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Sample records for amputated upper limb

  1. Prevalence and Characteristics of Phantom Limb Pain and Residual Limb Pain in the Long Term after Upper Limb Amputation

    Science.gov (United States)

    Desmond, Deirdre M.; MacLachlan, Malcolm

    2010-01-01

    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…

  2. Prevalence and characteristics of phantom limb pain and residual limb pain in the long term following upper limb amputation

    OpenAIRE

    Desmond, Deirdre M.; MacLachlan, Malcolm

    2010-01-01

    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...

  3. Phantom limb perception interferes with motor imagery after unilateral upper-limb amputation.

    Science.gov (United States)

    Lyu, Yuanyuan; Guo, Xiaoli; Bekrater-Bodmann, Robin; Flor, Herta; Tong, Shanbao

    2016-01-01

    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

  4. Quality of Life among Egyptian Patients with Upper and Lower Limb Amputation: Sex Differences

    OpenAIRE

    Mohammed, Salwa A.; Shebl, Amany M.

    2014-01-01

    Background. Limb amputation is a life-changing event that can cause significant disruptions in many important areas of existence. Aim of this study. To evaluate the quality of life (QOL) of patients with limb amputation and identify the factors affecting the quality of life of patients with limb amputation among Egyptian patients. Research Design. It was a descriptive exploratory design. Setting. The study was conducted in Orthopedics and Surgical Department in Emergency Hospital at Mansou...

  5. Sensory cortical re-mapping following upper-limb amputation and subsequent targeted reinnervation: A case report

    OpenAIRE

    Jun Yao; Albert Chen; Todd Kuiken; Carolina Carmona; Julius Dewald

    2015-01-01

    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...

  6. Epidural electrocorticography of phantom hand movement following long-term upper-limb amputation

    Directory of Open Access Journals (Sweden)

    Alireza eGharabaghi

    2014-05-01

    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.

  7. Quality of Life among Egyptian Patients with Upper and Lower Limb Amputation: Sex Differences

    Directory of Open Access Journals (Sweden)

    Salwa A. Mohammed

    2014-01-01

    Full Text Available Background. Limb amputation is a life-changing event that can cause significant disruptions in many important areas of existence. Aim of this study. To evaluate the quality of life (QOL of patients with limb amputation and identify the factors affecting the quality of life of patients with limb amputation among Egyptian patients. Research Design. It was a descriptive exploratory design. Setting. The study was conducted in Orthopedics and Surgical Department in Emergency Hospital at Mansoura University Hospitals. Sample. A sample of convenience of 100 adult male and female patients who met the inclusion criteria was included. Tools. (a Structured interview questionnaire (SIQ was used to collect personal data, (b short form (36 health status questionnaires: this part was utilized to assess the quality of life among Egyptian patients with amputation. Results. The result of this study indicates that most participants experienced a change in the quality of life. There is a statistically significant difference between total QOL aspects and each of the following: age, gender, educational level, and type of work. Conclusion. Limb amputation tends to cause increased disability for those amputated patients. The age, gender, place of amputation, and marital status are found as statistically significant factors with physical component and psychological component.

  8. Phantom limb perception interferes with motor imagery after unilateral upper-limb amputation

    OpenAIRE

    Yuanyuan Lyu; Xiaoli Guo; Robin Bekrater-Bodmann; Herta Flor; Shanbao Tong

    2016-01-01

    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...

  9. Epidural electrocorticography of phantom hand movement following long-term upper-limb amputation

    OpenAIRE

    Alireza Gharabaghi

    2014-01-01

    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...

  10. Merkel cell carcinoma: A case of palliative upper limb amputation in a patient with refractory in-transit metastases.

    Science.gov (United States)

    Gunaratne, Dakshika A; Howle, Julie R; Veness, Michael J

    2016-05-01

    We report an unusual case of Merkel cell carcinoma in a 70-year-old woman with the rapid development of left upper limb in-transit and hepatic metastases. The patient had a preceding history of left-sided breast cancer. Palliative chemotherapy with carboplatin and etoposide produced a minimal response. The in-transit metastases rapidly progressed and were refractory to chemotherapy and a single fraction of palliative radiotherapy, leading to a marked impact on her quality of life, secondary to sepsis and bleeding. After lengthy discussion, she consented to an above-elbow amputation resulting in a marked improvement in her well-being. In this case, we believe that palliative amputation of the involved arm was justified and beneficial to the patient. PMID:25754425

  11. Sensory cortical re-mapping following upper-limb amputation and subsequent targeted reinnervation: A case report

    Directory of Open Access Journals (Sweden)

    Jun Yao

    2015-01-01

    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.

  12. Major limb amputations: A tertiary hospital experience in northwestern Tanzania

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    Chalya Phillipo L

    2012-05-01

    Full Text Available Abstract Background Major limb amputation is reported to be a major but preventable public health problem that is associated with profound economic, social and psychological effects on the patient and family especially in developing countries where the prosthetic services are poor. The purpose of this study was to outline the patterns, indications and short term complications of major limb amputations and to compare our experience with that of other published data. Methods This was a descriptive cross-sectional study that was conducted at Bugando Medical Centre between March 2008 and February 2010. All patients who underwent major limb amputation were, after informed consent for the study, enrolled into the study. Data were collected using a pre-tested, coded questionnaire and analyzed using SPSS version 11.5 computer software. Results A total of 162 patients were entered into the study. Their ages ranged between 2–78 years (mean 28.30 ± 13.72 days. Males outnumbered females by a ratio of 2:1. The majority of patients (76.5% had primary or no formal education. One hundred and twelve (69.1% patients were unemployed. The most common indication for major limb amputation was diabetic foot complications in 41.9%, followed by trauma in 38.4% and vascular disease in 8.6% respectively. Lower limbs were involved in 86.4% of cases and upper limbs in 13.6% of cases giving a lower limb to upper limb ratio of 6.4:1 Below knee amputation was the most common procedure performed in 46.3%. There was no bilateral limb amputation. The most common additional procedures performed were wound debridement, secondary suture and skin grafting in 42.3%, 34.5% and 23.2% respectively. Two-stage operation was required in 45.4% of patients. Revision amputation rate was 29.6%. Post-operative complication rate was 33.3% and surgical site infection was the most common complication accounting for 21.0%. The mean length of hospital stay was 22.4 days and mortality

  13. Amputation for tumor of the upper arm.

    Science.gov (United States)

    Blåder, S; Gunterberg, B; Markhede, G

    1983-04-01

    In a 10-year period 35 patients underwent a proximal amputation of the upper limb because of a malignant tumor. In 27 patients a forequarter amputation was made, in one a humeroscapular disarticulation and in seven an amputation through the humerus. The observed 5-year survival was 23 per cent. Twelve out of 23 patients followed for at least 3 years also survived 3 years. Fifteen living patients were questioned concerning prosthetic use and social and psychologic factors. Only three patients used a functional (mechanical) prosthesis and only five used a cosmetic prosthesis. The other seven patients rejected the use of a prosthesis. Half of the patients had the same occupation postoperatively as preoperatively. Activities of daily living did not constitute any major problem. One of three housekeepers needed daily help. One patient seemed to have suffered obvious psychologic damage. PMID:6845999

  14. [Psychological adjustment following lower limb amputation].

    Science.gov (United States)

    Panyi, Lilla Krisztina; Lábadi, Beatrix

    2015-09-27

    Rehabilitation of lower limb amputees and the fitting of their prosthesis depend highly on the psychological adjustment process and motivational state of the patient. The loss of a limb is extremely challenging and can cause various physical and psychological problems. Depression, anxiety, decreased well-being and quality of life, body image dissatisfaction and changes in self-concept and identity are frequent after lower limb amputation. In the interest of adjustment patients have to cope with the emerging changes and difficulties in their lifes as well as the problems in psychological functioning. It is important for them to accept the alterations in their body and identity, and integrate them in a new self-concept in which process motivation is a fundamental issue. The aim of this article is to review the literature on psychological consequences of lower limb amputation, and to propose an integrative way of rehabilitation for lower limb amputees. PMID:26550913

  15. Motor cortex changes after amputation are modulated by phantom limb motor control rather than pain

    DEFF Research Database (Denmark)

    Raffin, Estelle E.; Pascal, Giraux,; Karen, Reilly,; Nathalie, Richard,

    retains a residual M1-c activity when amputees perform phantom limb movements (4-5). Except a correlation between phantom limb pain and M1-c expansion of the face (2-3), the relationship between the ability to voluntary move the phantom hand, the level of phantom limb pain, the degree of M1-c......Amputation of a limb induces reorganization within the contralateral primary motor cortex (M1-c) (1-3). In the case of hand amputation, M1-c areas evoking movements in the face and the remaining part of the upper-limb expand toward the hand area. Despite this expansion, the amputated hand still...

  16. Pain Management in Four-Limb Amputation: A Case Report.

    Science.gov (United States)

    Warner, Nafisseh S; Warner, Matthew A; Moeschler, Susan M; Hoelzer, Bryan C

    2015-09-01

    Acute pain following amputation can be challenging to treat due to multiple underlying mechanisms and variable clinical responses to treatment. Furthermore, poorly controlled preoperative pain is a risk factor for developing chronic pain. Evidence suggests that epidural analgesia and peripheral nerve blockade may decrease the severity of residual limb pain and the prevalence of phantom pain after lower extremity amputation. We present the perioperative analgesic management of a patient with gangrene of the bilateral upper and lower extremities as a result of septic shock and prolonged vasopressor administration who underwent four-limb amputation in a single procedure. A multimodal analgesic regimen was utilized, including titration of preoperative opioid and neuropathic pain agents, perioperative intravenous, epidural and peripheral nerve catheter infusions, and postoperative oral medication titration. More than 8 months postoperatively, the patient has satisfactory pain control with no evidence for phantom limb pain. To our knowledge, there have been no publications to date concerning analgesic regimens in four-limb amputation. PMID:26011696

  17. The use of high-density EEG to map out cortical motor activity and reorganization following lower-limb amputation

    OpenAIRE

    Valur Guðnason 1991

    2016-01-01

    Introduction: Studies have shown that after amputation, changes occur in the sensory and motor cortex. These changes are called cortical reorganization, where adjacent cortical areas occupy the cortical area of the amputated limb. High-density electroencephalography (EEG) has been used to observe cortical reorganization in the motor cortex following upper limb amputation. The aim of this study was to use high-density EEG to map out motor cortical activity and cortical reorganization following...

  18. Amputation

    Science.gov (United States)

    ... of illnesses and disabilities Your health Everyday living Parenting Your rights Women veterans with disabilities Caregiver support ... partially cut off due to an accident or violence. With surgical amputation, a limb or part of ...

  19. Quality of Life of Nigerians with Unilateral Lower Limb Amputation

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    Christopher Olusanjo Akosile

    2013-02-01

    Full Text Available Purpose: The aims of this study were to determine the QoL of Nigerians with lower limb amputation and to investigate the influence of some clinical and socio-demographic variables on it. Method: Forty-seven individuals with lower limb amputation participated in this study. Participants’ age, gender, marital status, occupation, time since amputation, level of amputation, affected limb and use of prosthesis were recorded. Quality of life was then measured using the WHO QOL-BREF. Data were analysed using mean and standard deviation, Mann-Whitney U test and Kruskal-Wallis test at 0.05 alpha levels. Results: Participants’ overall health and QoL scores were 3.6(SD 0.9 and 3.9(SD 0.7 respectively. Male subjects had significantly higher scores than females in the domains of physical health (p = 0.007, social relationships (p = 0.024 and overall health (p = 0.012. Prosthesis-wearing subjects scored significantly higher in the domains of physical health (p = 0.015, psychological health (p = 0.008 and environment (p = 0.011 and overall health (0.033, than those not wearing prosthesis. Level of amputation, leg dominance and pre-amputation occupational category had no significant influence on participants’ QoL. Conclusion: The findings of this study suggest that the QoL of individuals with lower limb amputation in Nigeria is moderate. The only factors which have significant influence on some QoL domains are gender and use of prosthesis.Implications: Individuals with lower limb amputation, particularly females and those not wearing prosthesis, require special attention. Clinicians should identify barriers to the use of prosthesis so as to enhance their quality of life.

  20. Amputated Lower Limb Fixation to the Fracture Table.

    Science.gov (United States)

    Gamulin, Axel; Farshad, Mazda

    2015-11-01

    Fractures of the proximal and diaphyseal femur are frequently internally fixed using a fracture table with fracture reduction obtained by traction and adequate rotation exerted on the slightly abducted extremity. Although rare, these fractures may occur on an amputated limb. If so, standard use of a fracture table is not possible. To address this situation, the authors describe a simple novel technique allowing rigid fixation of the amputated limb to the traction device of the fracture table that provides accurate control of reduction in all planes. PMID:26558660

  1. Vascular surgery reduces the frequency of lower limb major amputations

    DEFF Research Database (Denmark)

    Lindholt, Jes Sanddal; Bøvling, Søren; Fasting, H; Henneberg, E W

    1994-01-01

    In June 1988 a Department of Vascular Surgery was established in the county of Viborg, Denmark. In this retrospective study of the periods 1986-87 and 1989-90, we have observed a significant rise in the number of patients evaluated by a vascular surgeon before amputation, from 19 to 49%. At the...... same time the number of major lower limb amputations significantly decreased. This reduction was most marked in 1990 probably due to a rise of 43% in the number of distal reconstructions. The distribution between below knee, through knee and mid-thigh amputation was unaffected by the increased vascular...... surgical activity. The frequency of major amputations in the county in 1986-87 of 40.9 per 100,000 per year declined by 25% to 30.9 per 100,000 per year in 1989-90. We conclude that vascular surgery reduces the number of major lower limb amputations and consequently all patients threatened with amputation...

  2. Upper-limb thrombo-embolectomy: national cohort study in Denmark

    DEFF Research Database (Denmark)

    Andersen, L V; Mortensen, L S; Lindholt, Jes S.; Faergeman, O; Henneberg, Eskild Winther; Frost, L

    2010-01-01

    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....

  3. Always Contact a Vascular Interventional Specialist Before Amputating a Patient with Critical Limb Ischemia

    International Nuclear Information System (INIS)

    Patients with severe critical limb ischemia (CLI) due to long tibial artery occlusions are often poor candidates for surgical revascularization and frequently end up with a lower limb amputation. Subintimal angioplasty (SA) offers a minimally invasive alternative for limb salvage in this severely compromised patient population. The objective of this study was to evaluate the results of SA in patients with CLI caused by long tibial occlusions who have no surgical options for revascularization and are facing amputation. We retrospectively reviewed all consecutive patients with CLI due to long tibial occlusions who were scheduled for amputation because they had no surgical options for revascularization and who were treated by SA. A total of 26 procedures in 25 patients (14 males; mean age, 70 ± 15 [SD] years) were evaluated. Technical success rate was 88% (23/26). There were four complications, which were treated conservatively. Finally, in 10 of 26 limbs, no amputation was needed. A major amputation was needed in 10 limbs (7 below-knee amputations and 3 above-knee amputations). Half of the major amputations took place within 3 months after the procedure. Cumulative freedom of major amputation after 12 months was 59% (SE = 11%). In six limbs, amputation was limited to a minor amputation. Seven patients (28%) died during follow-up. In conclusion, SA of the tibial arteries seem to be a valuable treatment option to prevent major amputation in patients with CLI who are facing amputation due to lack of surgical options.

  4. Factors related to successful job reintegration of people with a lower limb amputation

    NARCIS (Netherlands)

    Schoppen, Tanneke; Boonstra, Antje; Groothoff, JW; van Sonderen, E; Goeken, LN; Eisma, Willem

    2001-01-01

    Objective: To study demographically, amputation-, and employment-related factors that show a relationship to successful job reintegration of patients after lower limb amputation. Design: Cross-sectional study. Setting: University hospital. Patients: Subjects had an acquired unilateral major amputati

  5. Primary motor cortex changes after amputation correlate with phantom limb pain and the ability to move the phantom limb.

    Science.gov (United States)

    Raffin, Estelle; Richard, Nathalie; Giraux, Pascal; Reilly, Karen T

    2016-04-15

    A substantial body of evidence documents massive reorganization of primary sensory and motor cortices following hand amputation, the extent of which is correlated with phantom limb pain. Many therapies for phantom limb pain are based upon the idea that plastic changes after amputation are maladaptive and attempt to normalize representations of cortical areas adjacent to the hand area. Recent data suggest, however, that higher levels of phantom pain are associated with stronger local activity and more structural integrity in the missing hand area rather than with reorganization of neighbouring body parts. While these models appear to be mutually exclusive they could co-exist, and one reason for the apparent discrepancy between them might be that no single study has examined the organisation of lip, elbow, and hand movements in the same participants. In this study we thoroughly examined the 3D anatomy of the central sulcus and BOLD responses during movements of the hand, elbow, and lips using MRI techniques in 11 upper-limb amputees and 17 healthy control subjects. We observed different reorganizational patterns for all three body parts as the former hand area showed few signs of reorganization, but the lip and elbow representations reorganized and shifted towards the hand area. We also found that poorer voluntary control and higher levels of pain in the phantom limb were powerful drivers of the lip and elbow topological changes. In addition to providing further support for the maladaptative plasticity model, we demonstrate for the first time that motor capacities of the phantom limb correlate with post-amputation reorganization, and that this reorganization is not limited to the face and hand representations but also includes the proximal upper-limb. PMID:26854561

  6. Physical and social factors determining quality of life for veterans with lower-limb amputation(s)

    DEFF Research Database (Denmark)

    Christensen, Jan; Ipsen, Thomas; Doherty, Patrick; Langberg, Henning

    Purpose Most veterans live for many years after their war-related traumatic lower-limb amputation, which is why understanding which factors influence health-related quality of life (HRQoL) remains important to their long-term management. The objective of this study was to perform a review of the......-limb amputation(s), HRQoL outcome and veterans. Physical and social factors that influence HRQoL were extracted. Results The literature search identified 2073 citations, leading to the inclusion of 10 studies in the systematic review. Physical activity level, sport participation, level of amputation, back pain......, years of education, as well as duration and severity of phantom pain were found to be determining factors for HRQoL among veterans with lower-limb amputation. Conclusions The identified physical and social determinants were similar to those found in civilian traumatic amputees. More high quality...

  7. Analysis of predictor factors of limb amputation in patients with high-voltage electrical burns

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    Guillermo García Álvarez

    2015-09-01

    Full Text Available Background: Limb amputation is considered one of the most devastating consequences of electrical injury. Any factors that correlate with the degree of muscle damage can be used to predict the necessity of limb amputation. The aim of this study was to determine the factors that can be used to predict limb amputation in high-voltage electrically injured patients. Methods: Eighty-two high-voltage electrically injured patients were admitted to the Department of Plastic and Reconstructive Surgery and Burns of National Arzobispo Loayza Hospital on a 5 year period. A retrospective analysis of the possible related risk factors between amputation and non-amputation patients was performed. Results: A total of 68 patients were enrolled for analysis. Thirteen patients underwent limb amputations. Multivariate analysis of the risk factors between amputation and non-amputation groups showed statistical significance for first 24 hour creatine kinase-isoenzyme MB (CKMB level. A serum CK-MB level above 14,955 U/L predicted high risk of limb amputation with high specificity (84% and sensitivity (77%. Only one patient with a remarkable decrease of creatine kinase (CPKt and CK-MB levels after fasciotomy avoided a major limb amputation. Conclusion: Our results suggest that CPK-MB level is an independent factor for prediction of limb amputation in patients with high-voltage electrical burns. We suggest that the addition of CPK-MB evaluation to clinical symptom screening may be a valuable method for early detection of muscle damage.

  8. Analysis of predictor factors of limb amputation in patients with high-voltage electrical burns

    OpenAIRE

    Guillermo García Álvarez; Guillermo Wiegering Cecchi

    2015-01-01

    Background: Limb amputation is considered one of the most devastating consequences of electrical injury. Any factors that correlate with the degree of muscle damage can be used to predict the necessity of limb amputation. The aim of this study was to determine the factors that can be used to predict limb amputation in high-voltage electrically injured patients. Methods: Eighty-two high-voltage electrically injured patients were admitted to the Department of Plastic and Reconstructive Surg...

  9. Assessment of gait stability, harmony, and symmetry in subjects with lower-limb amputation evaluated by trunk accelerations

    Directory of Open Access Journals (Sweden)

    Marco Iosa, PhD

    2014-07-01

    Full Text Available Analysis of upper-body accelerations is a promising and simple technique for quantitatively assessing some general features of gait such as stability, harmony, and symmetry. Despite the growing literature on elderly healthy populations and neurological patients, few studies have used accelerometry to investigate these features in subjects with lower-limb amputation. We enrolled four groups of subjects: subjects with transfemoral amputation who walked with a locked knee prosthesis, subjects with transfemoral amputation who walked with an unlocked knee prosthesis, subjects with transtibial amputation, and age-matched nondisabled subjects. We found statistically significant differences for stability (p < 0.001, harmony (p < 0.001, and symmetry (p < 0.001 of walking, with general trends following the noted order of subjects, but with the lowest laterolateral harmony in subjects with transtibial amputation. This study is the first to investigate upper-body acceleration of subjects with unilateral lower-limb amputation during walking who were evaluated upon dismissal from a rehabilitation hospital; it is also the first study to differentiate the sample in terms of level of amputation and type of prosthesis used.

  10. Phantom pain and phantom sensations in upper limb amputees: an epidemiological study

    OpenAIRE

    Kooijman, CM; Dijkstra, PU; Geertzen, JHB; Elzinga, A; Van Der Schans, CP

    2000-01-01

    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...

  11. Infantile lipofibromatosis of the upper limb

    Energy Technology Data Exchange (ETDEWEB)

    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)

    2005-12-01

    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.)

  12. Tactile, thermal, and electrical thresholds in patients with and without phantom limb pain after traumatic lower limb amputation

    OpenAIRE

    Melton DH; Li S

    2015-01-01

    Shengai Li,1,2 Danielle H Melton,1,2 Sheng Li1,2 1Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston, TX, USA; 2Neurorehabilitation Research Laboratory, TIRR Memorial Hermann Research Center, Houston, TX, USA Purpose: To examine whether there is central sensitization in patients with phantom limb pain (PLP) after traumatic limb amputation. Methods: Seventeen patients after unilateral lower limb amputation secondary to trauma were...

  13. Painful neuroma requiring surgical excision after lower limb amputation caused by landmine explosions

    OpenAIRE

    Sehirlioglu, Ali; Ozturk, Cagatay; Yazicioglu, Kamil; Tugcu, Ilknur; Yilmaz, Bilge; Goktepe, Ahmet Salim

    2007-01-01

    This article reports an analysis of 75 consecutive lower limb amputees who developed painful neuroma requiring surgical excision after lower limb amputation following landmine explosions. This retrospective study analyses the results of 75 patients who were treated for painful neuroma after lower limb amputation following landmine explosions between the years 2000 and 2006. The average time period from use of prosthesis to start of symptoms suggesting neuroma was 9.6 months. The average time ...

  14. Combined mirror visual and auditory feedback therapy for upper limb phantom pain: a case report

    OpenAIRE

    Yan Kun; Chernev Ivan; Wilcher Delia G

    2011-01-01

    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...

  15. Pediatric Traumatic Limb Amputation: The Principles of Management and Optimal Residual Limb Lengths.

    Science.gov (United States)

    Khan, Muhammad Adil Abbas; Javed, Ammar Asrar; Rao, Dominic Jordan; Corner, J Antony; Rosenfield, Peter

    2016-01-01

    Pediatric traumatic limb amputations are rare and their acute and long term management can be challenging in this subgroup of patients. The lengthy and costly hospital stays, and resulting physical and psychological implications leads to significant morbidity. We present a summary of treatment principles and the evidence base supporting the management options for this entity. The initial management focuses on resuscitating and stabilization of the patients, administration of appropriate and adequate analgesics, and broad spectrum antibiotics. The patient should ideally be managed by an orthopedic or a plastic surgeon and when an amputation is warranted, the surgical team should aim to conserve as much of the viable physis as possible aimed at allowing bone development in a growing child. A subsequent wound inspection should be performed to assess for signs of ischemia or non-viability of tissue. Depending on the child's age, approximations of the ideal residual limb length can be calculated using our guidelines, allowing an ideal stump length at skeletal maturity for a well-fitting and appropriate prosthesis. Myodesis and myoplasties can be performed according to the nature of the amputation. Removable rigid dressings are safe and cost effective offering better protection of the stump. Complications such as necrosis and exostosis, on subsequent examination, warrant further revisions. Other complications such as neuromas can be prevented by proximal division of the nerves. Successful rehabilitation can be accomplished with a multidisciplinary approach, involving physiotherapist, play therapist and a child psychiatrist, in addition to the surgeon and primary care providers. PMID:27308235

  16. Very low survival rates after non-traumatic lower limb amputation in a consecutive series

    DEFF Research Database (Denmark)

    Kristensen, Morten Tange; Holm, Gitte; Kirketerp-Møller, Klaus;

    2012-01-01

    The aim of this retrospective study was to evaluate factors potentially influencing short- and long-term mortality in patients who had a non-traumatic lower limb amputation in a university hospital. A consecutive series of 93 amputations (16% toe/foot, 33% trans-tibial, 9% through knee and 42% tr...

  17. Spinal, pelvic, and hip movement asymmetries in people with lower-limb amputation: Systematic review

    Directory of Open Access Journals (Sweden)

    Hemakumar Devan, MPhty

    2015-04-01

    Full Text Available Following amputation, people with transfemoral amputation (TFA and transtibial amputation (TTA adapt with asymmetrical movements in the spinal and lower-limb joints. The aim of this review is to describe the trunk, lumbopelvic, and hip joint movement asymmetries of the amputated limb of people with TFA and TTA during functional tasks as compared with the intact leg and/or referent leg of nondisabled controls. Electronic databases were searched from inception to February 2014. Studies with kinematic data comparing (1 amputated and intact leg and (2 amputated and referent leg of nondisabled controls were included (26 articles. Considerable heterogeneity in the studies precluded data pooling. During stance phase of walking in participants with TFA, there is moderate evidence for increased trunk lateral flexion toward the amputated limb as compared with the intact leg and increased anterior pelvic tilt as compared with nondisabled controls. None of the studies investigated spinal kinematics during other functional tasks such as running, ramp walking, stair climbing, or obstacle crossing in participants with TFA or TTA. Overall, persons with TFA adapt with trunk and pelvic movement asymmetries at the amputated limb to facilitate weight transfer during walking. Among participants with TTA, there is limited evidence of spinal and pelvic asymmetries during walking.

  18. Sexuality in people with a lower limb amputation : a topic too hot to handle?

    NARCIS (Netherlands)

    Verschuren, J. E. A.; Enzlin, P.; Geertzen, J. H. B.; Dijkstra, P. U.; Dekker, R.

    2013-01-01

    Purpose: The purpose of this study was to analyze whether, and by whom sexuality is discussed in amputation departments. The focus was on whether professionals received questions about sexuality from their patients with a lower limb amputation and whether they addressed sexuality themselves, as well

  19. A Clinical Evaluation of Postamputation Phenomena Including Phantom Limb Pain after Lower Limb Amputation in Dysvascular Patients.

    Science.gov (United States)

    Richardson, Cliff; Crawford, Kath; Milnes, Karen; Bouch, Elizabeth; Kulkarni, Jai

    2015-08-01

    To explore the effects of phantom phenomena on a group of dysvascular lower limb amputees. This was a cross-sectional study of dysvascular lower limb amputees. A modified version of the phantom phenomena questionnaire was used to measure the prevalence of phantom phenomena and the effects of those phenomena on daily life. Eighty-nine amputees were recruited. The majority were inpatients (72%) and male (72%). Most had pain before amputation (83%). Sixty-three percent had phantom limb pain. No associations were found between phantom limb pain and preamputation pain (p = .397). Phantom limb pain was present immediately on waking from amputation in 23%. Phantom limb pain is highly fluctuant. It is more likely that phantom limb pain was present with more time passed since amputation (p = .002). Outpatients with unhealed wounds were less likely to have phantom limb pain (p = .007). The effects of postamputation phenomena include sleep loss and social restrictions. These results challenge the belief that phantom limb pain reduces over time as more outpatients reported phantom limb pain than inpatients. Preamputation pain is not linked to the presence of phantom limb pain. The fluctuant nature of phantom limb pain makes its treatment complex. Some may wish intensity to reduce, whereas others may prefer to reduce the number of episodes or duration of each episode instead. More research is needed to clarify the needs of amputees in relation to the postamputation phenomena. PMID:26092194

  20. Quality of Life Following Amputation or Limb Preservation in Patients with Lower Extremity Bone Sarcoma

    OpenAIRE

    Gary E Mason; Lele eAung; Sarah eGall; Meyers, Paul A; Robert eButler; Sarah eKrug; Mimi eKim; Healey, John H.; Richard eGorlick

    2013-01-01

    PURPOSE: Although functional differences have been described between patients with lower extremity bone sarcoma with amputation and limb preservation surgery, differences have not clearly been shown between the two groups related to quality of life. The aim of the study was to determine if there is a difference in overall quality of life in lower extremity bone sarcoma survivors related to whether they had an amputation or a limb preservation procedure. PATIENTS AND METHODS: Eighty-two lon...

  1. Quality of Life Following Amputation or Limb Preservation in Patients with Lower Extremity Bone Sarcoma

    Directory of Open Access Journals (Sweden)

    Gary E Mason

    2013-08-01

    Full Text Available PURPOSE: Although functional differences have been described between patients with lower extremity bone sarcoma with amputation and limb preservation surgery, differences have not clearly been shown between the two groups related to quality of life. The aim of the study was to determine if there is a difference in overall quality of life in lower extremity bone sarcoma survivors related to whether they had an amputation or a limb preservation procedure. PATIENTS AND METHODS: Eighty-two long-term survivors of lower extremity bone sarcoma were studied to make a comparison of the overall quality of life, pain assessment and psychological evaluations in limb preservation and amputation patients. Forty-eight patients with limb preservation and thirty-four patients with amputations were enrolled in the study. Validated psychometric measures including the Quality of Life Questionnaire, the Minnesota Multiphasic Personality Inventory and visual analog scales were utilized.RESULTS: The overall quality of life of patients with limb preservation was significantly higher than patients with amputation (p-value < 0.01. Significant differences were noted in the categories of material well being, job satisfiers and occupational relations. CONCLUSION: The overall quality of life of patients with limb preservation appears to be better than for those patients with amputation based on the quality of life questionnaire in patients surviving lower extremity bone sarcoma. Further analysis needs to verify the results and focus on the categories that significantly affect the overall quality of life.

  2. Affective Distress and Amputation-Related Pain Among Older Men with Long-Term, Traumatic Limb Amputations

    OpenAIRE

    Desmond, Deirdre; MacLachlan, Malcolm

    2006-01-01

    Psychological distress and postamputation pain were investigated in a sample of 582 males with long-term limb amputations (mean time since amputation 639.3 months, standard deviation 166.1; range 240–784 months). Prevalence of significant depressive symptoms (Hospital Anxiety and Depression Scale [HADS]-D score ≥ 8) was 32.0%, and 34.0% of respondents met the screening criterion for clinical anxiety (HADS-A score ≥ 8). Nearly one quarter (24.6%) of respondents reported significant post-...

  3. The Plasticity of Brain Gray Matter and White Matter following Lower Limb Amputation.

    Science.gov (United States)

    Jiang, Guangyao; Yin, Xuntao; Li, Chuanming; Li, Lei; Zhao, Lu; Evans, Alan C; Jiang, Tianzi; Wu, Jixiang; Wang, Jian

    2015-01-01

    Accumulating evidence has indicated that amputation induces functional reorganization in the sensory and motor cortices. However, the extent of structural changes after lower limb amputation in patients without phantom pain remains uncertain. We studied 17 adult patients with right lower limb amputation and 18 healthy control subjects using T1-weighted magnetic resonance imaging and diffusion tensor imaging. Cortical thickness and fractional anisotropy (FA) of white matter (WM) were investigated. In amputees, a thinning trend was seen in the left premotor cortex (PMC). Smaller clusters were also noted in the visual-to-motor regions. In addition, the amputees also exhibited a decreased FA in the right superior corona radiata and WM regions underlying the right temporal lobe and left PMC. Fiber tractography from these WM regions showed microstructural changes in the commissural fibers connecting the bilateral premotor cortices, compatible with the hypothesis that amputation can lead to a change in interhemispheric interactions. Finally, the lower limb amputees also displayed significant FA reduction in the right inferior frontooccipital fasciculus, which is negatively correlated with the time since amputation. In conclusion, our findings indicate that the amputation of lower limb could induce changes in the cortical representation of the missing limb and the underlying WM connections. PMID:26587289

  4. The Plasticity of Brain Gray Matter and White Matter following Lower Limb Amputation

    Science.gov (United States)

    Jiang, Guangyao; Yin, Xuntao; Li, Chuanming; Li, Lei; Zhao, Lu; Evans, Alan C.; Jiang, Tianzi; Wu, Jixiang; Wang, Jian

    2015-01-01

    Accumulating evidence has indicated that amputation induces functional reorganization in the sensory and motor cortices. However, the extent of structural changes after lower limb amputation in patients without phantom pain remains uncertain. We studied 17 adult patients with right lower limb amputation and 18 healthy control subjects using T1-weighted magnetic resonance imaging and diffusion tensor imaging. Cortical thickness and fractional anisotropy (FA) of white matter (WM) were investigated. In amputees, a thinning trend was seen in the left premotor cortex (PMC). Smaller clusters were also noted in the visual-to-motor regions. In addition, the amputees also exhibited a decreased FA in the right superior corona radiata and WM regions underlying the right temporal lobe and left PMC. Fiber tractography from these WM regions showed microstructural changes in the commissural fibers connecting the bilateral premotor cortices, compatible with the hypothesis that amputation can lead to a change in interhemispheric interactions. Finally, the lower limb amputees also displayed significant FA reduction in the right inferior frontooccipital fasciculus, which is negatively correlated with the time since amputation. In conclusion, our findings indicate that the amputation of lower limb could induce changes in the cortical representation of the missing limb and the underlying WM connections. PMID:26587289

  5. The Plasticity of Brain Gray Matter and White Matter following Lower Limb Amputation

    Directory of Open Access Journals (Sweden)

    Guangyao Jiang

    2015-01-01

    Full Text Available Accumulating evidence has indicated that amputation induces functional reorganization in the sensory and motor cortices. However, the extent of structural changes after lower limb amputation in patients without phantom pain remains uncertain. We studied 17 adult patients with right lower limb amputation and 18 healthy control subjects using T1-weighted magnetic resonance imaging and diffusion tensor imaging. Cortical thickness and fractional anisotropy (FA of white matter (WM were investigated. In amputees, a thinning trend was seen in the left premotor cortex (PMC. Smaller clusters were also noted in the visual-to-motor regions. In addition, the amputees also exhibited a decreased FA in the right superior corona radiata and WM regions underlying the right temporal lobe and left PMC. Fiber tractography from these WM regions showed microstructural changes in the commissural fibers connecting the bilateral premotor cortices, compatible with the hypothesis that amputation can lead to a change in interhemispheric interactions. Finally, the lower limb amputees also displayed significant FA reduction in the right inferior frontooccipital fasciculus, which is negatively correlated with the time since amputation. In conclusion, our findings indicate that the amputation of lower limb could induce changes in the cortical representation of the missing limb and the underlying WM connections.

  6. Replantation of traumatic limb amputation above the elbow: a report of 4 cases

    Directory of Open Access Journals (Sweden)

    Faramarz Karimian

    2014-02-01

    Conclusion: Transplantation of the amputated limb can be done in spite of limited resources. Any delay in repairing damaged nerves will result great reduction of final organs’ performance. A limb, made from the own body, always take precedence to prosthesis, even when the efficiency is low.

  7. Salvage versus amputation: Utility of mangled extremity severity score in severely injured lower limbs

    Directory of Open Access Journals (Sweden)

    Kumar M

    2007-01-01

    Full Text Available Background: The purpose of the present study was to evaluate the clinical utility of Mangled extremity severity score (MESS in severely injured lower limbs. Materials and Methods: Retrospectively 25 and prospectively 36 lower limbs in 58 patients with high-energy injuries were evaluated with the use of MESS, to assist in the decision-making process for the care of patients with such injuries. Difference between the mean MESS scores for amputated and salvaged limbs was analyzed. Results: In the retrospective study 4.65 (4.65 ± 1.32 was the mean score for the salvaged limbs and 8.80 (8.8 ± 1.4 for the amputated limbs. In the prospective study 4.53 (4.53 ± 2.44 was the mean score for the salvaged limbs and 8.83 (8.83 ± 2.34 for the amputated limbs. There was a significant difference in the mean scores for salvaged and amputated limbs. Retrospective 21 (84% and prospective 29 (80.5% limbs remained in the salvage pathway six months after the injury. Conclusion: MESS could predict amputation of severely injured lower limbs, having score of equal or more than 7 with 91% sensitivity and 98% specificity. There was a significant difference in the mean MESS scores in the prospective study (n=36, 4.53 (4.53 ± 2.44 in thirty salvaged limbs (83.33% and 8.83 (8.83 ± 2.34 in six amputated limbs (16.66% with a P -value 0.002 ( P -value < 0.01. Similarly there was a significant difference in the mean MESS score in the retrospective study (n=25, 4.65 (4.65 ± 1.32 in twenty salvaged limbs (80% and 8.80 (8.8 ± 1.4 in five amputated limbs (20% with a P -value 0.00005 ( P -value < 0.01. MESS is a simple and relatively easy and readily available scoring system which can help the surgeon to decide the fate of the lower extremity with a high-energy injury.

  8. Crossover replantation after bilateral traumatic lower limb amputations: a case report

    Directory of Open Access Journals (Sweden)

    Fang Jun

    2012-07-01

    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.

  9. Clinical and theoretical parallels between desire for limb amputation and gender identity disorder.

    Science.gov (United States)

    Lawrence, Anne A

    2006-06-01

    Desire for amputation of a healthy limb has usually been regarded as a paraphilia (apotemnophilia), but some researchers propose that it may be a disorder of identity, similar to Gender Identity Disorder (GID) or transsexualism. Similarities between the desire for limb amputation and nonhomosexual male-to-female (MtF) transsexualism include profound dissatisfaction with embodiment, related paraphilias from which the conditions plausibly derive (apotemnophilia and autogynephilia), sexual arousal from simulation of the sought-after status (pretending to be an amputee and transvestism), attraction to persons with the same body type one wants to acquire, and an elevated prevalence of other paraphilic interests. K. Freund and R. Blanchard (1993) proposed that nonhomosexual MtF transsexualism represents an erotic target location error, in which men whose preferred erotic targets are women also eroticize their own feminized bodies. Desire for limb amputation may also reflect an erotic target location error, occurring in combination with an unusual erotic target preference for amputees. This model predicts that persons who desire limb amputation would almost always be attracted to amputees and would display an increased prevalence of gender identity problems, both of which have been observed. Persons who desire limb amputation and nonhomosexual MtF transsexuals often assert that their motives for wanting to change their bodies reflect issues of identity rather than sexuality, but because erotic/romantic orientations contribute significantly to identity, such distinctions may not be meaningful. Experience with nonhomosexual MtF transsexualism suggests possible directions for research and treatment for persons who desire limb amputation. PMID:16799838

  10. Phantom-limb pain as a perceptual correlate of cortical reorganization following arm amputation

    OpenAIRE

    Flor, Herta; Elbert, Thomas; Knecht, Stefan; Wienbruch, Christian; Pantev, Christo; Birbaumer, Niels; Larbig, Wolfgang; Taub, Edward

    1995-01-01

    Although phantom-limb pain is a frequent consequence of the amputation of an extremity, little is known about its origin1-4. On the basis of the demonstration of substantial plasticity of the somatosensory cortex after amputation5 or somatosensory deafferentation in adult monkeys6, it has been suggested that cortical reorganization could account for some non-painful phantom-limb phenomena in amputees and that cortical reorganization has an adaptive (that is, pain-preventing) function2,5,7,8. ...

  11. Phantom hand and wrist movements in upper limb amputees are slow but naturally controlled movements.

    Science.gov (United States)

    De Graaf, J B; Jarrassé, N; Nicol, C; Touillet, A; Coyle, T; Maynard, L; Martinet, N; Paysant, J

    2016-01-15

    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

  12. Sequential compression biomechanical device versus primary amputation in patients with critical limb ischemia.

    LENUS (Irish Health Repository)

    Tawfick, Wael A

    2013-10-01

    Introduction: Patients with critical limb ischemia (CLI), who are unsuitable for intervention, face the consequence of primary amputation. Sequential compression biomechanical device (SCBD) therapy provides a limb salvage option for these patients. Objectives: To assess the outcome of SCBD in patients with severe CLI who are unsuitable for revascularization. Primary end points were limb salvage and 30-day mortality. Methods: From 2005 to 2012, 189 patients with severe CLI were not suitable for revascularization. In all, 171 joined the SCBD program. We match controlled 75 primary amputations. Results: All patients were Rutherford category 4 or higher. Sustained clinical improvement was 68% at 1 year. Mean toe pressure increased from 19.9 to 35.42 mm Hg, P < .0001. Mean popliteal flow increased from 35.44 to 55.91 cm\\/sec, P < .0001. The 30-day mortality was 0.6%. Limb salvage was 94% at 5 years. Freedom from major adverse clinical events was 62.5%. All-cause survival was 69%. Median cost of managing a primary amputation patient is €29 815 compared to €3985 for SCBD. We treated 171 patients with artassist at a cost of €681 965. However, primary amputation for 75 patients cost €2 236 125. Conclusion: The SCBD therapy is a cost-effective and clinically effective solution in patients with CLI having no option of revascularization. It provides adequate limb salvage while providing relief of rest pain without any intervention.

  13. Tactile, thermal, and electrical thresholds in patients with and without phantom limb pain after traumatic lower limb amputation

    Directory of Open Access Journals (Sweden)

    Li S

    2015-04-01

    Full Text Available Shengai Li,1,2 Danielle H Melton,1,2 Sheng Li1,2 1Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston, TX, USA; 2Neurorehabilitation Research Laboratory, TIRR Memorial Hermann Research Center, Houston, TX, USA Purpose: To examine whether there is central sensitization in patients with phantom limb pain (PLP after traumatic limb amputation. Methods: Seventeen patients after unilateral lower limb amputation secondary to trauma were enrolled. Ten patients had chronic PLP, while the other seven patients had no PLP. Tactile-sensation threshold, cold- and warm-sensation thresholds, cold- and heat-pain thresholds, electrical-sensation threshold (EST, and electrical-pain threshold on the distal residual limb and the symmetrical site on the sound limb were measured in all tested patients. Their thresholds were compared within the PLP and non-PLP group, and between the groups. Results: The novel findings included: 1 electrical-pain threshold was only decreased in the sound limb in the PLP group and there was no difference between two limbs in the non-PLP group, suggesting central sensitization in patients with PLP; and 2 EST was increased on the affected limb as compared to the sound limb within the PLP group, but there were no significant differences in EST between the PLP and non-PLP group. There were in general no significant differences in other tested thresholds within the groups and between groups. Conclusion: Our results demonstrate central sensitization in the patients with PLP after traumatic limb amputation. Keywords: central sensitization, pain threshold, human

  14. Instrumented Measurement of Balance and Postural Control in Individuals with Lower Limb Amputation: A Critical Review

    Science.gov (United States)

    Jayakaran, Prasath; Johnson, Gillian M.; Sullivan, S. John; Nitz, Jennifer C.

    2012-01-01

    Measurement of balance and postural performance that underpins activities of daily living is important in the rehabilitation of individuals with a lower limb amputation (LLA), and there are a number of methods and strategies available for this purpose. To provide an evidence-based choice of approach, this review aims to critically review the tasks…

  15. Incidence, severity, and impact of hyperhidrosis in people with lower-limb amputation

    Directory of Open Access Journals (Sweden)

    Colby Hansen, MD

    2015-04-01

    Full Text Available To assess the incidence and severity of self-reported hyperhidrosis in patients with amputation and understand its effects on prosthetic fit or function, a cross-sectional survey of patients at two amputee clinics was performed. Responses from 121 subjects with lower-limb amputation were analyzed. Of these subjects, 66% reported sweating to a degree that it interfered with daily activities, as measured by the Hyperhidrosis Disease Severity Scale. There was a significant association between sweating and interference with prosthetic fit and function. Sweating was more severe in cases of transtibial amputations, patients under the age of 60 yr, warm weather, and vigorous activity. There was no relationship between severity of sweating and time since amputation, etiology of amputation, duration of daily prosthetic use, or reported ability to perform functional tasks. Subjects reported trying multiple interventions, but the self-reported effectiveness of these treatments was low. Hyperhidrosis, a common problem associated with prosthetic usage, varies in severity and often interferes with daily activities. Sweating severity is associated with poor prosthetic fit and function. Risk factors include younger age and transtibial amputation status. Treatment strategies generally lack efficacy. The results of this study may provide guidance for future interventions and treatment options.

  16. Prevalence and Risk Factors for Diabetic Lower Limb Amputation: A Clinic-Based Case Control Study

    Science.gov (United States)

    Rodrigues, Beverly T.; Vangaveti, Venkat N.

    2016-01-01

    Objective. The aim of the study was to evaluate the prevalence of and risk factors for lower limb amputation in a specialist foot clinic-based setting. Methods. A retrospective quantitative study was conducted, using clinical and biochemical profiles of diabetic foot patients attending the High Risk Foot Clinic at The Townsville Hospital, Australia, between January 1, 2011, and December 31, 2013. Results. The total study sample included 129 subjects, comprising 81 males and 48 females with M : F ratio of 1.7 : 1. Twenty-three subjects were Indigenous Australians, representing 17.8% of the study population. The average age of the cohort was 63.4 years ± 14.1 years [CI 90.98–65.89]. Lower limb amputation was identified as a common and significant outcome (n = 44), occurring in 34.1%, more commonly amongst the Indigenous Australians (56.5% versus 29.2%; p = 0.94, OR 0.94). Risk factors most closely associated with amputation included diabetic retinopathy (p = 0.00, OR 4.4), coronary artery bypass graft (CABG) surgery (p = 0.01, OR 4.1), Charcot's arthropathy (p = 0.01, OR 2.9), and Indigenous ethnicity (p = 0.01, OR 3.4). Although average serum creatinine, corrected calcium, and glycosylated haemoglobin A1c (Hba1c) levels were higher amongst amputees they were statistically insignificant. Conclusions. Lower limb amputation is a common outcome and linked to ethnicity and neurovascular diabetic complications amongst subjects with diabetic foot ulcer. Further research is needed to identify why risk of lower limb amputation seems to differ according to ethnicity.

  17. Proximal major limb amputations – a retrospective analysis of 45 oncological cases

    Directory of Open Access Journals (Sweden)

    Goertz Ole

    2009-02-01

    Full Text Available Abstract Background Proximal major limb amputations due to malignant tumors have become rare but are still a valuable treatment option in palliation and in some cases can even cure. The aim of this retrospective study was to analyse outcome in those patients, including the postoperative course, survival, pain, quality of life, and prosthesis usage. Methods Data of 45 consecutive patients was acquired from patient's charts and contact to patients, and general practitioners. Patients with interscapulothoracic amputation (n = 14, shoulder disarticulation (n = 13, hemipelvectomy (n = 3 or hip disarticulation (n = 15 were included. Results The rate of proximal major limb amputations in patients treated for sarcoma was 2.3% (37 out of 1597. Survival for all patients was 42.9% after one year and 12.7% after five years. Survival was significantly better in patients with complete tumor resections. Postoperative chemotherapy and radiation did not prolong survival. Eighteen percent of the patients with malignant disease developed local recurrence. In 44%, postoperative complications were observed. Different modalities of postoperative pain management and the site of the amputation had no significant influence on long-term pain assessment and quality of life. Eighty-seven percent suffered from phantom pain, 15.6% considered their quality of life worse than before the operation. Thirty-two percent of the patients who received a prosthesis used it regularly. Conclusion Proximal major limb amputations severely interfere with patients' body function and are the last, albeit valuable, option within the treatment concept of extremity malignancies or severe infections. Besides short survival, high complication rates, and postoperative pain, patients' quality of life can be improved for the time they have remaining.

  18. Conservative management of phantom-limb and amputation-stump pain.

    OpenAIRE

    Berger, S. M.

    1980-01-01

    The causes of pain in the amputation stump or in the so-called phantom limb are far from clear and a wide variety of methods of treatment have been used with varying degrees of success. Surgical techniques do not always give lasting relief and it is suggested that conservative methods such as vibration therapy and various forms of electrical stimulation may prove more helpful.

  19. Proximal major limb amputations – a retrospective analysis of 45 oncological cases

    OpenAIRE

    Goertz Ole; Langer Stefan; Steinstraesser Lars; Hauser Joerg; Khadra Ammar; Lehnhardt Marcus; Daigeler Adrien; Steinau Hans-Ulrich

    2009-01-01

    Abstract Background Proximal major limb amputations due to malignant tumors have become rare but are still a valuable treatment option in palliation and in some cases can even cure. The aim of this retrospective study was to analyse outcome in those patients, including the postoperative course, survival, pain, quality of life, and prosthesis usage. Methods Data of 45 consecutive patients was acquired from patient's charts and contact to patients, and general practitioners. Patients with inter...

  20. PERCEIVED INDEPENDENCE AND LIMITATIONS IN RISING AND SITTING DOWN AFTER REHABILITATION FOR A LOWER-LIMB AMPUTATION

    OpenAIRE

    de Laat, Fred A.; Dijkstra, Pieter U.; Rommers, Gerardus M.; Geertzen, Jan H. B.; Roorda, Leo D

    2014-01-01

    Objective: To study perceived independence in rising and perceived limitations in rising and sitting down in persons after a lower-limb amputation and the relationship of these perceptions with personal and clinical characteristics. Design: Cross-sectional study. Subjects/patients: Persons with a lower-limb amputation wearing a prosthesis (n=172). Methods: Perceived independence in rising was assessed with the Locomotor Capabilities Index. Limitations in rising and sitting down were assessed ...

  1. Global trends in incidence of lower limb amputation: a review of the literature

    Directory of Open Access Journals (Sweden)

    L. Godlwana

    2008-02-01

    Full Text Available The aim of this paper was to compile a literature report on the global epidemiology of lower limb amputations. Specifically it aimed at capturing information on the incidence of traumatic and non-traumatic lowerlimb amputations throughout the world, to identify the etiology including diseases and lifestyle habits associated with lower limb amputees (LLA in boththe developed and the developing countries, to identify the demographiccharacteristics, age, sex, race, geographical location of the people undergoing LLA including the levels of amputation as pointed out by the literature. Aliterature search was conducted. Different keyword combinations were used togather as much literature on the subject as possible. The authors systemicallyreviewed literature from some parts of Europe, Asia, North and South America and South Africa. The data was analyzed and presented under various themes. The existing literature shows that diabetes is the leading cause of LLA and trauma accounts for the minority of these cases. The incidence of LLA can be predicted by gender, age, maritalstatus, level of education and socio-economic status. Information on LLA in South Africa is almost absent.

  2. A Robot Hand Testbed Designed for Enhancing Embodiment and Functional Neurorehabilitation of Body Schema in Subjects with Upper Limb Impairment or Loss

    OpenAIRE

    Hellman, Randall B.; Justin Tanner; Santos, Veronica J.

    2015-01-01

    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...

  3. Impact of a diabetic foot care education program on lower limb amputation rate

    Directory of Open Access Journals (Sweden)

    Abdullah M Al-Wahbi

    2010-10-01

    stage, has increased the awareness of both patients and health care staff about the prevention and management of diabetic foot disease, and decreased the rate of lower extremity amputation. We believe that the statistical proof of its impact will be evident in the final evaluation.Keywords: diabetic foot, prevention, complications, lower limb amputation

  4. Demographics of Lower Limb Amputations in the Pakistan Military: A Single Center, Three-Year Prospective Survey.

    Science.gov (United States)

    Rathore, Farooq A; Ayaz, Saeed B; Mansoor, Sahibzada N; Qureshi, Ali R; Fahim, Muhammad

    2016-01-01

    INTRODUCTION : The Pakistan military has been actively engaged in the war against terror for more than a decade. Many officers and soldiers have lost their limbs in this war. But the data on traumatic lower limb amputations in Pakistan is sparse. The aim of this study is to prospectively document the epidemiological profile of lower limb military amputees presenting at the largest rehabilitation centre of Pakistan over a three-year period. MATERIALS & METHODS : A prospective three-year survey was conducted at the Armed Forces Institute of Rehabilitation Medicine (AFIRM), Pakistan. One hundred twenty-three consecutive patients with lower limb amputations were enrolled in the survey. The demographic data, etiology, associated injuries, complications profile, and type of prosthesis provided were documented. The data analysis was done using the statistical analysis tool SPSS V 20 (IBM®,NY, USA). RESULTS : All patients were male. Most had traumatic amputation (119), were between 20-40 years (106), with unilateral amputation (115). Mine blast injury was the leading cause in 73 (59.3%) and most (58.5%) were fitted with modular prosthesis. Transtibial amputation was the commonest level (65), followed by transfemoral (30). The time of surgical amputation was not documented in 87% of the patients. Half of the patients (54%) had associated injuries. Seventy-nine patients had at least one complication with phantom pain being the commonest in 25% cases. CONCLUSIONS : This is the largest prospective demographic survey of lower limb amputees in Pakistan military to date. Scores of soldiers and civilians in Pakistan have suffered lower limb amputation. The availability of demographic data can improve the trauma and rehabilitation services for better understanding and management of such cases. There is a need to conduct large scale community-based epidemiological surveys to direct future policies and develop amputee rehabilitation services in the public sector. PMID:27186448

  5. Prevention of phantom pain after major lower limb amputation by epidural infusion of diamorphine, clonidine and bupivacaine.

    OpenAIRE

    M Jahangiri; Jayatunga, A. P.; Bradley, J. W.; Dark, C. H.

    1994-01-01

    Phantom limb pain may appear in up to 85% of patients after amputation. There is no effective treatment. Perioperative epidural infusion of morphine and bupivacaine, alone or in combination, is effective in preventing phantom limb pain in patients with pre-existing limb pain. Serious side-effects, however, make them difficult to manage on a general ward. Clonidine has been shown to be an effective postoperative analgesia when applied epidurally. To mitigate the potentially serious side-effect...

  6. Myoelectric signal features for upper limb prostheses

    OpenAIRE

    Bach, Per Ferdinand

    2009-01-01

    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 ...

  7. [Mirror therapy for the treatment of phantom limb pain after bilateral thigh amputation. A case report].

    Science.gov (United States)

    Wosnitzka, M; Papenhoff, M; Reinersmann, A; Maier, C

    2014-12-01

    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

  8. Cross-sectional study of alteration of phantom limb pain with visceral stimulation in military personnel with amputation.

    Science.gov (United States)

    Rafferty, Michael; Bennett Britton, Thomas M; Drew, Benjamin T; Phillip, Rhodri D

    2015-01-01

    While phantom limb pain is a well-recognized phenomenon, clinical experience has suggested that the augmentation of phantom limb pain with visceral stimulation is an issue for many military personnel with amputation (visceral stimulation being the sensation of the bowel or bladder either filling or evacuating). However, the prevalence of this phenomenon is not known. The aim of this study was to investigate the prevalence of the alteration in phantom limb pain and the effect that visceral stimulation has on phantom limb pain intensity. A cross-sectional study of 75 military personnel who have lost one or both lower limbs completed a questionnaire to assess the prevalence of the alteration of phantom limb pain with visceral stimulation. Included in the questionnaire was a pain visual analog scale (VAS) graded from 0 to 10. Patients recorded the presence and intensity of phantom limb pain. They also recorded whether and how this pain altered with a need to micturate or micturition, and/or a need to defecate or defecation, again using a pain VAS. Time since amputation, level of amputation, and medications were also recorded. Patients reported a phantom limb pain prevalence of 85% with a mean VAS of 3.6. In all, 56% of patients reported a change in the severity of phantom limb pain with visceral stimuli. The mean increase in VAS for visceral stimulation was 2.5 +/- 1.6 for bladder stimulation and 2.9 +/- 2.0 for bowel stimulation. Of the patients questioned, 65% reported an improvement in symptoms over time. VAS scores were highest in the subgroup less than 6 mo postamputation. An increase in phantom limb pain with visceral stimulation is a common problem for military personnel with amputation. PMID:26360529

  9. Pain and pain-related interference in adults with lower-limb amputation: Comparison of knee-disarticulation, transtibial, and transfemoral surgical sites

    OpenAIRE

    Behr, James; Friedly, Janna; Molton, Ivan; Morgenroth, David; Jensen, Mark P.; Smith, Douglas G.

    2009-01-01

    Pain and pain-related interference with physical function have not been thoroughly studied in individuals who have undergone knee-disarticulation amputations. The principal aim of this study was to determine whether individuals with knee-disarticulation amputations have worse pain and pain-related interference with physical function than do individuals with transtibial or transfemoral amputations. We analyzed cross-sectional survey data provided by 42 adults with lower-limb amputations. These...

  10. [Lower limb salvage with a free fillet fibula flap harvested from the contralateral amputated leg].

    Science.gov (United States)

    Bouyer, M; Corcella, D; Forli, A; Mesquida, V; Semere, A; Moutet, F

    2015-06-01

    We report a unusual case of "fillet flap" to reconstruct the lower limb with the amputated contralateral leg. This kind of procedure was first described by Foucher et al. in 1980 for traumatic hand surgery as the "bank finger". A 34-year-old man suffered a microlight accident with bilateral open legs fractures. A large skin defect of the left leg exposed the ankle, the calcaneus and a non-vascularized part of the tibial nerve (10 cm). The patient came to the OR for surgical debridement and had massive bone resection of the left calcaneus. The right leg showed limited skin defect at the lower part, exposing the medial side of the ankle and a tibial bone defect, measuring 10 cm. Salvage the left leg was impossible due to complex nerve, bones and skin associated injuries, so this leg was sacrificed and used as a donor limb, to harvest a free fibula flap for contralateral tibial reconstruction. At 18 months of follow-up, the patient was very satisfied, the clinical result was very good on both lower limbs and X-rays showed excellent integration of the free fibula flap. The patient had normal dailies occupations, can run and have bicycle sport practice with a functional left leg fit prosthesis. This case showed an original application of the "fillet flap concept" to resolve complex and rare traumatic situations interesting the both lower limbs. In our opinion, this strategy must be a part of the plastic surgeon skills in uncommon situations. PMID:25069828

  11. A myoelectric-controlled virtual hand for the assessment and treatment of phantom limb pain in trans-radial upper extremity amputees: a research protocol.

    Science.gov (United States)

    Gaggioli, Andrea; Amoresano, Amedeo; Gruppioni, Emanuele; Verni, Gennaro; Riva, Giuseppe

    2010-01-01

    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

  12. Combined mirror visual and auditory feedback therapy for upper limb phantom pain: a case report

    Directory of Open Access Journals (Sweden)

    Yan Kun

    2011-01-01

    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.

  13. Mind-body interventions for treatment of phantom limb pain in persons with amputation.

    Science.gov (United States)

    Moura, Vera Lucia; Faurot, Keturah R; Gaylord, Susan A; Mann, J Douglas; Sill, Morgan; Lynch, Chanee; Lee, Michael Y

    2012-08-01

    Phantom limb pain (PLP) is a significant source of chronic pain in most persons with amputation at some time in their clinical course. Pharmacologic therapies for this condition are often only moderately effective and may produce unwanted adverse effects. There is growing empirical evidence of the therapeutic effectiveness of mind-body therapies for the relief of chronic pain; therefore, an exploration of their role in relieving amputation-related chronic pain is warranted. We undertook a focused literature review on mind-body interventions for patients with amputation who experience PLP. Because of study heterogeneity, only descriptive presentations of the studies are presented. Only studies of hypnosis, imagery, and biofeedback, including visual mirror feedback, were found; studies on meditation, yoga, and tai chi/qigong were missing from the literature. Few studies of specific mind-body therapies were dedicated to management of PLP, with the exception of mirror visual therapy. Overall, studies were largely exploratory and reflect considerable variability in the application of mind-body techniques, making definitive conclusions inadvisable. Nevertheless, the weight of existing findings indicates that a mind-body approach to PLP pain management is promising and that specific methods may offer either temporary or long-term relief, either alone or in combination with conventional therapies. The authors discuss the potential for usefulness of specific mind-body therapies and the relevance of their mechanisms of action to those of PLP, including targeting cortical reorganization, autonomic nervous system deregulation, stress management, coping ability, and quality-of-life. The authors recommend more and better quality research exploring the efficacy and mechanisms of action. PMID:22286895

  14. Increased slow transport in axons of regenerating newt limbs after a nerve conditioning lesion made prior to amputation

    International Nuclear Information System (INIS)

    The first part of this study shows that axonal density is constant in the limb stump of the next proximal to the area of traumatic nerve degeneration caused by limb amputation. The results of the second part of this work reveal that a nerve conditioning lesion made two weeks prior to amputation is associated with accelerated limb regeneration and that this accelerated limb regeneration is accompanied by an earlier arrival of axons. This is the first demonstration of naturally occurring limb regeneration being enhanced. In this study SCb cytoskeletal proteins were identified and measured using SDS-PAGE and liquid scintillation counting. Proteins were measured at 7, 14, 21, and 28 days after 35S-methionine injection and the normal rate of SCb transport determined to be 0.19 mm/day. A single axotomy does not enhance the rate of SCb transport but does increase the amount of labeled SCb proteins that are transported. When a conditioning lesion is employed prior to limb amputation and SCb proteins are measured at 7, 14, and 21 days after injection, there is a twofold acceleration in the rate of SCb transport and an increase in the amount of SCb proteins transported in conditioned axons

  15. Amputation history and rehabilitation of black men living in the greater Durban area who have had traumatic amputations of the lower limb

    Directory of Open Access Journals (Sweden)

    B. A. Kubheka

    1995-05-01

    Full Text Available A survey was undertaken amongst twenty five black men living in the greater Durban area who had had amputations of the lower limbs. The type of amputation care and the rehabilitation programme they underwent post-operatively is described. The sample included men from 24 to 50 years of age, of whom the majority were from rural areas. The amputation care intra and post-operatively was marked by the lack of emotional preparation pre-operatively, and lack of rehabilitation information and teaching afterwards. Most respondents had to find information for themselves. This lack of information and teaching seemed to impede physical rehabilitation, with stump sores and limited use of prostheses being the main problems. Vocational rehabilitation was almost totally absent. In contrast to the twenty two respondents who worked before their amputations, only four worked afterwards. The majority had to support their families alone; sixteen of them were totally reliant on a Disability Grant. These problems lead to social isolation, depression, loneliness and other psycho-social problems.

  16. The upper limb of Australopithecus sediba.

    Science.gov (United States)

    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

    2013-04-12

    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

  17. Financial analysis of diabetic patients hospitalizations submitted to lower limb amputation in a public hospital

    Directory of Open Access Journals (Sweden)

    Renata Santos Silva

    2015-03-01

    Full Text Available This study is a documental descriptive analysis which aimed to verify the cost established in 2006, in relation to the hospitalization of 21 diabetic patients submitted to the lower limb amputation in a public hospital and the value transferred by the Unified Health System (SUS regarding this procedure. Among the studied patients, 57.14% were female and 42.86% male, aged 40 to 90 years. The time of diagnosis varied from 5 to 25 years. The average of hospitalization was 14 days per patient. The cost to the hospital was R$ 99,455.74, average cost per patient was R$ 4,735.98. The total amount transferred by SUS to the hospital was R$ 27,740.15, a cost 3.6 times lower than the hospital costs. The SUS transferring is in accordance with the predetermined values for its table of procedure. Prevention is the only alternative to reduce the rate of amputation and improve survival of diabetes patients. It is necessary an early diagnosis and better control of diabetes mellitus with appropriate government and institutional policies.

  18. Phantom phenomena and body scheme after limb amputation: a literature review.

    Science.gov (United States)

    Pirowska, Aneta; Wloch, Tomasz; Nowobilski, Roman; Plaszewski, Maciej; Hocini, Abdellah; Ménager, Doménico

    2014-01-01

    Phantom phenomena are subject of various, often inconsistent, descriptions, and new concepts and treatment approaches emerge. The aim of the study is to describe contemporary terminology and developments in the field, and to share personal experience. A review of English and French language literature, published prior to 27th February, 2012, extracted from PubMed/MEDLINE, Google.fr, GoogleScholar databases, and by hand searching of selected full text papers and textbooks with correspondence to personal clinical experience was performed. The terminology and classification of phantom phenomena sensations, relations between intensity and character of phantom pain to the etiology and level of amputations, as well as the influence of presence and intensity of pre-operative limb pain and post-operative stump pain on phantom phenomena are described. The benefits of mirror therapy and early introduction of prosthesis and applying functional prosthesis are also presented, with a glance at other conservative and surgical treatment approaches. PMID:24636771

  19. Anxiety and Depression in Patients with Amputated Limbs Suffering from Phantom Pain: A Comparative Study with Non-Phantom Chronic Pain

    OpenAIRE

    Hadi Kazemi; Shahin Ghassemi; Seyed Mohammad Fereshtehnejad; Afshin Amini; Pier Hossein Kolivand; Taher Doroudi

    2013-01-01

    Background: Phantom limb pain (PLP) is approximately a common condition after limb amputation, which potentially affects the quality of life. We aimed to evaluate anxiety and depression in patients with amputated limbs suffering from PLP and to compare these psychological dysfunctions with that of patients with non-phantom chronic pain. Methods : A total number of 16 male amputees with PLP and 24 male age-matched patients with non-phantom chronic pain were recruited in this study, which wa...

  20. Post-Amputation Pain Is Associated with the Recall of an Impaired Body Representation in Dreams—Results from a Nation-Wide Survey on Limb Amputees

    OpenAIRE

    Bekrater-Bodmann, Robin; Schredl, Michael; Diers, Martin; Reinhard, Iris; Foell, Jens; Trojan, Jörg; Fuchs, Xaver; Flor, Herta

    2015-01-01

    The experience of post-amputation pain such as phantom limb pain (PLP) and residual limb pain (RLP), is a common consequence of limb amputation, and its presence has negative effects on a person’s well-being. The continuity hypothesis of dreams suggests that the presence of such aversive experiences in the waking state should be reflected in dream content, with the recalled body representation reflecting a cognitive proxy of negative impact. In the present study, we epidemiologically assessed...

  1. Interhemispheric sensorimotor integration; an upper limb phenomenon?

    Science.gov (United States)

    Ruddy, Kathy L; Jaspers, Ellen; Keller, Martin; Wenderoth, Nicole

    2016-10-01

    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

  2. Treatment of phantom limb pain by cryoneurolysis of the amputated nerve.

    Science.gov (United States)

    Moesker, Albert A; Karl, Helen W; Trescot, Andrea M

    2014-01-01

    The pathophysiology of phantom limb pain (PLP) is multifactorial. It probably starts in the periphery and is amplified and modified in the central nervous system. A small group of patients with PLP were questioned as to the portion of the phantom limb affected by pain (e.g., "great toe," "thumb"). In the stump, the corresponding amputated nerve was located with a nerve stimulator. With correct placement and stimulation, the PLP could then be reproduced or exacerbated. A small dose of local anesthesia was then injected, resulting in the disappearance of the PLP. If a peripheral nerve injection gave temporary relief, our final treatment was cryoanalgesia at this location. Evaluation of 5 patients, followed for at least 2.5 years, yielded the following results: 3 patients had excellent results (100%, 95%, and 90% decrease in complaints, respectively), 1 patient had an acceptable result (40% decrease), and 1 patient had only a 20% decrease in pain. Although both central and peripheral components are likely involved in PLP, treatment of a peripheral pain locus with cryoanalgesia should be considered. We propose the identification of a peripheral etiology may help match patients to an appropriate therapy, and cryoanalgesia may result in long-term relief of PLP. PMID:23279331

  3. Ectopic major transplantation for salvage of upper and lower extremity amputations

    Directory of Open Access Journals (Sweden)

    Nazerani Shahram

    2013-12-01

    Full Text Available 【Abstract】Objective: Ectopic tissue transplanta- tion is not a new idea. Godina and his colleagues pioneered this method in the 1980s. This method is a last resort method of preserving an amputated body part, which consists of banking the amputated segment in an ectopic area and re- turning it to its native place at a later date. In this article we present our experience with this demanding procedure. Methods: Debridement was the mainstay of this procedure. The stump and amputated part are carefully de- brided and the stump was either closed primarily or covered by a flap. The amputated part was transplanted to one of several banking sites in the body and at a later date it will be transferred to its native site in an elective setting. Results: Seven patients meeting the set criteria for ectopic transplantation were enrolled in this study. The over- all success rate was about 70%, lower than expected but these are cases of severe crush injury. Although the func- tional recovery of these patients are very low, all of the successful cases except one could find a job as a janitor or light manual worker. No patient could return to his previous job. Conclusion: Ectopic transplantation of body parts is an accepted method of treatment of severely crushed ex- tremity or finger injuries. In our country an amputee has very little chance of finding a job instead a disabled person can. In addition in Iran cultures amputation is seen as pu- nishment of either the God or the society, so it is not well accepted and many patients persist on saving the limb even with no functional recovery. None of our successful cases could return to his previous occupation but almost all of them could find a job as janitors or light manual workers. Key words: Replantation; Transplantation; Extremities; Amputation, traumatic

  4. UPPER LIMB PROSTHETIC FOR STROKE AFFECTED PATIENTS

    Directory of Open Access Journals (Sweden)

    DEBIKA KHANRA,

    2011-04-01

    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.

  5. The Use of the 6-Min Walk Test as a Proxy for the Assessment of Energy Expenditure during Gait in Individuals with Lower-Limb Amputation

    Science.gov (United States)

    Kark, Laurena; McIntosh, Andrew S.B; Simmons, Annea

    2011-01-01

    The objective of this study was to determine, and compare, the utility of the 6-min walk test (6 MWT) and self-selected walking speed over 15 m as proxies for the assessment of energy expenditure during gait in individuals with lower-limb amputation. Patients with unilateral, transfemoral amputation (n = 6) and patients with unilateral,…

  6. Upper limb lymphedema after breast cancer treatment

    International Nuclear Information System (INIS)

    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)

  7. Lower limb amputations: differences between the genders and long-term survival.

    Science.gov (United States)

    Heikkinen, M; Saarinen, J; Suominen, V P; Virkkunen, J; Salenius, J

    2007-09-01

    The purpose of the study was to evaluate possible differences between genders in amputation incidence, revascularization activity before and survival after amputation. This population-based study was carried out in a well-defined geographical area, where all vascular surgical consultations and reconstructions are performed in one university hospital. All amputations performed in the region during 1990 - 1999 were identified from the hospital central registers. According to patient's identity codes, the Cause of Death Registry of Statistics Finland provided death data. Amputation data were cross-linked with the local vascular registry using identity codes. Women were found to be 8 years older than men (p < 0.0001). Major amputations comprised 73.4% in males and 77.7% in females. The age-standardized amputation incidence among males was 338 and among females 226 (per 10(6) inhabitants/year) (p < 0.001). The most prominent difference was seen in amputations due to trauma, where the age-adjusted major amputation incidence was over three-fold among males compared to females. The proportion of patients who had undergone vascular procedure before amputation was 23% in both genders. Median survival after amputation was 943 days in men and 716 in women (p = 0.01). When the higher age of women was considered, there was no significant difference between the genders. Survival was poorer among diabetics in both genders and the difference was significant in males. The amputation incidence was found to be higher in men compared to women in all etiologic subgroups except malignant tumour. Almost one in 4 patients had undergone vascular surgical reconstruction before amputation in both genders. There was no significant difference between the genders in survival after amputation. Subjects with diabetes had a poorer survival after major amputation than those without diabetes. PMID:17979013

  8. A prospective study of the importance of life goal characteristics and goal adjustment capacities in longer term psychosocial adjustment to lower limb amputation

    OpenAIRE

    Coffey, Laura; Gallagher, Pamela; Desmond, Deirdre

    2014-01-01

    Objective: To explore the life goal characteristics and goal adjustment capacities of persons with lower limb amputation on admission to rehabilitation, and to examine their efficacy as predictors of psychosocial outcomes 6 months post-discharge. Design: Prospective, descriptive. Setting: Two specialist inpatient rehabilitation facilities in Ireland. Subjects: A consecutive sample of 64 patients with lower limb amputation. Main measures: On admission to rehabilitation, life goal c...

  9. Number of test trials needed for performance stability and interrater reliability of the one leg stand test in patients with a major non-traumatic lower limb amputation

    DEFF Research Database (Denmark)

    Kristensen, Morten Tange; Nielsen, Anni Østergaard; Madsen Topp, Ulla; Jakobsen, Berit; Nielsen, Kirsten Juel; Gybel Juul-Larsen, Helle; Jakobsen, Thomas Linding

    2014-01-01

    Balance is beneficial for daily functioning of patients with a lower limb amputation and sometimes assessed by the one-leg stand test (OLST). The aims of the study were to examine (1) the number of trials needed to achieve performance stability, (2) the interrater reliability of the OLST in...... patients with a major non-traumatic lower limb amputation, and (3) to provide a test procedure....

  10. Autobiographical memory and psychological distress in a sample of upper-limb amputees.

    Science.gov (United States)

    Luchetti, Martina; Montebarocci, Ornella; Rossi, Nicolino; Cutti, Andrea G; Sutin, Angelina R

    2014-01-01

    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

  11. Autobiographical memory and psychological distress in a sample of upper-limb amputees.

    Directory of Open Access Journals (Sweden)

    Martina Luchetti

    Full Text Available 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.

  12. Radiogrammetric analysis of upper limb long bones

    Directory of Open Access Journals (Sweden)

    Stojanović Zlatan

    2011-01-01

    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.

  13. Music related upper limb pain in schoolchildren.

    Science.gov (United States)

    Fry, H J; Rowley, G L

    1989-12-01

    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

  14. Estimation of sex from the upper limb measurements of Sudanese adults.

    Science.gov (United States)

    Ahmed, Altayeb Abdalla

    2013-11-01

    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

  15. The role of amputation as an outcome measure in cellular therapy for critical limb ischemia: implications for clinical trial design

    Directory of Open Access Journals (Sweden)

    Pearl Gregory J

    2011-09-01

    Full Text Available Abstract Background Autologous bone marrow-derived stem cells have been ascribed an important therapeutic role in No-Option Critical limb Ischemia (NO-CLI. One primary endpoint for evaluating NO-CLI therapy is major amputation (AMP, which is usually combined with mortality for AMP-free survival (AFS. Only a trial which is double blinded can eliminate physician and patient bias as to the timing and reason for AMP. We examined factors influencing AMP in a prospective double-blinded pilot RCT (2:1 therapy to control of 48 patients treated with site of service obtained bone marrow cells (BMAC as well as a systematic review of the literature. Methods Cells were injected intramuscularly in the CLI limbs as either BMAC or placebo (peripheral blood. Six month AMP rates were compared between the two arms. Both patient and treating team were blinded of the assignment in follow-up examinations. A search of the literature identified 9 NO-CLI trials, the control arms of which were used to determine 6 month AMP rates and the influence of tissue loss. Results Fifteen amputations occurred during the 6 month period, 86.7% of these during the first 4 months. One amputation occurred in a Rutherford 4 patient. The difference in amputation rate between patients with rest pain (5.6% and those with tissue loss (46.7%, irrespective of treatment group, was significant (p = 0.0029. In patients with tissue loss, treatment with BMAC demonstrated a lower amputation rate than placebo (39.1% vs. 71.4%, p = 0.1337. The Kaplan-Meier time to amputation was longer in the BMAC group than in the placebo group (p = 0.067. Projecting these results to a pivotal trial, a bootstrap simulation model showed significant difference in AFS between BMAC and placebo with a power of 95% for a sample size of 210 patients. Meta-analysis of the literature confirmed a difference in amputation rate between patients with tissue loss and rest pain. Conclusions BMAC shows promise in improving AMP

  16. A developing world experience with distal foot amputations for diabetic limb salvage

    Directory of Open Access Journals (Sweden)

    Omer Salahuddin

    2013-10-01

    Full Text Available Objectives: To evaluate the functional outcome, morbidity, and viability of foot salvage in diabetic patients. Materials and methods: This prospective case series was conducted from March 2007 to December 2012 at the department of surgery Pakistan Ordnance Factories Hospital, Wah Cantt, Pakistan. 123 males and 26 female patients were included in the study. All the patients were treated after getting admitted in the hospital and wounds were managed with daily dressings, nursing care and debridement of necrotic tissue with adequate antibiotic coverage. Results: In total, 149 patients (mean age: 56±7.52 years with 171 amputations were included in the study. The mean duration of diabetes mellitus (DM was 9±4.43 years. Ninety-seven percent of the patients were diagnosed with type 2 DM. Wound debridement was performed under general anesthesia in 48 (33.2% patients, whereas local anesthesia was used for the rest of the patients after having good glycemic control and improvement in general health. The most common pathogen isolated from the infected wounds was Staphylococcus aureus in approximately 46% cases. Regarding the types of amputation, partial toe amputation was performed in 21 (12.2% cases, second-toe amputation in 60 (35% cases, hallux amputation in 41 (24% cases, multiple toe amputations in 29 (17% cases, bilateral feet involvement was observed in 16 (9.3% cases, and transmetatarsal amputation was performed in 4 (2.3% cases. The wounds healed well except in 19 cases where amputation had to be revised to a more proximal level. Thirty-nine patients died during the study period: 3 died of wound-related complications and 36 died of systemic complications. Conclusion: With the ever-increasing epidemic of DM, the number of patients with diabetic foot ulcers has also significantly risen. Early surgical management with good glycemic control and foot care with close monitoring can decrease amputations and thus foot salvage can be successfully

  17. Total and subtotal amputation of lower limbs treated by acute shortening, revascularization and early limb lengthening with ilizarov ring fixation - a retrospective study.

    Science.gov (United States)

    Kovoor, C C; George, V V; Jayakumar, R; Guild, A J; Bhaskar, D; Cyriac, A

    2015-10-01

    We present the results of 15 patients who sustained total or subtotal traumatic amputation of the lower limbs who were treated by acute limb shortening and stabilisation with external fixator, revascularization and early lengthening with Ilizarov ring fixator. The mean age of the patients was 28 years [5-38]. There were three females and 12 males. The mean Mangled Extremity Severity Score was 8.5 [range 6-11]. The mean amount of shortening done was 6.9cm [range 3-12.5] to enable revascularization and soft tissue repair. Three cases had to be amputated early because of failure of vascular repair. In the remaining 12 patients who were followed up the mean interval between revascularization and application of Ilizarov ring fixator was 4.7 weeks [range 3-10]. The mean follow up was 6.5 years [3-16 years]. Union occurred in all patients. Ten of the 12 patients returned to work and residual shortening was present in two cases. We conclude that whenever possible lower limb salvage should be undertaken. PMID:26256784

  18. Amputation-Free Survival after Crural Percutaneous Transluminal Angioplasty for Critical Limb Ischemia

    DEFF Research Database (Denmark)

    Strøm, M; Konge, L; Lönn, L; Schroeder, T V; Rørdam, P

    2015-01-01

    BACKGROUND AND AIM: To evaluate the amputation-free survival after below the knee percutaneous transluminal angioplasty in a consecutive group of patients with critical ischemia of the lower extremity. MATERIALS AND METHODS: A total of 70 consecutive patients with critical ischemia were treated......-up clinical examinations were performed within 6 weeks and after 1 year. All medical records were crosschecked with the national vascular registry ensuring a valid 1-year status in 97% of the patients. RESULTS: A total of 15 major amputations were performed during follow-up, with 11 amputations performed...... within the first year. Complications after percutaneous transluminal angioplasty were rare. Cumulative mortality after 1 and 2 years was 22% and 34%, respectively. Amputation-free survival at 1 and 2 years of follow-up was 68% and 58%, respectively. There were no association between known risk factors...

  19. Biphasic synovial sarcoma of the extremity : quadruple approach of isolated limb perfusion, surgical ablation, adipofascial perforator flap and radiation to avoid amputation

    OpenAIRE

    Steinsträßer, Lars; Agarwal, R.; Stricker, Ingo; Steinau, Hans-Ulrich; al- Benna, Sammy

    2011-01-01

    Synovial sarcoma is a rare type of soft tissue sarcoma that occurs mostly in young adults, and it is always regarded as a high-grade tumor. Here, we report the case of a 31-year-old German Caucasian male with synovial sarcoma of the wrist who was offered amputation at his local hospital. After referral to our Reference Centre for Soft Tissue Sarcoma, the quadruple approach of isolated limb perfusion, surgical ablation, adipofascial perforator flap and radiation avoided amputation and enabled ...

  20. Abnormal access of axial vibrotactile input to deafferented somatosensory cortex in human upper limb amputees.

    Science.gov (United States)

    Kew, J J; Halligan, P W; Marshall, J C; Passingham, R E; Rothwell, J C; Ridding, M C; Marsden, C D; Brooks, D J

    1997-05-01

    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

  1. Reflections on the present and future of upper limb prostheses.

    Science.gov (United States)

    Farina, Dario; Amsüss, Sebastian

    2016-04-01

    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

  2. Surveillance case definitions for work related upper limb pain syndromes

    OpenAIRE

    Harrington, J. M.; Carter, J T; Birrell, L.; Gompertz, D

    1998-01-01

    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...

  3. Effect of upper limb, lower limb and combined training on health-related quality of life in COPD

    OpenAIRE

    Subin,; Rao Vaishali; Prem V; Sahoo

    2010-01-01

    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,...

  4. Pattern of injury in those dying from traumatic amputation caused by bomb blast.

    Science.gov (United States)

    Hull, J B; Bowyer, G W; Cooper, G J; Crane, J

    1994-08-01

    Traumatic amputation of limbs caused by bomb blast carries a high risk of mortality. This paper describes 73 amputations in 34 deaths from bomb blast in Northern Ireland. The principal aim was to determine the sites of traumatic amputation to provide a biophysical basis for the development of protective measures. Few amputations were through joints; nearly all were through the bone shafts. The most common site in the tibia was the upper third. The distribution of femoral sites resulting from car bombs differed from that characterizing other types of explosion. For car bombs the principal site of amputation was the upper third; for other types of device it was the lower third. It is concluded that flailing is not a notable contributor to limb avulsion. The pattern of amputation is consistent with direct local pressure loads leading to bone fracture; the amputation itself is a secondary event arising from the flow of combustion products. PMID:7953338

  5. The Treatment of Phantom Limb Pain Using Immersive Virtual Reality : Three Case Studies.

    OpenAIRE

    Murray, Craig; Pettifer, Stephen; Howard, Toby; Patchick, Emma; Caillette, Fabrice; Kulkarni, Jai; Bamford, Candy

    2007-01-01

    Purpose: This paper describes the design and implementation of a case-study based investigation using immersive virtual reality as a treatment for phantom limb pain. Method: Three participants who experienced phantom limb pain (two with an upper-limb amputation, and one with a lower-limb amputation) took part in between 2-5 Immersive Virtual Reality (IVR) sessions over a three week period. The movements of participants’ anatomical limbs were transposed into the movements of a virtual limb, pr...

  6. How Depressive Levels Are Related to the Adults' Experiences of Lower-Limb Amputation: A Mixed Methods Pilot Study

    Science.gov (United States)

    Senra, Hugo

    2013-01-01

    The current pilot study aims to explore whether different adults' experiences of lower-limb amputation could be associated with different levels of depression. To achieve these study objectives, a convergent parallel mixed methods design was used in a convenience sample of 42 adult amputees (mean age of 61 years; SD = 13.5). All of them had…

  7. Effect of amputation level on the stress transferred to the femur by an artificial limb directly attached to the bone.

    Science.gov (United States)

    Newcombe, L; Dewar, M; Blunn, G W; Fromme, P

    2013-12-01

    Attachment of an artificial limb directly to the skeleton has a number of potential benefits and the technique has been implemented for several amputation sites. In this paper the transfer of stress from an external, transfemoral prosthesis to the femur during normal walking activity is investigated. The stress distribution in the femur and at the implant-bone interface is calculated using finite element analysis for the 3D geometry and inhomogeneous, anisotropic material properties obtained from a CT scan of a healthy femur. Attachment of the prosthetic leg at three different levels of amputation is considered. Stress concentrations are found at the distal end of the bone and adjacent to the implant tip and stress shielding is observed adjacent to the implant. It is found that the stress distribution in the femur distal to the epiphysis, where the femur geometry is close to cylindrical, can be predicted from a cylindrical finite element model, using the correct choice of bone diameter as measured from a radiograph. Proximal to the lesser trochanter the stress decreases as the femur geometry diverges significantly from a cylinder. The stress concentration at the distal, resected end of the bone is removed when a collared implant is employed. These findings form the basis for appropriate settings of an external fail-safe device to protect the bone from excessive stress in the event of an undue load. PMID:23953406

  8. Stellate ganglion blockade for analgesia following upper limb surgery.

    LENUS (Irish Health Repository)

    McDonnell, J G

    2012-01-31

    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.

  9. Work-related upper limb “overuse” syndromes

    DEFF Research Database (Denmark)

    Jepsen, Jørgen Riis

    2016-01-01

    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....

  10. Work-Related Upper Limb Disorders: A Case Report

    Directory of Open Access Journals (Sweden)

    Zlatka Borisova Stoyneva

    2015-03-01

    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.

  11. Using virtual reality environment to facilitate training with advanced upper-limb prosthesis

    Directory of Open Access Journals (Sweden)

    Linda Resnik, PT, PhD, OCS

    2011-07-01

    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.

  12. Diagnostic distribution of non-traumatic upper limb disorders

    DEFF Research Database (Denmark)

    Laursen, Lise H; Sjøgaard, Gisela; Hagert, C G;

    2007-01-01

    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...

  13. Prosthetic rehabilitation of the upper limb amputee

    Directory of Open Access Journals (Sweden)

    Bernard O′Keeffe

    2011-01-01

    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.

  14. Vascular anomalies of the upper limb

    Directory of Open Access Journals (Sweden)

    G Balakrishnan

    2011-01-01

    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.

  15. Amputation and prosthesis implantation shape body and peripersonal space representations

    OpenAIRE

    Elisa Canzoneri; Marilena Marzolla; Amedeo Amoresano; Gennaro Verni; Andrea Serino

    2013-01-01

    Little is known about whether and how multimodal representations of the body (BRs) and of the space around the body (Peripersonal Space, PPS) adapt to amputation and prosthesis implantation. In order to investigate this issue, we tested BR in a group of upper limb amputees by means of a tactile distance perception task and PPS by means of an audio-tactile interaction task. Subjects performed the tasks with stimulation either on the healthy limb or the stump of the amputated limb, while wearin...

  16. Pain in traumatic upper limb amputees in Sierra Leone.

    OpenAIRE

    Lacoux, Philippe A; Crombie, Iain K; MacRae, William A

    2002-01-01

    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...

  17. Disorders of Upper Limb Movements in Ataxia-Telangiectasia.

    Directory of Open Access Journals (Sweden)

    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.

  18. Management of neglected femoral neck fracture in above knee amputated limb: A case report

    Institute of Scientific and Technical Information of China (English)

    Umesh Meena; Ramesh Meena; Balaji S; Sahil Gaba

    2015-01-01

    The treatment of an above knee amputee who has sustained a fracture of the femoral neck is a challenging situation for both the orthopedic surgeon and the rehabilitation team.These fractures may be managed acutely either by reduction and internal fixation or by endoprosthetic replacement based on the same criteria as in any other patient with otherwise intact limbs.We present a neglected case treated successfully with valgus osteotomy.We conclude that these fractures should be treated with the same urgency and expertise as similar fractures in non-amputees as long-term survival and good quality of life can be expected.

  19. Management of neglected femoral neck fracture in above knee amputated limb: A case report.

    Science.gov (United States)

    Meena, Umesh; Meena, Ramesh; S, Balaji; Gaba, Sahil

    2015-01-01

    The treatment of an above knee amputee who has sustained a fracture of the femoral neck is a chal- lenging situation for both the orthopedic surgeon and the rehabilitation team. These fractures may be managed acutely either by reduction and internal fixation or by endoprosthetic replacement based on the same criteria as in any other patient with otherwise intact limbs.We present a neglected case treated successfully with valgus osteotomy. We conclude that these fractures should be treated with the same urgency and expertise as similar fractures in non-amputees as long-term survival and good quality of life can be expected. PMID:26917032

  20. Determinants of Quality of Life in the Caregivers of Iranian War Survivors with Bilateral Lower-Limb Amputation after More than Two Decades

    OpenAIRE

    Zohreh Ganjparvar; Batool Mousavi; Mehdi Masumi; Mohammadreza Soroush; Ali Montazeri

    2016-01-01

    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...

  1. Motor Impairment Evaluation for Upper Limb in Stroke Patients on the Basis of a Microsensor

    Science.gov (United States)

    Huang, Shuai; Luo, Chun; Ye, Shiwei; Liu, Fei; Xie, Bin; Wang, Caifeng; Yang, Li; Huang, Zhen; Wu, Jiankang

    2012-01-01

    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…

  2. Computer assisted surgery for malunited fractures in upper limb

    International Nuclear Information System (INIS)

    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)

  3. Staging of upper limb lymphedema from routine lymphoscintigraphic examinations

    Czech Academy of Sciences Publication Activity Database

    Gebouský, Petr; Kárný, Miroslav; Křížová, H.; Wald, M.

    2009-01-01

    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

  4. Upper-limb activity in adults: Referent values using accelerometry

    OpenAIRE

    Ryan R. Bailey, MSOT, OTR/L; Catherine E. Lang, PT, PhD

    2013-01-01

    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...

  5. Unusual Cause of Swelling in the Upper Limb: Kimura Disease

    Directory of Open Access Journals (Sweden)

    Kabilan Chokkappan

    2015-09-01

    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.

  6. The association of gegenhalten in the upper limbs with dyspraxia.

    OpenAIRE

    Tyrrell, P.; Rossor, M

    1988-01-01

    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.

  7. The association of gegenhalten in the upper limbs with dyspraxia.

    Science.gov (United States)

    Tyrrell, P; Rossor, M

    1988-01-01

    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

  8. Acupuncture in the Treatment of Upper-Limb Lymphedema

    OpenAIRE

    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.

    2013-01-01

    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 ...

  9. Literature Review on Needs of Upper Limb Prosthesis Users

    OpenAIRE

    Cordella, Francesca; Ciancio, Anna Lisa; Sacchetti, Rinaldo; Davalli, Angelo; Cutti, Andrea Giovanni; Guglielmelli, Eugenio; Zollo, Loredana

    2016-01-01

    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 ...

  10. Thoracodorsal artery perforator flap for upper limb reconstruction

    International Nuclear Information System (INIS)

    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)

  11. ERYSIPELAS OF UPPER LIMB: A COMPLICATION OF BREAST CANCER SURGERY

    Directory of Open Access Journals (Sweden)

    Natalia Cireap

    2010-05-01

    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+.

  12. Repetitive training for ameliorating upper limbs spasm of hemiplegic patients

    Institute of Scientific and Technical Information of China (English)

    Lin Zhu; Lin Liu; Weiqun Song

    2006-01-01

    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

  13. Tracking upper limbs fatigue by means of electronic dynamometry

    Directory of Open Access Journals (Sweden)

    Fernando Max Lima

    2015-06-01

    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.

  14. Impact of deteriorated calcium-phosphate homeostasis on amputation-free survival after endovascular revascularization in patients with critical limb ischemia on hemodialysis.

    Science.gov (United States)

    Hioki, Hirofumi; Miyashita, Yusuke; Shiraki, Tatsuya; Iida, Osamu; Uematsu, Masaaki; Miura, Takashi; Ebisawa, Souichirou; Ikeda, Uichi

    2016-04-01

    Patients on hemodialysis (HD) have abnormalities of calcium-phosphate (CaP) homeostasis and high CaP product contributes to atherosclerosis pathogenesis and adverse events. Patients on HD with critical limb ischemia (CLI) are at risk for major amputation and death because of advanced systemic atherosclerotic disease. The aim of this study was to evaluate the relationship between CaP product and amputation-free survival (AFS) in CLI after endovascular treatment (EVT). We retrospectively analyzed 221 CLI patients on HD. In Kaplan-Meier analysis, AFS was significantly lower in patients with CaP product ⩾ 55 mg(2)/dL(2) compared to those with CaP product EVT in CLI patients on HD, and can serve for their risk stratification. PMID:26681436

  15. Review on Upper Limb Continuous Passive Motion Devices

    Directory of Open Access Journals (Sweden)

    Ragazzo Francesco

    2016-01-01

    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.

  16. Literature Review on Needs of Upper Limb Prosthesis Users

    Science.gov (United States)

    Cordella, Francesca; Ciancio, Anna Lisa; Sacchetti, Rinaldo; Davalli, Angelo; Cutti, Andrea Giovanni; Guglielmelli, Eugenio; Zollo, Loredana

    2016-01-01

    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 the main critical aspects of the current prosthetic solutions, in terms of users satisfaction and activities of daily living they would like to perform with the prosthetic device. The ultimate goal is to provide design inputs in the prosthetic field and, contemporary, increase user satisfaction rates and reduce device abandonment. A list of requirements for upper limb prostheses is proposed, grounded on the performed analysis on user needs. It wants to (i) provide guidelines for improving the level of acceptability and usefulness of the prosthesis, by accounting for hand functional and technical aspects; (ii) propose a control architecture of PNS-based prosthetic systems able to satisfy the analyzed user wishes; (iii) provide hints for improving the quality of the methods (e.g., questionnaires) adopted for understanding the user satisfaction with their prostheses. PMID:27242413

  17. Literature Review on Needs of Upper Limb Prosthesis Users.

    Science.gov (United States)

    Cordella, Francesca; Ciancio, Anna Lisa; Sacchetti, Rinaldo; Davalli, Angelo; Cutti, Andrea Giovanni; Guglielmelli, Eugenio; Zollo, Loredana

    2016-01-01

    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 the main critical aspects of the current prosthetic solutions, in terms of users satisfaction and activities of daily living they would like to perform with the prosthetic device. The ultimate goal is to provide design inputs in the prosthetic field and, contemporary, increase user satisfaction rates and reduce device abandonment. A list of requirements for upper limb prostheses is proposed, grounded on the performed analysis on user needs. It wants to (i) provide guidelines for improving the level of acceptability and usefulness of the prosthesis, by accounting for hand functional and technical aspects; (ii) propose a control architecture of PNS-based prosthetic systems able to satisfy the analyzed user wishes; (iii) provide hints for improving the quality of the methods (e.g., questionnaires) adopted for understanding the user satisfaction with their prostheses. PMID:27242413

  18. Eponyms in imaging of the upper limb: A historical review

    International Nuclear Information System (INIS)

    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.

  19. Rhesus monkey is a new model of secondary lymphedema in the upper limb

    OpenAIRE

    Wu, Guojun; Xu, Hao; Zhou, Wenhong; Yuan, Xianshun; Yang, Zhe; Yang, Qing; Ding, Feng; Meng, Zhigang; Liang, Weili; Geng, Chong; Gao, Ling; Tian, Xingsong

    2014-01-01

    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 ...

  20. Expression of Endothelial Nitric Oxide Synthase and Endothelin-1 in Skin Tissue from Amputated Limbs of Patients with Complex Regional Pain Syndrome

    Directory of Open Access Journals (Sweden)

    J. George Groeneweg

    2008-07-01

    Full Text Available Background and Objectives. Impaired microcirculation during the chronic stage of complex regional pain syndrome (CRPS is related to increased vasoconstriction, tissue hypoxia, and metabolic tissue acidosis in the affected limb. Endothelial dysfunction is suggested to be the main cause of diminished blood flow. The aim of this study was to examine the distribution of endothelial nitric oxide synthase (eNOS and endothelin-1(ET-1 relative to vascular density represented by the endothelial marker CD31-immunoreactivity in the skin tissue of patients with chronic CRPS. Methods. We performed immunohistochemical staining on sections of skin specimens obtained from the amputated limbs (one arm and one leg of two patients with CRPS. Results. In comparison to proximal specimens we found an increased number of migrated endothelial cells as well as an increase of eNOS activity in distal dermis specimens. Conclusions. We found indications that endothelial dysfunction plays a role in chronic CRPS.

  1. The effect of upper limb casting on gait pattern.

    Science.gov (United States)

    Dreyfuss, Daniel; Elbaz, Avi; Mor, Amit; Segal, Ganit; Calif, Edward

    2016-06-01

    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

  2. Transcutaneous oximetry measurement: normal values for the upper limb.

    Science.gov (United States)

    2016-03-01

    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

  3. Limb Prosthetics

    Science.gov (United States)

    ... in the Residual Limb A prosthesis is an artificial device that replaces a missing body part. A limb may be amputated or missing because of a blood vessel disorder (such as atherosclerosis or damage due to ...

  4. The treatment of soft-tissue sarcomas of the extremities - prospective randomized evaluations of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant chemotherapy

    International Nuclear Information System (INIS)

    Between May 1975 and April 1981, 43 adult patients with high-grade soft tissue sarcomas of the extremities were prospectively randomized to receive either amputation at or above the joint proximal to the tumor, including all involved muscle groups, or to receive a limb-sparing resection plus adjuvant radiation therapy. The limb-sparing resection group received wide local excision followed by 5000 rads to the entire anatomic area at risk for local spread and 6000 to 7000 rads to the tumor bed. Both randomization groups received postoperative chemotherapy with doxorubicin (maximum cumulative dose 550 mg/m2), cyclophosphamide, and high-dose methotrexate. Twenty-seven patients randomized to receive limb-sparing resection and radiotherapy, and 16 received amputation (randomization was 2:1). There were four local recurrences in the limb-sparing group and none in the amputation group (p1 = 0.06 generalized Wilcoxon test). However, there were no differences in disease-free survival rates (83% and 88% at five years; p2 = 0.99) between the limb-sparing group and the amputation treatment groups. Multivariate analysis indicated that the only correlate of local recurrence was the final margin of resection. Patients with positive margins of resection had a higher likelihood of local recurrence compared with those with negative margins (p1 1 = 0.00008) and overall survival (95% vs. 74%; p1 = 0.04)

  5. An upper limb robot model of children limb for cerebral palsy neurorehabilitation.

    Science.gov (United States)

    Pathak, Yagna; Johnson, Michelle

    2012-01-01

    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

  6. Restlessness in right upper limb as sole presentation of restless legs syndrome

    OpenAIRE

    Ravi Gupta; Vivekananda Lahan; Deepak Goel

    2013-01-01

    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.

  7. Technology that Touches Lives: Teleconsultation to Benefit Persons with Upper Limb Loss

    OpenAIRE

    Lynsay R. Whelan; Wagner, Nathan

    2011-01-01

    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...

  8. EFFECTS OF BURN ON THE MOBILITY OF UPPER LIMB/S, FUNCTIONS OF HAND /S & ACTIVITIES OF DAILY LIVING

    OpenAIRE

    Perera M M N; Nanayakkarawasam P P; Katulanda P

    2015-01-01

    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...

  9. Upper limb malformations in chromosome 22q11 deletions

    Energy Technology Data Exchange (ETDEWEB)

    Shalev, S.A.; Dar, H.; Barel, H.; Borochowitz, Z. [Bnai Zion Medical Center, Haifa (Israel)

    1996-03-29

    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.

  10. Upper-limb activity in adults: Referent values using accelerometry

    Directory of Open Access Journals (Sweden)

    Ryan R. Bailey, MSOT, OTR/L

    2013-12-01

    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.

  11. Work related upper limb disorders in telecommunication workers in Malaysia.

    Science.gov (United States)

    Premalatha, G D; Noor Hassim, I

    1999-06-01

    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

  12. [The use of occupational therapy in upper limb amputees].

    Science.gov (United States)

    Moscato, T A; Orlandini, D

    2010-01-01

    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

  13. Robot-Aided Upper-Limb Rehabilitation Based on Motor Imagery EEG

    Directory of Open Access Journals (Sweden)

    Baoguo Xu

    2011-09-01

    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.

  14. Feedforward control strategies of subjects with transradial amputation in planar reaching

    Directory of Open Access Journals (Sweden)

    Anthony J. Metzger, MBE

    2010-05-01

    Full Text Available The rate of upper-limb amputations is increasing, and the rejection rate of prosthetic devices remains high. People with upper-limb amputation do not fully incorporate prosthetic devices into their activities of daily living. By understanding the reaching behaviors of prosthesis users, researchers can alter prosthetic devices and develop training protocols to improve the acceptance of prosthetic limbs. By observing the reaching characteristics of the nondisabled arms of people with amputation, we can begin to understand how the brain alters its motor commands after amputation. We asked subjects to perform rapid reaching movements to two targets with and without visual feedback. Subjects performed the tasks with both their prosthetic and nondisabled arms. We calculated endpoint error, trajectory error, and variability and compared them with those of nondisabled control subjects. We found no significant abnormalities in the prosthetic limb. However, we found an abnormal leftward trajectory error (in right arms in the nondisabled arm of prosthetic users in the vision condition. In the no-vision condition, the nondisabled arm displayed abnormal leftward endpoint errors and abnormally higher endpoint variability. In the vision condition, peak velocity was lower and movement duration was longer in both arms of subjects with amputation. These abnormalities may reflect the cortical reorganization associated with limb loss.

  15. Impairment of complex upper limb motor function in de novo Parkinson's disease.

    Science.gov (United States)

    Ponsen, Mirthe M; Daffertshofer, Andreas; Wolters, Erik Ch; Beek, Peter J; Berendse, Henk W

    2008-01-01

    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

  16. FLAP TRANSFERS IN UPPER LIMB RECONSTRUCTION AFTER SEVERE TRAUMA

    Directory of Open Access Journals (Sweden)

    D. Pieptu

    2010-11-01

    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

  17. Upper limb impairments associated with spasticity in neurological disorders

    Directory of Open Access Journals (Sweden)

    Mirbagheri Mehdi M

    2007-11-01

    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.

  18. A robot hand testbed designed for enhancing embodiment and functional neurorehabilitation of body schema in subjects with upper limb impairment or loss.

    Science.gov (United States)

    Hellman, Randall B; Chang, Eric; Tanner, Justin; Helms Tillery, Stephen I; Santos, Veronica J

    2015-01-01

    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 feedback (MVF), rely on visualizations of postural changes. Advances in neural interfaces for artificial sensory feedback now make it possible to combine MVF with a high-tech "rubber hand" illusion, in which subjects develop a sense of embodiment with a fake hand when subjected to congruent visual and somatosensory feedback. We discuss clinical benefits that could arise from the confluence of known concepts such as MVF and the rubber hand illusion, and new technologies such as neural interfaces for sensory feedback and highly sensorized robot hand testbeds, such as the "BairClaw" presented here. Our multi-articulating, anthropomorphic robot testbed can be used to study proprioceptive and tactile sensory stimuli during physical finger-object interactions. Conceived for artificial grasp, manipulation, and haptic exploration, the BairClaw could also be used for future studies on the neurorehabilitation of somatosensory disorders due to upper limb impairment or loss. A remote actuation system enables the modular control of tendon-driven hands. The artificial proprioception system enables direct measurement of joint angles and tendon tensions while temperature, vibration, and skin deformation are provided by a multimodal tactile sensor. The provision of multimodal sensory feedback that is spatiotemporally consistent with commanded actions could lead to benefits such as reduced phantom limb pain, and increased prosthesis use due to improved functionality and reduced cognitive burden

  19. A robot hand testbed designed for enhancing embodiment and functional neurorehabilitation of body schema in subjects with upper limb impairment or loss

    Directory of Open Access Journals (Sweden)

    Randall B. Hellman

    2015-02-01

    Full Text Available 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 feedback (MVF, rely on visualizations of postural changes. Advances in neural interfaces for artificial sensory feedback now make it possible to combine MVF with a high-tech rubber hand illusion, in which subjects develop a sense of embodiment with a fake hand when subjected to congruent visual and somatosensory feedback. We discuss clinical benefits that could arise from the confluence of known concepts such as MVF and the rubber hand illusion, and new technologies such as neural interfaces for sensory feedback and highly sensorized robot hand testbeds, such as the BairClaw presented here. Our multi-articulating, anthropomorphic robot testbed can be used to study proprioceptive and tactile sensory stimuli during physical finger-object interactions. Conceived for artificial grasp, manipulation, and haptic exploration, the BairClaw could also be used for future studies on the neurorehabilitation of somatosensory disorders due to upper limb impairment or loss. A remote actuation system enables the modular control of tendon-driven hands. The artificial proprioception system enables direct measurement of joint angles and tendon tensions while temperature, vibration, and skin deformation are provided by a multimodal tactile sensor. The provision of multimodal sensory feedback that is spatiotemporally consistent with commanded actions could lead to benefits such as reduced phantom limb pain, and increased prosthesis use due to improved functionality and reduced

  20. Distal amputations for the diabetic foot

    Directory of Open Access Journals (Sweden)

    Aziz Nather

    2013-07-01

    Full Text Available Minor amputations in diabetic patients with foot complications have been well studied in the literature but controversy still remains as to what constitutes successful or non-successful limb salvage. In addition, there is a lack of consensus on the definition of a minor or distal amputation and a major or proximal amputation for the diabetic population. In this article, the authors review the existing literature to evaluate the efficacy of minor amputations in this selected group of patients in terms of diabetic limb salvage and also propose several definitions regarding diabetic foot amputations.

  1. Amputation - traumatic

    Science.gov (United States)

    Traumatic amputation is the loss of a body part -- usually a finger, toe, arm, or leg -- that occurs as ... If an accident or trauma results in complete amputation (the body part is totally severed), the part ...

  2. A review of nerve conduction studies in cases of suspected compression neuropathies of the upper limb.

    LENUS (Irish Health Repository)

    Neligan, A

    2010-01-01

    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.

  3. Functional rehabilitation of upper limb apraxia in poststroke patients: study protocol for a randomized controlled trial

    OpenAIRE

    Pérez-Mármol, Jose Manuel; García-Ríos, Mª Carmen; Barrero-Hernandez, Francisco J.; Molina-Torres, Guadalupe; Brown, Ted; Aguilar-Ferrándiz, María Encarnación

    2015-01-01

    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...

  4. [Hand-arm vibration syndrome and upper limbs diseases in the forest workers of Italia meridionale].

    Science.gov (United States)

    Fenga, C; Rapisarda, V; Valentino, M; Cacciola, A; Deboli, R; Calvo, A; Germanò, D

    2007-01-01

    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

  5. Perioperative nursing of imb salvage of patients with near limb amputation%濒临截肢损毁伤保肢围术期护理

    Institute of Scientific and Technical Information of China (English)

    孙琳琳; 于吉文

    2015-01-01

    目的:探究濒临截肢损毁伤保肢手术患者术前、术后护理方法。方法选取近几年于本院就诊的保肢手术患者,对其采取心理护理、疼痛护理等各项护理措施,并观察最终护理效果。结果对濒临截肢损毁伤保肢手术患者采取护理措施后,患者的心理状态明显改善,术后恢复较快,未出现任何护理事故。结论濒临截肢损毁伤保肢手术患者不仅应重视身体方面的护理,也应注重精神上的护理,同时注重提升护理技巧、总结护理经验。%Objective To explore nursing methods before and after operation in limb sal-vage patients who were closed to amputation.Methods The patients with limb salvage operation in our hospital in recent years were chosen.And nursing measures such as psychological nursing and pain nursing were taken and nursing results were observed.Results After nursing,the mental sta-tus of patients had improved.Besides,the patients had a good recovery and no nursing accident oc-curred.Conclusion The patients with limb salvage should focus on both body nursing and the mental nursing.It is very important for the nurses to improve nursing skills and summarize nursing experience.

  6. Determinants of Quality of Life in the Caregivers of Iranian War Survivors with Bilateral Lower-Limb Amputation after More than Two Decades

    Science.gov (United States)

    Ganjparvar, Zohreh; Mousavi, Batool; Masumi, Mehdi; Soroush, Mohammadreza; Montazeri, Ali

    2016-01-01

    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

  7. Technology that Touches Lives: Teleconsultation to Benefit Persons with Upper Limb Loss

    OpenAIRE

    Lynsay R. Whelan; Nathan Wagner

    2011-01-01

    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...

  8. [Phantom limb pains].

    Science.gov (United States)

    Giraux, Pascal

    2015-03-01

    With the radical experience of an amputation, the adaptation of body image is often incomplete. Some people experience phantom body perceptions, often painful and difficult to treat, after the amputation of a limb. PMID:26145132

  9. A Patient-Controlled Analgesia Adaptor to Mitigate Postsurgical Pain for Combat Casualties With Multiple Limb Amputation: A Case Series.

    Science.gov (United States)

    Pasquina, Paul F; Isaacson, Brad M; Johnson, Elizabeth; Rhoades, Daniel S; Lindholm, Mark P; Grindle, Garrett G; Cooper, Rory A

    2016-08-01

    The use of explosive armaments during Operation Iraqi Freedom, Operation Enduring Freedom, and Operation New Dawn has resulted in a significant number of injured U.S. service members. These weapons often generate substantial extremity trauma requiring multiple surgical procedures to preserve life, limb, and restore function. For those individuals who require multiple surgeries, the use of patient-controlled analgesia (PCA) devices can be an effective way to achieve adequate pain management and promote successful rehabilitation and recovery during inpatient treatment. A subpopulation of patients are unable to independently control a PCA device because of severe multiple limb dysfunction and/or loss. In response to the needs of these patients, our team designed and developed a custom adaptor to assist service members who would otherwise not be able to use a PCA. Patient feedback of the device indicated a positive response, improved independence, and overall satisfaction during inpatient hospitalization. PMID:27483540

  10. Bilateral Lower Limb Amputations in a Nigerian Child Following High-Voltage Electrical Burns Injury: A Case Report

    OpenAIRE

    Dim, EM; Amanari, OC; Nottidge, TE; Inyang, UC; Nwashindi, A

    2013-01-01

    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...

  11. Research, design and development project Myoelectric Prosthesis of Upper Limb

    Energy Technology Data Exchange (ETDEWEB)

    Galiano, L; Montaner, E; Flecha, A [Bioparx, J Hernandez 1101, Parana, ERios (Argentina)

    2007-11-15

    A Research Design and Development Project was developed of a myoelectric prosthesis for a pediatric patient presenting congenital amputation of the left forearm below the elbow. A multidisciplinary work-team was formed for this goal, in order to solve the several (/various) aspects regarding this project (mechanical, ergonomics, electronics, physical). The prosthesis as an electromechanical device was divided in several blocks, trying to achieve a focused development for each stage, acording to requisites. A mechanical prototype of the prothesis was designed and built along with the circuitry needed for EMG aquisition, control logic and drivers. Having acomplished the previuos stages, the project is now dealing with the definitions of the interface between the prosthesis and the patient, with promising perspectives.

  12. Research, design & development project Myoelectric Prosthesis of Upper Limb

    Science.gov (United States)

    Galiano, L.; Montaner, E.; Flecha, A.

    2007-11-01

    A Research Design and Development Project was developed of a myoelectric prosthesis for a pediatric patient presenting congenital amputation of the left forearm below the elbow. A multidisciplinary work-team was formed for this goal, in order to solve the several (/various) aspects regarding this project (mechanical, ergonomics, electronics, physical). The prosthesis as an electromechanical device was divided in several blocks, trying to achieve a focused development for each stage, acording to requisites. A mechanical prototype of the prothesis was designed and built along with the circuitry needed for EMG aquisition, control logic and drivers. Having acomplished the previuos stages, the project is now dealing with the definitions of the interface between the prosthesis and the patient, with promising perspectives.

  13. Research, design and development project Myoelectric Prosthesis of Upper Limb

    International Nuclear Information System (INIS)

    A Research Design and Development Project was developed of a myoelectric prosthesis for a pediatric patient presenting congenital amputation of the left forearm below the elbow. A multidisciplinary work-team was formed for this goal, in order to solve the several (/various) aspects regarding this project (mechanical, ergonomics, electronics, physical). The prosthesis as an electromechanical device was divided in several blocks, trying to achieve a focused development for each stage, acording to requisites. A mechanical prototype of the prothesis was designed and built along with the circuitry needed for EMG aquisition, control logic and drivers. Having acomplished the previuos stages, the project is now dealing with the definitions of the interface between the prosthesis and the patient, with promising perspectives

  14. Metal bar prevents phantom limb motion: case study of an amputation patient who showed a profound change in the awareness of his phantom limb.

    Science.gov (United States)

    Kawashima, Noritaka; Mita, Tomoki

    2009-12-01

    This case report describes an amputee (patient A.S., a 60-year-old male forelimb amputee) who had an extraordinary experience with a phantom limb. He complained that he could not move the wrist of his phantom limb because a metal bar was perceived to be grasped by the hand. As a solution for removing the metal bar, we invited the patient to undergo mirror reflection-induced visual feedback therapy. The patient reported that the metal bar previously grasped by his hand was successfully removed from the phantom during the course of therapy. Interestingly, this experience was accompanied by profound changes in the EMG modulation in the residual wrist muscles. In this article, the possible mechanisms underlying this interesting phenomenon will be discussed. PMID:19585348

  15. Thermographic Patterns of the Upper and Lower Limbs: Baseline Data

    Science.gov (United States)

    Cassar, Kevin; Camilleri, Kenneth P.; De Raffaele, Clifford; Mizzi, Stephen; Cristina, Stefania

    2015-01-01

    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

  16. A Telehealth Intervention Using Nintendo Wii Fit Balance Boards and iPads to Improve Walking in Older Adults With Lower Limb Amputation (Wii.n.Walk): Study Protocol for a Randomized Controlled Trial

    OpenAIRE

    Imam, Bita; Miller, William C.; Finlayson, Heather C; Eng, Janice J.; Payne, Michael WC; Jarus, Tal; Goldsmith, Charles H.; Mitchell, Ian M.

    2014-01-01

    Background The number of older adults living with lower limb amputation (LLA) who require rehabilitation for improving their walking capacity and mobility is growing. Existing rehabilitation practices frequently fail to meet this demand. Nintendo Wii Fit may be a valuable tool to enable rehabilitation interventions. Based on pilot studies, we have developed “Wii.n.Walk”, an in-home telehealth Wii Fit intervention targeted to improve walking capacity in older adults with LLA. Objective The obj...

  17. Sensación de miembro fantasma y dolor de miembro residual tras 50 años de la amputación Chronic phantom sensation and residual limb pain 50 years after amputation

    Directory of Open Access Journals (Sweden)

    J. Olarra

    2007-08-01

    Full Text Available Introducción El dolor del miembro residual o dolor de muñón es aquel que aparece en la parte todavía existente de la extremidad amputada. Paciente: Presentamos el caso de un paciente varón de 74 años con antecedentes de amputación supracondílea postraumática del miembro inferior izquierdo, que desarrolló dolor de miembro residual y sensación de miembro fantasma 50 años después de la amputación sin una causa que Justificara su aparición. El tratamiento con antidepresivos tricíclicos (amitriptilina, anticonvulsivantes (gabapentina y tramadol permitió un buen control del dolor. Conclusiones: La existencia de una matriz neuronal determinada genéticamente pero modulada durante la vida por los impulsos nerviosos (nociceptivos, crearía una memoria somato-sensorial que sería responsable de la aparición del dolor de miembro fantasma.Background and objective: Residual limb pain or stump pain is defined as pain in the remaining part of an amputated limb. Patient: We present the case of a 74-year-old male patient with a history of posttraumatic transfemoral (above knee amputation of the left lower limb who developed residual limb pain and phantom limb sensation 50 years after amputation without a clear etiology. Treatment with tricyclic antidepressants (amitriptyline, anticonvulsivants (gabapentin and opioids (tramadol, provided a satisfactory control of pain. Conclusions: The existence of a neuromatrix initially determined genetically and later sculpted by sensory inputs (continuous nociceptive stimulation, could create what is known as the somatosensorial memory, responsible for the development of phantom limb pain.

  18. Patterns of extremity traumas leading to amputation in lran:results of Iranian National Trauma Project

    Institute of Scientific and Technical Information of China (English)

    Majid Moini; Mohammad R Rasouli; Ali Khaji; Farshad Farshidfar; Pedram Heidari

    2009-01-01

    Obiective: To determine the patterns of traumatic extremity injuries leading to amputation in Iran.Methotis: Data of Iranian National Trauma Project was used to identify patients with upper and lower extremity traumas undergoing amputation.This project was conducted in 8 major cities during 2000-2004.Results: of 17 753 traumatic Patients,164 (0.92%) had injuries to the extremities that resulted in the limb amputation.Of these,143 (87.2%) were men.The patient's mean age was 29.0 years±15.4 years and the highest incidence was seen in the age group of 21 to 30 years (34.1%).One hundred and four cases were occupational accidents (63.4%).Blunt trauma was in 54.9% of the cases.The most common reasons for amputation were respectively stabbings (37.8%) and crush injuries (31.7%).Amputation of hand fingers was the most frequent type of amputation (125 cases,76.2%).One patient died from severe associated injuries.Conclusions: This study shows the patterns of traumatic limb amputation in Iran,a developing country.Resuits of this study may be used in preventive strategic planning.

  19. Upper Limb Posture Estimation in Robotic and Virtual Reality-Based Rehabilitation

    Directory of Open Access Journals (Sweden)

    Camilo Cortés

    2014-01-01

    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.

  20. Design and preliminary evaluation of an exoskeleton for upper limb resistance training

    Science.gov (United States)

    Wu, Tzong-Ming; Chen, Dar-Zen

    2012-06-01

    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.

  1. Wearable sensors for 3D upper limb motion modeling and ubiquitous estimation

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    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...

  2. Vasoconstrictor responses in the upper and lower limbs to increases in transmural pressure

    OpenAIRE

    Lott, Mary E. J.; Hogeman, Cynthia; Herr, Michael; Bhagat, Monica; Kunselman, Allen; Sinoway, Lawrence I.

    2009-01-01

    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...

  3. Amplitude Manipulation Evokes Upper Limb Freezing during Handwriting in Patients with Parkinson’s Disease with Freezing of Gait

    OpenAIRE

    Elke Heremans; Evelien Nackaerts; Griet Vervoort; Sarah Vercruysse; Sanne Broeder; Carolien Strouwen; Stephan P Swinnen; Alice Nieuwboer

    2015-01-01

    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...

  4. Acupotomy and venesection in Upper Limb Lymphedema and Peripheral neuropathy following Breast Cancer Surgery

    Directory of Open Access Journals (Sweden)

    Jang Eun-ha

    2009-12-01

    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.

  5. Technology that Touches Lives: Teleconsultation to Benefit Persons with Upper Limb Loss

    Directory of Open Access Journals (Sweden)

    Lynsay R. Whelan

    2011-12-01

    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.

  6. Technology that Touches Lives: Teleconsultation to Benefit Persons with Upper Limb Loss.

    Science.gov (United States)

    Whelan, Lynsay R; Wagner, Nathan

    2011-01-01

    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

  7. Primed Physical Therapy Enhances Recovery of Upper Limb Function in Chronic Stroke Patients.

    Science.gov (United States)

    Ackerley, Suzanne J; Byblow, Winston D; Barber, P Alan; MacDonald, Hayley; McIntyre-Robinson, Andrew; Stinear, Cathy M

    2016-05-01

    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

  8. Restoring motor control and sensory feedback in people with upper extremity amputations using arrays of 96 microelectrodes implanted in the median and ulnar nerves

    Science.gov (United States)

    Davis, T. S.; Wark, H. A. C.; Hutchinson, D. T.; Warren, D. J.; O'Neill, K.; Scheinblum, T.; Clark, G. A.; Normann, R. A.; Greger, B.

    2016-06-01

    Objective. An important goal of neuroprosthetic research is to establish bidirectional communication between the user and new prosthetic limbs that are capable of controlling >20 different movements. One strategy for achieving this goal is to interface the prosthetic limb directly with efferent and afferent fibres in the peripheral nervous system using an array of intrafascicular microelectrodes. This approach would provide access to a large number of independent neural pathways for controlling high degree-of-freedom prosthetic limbs, as well as evoking multiple-complex sensory percepts. Approach. Utah Slanted Electrode Arrays (USEAs, 96 recording/stimulating electrodes) were implanted for 30 days into the median (Subject 1-M, 31 years post-amputation) or ulnar (Subject 2-U, 1.5 years post-amputation) nerves of two amputees. Neural activity was recorded during intended movements of the subject’s phantom fingers and a linear Kalman filter was used to decode the neural data. Microelectrode stimulation of varying amplitudes and frequencies was delivered via single or multiple electrodes to investigate the number, size and quality of sensory percepts that could be evoked. Device performance over time was assessed by measuring: electrode impedances, signal-to-noise ratios (SNRs), stimulation thresholds, number and stability of evoked percepts. Main results. The subjects were able to proportionally, control individual fingers of a virtual robotic hand, with 13 different movements decoded offline (r = 0.48) and two movements decoded online. Electrical stimulation across one USEA evoked >80 sensory percepts. Varying the stimulation parameters modulated percept quality. Devices remained intrafascicularly implanted for the duration of the study with no significant changes in the SNRs or percept thresholds. Significance. This study demonstrated that an array of 96 microelectrodes can be implanted into the human peripheral nervous system for up to 1 month durations. Such an

  9. Lymphoedema of the upper limb: a rare complication of thyroid surgery?

    Science.gov (United States)

    Stephen, Christopher; Munnoch, David Alexander

    2016-01-01

    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

  10. The Locomotor Capabilities Index; validity and reliability of the Swedish version in adults with lower limb amputation

    Directory of Open Access Journals (Sweden)

    Andersson Ingemar H

    2009-05-01

    Full Text Available Abstract Background The Locomotor Capabilities Index (LCI is a validated measure of lower-limb amputees' ability to perform activities with prosthesis. We have developed the LCI Swedish version and evaluated its validity and reliability. Methods Cross-cultural adaptation to Swedish included forward/backward translations and field testing. The Swedish LCI was then administered to 144 amputees (55 women, mean age 74 (40–93 years, attending post-rehabilitation prosthetic training. Construct validity was assessed by examining the relationship between the LCI and Timed "Up-and-Go" (TUG test and between the LCI and EQ-5D health utility index in 2 subgroups of 40 and 20 amputees, respectively. Discriminative validity was assessed by comparing scores in different age groups and in unilateral and bilateral amputees. Test-retest reliability (1–2 weeks was evaluated in 20 amputees (14 unilateral. Results The Swedish LCI showed good construct convergent validity, with high correlation with the TUG (r = -0.75 and the EQ-5D (r = 0.84, and discriminative validity, with significantly worse mean scores for older than younger and for bilateral than unilateral amputees (p Conclusion The Swedish version of the LCI demonstrated good validity and internal consistency in adult amputees. Test-retest reliability in a small subsample appears to be acceptable. The high ceiling effect of the LCI may imply that it would be most useful in assessing amputees with low to moderate functional abilities.

  11. Upper Limb Assessment in Tetraplegia: Clinical, Functional and Kinematic Correlations

    Science.gov (United States)

    Cacho, Enio Walker Azevedo; de Oliveira, Roberta; Ortolan, Rodrigo L.; Varoto, Renato; Cliquet, Alberto

    2011-01-01

    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…

  12. Entrapment Neuropathies in the Upper and Lower Limbs: Anatomy and MRI Features

    International Nuclear Information System (INIS)

    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

  13. Impact of early applied upper limb stimulation: The EXPLICIT-stroke programme design

    NARCIS (Netherlands)

    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.

    2008-01-01

    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

  14. A novel motion tracking system for evaluation of functional rehabilitation of the upper limbs*****

    Institute of Scientific and Technical Information of China (English)

    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

    2013-01-01

    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.

  15. Normative data for modified Box and Blocks test measuring upper-limb function via motion capture

    Directory of Open Access Journals (Sweden)

    Jacqueline S. Hebert, MD, FRCPC

    2014-10-01

    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.

  16. Isotopic angiography in the study of deep vein circulation of the upper limb

    International Nuclear Information System (INIS)

    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

  17. Improving work style behavior in computer workers with neck and upper limb symptoms

    NARCIS (Netherlands)

    Bernaards, C.M.; Ariëns, G.A.M.; Simons, M.; Knol, D.L.; Hildebrandt, V.H.

    2008-01-01

    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

  18. Do work-related physical factors predict neck and upper limb symptoms in office workers?

    NARCIS (Netherlands)

    Heuvel, S.G. van den; Beek, A.J. van der; Blatter, B.M.; Bonger, P.M.

    2006-01-01

    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

  19. Golf and upper limb injuries: a summary and review of the literature

    Directory of Open Access Journals (Sweden)

    Pollard Henry P

    2005-05-01

    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.

  20. Paravertebral and Brachial plexus block for Abdominal flap to cover the upper limb wound

    OpenAIRE

    Narendra kumar; Neelam Dogra

    2011-01-01

    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.

  1. Sirenomelia with upper limb malformation: a case report and review of the literature.

    Science.gov (United States)

    Su, D; Yao, Q

    2015-01-01

    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

  2. Evaluation of suitability of a micro-processing unit of motion analysis for upper limb tracking.

    Science.gov (United States)

    Barraza Madrigal, José Antonio; Cardiel, Eladio; Rogeli, Pablo; Leija Salas, Lorenzo; Muñoz Guerrero, Roberto

    2016-08-01

    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

  3. Robot-Mediated Upper Limb Physiotherapy: Review and Recommendations for Future Clinical Trials

    Science.gov (United States)

    Peter, Orsolya; Fazekas, Gabor; Zsiga, Katalin; Denes, Zoltan

    2011-01-01

    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…

  4. Casting for upper limb hypertonia: A retrospective study to determine the factors associated with intervention decisions

    NARCIS (Netherlands)

    Kuipers, K.; Burger, L.; Copley, J.

    2012-01-01

    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

  5. A case report of neck, chest and upper limb cutaneous metastasis from synchronous colorectal cancer

    Institute of Scientific and Technical Information of China (English)

    WANG Jian; SHI Yu-qian; WU Zhi-yong

    2009-01-01

    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.

  6. Frequency upper limbs injuries in the emergency health service in Paranaiba, MS, Brazil

    Directory of Open Access Journals (Sweden)

    Eliane Cristina Coelho de Oliveira Correia

    2012-09-01

    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.

  7. Exoskeleton-Based Robotic Platform Applied in Biomechanical Modelling of the Human Upper Limb

    Directory of Open Access Journals (Sweden)

    Andres F. Ruiz

    2009-01-01

    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.

  8. Addressing Sexuality as Standard Care in People with an Upper Limb Deficiency : Taboo or Necessary Topic?

    NARCIS (Netherlands)

    Verschuren, J.E.A.; Geertzen, J.H.B.; Enzlin, P.; Dijkstra, P. U.; Dekker, R.; Van Der Sluis, C.K.

    2013-01-01

    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

  9. The role of order of practice in learning to handle an upper-limb prosthesis

    NARCIS (Netherlands)

    Bouwsema, Hanneke; van der Sluis, Corry K.; Bongers, Raoul M.

    2008-01-01

    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

  10. The Corticospinal Tract: A Biomarker to Categorize Upper Limb Functional Potential in Unilateral Cerebral Palsy

    Science.gov (United States)

    Jaspers, Ellen; Byblow, Winston D.; Feys, Hilde; Wenderoth, Nicole

    2016-01-01

    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

  11. Regenerative Engineering and Bionic Limbs

    OpenAIRE

    James, Roshan; Laurencin, Cato T.

    2015-01-01

    Amputations of the upper extremity are severely debilitating, current treatments support very basic limb movement, and patients undergo extensive physiotherapy and psychological counselling. There is no prosthesis that allows the amputees near-normal function. With increasing number of amputees due to injuries sustained in accidents, natural calamities and international conflicts, there is a growing requirement for novel strategies and new discoveries. Advances have been mad...

  12. Work related neck and upper limb symptoms (RSI) : high risk occupations and risk factors in the Belgian working population

    NARCIS (Netherlands)

    Blatter, B.M.; Bongers, P.M.; Witte, H. de

    1999-01-01

    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

  13. Intra-arterial Autologous Bone Marrow Cell Transplantation in a Patient with Upper-extremity Critical Limb Ischemia

    International Nuclear Information System (INIS)

    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.

  14. EFFECTS OF BURN ON THE MOBILITY OF UPPER LIMB/S, FUNCTIONS OF HAND /S & ACTIVITIES OF DAILY LIVING

    Directory of Open Access Journals (Sweden)

    Perera M M N

    2015-02-01

    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.

  15. Proposed equation between flexor carpi radialis H-reflex latency and upper limb length.

    Directory of Open Access Journals (Sweden)

    Saeid Khosrawi

    2015-03-01

    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.

  16. Nature and incidence of upper limb injuries in professional cricket players a prospective observation

    Directory of Open Access Journals (Sweden)

    Dhillon Mandeep S

    2012-11-01

    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.

  17. Age Effects on Upper Limb Kinematics Assessed by the REAplan Robot in Healthy School-Aged Children.

    Science.gov (United States)

    Gilliaux, Maxime; Dierckx, Floriane; Vanden Berghe, Lola; Lejeune, Thierry M; Sapin, Julien; Dehez, Bruno; Stoquart, Gaëtan; Detrembleur, Christine

    2015-05-01

    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

  18. Upper limb artery segmental occlusions due to chronic use of ergotamine combined with itraconazole, treated by thrombolysis

    Directory of Open Access Journals (Sweden)

    Nodari Franco

    2011-08-01

    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

  19. Data on amputation free survival of patients with lower limb peripheral artery disease classified according TASC II classification and a new crural index.

    Science.gov (United States)

    Jalkanen, Juho M; Wickström, Jan-Erik; Venermo, Maarit; Hakovirta, Harri H

    2016-09-01

    The results of amputation free survival (AFS) of a cohort of 887 caucasian patients is shown. The data is based on further analyses of data presented in Jalkanen et al. (2016) [1]. The 36-month amputation free survival of patients divided in new crural vessel disease classification (Crural Index), aortoiliac TASC II classification, femoropopliteal TASC II classification and most severe segment is presented. Also, in depth demographic data is presented for each Crural Index group Jalkanen et al., 2016 [1]. PMID:27331095

  20. Computer simulations of neural mechanisms explaining upper and lower limb excitatory neural coupling

    Directory of Open Access Journals (Sweden)

    Ferris Daniel P

    2010-12-01

    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

  1. Upper limb joint muscle/tendon injury and anthropometric adaptations in French competitive tennis players.

    Science.gov (United States)

    Rogowski, Isabelle; Creveaux, Thomas; Genevois, Cyril; Klouche, Shahnaz; Rahme, Michel; Hardy, Philippe

    2016-01-01

    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

  2. Ultrasound guided distal peripheral nerve block of the upper limb: A technical review

    Directory of Open Access Journals (Sweden)

    Herman Sehmbi

    2015-01-01

    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.

  3. Selective impairment of sensorimotor representations following short-term upper-limb immobilization.

    Science.gov (United States)

    Meugnot, Aurore; Agbangla, Nounagnon Frutueux; Toussaint, Lucette

    2016-09-01

    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

  4. Development of rehabilitation training support system for occupational therapy of upper limb motor function

    Science.gov (United States)

    Morita, Yoshifumi; Hirose, Akinori; Uno, Takashi; Uchid, Masaki; Ukai, Hiroyuki; Matsui, Nobuyuki

    2007-12-01

    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.

  5. Analysis of upper limb movement in Multiple Sclerosis subjects during common daily actions.

    Science.gov (United States)

    Pellegrino, L; Stranieri, G; Tiragallo, E; Tacchino, A; Brichetto, G; Coscia, M; Casadio, M

    2015-08-01

    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

  6. Risk of upper limb complaints due to computer use in older persons: a randomized study

    Directory of Open Access Journals (Sweden)

    Jolles Jelle

    2007-08-01

    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.

  7. Associations between biopsychosocial factors and chronic upper limb pain among slaughterhouse workers

    DEFF Research Database (Denmark)

    Sundstrup, Emil; Jakobsen, Markus D; Brandt, Mikkel;

    2016-01-01

    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...

  8. Proprioceptive rehabilitation of upper limb dysfunction in movement disorders: a clinical perspective

    Directory of Open Access Journals (Sweden)

    Giovanni eAbbruzzese

    2014-11-01

    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.

  9. Somatosensory evoked potentials after multisegmental upper limb stimulation in diagnosis of cervical spondylotic myelopathy.

    OpenAIRE

    Restuccia, D; Valeriani, M.; Di Lazzaro, V; Tonali, P.; Mauguière, F

    1994-01-01

    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...

  10. Studying upper-limb kinematic using inertial sensors embedded in smartphones

    OpenAIRE

    Cuesta Vargas, Antonio; Roldan Jimenez, Cristina; Bennett, Paul

    2014-01-01

    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...

  11. DESIGN OF AN ANTHROPOMORPHIC UPPER LIMB EXOSKELETON ACTUATED BY BALL-SCREWS AND CABLES

    OpenAIRE

    Garrec, Philippe

    2010-01-01

    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...

  12. Effects and Adherence of Mirror Therapy in People with Chronic Upper Limb Hemiparesis: A Preliminary Study

    OpenAIRE

    Kuys, Suzanne S.; Tara Edwards; Morris, Norman R.

    2012-01-01

    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....

  13. Proposed equation between flexor carpi radialis H-reflex latency and upper limb length

    OpenAIRE

    Saeid Khosrawi; Parisa Taheri; Seyed Hasan Hashemi

    2015-01-01

    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...

  14. Strategy for respiratory exercise pattern associated with upper limb movements in COPD patients

    Directory of Open Access Journals (Sweden)

    Dirceu Costa

    2011-01-01

    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.

  15. The effect of bilateral activities on the improvement of upper limb function in CVA patients

    OpenAIRE

    Mehdi Hassanpour; Sayed Ali Hoseini; Shahram Aboutaleb; Mahdi Rahgozar; Zohre Sarafraz

    2011-01-01

    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...

  16. Pulmonary rehabilitation in copd exacerbation: is upper limbs exercise training safe and effective?

    OpenAIRE

    Ferreira, Dulce; Mendes, Eugénia; Noronha, Bruno; Preto, Leonel; Novo, André

    2015-01-01

    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...

  17. Upper Limb Outcome Measures Used in Stroke Rehabilitation Studies: A Systematic Literature Review

    Science.gov (United States)

    Santisteban, Leire; Térémetz, Maxime; Bleton, Jean-Pierre; Baron, Jean-Claude; Maier, Marc A.; Lindberg, Påvel G.

    2016-01-01

    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

  18. Electromyographic Analysis of the Dominant Upper Limb During the Golf Swing

    OpenAIRE

    Pezarat, P.; Cabri, J; O Fernandes; de Sousa, J P

    2006-01-01

    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...

  19. Development and testing of new upper-limb prosthetic devices: Research designs for usability testing

    OpenAIRE

    Linda Resnik, PT, PhD

    2011-01-01

    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...

  20. Electromyography-Based Quantitative Representation Method for Upper-Limb Elbow Joint Angle in Sagittal Plane

    OpenAIRE

    Pang, Muye; Guo, Shuxiang; Huang, Qiang; Ishihara, Hidenori; Hirata, Hideyuki

    2015-01-01

    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...

  1. Imaging appearances of Buerger's disease complications in the upper and lower limbs

    International Nuclear Information System (INIS)

    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.

  2. ENTHESEAL CHANGE OF THE UPPER LIMB IN A MYCENAEAN POPULATION FROM ATHENS

    OpenAIRE

    Mountrakis, Constantine; Manolis, Sotiris K.

    2014-01-01

    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...

  3. Variable structure pantograph mechanism with spring suspension system for comprehensive upper-limb haptic movement training

    Directory of Open Access Journals (Sweden)

    Joel C. Perry, PhD

    2011-05-01

    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.

  4. A Framework to Automate Assessment of Upper-Limb Motor Function Impairment: A Feasibility Study

    Directory of Open Access Journals (Sweden)

    Paul Otten

    2015-08-01

    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.

  5. The effect of bilateral activities on the improvement of upper limb function in CVA patients

    Directory of Open Access Journals (Sweden)

    Mehdi Hassanpour

    2011-03-01

    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.

  6. Gesture recognition in upper-limb prosthetics: a viability study using dynamic time warping and gyroscopes.

    Science.gov (United States)

    Dermitzakis, Konstantinos; Arieta, Alejandro Hernandez; Pfeifer, Rolf

    2011-01-01

    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

  7. The pedicled thoraco-umbilical flap: A versatile technique for upper limb coverage

    Directory of Open Access Journals (Sweden)

    Mishra Sharad

    2009-01-01

    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.

  8. Bilateral upper-limb rehabilitation after stroke using a movement-based game controller

    Directory of Open Access Journals (Sweden)

    Juha M. Hijmans, PhD

    2011-10-01

    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.

  9. Caracterização dos portadores de diabetes submetidos à amputação de membros inferiores em Londrina, Estado do Paraná = Characterization of diabetic patients submitted to lower limb amputation in Londrina, Paraná State

    Directory of Open Access Journals (Sweden)

    Maira Sayuri Sakay Bortoletto

    2010-07-01

    patients had diabetic neuropathy, 93% had lower limb ulcers, 52% had gangrene. They remained hospitalized an average of 14 days, and the length of hospital stay varied from 3 to 50 days. Of the amputations performed, 30% involved the thigh, 30% toes, 27.50% upper third of the leg, 5% transmetatarsal region, 5% knee disarticulation and 2.5% calcaneus bone. The increase in amputations is cause for concern for the quality of life of these patients, considering the physical and psychological impact that amputation has on the individual. Furthermore, higher government and institutional costs will be required to assist the health needs of these patients. It was concluded that prevention is the best alternative to reduce this amputation rate and improve the quality of life of diabetics.

  10. Diagnostic accuracy of the neurological upper limb examination II: Relation to symptoms of patterns of findings

    Directory of Open Access Journals (Sweden)

    Kreiner Svend

    2006-02-01

    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

  11. Postoperative Massive Pulmonary Embolism Due to Superficial Vein Thrombosis of the Upper Limb

    Science.gov (United States)

    Cascella, Marco; Viscardi, Daniela; Bifulco, Francesca; Cuomo, Arturo

    2016-01-01

    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

  12. Predictive Value of Upper Limb Muscles and Grasp Patterns on Functional Outcome in Cervical Spinal Cord Injury.

    Science.gov (United States)

    Velstra, Inge-Marie; Bolliger, Marc; Krebs, Jörg; Rietman, Johan S; Curt, Armin

    2016-05-01

    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

  13. Multibody system of the upper limb including a reverse shoulder prosthesis.

    Science.gov (United States)

    Quental, C; Folgado, J; Ambrósio, J; Monteiro, J

    2013-11-01

    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

  14. Home-based neurologic music therapy for upper limb rehabilitation with stroke patients at community rehabilitation stage—a feasibility study protocol

    OpenAIRE

    Alex J Street; Magee, Wendy L.; Helen eOdell-Miller; Andrew eBateman; Jörg Christfried Fachner

    2015-01-01

    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...

  15. Differential diagnosis of a rare case of upper limb pain: Paget-Schroetter syndrome in a doner kebab chef

    OpenAIRE

    Aytekin, Ebru; Dogan, Yasemin Pekin; Okur, Sibel Caglar; Burnaz, Ozer; Caglar, Nil Sayiner

    2015-01-01

    [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...

  16. Differences in myoelectric and body-powered upper-limb prostheses: Systematic literature review

    Directory of Open Access Journals (Sweden)

    Stephanie L. Carey, PhD

    2015-06-01

    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.

  17. Differences in myoelectric and body-powered upper-limb prostheses: Systematic literature review.

    Science.gov (United States)

    Carey, Stephanie L; Lura, Derek J; Highsmith, M Jason

    2015-01-01

    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

  18. Comparison of TMS-induced arm activation and upper limb functional tests in hemiparetic stroke

    Directory of Open Access Journals (Sweden)

    Tarkka Ina M.

    2013-01-01

    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 [1]. 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.

  19. Support of the upper limbs of office workers during a daily work journey.

    Science.gov (United States)

    Filgueiras, Ernesto; Rebelo, Francisco; da Silva, Moreira

    2012-01-01

    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 [1] 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

  20. Differences in Maximum Upper and Lower Limb Strength in Older Adults After a 12 Week Intense Resistance Training Program

    OpenAIRE

    Sousa, Nelson; Mendes, Romeu; Abrantes, Catarina; Sampaio, Jaime

    2011-01-01

    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...

  1. Amputations in Sickle Cell Disease: Case Series and Literature Review.

    Science.gov (United States)

    Maximo, Claudia; Olalla Saad, Sara T; Thome, Eleonora; Queiroz, Ana Maria Mach; Lobo, Clarisse; Ballas, Samir K

    2016-06-01

    In this study, we describe four new patients with sickle cell disease who had limb amputations. Two of the patients had sickle cell anemia [Hb S (HBB: c.20A > T) (β(S)/β(S))] with refractory leg ulcers that required amputations. The third patient had sickle cell trait with an extensive leg ulcer that was associated with epidermoid carcinoma. The fourth patient had amputations of both forearms and feet due to a misdiagnosis of dactylitis. Review of the literature showed that the indications for amputations in sickle cell disease included three distinct categories: mythical beliefs, therapeutic and malpractice. All therapeutic amputations were for severely painful, large, recalcitrant leg ulcers that failed non-interventional therapies. Amputation resulted in pain relief and better quality of life. Phantom neuropathic pain was not a major issue post-operatively. It was absent, transient or well controlled with antidepressants. Limb function was restored post-amputation with prosthetic artificial limbs, wheelchairs or crutches. Malpractice amputations were due to misdiagnosis or to cryotherapy by exposing the painful limb to ice water resulting in thrombosis, gangrene and amputation. We strongly suggest that leg amputations should be considered in the management of certain patients with severe extensive refractory leg ulcers, and topical cryotherapy should never be used to manage sickle cell pain. PMID:27117565

  2. Diffuse venous malformations of the upper limb: morphologic characterization by MRI and venography

    International Nuclear Information System (INIS)

    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.)

  3. Relationships between power and strength of the upper and lower limb muscles and throwing velocity in male handball players.

    Science.gov (United States)

    Chelly, Mohamed Souhaiel; Hermassi, Souhail; Shephard, Roy J

    2010-06-01

    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

  4. Gesture therapy: an upper limb virtual reality-based motor rehabilitation platform.

    Science.gov (United States)

    Sucar, Luis Enrique; Orihuela-Espina, Felipe; Velazquez, Roger Luis; Reinkensmeyer, David J; Leder, Ronald; Hernández-Franco, Jorge

    2014-05-01

    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

  5. Stewart-Treves syndrome: MR imaging of a postmastectomy upper-limb chronic lymphedema with angiosarcoma

    Energy Technology Data Exchange (ETDEWEB)

    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)

    2005-03-01

    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.)

  6. Prevention of upper limb symptoms and signs of nerve afflictions in computer operators

    DEFF Research Database (Denmark)

    Riis Jepsen, Jørgen; Thomsen, Gert

    2008-01-01

    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...

  7. A Pre-Clinical Framework for Neural Control of a Therapeutic Upper-Limb Exoskeleton

    OpenAIRE

    Blank, Amy; O’Malley, Marcia K.; Francisco, Gerard E.; Contreras-Vidal, Jose L.

    2013-01-01

    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...

  8. Foot amputation - discharge

    Science.gov (United States)

    Amputation - foot - discharge; Trans-metatarsal amputation - discharge ... You have had a foot amputation. You may have had an accident, or your foot may have had an infection or disease and doctors could ...

  9. [Unidimensionality of a functional measure for patient with an injured upper limb].

    Science.gov (United States)

    Luquet, C; Chau, N; Nadif, M; Guillemin, F; Gavillot, C; Petry, D; Moreau, T; Bourgkard, E; Hecquet, B; André, J M; Mur, J M

    1996-06-01

    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

  10. Evaluation of inter-rater reliability of subjective and objective criteria for diagnosis of lymphedema in upper and lower limbs

    Directory of Open Access Journals (Sweden)

    Larissa Louise Campanholi

    2015-03-01

    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.

  11. Rehabilitation After Surgical Reconstruction to Restore Function to the Upper Limb in Tetraplegia: A Changing Landscape

    Science.gov (United States)

    Johanson, M. Elise

    2016-01-01

    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

  12. Electromyography-based analysis of human upper limbs during 45-day head-down bed-rest

    Science.gov (United States)

    Fu, Anshuang; Wang, Chunhui; Qi, Hongzhi; Li, Fan; Wang, Zheng; He, Feng; Zhou, Peng; Chen, Shanguang; Ming, Dong

    2016-03-01

    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.

  13. Design of a rotational hydroelastic actuator for a powered exoskeleton for upper limb rehabilitation.

    Science.gov (United States)

    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

    2010-03-01

    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

  14. Power hand tool kinetics associated with upper limb injuries in an automobile assembly plant.

    Science.gov (United States)

    Ku, Chia-Hua; Radwin, Robert G; Karsh, Ben-Tzion

    2007-06-01

    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

  15. Bilateral robots for upper-limb stroke rehabilitation: State of the art and future prospects.

    Science.gov (United States)

    Sheng, Bo; Zhang, Yanxin; Meng, Wei; Deng, Chao; Xie, Shengquan

    2016-07-01

    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

  16. A Serious Game for Upper Limb Stroke Rehabilitation Using Biofeedback and Mirror-Neurons Based Training.

    Science.gov (United States)

    Cargnin, Diego João; Cordeiro d'Ornellas, Marcos; Cervi Prado, Ana Lúcia

    2015-01-01

    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

  17. Inadvertent recovery in communication deficits following the upper limb mirror therapy in stroke: A case report.

    Science.gov (United States)

    Arya, Kamal Narayan; Pandian, Shanta

    2014-10-01

    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

  18. Midazolam with Bupivacaine for Improving Analgesia Quality in Brachial Plexus Block for Upper Limb Surgeries

    International Nuclear Information System (INIS)

    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)

  19. COMPARISON OF MOTOR AND SENSORY NERVE CONDUCTION IN UPPER LIMB OF DIABETICS AND NON DIABETICS

    Directory of Open Access Journals (Sweden)

    Ajay

    2015-01-01

    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.

  20. Muscle fatigue evaluation of astronaut upper limb based on sEMG and subjective assessment

    Science.gov (United States)

    Zu, Xiaoqi; Zhou, Qianxiang; Li, Yun

    2012-07-01

    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.

  1. Posture-movement responses to stance perturbations and upper limb fatigue during a repetitive pointing task.

    Science.gov (United States)

    Fuller, Jason R; Fung, Joyce; Côté, Julie N

    2013-08-01

    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

  2. Duplex correlation phlebography in venous mapping of the upper limbs for artery venous fistulas for hemodialysis

    International Nuclear Information System (INIS)

    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

  3. Critical analysis of musculoskeletal modelling complexity in multibody biomechanical models of the upper limb.

    Science.gov (United States)

    Quental, Carlos; Folgado, João; Ambrósio, Jorge; Monteiro, Jacinto

    2015-01-01

    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

  4. A Pre-Clinical Framework for Neural Control of a Therapeutic Upper-Limb Exoskeleton.

    Science.gov (United States)

    Blank, Amy; O'Malley, Marcia K; Francisco, Gerard E; Contreras-Vidal, Jose L

    2013-01-01

    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

  5. Robotic unilateral and bilateral upper-limb movement training for stroke survivors afflicted by chronic hemiparesis.

    Science.gov (United States)

    Simkins, Matt; Kim, Hyuchul; Abrams, Gary; Byl, Nancy; Rosen, Jacob

    2013-06-01

    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

  6. Occupational musculoskeletal disorders in the neck and upper limbs of forestry workers exposed to hand-arm vibration.

    Science.gov (United States)

    Bovenzi, M; Zadini, A; Franzinelli, A; Borgogni, F

    1991-05-01

    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

  7. Upper limb joint motion of two different user groups during manual wheelchair propulsion

    Science.gov (United States)

    Hwang, Seonhong; Kim, Seunghyeon; Son, Jongsang; Lee, Jinbok; Kim, Youngho

    2013-02-01

    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.

  8. WORK RELATED MUSCULOSKELETAL DISORDERS OF THE UPPER LIMBS AMONG STEEL INDUSTRY POPULATIONS

    Directory of Open Access Journals (Sweden)

    S. A. Moussavi-Najarkola A. Khavanin

    2007-08-01

    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.

  9. Detecting Elementary Arm Movements by Tracking Upper Limb Joint Angles With MARG Sensors.

    Science.gov (United States)

    Mazomenos, Evangelos B; Biswas, Dwaipayan; Cranny, Andy; Rajan, Amal; Maharatna, Koushik; Achner, Josy; Klemke, Jasmin; Jobges, Michael; Ortmann, Steffen; Langendorfer, Peter

    2016-07-01

    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

  10. Prosthetics / Amputations

    Science.gov (United States)

    PrOstHetics/liMb lOss VA researchers are exploring the use of leading-edge technology such as robotics, tissue engineering, and nanotechnology ... prosthetic components to the needs of Veterans with limb loss—especially those who seek to maintain an active ...

  11. Endovascular diagnostics and treatment of stenosis, acute thrombosis and chronic occlusion of arteries and upper limbs

    International Nuclear Information System (INIS)

    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

  12. Cognitive-emotional sensitization contributes to wind-up-like pain in phantom limb pain patients

    DEFF Research Database (Denmark)

    Vase, Lene; Nikolajsen, Lone; Christensen, Bente;

    2011-01-01

    Peripheral mechanisms are known to play a role in phantom pain following limb amputation, and more recently it has been suggested that central mechanisms may also be of importance. Some patients seem to have a psychological sensitivity that predisposes them to react with pain catastrophizing after...... amputation of a limb, and this coping style may contribute to increased facilitation, impaired modulation of nociceptive signals, or both. To investigate how pain catastrophizing, independently of anxiety and depression, may contribute to phantom limb pain and to alterations in pain processing twenty......-four upper-limb amputees with various levels of phantom limb pain were included in the study. Patients' level of pain catastrophizing, anxiety and depression was assessed and they went through quantitative sensory testing (QST) of thresholds (mechanical and thermal) and wind-up-like pain (brush and pinprick...

  13. Detecting the Intention to Move Upper Limbs from Electroencephalographic Brain Signals

    Directory of Open Access Journals (Sweden)

    Berenice Gudiño-Mendoza

    2016-01-01

    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.

  14. Control system design for electrical stimulation in upper limb rehabilitation modelling, identification and robust performance

    CERN Document Server

    Freeman, Chris

    2016-01-01

    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...

  15. Technical guide to evaluate upper limb joints (shoulder, elbow and wrist) by ultrasound

    International Nuclear Information System (INIS)

    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

  16. EEG controlled neuromuscular electrical stimulation of the upper limb for stroke patients

    Science.gov (United States)

    Tan, Hock Guan; Shee, Cheng Yap; Kong, Keng He; Guan, Cuntai; Ang, Wei Tech

    2011-03-01

    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.

  17. Development of Quasi-3DOF upper limb rehabilitation system using ER brake: PLEMO-P1

    International Nuclear Information System (INIS)

    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.

  18. Neuromuscular Activity of Upper and Lower Limbs during two Backstroke Swimming Start Variants

    Science.gov (United States)

    De Jesus, Karla; De Jesus, Kelly; Medeiros, Alexandre I. A.; Gonçalves, Pedro; Figueiredo, Pedro; Fernandes, Ricardo J.; Vilas-Boas, João Paulo

    2015-01-01

    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

  19. Benchmarking of dynamic simulation predictions in two software platforms using an upper limb musculoskeletal model.

    Science.gov (United States)

    Saul, Katherine R; Hu, Xiao; Goehler, Craig M; Vidt, Meghan E; Daly, Melissa; Velisar, Anca; Murray, Wendy M

    2015-01-01

    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

  20. Effect of two contrasting interventions on upper limb chronic pain and disability

    DEFF Research Database (Denmark)

    Sundstrup, Emil; Jakobsen, Markus D; Andersen, Christoffer H;

    2014-01-01

    (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...

  1. Effect of two contrasting interventions on upper limb chronic pain and disability

    DEFF Research Database (Denmark)

    Sundstrup, Emil; Jakobsen, Markus D; Andersen, Christoffer H;

    2014-01-01

    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...

  2. Effect of muscular fatigue on fractal upper limb coordination dynamics and muscle synergies.

    Science.gov (United States)

    Bueno, Diana R; Lizano, J M; Montano, L

    2015-08-01

    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

  3. Characteristics of upper limb muscular strength in male wheelchair tennis players

    Science.gov (United States)

    Moon, Hyo-Bin; Park, Seung-Jae; Kim, Al-Chan; Jang, Jee-Hun

    2013-01-01

    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

  4. Design of a Workstation for People with Upper-Limb Disabilities Using a Brain Computer Interface

    Directory of Open Access Journals (Sweden)

    John E. Muñoz-Cardona

    2013-11-01

    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.

  5. Neuromuscular Activity of Upper and Lower Limbs during two Backstroke Swimming Start Variants.

    Science.gov (United States)

    De Jesus, Karla; De Jesus, Kelly; Medeiros, Alexandre I A; Gonçalves, Pedro; Figueiredo, Pedro; Fernandes, Ricardo J; Vilas-Boas, João Paulo

    2015-09-01

    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

  6. Positive effects of robotic exoskeleton training of upper limb reaching movements after stroke.

    Science.gov (United States)

    Frisoli, Antonio; Procopio, Caterina; Chisari, Carmelo; Creatini, Ilaria; Bonfiglio, Luca; Bergamasco, Massimo; Rossi, Bruno; Carboncini, Maria Chiara

    2012-01-01

    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

  7. Positive effects of robotic exoskeleton training of upper limb reaching movements after stroke

    Directory of Open Access Journals (Sweden)

    Frisoli Antonio

    2012-06-01

    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

  8. Study on 3D printer production of auxiliary device for upper limb for medical imaging test

    Energy Technology Data Exchange (ETDEWEB)

    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)

    2015-12-15

    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.

  9. Lesões do membro superior no esporte Sports injuries of the upper limb

    Directory of Open Access Journals (Sweden)

    Rogerio Teixeira da Silva

    2010-01-01

    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.

  10. Upper Limb Static-Stretching Protocol Decreases Maximal Concentric Jump Performance

    Directory of Open Access Journals (Sweden)

    Paulo H. Marchetti

    2014-12-01

    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.

  11. NORMATIVE DATA OF UPPER LIMB NERVE CONDUCTION IN YOUNG POPULATION IN AND AROUND BARPETA TOWN, ASSAM

    Directory of Open Access Journals (Sweden)

    Dipti

    2015-12-01

    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.

  12. Neuromuscular Activity of Upper and Lower Limbs during two Backstroke Swimming Start Variants

    Directory of Open Access Journals (Sweden)

    Karla De Jesus, Kelly De Jesus, Alexandre I. A. Medeiros, Pedro Gonçalves, Pedro Figueiredo, Ricardo J. Fernandes, João Paulo Vilas-Boas

    2015-09-01

    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.

  13. Modulation of the Cutaneous Silent Period in the Upper-Limb with Whole-Body Instability

    Science.gov (United States)

    Eckert, Nathanial R.; Poston, Brach; Riley, Zachary A.

    2016-01-01

    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

  14. Amputation of extremity in patients with atherosclerotic gangrene

    Directory of Open Access Journals (Sweden)

    Tsareva Yu.O.

    2011-12-01

    Full Text Available Aim of investigation — to analyze the results of treatment of patients with atherosclerotic gangrene of a limb, to identify the causes of adverse outcomes amputation. Materials and methods: We analyzed the results of examination and treatment of 218 patients with atherosclerotic gangrene of the limb. Good outcome of amputation was considered the primary surgical wound healing of the stump. Suppuration, secondary healing, re-amputation and death we attributed to the adverse results of amputation. Results: The adverse outcomes of amputation due to technical errors in surgery, properly chosen level, inadequate drainage of the wound stump, an unsuccessful operation on the arteries of a limb, inadequate empirical antibiotic therapy, patient's age, functional capabilities of myocardium, the duration of critical ischemia, as well as the lack of psychological adaptation of patients before amputation. Conclusion: To decide the need for amputation in patients with atherosclerotic gangrene follows the assessment of possible vascular reconstructive surgery. In determining the level of amputation is necessary to objectively assess the degree of disruption of regional blood flow using multilevel manometry and laser Dopplerflowmetry. In preparation for amputation should be paid special attention to the correction of rheological and coagulation properties of blood, normalization of the functional state of the myocardium, as well as specialized psychotherapeutic training for timely and adequate psychological adaptation of the patient

  15. Sports Adaptations for Unilateral and Bilateral Upper-Limb Amputees: Archery/Badminton/Baseball/Softball/Bowling/Golf/Table Tennis.

    Science.gov (United States)

    Cowart, Jim

    1979-01-01

    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…

  16. Current status of robotic stroke rehabilitation and opportunities for a cyber-physically assisted upper limb stroke rehabilitation

    NARCIS (Netherlands)

    Li, C.; Rusak, Z.; Horvath, I.; Ji, L.; Hou, Y.

    2014-01-01

    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

  17. Amplitude Manipulation Evokes Upper Limb Freezing during Handwriting in Patients with Parkinson’s Disease with Freezing of Gait

    Science.gov (United States)

    Heremans, Elke; Nackaerts, Evelien; Vervoort, Griet; Vercruysse, Sarah; Broeder, Sanne; Strouwen, Carolien; Swinnen, Stephan P.; Nieuwboer, Alice

    2015-01-01

    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

  18. Differential diagnosis of a rare case of upper limb pain: Paget-Schroetter syndrome in a doner kebab chef

    Science.gov (United States)

    Aytekin, Ebru; Dogan, Yasemin Pekin; Okur, Sibel Caglar; Burnaz, Ozer; Caglar, Nil Sayiner

    2015-01-01

    [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

  19. Caracterização dos portadores de diabetes submetidos à amputação de membros inferiores em Londrina, Estado do Paraná - doi: 10.4025/actascihealthsci.v32i2.7754 Characterization of diabetic patients submitted to lower limb amputation in Londrina, Paraná State - doi: 10.4025/actascihealthsci.v32i2.7754

    Directory of Open Access Journals (Sweden)

    Maria do Carmo Lourenço Haddad

    2010-09-01

    % of patients had diabetic neuropathy, 93% had lower limb ulcers, 52% had gangrene. They remained hospitalized an average of 14 days, and the length of hospital stay varied from 3 to 50 days. Of the amputations performed, 30% involved the thigh, 30% toes, 27.50% upper third of the leg, 5% transmetatarsal region, 5% knee disarticulation and 2.5% calcaneus bone. The increase in amputations is cause for concern for the quality of life of these patients, considering the physical and psychological impact that amputation has on the individual. Furthermore, higher government and institutional costs will be required to assist the health needs of these patients. It was concluded that prevention is the best alternative to reduce this amputation rate and improve the quality of life of diabetics.

  20. Bihemispheric repetitive transcranial magnetic stimulation combined with intensive occupational therapy for upper limb hemiparesis after stroke: a preliminary study.

    Science.gov (United States)

    Yamada, Naoki; Kakuda, Wataru; Kondo, Takahiro; Shimizu, Masato; Mitani, Sugao; Abo, Masahiro

    2013-12-01

    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

  1. The Armeo Spring as training tool to improve upper limb functionality in multiple sclerosis: a pilot study

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    Kerkhofs Lore

    2011-01-01

    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.

  2. PSYCHIATRIC SEQUELAE OF AMPUTATION : I IMMEDIATE EFFECTS

    OpenAIRE

    Mall, C.P.; Trivedi, J.K.; U.S. Mishra; Sharma, V. P.; Dalal, P.K.; Katiyar, M.; Srivastava, Shrikant; Sinha, P.K.

    1997-01-01

    Twenty-five subjects, who had undergone amputation within last 6 weeks, were studied for psychiatric complications, including phantom limb phenomena. The patients were interviewed on SCID, HRSD and HARS. Out of a total of 25 subjects, 8 (34.6%) developed psychiatric disorders - PTSD and major depression. The whole sample was thus divided into 2 groups-sick and nonsick. Phantom limb was seen in 88% subjects. No significant difference was present between the two groups with regard to presence o...

  3. Upper Limb Kinematics Using Inertial and Magnetic Sensors: Comparison of Sensor-to-Segment Calibrations

    Directory of Open Access Journals (Sweden)

    Brice Bouvier

    2015-07-01

    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.

  4. Exoskeleton Technology in Rehabilitation: Towards an EMG-Based Orthosis System for Upper Limb Neuromotor Rehabilitation

    Directory of Open Access Journals (Sweden)

    Luis Manuel Vaca Benitez

    2013-01-01

    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.

  5. Usability testing of gaming and social media applications for stroke and cerebral palsy upper limb rehabilitation.

    Science.gov (United States)

    Valdés, Bulmaro A; Hilderman, Courtney G E; Hung, Chai-Ting; Shirzad, Navid; Van der Loos, H F Machiel

    2014-01-01

    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

  6. Study on development of active-passive rehabilitation system for upper limbs: Hybrid-PLEMO

    International Nuclear Information System (INIS)

    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.

  7. Primary cutaneous diffuse large B-cell lymphoma of the upper limb: A fascinating entity

    Directory of Open Access Journals (Sweden)

    Manoj Madakshira Gopal

    2013-01-01

    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.

  8. Energy Harvesting from Upper-Limb Pulling Motions for Miniaturized Human-Powered Generators

    Directory of Open Access Journals (Sweden)

    Jeongjin Yeo

    2015-07-01

    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.

  9. Energy Harvesting from Upper-Limb Pulling Motions for Miniaturized Human-Powered Generators.

    Science.gov (United States)

    Yeo, Jeongjin; Ryu, Mun-ho; Yang, Yoonseok

    2015-01-01

    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. PMID:26151204

  10. Validating ArmAssist Assessment as outcome measure in upper-limb post-stroke telerehabilitation.

    Science.gov (United States)

    Rodriguez-de-Pablo, Cristina; Balasubramanian, Sivakumar; Savic, Andrej; Tomic, Tijana D; Konstantinovic, Ljubica; Keller, Thierry

    2015-08-01

    The ArmAssist is a low-cost robotic system for post-stroke upper-limb telerehabilitation based on serious games. The system incorporates a set of games for the assessment of arm function, the ArmAssist Assessment (AAA), which allows a remote monitoring of the progress of the patient and an automatic adaptation of the therapy. In this study, different components of the AAA are compared against three widely-used clinical tests, the Fugl-Meyer Assessment (FMA) [1], the Action Research Arm Test (ARAT) [2] and the Wolf Motor Function Test (WMFT) [3] in order to select the most clinically meaningful ones for the final score provided to patients and therapist, and evaluate their capability to predict or even improve some aspects of these standard scales. All four tests were performed in 38 separate sessions in 19 post-stroke individuals in their sub-acute phase, as part of a broader study. Statistically significant correlation could be shown with the three clinical tests. These preliminary results are promising for the validation of AAA as a fast, automatic and clinically meaningful tool for remote progress assessment and therapy adaptation; however, more data and further analysis is needed to confirm this. PMID:26737324

  11. Admittance-based Upper Limb Robotic Active and Active-assistive Movements

    Directory of Open Access Journals (Sweden)

    Cristóbal Ochoa Luna

    2015-09-01

    Full Text Available This paper presents two rehabilitation schemes for patients with upper limb impairments. The first is an active-assistive scheme based on the trajectory tracking of predefined paths in Cartesian space. In it, the system allows for an adjustable degree of variation with respect to ideal tracking. The amount of variation is determined through an admittance function that depends on the opposition forces exerted on the system by the user, due to possible impairments. The coefficients of the function allow the adjustment of the degree of assistance the robot will provide in order to complete the target trajectory. The second scheme corresponds to active movements in a constrained space. Here, the same admittance function is applied; however, in this case, it is unattached to a predefined trajectory and instead connected to one generated in real time, according to the user’s intended movements. This allows the user to move freely with the robot in order to track a given path. The free movement is bounded through the use of virtual walls that do not allow users to exceed certain limits. A human-machine interface was developed to guide the robot’s user.

  12. Computationally Efficient Modelling of Proprioceptive Signals in the Upper Limb for Prostheses: a Simulation Study

    Directory of Open Access Journals (Sweden)

    Ian eWilliams

    2014-06-01

    Full Text Available Accurate models of proprioceptive neural patterns could one day play an important role in the creation of an intuitive proprioceptive neural prosthesis for amputees. This paper looks at combining efficient implementations of biomechanical and proprioceptor models in order to generate signals that mimic human muscular proprioceptive patterns for future experimental work in prosthesis feedback. A neuro-musculoskeletal model of the upper limb with 7 degrees of freedom and 17 muscles is presented and generates real time estimates of muscle spindle and Golgi Tendon Organ neural firing patterns. Unlike previous neuro-musculoskeletal models, muscle activation and excitation levels are unknowns in this application and an inverse dynamics tool (static optimisation is integrated to estimate these variables. A proprioceptive prosthesis will need to be portable and this is incompatible with the computationally demanding nature of standard biomechanical and proprioceptor modelling. This paper uses and proposes a number of approximations and optimisations to make real time operation on portable hardware feasible. Finally technical obstacles to mimicking natural feedback for an intuitive proprioceptive prosthesis, as well as issues and limitations with existing models, are identified and discussed.

  13. Two-dimensional myoelectric control of a robotic arm for upper limb amputees

    Science.gov (United States)

    López Celani, Natalia M.; Soria, Carlos M.; Orosco, Eugenio C.; di Sciascio, Fernando A.; Valentinuzzi, Max E.

    2007-11-01

    Rehabilitation engineering and medicine have become integral and significant parts of health care services, particularly and unfortunately in the last three or four decades, because of wars, terrorism and large number of car accidents. Amputees show a high rate of rejection to wear prosthetic devices, often because of lack of an adequate period of adaptation. A robotic arm may appear as a good preliminary stage. To test the hypothesis, myoelectric signals from two upper limb amputees and from four normal volunteers were fed, via adequate electronic conditioning and using MATLAB, to an industrial robotic arm. Proportional strength control was used for two degrees of freedom (x-y plane) by means of eight signal features of control (four traditional statistics plus energy, integral of the absolute value, Willison's amplitude, waveform length and envelope) for comparison purposes, and selecting the best of them as final reference. Patients easily accepted the system and learned in short time how to operate it. Results were encouraging so that valuable training, before prosthesis is implanted, appears as good feedback; besides, these patients can be hired as specialized operators in semi-automatized industry.

  14. Two-dimensional myoelectric control of a robotic arm for upper limb amputees

    International Nuclear Information System (INIS)

    Rehabilitation engineering and medicine have become integral and significant parts of health care services, particularly and unfortunately in the last three or four decades, because of wars, terrorism and large number of car accidents. Amputees show a high rate of rejection to wear prosthetic devices, often because of lack of an adequate period of adaptation. A robotic arm may appear as a good preliminary stage. To test the hypothesis, myoelectric signals from two upper limb amputees and from four normal volunteers were fed, via adequate electronic conditioning and using MATLAB, to an industrial robotic arm. Proportional strength control was used for two degrees of freedom (x-y plane) by means of eight signal features of control (four traditional statistics plus energy, integral of the absolute value, Willison's amplitude, waveform length and envelope) for comparison purposes, and selecting the best of them as final reference. Patients easily accepted the system and learned in short time how to operate it. Results were encouraging so that valuable training, before prosthesis is implanted, appears as good feedback; besides, these patients can be hired as specialized operators in semi-automatized industry

  15. Motor Cortex Representation of the Upper-Limb in Individuals Born without a Hand

    OpenAIRE

    Reilly, Karen T; Sirigu, Angela

    2011-01-01

    The body schema is an action-related representation of the body that arises from activity in a network of multiple brain areas. While it was initially thought that the body schema developed with experience, the existence of phantom limbs in individuals born without a limb (amelics) led to the suggestion that it was innate. The problem with this idea, however, is that the vast majority of amelics do not report the presence of a phantom limb. Transcranial magnetic stimulation (TMS) applied over...

  16. Cost-Effectiveness of Treating Upper Limb Spasticity Due to Stroke with Botulinum Toxin Type A: Results from the Botulinum Toxin for the Upper Limb after Stroke (BoTULS Trial

    Directory of Open Access Journals (Sweden)

    Nick Steen

    2012-11-01

    Full Text Available Stroke imposes significant burdens on health services and society, and as such there is a growing need to assess the cost-effectiveness of stroke treatment to ensure maximum benefit is derived from limited resources. This study compared the cost-effectiveness of treating post-stroke upper limb spasticity with botulinum toxin type A plus an upper limb therapy programme against the therapy programme alone. Data on resource use and health outcomes were prospectively collected for 333 patients with post-stroke upper limb spasticity taking part in a randomized trial and combined to estimate the incremental cost per quality adjusted life year (QALY gained of botulinum toxin type A plus therapy relative to therapy alone. The base case incremental cost-effectiveness ratio (ICER of botulinum toxin type A plus therapy was £93,500 per QALY gained. The probability of botulinum toxin type A plus therapy being cost-effective at the England and Wales cost-effectiveness threshold value of £20,000 per QALY was 0.36. The point estimates of the ICER remained above £20,000 per QALY for a range of sensitivity analyses, and the probability of botulinum toxin type A plus therapy being cost-effective at the threshold value did not exceed 0.39, regardless of the assumptions made.

  17. Combined transcranial direct current stimulation and homebased occupational therapy of upper limb motor impairment following intracerebral hemorrhage

    DEFF Research Database (Denmark)

    Mortensen, Jesper; Figlewski, Krystian; Andersen, Henning

    2016-01-01

    Purpose: To investigate the combined effect of transcranial direct current stimulation (tDCS) andhome-based occupational therapy on activities of daily living (ADL) and grip strength, inpatients with upper limb motor impairment following intracerebral hemorrhage (ICH). Methods:A double......-blind randomized controlled trial with one-week follow-up. Patients received fiveconsecutive days of occupational therapy at home, combined with either anodal (n ¼ 8) orsham (n ¼ 7) tDCS. The primary outcome was ADL performance, which was assessed with theJebsen–Taylor test (JTT). Results: Both groups improved JTT...... group, from baseline to post-assessment (p ¼ 0.158). Conclusions: Fiveconsecutive days of tDCS combined with occupational therapy provided greater improvementsin grip strength compared with occupational therapy alone. tDCS is a promising add-onintervention regarding training of upper limb motor...

  18. Investigation of Risk Factors of Work-Related Upper-Limb Musculoskeletal Disorders in a Pharmaceutical Industry or Research Article

    Science.gov (United States)

    Pourmahabadian, Mohammad; Akhavan, Mehdi; Azam, Kamal

    This study was performed among workers of an Iranian pharmaceutical industry with the aiming to determine WRMDs prevalence and exposure assessment of WRMDs risks. In this cross-sectional study, 84 female and male workers randomly selected from five packing operations. Modified Nordic Musculoskeletal Questionnaire (NMQ) was applied to study the prevalence of WRMDs and Rapid Upper Limb Assessment (RULA) method was used for the evaluation of the exposure to risk factors associated with work-related upper limb disorders. Results showed a significant association exists between neck, lower arm and A scores group with those obtained by self-reported pain (pworkers in five packing operations. Also, the results of this study revealed that RULA method is a fairly suitable tool for the evaluation of WRMDs among packing workers in pharmaceutical industry.

  19. On the use of information theory for detecting upper limb motor dysfunction: An application to Parkinson’s disease

    Science.gov (United States)

    de Oliveira, M. Elias; Menegaldo, L. L.; Lucarelli, P.; Andrade, B. L. B.; Büchler, P.

    2011-11-01

    Parkinson’s disease (PD) is a chronic neurodegenerative disorder characterized by a selective loss of dopaminergic neurons in the substantia nigra, decreased striatal dopamine levels, and consequent extrapyramidal motor dysfunctions. Several potential early diagnostic markers of PD have been proposed. Since they have not been validated in presymptomatic PD, the diagnosis and monitoring of the disease is based on subjective clinical assessment of cognitive and motor symptoms. In this study, we investigated interjoint coordination synergies in the upper limb of healthy and parkinsonian subjects during the performance of unconstrained linear-periodic movements in a horizontal plane using the mutual information (MI). We found that the MI is a sensitive metric in detecting upper limb motor dysfunction, thus suggesting that this method might be applicable to quantitatively evaluating the effects of the antiparkinsonian medication and to monitor the disease progression.

  20. Continuous theta-burst stimulation combined with occupational therapy for upper limb hemiparesis after stroke: a preliminary study.

    Science.gov (United States)

    Yamada, Naoki; Kakuda, Wataru; Kondo, Takahiro; Shimizu, Masato; Sageshima, Masashi; Mitani, Sugao; Abo, Masahiro

    2014-12-01

    The purpose of this study was to assess the safety, feasibility and efficacy of continuous theta-burst stimulation (cTBS) combined with intensive occupational therapy (OT) for upper limb hemiparesis after stroke. Ten patients with history of stroke and upper limb hemiparesis (age 62.0 ± 11.1 years, time since stroke 95.7 ± 70.2 months, mean ± SD) were studied. Each patient received 13 sessions, each comprising 160 s of cTBS applied to the skull on the area of the non-lesional hemisphere (using a 70-mm figure-8 coil, three pulse bursts at 50 Hz, repeated every 200 ms, i.e., 5 Hz, with total stimulation of 2,400 pulses), followed by intensive OT (comprising 120-min one-to-one training and 120-min self-training) during 15-day hospitalization. The motor function of the affected upper limb was evaluated by Fugl-Meyer Assessment (FMA) and Wolf Motor Function Test (WMFT) on the days of admission and discharge. All patients completed the 15-day protocol without any adverse effects. Treatment significantly increased the FMA score (from 46.6 ± 8.7 to 51.6 ± 8.2 points, p < 0.01) and shortened the log performance time of WMFT (from 2.5 ± 1.1 to 2.2 ± 1.2 s, p < 0.01). The 15-day protocol of cTBS combined with intensive OT is a safe and potentially useful therapeutic modality for upper limb hemiparesis after stroke. PMID:24696408

  1. PHYSICAL WORKLOAD AS A RISK FACTOR FOR SYMPTOMS IN THE NECK AND UPPER LIMBS: EXPOSURE ASSESSMENT AND ERGONOMIC INTERVENTION

    OpenAIRE

    Ritva Ketola

    2004-01-01

    The aims of this study were to investigate work related and individual factors as predictors of insident neck pain among video display unit (VDU) workers, to assess the effects of an ergonomic intervention and education on musculoskeletal symptoms, and to study the repeatability and validity of an expert assessment method of VDU workstation ergonomics. A method to assess the risk factors for upper limb disorders was developed, and its validity and repeatability were studied. The annual inc...

  2. Upper body and lower limbs musculoskeletal symptoms and health inequalities in Europe: an analysis of cross-sectional data

    OpenAIRE

    Montano, Diego

    2014-01-01

    Background Musculoskeletal disorders are the most frequent occupational diseases in Europe. However, their multifactorial aetiology poses several challenges concerning not only the estimation of relative prevalence rates across occupational groups but also how the co-occurrence of known risk factors might differ between disorders of the upper and lower limbs. Against this background, the following objectives are pursued: (1) to estimate the relative odds and prevalence rates of self-reported ...

  3. Upper limb children action-observation training (UP-CAT): a randomised controlled trial in Hemiplegic Cerebral Palsy

    OpenAIRE

    Biagi Laura; Guzzetta Andrea; Cossu Giuseppe; Ferrari Adriano; Sgandurra Giuseppina; Tosetti Michela; Fogassi Leonardo; Cioni Giovanni

    2011-01-01

    Abstract Background Rehabilitation for children with hemiplegic cerebral palsy (HCP) aimed to improve function of the impaired upper limb (UL) uses a wide range of intervention programs. A new rehabilitative approach, called Action-Observation Therapy, based on the recent discovery of mirror neurons, has been used in adult stroke but not in children. The purpose of the present study is to design a randomised controlled trial (RCT) for evaluating the efficacy of Action-Observation Therapy in i...

  4. Management of multijoint stiffness of bilateral upper limbs secondary to heterotopic ossification: Case report and literature review

    OpenAIRE

    Hong-wei Min, MD; Ke-min Liu, MD; Xin-zuo Han, MD; Rui Gu, MD

    2014-01-01

    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...

  5. High Intensity Physical Exercise and Pain in the Neck and Upper Limb among Slaughterhouse Workers: Cross-Sectional Study

    OpenAIRE

    2014-01-01

    Slaughterhouse work involves a high degree of repetitive and forceful upper limb movements and thus implies an elevated risk of work-related musculoskeletal disorders. High intensity strength training effectively rehabilitates musculoskeletal disorders among sedentary employees, but less is known about the effect among workers with repetitive and forceful work demands. Before performing randomized controlled trials it may be beneficial to assess the cross-sectional connection between exercise...

  6. Robot-assisted upper-limb therapy in acute rehabilitation setting following stroke: Department of Veterans Affairs multisite clinical trial

    OpenAIRE

    Charles G. Burgar, MD; Peter S. Lum, PhD; A. M. Erika Scremin, MD; Susan L. Garber, MA, OTR; H. F. Machiel Van der Loos, PhD; Deborah Kenney, MS, OTR; Peggy Shor, OTR

    2011-01-01

    This randomized, controlled, multisite Departmentof Veterans Affairs clinical trial assessed robot-assisted (RA)upper-limb therapy with the Mirror Image Movement Enabler(MIME) in the acute stroke rehabilitation setting. Hemipareticsubjects (n = 54) received RA therapy using MIME for either upto 15 hours (low-dose) or 30 hours (high-dose) or received up to15 hours of additional conventional therapy in addition to usualcare (control). The primary outcome measure was the Fugl-Meyer Assessment (F...

  7. An early warning surveillance programme for detecting upper limb deterioration after treatment for breast cancer: A novel technology supported system

    OpenAIRE

    Shamley, Delva; Robb, Karen

    2015-01-01

    Upper limb morbidity is a well-recognised consequence of treatment for breast cancer that can develop for up to 6 years after treatment. However, the capacity to fully integrate evidence-based rehabilitation pathways into routine care for all patients is questionable due to limited resources. A long term surveillance programme must therefore be accessible to all patients, should identify those at risk of developing morbidity and target the interventions at the high risk population of patients...

  8. Evaluation of Frequency and Risk Factors of Soft Tissue Rheumatism of Upper Limbs in Diabetic Patients in Kerman in 2001

    Directory of Open Access Journals (Sweden)

    M.R. Shakibi

    2003-10-01

    Full Text Available Diabetes mellitus is a metabolic disorder that affect different systems in human. Wide range of musculoskeletal syndromes have been described in association with diabetes. To determine the prevalence of upper limb soft tissue rheumatism in diabetes patients. In a cross sectional study 300 diabetic patients was examined by COPCORD questionnaire. The examination was performed by internist and rheumatologist . Data was analyzed by logistic regression. 73.3% of patients were female. Average age of cases was 51.2±13.7 years and mean of duration of disease was 7±6.4 years. 152 cases (50.7% had soft tissue rheumatism in upper limbs. 66 cases had carpal tannel syndrome, 23 cases with Dupuytren’s disease, 23 cases with Flexortenosynovitis, 91 cases with shoulder periarthritis, 4 cases had limited joint mobility and 12 had Elbow Epicandititis. Logestic regression analysis showed that type 2 diabetes, weak control of blood sugur and duration of disease>5years were risk factors for incidence of soft tissue rheumatism in upper limbs. Results have showed the high prevalence of soft tissue rheumatism in diabetic patients.

  9. Participant perceptions of use of CyWee Z as adjunct to rehabilitation of upper-limb function following stroke

    Directory of Open Access Journals (Sweden)

    Leigh A. Hale, PhD

    2012-06-01

    Full Text Available This article reports on the perceptions of 14 adults with chronic stroke who participated in a pilot study to determine the utility, acceptability, and potential efficacy of using an adapted CyWee Z handheld game controller to play a variety of computer games aimed at improving upper-limb function. Four qualitative in-depth interviews and two focus groups explored participant perceptions. Data were thematically analyzed with the general inductive approach. Participants enjoyed playing the computer games with the technology. The perceived benefits included improved upper-limb function, concentration, and balance; however, six participants reported shoulder and/or arm pain or discomfort, which presented while they were engaged in play but appeared to ease during rest. Participants suggested changes to the games and provided opinions on the use of computer games in rehabilitation. Using an adapted CyWee Z controller and computer games in upper-limb rehabilitation for people with chronic stroke is an acceptable and potentially beneficial adjunct to rehabilitation. The development of shoulder pain was a negative side effect for some participants and requires further investigation.

  10. Isotropy of an Upper Limb Exoskeleton and the Kinematics and Dynamics of the Human Arm

    Directory of Open Access Journals (Sweden)

    Joel C. Perry

    2009-01-01

    Full Text Available The integration of human and robot into a single system offers remarkable opportunities for a new generation of assistive technology. Despite the recent prominence of upper limb exoskeletons in assistive applications, the human arm kinematics and dynamics are usually described in single or multiple arm movements that are not associated with any concrete activity of daily living (ADL. Moreover, the design of an exoskeleton, which is physically linked to the human body, must have a workspace that matches as close as possible with the workspace of the human body, while at the same time avoid singular configurations of the exoskeleton within the human workspace. The aims of the research reported in this manuscript are (1 to study the kinematics and the dynamics of the human arm during daily activities in a free and unconstrained environment, (2 to study the manipulability (isotropy of a 7-degree-of-freedom (DOF-powered exoskeleton arm given the kinematics and the dynamics of the human arm in ADLs. Kinematic data of the upper limb were acquired with a motion capture system while performing 24 daily activities from six subjects. Utilising a 7-DOF model of the human arm, the equations of motion were used to calculate joint torques from measured kinematics. In addition, the exoskeleton isotropy was calculated and mapped with respect to the spacial distribution of the human arm configurations during the 24 daily activities. The results indicate that the kinematic joint distributions representing all 24 actions appear normally distributed except for elbow flexion–extension with the emergence of three modal centres. Velocity and acceleration components of joint torque distributions were normally distributed about 0 Nm, whereas gravitational component distributions varied with joint. Additionally, velocity effects were found to contribute only 1/100th of the total joint torque, whereas acceleration components contribute 1/10th of the total torque at the

  11. When does action comprehension need motor involvement? Evidence from upper limb aplasia.

    Science.gov (United States)

    Vannuscorps, Gilles; Andres, Michael; Pillon, Agnesa

    2013-01-01

    Motor theories of action comprehension claim that comprehending the meaning of an action performed by a conspecific relies on the perceiver's own motor representation of the same action. According to this view, whether an action belongs to the motor repertoire of the perceiver should impact the ease by which this action is comprehended. We tested this prediction by assessing the ability of an individual (D.C.) born without upper limbs to comprehend actions involving hands (e.g., throwing) or other body parts (e.g., jumping). The tests used a range of different visual stimuli differing in the kind of information provided. The results showed that D.C. was as accurate and fast as control participants in comprehending natural video and photographic presentations of both manual and nonmanual actions, as well as pantomimes. However, he was selectively impaired at identifying point-light animations of manual actions. This impairment was not due to a difficulty in processing kinematic information per se. D.C. was indeed as accurate as control participants in two additional tests requiring a fine-grained analysis of an actor's arm or whole-body movements. These results challenge motor theories of action comprehension by showing that the visual analysis of body shape and motion provides sufficient input for comprehending observed actions. However, when body shape information is sparsely available, motor involvement becomes critical to interpret observed actions. We suggest that, with natural human movement stimuli, motor representations contribute to action comprehension each time visual information is incomplete or ambiguous. PMID:24215324

  12. A study of computer-related upper limb discomfort and computer vision syndrome.

    Science.gov (United States)

    Sen, A; Richardson, Stanley

    2007-12-01

    Personal computers are one of the commonest office tools in Malaysia today. Their usage, even for three hours per day, leads to a health risk of developing Occupational Overuse Syndrome (OOS), Computer Vision Syndrome (CVS), low back pain, tension headaches and psychosocial stress. The study was conducted to investigate how a multiethnic society in Malaysia is coping with these problems that are increasing at a phenomenal rate in the west. This study investigated computer usage, awareness of ergonomic modifications of computer furniture and peripherals, symptoms of CVS and risk of developing OOS. A cross-sectional questionnaire study of 136 computer users was conducted on a sample population of university students and office staff. A 'Modified Rapid Upper Limb Assessment (RULA) for office work' technique was used for evaluation of OOS. The prevalence of CVS was surveyed incorporating a 10-point scoring system for each of its various symptoms. It was found that many were using standard keyboard and mouse without any ergonomic modifications. Around 50% of those with some low back pain did not have an adjustable backrest. Many users had higher RULA scores of the wrist and neck suggesting increased risk of developing OOS, which needed further intervention. Many (64%) were using refractive corrections and still had high scores of CVS commonly including eye fatigue, headache and burning sensation. The increase of CVS scores (suggesting more subjective symptoms) correlated with increase in computer usage spells. It was concluded that further onsite studies are needed, to follow up this survey to decrease the risks of developing CVS and OOS amongst young computer users. PMID:18572794

  13. Therapists’ Perceptions of Social Media and Video Game Technologies in Upper Limb Rehabilitation

    Science.gov (United States)

    Shirzad, Navid; Lohse, Keith R; Virji-Babul, Naznin; Hoens, Alison M; Holsti, Liisa; Li, Linda C; Miller, Kimberly J; Lam, Melanie Y; Van der Loos, HF Machiel

    2015-01-01

    Background The application of technologies, such as video gaming and social media for rehabilitation, is garnering interest in the medical field. However, little research has examined clinicians’ perspectives regarding technology adoption by their clients. Objective The objective of our study was to explore therapists’ perceptions of how young people and adults with hemiplegia use gaming and social media technologies in daily life and in rehabilitation, and to identify barriers to using these technologies in rehabilitation. Methods We conducted two focus groups comprised of ten occupational therapists/physiotherapists who provide neurorehabilitation to individuals with hemiplegia secondary to stroke or cerebral palsy. Data was analyzed using inductive thematic analysis. The diffusion of innovations theory provided a framework to interpret emerging themes. Results Therapists were using technology in a limited capacity. They identified barriers to using social media and gaming technology with their clients, including a lack of age appropriateness, privacy issues with social media, limited transfer of training, and a lack of accessibility of current systems. Therapists also questioned their role in the context of technology-based interventions. The opportunity for social interaction was perceived as a major benefit of integrated gaming and social media. Conclusions This study reveals the complexities associated with adopting new technologies in clinical practice, including the need to consider both client and clinician factors. Despite reporting several challenges with applying gaming and social media technology with clinical populations, therapists identified opportunities for increased social interactions and were willing to help shape the development of an upper limb training system that could more readily meet the needs of clients with hemiplegia. By considering the needs of both therapists and clients, technology developers may increase the likelihood that

  14. Cardiac autonomic modulation during progressive upper limb exercise by patients with coronary artery disease

    Directory of Open Access Journals (Sweden)

    H.G. Machado

    2011-12-01

    Full Text Available The purpose of this study was to investigate the behavior of heart rate (HR and HR variability (HRV during different loads of resistance exercise (incline bench press in patients with coronary artery disease (CAD and healthy sedentary controls. Ten healthy men (65 ± 1.2 years, control group, CG and 10 men with clinically stable CAD (66 ± 2.4 years, CADG were recruited. A discontinuous progressive protocol was applied with an initial load of 10% of the maximum load achieved in the 1RM (1 repetition maximum with increases of 10% until 30% 1RM was reached, which was followed by subsequent increases of 5% 1RM until exhaustion. HRV was analyzed by linear and non-linear methods. There was a significant reduction in rMSSD (CG: 20 ± 2 to 11 ± 3 ms; CADG: 19 ± 3 to 9 ± 1 ms and SD1 indexes (CG: 14 ± 2 to 8 ± 1 ms; CADG: 14 ± 2 to 7 ± 1 ms. An increase in HR (CG: 69 ± 5 to 90 ± 5 bpm; CADG: 62 ± 4 to 75 ± 4 bpm and in systolic blood pressure (CG: 124 ± 3 to 138 ± 3 mmHg; CADG: 122 ± 6 to 126 ± 9 bpm were observed (P < 0.05 when comparing pre-effort rest and 40% 1RM in both groups. Furthermore, an increase in RMSM index was also observed (CG: 28 ± 3 to 45 ± 9 ms; CADG: 22 ± 2 to 79 ± 33 ms, with higher values in CADG. We conclude that loads up to 30% 1RM during incline bench press result in depressed vagal modulation in both groups, although only stable CAD patients presented sympathetic overactivity at 20% 1RM upper limb exercise.

  15. Bradykinesia-akinesia incoordination test: validating an online keyboard test of upper limb function.

    Directory of Open Access Journals (Sweden)

    Alastair J Noyce

    Full Text Available The Bradykinesia Akinesia Incoordination (BRAIN test is a computer keyboard-tapping task that was developed for use in assessing the effect of symptomatic treatment on motor function in Parkinson's disease (PD. An online version has now been designed for use in a wider clinical context and the research setting.Validation of the online BRAIN test was undertaken in 58 patients with Parkinson's disease (PD and 93 age-matched, non-neurological controls. Kinesia scores (KS30, number of key taps in 30 seconds, akinesia times (AT30, mean dwell time on each key in milliseconds, incoordination scores (IS30, variance of travelling time between key presses and dysmetria scores (DS30, accuracy of key presses were compared between groups. These parameters were correlated against total motor scores and sub-scores from the Unified Parkinson's Disease Rating Scale (UPDRS.Mean KS30, AT30 and IS30 were significantly different between PD patients and controls (p≤0.0001. Sensitivity for 85% specificity was 50% for KS30, 40% for AT30 and 29% for IS30. KS30, AT30 and IS30 correlated significantly with UPDRS total motor scores (r = -0.53, r = 0.27 and r = 0.28 respectively and motor UPDRS sub-scores. The reliability of KS30, AT30 and DS30 was good on repeated testing.The BRAIN test is a reliable, convenient test of upper limb motor function that can be used routinely in the outpatient clinic, at home and in clinical trials. In addition, it can be used as an objective longitudinal measurement of emerging motor dysfunction for the prediction of PD in at-risk cohorts.

  16. An Upper-Limb Power-Assist Exoskeleton Using Proportional Myoelectric Control

    Directory of Open Access Journals (Sweden)

    Zhichuan Tang

    2014-04-01

    Full Text Available We developed an upper-limb power-assist exoskeleton actuated by pneumatic muscles. The exoskeleton included two metal links: a nylon joint, four size-adjustable carbon fiber bracers, a potentiometer and two pneumatic muscles. The proportional myoelectric control method was proposed to control the exoskeleton according to the user’s motion intention in real time. With the feature extraction procedure and the classification (back-propagation neural network, an electromyogram (EMG-angle model was constructed to be used for pattern recognition. Six healthy subjects performed elbow flexion-extension movements under four experimental conditions: (1 holding a 1-kg load, wearing the exoskeleton, but with no actuation and for different periods (2-s, 4-s and 8-s periods; (2 holding a 1-kg load, without wearing the exoskeleton, for a fixed period; (3 holding a 1-kg load, wearing the exoskeleton, but with no actuation, for a fixed period; (4 holding a 1-kg load, wearing the exoskeleton under proportional myoelectric control, for a fixed period. The EMG signals of the biceps brachii, the brachioradialis, the triceps brachii and the anconeus and the angle of the elbow were collected. The control scheme’s reliability and power-assist effectiveness were evaluated in the experiments. The results indicated that the exoskeleton could be controlled by the user’s motion intention in real time and that it was useful for augmenting arm performance with neurological signal control, which could be applied to assist in elbow rehabilitation after neurological injury.

  17. Electroencephalographic markers of robot-aided therapy in stroke patients for the evaluation of upper limb rehabilitation.

    Science.gov (United States)

    Sale, Patrizio; Infarinato, Francesco; Del Percio, Claudio; Lizio, Roberta; Babiloni, Claudio; Foti, Calogero; Franceschini, Marco

    2015-12-01

    Stroke is the leading cause of permanent disability in developed countries; its effects may include sensory, motor, and cognitive impairment as well as a reduced ability to perform self-care and participate in social and community activities. A number of studies have shown that the use of robotic systems in upper limb motor rehabilitation programs provides safe and intensive treatment to patients with motor impairments because of a neurological injury. Furthermore, robot-aided therapy was shown to be well accepted and tolerated by all patients; however, it is not known whether a specific robot-aided rehabilitation can induce beneficial cortical plasticity in stroke patients. Here, we present a procedure to study neural underpinning of robot-aided upper limb rehabilitation in stroke patients. Neurophysiological recordings use the following: (a) 10-20 system electroencephalographic (EEG) electrode montage; (b) bipolar vertical and horizontal electrooculographies; and (c) bipolar electromyography from the operating upper limb. Behavior monitoring includes the following: (a) clinical data and (b) kinematic and dynamic of the operant upper limb movements. Experimental conditions include the following: (a) resting state eyes closed and eyes open, and (b) robotic rehabilitation task (maximum 80 s each block to reach 4-min EEG data; interblock pause of 1 min). The data collection is performed before and after a program of 30 daily rehabilitation sessions. EEG markers include the following: (a) EEG power density in the eyes-closed condition; (b) reactivity of EEG power density to eyes opening; and (c) reactivity of EEG power density to robotic rehabilitation task. The above procedure was tested on a subacute patient (29 poststroke days) and on a chronic patient (21 poststroke months). After the rehabilitation program, we observed (a) improved clinical condition; (b) improved performance during the robotic task; (c) reduced delta rhythms (1-4 Hz) and increased alpha

  18. Prevention of upper limb symptoms and signs of nerve afflictions in computer operators: The effect of intervention by stretching

    Directory of Open Access Journals (Sweden)

    Thomsen Gert

    2008-01-01

    Full Text Available Abstract Background In a previous study of computer operators we have demonstrated the relation of upper limb pain to individual and patterns of neurological findings (reduced function of muscles, sensory deviations from normal and mechanical allodynia of nerve trunks. The identified patterns were in accordance with neural afflictions at three specific locations (brachial plexus at chord level, posterior interosseous and median nerve on elbow level. We have introduced an intervention program aiming to mobilize nerves at these locations and tested its efficacy. Methods 125 and 59, respectively, computer operators in two divisions of an engineering consultancy company were invited to answer a questionnaire on upper limb symptoms and to undergo a blinded neurological examination. Participants in one division were subsequently instructed to participate in an upper limb stretching course at 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. Perceived changes of pain were recorded and individual and patterns of physical findings assessed for both groups at baseline and at follow-up. In subjects with no or minimal preceding pain we additionally studied the relation of incident pain to the summarized findings for parameters contained in the 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 could be drawn regarding the relation to the intervention of this reduction. Incident pain correlated to findings in accordance with the three locations of nerve

  19. Functional influence of botulinum neurotoxin type A treatment (Xeomin® of multifocal upper and lower limb spasticity on chronic hemiparetic gait

    Directory of Open Access Journals (Sweden)

    Maurizio Falso

    2012-05-01

    Full Text Available This report describes the modification of hemiplegic shoulder pain and walking velocity through injections of Xeomin®, a new botulinum neurotoxin type A formulation, in a 67-year-old woman with chronic residual left hemiparesis and hemiparetic gait attributable to stroke. Clinical evaluation included upper and lower limb spasticity, upper and lower limb pain, trunk control, upper and lower limb motricity index, visual gait analysis, and gait velocity. Assessments were performed before, 1 week after, and 1 month after treatment. Improvement was observed in all clinical parameters assessed. Amelioration of spasticity of the upper and lower limbs and shoulder pain was observed after 1 month. Trunk postural attitude and paraxial muscle recruitment recovered. No adverse events were observed and the patient shows significant improvement of functional impairment derived from chronic spasticity after treatment with Xeomin®. We also provide a simple and useful protocol for clinical evaluation of the treatment.

  20. [Therapy of phantom limb pain].

    Science.gov (United States)

    Schwarzer, Andreas; Zenz, Michael; Maier, Christoph

    2009-03-01

    About 80 % of all extremity amputations suffer from phantom limb pain following the operation. In this context, it is important to differentiate between painful phantom limb sensations, non-painful phantom limb sensations and residual limb pain. The pathophysiology of phantom limb pain is not fully understood. Current research findings ascribe a major pathophysiological role to cortical changes as well as a disturbed body perception. Peripheral and spinal mechanisms appear less relevant in the development of phantom limb pain. An essential part of the therapy is the pharmacological treatment with antidepressants, anticonvulsives and opioids. Another significant aspect of therapy is senso-motory training, important to mention here would be mirror therapy, lateralisation and motor imaging. In case of an elective amputation, an epidural or axiliar plexus catheter should be considered prior to the amputation. The perioperative treatment with ketamine is debated. PMID:19266417

  1. Side-to-side comparisons of bone mineral density in upper and lower limbs of collegiate athletes.

    Science.gov (United States)

    McClanahan, Barbara S; Harmon-Clayton, Karen; Ward, Kenneth D; Klesges, Robert C; Vukadinovich, Christopher M; Cantler, Edwin D

    2002-11-01

    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

  2. Biomechanical study of upper-limb exoskeleton for resistance training with three-dimensional motion analysis system

    Directory of Open Access Journals (Sweden)

    Tzong-Ming Wu, PhD

    2014-03-01

    Full Text Available The world’s population is aging rapidly, particularly in developed countries. The trend toward prolonged life expectancy will increase the elderly population and thereby lead to an increase in occurrences of age-related health problems such as chronic disease. Healthcare services and home-based rehabilitation are in high demand, and the demand for professional physical therapy is imposing an increasing burden on the healthcare system. Rehabilitation training devices must keep pace with standards of care, be cost effective, and meet the home-based training requirements of today’s rehabilitation trends. This article presents an experimental study of a novel spring-loaded upper-limb exoskeleton meant to enable a patient or nondisabled individual to move a limb at multiple joints in different planes for resistance training in a free and unconstrained environment. To assess the functionality of the design, we have measured its kinematic data while performing designated movements and adopted a motion-capture system to verify the function of our mechanism. The collected data and analysis of the kinematic and dynamic joint torques may not only verify our mechanism but also provide a profound understanding of the design requirements for an appropriate spring-loaded exoskeleton for upper-limb resistance training.

  3. The development of an adaptive upper-limb stroke rehabilitation robotic system

    Directory of Open Access Journals (Sweden)

    Goetschalckx Robby

    2011-06-01

    Full Text Available Abstract Background Stroke is the primary cause of adult disability. To support this large population in recovery, robotic technologies are being developed to assist in the delivery of rehabilitation. This paper presents an automated system for a rehabilitation robotic device that guides stroke patients through an upper-limb reaching task. The system uses a decision theoretic model (a partially observable Markov decision process, or POMDP as its primary engine for decision making. The POMDP allows the system to automatically modify exercise parameters to account for the specific needs and abilities of different individuals, and to use these parameters to take appropriate decisions about stroke rehabilitation exercises. Methods The performance of the system was evaluated by comparing the decisions made by the system with those of a human therapist. A single patient participant was paired up with a therapist participant for the duration of the study, for a total of six sessions. Each session was an hour long and occurred three times a week for two weeks. During each session, three steps were followed: (A after the system made a decision, the therapist either agreed or disagreed with the decision made; (B the researcher had the device execute the decision made by the therapist; (C the patient then performed the reaching exercise. These parts were repeated in the order of A-B-C until the end of the session. Qualitative and quantitative question were asked at the end of each session and at the completion of the study for both participants. Results Overall, the therapist agreed with the system decisions approximately 65% of the time. In general, the therapist thought the system decisions were believable and could envision this system being used in both a clinical and home setting. The patient was satisfied with the system and would use this system as his/her primary method of rehabilitation. Conclusions The data collected in this study can only be

  4. Effects of the racket polar moment of inertia on dominant upper limb joint moments during tennis serve.

    Directory of Open Access Journals (Sweden)

    Isabelle Rogowski

    Full Text Available This study examined the effect of the polar moment of inertia of a tennis racket on upper limb loading in the serve. Eight amateur competition tennis players performed two sets of 10 serves using two rackets identical in mass, position of center of mass and moments of inertia other than the polar moment of inertia (0.00152 vs 0.00197 kg.m2. An eight-camera motion analysis system collected the 3D trajectories of 16 markers, located on the thorax, upper limbs and racket, from which shoulder, elbow and wrist net joint moments and powers were computed using inverse dynamics. During the cocking phase, increased racket polar moment of inertia was associated with significant increases in the peak shoulder extension and abduction moments, as well the peak elbow extension, valgus and supination moments. During the forward swing phase, peak wrist extension and radial deviation moments significantly increased with polar moment of inertia. During the follow-through phase, the peak shoulder adduction, elbow pronation and wrist external rotation moments displayed a significant inverse relationship with polar moment of inertia. During the forward swing, the magnitudes of negative joint power at the elbow and wrist were significantly larger when players served using the racket with a higher polar moment of inertia. Although a larger polar of inertia allows players to better tolerate off-center impacts, it also appears to place additional loads on the upper extremity when serving and may therefore increase injury risk in tennis players.

  5. High intensity physical exercise and pain in the neck and upper limb among slaughterhouse workers: cross-sectional study.

    Science.gov (United States)

    Sundstrup, Emil; Jakobsen, Markus D; Jay, Kenneth; Brandt, Mikkel; Andersen, Lars L

    2014-01-01

    Slaughterhouse work involves a high degree of repetitive and forceful upper limb movements and thus implies an elevated risk of work-related musculoskeletal disorders. High intensity strength training effectively rehabilitates musculoskeletal disorders among sedentary employees, but less is known about the effect among workers with repetitive and forceful work demands. Before performing randomized controlled trials it may be beneficial to assess the cross-sectional connection between exercise and musculoskeletal pain. We investigated the association between high intensity physical exercise and pain among 595 slaughterhouse workers in Denmark, Europe. Using logistic regression analyses, odds ratios for pain and work disability as a function of physical exercise, gender, age, BMI, smoking, and job position were estimated. The prevalence of pain in the neck, shoulder, elbow, and hand/wrist was 48%, 60%, 40%, and 52%, respectively. The odds for experiencing neck pain were significantly lower among slaughterhouse workers performing physical exercise (OR = 0.70, CI: 0.49-0.997), whereas the odds for pain in the shoulders, elbow, or hand/wrist were not associated with exercise. The present study can be used as general reference of pain in the neck and upper extremity among slaughterhouse workers. Future studies should investigate the effect of high intensity physical exercise on neck and upper limb pain in slaughterhouse workers. PMID:24527440

  6. High Intensity Physical Exercise and Pain in the Neck and Upper Limb among Slaughterhouse Workers: Cross-Sectional Study

    Directory of Open Access Journals (Sweden)

    Emil Sundstrup

    2014-01-01

    Full Text Available Slaughterhouse work involves a high degree of repetitive and forceful upper limb movements and thus implies an elevated risk of work-related musculoskeletal disorders. High intensity strength training effectively rehabilitates musculoskeletal disorders among sedentary employees, but less is known about the effect among workers with repetitive and forceful work demands. Before performing randomized controlled trials it may be beneficial to assess the cross-sectional connection between exercise and musculoskeletal pain. We investigated the association between high intensity physical exercise and pain among 595 slaughterhouse workers in Denmark, Europe. Using logistic regression analyses, odds ratios for pain and work disability as a function of physical exercise, gender, age, BMI, smoking, and job position were estimated. The prevalence of pain in the neck, shoulder, elbow, and hand/wrist was 48%, 60%, 40%, and 52%, respectively. The odds for experiencing neck pain were significantly lower among slaughterhouse workers performing physical exercise (OR = 0.70, CI: 0.49–0.997, whereas the odds for pain in the shoulders, elbow, or hand/wrist were not associated with exercise. The present study can be used as general reference of pain in the neck and upper extremity among slaughterhouse workers. Future studies should investigate the effect of high intensity physical exercise on neck and upper limb pain in slaughterhouse workers.

  7. Effects of the Racket Polar Moment of Inertia on Dominant Upper Limb Joint Moments during Tennis Serve

    Science.gov (United States)

    Rogowski, Isabelle; Creveaux, Thomas; Chèze, Laurence; Macé, Pierre; Dumas, Raphaël

    2014-01-01

    This study examined the effect of the polar moment of inertia of a tennis racket on upper limb loading in the serve. Eight amateur competition tennis players performed two sets of 10 serves using two rackets identical in mass, position of center of mass and moments of inertia other than the polar moment of inertia (0.00152 vs 0.00197 kg.m2). An eight-camera motion analysis system collected the 3D trajectories of 16 markers, located on the thorax, upper limbs and racket, from which shoulder, elbow and wrist net joint moments and powers were computed using inverse dynamics. During the cocking phase, increased racket polar moment of inertia was associated with significant increases in the peak shoulder extension and abduction moments, as well the peak elbow extension, valgus and supination moments. During the forward swing phase, peak wrist extension and radial deviation moments significantly increased with polar moment of inertia. During the follow-through phase, the peak shoulder adduction, elbow pronation and wrist external rotation moments displayed a significant inverse relationship with polar moment of inertia. During the forward swing, the magnitudes of negative joint power at the elbow and wrist were significantly larger when players served using the racket with a higher polar moment of inertia. Although a larger polar of inertia allows players to better tolerate off-center impacts, it also appears to place additional loads on the upper extremity when serving and may therefore increase injury risk in tennis players. PMID:25117871

  8. Optimum ratio of upper to lower limb lengths in hand-carrying of a load under the assumption of frequency coordination.

    Science.gov (United States)

    Wang, W J; Crompton, R H; Li, Y; Gunther, M M

    2003-02-01

    The ratio of the upper to lower limb lengths [or the intermembral index (IMI)] in the earliest human ancestors is closer to that of the living chimpanzees than to our own, although the former show undoubted adaptations to bipedality. What biomechanical factors could then have led to the phenomenon of genus Homo? This paper proposes and evaluates a relationship between IMI and hand-carrying. Assuming that coordination of limb swing frequencies of the upper and lower limbs would be the subject of positive selection, a mathematical expression was derived and can in part explain the changes in IMI. We found that AL-288-1 [3.6 million years old (MY)], the most complete skeleton of the early hominid Australopithecus afarensis, could only have carried loads equivalent to 15-50% of the upper limb weight while maintaining swing symmetry, but KNM WT-15000, Homo ergaster (1.8MY) and modern humans could both carry loads 3 times heavier than the upper limb while maintaining swing symmetry. The carrying ability of chimpanzees would be inferior to that of AL-288-1. The IMI of modern humans, at 68-70, is the smallest, and is optimal for hand-carrying under our criteria. Under reduced selection pressure for hand-carrying, but unreduced selection for mechanical effectiveness, we might expect humans to evolve a longer upper limb, to improve swing symmetry when unloaded. PMID:12547362

  9. Effect of primary and secondary wartime below-knee amputation on length of hospitalization and rehabilitation

    OpenAIRE

    Jandrić Slavica; Topić Brano

    2002-01-01

    The results of below-knee amputations in 36 war wounded (mean age 35,42) were reviewed. The majority of the patients was wounded by land mines (94.4%). Most of them were between 25 and 35 years old. Bilateral amputation was done in 2.8% of cases. The amputation was performed on the day of wounding (primary below-knee amputation) in 30 (83.3%) amputees. Secondary amputation after the attempt to save the severely injured lower-limb was performed in 6 patients (16,7%) average 4.61 ± 11.67 days a...

  10. [Amputation and prosthesis attachment of the lower extremities].

    Science.gov (United States)

    Matthes, I; Beirau, M; Ekkernkamp, A; Matthes, G

    2015-06-01

    Approximately 61,000 amputations are performed in Germany per year. In most cases the lower limbs are affected. The reasons for amputations are arteriosclerosis, diabetes mellitus, severe infections, tumors and complex trauma to the extremities. A decision must be made concerning whether a salvage procedure or amputation is appropriate, specially after trauma. In cases where the need for amputation is clear, the site of amputation needs to be planned in advance with the aim of creating a stump which allows sufficient prosthetic attachment. Adjuvant pain therapy is mandatory, especially in order to avoid subsequent phantom pain. The type of prosthetic restoration is influenced by the grade of mobility and personal requirements of patients. Moreover, aftercare and adjusted rehabilitation are recommended. PMID:26013390

  11. VA paradigm shift in care of veterans with limb loss

    Directory of Open Access Journals (Sweden)

    Gayle E. Reiber, PhD, MPH

    2010-08-01

    Full Text Available Traumatic limb loss results in pain and discomfort in addition to the loss of an important part of the body and its function. The mental health challengesaccompanying limb loss include issues of frustration and body image, role in life, and feelings of not being whole. Many servicemembers and veteranswith limb loss need to prove to themselves that they can still accomplishphysical feats, such as those with lower-limb loss returning to running or those with upper-limb loss working with tools. If our servicemembers and veterans let these activities go, they again feel a loss. Therefore, Department of Veterans Affairs (VA services are available to help individuals meet their physical and recreational goals, whether they be running, walking, or masteringcomplex upper-limb activities. Veterans with limb loss need ongoing clinical care, prosthetic devices, and mobility assistance. As their prosthetic devices are repaired, replaced, and updated, they need corresponding educationand training. Too often in the past, the VA has taken a narrow view of amputation care, focusing only on managing prosthetic devices. Prosthetic care is one small but important aspect of the complex rehabilitation partnershipbetween the veteran with limb loss and the VA.

  12. Immunological indices of blood and interstitial fluid in estimation of a program of therapy of upper limb secondary edemas

    International Nuclear Information System (INIS)

    The efficacy of therapy of upper limb secondary edemas after 4 programs was compared among 83 patients. The methods were as follows: traditional method (TM) including routine conservative therapy, acupuncture (AP), He-Ne laser OKG-13 and semiconductor laser against a background of traditional therapy. A study was made of the time course of the extent of edema, total protein, IG, G, A and M and circulating immune complexes (CIC) during therapy of such patients. Blood serum and interstitial fluid indices were compared. It was shown that the application of both lasers led to increasing efficacy of TM and AP

  13. Management of multijoint stiffness of bilateral upper limbs secondary to heterotopic ossification: Case report and literature review

    Directory of Open Access Journals (Sweden)

    Hong-wei Min, MD

    2014-06-01

    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.

  14. Sciatic Neuroma Presenting Forty Years After Above-Knee Amputation

    OpenAIRE

    Kitcat, M; Hunter, J. E.; C.M. Malata

    2009-01-01

    We report a case of a sciatic neuroma presenting forty years after above knee amputation. Patients developing neuroma following a limb amputation can present with stump pain which is commonly resistant to medical intervention. The length of interval from the initial injury to presentation is widely variable. Diagnosis relies on clinical suspicion and accurate assessment, radiological imaging and, if indicated, surgical exploration. MRI provides a better soft tissue definition than CT and is m...

  15. Amputee Mobility Predictor-Bilateral: A performance-based measure of mobility for people with bilateral lower-limb loss

    Directory of Open Access Journals (Sweden)

    Michele A. Raya, PhD, PT, SCS, ATC

    2013-10-01

    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.

  16. Comparative study of the effect of taping on scapular stability and upper limb function in recovering hemiplegics with scapular weakness

    Directory of Open Access Journals (Sweden)

    Dhwanit Shah

    2013-01-01

    Full Text Available Background: Hemiplegia is the commonest form of paralysis, involving arm, leg and sometimes the face on one side of the body. Shoulder girdle in chronic hemiplegic suffers from two sorts of problems (a spasticity of elevators and retractors, which pull the scapula into a fixed elevated and retracted position. (b weakness of the opposite group of scapular muscles, i.e., depressors and protectors. This leads to instability of the scapulothoracic joint resulting in impaired functional use of the upper limb, taping is a method of maintaining orientation of the scapula by means of proprioceptive biofeedback to the patient. Aim of this study is to check the effect of taping on scapular stability and upper limb function in recovering hemiplegics. Objectives of the Study: (1 To study the effect of taping on functional performance of the hemiplegic upper extremity. (2 To compare the effect of taping combined with physiotherapeutic exercises v/s physiotherapeutic exercises alone on functional independence of the hemiplegic upper extremity. Subjects: All the 37 chronic hemiplegic patients with scapular weakness were taken and divided into two groups: Group A (Experimental group and Group B (Control group. Materials and Methods: All the 37 chronic hemiplegic patients were evaluated by Fugl Meyer Physical Performance Assessment Scale for hemiplegic upper extremity before starting the treatment. Group A patients received scapular taping combined with physiotherapeutic exercises and Group B patients received only physiotherapeutic exercises for the period of 2 weeks. After 2 weeks both Group A and B patients were re-evaluated on Fugl Meyer Physical Performance Assessment Scale for hemiplegic upper extremity. Results: There was a significant improvement between the pre- and post-treatment scores of Group A patients on the Fugl Meyer Physical Performance Assessment Scale of hemiplegic upper extremity, whereas Group B patients score on the same scale was

  17. Agency over a phantom limb and electromyographic activity on the stump depend on visuomotor synchrony: a case study

    Directory of Open Access Journals (Sweden)

    Shu Imaizumi

    2014-07-01

    Full Text Available Most patients, post-amputation, report the experience of a phantom limb. Some even sense voluntary movements when viewing a mirror image of the intact limb superimposed onto the phantom limb. While delayed visual feedback of an action is known to reduce a sense of agency, the effect of delayed visual feedback on phantom motor sensation (i.e., sense of controlling a phantom limb has not been examined. Using a video-projection system, we examined the effect of delayed visual feedback on phantom motor sensation in an upper-limb amputee (male; left upper-limb amputation. He was instructed to view mirrored video images of his intact hand clasping and unclasping during a phantom limb movement. He then rated the intensity of the phantom motor sensation. Three types of hand movement images were presented as follows: synchronous, asynchronous with a 250-ms delay, and asynchronous with a 500-ms delay. Results showed that phantom motor sensation decreased when the image was delayed by 250 and 500 ms. However, when we instructed the patient to adjust the phase of phantom limb movement to that of the image with a 500-ms delay, phantom motor sensation increased. There was also a positive correlation between intensity of phantom motor sensation and electromyographic activity on deltoids at the patient’s stump. These results suggest that phantom motor sensation and electromyographic activity on the stump depend on visuomotor synchrony and top-down effects.

  18. Bone dosimetry and scintigraphy in post-traumatic reflex sympathetic dystrophy syndrome (RSDS) with upper limb involvement

    International Nuclear Information System (INIS)

    In 24 patients affected with post-traumatic reflex sympathetic dystrophy syndrome (RSDS) with upper limb involvement following humeral fractures, bone mineral density (BMD, mg/cm2) was measured by means of dual-photon absorptiometry in the distal radius of both the affected and the normal contralateral limbs. Subsequently, all patients underwent dynamic and static scintigraphic exams after i.v. injection of 99mTc-MDP (20 mCi), with gamma camera collimator centered in both limbs. BMD values were significantly lower in the affected sides than in the normal contralateral ones. Time-activity curves with MDP showed increased flow in the involved limbs. Significant increase in blood pool and in bone uptake was also oserved. After carbocalcin treatment (80 U/q.d.i.m. in 12 cases and 40 U/q.d.i.m. in the other 12 cases for month) all the patients presented improved clinical symptoms and significant increase in BMD, that was restored to normal values in 7 of the patients who had a longer treatment (40 U/q.d.i.m. for 2 months). Both local blood flow and bone up-take in the affected side significantly decreased after carbocalcitonin therapy while bone avidity index increased in those patients in whom this parameter had been measured. Results confirmed the usefulness of radioisotopic procedures in post-traumatic RSDS for both diagnosis (by demonstrating increased local blood flow and early bone demineralization) and monitoring response to treatment with carbocalcitonin, which seems to play an important role in this condition

  19. Minor amputations for diabetic foot salvage

    Directory of Open Access Journals (Sweden)

    Salah Y. Habel

    2015-10-01

    Full Text Available Foot ulceration in diabetic patients is a frequent complication of diabetes mellitus (DM, necessitating hospitalization for control of infection, wound care and glycemic control. These patients are at risk for potential loss of the involved limb as well as for future loss of the contralateral limb. Diabetic foot is the consequence of peripheral neuropathy complicated by infrapopliteal peripheral vascular disease. Most of the patients present with chronic plantar ulceration and with cellulitis or an abscess. In a significant number of patients, it is observed that the frequency of life or limb threatening infection is less with an intact skin cover. Limb salvage employs the use of culture specific antibiotics, sharp debridement or a minor amputation, wound care and/or skin cover as the situation demands.

  20. A functional and psychosocial assessment of patients with post-Sudeck atrophy amputation.

    Science.gov (United States)

    Szeinberg-Arazi, D; Heim, M; Nadvorna, H; Ner, I Z; Szeinberg, A; Azaria, M

    1993-04-01

    Twelve patients with reflex sympathetic dystrophy were referred to a comprehensive orthopaedic rehabilitation center after failure of conservative management. Ten underwent amputation of the affected limb and, although functional improvement occurred in the patients undergoing lower limb amputation, psychosocial dysfunction persisted. All the patients required psychological support. In cases of post-Sudeck amputation, early orthopaedic diagnosis and referral to a comprehensive treatment center are recommended. In the 12 cases described here, apart from the obvious limb pathology, severe psychological inadequacies were found to be present. PMID:7682058

  1. THE EFFECT OF THE UPPER LIMB TENSION TEST IN THE MANAGEMENT OF ROM LIMITATION AND PAIN IN CERVICAL RADICULOPATHY

    Directory of Open Access Journals (Sweden)

    Shah Sarfraznawaz F

    2015-06-01

    Full Text Available Aim and Objectives: To study the effect of the upper limb tension test in the management of limitation of range of motion and pain in patients with cervical radiculopathy compared with a control group. Intervention and Outcomes: A total of 40 patients were treated with two types of interventions. The Control group received a conservative management protocol and the Experimental group received an experimental protocol that included mobilization using the Upper Limb Tension Test in addition to the conservative protocol .The outcomes measures were flexion, extension, right side flexion and left side flexion ranges of the cervical spine and VAS score for Pain. Results: All data collected was statistically analysed on the Stat Pac 3.0. Pre and Post test values were taken for both cervical range of motion and pain for both the Control and Experimental groups. Paired ‘t’ test was used for within the group comparison. Unpaired ‘t’ test was used for between the group comparison which showed a highly significant difference in favor of the experimental group at 99.9%(P<0.001 between the ROM of Flexion, Extension, right Side Flexion and left Side Flexion of the cervical spine. Conclusion: The results of the study showed that adding neural mobilization using ULLT certainly benefits patients of cervical radiculopathy as far as the cervical range of motion and pain is considered.

  2. Neurophysiological and behavioural effects of dual-hemisphere transcranial direct current stimulation on the proximal upper limb.

    Science.gov (United States)

    McCambridge, Alana B; Stinear, James W; Byblow, Winston D

    2016-06-01

    Dual-hemisphere transcranial direct current stimulation over the primary motor cortex (M1-M1 tDCS) is assumed to modulate neural excitability in a polarity-dependent manner and improve motor performance of the hand. In the proximal upper limb, the neurophysiological and behavioural after-effects of M1-M1 tDCS are not well known. This study investigated the after-effects of M1-M1 tDCS on contralateral, ipsilateral and transcallosal excitability to the proximal upper limb muscle biceps brachii (BB). Circle tracing was used to assess motor performance before and after tDCS as this task requires coordination of proximal and distal musculature. Sixteen healthy right-handed adults participated in the study, each receiving M1-M1 tDCS (1 mA, 15 min) or sham tDCS in separate sessions. The anode was positioned over right M1 and cathode over left M1. M1-M1 tDCS suppressed transcallosal inhibition from the M1 under the cathode (P  0.6). The study provides important information regarding inconsistent neurophysiological and behavioural changes following tDCS that have implications for future tDCS research on the motor system. PMID:26749182

  3. Exploring the factor on sensory motor function of upper limb associated with executive function in communitydwelling older adults.

    Science.gov (United States)

    Hayashi, Hiroyuki; Nakashima, Daiki; Matsuoka, Hiroka; Iwai, Midori; Nakamura, Shugo; Kubo, Ayumi; Tomiyama, Naoki

    2016-08-01

    Exercise, such as cardiovascular fitness training, has been shown to have utility in improving executive function but is difficult for older adults with low mobility to perform. Accordingly, there is interest in the development of regimens other than high mobility exercises for older adults with low mobility. The aim of the present study was to evaluate the association between sensory motor function of the upper limb and executive function in community-dwelling older adults. A cross-sectional study was conducted in 57 right-handed, independent, community-dwelling older adults. Sensory motor function of upper limb, including range of motion, strength, sensation, finger dexterity, and comprehensive hand function was measured in both hands. Executive function was assessed using the Delta Trail Making Test. Multiple regression analysis indicated the finger dexterity of the non-dominant hand as independently associated with executive function (β = -0.414, P physical fitness levels. As this was a cross-sectional study, further studies are required to validate the efficacy of non-dominant finger dexterity training for improving executive function in older adults. PMID:27578912

  4. Effectiveness of the Virtual Reality System Toyra on Upper Limb Function in People with Tetraplegia: A Pilot Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    I. Dimbwadyo-Terrer

    2016-01-01

    Full Text Available The aim of this study was to investigate the effects of a virtual reality program combined with conventional therapy in upper limb function in people with tetraplegia and to provide data about patients’ satisfaction with the virtual reality system. Thirty-one people with subacute complete cervical tetraplegia participated in the study. Experimental group received 15 sessions with Toyra® virtual reality system for 5 weeks, 30 minutes/day, 3 days/week in addition to conventional therapy, while control group only received conventional therapy. All patients were assessed at baseline, after intervention, and at three-month follow-up with a battery of clinical, functional, and satisfaction scales. Control group showed significant improvements in the manual muscle test (p = 0,043, partial η2 = 0,22 in the follow-up evaluation. Both groups demonstrated clinical, but nonsignificant, changes to their arm function in 4 of the 5 scales used. All patients showed a high level of satisfaction with the virtual reality system. This study showed that virtual reality added to conventional therapy produces similar results in upper limb function compared to only conventional therapy. Moreover, the gaming aspects incorporated in conventional rehabilitation appear to produce high motivation during execution of the assigned tasks. This trial is registered with EudraCT number 2015-002157-35.

  5. Exploring the factor on sensory motor function of upper limb associated with executive function in communitydwelling older adults

    Science.gov (United States)

    Hayashi, Hiroyuki; Nakashima, Daiki; Matsuoka, Hiroka; Iwai, Midori; Nakamura, Shugo; Kubo, Ayumi; Tomiyama, Naoki

    2016-01-01

    ABSTRACT Exercise, such as cardiovascular fitness training, has been shown to have utility in improving executive function but is difficult for older adults with low mobility to perform. Accordingly, there is interest in the development of regimens other than high mobility exercises for older adults with low mobility. The aim of the present study was to evaluate the association between sensory motor function of the upper limb and executive function in community-dwelling older adults. A cross-sectional study was conducted in 57 right-handed, independent, community-dwelling older adults. Sensory motor function of upper limb, including range of motion, strength, sensation, finger dexterity, and comprehensive hand function was measured in both hands. Executive function was assessed using the Delta Trail Making Test. Multiple regression analysis indicated the finger dexterity of the non-dominant hand as independently associated with executive function (β = –0.414, P executive function that are more suitable for older adults with limited physical fitness levels. As this was a cross-sectional study, further studies are required to validate the efficacy of non-dominant finger dexterity training for improving executive function in older adults. PMID:27578912

  6. Effects of motor imagery combined with functional electrical stimulation on upper limb motor function of patients with acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Shou-feng LIU

    2015-03-01

    Full Text Available Objective To explore the effects of motor imagery (MI combined with the third generation functional electrical stimulation (FES on upper limb motor function in acute ischemic stroke patients with hemiplegia.  Methods Forty acute ischemic stroke patients, within 48 h of onset, were randomly divided into FES group (N = 20 and combination group (FES combined with motor imagery, N = 20. All patients received basic routine rehabilitation training, for example, good limb positioning, accepting braces, balance training and training in the activities of daily living (ADL. FES group received the third generation FES therapy and the combination group also received motor imagery for 2 weeks. All of the patients were assessed with Fugl-Meyer Assessment (FMA, Action Research Arm Test (ARAT and active range of motion (AROM of wrist dorsiflexion before and after 2 weeks of treatment.  Results After 2 weeks of treatment, the 2 groups had significantly higher FMA score, ARAT score and AROM of wrist dorsiflexion than that in pre-treatment (P = 0.000, for all. Besides, the FMA score (t = - 2.528, P = 0.016, ARAT score (t = - 2.562, P = 0.014 and AROM of wrist dorsiflexion (t = - 2.469, P = 0.018 in the combination group were significantly higher than that in the FES group. There were interactions of treatment methods with observation time points (P < 0.05, for all.  Conclusions Motor imagery combined with the third generation FES can effectively promote the recovery of upper limb motor function and motion range of wrist dorsiflexion in patients with acute ischemic stroke. DOI: 10.3969/j.issn.1672-6731.2015.03.008

  7. Inverse Kinematics for Upper Limb Compound Movement Estimation in Exoskeleton-Assisted Rehabilitation

    Directory of Open Access Journals (Sweden)

    Camilo Cortés

    2016-01-01

    Full Text Available Robot-Assisted Rehabilitation (RAR is relevant for treating patients affected by nervous system injuries (e.g., stroke and spinal cord injury. The accurate estimation of the joint angles of the patient limbs in RAR is critical to assess the patient improvement. The economical prevalent method to estimate the patient posture in Exoskeleton-based RAR is to approximate the limb joint angles with the ones of the Exoskeleton. This approximation is rough since their kinematic structures differ. Motion capture systems (MOCAPs can improve the estimations, at the expenses of a considerable overload of the therapy setup. Alternatively, the Extended Inverse Kinematics Posture Estimation (EIKPE computational method models the limb and Exoskeleton as differing parallel kinematic chains. EIKPE has been tested with single DOF movements of the wrist and elbow joints. This paper presents the assessment of EIKPE with elbow-shoulder compound movements (i.e., object prehension. Ground-truth for estimation assessment is obtained from an optical MOCAP (not intended for the treatment stage. The assessment shows EIKPE rendering a good numerical approximation of the actual posture during the compound movement execution, especially for the shoulder joint angles. This work opens the horizon for clinical studies with patient groups, Exoskeleton models, and movements types.

  8. A haptic-robotic platform for upper-limb reaching stroke therapy: Preliminary design and evaluation results

    Directory of Open Access Journals (Sweden)

    Boger Jennifer

    2008-05-01

    Full Text Available Abstract Background It has been shown that intense training can significantly improve post-stroke upper-limb functionality. However, opportunities for stroke survivors to practice rehabilitation exercises can be limited because of the finite availability of therapists and equipment. This paper presents a haptic-enabled exercise platform intended to assist therapists and moderate-level stroke survivors perform upper-limb reaching motion therapy. This work extends on existing knowledge by presenting: 1 an anthropometrically-inspired design that maximizes elbow and shoulder range of motions during exercise; 2 an unobtrusive upper body postural sensing system; and 3 a vibratory elbow stimulation device to encourage muscle movement. Methods A multi-disciplinary team of professionals were involved in identifying the rehabilitation needs of stroke survivors incorporating these into a prototype device. The prototype system consisted of an exercise device, postural sensors, and a elbow stimulation to encourage the reaching movement. Eight experienced physical and occupational therapists participated in a pilot study exploring the usability of the prototype. Each therapist attended two sessions of one hour each to test and evaluate the proposed system. Feedback about the device was obtained through an administered questionnaire and combined with quantitative data. Results Seven of the nine questions regarding the haptic exercise device scored higher than 3.0 (somewhat good out of 4.0 (good. The postural sensors detected 93 of 96 (97% therapist-simulated abnormal postures and correctly ignored 90 of 96 (94% of normal postures. The elbow stimulation device had a score lower than 2.5 (neutral for all aspects that were surveyed, however the therapists felt the rehabilitation system was sufficient for use without the elbow stimulation device. Conclusion All eight therapists felt the exercise platform could be a good tool to use in upper-limb rehabilitation as

  9. Use of pedicled latissimus dorsi myocutaneous flap to reconstruct the upper limb with large soft tissue defects

    Directory of Open Access Journals (Sweden)

    QU Zhi-gang

    2012-12-01

    Full Text Available 【Abstract】 Objective: To report the technique of reconstruction of large skin and soft tissue defects in the upper extremity using pedicled latissimus dorsi myocu-taneous flaps. Methods: Six patients with large skin and soft tissue defects were included in this report. There were 5 trauma patients and the rest one needed to receive plastic surgery for his extremity scar. All wounds were in the upper extremity. The sizes of defects ranged from 15 cm×6 cm to 30 cm×18 cm. Pedicled latissimus dorsi myocutaneous flaps were designed according to the defect area and raised with part of latissi-mus dorsi. The thoracodorsal artery and its perforators were carefully protected during surgery. Results: All flaps healed primarily without flap congestion, margin necrosis or infection. The skin donor sites either received split-thickness skin graft (3 cases, mostly from the anterior thigh or was closed primarily (3 cases and had minimal morbidity. Follow-up of 6-12 months showed that the contour of flap was aesthetic and the func-tion of limb was excellent. Conclusion: Our experience indicates that the pedicled latissimus dorsi myocutaneous flap is favorable for recon-struction of large skin and soft tissue defects in the upper extremity. Key words: Surgical flaps; Upper extremity; Soft tissue injuries; Reconstructive surgical procedures

  10. PSYCHIATRIC SEQUELAE OF AMPUTATION : II LONG TERM EFFECTS

    OpenAIRE

    Trivedi, J.K.; Mall, C.P.; U.S. Mishra; Sharma, V. P.; Dalal, P.K.; Katiyar, M.; Srivastava, Shrikant; Sinha, P.K.

    1997-01-01

    Psychiatric sequelae present after 6 months to 2 years following amputation were studied in a group of 25 subjects. The subjects were screened on SCID, HRSD and HARS. The most common diagnoses were depressive disorder NOS (20.6%) and major depressive disorder (10.3%). Patients having right sided amputation were more psychiatrically ill than those with loss of a left limb. Phantom limb was seen in about two-thirds of the total sample-more in the sick group (about 88%) than in the non-sick grou...

  11. Supernumerary phantom limb after stroke

    OpenAIRE

    Bakheit, A; Roundhill, S

    2005-01-01

    The perception of a phantom limb is commonly reported after amputations. However, only a few cases have been described after a stroke. This article presents a patient who reported a supernumerary phantom limb (pseudopolymelia) after spontaneous intracerebral haemorrhage and discusses the possible underlying mechanisms for this rare phenomenon.

  12. The Potency of Optical and Augmented Reality Mirror Boxes in Amputees and People with Intact Limbs

    Directory of Open Access Journals (Sweden)

    Kieran O'Neill

    2006-01-01

    Full Text Available Phantom limb pain is the distressing problem experienced by many amputees, defined as a painful sensation perceived in the area of the missing body part. Phantom limb pain can be very severe and disabling. It continues to be experienced by two thirds of amputees, eight years post-amputation. Augmented reality has the ability to change a person’s sensory experience. More applications of this technology are gradually being utilised for therapeutic purposes as augmented environments can be used both to distract the attention of patients from excruciatingly painful experiences and to promote cortical re-mapping at the site from where the pain arises. Using Augmented Reality, an environment has been created where upper limb amputees can both view and control motion of their phantom limb to help alleviate phantom limb pain.

  13. PHYSICAL WORKLOAD AS A RISK FACTOR FOR SYMPTOMS IN THE NECK AND UPPER LIMBS: EXPOSURE ASSESSMENT AND ERGONOMIC INTERVENTION

    Directory of Open Access Journals (Sweden)

    Ritva Ketola

    2004-06-01

    Full Text Available The aims of this study were to investigate work related and individual factors as predictors of insident neck pain among video display unit (VDU workers, to assess the effects of an ergonomic intervention and education on musculoskeletal symptoms, and to study the repeatability and validity of an expert assessment method of VDU workstation ergonomics. A method to assess the risk factors for upper limb disorders was developed, and its validity and repeatability were studied. The annual incidence of neck pain was 34.4%. A poor physical work environment and placement of the keyboard were work-related factors increasing the risk of neck pain. Among the individual factors, female sex was a strong predictor. The randomized intervention study included questionnaire survey, a diary of discomfort, and ergonomic rating of the workstations. The subjects (n=124 were allocated into three groups. The intensive and the education groups had less musculoskeletal discomfort than the control group at the 2-month follow-up. After the intervention, the level of ergonomics was distinctly higher in the intensive ergonomic group than in the education or control group. Two experts in ergonomics analyzed and rated the ergonomics of workstations before and after intervention. The validity of the assessment method was rated against the technical measurements, assessment of tidiness and space, and work chair ergonomics. The intraclass correlation coefficient between ratings of the two experts was 0.74. Changes in the location of the input devises and the screen, as well as the values of tidiness and space and work chair ergonomics showed a significant association with the ratings of both experts. The method to assess the loads imposed on the upper limbs was validated against the expert observations from the video, continuous recordings of myoelectric activity of forearm muscles, and wrist posture, measured with goniometers. Inter-observer repeatability and validity were

  14. Inferior knee arterial endoluminal angioplasty in treating severe lower limb ischemia though the DEEP balloon catheter

    International Nuclear Information System (INIS)

    Objective: To evaluate the efficacy of inferior knee arterial endoluminal angioplasty for treating severe lower limb ischemia with the use of the DEEP balloon catheter. Methods: Eleven patients (17 limbs) with severe ischemia of lower extremities from August 2007 to April 2008 were retrospectively studied. All involved limbs suffered from rest pain including 6 limbs (6/17)complicated with ulcer, 2 (2/17) with toe gangrene or 3 (3/17)with both of the complaints. ABI (Ankle bxancial index) were 0.2-0.5 and 0.51-0.7 in 12 limbs and 5 limbs respectively, with average value 0.47. Results: The success rate of operation was 100% (17/17). Pain relieved obviously in 13 limbs (13/17) and reduced in 2 limbs (2/17). 2 limbs (2/17) still suffered from pain and underwent upper-knee amputation and other 2 with ulcerations(2/ 17)were healed. 3 (3/17) with toe gangrene underwent partial foot amputation, 1 with dried gangrene remained unchanged and the other was lost. Another one showed ulcer healed and toe was lost. Increase of ABI was more than 0.5 in 10 limbs(10/17) and 0.3-0.5 in 5 limbs(5/17) with average value of 0.83. 10 patients with sixteen limbs were followed up in an average period of 4.3 months (1-9 months). Of the 15 immediate pain-relieved limbs, 12(12/15) limbs remained free of pain and pain recurred in 3 other limbs; and 2 of them with pain-reduced after PTA again; the other 1 underwent amputation, Average value of ABI was 0.70. Conclusions: Inferior arterial endoluminal angioplasty for the treatment of severe limb ischemia with application of the DEEP balloon catheter show high successful rate and short-term encouraging clinical results but mid-term and long-terms follow up should be undertaken for further investigation. (authors)

  15. Use of pedicled latissimus dorsi myocutaneous flap to reconstruct the upper limb with large soft tissue defects

    Institute of Scientific and Technical Information of China (English)

    QU Zhi-gang; LIU Yu-jie; HE Xu; DING Xiao-hen; FANG Guan-grong

    2012-01-01

    Objective:To report the technique of reconstruction of large skin and soft tissue defects in the upper extremity using pedicled latissimus dorsi myocutaneous flaps.Methods:Six patients with large skin and soft tissue defects were included in this report.There were 5 trauma patients and the rest one needed to receive plastic surgery for his extremity scar.All wounds were in the upper extremity.The sizes of defects ranged from 15 cm×6 cm to 30 cm× 18 cm.Pedicled latissimus dorsi myocutaneous flaps were designed according to the defect area and raised with part of latissimus dorsi.The thoracodorsal artery and its perforators were carefully protected during surgery.Results:All flaps healed primarily without flap congestion,margin necrosis or infection.The skin donor sites either received split-thickness skin graft (3 cases,mostly from the anterior thigh) or was closed primarily (3 cases)and had minimal morbidity.Follow-up of 6-12 months showed that the contour of flap was aesthetic and the function of limb was excellent.Conclusion:Our experience indicates that the pedicled latissimus dorsi myocutaneous flap is favorable for reconstruction of large skin and soft tissue defects in the upper extremity.

  16. Indocyanine green (ICG lymphography is superior to lymphoscintigraphy for diagnostic imaging of early lymphedema of the upper limbs.

    Directory of Open Access Journals (Sweden)

    Makoto Mihara

    Full Text Available BACKGROUND: Secondary lymphedema causes swelling in limbs due to lymph retention following lymph node dissection in cancer therapy. Initiation of treatment soon after appearance of edema is very important, but there is no method for early diagnosis of lymphedema. In this study, we compared the utility of four diagnostic imaging methods: magnetic resonance imaging (MRI, computed tomography (CT, lymphoscintigraphy, and Indocyanine Green (ICG lymphography. PATIENTS AND METHODS: Between April 2010 and November 2011, we examined 21 female patients (42 arms with unilateral mild upper limb lymphedema using the four methods. The mean age of the patients was 60.4 years old (35-81 years old. Biopsies of skin and collecting lymphatic vessels were performed in 7 patients who underwent lymphaticovenous anastomosis. RESULTS: The specificity was 1 for all four methods. The sensitivity was 1 in ICG lymphography and MRI, 0.62 in lymphoscintigraphy, and 0.33 in CT. These results show that MRI and ICG lymphography are superior to lymphoscintigraphy or CT for diagnosis of lymphedema. In some cases, biopsy findings suggested abnormalities in skin and lymphatic vessels for which lymphoscintigraphy showed no abnormal findings. ICG lymphography showed a dermal backflow pattern in these cases. CONCLUSIONS: Our findings suggest the importance of dual diagnosis by examination of the lymphatic system using ICG lymphography and evaluation of edema in subcutaneous fat tissue using MRI.

  17. Potential of robots as next-generation technology for clinical assessment of neurological disorders and upper-limb therapy

    Directory of Open Access Journals (Sweden)

    Stephen H. Scott, PhD

    2011-05-01

    Full Text Available Robotic technologies have profoundly affected the identification of fundamental properties of brain function. This success is attributable to robots being able to control the position of or forces applied to limbs, and their inherent ability to easily, objectively, and reliably quantify sensorimotor behavior. Our general hypothesis is that these same attributes make robotic technologies ideal for clinically assessing sensory, motor, and cognitive impairments in stroke and other neurologi-cal disorders. Further, they provide opportunities for novel therapeutic strategies. The present opinionated review describes how robotic technologies combined with virtual/augmented reality systems can support a broad range of behavioral tasks to objectively quantify brain function. This information could potentially be used to provide more accurate diagnostic and prognostic information than is available from current clinical assessment techniques. The review also highlights the potential benefits of robots to provide upper-limb therapy. Although the capital cost of these technologies is substantial, it pales in comparison with the potential cost reductions to the overall healthcare system that improved assessment and therapeutic interventions offer.

  18. Psychophysical correlates of phantom limb experience.

    OpenAIRE

    Katz, J

    1992-01-01

    Phantom limb phenomena were correlated with psychophysiological measures of peripheral sympathetic nervous system activity measured at the amputation stump and contralateral limb. Amputees were assigned to one of three groups depending on whether they reported phantom limb pain, non-painful phantom limb sensations, or no phantom limb at all. Skin conductance and skin temperature were recorded continuously during two 30 minute sessions while subjects continuously monitored and rated the intens...

  19. Interrater reliability of the Melbourne Assessment of Unilateral Upper Limb Function for children with hemiplegic cerebral palsy.

    LENUS (Irish Health Repository)

    Spirtos, Michelle

    2012-02-01

    OBJECTIVE: We examined the interrater reliability of the Melbourne Assessment of Unilateral Upper Limb Function. METHOD: Three occupational therapists independently scored 34 videotaped assessments of children with hemiplegic cerebral palsy aged 6 yr, 1 mo, to 14 yr, 5 mo. Intraclass correlation coefficients (ICCs) at a 95% confidence interval were calculated for total scores, category scores, and item scores. RESULTS: The correlation between raters\\' total scores was high (ICC = .961). The highest correlation for test components between raters was found for fluency (ICC = .902), followed by range of movement (ICC = .866), and the lowest correlation was found for quality of movement (ICC = .683). The ICCs for individual test item scores varied and ranged from .368 to .899. CONCLUSION: This study demonstrated high interrater reliability for total scores, with scoring of some individual components and items requiring further consideration from both a clinical and a research perspective.

  20. A decision-theoretic approach in the design of an adaptive upper-limb stroke rehabilitation robot.

    Science.gov (United States)

    Huq, Rajibul; Kan, Patricia; Goetschalckx, Robby; Hébert, Debbie; Hoey, Jesse; Mihailidis, Alex

    2011-01-01

    This paper presents an automated system for a rehabilitation robotic device that guides stroke patients through an upper-limb reaching task. The system uses a partially observable Markov decision process (POMDP) as its primary engine for decision-making. The POMDP allows the system to automatically modify exercise parameters to account for the specific needs and abilities of different individuals, and to use these parameters to take appropriate decisions about stroke rehabilitation exercises. The performance of the system was evaluated through various simulations and by comparing the decisions made by the system with those of a human therapist for a single patient. In general, the simulations showed promising results and the therapist thought the system decisions were believable. PMID:22275621

  1. Restoration of Upper Limb Function in an Individual with Cervical Spondylotic Myelopathy using Functional Electrical Stimulation Therapy: A Case Study.

    Science.gov (United States)

    Popovic, Milos R; Zivanovic, Vera; Valiante, Taufik A

    2016-01-01

    Non-traumatic spinal cord pathology is responsible for 25-52% of all spinal cord lesions. Studies have revealed that spinal stenosis accounts for 16-21% of spinal cord injury (SCI) admissions. Impaired grips as well as slow unskilled hand and finger movements are the most common complaints in patients with spinal cord disorders, such as myelopathy secondary to cervical spondylosis. In the past, our team carried out couple of successful clinical trials, including two randomized control trials, showing that functional electrical stimulation therapy (FEST) can restore voluntary reaching and/or grasping function, in people with stroke and traumatic SCI. Motivated by this success, we decided to examine changes in the upper limb function following FEST in a patient who suffered loss of hand function due to myelopathy secondary to cervical spondylosis. The participant was a 61-year-old male who had C3-C7 posterior laminectomy and instrumented fusion for cervical myelopathy. The participant presented with progressive right hand weakness that resulted in his inability to voluntarily open and close the hand and to manipulate objects unilaterally with his right hand. The participant was enrolled in the study ~22 months following initial surgical intervention. Participant was assessed using Toronto Rehabilitation Institute's Hand Function Test (TRI-HFT), Action Research Arm Test (ARAT), Functional Independence Measure (FIM), and Spinal Cord Independence Measure (SCIM). The pre-post differences in scores on all measures clearly demonstrated improvement in voluntary hand function following 15 1-h FEST sessions. The changes observed were meaningful and have resulted in substantial improvement in performance of activities of daily living. These results provide preliminary evidence that FEST has a potential to improve upper limb function in patients with non-traumatic SCI, such as myelopathy secondary to cervical spondylosis. PMID:27375547

  2. An investigation of somatosensory profiles in work related upper limb disorders: a case-control observational study protocol.

    LENUS (Irish Health Repository)

    Moloney, Niamh

    2010-01-01

    BACKGROUND: Work related upper limb disorders constitute 45% of all occupational diseases and are a significant public health problem. A subgroup, non specific arm pain (NSAP), remains elusive in terms of understanding its pathophysiological mechanisms with its diagnosis based on the absence of specific clinical findings. One commonly proposed theory is that a neural tissue disorder is the primary dysfunction in NSAP and findings from previous studies lend some support to this theory. However, it is not clear if changes identified are simply a consequence of ongoing pain rather than due to specific neural changes. The presence of neuropathic pain has been investigated in several other musculoskeletal conditions but currently, there is no specific diagnostic tool or gold standard which permits an unequivocal diagnosis of neuropathic pain. The purpose of this study is to further describe the somatosensory profiles in patients with NSAP and to compare these profiles to a group of patients with MRI confirmed cervical radiculopathy who have been previously classified as having neuropathic pain. METHODS\\/DESIGN: Three groups of participants will be investigated: Groups 1 and 2 will be office workers with either NSAP or cervical radiculopathy and Group 3 will be a control group of non office workers without upper limb pain. Participants will undergo a clinical assessment, pain questionnaires (LANSS, Short Form McGill, DASH and TSK) and quantitative sensory testing comprising thermal detection and pain thresholds, vibration thresholds and pressure pain thresholds. DISCUSSION: The spectrum of clinically suspected neuropathic pain ranges from more obvious conditions such as trigeminal neuralgia to those with vague signs of nerve disorder such as NSAP. A thorough description of the somatosensory profiles of NSAP patients and a comparison with a more defined group of patients with evidence of neuropathic pain will help in the understanding of underlying neurophysiology in

  3. Motor and parietal cortex stimulation for phantom limb pain and sensations.

    Science.gov (United States)

    Bolognini, Nadia; Olgiati, Elena; Maravita, Angelo; Ferraro, Francesco; Fregni, Felipe

    2013-08-01

    Limb amputation may lead to chronic painful sensations referred to the absent limb, ie phantom limb pain (PLP), which is likely subtended by maladaptive plasticity. The present study investigated whether transcranial direct current stimulation (tDCS), a noninvasive technique of brain stimulation that can modulate neuroplasticity, can reduce PLP. In 2 double-blind, sham-controlled experiments in subjects with unilateral lower or upper limb amputation, we measured the effects of a single session of tDCS (2 mA, 15 min) of the primary motor cortex (M1) and of the posterior parietal cortex (PPC) on PLP, stump pain, nonpainful phantom limb sensations and telescoping. Anodal tDCS of M1 induced a selective short-lasting decrease of PLP, whereas cathodal tDCS of PPC induced a selective short-lasting decrease of nonpainful phantom sensations; stump pain and telescoping were not affected by parietal or by motor tDCS. These findings demonstrate that painful and nonpainful phantom limb sensations are dissociable phenomena. PLP is associated primarily with cortical excitability shifts in the sensorimotor network; increasing excitability in this system by anodal tDCS has an antalgic effect on PLP. Conversely, nonpainful phantom sensations are associated to a hyperexcitation of PPC that can be normalized by cathodal tDCS. This evidence highlights the relationship between the level of excitability of different cortical areas, which underpins maladaptive plasticity following limb amputation and the phenomenology of phantom limb, and it opens up new opportunities for the use of tDCS in the treatment of PLP. PMID:23707312

  4. A modified scintigrafic technique for amputation level selection in diabetics

    International Nuclear Information System (INIS)

    A modified 123I-antipyrine cutaneous washout technique for the selection of amputation levels is described. The modifications imply a reduction of time needed for the examination by simultaneous recordings on different levels, and a better patient acceptance by reducing inconvenience. Furthermore, both skin perfusion pressure (SPP) and skin blood flow (SBF) are determined from each clearance curve. In a prospective study among 26 diabetic patients presenting with ulcers or gangrene of the foot, both SPP and SBF were determined preoperatively on the selected level of surgery and on adjacent amputation sites. These 26 patients underwent 12 minor foot amputations and 17 major lower limb amputations. Two of these amputations failed to heal. SBF values appeared indicative for the degree of peripheral vascular disease, as low SBF values were found with low SPP values. SPP determinations revealed good predictive values: All surgical procedures healed when SPP>20 mmHg, but 2 out of 3 failed when SPP<2 mmHg. If SPP values would have been decisive, the amputation would have been converted to a lower level in 6 out of 17 cases. This modified scintigrafic technique provides accurate objective information for amputation level selection. (orig.)

  5. Epidemiological Study on Reasons for Leg Amputation in Japanese

    OpenAIRE

    Hayashi, Yoshitaka; IMAKI, Masahide; Ogawa, Yukiko; FUCHOKA, Satoshi; OKUDA, Kuniharu

    2006-01-01

    This study was conducted, with special reference to elucidating the causes for lower limb amputation, which would have the most significant effect on "locomotion", the basis of independence of the aged. The subjects were leg amputees for whom artificial limbs had been fitted financed by various insurance policies in Osaka prefecture. The survey was conducted on 3, 138 subjects, from whom acceptable responses were obtained from 1, 460 (recovery rate, 46.5%). Questionnaires were mailed to each ...

  6. Disappearance of “phantom limb” and amputated arm usage during dreaming in REM sleep behaviour disorder

    OpenAIRE

    Vetrugno, Roberto; Arnulf, Isabelle; Montagna, Pasquale

    2009-01-01

    Limb amputation is followed, in approximately 90% of patients, by “phantom limb” sensations during wakefulness. When amputated patients dream, however, the phantom limb may be present all the time, part of the time, intermittently or not at all. Such dreaming experiences in amputees have usually been obtained only retrospectively in the morning and, moreover, dreaming is normally associated with muscular atonia so the motor counterpart of the phantom limb experience cannot be observed directl...

  7. Biodynamic characteristics of upper limb reaching movements of the seated human under whole-body vibration.

    Science.gov (United States)

    Kim, Heon-Jeong; Martin, Bernard J

    2013-02-01

    Simulation of human movements is an essential component for proactive ergonomic analysis and biomechanical model development (Chaffin, 2001). Most studies on reach kinematics have described human movements in a static environment, however the models derived from these studies cannot be applied to the analysis of human reach movements in vibratory environments such as in-vehicle operations. This study analyzes three-dimensional joint kinematics of the upper extremity in reach movements performed in static and specific vibratory conditions and investigates vibration transmission to shoulder, elbow, and hand along the body path during pointing tasks. Thirteen seated subjects performed reach movements to five target directions distributed in their right hemisphere. The results show similarities in the characteristics of movement patterns and reach trajectories of upper body segments for static and dynamic environments. In addition, vibration transmission through upper body segments is affected by vibration frequency, direction, and location of the target to be reached. Similarities in the pattern of movement trajectories revealed by filtering vibration-induced oscillations indicate that coordination strategy may not be drastically different in static and vibratory environments. This finding may facilitate the development of active biodynamic models to predict human performance and behavior under whole body vibration exposure. PMID:22814094

  8. Treatment of keloid in upper limb by combined surgical excision and immediate postoperative electron beam irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Shimada, Kenichi; Yoshida, Jun; Heshiki, Takaya; Ishikura, Naotaka; Kawakami, Shigehiko [Kanazawa Medical Univ., Uchinada, Ishikawa (Japan)

    2002-02-01

    A scar in the upper extremities sometimes leads to onset of keloid, whose treatment is difficult and many treatment methods have been tried. Recently our hospital has performed electron beam radiation for treatment of keloid. In this report, we describe our examination on patients with keloid in the upper extremities who visited our hospital and underwent electron beam irradiation in these past 7 years. The patients were 9 males and 15 females, age between 9 and 84 (average age 26.6 years). Treatments included the following: Total ablation of keloid plus electron beam radiation, electron beam radiation alone, localized administration of triamcinolone. Treatment evaluation and presence or absence of pigmentation was examined. Electron beam radiation was performed with a total of 25 Gy for consecutive 5 days by 5 Gy electron beam since 1 week after keloid ablation with sufficient informed consent. Onset site of 24 patients with keloid in the upper extremities was the shoulder in 12 patients, the upper arm in 11, and the elbow in one patient. Development cause was BCG inoculation in 8 patients, wound associated with surgery in 6, unknown cause in 6, and others in 4 patients. The number of patients who were followed-up after treatment was 16 for each examination respectively, and mean followed-up period was 2 years and 10 months. Postoperative evaluation for ablation plus electron beam was good in 1 patient and fair in 6, that for electron beam radiation alone was good in 1, fair in 2, and unknown in 2, and that for triamcinolone was fair in 2, poor in 4, and unknown in 1 patient. Postoperative pigmentation was observed in all the patients immediately after radiation, and at the time of final follow-up, in 6 (33%) out of 9 patients confirmed. Ablation plus electron beam irradiation for keloid in the upper extremities was effective. However, this treatment cannot avoid a possibility of cancerogenesis. Thus, sufficient explanation and consent may be essential after full

  9. Pattern recognition control outperforms conventional myoelectric control in upper limb patients with targeted muscle reinnervation.

    Science.gov (United States)

    Hargrove, Levi J; Lock, Blair A; Simon, Ann M

    2013-01-01

    Pattern recognition myoelectric control shows great promise as an alternative to conventional amplitude based control to control multiple degree of freedom prosthetic limbs. Many studies have reported pattern recognition classification error performances of less than 10% during offline tests; however, it remains unclear how this translates to real-time control performance. In this contribution, we compare the real-time control performances between pattern recognition and direct myoelectric control (a popular form of conventional amplitude control) for participants who had received targeted muscle reinnervation. The real-time performance was evaluated during three tasks; 1) a box and blocks task, 2) a clothespin relocation task, and 3) a block stacking task. Our results found that pattern recognition significantly outperformed direct control for all three performance tasks. Furthermore, it was found that pattern recognition was configured much quicker. The classification error of the pattern recognition systems used by the patients was found to be 16% ±(1.6%) suggesting that systems with this error rate may still provide excellent control. Finally, patients qualitatively preferred using pattern recognition control and reported the resulting control to be smoother and more consistent. PMID:24110008

  10. Enhancements in lower stratospheric CH3CN observed by the upper atmosphere research Sattellite Microwave Limb Sounder following boreal forest fires

    Science.gov (United States)

    Livesey, N. J.; Fromm, M. D.; Waters, J. W.; Manney, G. L.; Santee, M. L.; Read, W. G.

    2004-01-01

    On 25 August 1992, the Microwave Limb Sounder (MLS) on the Upper Atmosphere Research Satellite observed a significant enhancement in the abundance of lower stratospheric methyl cyanide (CH3CN) at 100??hPa (16??km altitude) in a small region off the east coast of Florida.

  11. Comparative Study of Motor Performance of Deaf and Hard of Hearing Students in Reaction Time, Visual-Motor Control and Upper Limb Speed and Dexterity Abilities

    Science.gov (United States)

    Gkouvatzi, Anastasia N.; Mantis, Konstantinos; Kambas, Antonis

    2010-01-01

    Using the Bruininks-Oseretsky Test the motor performance of 34 deaf--hard-of-hearing pupils, 6-14 year, was evaluated in reaction time, visual-motor control and upper limb speed and dexterity. The two-way ANOVA variance analysis for two independent variables, group, age, and the Post Hoc (Scheffe test) for multiple comparisons were used. The…

  12. Assessment of Body-Powered Upper Limb Prostheses by Able-Bodied Subjects, using the Box and Blocks Test and the Nine Hole Peg Test

    NARCIS (Netherlands)

    Haverkate, L.; Smit, G.; Plettenburg, D.H.

    2014-01-01

    Study Design: Experimental trial. Background: The functional performance of currently available body-powered prostheses is unknown. Objective: The goal of this study was to objectively assess and compare the functional performance of three commonly used body-powered upper limb terminal devices. Meth

  13. Epidemiology of work related neck and upper limb problems: Psychosocial and personal risk factors (Part I) and effective interventions from a bio behavioural perspective (Part II)

    NARCIS (Netherlands)

    Bongers, P.M.; IJmker, S.; Heuvel, S. van den; Blatter, B.M.

    2006-01-01

    Work related neck and upper limb symptoms have a multi-factorial origin. Possible risk factors are of a physical, psychosocial or personal origin. These factors can reinforce each other and their influence can also be mediated by cultural or societal factors. Initially, most research on neck and upp

  14. The Profile of Patients and Current Practice of Treatment of Upper Limb Muscle Spasticity with Botulinum Toxin Type A: An International Survey

    Science.gov (United States)

    Bakheit, Abdel Magid

    2010-01-01

    To document the current practice in relation with the treatment of patients with upper limb spasticity with botulinum toxin type A to inform future research in this area. We designed an international, cross-sectional, noninterventional survey of current practice. Nine hundred and seventy-four patients from 122 investigational centres in 31…

  15. Notes to Parents - When Your Child Has Undergone Amputation.

    Science.gov (United States)

    Pierson, Margaret Hauser

    Designed to provide parents with basic information about the physical and emotional aspects of amputation, the booklet gives information about the grief response, body image, phantom limb sensation, stump care, and the prosthesis. The section on the grief process describes normal reactions to loss: denial, anger, bargaining, depression, and…

  16. The accuracy of conventional 2D video for quantifying upper limb kinematics in repetitive motion occupational tasks.

    Science.gov (United States)

    Chen, Chia-Hsiung; Azari, David P; Hu, Yu Hen; Lindstrom, Mary J; Thelen, Darryl; Yen, Thomas Y; Radwin, Robert G

    2015-01-01

    Marker-less 2D video tracking was studied as a practical means to measure upper limb kinematics for ergonomics evaluations. Hand activity level (HAL) can be estimated from speed and duty cycle. Accuracy was measured using a cross-correlation template-matching algorithm for tracking a region of interest on the upper extremities. Ten participants performed a paced load transfer task while varying HAL (2, 4, and 5) and load (2.2 N, 8.9 N and 17.8 N). Speed and acceleration measured from 2D video were compared against ground truth measurements using 3D infrared motion capture. The median absolute difference between 2D video and 3D motion capture was 86.5 mm/s for speed, and 591 mm/s(2) for acceleration, and less than 93 mm/s for speed and 656 mm/s(2) for acceleration when camera pan and tilt were within ± 30 degrees. Single-camera 2D video had sufficient accuracy (tracking had sufficient accuracy to measure HAL for ascertaining the American Conference of Government Industrial Hygienists Threshold Limit Value(®) for repetitive motion when the camera is located within ± 30 degrees off the plane of motion when compared against 3D motion capture for a simulated repetitive motion task. PMID:25978764

  17. Diabetic Complications and Amputation Prevention

    Science.gov (United States)

    ... Prevention Text Size Print Bookmark Diabetic Complications and Amputation Prevention People with diabetes are prone to having ... complication is so severe that surgery, and occasionally amputation, may become necessary. Poor blood flow. In diabetes, ...

  18. Prediction of Upper Limb Motor Recovery after Subacute Ischemic Stroke Using Diffusion Tensor Imaging: A Systematic Review and Meta-Analysis

    Science.gov (United States)

    Kumar, Pradeep; Kathuria, Prachi; Nair, Pallavi; Prasad, Kameshwar

    2016-01-01

    Early evaluation of the pyramidal tract using Diffusion Tensor Imaging (DTI) is a prerequisite to decide the optimal treatment or to assess appropriate rehabilitation. The early predictive value of DTI for assessing motor and functional recovery in ischemic stroke (IS) has yielded contradictory results. The purpose is to systematically review and summarize the current available literature on the value of Fractional Anisotropy (FA) parameter of the DTI in predicting upper limb motor recovery after sub-acute IS. MEDLINE, PubMed, EMBASE, Google Scholar and Cochrane CENTRAL searches were conducted from January 1, 1950, to July 31, 2015, which was supplemented with relevant articles identified in the references. Correlation between FA and upper limb motor recovery measure was done. Heterogeneity was examined using Higgins I-squared, Tau-squared. Summary of correlation coefficient was determined using Random Effects model. Out of 166 citations, only eleven studies met the criteria for inclusion in the systematic review and six studies were included in the meta-analysis. A random effects model revealed that DTI parameter FA is a significant predictor for upper limb motor recovery after sub-acute IS [Correlation Coefficient=0.82; 95% Confidence Interval-0.66 to 0.90, P value<0.001]. Moderate heterogeneity was observed (Tau-squared=0.12, I-squared=62.14). The studies reported so far on correlation between DTI and upper limb motor recovery are few with small sample sizes. This meta-analysis suggests strong correlation between DTI parameter FA and upper limb motor recovery. Well-designed prospective trials embedded with larger sample size are required to establish these findings. PMID:26846758

  19. Experience of using vascularized bone grafts in reconstructive surgery of the upper limbs

    Science.gov (United States)

    Atamanov, E. A.; Keosyan, V. T.; Bryukhanov, A. V.; Tsaregorodtseva, E. M.; Danilov, A. V.

    2015-11-01

    The article describes the results of treatment patients with defects and diseases of bone tissue using bone grafting with vascularized bone grafts from different areas of the body. The results of treatment of 27 patients with bone tissue defects of the upper extremities are demonstrated. 16 of patients had scaphoid nonunion. 2 cases of nonunion were reported: one scaphoid nonunion due to unstable osteosynthesis and one lunate fragmentation nonunion in patient with late stage Kienbock`s disease. Vascularized bone graft from distal radius was used in both cases. We had two cases of delayed union at 18 months in surgical treatment of scaphoid. 2 patients had metacarpal bone defect, 1 patient with radius bone defect, 2 patients with SLAC (scapholunate advanced collapse), 2 patients with bone defect of the humerus, 1 patient with bone defect of the ulna. In all cases we used vascularized bone crafts from various anatomical areas. We achieved union in all other cases. The study shows high efficiency of upper extremity bone defect replacement methods.

  20. The Relationship between Independent Transfer Skills and Upper Limb Kinetics in Wheelchair Users

    Directory of Open Access Journals (Sweden)

    Chung-Ying Tsai

    2014-01-01

    Full Text Available Transfers are one of the most physically demanding wheelchair activities. The purpose of this study was to determine if using proper transfer skills as measured by the Transfer Assessment Instrument (TAI is associated with reduced loading on the upper extremities. Twenty-three wheelchair users performed transfers to a level-height bench while a series of forces plates, load cells, and a motion capture system recorded the biomechanics of their natural transferring techniques. Their transfer skills were simultaneously evaluated by two study clinicians using the TAI. Logistic regression and multiple linear regression models were used to determine the relationships between TAI scores and the kinetic variables on both arms across all joints. The results showed that the TAI measured transfer skills were closely associated with the magnitude and timing of joint moments (P<.02, model R2 values ranged from 0.27 to 0.79. Proper completion of the skills which targeted the trailing arm was associated with lower average resultant moments and rates of rise of resultant moments at the trailing shoulder and/or elbow. Some skills involving the leading side had the effect of increasing the magnitude or rate loading on the leading side. Knowledge of the kinetic outcomes associated with each skill may help users to achieve the best load-relieving effects for their upper extremities.

  1. Effect of primary and secondary wartime below-knee amputation on length of hospitalization and rehabilitation

    Directory of Open Access Journals (Sweden)

    Jandrić Slavica

    2002-01-01

    Full Text Available The results of below-knee amputations in 36 war wounded (mean age 35,42 were reviewed. The majority of the patients was wounded by land mines (94.4%. Most of them were between 25 and 35 years old. Bilateral amputation was done in 2.8% of cases. The amputation was performed on the day of wounding (primary below-knee amputation in 30 (83.3% amputees. Secondary amputation after the attempt to save the severely injured lower-limb was performed in 6 patients (16,7% average 4.61 ± 11.67 days after wounding. Reamputation was necessary in 6 cases (16.7%. Time period from the beginning of rehabilitation to the fitting of prosthesis, was 36.25 ± 14.97 days for primary amputations, 32 ± 17.8 days for secondary amputations and 68.66 ± 33.52 days for reamputations. There was no significant correlation between the duration of rehabilitation to prosthetic management and the period between wounding and amputation (r = -0.102. The attempt to save the limb after severe below-knee injuries and the secondary amputation afterwards, did not significantly influence the ensuing rehabilitation and prosthetic works.

  2. Epidemiology of leg amputation

    DEFF Research Database (Denmark)

    Ebskov, L B; Schroeder, T V; Holstein, P E

    1994-01-01

    The number of amputations performed for vascular disease in Denmark has decreased from 1777 (34.5 per 100,000 population) in 1983 to 1288 (25.0 per 100,000) in 1990, a reduction of 28 per cent. This decline coincided with an increase in vascular surgical activity of up to 100 per cent, including ...

  3. Robot-aided therapy for upper limbs in patients with stroke-related lesions. Brief report of a clinical experience

    Directory of Open Access Journals (Sweden)

    Dall'Armi Valentina

    2011-04-01

    Full Text Available Abstract This study was aimed at verifying the improvement on the motor impairment and functionality in 19 patients with chronic hemiparesis after stroke treated with a robot-aided rehabilitation protocol using the ReoGo™ system (Motorika Medical Ltd, Israel, and at evaluating the persistence of the effects after 1 month. The study also focused on the actual possibility of administering the robot-aided therapy with the ReoGo™ for the upper limbs and on the patients' degree of acceptance and compliance with the treatment. Subjects underwent an assessment prior to the start of the rehabilitation project (T-1, one at the start (T0, one at the end of the treatment (T1 and one after one month from the end of the treatment (T2. The following tests were administered: (i Fugl-Meyer (FM upper limb; Ashworth scale (AS; Functional Independence Measure (FIM™ (T-1 - T2; (ii strength evaluation; Visual Analogue Scale (VAS for pain; Frenchay Arm test (FAT; Box and Block test (BBT; Timed Up and Go (TUG test (T0 - T2. Additionally, the Euro-QoL questionnaire and a VAS for the treatment satisfaction were administered to the subjects. Non-statistical difference of scores at T-1 and T0 on almost the entire battery of tasks suggested a stable patients' performance prior to the start of the rehabilitation. With the exception of the Medical Research Council (MRC and the AS sub-scales measuring -as appropriate- strength and spasticity of the shoulder, triceps and wrist, all scores showed a significant increase between T0 and T1. The improvement on the pain could not be proved significant (p = 0.10. A significant increase between T0 and T2 was found for all assessment scores, with the exception of the MRC for external shoulder rotators (p = 0.05 and of the AS for shoulder (p = 0.32 and wrist (p = 0.08. Substantial stability was observed between T1 and T2. Patients were capable of completing the treatment and showed good participant satisfaction. This pilot study

  4. Upper limb children action-observation training (UP-CAT: a randomised controlled trial in Hemiplegic Cerebral Palsy

    Directory of Open Access Journals (Sweden)

    Biagi Laura

    2011-06-01

    Full Text Available Abstract Background Rehabilitation for children with hemiplegic cerebral palsy (HCP aimed to improve function of the impaired upper limb (UL uses a wide range of intervention programs. A new rehabilitative approach, called Action-Observation Therapy, based on the recent discovery of mirror neurons, has been used in adult stroke but not in children. The purpose of the present study is to design a randomised controlled trial (RCT for evaluating the efficacy of Action-Observation Therapy in improving UL activity in children with HCP. Methods/Design The trial is designed according to CONSORT Statement. It is a randomised, evaluator-blinded, match-pair group trial. Children with HCP will be randomised within pairs to either experimental or control group. The experimental group will perform an Action-Observation Therapy, called UP-CAT (Upper Limb-Children Action-Observation Training in which they will watch video sequences showing goal-directed actions, chosen according to children UL functional level, combined with motor training with their hemiplegic UL. The control group will perform the same tailored actions after watching computer games. A careful revision of psychometric properties of UL outcome measures for children with hemiplegia was performed. Assisting Hand Assessment was chosen as primary measure and, based on its calculation power, a sample size of 12 matched pairs was established. Moreover, Melbourne and ABILHAND-Kids were included as secondary measures. The time line of assessments will be T0 (in the week preceding the onset of the treatment, T1 and T2 (in the week after the end of the treatment and 8 weeks later, respectively. A further assessment will be performed at T3 (24 weeks after T1, to evaluate the retention of effects. In a subgroup of children enrolled in both groups functional Magnetic Resonance Imaging, exploring the mirror system and sensory-motor function, will be performed at T0, T1 and T2. Discussion The paper aims to

  5. Characterization of age-related modifications of upper limb motor control strategies in a new dynamic environment

    Directory of Open Access Journals (Sweden)

    Dario Paolo

    2008-11-01

    Full Text Available Abstract Background In the past, several research groups have shown that when a velocity dependent force field is applied during upper limb movements subjects are able to deal with this external perturbation after some training. This adaptation is achieved by creating a new internal model which is included in the normal unperturbed motor commands to achieve good performance. The efficiency of this motor control mechanism can be compromised by pathological disorders or by muscular-skeletal modifications such as the ones due to the natural aging process. In this respect, the present study aimed at identifying the age-related modifications of upper limb motor control strategies during adaptation and de-adaptation processes in velocity dependent force fields. Methods Eight young and eight elderly healthy subjects were included in the experiment. Subjects were instructed to perform pointing movements in the horizontal plane both in a null field and in a velocity dependent force field. The evolution of smoothness and hand path were used to characterize the performance of the subjects. Furthermore, the ability of modulating the interactive torque has been used as a paradigm to explain the observed discoordinated patterns during the adaptation process. Results The evolution of the kinematics during the experiments highlights important behavioural differences between the two groups during the adaptation and de-adaptation processes. In young subjects the improvement of movement smoothness was in accordance with the expected learning trend related to the consolidation of the internal model. On the contrary, elders did not show a coherent learning process. The kinetic analysis pointed out the presence of different strategies for the compensation of the external perturbation: older people required an increased involvement of the shoulder with a different modulation of joint torque components during the evolution of the experiments. Conclusion The results

  6. Reliability of the mangled extremity severity score in combat-related upper and lower extremity injuries

    Directory of Open Access Journals (Sweden)

    Tolga Ege

    2015-01-01

    Full Text Available Background: Decision of limb salvage or amputation is generally aided with several trauma scoring systems such as the mangled extremity severity score (MESS. However, the reliability of the injury scores in the settling of open fractures due to explosives and missiles is challenging. Mortality and morbidity of the extremity trauma due to firearms are generally associated with time delay in revascularization, injury mechanism, anatomy of the injured site, associated injuries, age and the environmental circumstance. The purpose of the retrospective study was to evaluate the extent of extremity injuries due to ballistic missiles and to detect the reliability of mangled extremity severity score (MESS in both upper and lower extremities. Materials and Methods: Between 2004 and 2014, 139 Gustillo Anderson Type III open fractures of both the upper and lower extremities were enrolled in the study. Data for patient age, fire arm type, transporting time from the field to the hospital (and the method, injury severity scores, MESS scores, fracture types, amputation levels, bone fixation methods and postoperative infections and complications retrieved from the two level-2 trauma center's data base. Sensitivity, specificity, positive and negative predictive values of the MESS were calculated to detect the ability in deciding amputation in the mangled limb. Results: Amputation was performed in 39 extremities and limb salvage attempted in 100 extremities. The mean followup time was 14.6 months (range 6–32 months. In the amputated group, the mean MESS scores for upper and lower extremity were 8.8 (range 6–11 and 9.24 (range 6–11, respectively. In the limb salvage group, the mean MESS scores for upper and lower extremities were 5.29 (range 4–7 and 5.19 (range 3–8, respectively. Sensitivity of MESS in upper and lower extremities were calculated as 80% and 79.4% and positive predictive values detected as 55.55% and 83.3%, respectively. Specificity of MESS

  7. Home-based Neurologic Music Therapy for Upper Limb Rehabilitation with Stroke Patients at Community Rehabilitation Stage - a Feasibility Study Protocol.

    Directory of Open Access Journals (Sweden)

    Alex J Street

    2015-09-01

    Full Text Available 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 months post stroke has been determined through clinical discussion between the researcher and study host in order to test for management, feasibility and effects, before planning a larger trial determined through power analysis. A cross-over design with five repeated measures will be used, whereby participants will be randomized into either a treatment (n=7 or wait list control (n=7 group. Intervention will take place twice weekly over 6 weeks. The ARAT and 9HPT will be used to measure for quantitative gains in arm function and finger dexterity, pre/post treatment interviews will serve to investigate treatment compliance and tolerance. A lab based EEG case comparison study will be undertaken to explore audio-motor coupling, brain connectivity and neural reorganization with this intervention, as evidenced in similar studies. Discussion: Before evaluating the effectiveness of a home-based intervention in a larger scale study, it is important to assess whether implementation of the trial methodology is feasible. This study investigates the feasibility, efficacy and patient experience of a music therapy treatment protocol comprising a chart of 12 different instrumental exercises and variations, which aims at promoting measurable changes in upper limb function in hemiparetic stroke patients. The study proposes to examine several new aspects including home-based treatment and dosage, and will provide data on recruitment, adherence and variability of outcomes.

  8. Event-related Potentials During Target-response Tasks to Study Cognitive Processes of Upper Limb Use in Children with Unilateral Cerebral Palsy

    Science.gov (United States)

    Zielinski, Ingar Marie; Steenbergen, Bert; Baas, C. Marjolein; Aarts, Pauline; Jongsma, Marijtje L. A.

    2016-01-01

    Unilateral Cerebral Palsy (CP) is a neurodevelopmental disorder that is a very common cause of disability in childhood. It is characterized by unilateral motor impairments that are frequently dominated in the upper limb. In addition to a reduced movement capacity of the affected upper limb, several children with unilateral CP show a reduced awareness of the remaining movement capacity of that limb. This phenomenon of disregarding the preserved capacity of the affected upper limb is regularly referred to as Developmental Disregard (DD). Different theories have been postulated to explain DD, each suggesting slightly different guidelines for therapy. Still, cognitive processes that might additionally contribute to DD in children with unilateral CP have never been directly studied. The current protocol was developed to study cognitive aspects involved in upper limb control in children with unilateral CP with and without DD. This was done by recording event-related potentials (ERPs) extracted from the ongoing EEG during target-response tasks asking for a hand-movement response. ERPs consist of several components, each of them associated with a well-defined cognitive process (e.g., the N1 with early attention processes, the N2 with cognitive control and the P3 with cognitive load and mental effort). Due to its excellent temporal resolution, the ERP technique enables to study several covert cognitive processes preceding overt motor responses and thus allows insight into the cognitive processes that might contribute to the phenomenon of DD. Using this protocol adds a new level of explanation to existing behavioral studies and opens new avenues to the broader implementation of research on cognitive aspects of developmental movement restrictions in children. PMID:26780483

  9. Combining Dopaminergic Facilitation with Robot-Assisted Upper Limb Therapy in Stroke Survivors

    Science.gov (United States)

    Tran, Duc A.; Pajaro-Blazquez, Marta; Daneault, Jean-Francois; Gallegos, Jaime G.; Pons, Jose; Fregni, Felipe; Bonato, Paolo; Zafonte, Ross

    2016-01-01

    ABSTRACT Despite aggressive conventional therapy, lasting hemiplegia persists in a large percentage of stroke survivors. The aim of this article is to critically review the rationale behind targeting multiple sites along the motor learning network by combining robotic therapy with pharmacotherapy and virtual reality–based reward learning to alleviate upper extremity impairment in stroke survivors. Methods for personalizing pharmacologic facilitation to each individual’s unique biology are also reviewed. At the molecular level, treatment with levodopa was shown to induce long-term potentiation-like and practice-dependent plasticity. Clinically, trials combining conventional therapy with levodopa in stroke survivors yielded statistically significant but clinically unconvincing outcomes because of limited personalization, standardization, and reproducibility. Robotic therapy can induce neuroplasticity by delivering intensive, reproducible, and functionally meaningful interventions that are objective enough for the rigors of research. Robotic therapy also provides an apt platform for virtual reality, which boosts learning by engaging reward circuits. The future of stroke rehabilitation should target distinct molecular, synaptic, and cortical sites through personalized multimodal treatments to maximize motor recovery. PMID:26829074

  10. Integrated vision-based robotic arm interface for operators with upper limb mobility impairments.

    Science.gov (United States)

    Jiang, Hairong; Wachs, Juan P; Duerstock, Bradley S

    2013-06-01

    An integrated, computer vision-based system was developed to operate a commercial wheelchair-mounted robotic manipulator (WMRM). In this paper, a gesture recognition interface system developed specifically for individuals with upper-level spinal cord injuries (SCIs) was combined with object tracking and face recognition systems to be an efficient, hands-free WMRM controller. In this test system, two Kinect cameras were used synergistically to perform a variety of simple object retrieval tasks. One camera was used to interpret the hand gestures to send as commands to control the WMRM and locate the operator's face for object positioning. The other sensor was used to automatically recognize different daily living objects for test subjects to select. The gesture recognition interface incorporated hand detection, tracking and recognition algorithms to obtain a high recognition accuracy of 97.5% for an eight-gesture lexicon. An object recognition module employing Speeded Up Robust Features (SURF) algorithm was performed and recognition results were sent as a command for "coarse positioning" of the robotic arm near the selected daily living object. Automatic face detection was also provided as a shortcut for the subjects to position the objects to the face by using a WMRM. Completion time tasks were conducted to compare manual (gestures only) and semi-manual (gestures, automatic face detection and object recognition) WMRM control modes. The use of automatic face and object detection significantly increased the completion times for retrieving a variety of daily living objects. PMID:24187264

  11. Combining Dopaminergic Facilitation with Robot-Assisted Upper Limb Therapy in Stroke Survivors: A Focused Review.

    Science.gov (United States)

    Tran, Duc A; Pajaro-Blazquez, Marta; Daneault, Jean-Francois; Gallegos, Jaime G; Pons, Jose; Fregni, Felipe; Bonato, Paolo; Zafonte, Ross

    2016-06-01

    Despite aggressive conventional therapy, lasting hemiplegia persists in a large percentage of stroke survivors. The aim of this article is to critically review the rationale behind targeting multiple sites along the motor learning network by combining robotic therapy with pharmacotherapy and virtual reality-based reward learning to alleviate upper extremity impairment in stroke survivors. Methods for personalizing pharmacologic facilitation to each individual's unique biology are also reviewed. At the molecular level, treatment with levodopa was shown to induce long-term potentiation-like and practice-dependent plasticity. Clinically, trials combining conventional therapy with levodopa in stroke survivors yielded statistically significant but clinically unconvincing outcomes because of limited personalization, standardization, and reproducibility. Robotic therapy can induce neuroplasticity by delivering intensive, reproducible, and functionally meaningful interventions that are objective enough for the rigors of research. Robotic therapy also provides an apt platform for virtual reality, which boosts learning by engaging reward circuits. The future of stroke rehabilitation should target distinct molecular, synaptic, and cortical sites through personalized multimodal treatments to maximize motor recovery. PMID:26829074

  12. [Outbreak of carpal tunnel syndrome of the upper limbs in automobile seat assemblers: results of exposure evaluation and clinical investigation].

    Science.gov (United States)

    Barbieri, P G; Colombini, D; Rocco, A; Custureri, F; Paderno, G

    1996-01-01

    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

  13. Upper-limb stroke rehabilitation using electrode-array based functional electrical stimulation with sensing and control innovations.

    Science.gov (United States)

    Kutlu, M; Freeman, C T; Hallewell, E; Hughes, A-M; Laila, D S

    2016-04-01

    Functional electrical stimulation (FES) has shown effectiveness in restoring upper-limb movement post-stroke when applied to assist participants' voluntary intention during repeated, motivating tasks. Recent clinical trials have used advanced controllers that precisely adjust FES to assist functional reach and grasp tasks with FES applied to three muscle groups, showing significant reduction in impairment. The system reported in this paper advances the state-of-the-art by: (1) integrating an FES electrode array on the forearm to assist complex hand and wrist gestures; (2) utilising non-contact depth cameras to accurately record the arm, hand and wrist position in 3D; and (3) employing an interactive touch table to present motivating virtual reality (VR) tasks. The system also uses iterative learning control (ILC), a model-based control strategy which adjusts the applied FES based on the tracking error recorded on previous task attempts. Feasibility of the system has been evaluated in experimental trials with 2 unimpaired participants and clinical trials with 4 hemiparetic, chronic stroke participants. The stroke participants attended 17, 1 hour training sessions in which they performed functional tasks, such as button pressing using the touch table and closing a drawer. Stroke participant results show that the joint angle error norm reduced by an average of 50.3% over 6 attempts at each task when assisted by FES. PMID:26947097

  14. Effect of position feedback during task-oriented upper-limb training after stroke: Five-case pilot study

    Directory of Open Access Journals (Sweden)

    Birgit I. Molier, MSc

    2011-11-01

    Full Text Available Feedback is an important element in motor learning during rehabilitation therapy following stroke. The objective of this pilot study was to better understand the effect of position feedback during task-oriented reach training of the upper limb in people with chronic stroke. Five subjects participated in the training for 30 minutes three times a week for 6 weeks. During training, subjects performed reaching movements over a predefined path. When deviation from this path occurred, shoulder and elbow joints received position feedback using restraining forces. We recorded the amount of position feedback used by each subject. During pre- and posttraining assessments, we collected data from clinical scales, isometric strength, and workspace of the arm. All subjects showed improvement on one or several kinematic variables during a circular motion task after training. One subject showed improvement on all clinical scales. Subjects required position feedback between 7.4% and 14.7% of training time. Although augmented feedback use was limited, kinematic outcome measures and movement performance during training increased in all subjects, which was comparable with other studies. Emphasis on movement errors at the moment they occur may possibly stimulate motor learning when movement tasks with sufficiently high levels of difficulty are applied.

  15. A New Calibration Methodology for Thorax and Upper Limbs Motion Capture in Children Using Magneto and Inertial Sensors

    Directory of Open Access Journals (Sweden)

    Luca Ricci

    2014-01-01

    Full Text Available Recent advances in wearable sensor technologies for motion capture have produced devices, mainly based on magneto and inertial measurement units (M-IMU, that are now suitable for out-of-the-lab use with children. In fact, the reduced size, weight and the wireless connectivity meet the requirement of minimum obtrusivity and give scientists the possibility to analyze children’s motion in daily life contexts. Typical use of magneto and inertial measurement units (M-IMU motion capture systems is based on attaching a sensing unit to each body segment of interest. The correct use of this setup requires a specific calibration methodology that allows mapping measurements from the sensors’ frames of reference into useful kinematic information in the human limbs’ frames of reference. The present work addresses this specific issue, presenting a calibration protocol to capture the kinematics of the upper limbs and thorax in typically developing (TD children. The proposed method allows the construction, on each body segment, of a meaningful system of coordinates that are representative of real physiological motions and that are referred to as functional frames (FFs. We will also present a novel cost function for the Levenberg–Marquardt algorithm, to retrieve the rotation matrices between each sensor frame (SF and the corresponding FF. Reported results on a group of 40 children suggest that the method is repeatable and reliable, opening the way to the extensive use of this technology for out-of-the-lab motion capture in children.

  16. Robot-assisted upper-limb therapy in acute rehabilitation setting following stroke: Department of Veterans Affairs multisite clinical trial.

    Science.gov (United States)

    Burgar, Charles G; Lum, Peter S; Scremin, A M Erika; Garber, Susan L; Van der Loos, H F Machiel; Kenney, Deborah; Shor, Peggy

    2011-01-01

    This randomized, controlled, multisite Department of Veterans Affairs clinical trial assessed robot-assisted (RA) upper-limb therapy with the Mirror Image Movement Enabler (MIME) in the acute stroke rehabilitation setting. Hemiparetic subjects (n = 54) received RA therapy using MIME for either up to 15 hours (low-dose) or 30 hours (high-dose) or received up to 15 hours of additional conventional therapy in addition to usual care (control). The primary outcome measure was the Fugl-Meyer Assessment (FMA). The secondary outcome measures were the Functional Independence Measure (FIM), Wolf Motor Function Test, Motor Power, and Ashworth scores at intake, discharge, and 6-month follow-up. Mean duration of study treatment was 8.6, 15.8, and 9.4 hours for the low-dose, high-dose, and control groups, respectively. Gains in the primary outcome measure were not significantly different between groups at follow-up. Significant correlations were found at discharge between FMA gains and the dose and intensity of RA. Intensity also correlated with FMA gain at 6 months. The high-dose group had greater FIM gains than controls at discharge and greater tone but no difference in FIM changes compared with low-dose subjects at 6 months. As used during acute rehabilitation, motor-control changes at follow-up were no less with MIME than with additional conventional therapy. Intensity of training with MIME was positively correlated with motor-control gains. PMID:21674393

  17. Multiple schwannomas of the upper limb related exclusively to the ulnar nerve in a patient with segmental schwannomatosis.

    Science.gov (United States)

    Molina, Alexandra R; Chatterton, Benjamin D; Kalson, Nicholas S; Fallowfield, Mary E; Khandwala, Asit R

    2013-12-01

    Schwannomas are benign encapsulated tumours arising from the sheaths of peripheral nerves. They present as slowly enlarging solitary lumps, which may cause neurological defects. Multiple lesions are rare, but occur in patients with neurofibromatosis type 2 or schwannomatosis. Positive outcomes have been reported for surgical excision in solitary schwannomas. However, the role of surgery in patients with multiple lesions is less clear. The risk of complications such as iatrogenic nerve injury and the high likelihood of disease recurrence mean that surgical intervention should be limited to the prevention of progressive neurological deficit. We report a case of a 45 year old male who presented with multiple enlarging masses in the upper limb and sensory deficit in the distribution of the ulnar nerve. The tumours were found to be related exclusively to the ulnar nerve during surgical exploration and excision, a rare phenomenon. The masses were diagnosed as schwannomas following histopathological analysis, allowing our patient to be diagnosed with the rare entity segmental schwannomatosis. One year post-operatively motor function was normal, but intermittent numbness still occurred. Two further asymptomatic schwannomas developed subsequently and were managed conservatively. PMID:23810216

  18. Role of ultrasound-guided continuous brachial plexus block in the management of neonatal ischemia in upper limb

    Directory of Open Access Journals (Sweden)

    Vrushali C Ponde

    2012-01-01

    Full Text Available Neonatal upper limb ischemia due to accidental arterial damage remains a major concern, which can lead to devastating complications if untreated. The primary objective of this case report is to emphasize the role of continuous infraclavicular brachial plexus block, the issues related with block performance in an ischemic hand, and the importance of ultrasound guidance in this particular case scenario. A 1.1 kg infant suffered from distal forearm ischemia due to accidental arterial damage, which was treated with brachial plexus block. An ultrasound-guided single shot block with 0.5 mL/kg of 0.25% bupivacaine was followed by ultrasound-guided catheter placement in the target area. A continuous infusion of 0.03% of bupivacaine at the rate of 0.5 mL/kg/hr (approx. 0.15 mg/kg/h of bupivacaine was administered for 36 h. This treatment resulted in reversal of ischemia. Permanent ischemic damage was eventually confined to the tips of 4 fingers. We conclude that ultrasound-guided continuous infraclavicular block has a therapeutic role to play in the treatment of hand ischemia due to arterial damage and subsequent arterial spasm in neonates with added benefits.

  19. Outcome of tissue sparing surgical intervention in mine blast limb injuries

    International Nuclear Information System (INIS)

    To describe the pattern of mine blast limb injuries in civilian population of Kashmir, to evaluate the outcome of tissue sparing surgical intervention in these injuries and to determine the sensitivity of hand-held percutaneous Doppler for tissue viability. One hundred and three patients who sustained mine blast injuries to upper or lower limbs, along side the line of control between the Indian-held Kashmir and Azad Kashmir, regardless of age and gender, were included in this study. Patients who already had amputation after injury at some other place were excluded. All patients were initially managed in emergency and had more than one surgical intervention. Transcutaneous Doppler was used to evaluate the vascularity of the remaining tissue. All patients were operated under spinal or general anaesthesia and had repeated debridements followed by skin cover by split skin graft, full thickness skin graft or rotational flaps. Every patient received at least 5 days course of antibiotics and tetanus prophylaxis. Postoperative rehabilitation and follow-up was conducted for at least 6 months after discharge from the hospital. Mean age of victims in this study was 22 years. Out of 103 patients, 72 (69.9%) received initial wound care in the peripheral primary health care centre but were not amputated while 31 patients (30%) were just dressed and referred for further treatment at tertiary care hospitals. Eighty five patients (82.5%), out of the total, had some sort of traumatic amputation at presentation due to the original injury. That included loss of limb below knee in 19 (18.45%) patients, at distal tibiofibular region in 13 (12.6%), mid tarsal amputations in 39(37.9%), and hemi foot amputation in 15 (14.6%) patients. Nine (8.7%) patients had losses of two or less than two toes, 1 (0.97%) patient had injury at mid palmer region, and 5 (4.9%) patients had 2 fingers traumatic amputation. Eighteen (17.5%) patients had soft tissue ( with or without bony injury) injury only

  20. A functional MRI study of the brain in stroke patients with upper-limb paralysis treated with constraint-induced movement therapy

    International Nuclear Information System (INIS)

    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

  1. Evaluation of the cost per patient per injection of botulinum toxin A in upper limb spasticity: comparison of two preparations in 19 countries

    Directory of Open Access Journals (Sweden)

    Valentine W

    2012-11-01

    Full Text Available Stéphane Roze,1 Hannah Kurth,2 Barnaby Hunt,3 William Valentine,3 Rémi Marty11HEVA, Lyon, France; 2Ipsen Pharma, Boulogne-Billancourt, France; 3Ossian Health Economics and Communications, Basel, SwitzerlandBackground: Botulinum toxin A injections are indicated for the management of movement disorders, including upper limb spasticity. The aim of this study was to compare the cost per patient per injection for two botulinum toxin A preparations in 19 countries.Methods: Doses of botulinum toxin A are expressed in noninterchangeable units (U, ie, Botox® in 100 Allergan units (100 U and Dysport® in 500 Speywood units (500 U. Recommended dosages were derived from country-specific summaries of product characteristics or prescribing information. Cost analysis was based on official list prices and expressed in 2011 Euros. The cost per patient per injection was calculated using the recommended dosage in upper limb spasticity combined with price per vial in each country.Results: For upper limb spasticity, the recommended dosage for Dysport in the summary of product characteristics is 1000 U per patient, whereas for Botox the recommended dosage when recommendations were made is 300 U. Allowing for different prices per vial in each country, the cost per patient per injection for upper limb spasticity was less for Dysport than for Botox in 18 (95% of the 19 countries (mean 17% less across countries. The difference was 20% or higher in nearly half (47% of the countries. Sensitivity analyses considering available "real-world" dosing showed consistent results, with Dysport being less costly than Botox in all 19 countries.Conclusion: Considering costs per patient per injection based on analysis of recommended dosages in the summary of product characteristics, Dysport remains cheaper than Botox in most countries. Thus, when extrapolated to a national level, substantial savings could be realized by using Dysport in the treatment of upper limb spasticity

  2. Dermatological changes of amputation stump

    Directory of Open Access Journals (Sweden)

    Arora P

    1993-01-01

    Full Text Available Dermatological changes of stumps of 174 amputees are presented. The commonest dermatological change recorded at the site of amputation stump was hyperpigmentation in 46 (26.4% followed by callosities in 32 (18.3%, scaling in 29 (16.7%, cutaneous atrophy in 20 (11.5%, lichenification in 19(10.9%, traumatic ulcer and bacterial infections in 18 (10.3% each, hypertrophic scar in 14 (8.1%, hypopigmentation and corns in 13 (7.4% each, verrucous hypertrophy of stump in 12 (6.9%, dermatophytic infection in 5(2.9%, stump oedema and phantom limb in 4 (2.3% each, intertriginous dermatitis in 3( 1.7%, allergic contact dermatitis (resin and frictional eczema in 2(1.1% each. Epidermoid cyst, keloid formation, anaesthesia, gangrene and cutaneous horn were recorded in 1 (0.6% each. Atrophy (epidermal and derma, anaesthesia, alopecia and elephantiasis of the stump have not been documented in the literature earlier.

  3. Incidence of re-amputation following partial first ray amputation associated with diabetes mellitus and peripheral sensory neuropathy: a systematic review.

    Directory of Open Access Journals (Sweden)

    Sara L. Borkosky

    2012-01-01

    Full Text Available Diabetes mellitus with peripheral sensory neuropathy frequently results in forefoot ulceration. Ulceration at the first ray level tends to be recalcitrant to local wound care modalities and off-loading techniques. If healing does occur, ulcer recurrence is common. When infection develops, partial first ray amputation in an effort to preserve maximum foot length is often performed. However, the survivorship of partial first ray amputations in this patient population and associated re-amputation rate remain unknown. Therefore, in an effort to determine the actual re-amputation rate following any form of partial first ray amputation in patients with diabetes mellitus and peripheral neuropathy, the authors conducted a systematic review. Only studies involving any form of partial first ray amputation associated with diabetes mellitus and peripheral sensory neuropathy but without critical limb ischemia were included. Our search yielded a total of 24 references with 5 (20.8% meeting our inclusion criteria involving 435 partial first ray amputations. The weighted mean age of patients was 59 years and the weighted mean follow-up was 26 months. The initial amputation level included the proximal phalanx base 167 (38.4% times; first metatarsal head resection 96 (22.1% times; first metatarsal-phalangeal joint disarticulation 53 (12.2% times; first metatarsal mid-shaft 39 (9% times; hallux fillet flap 32 (7.4% times; first metatarsal base 29 (6.7% times; and partial hallux 19 (4.4% times. The incidence of re-amputation was 19.8% (86/435. The end stage, most proximal level, following re-amputation was an additional digit 32 (37.2% times; transmetatarsal 28 (32.6% times; below-knee 25 (29.1% times; and LisFranc 1 (1.2% time. The results of our systematic review reveal that one out of every five patients undergoing any version of a partial first ray amputation will eventually require more proximal re-amputation. These results reveal that partial first ray

  4. [Coping psychologically with amputation].

    Science.gov (United States)

    Schulz, M

    2009-02-01

    An amputation is a "tragic event" in someone's biography which causes a dramatic change in the outer appearance, the loss of mobility, independence and self esteem. The following article is about how people learn to cope with this difficult situation; with the practical problems of everyday life as well as their emotional problems. It is important for the amputees to go through the different stages of mourning: The first stage is the rejection of the situation. Repression and denial of the loss protects the patient from emotional overstrain. Confrontation is the next step: emotionally as well as mentally. "How could it happen?", (understanding the reasons why ...) "What will my future be like?", "How will I cope?" (ability of coping) "Why did it happen to me?" (sense) The last stage of coping with the amputation is to accept and deal with the new situation and to build up new self-confidence. A successful process of coping leads to a new identity. If a person fails to adapt to the new situation, he will develop an inferiority complex and fall into a depression. He might also try to look for culprit and blame the situation on someone else. About two thirds of all amputees don't cope with their amputation and become depressive. 15% develop symptoms of anxiety. Therefore it is important to offer help. The patients should get together in self helping groups and talk about their experiences and problems. If they need more intensive and individual help, they should have the opportunity to contact a psychologist. During the process of coping with their amputation the patients often alternate between optimistic and pessimistic moods. Sometimes they fall back into a negative and resigned state of mind. This is natural and part of the process as long as they find their own way to a positive attitude and view of life. PMID:19259934

  5. Improving the radial nerve neurodynamic test: An observation of tension of the radial, median and ulnar nerves during upper limb positioning.

    Science.gov (United States)

    Manvell, Joshua J; Manvell, Nicole; Snodgrass, Suzanne J; Reid, Susan A

    2015-12-01

    The radial nerve neurodynamic test (ULNT2b), used to implicate symptoms arising from the radial nerve, is proposed to selectively increase strain of the nerve without increasing strain of adjacent tissue, though this has not been established. This study aimed to determine the upper limb position that results in: (1) the greatest tension of the radial nerve and (2) the greatest difference in tension between the radial nerve and the other two major nerves of the upper limb: median and ulnar. Tension (N) of the radial, median and ulnar nerves was measured simultaneously using three buckle force transducers during seven upper limb positions in the axilla of ten embalmed whole body human cadavers (n = 20 limbs). Repeated measures analysis of variance (ANOVA) with Bonferroni post-hoc tests determined differences in tension between nerves and between limb positions. A Composite position consisting of ULNT2b (scapular depression, shoulder internal rotation, elbow extension, forearm pronation, wrist flexion) with the addition of shoulder abduction 40° and extension 25°, wrist ulnar deviation and thumb flexion demonstrated significantly greater tension of the radial nerve than any other tested position (mean tension 11.32N; 95% CI 10.25, 12.29, p < 0.01), including ULNT2b (2.20N; 1.84, 2.57; p < 0.01). Additionally, the Composite position demonstrated the greatest difference in tension between the radial and median (mean difference 4.88N; 95% CI 3.16, 6.61; p < 0.01) and radial and ulnar nerves (9.26N, 7.54, 10.99; p < 0.01). This position constitutes a biomechanically plausible test to detect neuropathic pain related to the radial nerve. PMID:25892706

  6. Factors Influencing Goal Attainment in Patients with Post-Stroke Upper Limb Spasticity Following Treatment with Botulinum Toxin A in Real-Life Clinical Practice: Sub-Analyses from the Upper Limb International Spasticity (ULIS-II Study

    Directory of Open Access Journals (Sweden)

    Klemens Fheodoroff

    2015-04-01

    Full Text Available In this post-hoc analysis of the ULIS-II study, we investigated factors influencing person-centred goal setting and achievement following botulinum toxin-A (BoNT-A treatment in 456 adults with post-stroke upper limb spasticity (ULS. Patients with primary goals categorised as passive function had greater motor impairment (p < 0.001, contractures (soft tissue shortening [STS] (p = 0.006 and spasticity (p = 0.02 than those setting other goal types. Patients with goals categorised as active function had less motor impairment (0.0001, contracture (p < 0.0001, spasticity (p < 0.001 and shorter time since stroke (p = 0.001. Patients setting goals for pain were older (p = 0.01 with more contractures (p = 0.008. The proportion of patients achieving their primary goal was not impacted by timing of first-ever BoNT-A injection (medium-term (≤1 year vs. longer-term (>1 year post-stroke (80.0% vs. 79.2% or presence or absence of severe contractures (76.7% vs. 80.6%, although goal types differed. Earlier BoNT-A intervention was associated with greater achievement of active function goals. Severe contractures impacted negatively on goal achievement except in pain and passive function. Goal setting by patients with ULS is influenced by impairment severity, age and time since stroke. Our findings resonate with clinical experience and may assist patients and clinicians in selecting realistic, achievable goals for treatment.

  7. Upper limb artery segmental occlusions due to chronic use of ergotamine combined with itraconazole, treated by thrombolysis

    OpenAIRE

    Nodari Franco; Maffeis Roberto; Gheza Federico; Battaglia Giuseppe; Bonardelli Stefano; Cervi Edoardo; Maroldi Roberto; Giulini Stefano M

    2011-01-01

    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 al...

  8. Development of Activity-Related Muscle Fatigue during Robot-Mediated Upper Limb Rehabilitation Training in Persons with Multiple Sclerosis: A Pilot Trial

    OpenAIRE

    Johanna Renny Octavia; Peter Feys; Karin Coninx

    2015-01-01

    Robot-assisted rehabilitation facilitates high-intensity training of the impaired upper limb in neurological rehabilitation. It has been clinically observed that persons with Multiple Sclerosis (MS) have difficulties in sustaining the training intensity during a session due to the development of activity-related muscle fatigue. An experimental observational pilot study was conducted to examine whether or not the muscle fatigue develops in MS patients during one session of robot-assisted train...

  9. Benefits of glucocorticoids in non-ambulant boys/men with Duchenne muscular dystrophy: A multicentric longitudinal study using the Performance of Upper Limb test.

    Science.gov (United States)

    Pane, Marika; Fanelli, Lavinia; Mazzone, Elena Stacy; Olivieri, Giorgia; D'Amico, Adele; Messina, Sonia; Scutifero, Marianna; Battini, Roberta; Petillo, Roberta; Frosini, Silvia; Sivo, Serena; Vita, Gian Luca; Bruno, Claudio; Mongini, Tiziana; Pegoraro, Elena; De Sanctis, Roberto; Gardani, Alice; Berardinelli, Angela; Lanzillotta, Valentina; Carlesi, Adelina; Viggiano, Emanuela; Cavallaro, Filippo; Sframeli, Maria; Bello, Luca; Barp, Andrea; Bianco, Flaviana; Bonfiglio, Serena; Rolle, Enrica; Palermo, Concetta; D'Angelo, Grazia; Pini, Antonella; Iotti, Elena; Gorni, Ksenija; Baranello, Giovanni; Bertini, Enrico; Politano, Luisa; Sormani, Maria Pia; Mercuri, Eugenio

    2015-10-01

    The aim of this study was to establish the possible effect of glucocorticoid treatment on upper limb function in a cohort of 91 non-ambulant DMD boys and adults of age between 11 and 26 years. All 91 were assessed using the Performance of Upper Limb test. Forty-eight were still on glucocorticoid after loss of ambulation, 25 stopped steroids at the time they lost ambulation and 18 were GC naïve or had steroids while ambulant for less than a year. At baseline the total scores ranged between 0 and 74 (mean 41.20). The mean total scores were 47.92 in the glucocorticoid group, 36 in those who stopped at loss of ambulation and 30.5 in the naïve group (p < 0.001). The 12-month changes ranged between -20 and 4 (mean -4.4). The mean changes were -3.79 in the glucocorticoid group, -5.52 in those who stopped at loss of ambulation and -4.44 in the naïve group. This was more obvious in the patients between 12 and 18 years and at shoulder and elbow levels. Our findings suggest that continuing glucocorticoids throughout teenage years and adulthood after loss of ambulation appears to have a beneficial effect on upper limb function. PMID:26248957

  10. Benefits of glucocorticoids in non-ambulant boys/men with Duchenne muscular dystrophy: A multicentric longitudinal study using the Performance of Upper Limb test

    Science.gov (United States)

    Pane, Marika; Fanelli, Lavinia; Mazzone, Elena Stacy; Olivieri, Giorgia; D'Amico, Adele; Messina, Sonia; Scutifero, Marianna; Battini, Roberta; Petillo, Roberta; Frosini, Silvia; Sivo, Serena; Vita, Gian Luca; Bruno, Claudio; Mongini, Tiziana; Pegoraro, Elena; De Sanctis, Roberto; Gardani, Alice; Berardinelli, Angela; Lanzillotta, Valentina; Carlesi, Adelina; Viggiano, Emanuela; Cavallaro, Filippo; Sframeli, Maria; Bello, Luca; Barp, Andrea; Bianco, Flaviana; Bonfiglio, Serena; Rolle, Enrica; Palermo, Concetta; D'Angelo, Grazia; Pini, Antonella; Iotti, Elena; Gorni, Ksenija; Baranello, Giovanni; Bertini, Enrico; Politano, Luisa; Sormani, Maria Pia; Mercuri, Eugenio

    2015-01-01

    The aim of this study was to establish the possible effect of glucocorticoid treatment on upper limb function in a cohort of 91 non-ambulant DMD boys and adults of age between 11 and 26 years. All 91 were assessed using the Performance of Upper Limb test. Forty-eight were still on glucocorticoid after loss of ambulation, 25 stopped steroids at the time they lost ambulation and 18 were GC naïve or had steroids while ambulant for less than a year. At baseline the total scores ranged between 0 and 74 (mean 41.20). The mean total scores were 47.92 in the glucocorticoid group, 36 in those who stopped at loss of ambulation and 30.5 in the naïve group (p < 0.001). The 12-month changes ranged between −20 and 4 (mean −4.4). The mean changes were −3.79 in the glucocorticoid group, −5.52 in those who stopped at loss of ambulation and −4.44 in the naïve group. This was more obvious in the patients between 12 and 18 years and at shoulder and elbow levels. Our findings suggest that continuing glucocorticoids throughout teenage years and adulthood after loss of ambulation appears to have a beneficial effect on upper limb function. PMID:26248957

  11. OPTIMIZING OVERALL FUNCTION OF THE UPPER LIMB IS EFFECTIVE TREATMENT FOR SHOULDER PAIN IN INDIVIDUALS WITH STROKE: A RANDOMIZED CONTROLLED TRIAL

    Directory of Open Access Journals (Sweden)

    Mohamed E Khallaf, PhD PT

    2014-04-01

    Full Text Available Background: Shoulder pain is frequent after stroke and interferes with the rehabilitative process and functional outcomes. Treatments used for post-stroke shoulder pain are limited and largely ineffective. Objectives: This randomized controlled study was conducted to study the effect of optimizing overall function of upper limb on the basis of pathomechanics and motor relearning as a treatment of hemiparetic shoulder pain. Subjects and methods: Thirty patients with first ever stroke suffering shoulder pain on movement and at rest were included in this study. Pain was measured by the Visual Analogue Scale (VAS and Chedoke-McMaster Stroke Assessment (CMSA was used for measuring motor recovery and functional level. Shoulder abduction, flexion and external rotation ranges of motion (ROM were also measured. The participants were randomly assigned into two equal groups (G1 and G2. Those in G1 received an exercise therapy based on optimizing overall function of upper limb as a treatment of hemiparetic shoulder pain. Shoulder range of motion exercises were done for the patients represented G2. Treatments were applied for twelve weeks 5 times per week for 60 minutes. Results: shoulder pain and motor recovery scores improved significantly in addition to a significant increase in the shoulder ROMs (p < 0.05. Conclusion: These results suggest that exercise therapy which emphasize interrelationship of all areas of the upper limb to optimize overall function exerts positive effects on shoulder pain and functional recovery in participants with stroke.

  12. Canoe game-based virtual reality training to improve trunk postural stability, balance, and upper limb motor function in subacute stroke patients: a randomized controlled pilot study

    Science.gov (United States)

    Lee, Myung-Mo; Shin, Doo-Chul; Song, Chang-Ho

    2016-01-01

    [Purpose] This study was aimed at investigating the preliminary therapeutic efficacy and usefulness of canoe game-based virtual reality training for stroke patients. [Subjects and Methods] Ten stroke patients were randomly assigned to an experimental group (EG; n=5) or a control group (CG; n=5). Patients in both groups participated in a conventional rehabilitation program, but those in the EG additionally participated in a 30-min canoe game-based virtual reality training program 3 days a week for 4 weeks. Therapeutic efficacy was assessed based on trunk postural stability, balance, and upper limb motor function. In addition, the usefulness of canoe game-based virtual reality training was assessed in the EG and therapist group (TG; n=20), which consisted of physical and occupational therapists, by using the System Usability Scale (SUS). [Results] Improvements in trunk postural stability, balance, and upper limb motor function were observed in the EG and CG, but were greater in the EG. The mean SUS scores in the EG and TG were 71 ± 5.2 and 74.2 ± 4.8, respectively. [Conclusion] Canoe game-based virtual reality training is an acceptable and effective intervention for improving trunk postural stability, balance, and upper limb motor function in stroke patients. PMID:27512255

  13. CT-guided stellate ganglion blockade vs. radiofrequency neurolysis in the management of refractory type I complex regional pain syndrome of the upper limb

    Energy Technology Data Exchange (ETDEWEB)

    Kastler, Adrian [University Hospital CHU Gabriel Montpied, Radiology Department, Clermont-Ferrand (France); Franche Comte University, I4S Laboratory-EA 4268-IFR 133, Besancon (France); CHU Clermont-Ferrand, Hopital Gabriel Montpied, Clermont-Ferrand (France); Aubry, Sebastien; Kastler, Bruno [University Hospital CHU Jean Minjoz, Radiology and Interventional Pain Unit, Besancon (France); Franche Comte University, I4S Laboratory-EA 4268-IFR 133, Besancon (France); Sailley, Nicolas; Michalakis, Demosthene [University Hospital CHU Jean Minjoz, Radiology and Interventional Pain Unit, Besancon (France); Siliman, Gaye [University Hospital CHU St Jacques, Clinical Investigation Center, Besancon (France); Gory, Guillaume [Franche Comte University, I4S Laboratory-EA 4268-IFR 133, Besancon (France); Lajoie, Jean-Louis [University Hospital CHU Jean Minjoz, Pain evaluation and Management Unit, Besancon (France)

    2013-05-15

    To describe and evaluate the feasibility and efficacy of CT-guided radiofrequency neurolysis (RFN) vs. local blockade of the stellate ganglion in the management of chronic refractory type I complex regional pain syndrome (CRPS) of the upper limb. Sixty-seven patients were included in this retrospective study between 2000 and 2011. All suffered from chronic upper limb type I CRPS refractory to conventional pain therapies. Thirty-three patients underwent stellate ganglion blockade and 34 benefited from radiofrequency neurolysis of the stellate ganglion. CT guidance was used in both groups. The procedure was considered effective when pain relief was {>=}50 %, lasting for at least 2 years. Thirty-nine women (58.2 %) and 28 men (41.8 %) with a mean age of 49.5 years were included in the study. Univariate analysis performed on the blockade and RFN groups showed a significantly (P < 0.0001) higher success rate in the RFN group (67.6 %, 23/34) compared with the blockade group (21.2 %, 7/33) with an odds ratio of 7.76. CT-guided radiofrequency neurolysis of the stellate ganglion is a safe and successful treatment of chronic refractory type I CRPS of the upper limb. It appears to be more effective than stellate ganglion blockade. (orig.)

  14. CT-guided stellate ganglion blockade vs. radiofrequency neurolysis in the management of refractory type I complex regional pain syndrome of the upper limb

    International Nuclear Information System (INIS)

    To describe and evaluate the feasibility and efficacy of CT-guided radiofrequency neurolysis (RFN) vs. local blockade of the stellate ganglion in the management of chronic refractory type I complex regional pain syndrome (CRPS) of the upper limb. Sixty-seven patients were included in this retrospective study between 2000 and 2011. All suffered from chronic upper limb type I CRPS refractory to conventional pain therapies. Thirty-three patients underwent stellate ganglion blockade and 34 benefited from radiofrequency neurolysis of the stellate ganglion. CT guidance was used in both groups. The procedure was considered effective when pain relief was ≥50 %, lasting for at least 2 years. Thirty-nine women (58.2 %) and 28 men (41.8 %) with a mean age of 49.5 years were included in the study. Univariate analysis performed on the blockade and RFN groups showed a significantly (P < 0.0001) higher success rate in the RFN group (67.6 %, 23/34) compared with the blockade group (21.2 %, 7/33) with an odds ratio of 7.76. CT-guided radiofrequency neurolysis of the stellate ganglion is a safe and successful treatment of chronic refractory type I CRPS of the upper limb. It appears to be more effective than stellate ganglion blockade. (orig.)

  15. Reliability of clinical tests to evaluate nerve function and mechanosensitivity of the upper limb peripheral nervous system

    Directory of Open Access Journals (Sweden)

    Bachmann Lucas M

    2009-01-01

    Full Text Available Abstract Background Clinical tests to assess peripheral nerve disorders can be classified into two categories: tests for afferent/efferent nerve function such as nerve conduction (bedside neurological examination and tests for increased mechanosensitivity (e.g. upper limb neurodynamic tests (ULNTs and nerve palpation. Reliability reports of nerve palpation and the interpretation of neurodynamic tests are scarce. This study therefore investigated the intertester reliability of nerve palpation and ULNTs. ULNTs were interpreted based on symptom reproduction and structural differentiation. To put the reliability of these tests in perspective, a comparison with the reliability of clinical tests for nerve function was made. Methods Two experienced clinicians examined 31 patients with unilateral arm and/or neck pain. The examination included clinical tests for nerve function (sensory testing, reflexes and manual muscle testing (MMT and mechanosensitivity (ULNTs and palpation of the median, radial and ulnar nerve. Kappa statistics were calculated to evaluate intertester reliability. A meta-analysis determined an overall kappa for the domains with multiple kappa values (MMT, ULNT, palpation. We then compared the difference in reliability between the tests of mechanosensitivity and nerve function using a one-sample t-test. Results We observed moderate to substantial reliability for the tests for afferent/efferent nerve function (sensory testing: kappa = 0.53; MMT: kappa = 0.68; no kappa was calculated for reflexes due to a lack of variation. Tests to investigate mechanosensitivity demonstrated moderate reliability (ULNT: kappa = 0.45; palpation: kappa = 0.59. When compared statistically, there was no difference in reliability for tests for nerve function and mechanosensitivity (p = 0.06. Conclusion This study demonstrates that clinical tests which evaluate increased nerve mechanosensitivity and afferent/efferent nerve function have comparable moderate to

  16. Factors predicting sensor y and motor recover y after the repair of upper limb peripheral nerve injuries

    Institute of Scientific and Technical Information of China (English)

    Bo He; Zhaowei Zhu; Qingtang Zhu; Xiang Zhou; Canbin Zheng; Pengliang Li; Shuang Zhu; Xiaolin Liu; Jiakai Zhu

    2014-01-01

    OBJECTIVE:To investigate the factors associated with sensory and motor recovery after the repair of upper limb peripheral nerve injuries. DATA SOURCES:The online PubMed database was searched for English articles describing outcomes after the repair of median, ulnar, radial, and digital nerve injuries in humans with a publication date between 1 January 1990 and 16 February 2011. STUDY SELECTION:The following types of article were selected:(1) clinical trials describ-ing the repair of median, ulnar, radial, and digital nerve injuries published in English;and (2) studies that reported sufifcient patient information, including age, mechanism of injury, nerve injured, injury location, defect length, repair time, repair method, and repair materials. SPSS 13.0 software was used to perform univariate and multivariate logistic regression analyses and to in-vestigate the patient and intervention factors associated with outcomes. MAIN OUTCOME MEASURES:Sensory function was assessed using the Mackinnon-Dellon scale and motor function was assessed using the manual muscle test. Satisfactory motor recovery was deifned as grade M4 or M5, and satisfactory sensory recovery was deifned as grade S3+or S4. RESULTS:Seventy-one articles were included in this study. Univariate and multivariate logistic regression analyses showed that repair time, repair materials, and nerve injured were inde-pendent predictors of outcome after the repair of nerve injuries (P CONCLUSION:Predictors of outcome after the repair of peripheral nerve injuries include age, gender, repair time, repair materials, nerve injured, defect length, and duration of follow-up.

  17. Hybrid Neuroprosthesis for the Upper Limb: Combining Brain-Controlled Neuromuscular Stimulation with a Multi-Joint Arm Exoskeleton.

    Science.gov (United States)

    Grimm, Florian; Walter, Armin; Spüler, Martin; Naros, Georgios; Rosenstiel, Wolfgang; Gharabaghi, Alireza

    2016-01-01

    and antigravity assistance augments upper limb function and brain activity during rehabilitation exercises and may thus provide a novel restorative framework for severely affected stroke patients. PMID:27555805

  18. Terapija z ogledalom za zgornji ud pri pacientu po možganski kapi - poročilo o primeru: Mirror therapy for upper limb in patient after stroke - case report:

    OpenAIRE

    Hlebš, Sonja; Pišek, Irena; Puh, Urška

    2012-01-01

    Background: Mirror therapy is a recent method that has already been used in patients after stroke. Mirror therapy facilitates the recovery of paretic limb movement by using the nonparetic limb movement to treat the paretic limb. The purpose of our study was to investigate the suitability of mirror therapy for upper extremity in a patient after stroke in the home environment. The effects of mirror therapy on passive range of movement, hand and pinch grip strenght, sensibility, spasticity, dext...

  19. Preventing amputation in adults with diabetes: identifying the risks.

    Science.gov (United States)

    Thomas, Eleanor

    2015-06-01

    Good management of diabetes can reduce the risk of complications of the disease. When not well managed, diabetes is associated with the complications of heart disease, stroke, blindness, kidney disease and amputations. Diabetes can reduce the blood supply to the feet and cause a loss of feeling. As a result, foot injuries do not heal well and the person may not realise that their foot is sore or injured. Damage to the foot may lead to the development of foot ulcers, which if left untreated may result in amputation of the limb. Preventive care is a priority, but when complications occur the next step is to halt progression. Therefore, effective foot care and timely treatment of foot ulcers are important in preserving foot function and mobility, and preventing amputation in adults with diabetes. PMID:26036406

  20. Transmetatarsal Amputation: A Case Series and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Ryan McCallum

    2012-01-01

    Full Text Available Foot ulceration is a major cause of morbidity amongst patients with diabetes. In severe cases of ulceration, osteomyelitis and amputation can ensue. A distinct lack of agreement exists on the most appropriate level of amputation in cases of severe foot ulceration/infection to provide predictable healing rates. This paper provides an overview of the transmetatarsal amputation (TMA as a limb salvage procedure and is written with the perspective and experiences of the Department of Podiatric Surgery at West Middlesex University Hospital (WMUH. We have reflected on the cases of 11 patients (12 feet and have found the TMA to be an effective procedure in the management of cases of severe forefoot ulceration and infection.

  1. 中药熨改善乳癌术后上肢淋巴水肿及上肢功能的效果观察%Observation on Upper Limb Lymphedema Relief and Upper Limb Function Improvement of Postoperative Breast Cancer Patients by Traditional Herbal Medicine Ironing Therapy*

    Institute of Scientific and Technical Information of China (English)

    郭健芬; 林丽燕; 李雪真; 包小英; 郭智涛

    2013-01-01

      目的:观察中药五籽散药熨治疗与空气波压力治疗对改善乳癌术后上肢淋巴水肿及上肢功能的效果差别.方法:采用方便抽样法抽取乳癌术后上肢淋巴水肿患者92例,随机分为药熨组和气压组,分别接受中药五籽散药熨治疗与空气波压力治疗,测量患肢周径,用上肢功能状况量表(KAPS)评估症状和功能,比较两组患者患肢淋巴水肿缓解效果及症状功能改善效果的差别.结果:两组患者患肢周径均减少,药熨组患肢周径减少更显著,比较有显著性差异(P<0.05);两组患者治疗三个月后上肢功能状况量表(KAPS)得分均明显降低,且药熨组得分比气压组低,比较有显著性差异(P<0.05),药熨组患者功能改善更显著.结论:中药五籽散药熨治疗和空气波压力治疗均可缓解乳癌术后上肢淋巴水肿,并促进患肢症状和功能的改善,且中药五籽散药熨治疗的效果更加显著.%Objective: To observe the differences on relieving lymphatic edema of upper limb and improving upper limb function of postoperative breast cancer patients by traditional herbal med-icine ironing therapy and the air pressure pulse therapy. Methods:92 postoperative breast cancer pa-tients with lymphatic edema of upper limb were randomized grouping into experimental group and control group. Experimental group received traditional herbal medicine ironing therapy; control group received the air pressure pulse therapy. Two groups were measured perimeter of upper limb, evaluated symptoms and function of upper limb, then compared the differences on upper limb lymphedema relief and upper limb function improvement. Results:The upper limb perimeter of two groups was reduced, experimental group reduced more significantly (P<0.05). The KAPS scores of two groups were reduced after received treatments three months later, experimental group reduced more significantly (P<0.05), which meant the function

  2. Avaliação funcional de idosos com amputação de membros inferiores atendidos em um hospital universitário Evaluación funcional de ancianos con amputación de los miembros inferiores atendidos en un hospital universitario Functional evaluation of elderly with lower limb amputation followed at a university hospital

    Directory of Open Access Journals (Sweden)

    Maria José D'Elboux Diogo

    2003-02-01

    Full Text Available Foram entrevistados 40 idosos com amputação acima dos maléolos em acompanhamento no ambulatório de Órteses e Próteses do Hospital das Clínicas da Universidade Estadual de Campinas, no período de junho de 1994 a junho de 1999, com objetivo de avaliar o nível de independência, segundo o índice de Barthel, e de identificar relações entre o índice de Barthel e o tipo e nível da amputação, e uso da prótese. Os sujeitos desta pesquisa apresentam elevado grau de independência para as atividades da vida diária, segundo o índice de Barthel. Houve associação significativa somente entre o índice de Barthel e o tipo de amputação, indicando que os idosos com amputação unilateral são mais independentes do que aqueles com amputação bilateral.Fueron entrevistados 40 ancianos con amputación por encima de los maleolos, que estaban en seguimiento ambulatorio en la Unidad de Órtesis y Prótesis del Hospital Clínicas de la Universidad Estatal de Campinas, en el período de junio de 1994 a junio de 1999. El objetivo fue evaluar el nivel de independencia según el Índice de Barthel e identificar las relaciones entre el Índice de Barthel, el nivel de amputación, y el uso de prótesis. Los sujetos de esta investigación presentaron elevado grado de independencia para las actividades de la vida diaria según el Índice de Barthel. El análisis mostró asociación significativa apenas entre el Índice de Barthel y el tipo de amputación, indicando que los ancianos con amputación unilateral son mas independientes que aquellos con amputación bilateral.We studied 40 elderly with lower limb amputation (above the malleolus, who attended a hospital outpatient clinic (Orthoses and Prostheses Unity, University Hospital, State University of Campinas, from June 1994 to June 1999. Our objectives were to evaluate the independence level according to the Barthel's Index and to identify relationships between the mentioned Index and the type and

  3. Functional Reorganization of the Primary Somatosensory Cortex of a Phantom Limb Pain Patient.

    Science.gov (United States)

    Zhao, Jia; Guo, Xiaoli; Xia, Xiaolei; Peng, Weiwei; Wang, Wuchao; Li, Shulin; Zhang, Ya; Hu, Li

    2016-07-01

    Functional reorganization of the somatosensory system was widely observed in phantom limb pain patients. Whereas some studies demonstrated that the primary somatosensory cortex (S1) of the amputated limb was engaged with the regions around it, others showed that phantom limb pain was associated with preserved structure and functional organization in the former brain region. However, according to the law of use and disuse, the sensitivity of S1 of the amputated limb to pain-related context should be enhanced due to the adaptation to the long-lasting phantom limb pain experience. Here, we collected neurophysiological data from a patient with 21-year phantom limb pain using electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) techniques. EEG data showed that both laser-evoked potentials (LEPs) and tactile-evoked potentials (TEPs) were clearly presented only when radiant-heat laser pulses and electrical pulses were delivered to the shoulder of the healthy limb, but not of the amputated limb. This observation suggested the functional deficit of somatosensory pathways at the amputated side. FMRI data showed that significant larger brain activations by painful rather than non-painful stimuli in video clips were observed not only at visual-related brain areas and anterior/mid-cingulate cortex, but also at S1 contralateral to the amputated limb. This observation suggested the increased sensitivity of S1 of the amputated limb to the pain-related context. In addition, such increase of sensitivity was significantly larger if the context was associated with the amputated limb of the patient. In summary, our findings provided novel evidence for a possible neuroplasticity of S1 of the amputated limb: in an amputee with long-lasting phantom limb pain, the sensitivity of S1 to pain-related and amputated-limb-related context was greatly enhanced. PMID:27389122

  4. Leg or foot amputation

    Science.gov (United States)

    ... of this surgery are: A feeling that the limb is still there. This is called phantom sensation. Sometimes this feeling can be painful. This is called phantom pain. The joint closest to the part that is ...

  5. Epidemiological Study to Investigate Potential Interaction Between Physical and Psychosocial Factors at Work that may Increase the Risk of Symptoms of Musculoskeletal Disorder of the Neck and Upper Limb

    OpenAIRE

    Devereux, J. J.; Vlachonikolis, I. G.; Buckle, P. W.

    2002-01-01

    Objectives: To investigate potential interactions between physical and psychosocial risk factors in the workplace that may be associated with symptoms of musculoskeletal disorder of the neck and upper limb. Methods: 891 of 1514 manual handlers, delivery drivers, technicians, customer services computer operators, and general office staff reported on physical and psychosocial working conditions and symptoms of neck and upper limb disorders using a self administered questionnaire (59% return ...

  6. Why are manual workers at high risk of upper limb disorders? The role of physical work factors in a random sample of workers in France (the Pays de la Loire study).

    OpenAIRE

    Melchior, Maria; Roquelaure, Yves; Evanoff, Bradley; Chastang, Jean-François; Ha, Catherine; Imbernon, Ellen; Goldberg, Marcel; Leclerc, Annette; Study Group, Pays De La Loire

    2006-01-01

    OBJECTIVE: To investigate the reasons for the excess risk of upper limb musculoskeletal disorders among manual workers compared with other workers in a random sample of 2656 French men and women (20-59 years old) participating in a study on the prevalence of work related upper limb disorders conducted by France's National Institute of Health Surveillance. METHODS: Prevalence ratios (PR) of physician-diagnosed musculoskeletal disorders of the shoulder, elbow, wrist, and hand (any of six leadin...

  7. Botulinum Toxin Type a Injection, Followed by Home-Based Functional Training for Upper Limb Hemiparesis after Stroke

    Science.gov (United States)

    Takekawa, Toru; Kakuda, Wataru; Taguchi, Kensuke; Ishikawa, Atsushi; Sase, Yousuke; Abo, Masahiro

    2012-01-01

    Botulinum toxin type A (BoNT-A) has been reported to be an effective treatment for limb spasticity after stroke. However, the reduction in the spasticity after BoNT-A injection alone does not ensure an improvement in the active motor function of the affected limb. The aim of this study was to clarify the clinical effects of a BoNT-A injection,…

  8. Psychological management, prevention and treatment of phantom pain after amputations for tumours

    OpenAIRE

    Tomeno, B.; Anract, P.; Ouaknine, M.

    1998-01-01

    Amputation for tumours is rarely carried out nowadays and has few specific technical features, apart from the rare cases where ingenuity is required to gain a few centimetres in length of a stump. As far as possible, the decision for amputation should not be imposed; it is better that the patient himself should take the initiative. The prosthesis and its constraints should be described honestly to avoid subsequent disappointment. Prevention of a painful phantom limb must always be undertaken,...

  9. Revisiting risks associated with mortality following initial transtibial or transfemoral amputation

    OpenAIRE

    Barbara E. Bates, MD; Dawei Xie, PhD; Jibby E. Kurichi, MPH; Diane Cowper Ripley, PhD; Pui L. Kwong, MPH; Margaret G. Stineman, MD

    2013-01-01

    This study’s objective was to determine how treatment-, environmental-, and facility-level characteristics contribute to postdischarge mortality prediction. The study included 4,153 Veterans who underwent lower-limb amputation in Department of Veterans Affairs facilities during fiscal years 2003 and 2004. Veterans were followed 1 yr postamputation. A Cox regression identified characteristics associated with mortality risk after hospital discharge following amputation. Older age, higher amputa...

  10. Embracing change: practical and theoretical considerations for successful implementation of technology assisting upper limb training in stroke

    Directory of Open Access Journals (Sweden)

    Hochstenbach-Waelen Ananda

    2012-08-01

    Full Text Available Abstract Background Rehabilitation technology for upper limb training of stroke patients may play an important role as therapy tool in future, in order to meet the increasing therapy demand. Currently, implementation of this technology in the clinic remains low. This study aimed at identifying criteria and conditions that people, involved in development of such technology, should take into account to achieve a (more successful implementation of the technology in the clinic. Methods A literature search was performed in PubMed and IEEE databases, and semi-structured interviews with therapists in stroke rehabilitation were held, to identify criteria and conditions technology should meet to facilitate (implementation of technology-assisted arm-hand skills training in rehabilitation therapy of stroke patients. In addition, an implementation strategy frequently applied in general health care was used to compose a stepwise guidance to facilitate successful implementation of this technology in therapy of stroke patients. Implementation-related criteria mentioned by therapists during the interviews were integrated in this guidance. Results Results indicate that, related to therapy content, technology should facilitate repetition of task-related movements, tailored to the patient and patient’s goals, in a meaningful context. Variability and increasing levels of difficulty in exercises should be on offer. Regarding hardware and software design of technology, the system should facilitate quick familiarisation and be easily adjustable to individual patients during therapy by therapists (and assistants. The system should facilitate adaptation to individual patients’ needs and their progression over time, should be adjustable as to various task-related variables, should be able to provide instructions and feedback, and should be able to document patient’s progression. The implementation process of technology in the clinic is provided as a stepwise

  11. Factors associated with phantom limb pain: a 31/2-year prospective study

    OpenAIRE

    Bosmans, J.C.; Geertzen, J. H. B.; Post, W.J.; van der Schans, C P; Dijkstra, P.U.

    2010-01-01

    Objective: To analyse the prevalence of phantom (limb) pain over time and to analyse factors associated with phantom (limb) pain in a prospective cohort of amputees. Design: A multicentre longitudinal study. Patients: One hundred and thirty-four patients scheduled for amputation were included. Methods: Patients filled in questionnaires before amputation, and postal questionnaires six months, 1 years and 2 years to a maximum of 3 years after amputation. Preoperative assessment included patient...

  12. Out on a Limb: Investigating the Anatomy of Tree Limbs

    Science.gov (United States)

    Shaw, Edward L.

    2008-01-01

    The author presents several upper elementary science activities involving tree limbs that were collected after severe weather conditions. The activities involved 3rd-grade students arranging tree limb pieces in the correct order from the trunk to the tip of the limb, measuring the pieces, determining the age of a tree limb by its rings,…

  13. Physical consequences of surgery for breast cancer in the affected upper limb and proposal of preventive physiotherapeutic treatment

    International Nuclear Information System (INIS)

    Breast cancer is a malignant growth that begins in breast tissue. The incidence rate in Costa Rica, for 2003, was 40.07 per 100,000 inhabitants (Registro Nacional de Tumores, 2007). The most used treatment for this pathology has been the surgery, has many variations; however, in Costa Rica the modified radical mastectomy and quadrantectomy (conservative surgery) are the most performed. Along with this, other treatments are practiced such as: hormonal therapy, radiation and chemotherapy. The physical consequences of such treatments are: lymphedema, decreased mobility of the shoulder joint on the side of surgery and postoperative pain. The consequences have represented an important change for people that live, because they will have limitations in activities of their daily lives. These can be treated, reduced and even avoided, through a program of physical therapy with techniques and exercises. Costa Rica lacks a prevention program, interdisciplinary and postoperative rehabilitation for people with breast surgery. Therefore, the creation of a proposal of physiotherapeutic intervention based on scientific criteria would be an instrument of great importance. The main objective of this transversal, descriptive and analytic study has been to examine the physical consequences of breast cancer surgery in the affected upper limb. A proposal of physiotherapeutic intervention was designed for the prevention of that physical consequences and possible treatments, from the literature review and valuing people post-breast surgery. In total 27 women were assessed post breast surgery (20 mastectomy and 7 with quadrantectomy), whose time post surgery was located at the range of 1 day -12 months (21 people), more than 12 months (6 people). The selection criteria were: unilateral breast surgery, radical type modified or quadrantectomy; located in the ranges of 35-59 years (19 people) and 60-85 years (8 people); no injuries previous in the upper limb the side of the surgery; with or

  14. Muscle power output properties using the stretch-shortening cycle of the upper limb and their relationships with a one-repetition maximum bench press.

    Science.gov (United States)

    Miyaguchi, Kazuyoshi; Demura, Shinichi

    2006-05-01

    The purpose of this study was to examine the output properties of muscle power by the dominant upper limb using SSC, and the relationships between the power output by SSC and a one-repetition maximum bench press (1 RM BP) used as a strength indicator of the upper body. Sixteen male athletes (21.4+/-0.9 yr) participated in this study. They pulled a load of 40% of maximum voluntary contraction (MVC) at a stretch by elbow flexion of the dominant upper limb in the following three preliminary conditions: static relaxed muscle state (SR condition), isometric muscle contraction state (ISO condition), and using SSC (SSC condition). The velocity with a wire load via a pulley during elbow flexion was measured accurately using a power instrument with a rotary encoder, and the muscle power curve was drawn from the product of the velocity and load. Significant differences were found among all evaluation parameters of muscle power exerted from the above three conditions and the parameters regarding early power output during concentric contraction were larger in the SSC condition than the SR and ISO conditions. The parameters on initial muscle contraction velocity when only using SSC significantly correlated with 1 RM BP (r=0.60-0.62). The use of SSC before powerful elbow flexion may contribute largely to early explosive power output during concentric contraction. Bench press capacity relates to a development of the above early power output when using SSC. PMID:16763366

  15. The influence of Kinesiology Taping on the volume of lymphoedema and manual dexterity of the upper limb in women after breast cancer treatment.

    Science.gov (United States)

    Taradaj, J; Halski, T; Rosinczuk, J; Dymarek, R; Laurowski, A; Smykla, A

    2016-07-01

    The aim of our study was to evaluate the effect of Kinesiology Taping (KT) on the size of lymphoedema and manual dexterity of the upper limb in women after breast cancer treatment. We also examined whether the application of KT can replace the traditional and standard multilayered bandaging in the treatment of upper extremity lymphoedema. Group A comprised of 22 patients who underwent KT as well as pneumatic and manual lymphatic drainage. Then, group B comprised of 23 patients who were treated with quasi-KT as well as pneumatic and manual lymphatic drainage. In contrast, group C had 25 patients subjected only to the standard procedure - pneumatic and manual lymphatic drainage and multilayered bandaging. Patient evaluation items included limb size, grip strength and range of motion. After 4-week therapy, we observed that KT is not an effective method of reducing lymphoedema II and III(0) in women after breast cancer treatment. At this moment, the taping cannot replace the traditional and standard multilayered bandaging in the treatment of upper extremity lymphoedema. PMID:25963332

  16. Study design and methods of the BoTULS trial: a randomised controlled trial to evaluate the clinical effect and cost effectiveness of treating upper limb spasticity due to stroke with botulinum toxin type A

    Directory of Open Access Journals (Sweden)

    Graham Laura

    2008-10-01

    Full Text Available Abstract Background Following a stroke, 55–75% of patients experience upper limb problems in the longer term. Upper limb spasticity may cause pain, deformity and reduced function, affecting mood and independence. Botulinum toxin is used increasingly to treat focal spasticity, but its impact on upper limb function after stroke is unclear. The aim of this study is to evaluate the clinical and cost effectiveness of botulinum toxin type A plus an upper limb therapy programme in the treatment of post stroke upper limb spasticity. Methods Trial design : A multi-centre open label parallel group randomised controlled trial and economic evaluation. Participants : Adults with upper limb spasticity at the shoulder, elbow, wrist or hand and reduced upper limb function due to stroke more than 1 month previously. Interventions : Botulinum toxin type A plus upper limb therapy (intervention group or upper limb therapy alone (control group. Outcomes : Outcome assessments are undertaken at 1, 3 and 12 months. The primary outcome is upper limb function one month after study entry measured by the Action Research Arm Test (ARAT. Secondary outcomes include: spasticity (Modified Ashworth Scale; grip strength; dexterity (Nine Hole Peg Test; disability (Barthel Activities of Daily Living Index; quality of life (Stroke Impact Scale, Euroqol EQ-5D and attainment of patient-selected goals (Canadian Occupational Performance Measure. Health and social services resource use, adverse events, use of other antispasticity treatments and patient views on the treatment will be compared. Participants are clinically reassessed at 3, 6 and 9 months to determine the need for repeat botulinum toxin type A and/or therapy. Randomisation : A web based central independent randomisation service. Blinding : Outcome assessments are undertaken by an assessor who is blinded to the randomisation group. Sample size : 332 participants provide 80% power to detect a 15% difference in treatment

  17. Quality parameters for a multimodal EEG/EMG/kinematic brain-computer interface (BCI) aiming to suppress neurological tremor in upper limbs.

    Science.gov (United States)

    Grimaldi, Giuliana; Manto, Mario; Jdaoudi, Yassin

    2013-01-01

    Tremor is the most common movement disorder encountered during daily neurological practice. Tremor in the upper limbs causes functional disability and social inconvenience, impairing daily life activities. The response of tremor to pharmacotherapy is variable. Therefore, a combination of drugs is often required. Surgery is considered when the response to medications is not sufficient. However, about one third of patients are refractory to current treatments. New bioengineering therapies are emerging as possible alternatives. Our study was carried out in the framework of the European project "Tremor" (ICT-2007-224051). The main purpose of this challenging project was to develop and validate a new treatment for upper limb tremor based on the combination of functional electrical stimulation (FES; which has been shown to reduce upper limb tremor) with a brain-computer interface (BCI). A BCI-driven detection of voluntary movement is used to trigger FES in a closed-loop approach. Neurological tremor is detected using a matrix of EMG electrodes and inertial sensors embedded in a wearable textile. The identification of the intentionality of movement is a critical aspect to optimize this complex system. We propose a multimodal detection of the intentionality of movement by fusing signals from EEG, EMG and kinematic sensors (gyroscopes and accelerometry). Parameters of prediction of movement are extracted in order to provide global prediction plots and trigger FES properly. In particular, quality parameters (QPs) for the EEG signals, corticomuscular coherence and event-related desynchronization/synchronization (ERD/ERS) parameters are combined in an original algorithm which takes into account the refractoriness/responsiveness of tremor. A simulation study of the relationship between the threshold of ERD/ERS of artificial EEG traces and the QPs is also provided. Very interestingly, values of QPs were much greater than those obtained for the corticomuscular module alone. PMID

  18. Symmetrical kinematics does not imply symmetrical kinetics in people with transtibial amputation using cycling model

    Directory of Open Access Journals (Sweden)

    W. Lee Childers, PhD, CP

    2015-01-01

    Full Text Available People with amputation move asymmetrically with regard to kinematics (joint angles and kinetics (joint forces and moments. Clinicians have traditionally sought to minimize kinematic asymmetries, assuming kinetic asymmetries would also be minimized. A cycling model evaluated locomotor asymmetries. Eight individuals with unilateral transtibial amputation pedaled with 172 mm-length crank arms on both sides (control condition and with the crank arm length shortened to 162 mm on the amputated side (CRANK condition. Pedaling kinetics and limb kinematics were recorded. Joint kinetics, joint angles (mean and range of motion [ROM], and pedaling asymmetries were calculated from force pedals and with a motion capture system. A one-way analysis of variance with Tukey post hoc compared kinetics and kinematics across limbs. Statistical significance was set to p amputated limb compared with the control condition. There were no differences in joint kinematics between the contralateral and amputated limbs during the CRANK condition. Pedaling asymmetries did not differ and were 23.0% +/– 9.8% and 23.2% +/– 12.0% for the control and CRANK conditions, respectively. Our results suggest that minimizing kinematic asymmetries does not relate to kinetic asymmetries as clinically assumed. We propose that future research should concentrate on defining acceptable asymmetry.

  19. Risk Factors for Foot Amputation in Patients Hospitalized for Diabetic Foot Infection

    Science.gov (United States)

    Verrone Quilici, Maria Teresa; Del Fiol, Fernando de Sá; Franzin Vieira, Alexandre Eduardo; Toledo, Maria Inês

    2016-01-01

    The aim of this study was to identify and quantify risk factors for amputation in diabetic patients hospitalized for foot infections. This cross-sectional study comprised 100 patients with diabetic infectious complications in the lower limbs. The variables investigated were related to diabetes, infection, and treatment compliance. Multiple Cox regression analysis was performed to identify the variables independently associated with the outcome of amputation. The most prevalent chronic complications were neuropathy and hypertension. Most patients presented with a neuroischemic foot (86%). The Morisky test showed that 72% were not compliant with diabetes treatment. Regarding patient outcome, 61% progressed to amputation, 14% to debridement, and 9% to revascularization. The results showed a 42% higher risk for progression to amputation in patients with previous use of antimicrobials. Also, the amputation risk was 26% higher for those less compliant with diabetes treatment. An increase of one point in the Wagner ulcer classification criteria corresponded to a 65% increase in the risk of amputation. Undergoing conservative, nonsurgical procedures prior to admission provided a 63% reduction in the risk of amputation. Knowledge of these factors is critical to enable multidisciplinary teams to develop treatment plans for these patients so as to prevent the need for amputation. PMID:26998493

  20. Microsurgical decompression of the median nerves for treating diabetic peripheral neuropathy in the upper limbs: A 21-month follow-up

    Institute of Scientific and Technical Information of China (English)

    Peng Lin; Li Zhang; Yanbing Yu; Xiaoli Xu; Jiang Liu; Fang Li; Jun Xu

    2007-01-01

    BACKGROUND: Peripheral nerve injured by abnormal glucose metabolism is compressed, which is an important etiological factor of diabetic peripheral neuropathy (DPN). Microsurgical decompression of peripheral nerve maybe effectively releases the symptoms of DPN.OBJECTIVE: To investigate the curative effects of microsurgical decompression of median nerves for treatment of DPN in upper limbs.DESIGN: Case-follow up observation.SETTING: Department of Orthopaedics, Department of Neurosurgery, China-Japan Friendship Hospital,Ministry of Health.PARTICIPANTS: Twelve patients with DPN in upper limbs (19 hands) who received treatment in the Department of Orthopaedics, Department of Neurosurgery, China-Japan Friendship Hospital, Ministry of Public Health between March 2004 and July 2006 were involved in this experiment. The involved patients, 5 male and 7 female, were aged 44 to 77 years, with DPN course of 6 months to 16 years. They all met 1999 WHO diabetic diagnosis criteria. Both two hands had symptom in 7 patients, and only one hand had symptom in 5 patients. Informed consents of detected items were obtained from all the patients, who also received 21 months of follow-up treatment.microscope, transverse carpal ligament was exposed. Subsequently, transverse carpal ligament, forearm superficial fascia and palmar aponeurosis were fully liberated, and then part of them was cut off. Connective tissue around median nerve, superficial flexor muscle of fingers, radial flexor, palmaris longus and other flexor tendons were completely loosened. Finally, epineurium was opened with microinstrument for neurolysis. After tourniquet was loosened, and bipolar coagulator was used to stop bleeding, and the incision distance of two normal points was 3 to 6 mm), nerve conduction velocity and action potential amplitude (short abductor muscle of thumb end Lat < 4.5 ms; Motor nerve conduction velocity of forearm > 50 m/s),etc. of all the patients were followed up.MAIN OUTCOME MEASURES: The

  1. Prevalence of work related upper limb disorders in hairdressers: a cross sectional study on the influence of working conditions and psychological, ergonomic and physical factors.

    Science.gov (United States)

    De Smet, E; Germeys, F; De Smet, L

    2009-01-01

    A cross sectional study where 145 hairdressers were interviewed for the occurrence of work related upper limb disorders (WRULD). The interview features for engagement, burnout and workaholism, as well as asks for general health and working conditions. The BMI, the hand size and gripping force of each worker was obtained. WRULD was present in 41%. It was significantly correlated with burnout and workaholism. Surprisingly it was not altered by engagement or by the use of ergonomic equipment. Morphological features (BMI), hand size and gripping force, were not related to the occurrence of WRULD. PMID:20037247

  2. Replantation vs revision amputation in single digit zone II amputations.

    Science.gov (United States)

    El-Diwany, M; Odobescu, A; Bélanger-Douet, M; Berbiche, D; Arsenault, J; Bou-Merhi, J; Harris, P G; Danino, A M

    2015-06-01

    The objective of this study was to compare the functional outcomes of zone II amputations treated with either replantation or revision amputation at our institution to better aid patients in their decision making process regarding these treatment options. We conducted a comparative retrospective study. All cases of single digit amputations received at our replantation center between 2007 and 2011 were screened for single digit zone II injuries. These patients were stratified based on the treatment received: replantation vs revision amputation. Patients were called and invited to participate in the research project. Those who accepted to enter the study were asked to complete the Quick-DASH, the Beck Depression Inventory-short form, and a custom made questionnaire. There were seventeen patients with single digit zone II replantation and fourteen patients with similar injuries who underwent revision amputation and agreed to take part in the study. Our data revealed that the duration of sick leave, occupation after injury, professional and social reintegration, discontinued activities, and self-confidence were not statistically different between the two groups. The average hospital stay and the follow-up period of replanted individuals were longer. The replantation group did not have higher levels of pain or cold intolerance, and the global functional and esthetic satisfaction levels were similar between the two groups. Also, Beck Depression Inventory and Quick-DASH scores were not statistically different. Yet, significantly more patients in the replantation group would opt to repeat the replantation than revised patients would opt for revision amputation. From a functional viewpoint, our study suggests that revision amputation is not superior to replantation in zone II single digit amputations. This is valuable information that should be given to patients when deciding on the treatment process and to insure a proper informed consent. PMID:25858276

  3. Classification of Posture in Poststroke Upper Limb Spasticity: A Potential Decision Tool for Botulinum Toxin A Treatment?

    Science.gov (United States)

    Hefter, Harald; Jost, Wolfgang H.; Reissig, Andrea; Zakine, Benjamin; Bakheit, Abdel Magid; Wissel, Jorg

    2012-01-01

    A significant percentage of patients suffering from a stroke involving motor-relevant central nervous system regions will develop a spastic movement disorder. Hyperactivity of different muscle combinations forces the limbs affected into abnormal postures or movement patterns. As muscular hyperactivity can effectively and safely be treated with…

  4. The prediction of the incidence rate of upper limb musculoskeletal disorders, with CTD risk index method on potters of Meybod city

    Directory of Open Access Journals (Sweden)

    Reza Khani Jazani

    2012-02-01

    Full Text Available Background: The objective of this study was to predict the incidence of musculoskeletal disorders in potters of Meybod city by performing CTD risk index method.Materials and Method: This is a descriptive cross-sectional study. Target society was all workers in pottery workshops which were located in the Meybod. Information related to musculoskeletal disorders was obtained by the Nordic questionnaire and we used CTD risk index method to predict the incidence of musculoskeletal disorders.Results: We observed in this study that 59.3% of the potters had symptoms of musculoskeletal disorders in at least in one of their upper extremities. Also significant differences between mean CTD risk index on potters with and without symptoms of the upper limb musculoskeletal disorders, respectively (p=0.038.Conclusion: CTD risk index method can be as a suitable method for predicting the incidence of musculoskeletal disorders used in the potters

  5. Magnitude of forward trunk flexion influences upper limb muscular efforts and dynamic postural stability requirements during sitting pivot transfers in individuals with spinal cord injury.

    Science.gov (United States)

    Desroches, Guillaume; Gagnon, Dany; Nadeau, Sylvie; Popovic, Milos

    2013-12-01

    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

  6. Development of Activity-Related Muscle Fatigue during Robot-Mediated Upper Limb Rehabilitation Training in Persons with Multiple Sclerosis: A Pilot Trial

    Directory of Open Access Journals (Sweden)

    Johanna Renny Octavia

    2015-01-01

    Full Text Available Robot-assisted rehabilitation facilitates high-intensity training of the impaired upper limb in neurological rehabilitation. It has been clinically observed that persons with Multiple Sclerosis (MS have difficulties in sustaining the training intensity during a session due to the development of activity-related muscle fatigue. An experimental observational pilot study was conducted to examine whether or not the muscle fatigue develops in MS patients during one session of robot-assisted training within a virtual learning environment. Six MS patients with upper limb impairment (motricity index ranging from 50 to 91/100 and six healthy persons completed five training bouts of three minutes each performing lifting tasks, while EMG signals of anterior deltoid and lower trapezius muscles were measured and their subjective perceptions on muscle fatigue were registered. Decreased performance and higher subjective fatigue perception were present in the MS group. Increased mean EMG amplitudes and subjective perception levels on muscle fatigue were observed in both groups. Muscle fatigue development during 15′ training has been demonstrated in the arm of MS patients, which influences the sustainability of training intensity in MS patients. To optimize the training performance, adaptivity based on the detection of MS patient’s muscle fatigue could be provided by means of training program adjustment.

  7. [Analysis of the Cochrane Review: Interventions for Improving Upper Limb Function after Stroke. Cochrane Database Syst Rev. 2014,11:CD010820].

    Science.gov (United States)

    Sousa Nanji, Liliana; Torres Cardoso, André; Costa, João; Vaz-Carneiro, António

    2015-01-01

    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

  8. Development of Activity-Related Muscle Fatigue during Robot-Mediated Upper Limb Rehabilitation Training in Persons with Multiple Sclerosis: A Pilot Trial

    Science.gov (United States)

    2015-01-01

    Robot-assisted rehabilitation facilitates high-intensity training of the impaired upper limb in neurological rehabilitation. It has been clinically observed that persons with Multiple Sclerosis (MS) have difficulties in sustaining the training intensity during a session due to the development of activity-related muscle fatigue. An experimental observational pilot study was conducted to examine whether or not the muscle fatigue develops in MS patients during one session of robot-assisted training within a virtual learning environment. Six MS patients with upper limb impairment (motricity index ranging from 50 to 91/100) and six healthy persons completed five training bouts of three minutes each performing lifting tasks, while EMG signals of anterior deltoid and lower trapezius muscles were measured and their subjective perceptions on muscle fatigue were registered. Decreased performance and higher subjective fatigue perception were present in the MS group. Increased mean EMG amplitudes and subjective perception levels on muscle fatigue were observed in both groups. Muscle fatigue development during 15′ training has been demonstrated in the arm of MS patients, which influences the sustainability of training intensity in MS patients. To optimize the training performance, adaptivity based on the detection of MS patient's muscle fatigue could be provided by means of training program adjustment. PMID:26090229

  9. Botulinum toxin type A plus rehabilitative training for improving the motor function of the upper limbs and activities of daily life in patients with stroke and brain injury

    Institute of Scientific and Technical Information of China (English)

    Fei Guo; Wei Yue; Li Ren; Yumiao Zhang; Jing Yang

    2006-01-01

    BACKGROUND: Botulinum toxin type A (BTX-A) is mostly to be used to treat various diseases of motor disorders, whereas its effect on muscle spasm after stroke and brain injury needs further observation.OBJECTIVE : To observe the effect of BTX-A plus rehabilitative training on treating muscle spasm after stroke and brain injury.DESIGN: A randomized controlled observation.SETTINGS: Department of Rehabilitation, Department of Neurology and Department of Neurosurgery, the Second Hospital of Hebei Medical University.PARTICIPANTS: Sixty inpatients with brain injury and stroke were selected from the Department of Rehabilitation, Department of Neurology and Department of Neurosurgery, the Second Hospital of Hebei Medical University from January 2001 to August 2006. They were all confirmed by CT and MRI, and had obvious increase of spastic muscle strength in upper limbs, their Ashworth grades were grade 2 or above. The patients were randomly divided into treatment group (n =30) and control group (n =30).METHODS: ① Patients in the treatment group undertook comprehensive rehabilitative trainings, and they were administrated with domestic BTX-A, which was provided by Lanzhou Institute of Biological Products, Ministry of Health (S10970037), and the muscles of flexion spasm were selected for upper limbs, 20-25 IU for each site.② Patients in the treatment group were assessed before injection and at 1 and 2 weeks, 1 and 3 months after injection respectively, and those in the control group were assessed at corresponding time points. The recovery of muscle spasm was assessed by modified Ashworth scale (MAS, grade 0-Ⅳ; Grade 0 for without increase of muscle strength; Grade Ⅳ for rigidity at passive flexion and extension); The recovery of motor function of the upper limbs was evaluated with Fugl-Meyer Assessment (FMA, total score was 226 points, including 100 for exercise, 14 for balance, 24 for sense, 44 for joint motion, 44 for pain and 66 for upper limb); The ADL were

  10. Recovery of somatosensory and motor functions of the paretic upper limb in patients after stroke: Comparison of two therapeutic approaches

    Directory of Open Access Journals (Sweden)

    Kateřina Macháčková

    2016-03-01

    Full Text Available Background: Frequent and extensive disturbances to the somatosensory and motor hand functions after stroke are common. This study explores a new therapeutic approach that may improve the effectiveness of rehabilitation for these upper limb impairments. Objective: To assess the effect of rehabilitation combining standard therapy and somatosensory stimulation on sensorimotor hand functions. To compare the effect of this method with the standard method of rehabilitation. Methods: Two groups of patients were used to compare the effect of standard therapy (group A, n = 15, age = 59.8 ± 9.4 years, and the effect of therapy with targeted somatosensory stimulation (group B, n = 15, age = 65.5 ± 8.2. The groups consisted of patients after an ischemic stroke in post-acute phase, with hemiparesis, aged from 45 to 75 years, both men and women. The methods used to assess patients comprised a neurological clinical examination, two batteries of tests of somatosensory function (Rivermead Assessment of Somatosensory Performance, Fabric Matching Test, two batteries of tests of motor function (Nine Hole Peg Test, Test of Manipulation Functions, and activities of daily living assessment. Results: The results show that before therapy a deficit of somatosensory function occurred on the paretic upper limb in more than 50% of patients in both groups. Motor functions were impaired more frequently than somatosensory functions. Somatosensory stimulation therapy had an enhanced improvement of somatosensory functions, especially tactile discrimination of the object surface. Conclusions: Major improvement, particularly of tactile discrimination sensation, occurred in group B, where therapy focused on somatosensory deficit was applied. We did not show that such considerable improvement in discrimination sensation in group B was associated with any change in motor function. Clinical improvement in the motor function of the paretic limb occurred in

  11. Mechanism of Kinect-based virtual reality training for motor functional recovery of upper limbs after subacute stroke

    OpenAIRE

    Bao, Xiao; Mao, Yurong; Lin, Qiang; Qiu, Yunhai; Chen, Shaozhen; Li, Le; Cates, Ryan S.; Zhou, Shufeng; HUANG, Dongfeng

    2013-01-01

    The Kinect-based virtual reality system for the Xbox 360 enables users to control and interact with the game console without the need to touch a game controller, and provides rehabilitation training for stroke patients with lower limb dysfunctions. However, the underlying mechanism remains unclear. In this study, 18 healthy subjects and five patients after subacute stroke were included. The five patients were scanned using functional MRI prior to training, 3 weeks after training and at a 12-w...

  12. Poland综合征常见的上肢及手畸形的临床特征%Clinical features of common deformities of the upper limb and hand in Poland syndrome

    Institute of Scientific and Technical Information of China (English)

    于龙彪; 田文; 张国安

    2014-01-01

    Poland syndrome ( PS ), also called pectoralis major muscle defect, brachydactyly and syndactylia syndrome, is a rare congenital anomaly characterized by unilateral chest wall hypoplasia and ipsilateral upper limb and hand abnormalities in different degrees. The clinical manifestations are various, especially the upper limb and hand deformities, with great individual differences. This article reviewed the domestic and foreign literatures in recent years and summarized the various deformities of the upper limb and hand in the PS patients. ( 1 ) The PS patients with upper limb deformities may have the following symptoms, including various degrees of short or even defected upper limb, congenital radioulnar synostosis, congenital high scapula, ulnar longitudinal dysplasia, posterior dislocation of the radial head and so on. ( 2 ) The PS patients with wrist deformities may have the following symptoms, including one or more pairs of intercarpal fusion, delay of carpal ossiifcation, disharmonious ossiifcation between the carpal and tubular bone, abnormal carpal morphology, absence of carpal bones and so on. ( 3 ) The PS patients with hand deformities may have the following symptoms, including volume decrease of the ipsilateral hand such as brachydactyly, ectrodactyly, split hand and acheiria, partially or completely soft tissue syndactyly, dysplasia or absence of the middle phalanx, contracture of the metacarpophalangeal joint and the interphalangeal joint, finger lateral deformity, congenital constriction band deformity and so on.

  13. Atypical Supernumerary Phantom Limb and Phantom Limb Pain in Two Patients with Pontine Hemorrhage

    OpenAIRE

    Yoo, Seung Don; Kim, Dong Hwan; Jeong, Yong Seol; Chon, Jinmann; Bark, Jihea

    2011-01-01

    Phantom limbs are usually observed after amputation of extremities. In patients after a stroke, a similar but rarely occurring phenomenon consisting of the patient experiencing the presence of an additional limb has been described. This phenomenon, generally called supernumerary phantom limb (SPL), may be caused by lesions in the right or left cerebral hemisphere, but has been predominantly reported in patients who have had a right hemispheric stroke. We report two cases of atypical SPL and p...

  14. CT evaluation of the damaged upper limb muscle in patients with Duchenne type progressive muscular dystrophy (DMD)

    International Nuclear Information System (INIS)

    In order to evaluate the changes of CT numbers and cross sectional areas of the muscles, we determined CT scores of the muscle. In twelve patients with Duchenne type progressive muscular dystrophy (DMD), we assessed the difference of CT scores of the muscle and the correlation between CT score of the muscle and 9-stage classification of upper extremities. CT scores of the subscapularis muscle and infraspinatus muscle were significantly lower than deltoideus muscle at the level of the shoulder, and flexor muscles showed also significantly lower than extensor muscles at the level of the upper extremity. Good correlations between CT score of the muscle and 9-stage classification of upper extremities were observed in the muscles of shoulder and upper arm. (author)

  15. Management of diabetic foot disease and amputation in the Irish health system: a qualitative study of patients' attitudes and experiences with health services.

    LENUS (Irish Health Repository)

    Delea, Sarah

    2015-07-01

    Diabetes is an increasingly prevalent chronic illness that places a huge burden on the individual, the health system and society. Patients with active foot disease and lower limb amputations due to diabetes have a significant amount of interaction with the health care services. The purpose of this study was to explore the attitudes and experiences of foot care services in Ireland among people with diabetes and active foot disease or lower limb amputations.

  16. COMPARATIVE EVALUATION OF ADDING CLONIDINE V/S DEXMEDETOMIDINE TO LIGNOCAINE DURING BIER’S BLOCK IN UPPER LIMB ORTHOPEDIC SURGERIES

    Directory of Open Access Journals (Sweden)

    Veena

    2014-12-01

    Full Text Available BACKGROUND AND AIMS: Intravenous regional anaesthesia is used for short procedures for upper limb and hand surgery. IVRA with adjuvants like opioids, NSAIDS, muscle relaxants increases the efficacy in terms of analgesic duration and quality of anaesthesia. We conducted this study for evaluation of adding clonidine with dexmedetomidine during bier’s block in upper limb orthopedic surgeries. MATERIAL AND METHODS: Sixty patients of American society of anaesthesiologist (ASA class I, II, III patients undergoing upper limb surgeries were enrolled. IVRA was established using 3mg/kg of 0.5% lignocaine diluted with saline to a total volume of 40ml to which 1µg/kg of clonidine in group I or 1µg/kg dexmedetomidine in group II was added. The sensory block and motor block onset and recovery, hemodynamic parameters sedation score, VAS score, doses of analgesic requirement, patient satisfaction score, surgeon satisfaction score were noted and recorded at 15min, 30min, 1hr, 2hr, 3hr, 12hr and 24hr time interval. RESULTS: Both like groups were comparable with respect to age, sex, weight, ASA grade, baseline hemodynamic vitals, duration of surgery and intra-operative and post-operative hemodynamic variables. Sensory block onset and recovery was 4.85 ±0.49 min and 5.9±0.66 min in group II (LD. Motor block onset and recovery was 10.91±0.6 min and 6.83±0.69 min in group I (LC and 11.2±0.59 min and 7.13±0.57 min respectively in group II (LD. CONCLUSION: The addition of 1µg/kg of clonidine or 1µg/kg or 1µg/kg of dexmedetomidine to 3mg/kg of 0.5% of lignocaine is found to be effective, comparable in terms of onset and recovery of sensory and motor blockade, hemodynamically stable and without any side effects and complications.

  17. A multi-center study on low-frequency rTMS combined with intensive occupational therapy for upper limb hemiparesis in post-stroke patients

    Directory of Open Access Journals (Sweden)

    Kakuda Wataru

    2012-01-01

    Full Text Available Abstract Background Both low-frequency repetitive transcranial magnetic stimulation (rTMS and intensive occupational therapy (OT have been recently reported to be clinically beneficial for post-stroke patients with upper limb hemiparesis. Based on these reports, we developed an inpatient combination protocol of these two modalities for the treatment of such patients. The aims of this pilot study were to confirm the safety and feasibility of the protocol in a large number of patients from different institutions, and identify predictors of the clinical response to the treatment. Methods The study subjects were 204 post-stroke patients with upper limb hemiparesis (mean age at admission 58.5 ± 13.4 years, mean time after stroke 5.0 ± 4.5 years, ± SD from five institutions in Japan. During 15-day hospitalization, each patient received 22 treatment sessions of 20-min low-frequency rTMS and 120-min intensive OT daily. Low-frequency rTMS of 1 Hz was applied to the contralesional hemisphere over the primary motor area. The intensive OT, consisting of 60-min one-to-one training and 60-min self-exercise, was provided after the application of low-frequency rTMS. Fugl-Meyer Assessment (FMA and Wolf Motor Function Test (WMFT were performed serially. The physiatrists and occupational therapists involved in this study received training prior to the study to standardize the therapeutic protocol. Results All patients completed the protocol without any adverse effects. The FMA score increased and WMFT log performance time decreased significantly at discharge, relative to the respective values at admission (change in FMA score: median at admission, 47 points; median at discharge, 51 points; p Conclusions The 15-day inpatient rTMS plus OT protocol is a safe, feasible, and clinically useful neurorehabilitative intervention for post-stroke patients with upper limb hemiparesis. The response to the treatment was not influenced by age or time after stroke onset. The

  18. Medical and Social Aspects of High Amputations in Patients with Obliterating Atherosclerosis of Lower Extremities

    OpenAIRE

    Gudz, I. M.; Hnatyshchak, A. I.

    2014-01-01

    Obliterating atherosclerosis of the lower extremities is one of the main causes of limb ischemia, that can result in high amputation of the lower limb (HALL). Despite the large number of publications on this subject, medical and social effects of HALL on the patients’ life are studied insufficiently. In some studies a significant impact of financial situation, the level of education, and accessibility of qualified vascular surgery care on the HALL index was stated. As this intervention is con...

  19. [Amputations. A five-year epidemiological study in Buenos Aires City].

    Science.gov (United States)

    Mendelevich, Alejandro; Kramer, Marcia; Maiarú, Mariano; Módica, Mariela; Ostolaza, Marco; Peralta, Federico

    2015-01-01

    An amputation is the removal of a limb by surgery or accident. The aim of this paper was to carry out an epidemiological analysis on patients with amputations treated at the Instituto de Rehabilitación Psicofísica between 2009 and 2013. This is a retrospective, observational and cross-sectional study. The analyzed data included a total of 262 patients: 180 men (68.7%) and 82 women (31.3%). Our population mainly included subjects with only one amputated lower limb (83.6%), of vascular etiology (mostly diabetics) and with an average age of 63.5 years. The second sample group comprised traumatic amputees (29.8%), with an average age of 37 years and with a higher frequency of phantom pain. The characteristics of these groups can make them to behave differently during rehabilitation. PMID:26707661

  20. Phantom pain after eye amputation

    DEFF Research Database (Denmark)

    Rasmussen, Marie L R; Prause, Jan U; Toft, Peter B

    2011-01-01

    Purpose: To characterize the quality of phantom pain, its intensity and frequency following eye amputation. Possible triggers and relievers of phantom pain are investigated. Methods: The hospital database was searched using surgery codes for patients who received ocular evisceration, enucleation...... conducted by a trained interviewer. Results: Of the 173 patients in the study, 39 experienced phantom pain. The median age of patients who had experienced phantom pain was 45 years (range: 19–88). Follow-up time from eye amputation to participation in the investigation was 4 years (range: 2–46). Phantom...... scale, ranging from 0 to 100, was 36 (range: 1–89). One-third of the patients experienced phantom pain every day. Chilliness, windy weather and psychological stress/fatigue were the most commonly reported triggers for pain. Conclusions: Phantom pain after eye amputation is relatively common. The pain...