evaluation analysis for disorders attributable to repeated trauma of the upper limbs (WMSDs) was simultaneously carried out using the protocol recommended by the EPM Research Unit in Milan. Evidence was found of a high frequency of elementary actions associated with considerable muscular involvement along with inadequate recovery periods. The clinical investigation revealed an unusually high percentage of carpal tunnel syndromes, often associated with Guyon channel syndrome. This disorder affects males and females equally, is often bilateral, and is not associated with known non-occupational factors. The widespread outbreak of work-related musculo-skeletal disorders reported in the departments in question may have arisen from a combination of significant risk factors relating to the types of activities performed, and the long service of the workers. It is reasonable to assume that failure to adopt technical preventive and organisational measures may have stemmed primarily from a poor evaluation of the relevant occupational risks, and from many years of substandard health surveillance practices. PMID:9148122
Sousa, Nelson; Mendes, Romeu; Abrantes, Catarina; Sampaio, Jaime
The purpose of this study was to identify differences in maximum strength after an intense strength training program, contrasting muscle groups from upper limbs versus lower limbs. The sample consisted of 10 healthy elderly males (age 73±6 years) with independent living. The training program lasted 12 weeks (3 × week, 50 to 80% of 1RM, 2–3 sets, 6 to 12 repetitions). Two muscle groups were analyzed: LOWER (sum of average values of three exercises for the lower limbs) and UPPER (sum of average...
Objectives. To define the morphologic abnormalities in patients presenting with diffuse pure venous malformations (VM) of the upper extremity. Subjects and methods. A retrospective review of MRI and venography was performed on five patients, aged 6 months to 20 years, with extensive VM of the upper limbs. Abnormalities of major conducting veins were categorized as varicosities, stenoses, and asymmetrical pouches; anomalous venous spaces were classified into confluent lakes, interconnecting channels and spongelike plexiform networks. MRI and venographic data were reviewed separately and then simultaneously in order to establish correlation between types, location, and extent of lesions. Results. In all patients, the percentage of replacement of normal tissues by VM was shown by MRI to be significantly higher in the distal limb than in the proximal limb. Involvement of multiple tissue layers was seen in all cases, including, with a decreasing rate, muscles, tendons, interosseous membrane of the forearm, and bone. Venography showed superficial varicosities, frequently associated with stenoses and assymetric pouches in all patients. Interconnecting channels and venous lakes were noted in half of the segments, typically in muscle and other deep locations, and subcutaneous spongelike lesions were seen in two patients. MRI provided a more accurate evaluation of tissue extent. Venograms better demonstrated morphological details and provided more information about the venous drainage. Direct comparison of MR images with venograms helped to identify and characterize venous lesions on cross-sectional MR data. Conclusion. Diffuse VM of the upper extremity are most extensive distally, and all tissues layers can be involved, each with a characteristic morphologic appearance. The morphology of different components of the VM is related to the nature of the surrounding tissue. (orig.)
Chelly, Mohamed Souhaiel; Hermassi, Souhail; Shephard, Roy J
This study aimed to investigate relationships between peak power (PP) as measured by upper limb (PPUL) and lower limb (PPLL) force-velocity tests, maximal upper limb force assessed by 1 repetition maximum bench press (1RMBP), and pullover (1RMPO) exercises, estimates of local muscle volume and 3-step running handball throwing velocity (T3-Steps). Fourteen male handball players volunteered for the investigation (age: 19.6+/-0.6 years; body mass: 86.7+/-12.9 kg; and height 1.87+/-0.07 m). Lower and upper limb force-velocity tests were performed on appropriately modified forms of a Monark cycle ergometer, with measurement of PPUL and PPLL, and the corresponding respective maximal forces (F0UL and F0LL) and velocities (V0UL and V0LL). T3-Steps was assessed using a radar Stalker ATS system. Muscle volumes of the upper and lower limbs were estimated with a standard anthropometric kit. T3-Steps was closely related to absolute PPUL and to F0UL (r=0.69, punit of limb muscle volume, the relationship with T3-Steps disappeared. This suggests the importance of muscle volume to performance in throwing events. Force-velocity data may prove useful in regulating conditioning and rehabilitation programs for handball players. Our results also highlight the contribution of both the lower and the upper limbs to handball throwing velocity, suggesting the need for coaches to include upper and lower limb strength and power programs when improving the throwing velocity of handball players. PMID:20508448
Sucar, Luis Enrique; Orihuela-Espina, Felipe; Velazquez, Roger Luis; Reinkensmeyer, David J; Leder, Ronald; Hernández-Franco, Jorge
Virtual reality platforms capable of assisting rehabilitation must provide support for rehabilitation principles: promote repetition, task oriented training, appropriate feedback, and a motivating environment. As such, development of these platforms is a complex process which has not yet reached maturity. This paper presents our efforts to contribute to this field, presenting Gesture Therapy, a virtual reality-based platform for rehabilitation of the upper limb. We describe the system architecture and main features of the platform and provide preliminary evidence of the feasibility of the platform in its current status. PMID:24760913
Schindera, S.T.; Anderson, S.E. [University Hospital of Bern, Department of Diagnostic Radiology, Inselspital, Bern (Switzerland); Streit, M.; Kaelin, U. [University Hospital of Bern, Department of Dermatology, Inselspital, Bern (Switzerland); Stauffer, E. [University Hospital of Bern, Department of Pathology, Inselspital, Bern (Switzerland); Steinbach, L. [University of California San Francisco, Department of Radiology, San Francisco, CA (United States)
The rare occurrence of angiosarcoma in postmastectomy upper-limb lymphedema with magnetic resonance (MR) imaging is discussed. Unfamiliarity with this aggressive vascular tumor and its harmless appearance often leads to delayed diagnosis. Angiosarcoma complicating chronic lymphedema may be low in signal intensity on T2-weighting and short tau inversion recovery (STIR) imaging reflecting the densely cellular, fibrous stroma, and sparsely vascularized tumor histology. Additional administration of intravenous contrast medium revealed significant enhancement of the tumorous lesions. Awareness of angiosarcoma and its MR imaging appearance in patients with chronic lymphedema may be a key to early diagnosis or allow at least inclusion in the differential diagnosis. (orig.)
Riis Jepsen, Jørgen; Thomsen, Gert
least three times during workdays in a six month period. Subjects from the other division served as controls. At the end of the intervention both groups were invited to a second identical evaluation by questionnaire and physical examination. Symptoms and findings were studied in the right upper limb...... definition of nerve affliction at the three locations. RESULTS: Summarized pain was significantly reduced in the intervention group but unchanged in controls. After the intervention, fewer neurological abnormalities in accordance with nerve affliction were recorded for the whole material but no conclusion...
Blank, Amy; O’Malley, Marcia K.; Francisco, Gerard E.; Contreras-Vidal, Jose L.
In this paper, we summarize a novel approach to robotic rehabilitation that capitalizes on the benefits of patient intent and real-time assessment of impairment. Specifically, an upper-limb, physical human-robot interface (the MAHI EXO-II robotic exoskeleton) is augmented with a non-invasive brain-machine interface (BMI) to include the patient in the control loop, thereby making the therapy ‘active’ and engaging patients across a broad spectrum of impairment severity in the rehabilitation tas...
Luquet, C; Chau, N; Nadif, M; Guillemin, F; Gavillot, C; Petry, D; Moreau, T; Bourgkard, E; Hecquet, B; André, J M; Mur, J M
The construction of an instrument including a number of tests requires an analysis of its structure and its unidimensionality (which allows calculation of global score), and the determination of the difficulty level of various tests. This study examined a tool including 67 tests designed to evaluate the functional ability of patients with an injured upper limb. The patients seen in a rehabilitation centre during 12 months (173 subjects) were evaluated by the occupational therapists familiar with the tool. The statistical analyses were made using the principal component analysis method (PCAM), the Cronbach's coefficient and the Rasch model. The PCAM showed 3 principal factors which explained 44%, 10% and 4% of the total variance respectively in the case of patients with injured dominant limb. The predominance of the first axis and the high ratio of first by second eigenvalues suggested the unidimensionality of the tool. The Cronbach's value of 0.97 attested the good congruence of the items. The results obtained with the Rasch model seemed to be consistent with the hypothesis of the unidimensionality of the tool. This analysis also provided the difficulty scale of various tests. Similar results were obtained in patients with injured non dominant limb or with all the sample. The methods used provide complementary results. PMID:8766984
Larissa Louise Campanholi
Full Text Available BACKGROUND: The diagnosis of lymphedema can be obtained objectively by measurement methods, and also by subjective methods, based on the patient's complaint. OBJECTIVE: To evaluate inter-rater reliability of objective and subjective criteria used for diagnosis of lymphedema and to propose a lymphedema cut-off for differences in volume between affected and control limbs. METHODS: We studied 84 patients who had undergone lymphadenectomy for treatment of cutaneous melanoma. Physical measures were obtained by manual perimetry (MP. The subjective criteria analyzed were clinical diagnosis of lymphedema in patients' medical records and self-report of feelings of heaviness and/or increase in volume in the affected limb. RESULTS: For upper limbs, the subjective criteria clinical observation (k 0.754, P<0.001 and heaviness and swelling (k 0.689, P<0.001 both exhibited strong agreement with MP results and there was moderate agreement between MP results and swelling (k 0.483 P<0.001, heaviness (k 0.576, P<0.001 and heaviness or swelling (k 0.412, P=0.001. For lower limbs there was moderate agreement between MP results and clinical observation (k 0.423, P=0.003 and regular agreement between MP and self-report of swelling (k 0.383, P=0.003. Cut-off values for diagnosing lymphedema were defined as a 9.7% difference between an affected upper limb and control upper limb and a 5.7% difference between lower limbs. CONCLUSION: Manual perimetry, medical criteria, and self-report of heaviness and/or swelling exhibited better agreement for upper limbs than for lower limbs for diagnosis of lymphedema.
Johanson, M. Elise
Upper limb reconstructive surgical procedures for individuals with tetraplegia are performed in many centers internationally. Most recipients of surgery return to local communities and nonsurgical centers for postoperative rehabilitation and long-term follow-up. This supplement focuses on the clinical significance of upper extremity reconstruction, addressing issues related to the availability and choice for surgery, preoperative assessments, postoperative training paradigms, and appropriate outcome measures. Comprehensive intervention protocols are described in terms of dose, timing, specific activities, modalities, and related outcomes. Shared knowledge of current rehabilitation practice, as it relates to reconstructive surgery, can expand treatment options communicated to patients, increase the availability of postoperative muscle reeducation programs, and motivate long-term follow-up assessments. PMID:27233593
Fu, Anshuang; Wang, Chunhui; Qi, Hongzhi; Li, Fan; Wang, Zheng; He, Feng; Zhou, Peng; Chen, Shanguang; Ming, Dong
Muscle deconditioning occurs in response to simulated or actual microgravity. In spaceflight, astronauts become monkey-like for mainly using their upper limbs to control the operating system and to complete corresponding tasks. The changes of upper limbs' athletic ability will directly affect astronauts' working performance. This study investigated the variation trend of surface electromyography (sEMG) during prolonged simulated microgravity. Eight healthy males participating in this study performed strict 45-day head-down bed-rest (HDBR). On the 5th day of pre-HDBR, and the 15th, the 30th and the 45th days of HDBR, the subjects performed maximum pushing task and maximum pulling task, and sEMG was collected from upper limbs synchronously. Each subject's maximum volunteer contractions of both the tasks during these days were compared, showing no significant change. However, changes were detected by sEMG-based analysis. It was found that integrated EMG, root mean square, mean frequency, fuzzy entropy of deltoid, and fuzzy entropy of triceps brachii changed significantly when comparing pre-HDBR with HDBR. The variation trend showed a recovery tendency after significant decline, which is inconsistent with the monotonic variation of lower limbs that was proved by previous research. These findings suggest that EMG changes in upper limbs during prolonged simulated microgravity, but has different variation trend from lower limbs.
Hellman, Randall B.; Justin Tanner; Santos, Veronica J.
Many upper limb amputees experience an incessant, post-amputation “phantom limb pain” and report that their missing limbs feel paralyzed in an uncomfortable posture. One hypothesis is that efferent commands no longer generate expected afferent signals, such as proprioceptive feedback from changes in limb configuration, and that the mismatch of motor commands and visual feedback is interpreted as pain. Non-invasive therapeutic techniques for treating phantom limb pain, such as mirror visual fe...
Stienenw, Arno H A; Hekman, Edsko E G; ter Braak, Huub; Aalsma, Arthur M M; van der Helm, Frans C T; van der Kooij, Herman
The goal of this study was to validate the suitability of a novel rotational hydroelastic actuator (rHEA) for use in our new rehabilitation exoskeleton for the upper limbs, the Limpact. The rHEA consists of a rotational hydraulic actuator and a custom-designed symmetric torsion spring in a series-elastic configuration. For rehabilitation therapy and impairment quantification, both compliant impedance control and stiff admittance control modes are possible. In the validation experiments, the torque bandwidth of the rHEA was limited to 18 Hz for a desired 20 N m reference signal (multisine, constant spectrum) due the transport delays in the long flexible tubes between the valve and cylinder. These transport delays also required changes to existing theoretical models to better fit the models on the measured frequency response functions. The (theoretical) measurable torque resolution was better than 0.01 N m and the (validated) delivered torque resolution below 1 N m. After the validation experiments, further iterative improvements resulted in a spring design capable of a maximum output torque of 50 N m with an intrinsic stiffness of 150 N . m/rad and a slightly higher bandwidth. With the design locked, the maximum measurable isometric torque is 100 N m. In conclusion, the rHEA is suitable for upper limb rehabilitation therapy as it matches the desired performance. PMID:19362903
Ku, Chia-Hua; Radwin, Robert G; Karsh, Ben-Tzion
This study investigated the relationship between pneumatic nutrunner handle reactions, workstation characteristics, and prevalence of upper limb injuries in an automobile assembly plant. Tool properties (geometry, inertial properties, and motor characteristics), fastener properties, orientation relative to the fastener, and the position of the tool operator (horizontal and vertical distances) were measured for 69 workstations using 15 different pneumatic nutrunners. Handle reaction response was predicted using a deterministic mechanical model of the human operator and tool that was previously developed in our laboratory, specific to the measured tool, workstation, and job factors. Handle force was a function of target torque, tool geometry and inertial properties, motor speed, work orientation, and joint hardness. The study found that tool target torque was not well correlated with predicted handle reaction force (r=0.495) or displacement (r=0.285). The individual tool, tool shape, and threaded fastener joint hardness all affected predicted forces and displacements (paverage peak handle force and displacement for right-angle tools were twice as great as pistol grip tools. Soft-threaded fastener joints had the greatest average handle forces and displacements. Upper limb injury cases were identified using plant OSHA 200 log and personnel records. Predicted handle forces for jobs where injuries were reported were significantly greater than those jobs free of injuries (ppower hand tool operations and for controlling exposure to forces in manufacturing jobs involving power nutrunners. Therefore, a combination of tool, work station, and task requirements should be considered. PMID:17474028
Linda Resnik, PT, PhD, OCS
Full Text Available Technological advances in upper-limb prosthetic design offer dramatically increased possibilities for powered movement. The DEKA Arm system allows users 10 powered degrees of movement. Learning to control these movements by utilizing a set of motions that, in most instances, differ from those used to obtain the desired action prior to amputation is a challenge for users. In the Department of Veterans Affairs "Study to Optimize the DEKA Arm," we attempted to facilitate motor learning by using a virtual reality environment (VRE program. This VRE program allows users to practice controlling an avatar using the controls designed to operate the DEKA Arm in the real world. In this article, we provide highlights from our experiences implementing VRE in training amputees to use the full DEKA Arm. This article discusses the use of VRE in amputee rehabilitation, describes the VRE system used with the DEKA Arm, describes VRE training, provides qualitative data from a case study of a subject, and provides recommendations for future research and implementation of VRE in amputee rehabilitation. Our experience has led us to believe that training with VRE is particularly valuable for upper-limb amputees who must master a large number of controls and for those amputees who need a structured learning environment because of cognitive deficits.
Cargnin, Diego João; Cordeiro d'Ornellas, Marcos; Cervi Prado, Ana Lúcia
Upper limb stroke rehabilitation requires early, intensive and repetitive practice to be effective. Consequently, it is often difficult to keep patients committed to their rehabilitation regimen. In addition to direct measures of rehabilitation achievable through targeted assessments, other factors can indirectly lead to rehabilitation. Current levels of integration between commodity graphics software, hardware, and body-tracking devices have provided a reliable tool to build what are referred to as serious games, focusing on the rehabilitation paradigm. More specifically, serious games can captivate and engage players for a specific purpose such as developing new knowledge or skills. This paper discusses a serious game application with a focus on upper limb rehabilitation in patients with hemiplegia or hemiparesis. The game makes use of biofeedback and mirror-neurons to enhance the patient's engagement. Results from the application of a quantitative self-report instrument to assess in-game engagement suggest that the serious game is a viable instructional approach rather than an entertaining novelty and, furthermore, demonstrates the future potential for dual action therapy-focused games. PMID:26262069
Arya, Kamal Narayan; Pandian, Shanta
Broca's aphasia is the most challenging communication deficit in stroke. Left inferior frontal gyrus (IFG), a key region of the mirror-neuron system, gets lesioned in Broca's aphasia. Mirror therapy (MT), a form of action-observation, may trigger the mirror neurons. The aim of this study was to report a case of poststroke subject with Broca's aphasia, who exhibited an inadvertent and significant improvement in speech after MT for the paretic upper limb. The 20-month old stroke patient underwent MT through goal-directed tasks. He received a total absence of spontaneous speech, writing, and naming. After 45 sessions of task-based MT for the upper limb, he showed tremendous recovery in expressive communication. He had fluent and comprehensive communication; however, with a low pitch and minor pronunciation errors. He showed a substantial change (from 18/100 to 79/100) on the Communicative Effective Index, particularly, on items such as expressing emotions, one-to-one conversation, naming, and spontaneous conversation. PMID:25440208
To compare the onset, duration and postoperative pain scores of supraclavicular block with bupivacaine alone and bupivacaine-midazolam combination. A randomized controlled clinical trial was conducted on 50 ASA-I or II adult patients undergoing upper limb surgeries under supraclavicular brachial plexus block. Patients were randomly allocated into two groups of 25 each. Patients in group A were administered 30 ml of 0.5% bupivacaine with midazolam 50 micro g kg/sup -1/. Hemodynamic variables (heart rate, noninvasive blood pressure, oxygen saturation), pain scores, rescue analgesic requirements and sedation score were recorded for 24 hours postoperatively, and compared using ANOVA with significance at p <0.05. The onset and duration of sensory and motor block was significantly faster and longer in group B compared to group A (p < 0.001). Pain scores were significantly lower in group B for 24 hours postoperatively (p < 0.001). Demand for rescue analgesic were significantly less in group B. Hemodynamics and sedation scores did not differ between the groups in the studied period. Bupivacaine (0.5%) in combination with Midazolam (50 micro g kg/sup -1/) quickened the onset as well as prolonged the duration of sensory and motor blockade of the brachial plexus for upper limb surgery. It improved postoperative analgesia without producing any adverse events compared to plain bupivacaine (0.5%) in equal volume. (author)
Full Text Available The physiological properties of nerve and muscle are usually modified due to patho physiological changes resulting from many diseases like diabetes. Impaired mobility and compromised dexterity leading to difficulties in daily life. Hand function in diabetes is affected mainly due to involvement of median nerve. Diabetic neuropathy the c ommon complication of diabetes can be assessed electro physiologically by nerve conduction studies. Therefore, we analyzed both motor and sensory nerve conduction on upper limb nerves. Distal latency, Amplitude and conduction velocity were measured in both upper limbs by using RMS EMG EP II machine with surface and ring electrodes. It was found that distal latencies of both nerves were higher in diabetics than non - diabetics. The difference was statistically significant. Motor responses are more reduced bel ow normal as compared with sensory responses in diabetics. Our study also revealed decreased amplitude and conduction velocity among cases. Our findings conclude that the nerve conduction studies are important in early detection of peripheral neuropathy so that prevention and management can be done in earliest possible way.
Zu, Xiaoqi; Zhou, Qianxiang; Li, Yun
All movements are driven by muscle contraction, and it is easy to cause muscle fatigue. Evaluation of muscle fatigue is a hot topic in the area of astronaut life support training and rehabilitation. If muscle gets into fatigue condition, it may reduce work efficiency and has an impact on psychological performance. Therefore it is necessary to develop an accurate and usable method on muscle fatigue evaluation of astronaut upper limb. In this study, we developed a method based on surface electromyography (sEMG) and subjective assessment (Borg scale) to evaluate local muscle fatigue. Fifteen healthy young male subjects participated in the experiment. They performed isometric muscle contractions of the upper limb. sEMG of the biceps brachii were recorded during the entire process of isotonic muscle contraction and Borg scales of muscle fatigue were collected in certain times. sEMG were divided into several parts, and then mean energy of each parts were calculated by the one-twelfth band octave method. Equations were derived based on the relationship between the mean energy of sEMG and Borg scale. The results showed that cubic curve could describe the degree of local muscle fatigue, and could be used to evaluate and monitor local muscle fatigue during the entire process.
Fuller, Jason R; Fung, Joyce; Côté, Julie N
Localized muscle fatigue and postural perturbation have separately been shown to alter whole-body movement but little is known about how humans respond when subjected to both factors combined. Here we sought to quantify the kinematics of postural control and repetitive upper limb movement during standing surface perturbations and in the presence of fatigue. Subjects stood on a motion-based platform and repetitively reached between two shoulder-height targets until noticeably fatigued (rating of perceived exertion=8/10). Every minute, subjects experienced a posterior and an anterior platform translation while reaching to the distal target. Outcomes were compared prior to and with fatigue (first vs. final minute data). When fatigued, regardless of the perturbation condition, subjects decreased their shoulder abduction and increased contralateral trunk flexion, a strategy that may relieve the load on the fatiguing upper limb musculature. During perturbations, kinematic adaptations emerged across the trunk and arm to preserve task performance. In contrast to our expectation, the kinematic response to the perturbations did not alter in the presence of fatigue. Kinematic adaptations in response to the perturbation predominantly occurred in the direction of the reach whereas fatigue adaptations occurred orthogonal to the reach. These findings suggest that during repetitive reaching, fatigue and postural perturbation compensations organize so as to minimize interaction with each other and preserve the global task characteristics of endpoint motion. PMID:24054899
When clinical evaluation is not enough,the evaluation of the venous condition of the upper limbs for the realization of angio access for hemodialysis is classically based on phlebography,an invasive,risky method.the appear rance of non invasive techniques such as eco Doppler(duplex) makes it necessary to do research in order to determine the utility of the method and define its indications.The authors analyse 35 venous mappings of the upper limbs by phlebography and duplex and compare its results for the different venous regions.They come to the conclusion that duplex presented the best performance for the hum ero axillary subclavian region,detecting thrombosis with a sensitivity of 100% a specificity of 97% positive predictive value of 50% and negative predictive value of 100%.For superficial axis (radial and superficial ulnar,basilic and cephalic)there is low sensitivity for the determination of presence and permeability of the axis but 100% specificity.Duplex was not useful for the description of veins in order to determine utility for Avf.Finally,the authors make recommendations as regards indications of these para clinical tests
Quental, Carlos; Folgado, João; Ambrósio, Jorge; Monteiro, Jacinto
The inverse dynamics technique applied to musculoskeletal models, and supported by optimisation techniques, is used extensively to estimate muscle and joint reaction forces. However, the solutions of the redundant muscle force sharing problem are sensitive to the detail and modelling assumptions of the models used. This study presents four alternative biomechanical models of the upper limb with different levels of discretisation of muscles by bundles and muscle paths, and their consequences on the estimation of the muscle and joint reaction forces. The muscle force sharing problem is solved for the motions of abduction and anterior flexion, acquired using video imaging, through the minimisation of an objective function describing muscle metabolic energy consumption. While looking for the optimal solution, not only the equations of motion are satisfied but also the stability of the glenohumeral and scapulothoracic joints is preserved. The results show that a lower level of muscle discretisation provides worse estimations regarding the muscle forces. Moreover, the poor discretisation of muscles relevant to the joint in analysis limits the applicability of the biomechanical model. In this study, the biomechanical model of the upper limb describing the infraspinatus by a single bundle could not solve the complete motion of anterior flexion. Despite the small differences in the magnitude of the forces predicted by the biomechanical models with more complex muscular systems, in general, there are no significant variations in the muscular activity of equivalent muscles. PMID:24156405
Blank, Amy; O'Malley, Marcia K; Francisco, Gerard E; Contreras-Vidal, Jose L
In this paper, we summarize a novel approach to robotic rehabilitation that capitalizes on the benefits of patient intent and real-time assessment of impairment. Specifically, an upper-limb, physical human-robot interface (the MAHI EXO-II robotic exoskeleton) is augmented with a non-invasive brain-machine interface (BMI) to include the patient in the control loop, thereby making the therapy 'active' and engaging patients across a broad spectrum of impairment severity in the rehabilitation tasks. Robotic measures of motor impairment are derived from real-time sensor data from the MAHI EXO-II and the BMI. These measures can be validated through correlation with widely used clinical measures and used to drive patient-specific therapy sessions adapted to the capabilities of the individual, with the MAHI EXO-II providing assistance or challenging the participant as appropriate to maximize rehabilitation outcomes. This approach to robotic rehabilitation takes a step towards the seamless integration of BMIs and intelligent exoskeletons to create systems that can monitor and interface with brain activity and movement. Such systems will enable more focused study of various issues in development of devices and rehabilitation strategies, including interpretation of measurement data from a variety of sources, exploration of hypotheses regarding large scale brain function during robotic rehabilitation, and optimization of device design and training programs for restoring upper limb function after stroke. PMID:24887296
Lettau Ludwig A
Full Text Available Abstract Introduction Restless legs syndrome is a sensorimotor neurological disorder characterized by an urge to move the legs in response to uncomfortable leg sensations. While asleep, 70 to 90 percent of patients with restless legs syndrome have periodic limb movements in sleep. Frequent periodic limb movements in sleep and related brain arousals as documented by polysomnography are associated with poorer quality of sleep and daytime fatigue. Restless legs syndrome in middle age is sometimes associated with neuropathic foot dysesthesias. The causes of restless legs syndrome and periodic limb movements in sleep are unknown, but the sensorimotor symptoms are hypothesized to originate in the central nervous system. We have previously determined that bilateral forefoot digital nerve impingement masses (neuromas may be a cause of both neuropathic foot dysesthesias and the leg restlessness of restless legs syndrome. To the best of our knowledge, this case is the first report of bilateral foot neuromas as a cause of periodic limb movements in sleep. Case presentation A 42-year-old Caucasian woman with severe restless legs syndrome and periodic limb movements in sleep and bilateral neuropathic foot dysesthesias was diagnosed as having neuromas in the second, third, and fourth metatarsal head interspaces of both feet. The third interspace neuromas represented regrowth (or 'stump' neuromas that had developed since bilateral third interspace neuroma excision five years earlier. Because intensive conservative treatments including repeated neuroma injections and various restless legs syndrome medications had failed, radical surgery was recommended. All six neuromas were excised. Leg restlessness, foot dysesthesias and subjective sleep quality improved immediately. Assessment after 18 days showed an 84 to 100 percent reduction of visual analog scale scores for specific dysesthesias and marked reductions of pre-operative scores of the Pittsburgh sleep
Bovenzi, M; Zadini, A; Franzinelli, A; Borgogni, F
An epidemiologic and clinical study of neck and upper limb musculoskeletal disorders was carried out on 65 vibration-exposed forestry operators using chain-saws and 31 comparable control subjects (maintenance workers) performing manual activity and not exposed to vibration. Upper limb function was evaluated by measuring finger and wrist circumference size, maximal hand grip strength and range of motion manoeuvres in both the controls and the exposed workers. Vibration from two chain-saws was measured, and vibration exposure for each forestry worker was assessed in terms of 4 h energy-equivalent frequency-weighted acceleration according to ISO 5349. Job analysis indicated a slight excess risk of upper extremity cumulative trauma disorders (CTDs) in the forestry operators compared with the control workers. After adjustment for age and body constitution, significantly higher prevalence rates of persistent upper limb pain, muscle-tendon syndromes and carpal tunnel syndrome were observed among the forestry workers than among the controls. In the forestry operators, the occurrence of upper limb musculoskeletal disorders increased with increasing vibration exposure. Upper limb function was found to be impaired in the forestry workers compared with the controls. Vibration exposure was significantly related to increased finger circumference size, diminished muscle force and reduced joint function. Even though it is difficult to establish the relative importance of vibration and ergonomic factors in the aetiology of CTDs, nevertheless the results of this study indicate that musculoskeletal impairment to the upper limbs was more severe in the forestry operators than in the controls who did solely manual work. This finding and the observed dose-effect relationships suggest that vibration stress is an important contributor to the development of musculoskeletal disorders in workers using hand-held vibrating tools. PMID:1653132
Jun Yao; Albert Chen; Todd Kuiken; Carolina Carmona; Julius Dewald
This case study demonstrates the change of sensory cortical representations of the residual parts of the arm in an individual who underwent a trans-humeral amputation and subsequent targeted reinnervation (TR). As a relatively new surgical technique, TR restores a direct neural connection from amputated sensorimotor nerves to specific target muscles. This method has been successfully applied to upper-limb and lower-limb amputees, and has shown effectiveness in regaining control signals via th...
Desroches, Guillaume; Gagnon, Dany; Nadeau, Sylvie; Popovic, Milos
The purpose of this study was to investigate the effects of imposing different degrees of forward trunk flexion during sitting pivot transfers on electromyographic activity at the leading and trailing upper limb muscles and on dynamic stability requirements. Thirty-two individuals with a spinal cord injury performed three types of sitting pivot transfers: natural technique, exaggerated forward trunk flexion and upright trunk position. Ground reaction forces, trunk kinematics, and bilateral electromyographic activity of eight upper limb muscles were recorded. Electromyographic data were analyzed using the area under the curve of the muscular utilization ratio. Dynamic stability requirements of sitting pivot transfers were assess using a dynamic equilibrium model. Compared to the natural strategy, significantly greater muscle activities were found for the forward trunk flexion condition at the anterior deltoid and both heads of the pectorialis major, whereas the upright trunk strategy yielded greater muscle activity at the latissimus dorsii and the triceps. The forward flexed condition was found to be more dynamically stable, with a lower stabilizing force, increased area of base of support and greater distance traveled. Thus, transferring with a more forward trunk inclination, even though it increases work of few muscles, may be a beneficial trade-off because increased dynamic stability of this technique and versatility in terms of potential distance of the transfer. PMID:24094473
Sousa Nanji, Liliana; Torres Cardoso, André; Costa, João; Vaz-Carneiro, António
Impairment of the upper limbs is quite frequent after stroke, making rehabilitation an essential step towards clinical recovery and patient empowerment. This review aimed to synthetize existing evidence regarding interventions for upper limb function improvement after Stroke and to assess which would bring some benefit. The Cochrane Database of Systematic Reviews, the Database of Reviews of Effects and PROSPERO databases were searched until June 2013 and 40 reviews have been included, covering 503 studies, 18 078 participants and 18 interventions, as well as different doses and settings of interventions. The main results were: 1- Information currently available is insufficient to assess effectiveness of each intervention and to enable comparison of interventions; 2- Transcranial direct current stimulation brings no benefit for outcomes of activities of daily living; 3- Moderate-quality evidence showed a beneficial effect of constraint-induced movement therapy, mental practice, mirror therapy, interventions for sensory impairment, virtual reality and repetitive task practice; 4- Unilateral arm training may be more effective than bilateral arm training; 5- Moderate-quality evidence showed a beneficial effect of robotics on measures of impairment and ADLs; 6- There is no evidence of benefit or harm for technics such as repetitive transcranial magnetic stimulation, music therapy, pharmacological interventions, electrical stimulation and other therapies. Currently available evidence is insufficient and of low quality, not supporting clear clinical decisions. High-quality studies are still needed. PMID:26667856
Hwang, Seonhong; Kim, Seunghyeon; Son, Jongsang; Lee, Jinbok; Kim, Youngho
Manual wheelchair users have a high risk of injury to the upper extremities. Recent studies have focused on kinematic and kinetic analyses of manual wheelchair propulsion in order to understand the physical demands on wheelchair users. The purpose of this study was to investigate upper limb joint motion by using a motion capture system and a dynamometer with two different groups of wheelchair users propelling their wheelchairs at different speeds under different load conditions. The variations in the contact time, release time, and linear velocity of the experienced group were all larger than they were in the novice group. The propulsion angles of the experienced users were larger than those of the novices under all conditions. The variances in the propulsion force (both radial and tangential) of the experienced users were larger than those of the novices. The shoulder joint moment had the largest variance with the conditions, followed by the wrist joint moment and the elbow joint moment. The variance of the maximum shoulder joint moment was over four times the variance of the maximum wrist joint moment and eight times the maximum elbow joint moment. The maximum joint moments increased significantly as the speed and load increased in both groups. Quick and significant manipulation ability based on environmental changes is considered an important factor in efficient propulsion. This efficiency was confirmed from the propulsion power results. Sophisticated strategies for efficient manual wheelchair propulsion could be understood by observation of the physical responses of each upper limb joint to changes in load and speed. We expect that the findings of this study will be utilized for designing a rehabilitation program to reduce injuries.
S. A. Moussavi-Najarkola A. Khavanin
Full Text Available For high occurrences of upper extremity disorders in working populations and in order to compare the occurrence of musculoskeletal alterations due to ergonomic risk factors such as highly force exertion, repetition, awkward posture between exposed and non-exposed groups, the research was carried out in Tabarestan steel industry. All 526 male workers (316 as exposed group : 132 aged 20-35 years, 184 aged >35 years; 210 as Non-exposed group: 89 aged 20-35 years, 121 aged > 35 years performing tasks exposed / not exposed to risk factors for WMSDS of the upper limbs underwent a clinical examinations as well as completing standardized Nordic Musculoskeletal Questionnaires. The anamnestic cases were defined on the basis of pain, paraesthesia, hyposthenia, and vegetative disorders during previous months. Mean age of exposed and non- exposed groups were obtained 36.3 years (SD= 5.9 and 37.9 years (SD = 7.3 respectively. There were distinguished differences in occurrences of WMSDS of upper limbs between two mentioned groups. The major occurrence was found for the right and left hands. Nocturnal and diurnal paraesthesia obtained an occurrence of about 54% and 53% respectively. Data bears witness to the greater occurrence of affected individuals in exposed group, with a non- exposed / exposed ratio of 1:7.2. The greater occurrences of affected individuals in exposed group (P = 0.006 and in subjects>35 years (P = 0.002 were significant. Structural, organizational and educational measures can be applied to prevent WMSDS or diminish the relative effects to acceptable limit.
Mazomenos, Evangelos B; Biswas, Dwaipayan; Cranny, Andy; Rajan, Amal; Maharatna, Koushik; Achner, Josy; Klemke, Jasmin; Jobges, Michael; Ortmann, Steffen; Langendorfer, Peter
This paper reports an algorithm for the detection of three elementary upper limb movements, i.e., reach and retrieve, bend the arm at the elbow and rotation of the arm about the long axis. We employ two MARG sensors, attached at the elbow and wrist, from which the kinematic properties (joint angles, position) of the upper arm and forearm are calculated through data fusion using a quaternion-based gradient-descent method and a two-link model of the upper limb. By studying the kinematic patterns of the three movements on a small dataset, we derive discriminative features that are indicative of each movement; these are then used to formulate the proposed detection algorithm. Our novel approach of employing the joint angles and position to discriminate the three fundamental movements was evaluated in a series of experiments with 22 volunteers who participated in the study: 18 healthy subjects and four stroke survivors. In a controlled experiment, each volunteer was instructed to perform each movement a number of times. This was complimented by a seminaturalistic experiment where the volunteers performed the same movements as subtasks of an activity that emulated the preparation of a cup of tea. In the stroke survivors group, the overall detection accuracy for all three movements was 93.75% and 83.00%, for the controlled and seminaturalistic experiment, respectively. The performance was higher in the healthy group where 96.85% of the tasks in the controlled experiment and 89.69% in the seminaturalistic were detected correctly. Finally, the detection ratio remains close ( ±6%) to the average value, for different task durations further attesting to the algorithms robustness. PMID:25966489
NASCIMENTO OSVALDO J. M.
Full Text Available Hirayama's disease (HD is frequently found in Asia, and is rarely referred among westerners. It affects young people with higher incidence in males. It is a focal distal amyotrophy with unilateral or asymmetric bilateral involvement of C7, C8 and T1 innervated muscles. HD appears sporadically and has a benign evolution with clinical stabilization in around one year. We report four young male patients with clinical and electrophysiological alterations described in HD, which were followed-up during 5 years. Electromyographic findings were indicative of lower motor neuron involvement. We analyzed cervical MRI aiming at understanding if a questionable spinal cord compression could be implicated in the pathogenesis, but no abnormality was verified. In view of its clinical, and EMG characteristics, HD is no more than a benign monomelic amyotrophy (BMA clinical variant, and not a specific disease. This eponym could be considered only for the distal upper limb variant (Hirayama's variant of the BMA.
Full text: Diseases of the upper limb arteries are significantly rarer than those of the lower limbs but they are not causes and due to the lack of diagnostic algorithms are often missed. the symptoms are not typical except for those in acute thrombosis. The complaints in acute thrombosis is strong, sudden pain in the limb or part of it, bruising or paleness of the ischemic area and a lack of pulsation. Diagnosis is fairly easy – clinical events, difference in blood pressure or a lack of blood pressure in the affected limb, a total lack of blood pressure or a difference in the pressure in the left and right arm. Then complaints in stenosis and chronic occlusions is significantly less pronounced and is expressed as weakness in the affected limb, heaviness, bluish or paleness. If the proximal segments are affected Still’s syndrome is often observed. The complaints is not decisive for diagnosis. A difference in blood pressure of more than 20 mm Hg and an echodoppler examination of the arteries are the main criteria for directing the patients for angiography. Contrast CT and MRT are not used often. treatment is vascular surgery and endovascular. In acute thrombosis priority takes vascular surgery through extraction of the thrombi with Fogerty catheters, and in chronical stenosis and occlusions – dilation and stenting. Clinical cases: Case 1 – Revascularization of artery brachialis, radialis and ulnaris after acute occlusion L.Y., 77 years old. Complains of sharp pain and bruising of right forearm since two hours before hospitalization. A lack of blood flow was identified using palpation and echodoppler. After a diagnostic angiography , thrombaspiration was undertaken, through a leading catheter, recovering blood flow in both arteries and stenting of the proximal segment of artery radialis. Case 2: Revascularization of Trunkus brachiocefalicus K.P., 65 years old. Suffering from bradypsychia for several months. Bradypsychia becomes worse after manual labor
Lum, Peter S; Burgar, Charles G; Van der Loos, Machiel; Shor, Peggy C; Majmundar, Matra; Yap, Ruth
This study presents results from a randomized controlled clinical trial of the Mirror Image Movement Enabler (MIME) robotic device for shoulder and elbow neurorehabilitation in subacute stroke patients, including data on the use of its bilateral training mode. MIME incorporates a PUMA 560 robot (Staubli Unimation Inc, Duncan, South Carolina) that applies forces to the paretic limb during unilateral and bilateral movements in three dimensions. Robot-assisted treatment (bilateral, unilateral, and combined bilateral and unilateral) was compared with conventional therapy. Similar to a previous study in chronic stroke, combined unilateral and bilateral robotic training had advantages compared with conventional therapy, producing larger improvements on a motor impairment scale and a measure of abnormal synergies. However, gains in all treatment groups were equivalent at the 6-month follow-up. Combined unilateral and bilateral training yielded functional gains that were similar to the gains from equivalent doses of unilateral-only robotic training, although the combined group had more hypertonia and less movement out of synergy at baseline. Robot-assisted treatment gains exceeded those expected from spontaneous recovery. These results are discussed in light of the need for further device development and continued clinical trials. PMID:17123204
Full Text Available Early decoding of motor states directly from the brain activity is essential to develop brain-machine interfaces (BMI for natural motor control of neuroprosthetic devices. Hence, this study aimed to investigate the detection of movement information before the actual movement occurs. This information piece could be useful to provide early control signals to drive BMI-based rehabilitation and motor assisted devices, thus providing a natural and active rehabilitation therapy. In this work, electroencephalographic (EEG brain signals from six healthy right-handed participants were recorded during self-initiated reaching movements of the upper limbs. The analysis of these EEG traces showed that significant event-related desynchronization is present before and during the execution of the movements, predominantly in the motor-related α and β frequency bands and in electrodes placed above the motor cortex. This oscillatory brain activity was used to continuously detect the intention to move the limbs, that is, to identify the motor phase prior to the actual execution of the reaching movement. The results showed, first, significant classification between relax and movement intention and, second, significant detection of movement intention prior to the onset of the executed movement. On the basis of these results, detection of movement intention could be used in BMI settings to reduce the gap between mental motor processes and the actual movement performed by an assisted or rehabilitation robotic device.
This book presents a comprehensive framework for model-based electrical stimulation (ES) controller design, covering the whole process needed to develop a system for helping people with physical impairments perform functional upper limb tasks such as eating, grasping and manipulating objects. The book first demonstrates procedures for modelling and identifying biomechanical models of the response of ES, covering a wide variety of aspects including mechanical support structures, kinematics, electrode placement, tasks, and sensor locations. It then goes on to demonstrate how complex functional activities of daily living can be captured in the form of optimisation problems, and extends ES control design to address this case. It then lays out a design methodology, stability conditions, and robust performance criteria that enable control schemes to be developed systematically and transparently, ensuring that they can operate effectively in the presence of realistic modelling uncertainty, physiological variation an...
A guideline to follow is offered to radiologists and residents of radiology service of medical imaging, when evaluating by ultrasound the shoulder joints, elbow, wrist. The importance to performing of musculoskeletal ultrasound by its pathology variable is established. The use of appropriate equipment and effective application of the techniques exposed of echography exploration have made enable the valuation of many pathologies with high sensitivity and specificity. The echography has been the musculoskeletal imaging technique that more rapidly has evolved. Currently, this technique has been replaced by magnetic resonance imaging in various clinical fields and also serves as a complement to other techniques. Exposed techniques have been of great benefit for radiologists medical and residents, obtaining with its use a quick guide for the realization of upper limb musculoskeletal ultrasounds. The appropriate and easy techniques are better known for the evaluation of these structures, and so document both sports injuries, as joint and rheumatic diseases
Tan, Hock Guan; Shee, Cheng Yap; Kong, Keng He; Guan, Cuntai; Ang, Wei Tech
This paper describes the Brain Computer Interface (BCI) system and the experiments to allow post-acute (Aided by visual feedback, subjects then trained to regulate their mu-rhythm EEG to operate the BCI to trigger NMES of the wrist/finger. 6 post-acute stroke patients successfully completed the training, with 4 able to learn to control and use the BCI to initiate NMES. This result is consistent with the reported BCI literacy rate of healthy subjects. Thereafter, without the loss of generality, the controller of the NMES is developed and is based on a model of the upper limb muscle (biceps/triceps) groups to determine the intensity of NMES required to flex or extend the forearm by a specific angle. The muscle model is based on a phenomenological approach, with parameters that are easily measured and conveniently implemented.
In recent years, many researchers have studied the potential of using robotics technology to assist and quantify the motor functions for neuron-rehabilitation. Some kinds of haptic devices have been developed and evaluated its efficiency with clinical tests, for example, upper limb training for patients with spasticity after stroke. However, almost all the devices are active-type (motor-driven) haptic devices and they basically require high-cost safety system compared to passive-type (brake-based) devices. In this study, we developed a new practical haptic device 'PLEMO-P1'; this system adopted ER brakes as its force generators. In this paper, the mechanism of PLEMO-P1 and its software for a reaching rehabilitation are described.
De Jesus, Karla; De Jesus, Kelly; Medeiros, Alexandre I. A.; Gonçalves, Pedro; Figueiredo, Pedro; Fernandes, Ricardo J.; Vilas-Boas, João Paulo
A proficient start is decisive in sprint competitive swimming events and requires swimmers’ to exert maximal forces in a short period to complete the task successfully. The aim of this study was to compare the electromyographic (EMG) activity in-between the backstroke start with feet positioned parallel and partially emerged performed with the hands on the highest horizontal and on the vertical handgrip at hands-off, take-off, flight and entry start phases. EMG comparisons between starting variants were supported by upper and lower limb joint angles at starting position and 15 m start time data. Following a four-week start training to familiarize participants with each start variant, 10 male competitive backstroke swimmers performed randomly six 15 m maximal trials, being three of each start variant. Surface EMG of Biceps Brachii, Triceps Brachii, Rectus Femoris, Biceps Femoris, Gastrocnemius Medialis and Tibialis Anterior was recorded and processed using the time integral EMG (iEMG). Eight video cameras (four surface and four underwater) were used to determine backstroke start phases and joint angles at starting position. EMG, joint angles and temporal parameters have not evidenced changes due to the different handgrips. Nevertheless, clear differences were observed in both variants for upper and lower limb muscles activity among starting phases (e.g. Biceps Brachii at take-off vs. flight phase, 15.17% ± 2.76% and 22.38% ± 4.25%; 14.24% ± 7.11% and 25.90% ± 8.65%, for variant with hands horizontal and vertically positioned, respectively). It was concluded that different handgrips did not affect EMG, kinematics and temporal profile in backstroke start. Despite coaches might plan similar strength training for both start variants, further attention should be given on the selection of proper exercises to maximize the contribution of relevant muscles at different starting phases. Key points An effective swim start component (from the starting signal until the
Saul, Katherine R; Hu, Xiao; Goehler, Craig M; Vidt, Meghan E; Daly, Melissa; Velisar, Anca; Murray, Wendy M
Several opensource or commercially available software platforms are widely used to develop dynamic simulations of movement. While computational approaches are conceptually similar across platforms, technical differences in implementation may influence output. We present a new upper limb dynamic model as a tool to evaluate potential differences in predictive behavior between platforms. We evaluated to what extent differences in technical implementations in popular simulation software environments result in differences in kinematic predictions for single and multijoint movements using EMG- and optimization-based approaches for deriving control signals. We illustrate the benchmarking comparison using SIMM-Dynamics Pipeline-SD/Fast and OpenSim platforms. The most substantial divergence results from differences in muscle model and actuator paths. This model is a valuable resource and is available for download by other researchers. The model, data, and simulation results presented here can be used by future researchers to benchmark other software platforms and software upgrades for these two platforms. PMID:24995410
Sundstrup, Emil; Jakobsen, Markus D; Andersen, Christoffer H;
(95% confidence interval -2.0 to -0.9) following resistance training compared with usual care, corresponding to an effect size of 0.91 (Cohen's d). LIMITATIONS: Blinding of participants is not possible in behavioral interventions. However, at baseline outcome expectations of the 2 interventions were...... capacity of the worker by physical conditioning. OBJECTIVES: To investigate the effect of 2 contrasting interventions, conventional ergonomic training (usual care) versus resistance training, on pain and disability in individuals with upper limb chronic pain exposed to highly repetitive and forceful manual......BACKGROUND: Chronic pain and disability of the arm, shoulder, and hand severely affect labor market participation. Ergonomic training and education is the default strategy to reduce physical exposure and thereby prevent aggravation of pain. An alternative strategy could be to increase physical...
Sundstrup, Emil; Jakobsen, Markus D; Andersen, Christoffer H;
interval -2.0 to -0.9) following resistance training compared with usual care, corresponding to an effect size of 0.91 (Cohen's d). LIMITATIONS: Blinding of participants is not possible in behavioral interventions. However, at baseline outcome expectations of the 2 interventions were similar. CONCLUSION...... capacity of the worker by physical conditioning. OBJECTIVES: To investigate the effect of 2 contrasting interventions, conventional ergonomic training (usual care) versus resistance training, on pain and disability in individuals with upper limb chronic pain exposed to highly repetitive and forceful manual......BACKGROUND: Chronic pain and disability of the arm, shoulder, and hand severely affect labor market participation. Ergonomic training and education is the default strategy to reduce physical exposure and thereby prevent aggravation of pain. An alternative strategy could be to increase physical...
Bueno, Diana R; Lizano, J M; Montano, L
Rehabilitation exercises cause fatigue because tasks are repetitive. Therefore, inevitable human motion performance changes occur during the therapy. Although traditionally fatigue is considered an event that occurs in the musculoskeletal level, this paper studies whether fatigue can be regarded as context that influences lower-dimensional motor control organization and coordination at neural level. Non Negative Factorization Matrix (NNFM) and Detrended Fluctuations Analysis (DFA) are the tools used to analyze the changes in the coordination of motor function when someone is affected by fatigue. The study establishes that synergies remain fairly stable with the onset of fatigue, but the fatigue affects the dynamical coordination understood as a cognitive process. These results have been validated with 9 healthy subjects for three representative exercises for upper limb: biceps, triceps and deltoid. PMID:26737679
John E. Muñoz-Cardona
Full Text Available This paper shows the design of work-station for work-related inclusion people upper-limb disability. The system involves the use of novel brain computer interface used to bridge the user-computer interaction. Our hope objective is elucidating functional, technological, ergonomic and procedural aspects to runaway operation station; with propose to scratch barrier to impossibility access to TIC’s tools and work done for individual disability person. We found access facility ergonomics, adaptability and portable issue of workstation are most important design criteria. Prototype implementations in workplace environment have TIR estimate of 43% for retrieve. Finally we list a typology of services that could be the most appropriate for the process of labor including: telemarketing, telesales, telephone surveys, order taking, social assistance in disasters, general information and inquiries, reservations at tourist sites, technical support, emergency, online support and after-sales services.
De Jesus, Karla; De Jesus, Kelly; Medeiros, Alexandre I A; Gonçalves, Pedro; Figueiredo, Pedro; Fernandes, Ricardo J; Vilas-Boas, João Paulo
A proficient start is decisive in sprint competitive swimming events and requires swimmers' to exert maximal forces in a short period to complete the task successfully. The aim of this study was to compare the electromyographic (EMG) activity in-between the backstroke start with feet positioned parallel and partially emerged performed with the hands on the highest horizontal and on the vertical handgrip at hands-off, take-off, flight and entry start phases. EMG comparisons between starting variants were supported by upper and lower limb joint angles at starting position and 15 m start time data. Following a four-week start training to familiarize participants with each start variant, 10 male competitive backstroke swimmers performed randomly six 15 m maximal trials, being three of each start variant. Surface EMG of Biceps Brachii, Triceps Brachii, Rectus Femoris, Biceps Femoris, Gastrocnemius Medialis and Tibialis Anterior was recorded and processed using the time integral EMG (iEMG). Eight video cameras (four surface and four underwater) were used to determine backstroke start phases and joint angles at starting position. EMG, joint angles and temporal parameters have not evidenced changes due to the different handgrips. Nevertheless, clear differences were observed in both variants for upper and lower limb muscles activity among starting phases (e.g. Biceps Brachii at take-off vs. flight phase, 15.17% ± 2.76% and 22.38% ± 4.25%; 14.24% ± 7.11% and 25.90% ± 8.65%, for variant with hands horizontal and vertically positioned, respectively). It was concluded that different handgrips did not affect EMG, kinematics and temporal profile in backstroke start. Despite coaches might plan similar strength training for both start variants, further attention should be given on the selection of proper exercises to maximize the contribution of relevant muscles at different starting phases. Key pointsAn effective swim start component (from the starting signal until the
Delafontaine, A; Honeine, J-L; Do, M-C; Gagey, O; Chong, R K
Improvement of motor performance in unilateral upper limb motor disability has been shown when utilizing inter-limb coupling strategies during physical rehabilitation. This suggests that 'default' bilateral central motor commands are facilitated. Here, we tested whether this bilateral motor control principle may be generalized to the lower limbs during gait initiation, which involves alternate bilateral actions. Disability was simulated by strapping to produce ankle hypomobility. Healthy adult subjects initiated gait at a self-paced speed with no ankle constraint (control), or with the stance, swing or bilateral ankles strapped. The duration of the anticipatory postural adjustments lengthened and the center of mass instantaneous progression velocity at foot-off decreased when the ankle was strapped. During the step execution phase, progression velocity at foot-contact was higher when both ankles were strapped compared to unilateral strapping of the stance ankle. These findings suggest that bilateral central motor commands are favored during walking tasks. Indeed, unilateral constraint of the stance ankle should compel the central nervous system to adapt specific commands to the constraint and normal sides whereas the 'default' bilateral motor commands would be utilized when both ankles are strapped leading to better kinematics performance. Bilateral in-phase upper limb coordination and bilateral alternating lower limb locomotor movements may share similar control mechanisms. PMID:26197055
Frisoli, Antonio; Procopio, Caterina; Chisari, Carmelo; Creatini, Ilaria; Bonfiglio, Luca; Bergamasco, Massimo; Rossi, Bruno; Carboncini, Maria Chiara
This study, conducted in a group of nine chronic patients with right-side hemiparesis after stroke, investigated the effects of a robotic-assisted rehabilitation training with an upper limb robotic exoskeleton for the restoration of motor function in spatial reaching movements. The robotic assisted rehabilitation training was administered for a period of 6 weeks including reaching and spatial antigravity movements. To assess the carry-over of the observed improvements in movement during training into improved function, a kinesiologic assessment of the effects of the training was performed by means of motion and dynamic electromyographic analysis of reaching movements performed before and after training. The same kinesiologic measurements were performed in a healthy control group of seven volunteers, to determine a benchmark for the experimental observations in the patients' group. Moreover degree of functional impairment at the enrolment and discharge was measured by clinical evaluation with upper limb Fugl-Meyer Assessment scale (FMA, 0-66 points), Modified Ashworth scale (MA, 0-60 pts) and active ranges of motion. The robot aided training induced, independently by time of stroke, statistical significant improvements of kinesiologic (movement time, smoothness of motion) and clinical (4.6 ± 4.2 increase in FMA, 3.2 ± 2.1 decrease in MA) parameters, as a result of the increased active ranges of motion and improved co-contraction index for shoulder extension/flexion. Kinesiologic parameters correlated significantly with clinical assessment values, and their changes after the training were affected by the direction of motion (inward vs. outward movement) and position of target to be reached (ipsilateral, central and contralateral peripersonal space). These changes can be explained as a result of the motor recovery induced by the robotic training, in terms of regained ability to execute single joint movements and of improved interjoint coordination of elbow
Full Text Available Abstract This study, conducted in a group of nine chronic patients with right-side hemiparesis after stroke, investigated the effects of a robotic-assisted rehabilitation training with an upper limb robotic exoskeleton for the restoration of motor function in spatial reaching movements. The robotic assisted rehabilitation training was administered for a period of 6 weeks including reaching and spatial antigravity movements. To assess the carry-over of the observed improvements in movement during training into improved function, a kinesiologic assessment of the effects of the training was performed by means of motion and dynamic electromyographic analysis of reaching movements performed before and after training. The same kinesiologic measurements were performed in a healthy control group of seven volunteers, to determine a benchmark for the experimental observations in the patients’ group. Moreover degree of functional impairment at the enrolment and discharge was measured by clinical evaluation with upper limb Fugl-Meyer Assessment scale (FMA, 0–66 points, Modified Ashworth scale (MA, 0–60 pts and active ranges of motion. The robot aided training induced, independently by time of stroke, statistical significant improvements of kinesiologic (movement time, smoothness of motion and clinical (4.6 ± 4.2 increase in FMA, 3.2 ± 2.1 decrease in MA parameters, as a result of the increased active ranges of motion and improved co-contraction index for shoulder extension/flexion. Kinesiologic parameters correlated significantly with clinical assessment values, and their changes after the training were affected by the direction of motion (inward vs. outward movement and position of target to be reached (ipsilateral, central and contralateral peripersonal space. These changes can be explained as a result of the motor recovery induced by the robotic training, in terms of regained ability to execute single joint movements and of improved
Kim, Hyeong Gyun [Dept. of Radiological Science, Far East University, Eumsung (Korea, Republic of); Yoon, Jae Ho [Jukwang Precision Co., Ltd., Gumi (Korea, Republic of); Choi, Seong Dae [Dept. of Mechanical system engineering, Kumoh Institute of Technology, Gumi (Korea, Republic of)
There is a progressive development in the medical imaging technology, especially of descriptive capability for anatomical structure of human body thanks to advancement of information technology and medical devices. But however maintenance of correct posture is essential for the medical imaging checkup on the shoulder joint requiring rotation of the upper limb due to the complexity of human body. In the cases of MRI examination, long duration and fixed posture are critical, as failure to comply with them leads to minimal possibility of reproducibility only with the efforts of the examiner and will of the patient. Thus, this study aimed to develop an auxiliary device that enables rotation of the upper limb as well as fixing it at quantitative angles for medical imaging examination capable of providing diagnostic values. An auxiliary device has been developed based on the results of precedent studies, by designing a 3D model with the CATIA software, an engineering application, and producing it with the 3D printer. The printer is Objet350 Connex from Stratasys, and acrylonitrile- butadiene-styrene(ABS) is used as the material of the device. Dimensions are 120 X 150 X 190 mm, with the inner diameter of the handle being 125.9 mm. The auxiliary device has 4 components including the body (outside), handle (inside), fixture terminal and the connection part. The body and handle have the gap of 2.1 mm for smooth rotation, while the 360 degree of scales have been etched on the handle so that the angle required for observation may be recorded per patient for traceability and dual examination.
Rogerio Teixeira da Silva
Full Text Available As lesões esportivas do membro superior são muito comuns da prática de atividades físicas e, por isso, devem ser estudadas detalhadamente, levando-se em consideração aspectos específicos da modalidades esportiva praticada. Especial atenção deve ser dada à dinâmica da articulação do ombro e toda cintura escapular, pois somente assim poderemos tratar de forma mais adequada os atletas, atuando também na prevenção das recidivas, que podem ocorrer em alguns casos devido ao fato de o atleta procurar sempre o retorno ao mesmo nível esportivo anterior à lesão. Este artigo vai focar principalmente o manejo das lesões tendíneas do membro superior, da fisiopatologia até os novos métodos de tratamento das lesões de maior prevalência na prática esportiva em nosso país.Sports injuries of the upper limbs are very common in physical activities, and need to be studied in detail, taking into consideration specific aspects of the types of sports practiced. Special attention should be paid to the dynamics of the shoulder girdle and scapular belt, as this will enable us to treat athletes more adequately, also helping prevent recurrences that can occur in some cases, due to the fact that the athlete always attempts to return to their pre-injury level of sport. This review focuses primarily on the management of upper limb tendon sports injuries, from the physiopathology through to the more common new methods of treatment in sports practice in our country.
Paulo H. Marchetti
Full Text Available The purpose of the present study was to evaluate the acute effects of an upper limb static-stretching (SS protocol on the maximal concentric jump performance. We recruited 25 young healthy, male, resistance trained individuals (stretched group, n = 15 and control group, n = 10 in this study. The randomized between group experimental protocol consisted of a three trials of maximal concentric jump task, before and after a SS of the upper limb. Vertical ground reaction forces (vGRF and surface electromyography (sEMG of both gastrocnemius lateralis (GL and vastus lateralis (VL were acquired. An extensive SS was employed consisting of ten stretches of 30 seconds, with 15 seconds of rest, and 70-90% of the point of discomfort (POD. ANOVA (2x2 (group x condition was used for shoulder joint range of motion (ROM, vGRF and sEMG. A significant interaction for passive ROM of the shoulder joint revealed significant increases between pre- and post-SS protocol (p < 0.001. A significant interaction demonstrated decreased peak force and an increased peak propulsion duration between pre- and post-stretching only for stretch group (p = 0.021, and p = 0.024, respectively. There was a significant main effect between groups (stretch and control for peak force for control group (p = 0.045. Regarding sEMG variables, there were no significant differences between groups (control versus stretched or condition (pre-stretching versus post-stretching for the peak amplitude of RMS and IEMG for both muscles (VL and GL. In conclusion, an acute extensive SS can increase the shoulder ROM, and negatively affect both the propulsion duration and peak force of the maximal concentric jump, without providing significant changes in muscle activation.
Full Text Available INTRODUCTION Goal of our work was to establish the data of normal nerve conduction velocity (NCV for the median and the ulnar nerves in normal healthy adults in Barpeta town area, Assam, India. METHODS Nerve conduction studies were performed prospectively in the upper limbs of 100 carefully screened, healthy individuals of either sex, who were between the ages of 20 and 60 years, by using a standardized technique. RESULTS: MOTOR STUDIES The median distal latency (DL in men was 3.48 (0.26 ms, the amplitude (CMAPA was 9.86 (1.92 mV, the conduction velocity (MNCV was 55.94 (2.94 m/s and the F-wave (min latency was 26.86 (2.12 minute. In the ulnar nerve, the motor DL was 2.3 (0.26 ms, the amplitude (CMAPA was 9.97 (3.90 mV, MNCV was 62.97 (3.90 m/s and the F-Wave (min latency was 25.98±2.41. In the sensory studies, the median nerve DL was 1.89 (0.25 ms, SNCV was 53.14±3.80 m/s and the amplitude (SNAPA was 42.69 (20.48 μV for was. For the ulnar nerve the DL was 1.89 (0.36 ms, SNCV was 56.86 (6.23 m/s and the amplitude (SNAPA was 40.92 (168.4 μV. CONCLUSION The normative conduction parameters of the commonly tested nerves in the upper limb were established in research laboratory of physiology department of our institute. The mean motor nerve conduction parameters for the median and the ulnar nerves correlated favorably with the existing literature data. However, for the sensory nerves, a higher value for the nerve action potential amplitude was demonstrated in this study.
Karla De Jesus, Kelly De Jesus, Alexandre I. A. Medeiros, Pedro Gonçalves, Pedro Figueiredo, Ricardo J. Fernandes, João Paulo Vilas-Boas
Full Text Available A proficient start is decisive in sprint competitive swimming events and requires swimmers’ to exert maximal forces in a short period to complete the task successfully. The aim of this study was to compare the electromyographic (EMG activity in-between the backstroke start with feet positioned parallel and partially emerged performed with the hands on the highest horizontal and on the vertical handgrip at hands-off, take-off, flight and entry start phases. EMG comparisons between starting variants were supported by upper and lower limb joint angles at starting position and 15 m start time data. Following a four-week start training to familiarize participants with each start variant, 10 male competitive backstroke swimmers performed randomly six 15 m maximal trials, being three of each start variant. Surface EMG of Biceps Brachii, Triceps Brachii, Rectus Femoris, Biceps Femoris, Gastrocnemius Medialis and Tibialis Anterior was recorded and processed using the time integral EMG (iEMG. Eight video cameras (four surface and four underwater were used to determine backstroke start phases and joint angles at starting position. EMG, joint angles and temporal parameters have not evidenced changes due to the different handgrips. Nevertheless, clear differences were observed in both variants for upper and lower limb muscles activity among starting phases (e.g. Biceps Brachii at take-off vs. flight phase, 15.17% ± 2.76% and 22.38% ± 4.25%; 14.24% ± 7.11% and 25.90% ± 8.65%, for variant with hands horizontal and vertically positioned, respectively. It was concluded that different handgrips did not affect EMG, kinematics and temporal profile in backstroke start. Despite coaches might plan similar strength training for both start variants, further attention should be given on the selection of proper exercises to maximize the contribution of relevant muscles at different starting phases.
Eckert, Nathanial R.; Poston, Brach; Riley, Zachary A.
The silent period induced by cutaneous electrical stimulation of the digits has been shown to be task-dependent, at least in the grasping muscles of the hand. However, it is unknown if the cutaneous silent period is adaptable throughout muscles of the entire upper limb, in particular when the task requirements are substantially altered. The purpose of the present study was to examine the characteristics of the cutaneous silent period in several upper limb muscles when introducing increased whole-body instability. The cutaneous silent period was evoked in 10 healthy individuals with electrical stimulation of digit II of the right hand when the subjects were seated, standing, or standing on a wobble board while maintaining a background elbow extension contraction with the triceps brachii of ~5% of maximal voluntary contraction (MVC) strength. The first excitatory response (E1), first inhibitory response (CSP), and second excitatory response (E2) were quantified as the percent change from baseline and by their individual durations. The results showed that the level of CSP suppression was lessened (47.7 ± 7.7% to 33.8 ± 13.2% of baseline, p = 0.019) and the duration of the CSP inhibition decreased (p = 0.021) in the triceps brachii when comparing the seated and wobble board tasks. For the wobble board task the amount of cutaneous afferent inhibition of EMG activity in the triceps brachii decreased; which is proposed to be due to differential weighting of cutaneous feedback relative to the corticospinal drive, most likely due to presynaptic inhibition, to meet the demands of the unstable task. PMID:26981863
Kew, J J; Halligan, P W; Marshall, J C; Passingham, R E; Rothwell, J C; Ridding, M C; Marsden, C D; Brooks, D J
We studied two human subjects with total deafferentation of one upper limb secondary to traumatic multiple cervical root avulsions. Both subjects developed a phantom limb and underwent elective amputation of the paralyzed, deafferentated limb. Psychophysical study revealed in each subject an area of skin in the pectoral region ipsilateral to the amputation where vibrotactile stimulation (VS) elicited referred sensations (RS) in the phantom limb. Positron emission tomography was then used to measure regional cerebral blood flow changes during VS of the pectoral region ipsilateral to the amputation with RS and during VS of a homologous part of the pectoral region adjacent to the intact arm without RS. A voxel-based correlation analysis was subsequently used to study functional connectivity. VS of the pectoral region adjacent to the intact arm was associated with activation of the dorsal part of the contralateral primary somatosensory cortex (S1) in a position consistent with the S1 trunk area. In contrast, VS of the pectoral region ipsilateral to the amputation with RS was associated with activation of the contralateral S1 that extended from the level of the trunk representation ventrally over distances of 20 and 12 mm, respectively, in the two subjects. The area of S1 activated during VS of the digits in a normal control subject was coextensive with the ventral S1 region abnormally activated during VS of the ectopic phantom representation in the two amputees, suggesting that the deafferented digit or hand/arm area had been activated by sensory input from the pectoral region. Correlation analysis showed an abnormal pattern of intrinsic connectivity within the deafferented S1 hand/arm area of both amputees. In one subject, the deafferented S1 was functionally connected with 3 times as many S1 voxels as the normally afferented S1. This abnormal functional connectivity extended in both the rostrocaudal and ventrodorsal dimensions. The results demonstrate that sensory
Lisboa, Maria; Domingues, Isabel; Pamplona, Jaime; Barata, Pedro; Morgado, Joana; Brotas, Vítor
[english] Purpose: To describe a clinical case and literature review of Whipple disease.Methods: A 65-year-old male with bilateral decreased visual acuity for 3 weeks as well as bilateral hypoacusia, vertigo, disequilibrium, headache and decreased strength in the right upper limb for 4 months. The clinical work-up revealed a bilateral panuveitis and an ischemic cerebellar stroke.Result: The diagnosis of Whipple disease was confirmed by histopathological analysis of adenopathy. The patient was...
Li, C.; Rusak, Z.; Horvath, I.; Ji, L.; Hou, Y.
In the last two decades, robotics-assisted stroke reha-bilitation has been wide-spread, in particular for movement rehabilitation of upper limbs. Several studies have reported on the clinical effectiveness of this kind of therapy. The results of these studies show that robot assisted therapy can be
Heremans, Elke; Nackaerts, Evelien; Vervoort, Griet; Vercruysse, Sarah; Broeder, Sanne; Strouwen, Carolien; Swinnen, Stephan P.; Nieuwboer, Alice
Background Recent studies show that besides freezing of gait (FOG), many people with Parkinson’s disease (PD) also suffer from freezing in the upper limbs (FOUL). Up to now, it is unclear which task constraints provoke and explain upper limb freezing. Objective To investigate whether upper limb freezing and other kinematic abnormalities during writing are provoked by (i) gradual changes in amplitude or by (ii) sustained amplitude generation in patients with and without freezing of gait. Methods Thirty-four patients with PD, including 17 with and 17 without FOG, performed a writing task on a touch-sensitive writing tablet requiring writing at constant small and large size as well as writing at gradually increasing and decreasing size. Patients of both groups were matched for disease severity, tested while ‘on’ medication and compared to healthy age-matched controls. Results Fifty upper limb freezing episodes were detected in 10 patients, including 8 with and 2 without FOG. The majority of the episodes occurred when participants had to write at small or gradually decreasing size. The occurrence of FOUL and the number of FOUL episodes per patient significantly correlated with the occurrence and severity of FOG. Patients with FOUL also showed a significantly smaller amplitude in the writing parts outside the freezing episodes. Conclusions Corroborating findings of gait research, the current study supports a core problem in amplitude control underlying FOUL, both in maintaining as well as in flexibly adapting the cycle size. PMID:26580556
Aytekin, Ebru; Dogan, Yasemin Pekin; Okur, Sibel Caglar; Burnaz, Ozer; Caglar, Nil Sayiner
[Purpose] Paget-Schroetter syndrome (PSS) is an uncommon deep vein thrombosis of the axillary and subclavian veins which may occur spontaneously, but is usually caused by excessive upper limb activity. PSS is clinically similar to other upper limb musculoskeletal disorders and soft tissue infections, and this may lead to delay in correct diagnosis in its early stages. The aim of our case report is to discuss this rare condition with reference to the available literature. [Subjects and Methods] Here we report the case of a doner kebab chef who complained of swelling and pain in his right arm around the biceps muscle. The initial diagnosis was biceps tendon rupture, for which the patient underwent magnetic resonance imaging (MRI) of the right arm and shoulder. Since the MRI revealed no pathological findings, right upper limb venous Doppler ultrasound analysis was performed. Subacute thrombosis materials were detected in the subclavian, axillary, and brachial veins. [Results] With rapid anticoagulant therapy, the patient’s symptoms quickly improved. [Conclusion] Early diagnosis and treatment of PSS is critical for preventing potentially fatal complications such as pulmonary embolism. Prophylaxis is important for preventing recurrent thrombosis and for avoiding the development of post-thrombotic syndrome. PSS should be considered a possible cause of painful swelling of the upper limbs, especially in young, active patients who use their arms excessively. PMID:26644704
Yamada, Naoki; Kakuda, Wataru; Kondo, Takahiro; Shimizu, Masato; Mitani, Sugao; Abo, Masahiro
We investigated the safety, feasibility, and efficacy of the combination of bihemispheric repetitive transcranial magnetic stimulation (rTMS) and intensive occupational therapy (OT) for upper limb hemiparesis in poststroke patients. The study participants were eight poststroke patients with upper limb hemiparesis (age at intervention: 62.8±4.9 years, time after stroke: 84.3±87.2 months, mean±SD). During 15 days of hospitalization, each patient received 10 sessions of 40-min bihemispheric rTMS and 240-min intensive OT (120-min one-to-one training and 120-min self-training). One session of bihemispheric rTMS comprised the application of both 1 and 10 Hz rTMS (2000 stimuli for each hemisphere). The Fugl-Meyer Assessment, Wolf Motor Function Test, and the Modified Ashworth Scale were administered on the day of admission and at discharge. All patients completed the treatment without any adverse effects. Motor function of the affected upper limb improved significantly, on the basis of changes in Fugl-Meyer Assessment and Wolf Motor Function Test (P<0.05, each). A significant decrease in the Modified Ashworth Scale score was noted in the elbow, wrist, and finger flexors of the affected upper limb (P<0.05, each). The combination of bihemispheric rTMS and intensive OT was safe and feasible therapy for poststroke hemiparetic patients, and improved motor function of the hemiparetic upper limb in poststroke patients. The findings provide a new avenue for the treatment of patients with poststroke hemiparesis. PMID:23797616
Full Text Available Abstract Background Few research in multiple sclerosis (MS has focused on physical rehabilitation of upper limb dysfunction, though the latter strongly influences independent performance of activities of daily living. Upper limb rehabilitation technology could hold promise for complementing traditional MS therapy. Consequently, this pilot study aimed to examine the feasibility of an 8-week mechanical-assisted training program for improving upper limb muscle strength and functional capacity in MS patients with evident paresis. Methods A case series was applied, with provision of a training program (3×/week, 30 minutes/session, supplementary on the customary maintaining care, by employing a gravity-supporting exoskeleton apparatus (Armeo Spring. Ten high-level disability MS patients (Expanded Disability Status Scale 7.0-8.5 actively performed task-oriented movements in a virtual real-life-like learning environment with the affected upper limb. Tests were administered before and after training, and at 2-month follow-up. Muscle strength was determined through the Motricity Index and Jamar hand-held dynamometer. Functional capacity was assessed using the TEMPA, Action Research Arm Test (ARAT and 9-Hole Peg Test (9HPT. Results Muscle strength did not change significantly. Significant gains were particularly found in functional capacity tests. After training completion, TEMPA scores improved (p = 0.02, while a trend towards significance was found for the 9HPT (p = 0.05. At follow-up, the TEMPA as well as ARAT showed greater improvement relative to baseline than after the 8-week intervention period (p = 0.01, p = 0.02 respectively. Conclusions The results of present pilot study suggest that upper limb functionality of high-level disability MS patients can be positively influenced by means of a technology-enhanced physical rehabilitation program.
Amit Goel; Punit Tiwari; Pramod Kumar Sharma; Suresh Kumar; Anup Kumar Kundu
Hydatid cyst is an endemic disease in our country. Most commonly, it occurs in the liver and lungs. Bilateral hydroureteronephrosis is one of the rare presentations of hydatid disease. Herein, we are reporting an unusual case of hydatid disease where the primary mode of presentation was external iliac vein compression with chronic renal failure because of bilateral ureteric involvement. The patient was treated with bilateral double-J stenting to improve the renal function and operated later f...
Ganjparvar, Zohreh; Mousavi, Batool; Masumi, Mehdi; Soroush, Mohammadreza; Montazeri, Ali
Background: Providing care to a disable relative at home exposes the caregiver to a potentially higher risk of physical and mental problems. We measured health-related quality of life (HRQOL) and its determinants among the caregivers of the Iranian survivors of the Iran-Iraq war (1980–1988) with bilateral lower-limb amputation. Methods: Data were collected from 464 individuals comprising war-related bilateral lower-limb amputees (n=232) and their caregivers (n=232) in January 2015 in Shiraz, Iran. The 36-Item Short-Form Health Survey (SF-36) questionnaire was used to evaluate the caregivers’ QOL. Logistic regression analysis was performed to determine the most significant contributing factors. Results: The mean age of the caregivers and the amputees was 39.4±6.2 and 42.5±6.2 years, respectively. The mean duration of disability was 22.8±3.9 years in the amputees. Most of the caregivers were reported to be in their first marriage. The highest and lowest mean scores of the SF-36 domains in the sample population were observed for physical function (76.65±21.97) and bodily pain (53.54±24.95). QOL in the caregivers was significantly lower than that in a sample of the general Iranian female population (Phealth problems (OR: 1.79, 95% CI: 1.02 to 3.15, P=0.04) in the amputees constituted the most important predicting factors in the caregivers’ QOL. Conclusion: The caregivers of the bilateral lower-limb amputees in the current study suffered from a poor QOL. Hospitalization and mental problems were the most significant contributing factors vis-à-vis the caregivers’ HRQOL. Health care and services should, therefore, be provided to both amputees and their caregivers. PMID:27365546
Full Text Available Magneto-Inertial Measurement Unit sensors (MIMU display high potential for the quantitative evaluation of upper limb kinematics, as they allow monitoring ambulatory measurements. The sensor-to-segment calibration step, consisting of establishing the relation between MIMU sensors and human segments, plays an important role in the global accuracy of joint angles. The aim of this study was to compare sensor-to-segment calibrations for the MIMU-based estimation of wrist, elbow, and shoulder joint angles, by examining trueness (“close to the reference” and precision (reproducibility validity criteria. Ten subjects performed five sessions with three different operators. Three classes of calibrations were studied: segment axes equal to technical MIMU axes (TECH, segment axes generated during a static pose (STATIC, and those generated during functional movements (FUNCT. The calibrations were compared during the maximal uniaxial movements of each joint, plus an extra multi-joint movement. Generally, joint angles presented good trueness and very good precision in the range 5°–10°. Only small discrepancy between calibrations was highlighted, with the exception of a few cases. The very good overall accuracy (trueness and precision of MIMU-based joint angle data seems to be more dependent on the level of rigor of the experimental procedure (operator training than on the choice of calibration itself.
Luis Manuel Vaca Benitez
Full Text Available The rehabilitation of patients should not only be limited to the first phases during intense hospital care but also support and therapy should be guaranteed in later stages, especially during daily life activities if the patient’s state requires this. However, aid should only be given to the patient if needed and as much as it is required. To allow this, automatic self-initiated movement support and patient-cooperative control strategies have to be developed and integrated into assistive systems. In this work, we first give an overview of different kinds of neuromuscular diseases, review different forms of therapy, and explain possible fields of rehabilitation and benefits of robotic aided rehabilitation. Next, the mechanical design and control scheme of an upper limb orthosis for rehabilitation are presented. Two control models for the orthosis are explained which compute the triggering function and the level of assistance provided by the device. As input to the model fused sensor data from the orthosis and physiology data in terms of electromyography (EMG signals are used.
Luchetti, Martina; Montebarocci, Ornella; Rossi, Nicolino; Cutti, Andrea G; Sutin, Angelina R
Amputation is a traumatic and life-changing event that can take years to adjust to. The present study (a) examines psychological adjustment in a specific trauma-exposed sample, (b) compares the phenomenology (e.g., vividness) of amputation-related memories to more recent memories, and (c) tests whether memory phenomenology is associated with psychological distress. A total of 24 upper-limb amputees recalled two autobiographical memories--an amputation-related memory and a recent memory--and rated the phenomenological qualities of each memory, including Vividness, Coherence, Emotional Intensity, Visual Perspective, and Distancing. Participants also completed self-rated measures of psychological distress and personality. The sample was generally well adjusted; participants showed no relevant symptoms of anxiety and depression, and personality scores were similar to the general population. There were no significant differences in phenomenology between the two types of memories recalled. Even though amputation-related memories were, on average, almost 20 years older than the recent memories, they retained their intense phenomenology. Despite the intensity of the memory, none of the phenomenological dimensions were associated with psychological distress. It is worth to further define which dimensions of phenomenology characterize memories of traumatic events, and their association with individuals' psychological reactions. PMID:24924483
Valdés, Bulmaro A; Hilderman, Courtney G E; Hung, Chai-Ting; Shirzad, Navid; Van der Loos, H F Machiel
As part of the FEATHERS (Functional Engagement in Assisted Therapy Through Exercise Robotics) project, two motion tracking and one social networking applications were developed for upper limb rehabilitation of stroke survivors and teenagers with cerebral palsy. The project aims to improve the engagement of clients during therapy by using video games and a social media platform. The applications allow users to control a cursor on a personal computer through bimanual motions, and to interact with their peers and therapists through the social media. The tracking applications use either a Microsoft Kinect or a PlayStation Eye camera, and the social media application was developed on Facebook. This paper presents a usability testing of these applications that was conducted with therapists from two rehabilitation clinics. The "Cognitive Walkthrough" and "Think Aloud" methods were used. The objectives of the study were to investigate the ease of use and potential issues or improvements of the applications, as well as the factors that facilitate and impede the adoption of technology in current rehabilitation programs. PMID:25570770
In recent years, many researchers have studied the potential of using robotics technology to assist and quantify the motor functions for neuron-rehabilitation. Some kinds of haptic devices have been developed and evaluated its efficiency with clinical tests, for example, upper limb training for patients with spasticity after stroke. Active-type (motor-driven) haptic devices can realize a lot of varieties of haptics. But they basically require high-cost safety system. On the other hand, passive-type (brake-based) haptic devices have inherent safety. However, the passive robot system has strong limitation on varieties of haptics. There are not sufficient evidences to clarify how the passive/active haptics effect to the rehabilitation of motor skills. In this paper, we developed an active-passive-switchable rehabilitation system with ER clutch/brake device named 'Hybrid-PLEMO' in order to address these problems. In this paper, basic structures and haptic control methods of the Hybrid-PLEMO are described.
Manoj Madakshira Gopal
Full Text Available Primary cutaneous lymphomas are defined as lymphoid neoplasms that present themselves clinically on the skin and do not have extra-cutaneous disease, when the diagnosis is made or even after 6 months of the diagnosis. Primary cutaneous lymphomas of B-cells are less frequent than lymphomas of T-cells. Primary B-cell lymphomas have a better prognosis than secondary B-cell lymphomas. Primary B-cell cutaneous lymphomas are classified into five types according to the World Health Organization and European Organization for Research and Treatment of Cancer classification. The primary diffuse large B-cell cutaneous lymphoma - leg type corresponds to approximately 5-10% of the B-cell cutaneous lymphomas. It is predominantly seen in elderly people and has a female preponderance. Skin lesions can be single, multiple, and even grouped. A 5-year survival rate ranges from 36 to 100% of the cases. The expression of Bcl-2, presence of multiple lesions, and involvement of both the upper limbs lead to a worse prognosis. Very few cases have been described in the literature.
Full Text Available The human-powered self-generator provides the best solution for individuals who need an instantaneous power supply for travel, outdoor, and emergency use, since it is less dependent on weather conditions and occupies less space than other renewable power supplies. However, many commercial portable self-generators that employ hand-cranking are not used as much as expected in daily lives although they have enough output capacity due to their intensive workload. This study proposes a portable human-powered generator which is designed to obtain mechanical energy from an upper limb pulling motion for improved human motion economy as well as efficient human-mechanical power transfer. A coreless axial-flux permanent magnet machine (APMM and a flywheel magnet rotor were used in conjunction with a one-way clutched power transmission system in order to obtain effective power from the pulling motion. The developed prototype showed an average energy conversion efficiency of 30.98% and an average output power of 0.32 W with a maximum of 1.89 W. Its small form factor (50 mm × 32 mm × 43.5 mm, 0.05 kg and the substantial electricity produced verify the effectiveness of the proposed method in the utilization of human power. It is expected that the developed generator could provide a mobile power supply.