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Sample records for upper extremity prosthesis

  1. Stiffness and ultimate load of osseointegrated prosthesis fixations in the upper and lower extremity

    PubMed Central

    2013-01-01

    Background Techniques for the skeletal attachment of amputation-prostheses have been developed over recent decades. This type of attachment has only been performed on a small number of patients. It poses various potential advantages compared to conventional treatment with a socket, but is also associated with an increased risk of bone or implant-bone interface fracture in the case of a fall. We therefore investigated the bending stiffness and ultimate bending moment of such devices implanted in human and synthetic bones. Methods Eight human specimens and 16 synthetic models of the proximal femora were implanted with lower extremity prostheses and eight human specimens and six synthetic humeri were implanted with upper extremity prostheses. They were dissected according to typical amputation levels and underwent loading in a material testing machine in a four-point bending setup. Bending stiffness, ultimate bending moment and fracture modes were determined in a load to failure experiment. Additionally, axial pull-out was performed on eight synthetic specimens of the lower extremity. Results Maximum bending moment of the synthetic femora was 160.6±27.5 Nm, the flexural rigidity of the synthetic femora was 189.0±22.6 Nm2. Maximum bending moment of the human femora was 100.4±38.5 Nm, and the flexural rigidity was 137.8±29.4 Nm2. The maximum bending moment of the six synthetic humeri was 104.9±19.0 Nm, and the flexural rigidity was 63.7±3.6 Nm2. For the human humeri the maximum bending moment was 36.7±11.0 Nm, and the flexural rigidity at was 43.7±10.5 Nm2. The maximum pull-out force for the eight synthetic femora was 3571±919 N. Conclusion Significant differences were found between human and synthetic specimens of the lower and upper extremity regarding maximum bending moment, bending displacement and flexural rigidity. The results of this study are relevant with respect to previous finding regarding the load at the interfaces of osseointegrated prosthesis

  2. Upper extremity myoelectric prosthetics.

    PubMed

    Uellendahl, J E

    2000-08-01

    Myoelectric control of upper limb prostheses has proven to be an effective and efficient means of controlling prosthetic components. This means of control has been used extensively for over 30 years, during which time these systems have become reliable and durable in most situations. Myoelectric control, or any other prosthetic control scheme, should not be considered as the optimal control for arm prostheses, but rather as one of the several effective ways of producing desired function. Advanced clinical practice calls for a blending of all control schemes, as appropriate, to allow the prosthesis to serve the intentions of the user efficiently and with little mental effort. Technology continues to change, bringing with it new and sometimes better ways of fitting amputees. Microprocessors and programmable controllers have opened new and exciting avenues for improvement in function. New, and as of yet unidentified, electronic and mechanical advances are certainly on the horizon. There is much work to be done before upper limb prostheses rightfully are called arm replacements. But progress is occurring and advances are being made toward the goal of replacing the function and appearance of that marvelous tool, the human arm. PMID:10989484

  3. Management of Major Traumatic Upper Extremity Amputations.

    PubMed

    Solarz, Mark K; Thoder, Joseph J; Rehman, Saqib

    2016-01-01

    Traumatic upper extremity amputation is a life-altering event, and recovery of function depends on proper surgical management and postoperative rehabilitation. Many injuries require revision amputation and postoperative prosthesis fitting. Care should be taken to preserve maximal length of the limb and motion of the remaining joints. Skin grafting or free tissue transfer may be necessary for coverage to allow preservation of length. Early prosthetic fitting within 30 days of surgery should be performed so the amputee can start rehabilitation while the wound is healing and the stump is maturing. Multidisciplinary care is essential for the overall care of the patient following a traumatic amputation of the upper limb. PMID:26614927

  4. Upper Extremity Regional Anesthesia

    PubMed Central

    Neal, Joseph M.; Gerancher, J.C.; Hebl, James R.; Ilfeld, Brian M.; McCartney, Colin J.L.; Franco, Carlo D.; Hogan, Quinn H.

    2009-01-01

    Brachial plexus blockade is the cornerstone of the peripheral nerve regional anesthesia practice of most anesthesiologists. As part of the American Society of Regional Anesthesia and Pain Medicine’s commitment to providing intensive evidence-based education related to regional anesthesia and analgesia, this article is a complete update of our 2002 comprehensive review of upper extremity anesthesia. The text of the review focuses on (1) pertinent anatomy, (2) approaches to the brachial plexus and techniques that optimize block quality, (4) local anesthetic and adjuvant pharmacology, (5) complications, (6) perioperative issues, and (6) challenges for future research. PMID:19282714

  5. Upper Extremity Amputations and Prosthetics

    PubMed Central

    Ovadia, Steven A.; Askari, Morad

    2015-01-01

    Upper extremity amputations are most frequently indicated by severe traumatic injuries. The location of the injury will determine the level of amputation. Preservation of extremity length is often a goal. The amputation site will have important implications on the functional status of the patient and options for prosthetic reconstruction. Advances in amputation techniques and prosthetic reconstructions promote improved quality of life. In this article, the authors review the principles of upper extremity amputation, including techniques, amputation sites, and prosthetic reconstructions. PMID:25685104

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

    PubMed

    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

  7. Literature Review on Needs of Upper Limb Prosthesis Users

    PubMed Central

    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

  8. Upper extremity injuries in golf.

    PubMed

    Bayes, Matthew C; Wadsworth, L Tyler

    2009-04-01

    Golf is an asymmetric sport with unique patterns of injury depending upon the skill level. Higher handicap players typically experience injuries that result from swing mechanics, whereas lower handicap and professional players have overuse as the major cause of their injuries. The majority of shoulder injuries affecting golfers occur in the nondominant shoulder. Common shoulder injuries include subacromial impingement, rotator cuff pathology, glenohumeral instability, and arthritis involving the acromioclavicular and/or glenohumeral joints. Lead arm elbow pain resulting from lateral epicondylosis (tennis elbow) is the leading upper extremity injury in amateur golfers. Tendon injury is the most common problem seen in the wrist and forearm of the golfer. Rehabilitation emphasizing improvement in core muscle streng is important in the treatment of golf injury. Emerging treatments for tendinopathy include topical nitrates, ultrasound-guided injection of therapeutic substances, and eccentric rehabilitation. There is evidence supporting physiotherapy, and swing modification directed by a teaching professional, for treatment of upper extremity golf injuries. This article focuses on upper extremity injuries in golf, including a discussion of the epidemiology, causes, diagnosis, treatment, and prevention of injuries occurring in the shoulder, elbow, wrist, and hand. PMID:20048492

  9. Innovations in prosthetic interfaces for the upper extremity.

    PubMed

    Kung, Theodore A; Bueno, Reuben A; Alkhalefah, Ghadah K; Langhals, Nicholas B; Urbanchek, Melanie G; Cederna, Paul S

    2013-12-01

    Advancements in modern robotic technology have led to the development of highly sophisticated upper extremity prosthetic limbs. High-fidelity volitional control of these devices is dependent on the critical interface between the patient and the mechanical prosthesis. Recent innovations in prosthetic interfaces have focused on several control strategies. Targeted muscle reinnervation is currently the most immediately applicable prosthetic control strategy and is particularly indicated in proximal upper extremity amputations. Investigation into various brain interfaces has allowed acquisition of neuroelectric signals directly or indirectly from the central nervous system for prosthetic control. Peripheral nerve interfaces permit signal transduction from both motor and sensory nerves with a higher degree of selectivity. This article reviews the current developments in each of these interface systems and discusses the potential of these approaches to facilitate motor control and sensory feedback in upper extremity neuroprosthetic devices. PMID:24281580

  10. Advances in upper extremity prosthetics.

    PubMed

    Zlotolow, Dan A; Kozin, Scott H

    2012-11-01

    Until recently, upper extremity prostheses had changed little since World War II. In 2006, the Defense Advanced Research Projects Agency responded to an increasing number of military amputees with the Revolutionizing Prosthetics program. The program has yielded several breakthroughs both in the engineering of new prosthetic arms and in the control of those arms. Direct brain-wave control of a limb with 22° of freedom may be within reach. In the meantime, advances such as individually powered digits have opened the door to multifunctional full and partial hand prostheses. Restoring sensation to the prosthetic limb remains a major challenge to full integration of the limb into a patient's self-image. PMID:23101609

  11. Functional and Clinical Outcomes of Upper Extremity Amputation.

    PubMed

    Fitzgibbons, Peter; Medvedev, Gleb

    2015-12-01

    Upper extremity amputation is an uncommon but often necessary procedure. It can be required as a result of trauma, infection, or malignancy. Amputation is a life-changing procedure. Careful planning for it must not only include the level of amputation and assurance of durable soft-tissue coverage of the amputation site, but it must also consider patients' goals and occupations, as well as social factors affecting amputees. The choice of prosthesis is an individual matter, but new technology permits lighter and more multifunctional prostheses. Targeted muscle reinnervation can be used to achieve improved myoelectric signaling and possibly decrease limb pain following amputation. Rehabilitation is crucial to achieving favorable results. PMID:26527583

  12. Upper extremity deep vein thrombosis

    PubMed Central

    Saseedharan, Sanjith; Bhargava, Sunil

    2012-01-01

    A 56-year-old female, recently (3 months) diagnosed with chronic kidney disease (CKD), on maintenance dialysis through jugular hemodialysis lines with a preexisting nonfunctional mature AV fistula made at diagnosis of CKD, presented to the hospital for a peritoneal dialysis line. The recently inserted indwelling dialysis catheter in left internal jugular vein had no flow on hemodialysis as was the right-sided catheter which was removed a day before insertion of the left-sided line. The left-sided line was removed and a femoral hemodialysis line was cannulated for maintenance hemodialysis, and the next day, a peritoneal catheter was inserted in the operation theater. However, 3 days later, there was progressive painful swelling of the left hand and redness with minimal numbness. The radial artery pulsations were felt. There was also massive edema of forearm, arm and shoulder region on the left side. Doppler indicated a steal phenomena due to a hyperfunctioning AV fistula for which a fistula closure was done. Absence of relief of edema prompted a further computed tomography (CT) angiogram (since it was not possible to evaluate the more proximal venous segments due to edema and presence of clavicle). Ct angiogram revealed central vein thrombosis for which catheter-directed thrombolysis and venoplasty was done resulting in complete resolution of signs and symptoms. Upper extremity DVT (UEDVT) is a very less studied topic as compared to lower extremity DVT and the diagnostic and therapeutic modalities still have substantial areas that need to be studied. We present a review of the present literature including incidences, diagnostic and therapeutic modalities for this entity. Data Sources: MEDLINE, MICROMEDEX, The Cochrane database of Systematic Reviews from 1950 through March 2011. PMID:22624098

  13. Upper Extremity Artificial Limb Control as an Issue Related to Movement and Mobility in Daily Living

    ERIC Educational Resources Information Center

    Wallace, Steve; Anderson, David I.; Trujillo, Michael; Weeks, Douglas L.

    2005-01-01

    The 1992 NIH Research Planning Conference on Prosthetic and Orthotic Research for the 21st Century (Childress, 1992) recognized that the field of prosthetics lacks theoretical understanding and empirical studies on learning to control an upper-extremity prosthesis. We have addressed this problem using a novel approach in which persons without…

  14. Prosthesis

    MedlinePlus

    ... by prosthetic devices. False teeth are known as dental prostheses. An artificial replacement of the jaw bone is called a maxillofacial prosthesis. Penis implants are also known as penile prostheses.

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

    NASA Astrophysics Data System (ADS)

    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.

  16. Golf injuries of the upper extremity.

    PubMed

    Wiesler, Ethan R; Lumsden, Boyd

    2005-01-01

    Golf has demonstrated increasing popularity and with this heightened enthusiasm has come an increased awareness of the significant number of injuries associated with playing golf. While back injuries represent the most commonly injured specific body part, upper extremity injuries are most frequent overall and the most likely to result in loss of play. Patterns of injury differ based on level of play and time spent playing or practicing golf. Among golf professionals, the hand/wrist is the most commonly injured upper extremity structure. Among amateurs, the elbow is most commonly injured. The vast majority of upper extremity injuries are due to overuse. Age, ability, equipment, and swing mechanics also play contributing roles. Most upper extremity golf injuries can be successfully treated with appropriate cessation or modification of play, anti-inflammatory modalities, and rehabilitation. Surgical treatment is rarely required, but if needed can prove successful in a high percentage of patients. PMID:15766435

  17. Upper Extremity Problems in Doner Kebab Masters

    PubMed Central

    Taspinar, Ozgur; Kepekci, Muge; Ozaras, Nihal; Aydin, Teoman; Guler, Mustafa

    2014-01-01

    [Purpose] Doner kebab is a food specific to Turkey; it is a cone-shaped meat placed vertically on a high stand. The doner kebab chefs stand against the meat and cut it by using both of their upper extremities. This work style may lead to recurrent trauma and correspondingly the upper extremity problems. The aim of this study was to investigate the upper extremity disorders of doner chefs. [Subjects and Methods] Doner kebab chefs were selected as the study group, and volunteers who were not doner kebab chefs and didn’t exert intense effort with upper extremities their business lives were selected as the control group. A survey form was prepared to obtain data about the participants’ ages, working experience (years), daily work hours, work at a second job, diseases, drug usage, and any musculoskeletal (lasting at least 1 week) complaint in last 6 months. [Results] A total of 164 individuals participated in the study, 82 doner chefs and 82 volunteers. In 20.6% of the study group and 15.6% of the control group, an upper extremity musculoskeletal system disorder was detected. Lateral epicondylitis was more frequently statistically significant in the work group. [Conclusion] Hand pain and lateral epicondylitis are more frequent in doner chefs than in other forms of business. PMID:25276030

  18. Arterial embolism of the upper extremities.

    PubMed

    Janevski, B

    1986-10-01

    The angiographic signs, the frequency and the site of distribution of acute emboli of the arteries of the upper extremity are described. The conclusions are based on the author's own experience gained from selective studies of acute arterial embolism of the upper limb, during a period of 15 years. A comparison is made with the results of two of the largest series reported in the literature. In addition, a brief review of the aetiology, pathogenesis, the clinical and roentgenological signs of the condition is given. PMID:3022344

  19. Thoracoscopic removal of dental prosthesis impacted in the upper thoracic esophagus.

    PubMed

    Bonavina, Luigi; Aiolfi, Alberto; Siboni, Stefano; Rausa, Emanuele

    2014-01-01

    Dental appliances are the most common cause of accidental foreign body esophageal impaction, especially in the elderly population with decreased oral sensory perception. A 47-year-old man with history of oligophrenia and recurrent epileptic seizures was referred to our hospital following dislocation and ingestion of his upper dental prosthesis. Endoscopic removal and clipping of an esophageal tear had been unsuccessfully attempted. A chest CT scan confirmed entrapment of the dental prosthesis in the upper thoracic esophagus, the presence of pneumomediastinum, and the close proximity of one of the metal clasps of the prosthesis to the left subclavian artery. A video-assisted right thoracoscopy in the left lateral decubitus position was performed and the foreign body was successfully removed. The patient was then allowed to wear the retrieved prosthesis after dentistry consultation and repair of the wire clasps by a dental technician. At the 6-month follow-up visit the patient was doing very well without any trouble in swallowing. PMID:24422752

  20. Bone Lengthening in the Pediatric Upper Extremity.

    PubMed

    Farr, Sebastian; Mindler, Gabriel; Ganger, Rudolf; Girsch, Werner

    2016-09-01

    ➤Bone lengthening has been used successfully for several congenital and acquired conditions in the pediatric clavicle, humerus, radius, ulna, and phalanges.➤Common indications for bone lengthening include achondroplasia, radial longitudinal deficiency, multiple hereditary exostosis, brachymetacarpia, symbrachydactyly, and posttraumatic and postinfectious growth arrest.➤Most authors prefer distraction rates of <1 mm/day for each bone in the upper extremity except the humerus, which can safely be lengthened by 1 mm/day.➤Most authors define success by the amount of radiographic bone lengthening, joint motion after lengthening, and subjective patient satisfaction rather than validated patient-related outcome measures.➤Bone lengthening of the upper extremity is associated with a high complication rate, with complications including pin-track infections, fixation device failure, nerve lesions, nonunion, fracture of regenerate bone, and joint dislocations. PMID:27605694

  1. Disorders of the upper extremity in children.

    PubMed

    Azouz, E M; Oudjhane, K

    1998-08-01

    This article presents a brief overview of the indications of MR imaging in a variety of disorders of the upper extremity of the pediatric patient. This covers congenital anomalies: Sprengel shoulder, Poland sequence, arthrogryposis; posttraumatic lesions of cartilage, bone, tendon, muscle and nerve including the brachial plexus injury; inflammatory arthritis and synovitis; bone and joint infection; osteochondritis dissecans, bone necrosis and infarcts in sickle cell anemia and juvenile Gaucher disease, as well as tumors. In this last category, the authors briefly describe the appearances of cysts and tumors of bones and soft tissues of the upper extremity. Indications for the intravenous administration of Gadolinium are given throughout the article with emphasis on the synovial enhancement seen in active arthritis and synovitis. PMID:9654591

  2. Upper extremity injuries in Homer's Iliad.

    PubMed

    Hutchison, Richard L; Hirthler, Maureen A

    2013-09-01

    Homer's Iliad remains a fascinating source of medical history. This epic poem, compiled around 800 BCE, describes several weeks of the last year of the 10-year siege of Troy (Ilion) by the Achaeans. Homer composed the epic by combining and formalizing oral poems, legends, customs, and experiences that originated in the later Mycenaean age (1600-1100 bce). The story centers on the rage of the great warrior Achilles. The Iliad remains the oldest record of Greek medicine and a unique source of surgical history. This study examines the upper extremity injuries described in the Iliad and compares them to those other sites of injury. PMID:23932117

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

    PubMed

    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

  4. Treatment of upper-extremity outflow thrombosis.

    PubMed

    van den Houten, Marijn Ml; van Grinsven, Regine; Pouwels, Sjaak; Yo, Lonneke Sf; van Sambeek, Marc Rhm; Teijink, Joep Aw

    2016-03-01

    Approximately 10% of all cases of deep vein thrombosis (DVT) occur in the upper extremities. The most common secondary cause of upper-extremity DVT (UEDVT) is the presence of a venous catheter. Primary UEDVT is far less common and usually occurs in patients with anatomic abnormalities of the costoclavicular space causing compression of the subclavian vein, called venous thoracic outlet syndrome (VTOS). Subsequently, movement of the arm results in repetitive microtrauma to the vein and its surrounding structures causing apparent 'spontaneous' thrombosis, or Paget-Schrötter syndrome. Treatment of UEDVT aims at elimination of the thrombus, thereby relieving acute symptoms, and preventing recurrence. Initial management for all UEDVT patients consists of anticoagulant therapy. In patients with Paget-Schrötter syndrome the underlying VTOS necessitates a more aggressive management strategy. Several therapeutic options exist, including catheter-directed thrombolysis, surgical decompression through first rib resection, and percutaneous transluminal angioplasty of the vein. However, several controversies exist regarding their indication and timing. PMID:26916766

  5. Upper extremity arterial combat injury management.

    PubMed

    Weber, Michael A; Fox, Charles J; Adams, Eric; Rice, Rob D; Quan, Reagan; Cox, Mitchell W; Gillespie, David L

    2006-06-01

    Traumatic hemorrhage and vascular injury management have been concerns for both civilian and military physicians. During the 20th century, advances in technique allowed surgeons to focus on vascular repair, restoration of perfusion, limb salvage, and life preservation. Military surgeons such as Makins, DeBakey, Hughes, Rich, and others made significant contributions to the field of surgery in general and vascular surgery in particular. Casualties from combat in Afghanistan and Iraq confront physicians and surgeons with devastating injuries. The current generation of providers is challenged with applying contemporary care while expanding upon the lessons taught by our predecessors. The objective of this report is to review the historical experience with managing military upper extremity arterial injuries and compare that experience with current management. PMID:17060232

  6. CT angiography in complex upper extremity reconstruction.

    PubMed

    Bogdan, M A; Klein, M B; Rubin, G D; McAdams, T R; Chang, J

    2004-10-01

    Computed tomography angiography is a new technique that provides high-resolution, three-dimensional vascular imaging as well as excellent bone and soft tissue spatial relationships. The purpose of this study was to examine the use of computed tomography angiography in planning upper extremity reconstruction. Seventeen computed tomography angiograms were obtained in 14 patients over a 20-month period. All studies were obtained on an outpatient basis with contrast administered through a peripheral vein. All the studies demonstrated the pertinent anatomy and the intraoperative findings were as demonstrated in all cases. Information from two studies significantly altered pre-operative planning. The average charge for computed tomography angiography was 1,140 dollars, compared to 3,900 dollars for traditional angiography. PMID:15336751

  7. [Exoprosthetic Replacement of the Upper Extremity].

    PubMed

    Salminger, S; Mayer, J A; Sturma, A; Riedl, O; Bergmeister, K D; Aszmann, O C

    2016-08-01

    During the last years, the prosthetic replacement in upper limb amputees has undergone different developments. The use of new nerve surgical concepts improved the control strategies tremendously, especially for high-level amputees. Technological innovation in the field of pattern recognition enables the control of multifunctional myoelectric hand prostheses in a natural and intuitive manner. However, the different levels of amputation pose different challenges for the therapeutic team which concern not only the prosthetic attachment; also the expected functional outcome of prosthetic limb replacement differs greatly between the individual levels of amputation. Therefore, especially in partial hand amputations the indication for prosthetic fitting has to be evaluated critically, as these patients may benefit more from biologic reconstructive concepts. The value of the upper extremity, in particular of the hand, is undisputable and, as such represents the driving force for the technological and surgical developments within the exoprosthetic replacement. This article discusses the possibilities and limitations of exoprosthetic limb replacement on the different amputation levels and explores new developments. PMID:27547980

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

    PubMed

    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

  9. Interpretation of upper extremity arteriography: vascular anatomy and pathology [corrected].

    PubMed

    Wong, Victor W; Katz, Ryan D; Higgins, James P

    2015-02-01

    Understanding the utility and interpretation of upper extremity angiography is critical for the hand surgeon treating vaso-occlusive diseases of the hand. Although invasive and requiring the use of contrast dye, it remains the gold standard for imaging of the vascular system of the upper extremity. Angiography may detect numerous variants of the upper limb arterial system which may contribute to surgical pathology. Extensive vascular collateralization helps to maintain perfusion to the hand and facilitates reconstruction of the upper extremity. It is paramount to remember that angiography is a dynamic study and should represent a "flexible roadmap" for surgical reconstruction. PMID:25455362

  10. The incidence of upper extremity injuries in endoscopy nurses.

    PubMed

    Drysdale, Susan A

    2007-01-01

    Endoscopy nurses are at risk for upper extremity injury because of the nature of their work, yet there has been little attention to this problem in the literature. The purpose of this study was to explore whether endoscopy nurses commonly experience upper extremity injuries and to identify factors associated with upper extremity injuries in this population. Results reveal that for this sample, endoscopy nurses working full-time are at the highest risk for injury, suggesting the importance of ergonomics in the endoscopy suite. PMID:17568257

  11. A method for determination of upper extremity kinematics.

    PubMed

    Rab, George; Petuskey, Kyria; Bagley, Anita

    2002-04-01

    Kinematic analysis of the upper extremity has been conducted using a wide variety of techniques, philosophies, and analytic methods. We describe a simple, marker-based three-dimensional video analytic technique that borrows concepts from lower extremity kinematic analysis. A sequential rotation order about orthogonal axes is described, although alternate methods are examined as well. The method has been verified by application to a mechanical model. In certain positions, gimbal lock may occur, and a different sequence of rotational decomposition may be required. Agreement on standardization of technique would assist in the dissemination of upper extremity scientific data. PMID:11869904

  12. Lymphatic Filariasis Disseminating to the Upper Extremity

    PubMed Central

    Maldjian, Catherine; Khanna, Vineet; Tandon, Bevan; Then, Matthew; Yassin, Mohamed; Adam, Richard; Klein, Michael J.

    2014-01-01

    Lymphatic filariasis is the most common cause of acquired lymphedema worldwide (Szuba and Rockson, 1998). It is endemic to tropical and subtropical regions, and its effects are devastating. With over 100 million infected persons, it ranks second only to leprosy as the leading cause of permanent and long-term disability. Wuchereria bancrofti is the etiologic agent in 90% of cases. There is a dearth of published MRI findings with pathologically proven active infections, making this entity even more of a diagnostic dilemma. Imaging may provide the first clue that one is dealing with a parasite and may facilitate proper treatment and containment of this disease. This is the first report of pathologic correlation with MRI findings in the extremity in active filariasis. The magnetic resonance images demonstrate an enhancing, infiltrative, mass-like appearance with partial encasement of vasculature that has not been previously described in filariasis. Low signal strands in T2-hyperintense dilated lymphatic channels are seen and may depict live adult worms. We hypothesize that the low signal strands correspond to the collagen rich acellular cuticle. This, in combination with the surrounding hyperintense T2 signal, corresponding to a dilated lymphatic channel, may provide more specific MRI findings for active nematodal infection, which can prompt early biopsy, pathological correlation, and diagnosis. PMID:24707427

  13. Application of RFID technology-upper extremity rehabilitation training.

    PubMed

    Chen, Chih-Chen; Chen, Yu-Luen; Chen, Shih-Ching

    2016-01-01

    [Purpose] Upper extremity rehabilitation after an injury is very important. This study proposes radio frequency identification (RFID) technology to improve and enhance the effectiveness of the upper extremity rehabilitation. [Subjects and Methods] People use their upper extremities to conduct daily activities. When recovering from injuries, many patients neglect the importance of rehabilitation, which results in degraded function. This study recorded the training process using the traditional rehabilitation hand gliding cart with a RFID reader, RFID tags in the panel, and a servo host computer. [Results] Clinical evidence, time taken to achieve a full score, counts of missing the specified spots, and Brunnstrom stage of aided recovery, the proximal part of the upper extremity show that the RFID-based upper extremity training significantly and reduce negative impacts of the disability in daily life and activities. [Conclusion] This study combined a hand-gliding cart with an RFID reader, and when patients moved the cart, the movement could be observed via the activated RFID tags. The training data was collected and quantified for a better understanding of the recovery status of the patients. Each of the participating patients made progress as expected. PMID:27065539

  14. Application of RFID technology—upper extremity rehabilitation training

    PubMed Central

    Chen, Chih-Chen; Chen, Yu-Luen; Chen, Shih-Ching

    2016-01-01

    [Purpose] Upper extremity rehabilitation after an injury is very important. This study proposes radio frequency identification (RFID) technology to improve and enhance the effectiveness of the upper extremity rehabilitation. [Subjects and Methods] People use their upper extremities to conduct daily activities. When recovering from injuries, many patients neglect the importance of rehabilitation, which results in degraded function. This study recorded the training process using the traditional rehabilitation hand gliding cart with a RFID reader, RFID tags in the panel, and a servo host computer. [Results] Clinical evidence, time taken to achieve a full score, counts of missing the specified spots, and Brunnstrom stage of aided recovery, the proximal part of the upper extremity show that the RFID-based upper extremity training significantly and reduce negative impacts of the disability in daily life and activities. [Conclusion] This study combined a hand-gliding cart with an RFID reader, and when patients moved the cart, the movement could be observed via the activated RFID tags. The training data was collected and quantified for a better understanding of the recovery status of the patients. Each of the participating patients made progress as expected. PMID:27065539

  15. Vascular injuries in the upper extremity in athletes.

    PubMed

    de Mooij, Tristan; Duncan, Audra A; Kakar, Sanjeev

    2015-02-01

    Repetitive, high-stress, or high-impact arm motions can cause upper extremity arterial injuries. The increased functional range of the upper extremity causes increased stresses on the vascular structures. Muscle hypertrophy and fatigue-induced joint translation may incite impingement on critical neurovasculature and can cause vascular damage. A thorough evaluation is essential to establish the diagnosis in a timely fashion as presentation mimics more common musculoskeletal injuries. Conservative treatment includes equipment modification, motion analysis and adjustment, as well as equipment enhancement to limit exposure to blunt trauma or impingement. Surgical options include ligation, primary end-to-end anastomosis for small defects, and grafting. PMID:25455355

  16. Ultrasonography for nerve compression syndromes of the upper extremity

    PubMed Central

    Choi, Soo-Jung; Ahn, Jae Hong; Ryu, Dae Shik; Kang, Chae Hoon; Jung, Seung Mun; Park, Man Soo; Shin, Dong-Rock

    2015-01-01

    Nerve compression syndromes commonly involve the nerves in the upper extremity. High-resolution ultrasonography (US) can satisfactorily assess these nerves and may detect the morphological changes of the nerves. US can also reveal the causes of nerve compression when structural abnormalities or space-occupying lesions are present. The most common US finding of compression neuropathy is nerve swelling proximal to the compression site. This article reviews the normal anatomic location and US appearances of the median, ulnar, and radial nerves. Common nerve compression syndromes in the upper extremity and their US findings are also reviewed. PMID:25682987

  17. Advances in percutaneous therapy for upper extremity arterial disease.

    PubMed

    Capers, Quinn; Phillips, John

    2011-08-01

    Upper extremity arteries are affected by occlusive diseases from diverse causes, with atherosclerosis being the most common. Although the overriding principle in managing patients with upper extremity arterial occlusive disease should be cardiovascular risk reduction by noninvasive and pharmacologic means, when target organ ischemia produces symptoms or threatens the patient's well-being, revascularization is necessary. Given their minimally invasive nature and successful outcomes, percutaneous catheter-based therapies are preferred to surgical approaches. The fact that expertise in these techniques resides in not one but several disciplines (vascular surgery, radiology, cardiology, vascular medicine) makes this an area ripe for multidisciplinary collaboration to the benefit of patients. PMID:21803225

  18. [Comparison of phantom limb pain or phantom extremity sensation of upper and lower extremity amputations].

    PubMed

    Uğur, Fatih; Akin, Aynur; Esmaoğlu, Aliye; Doğru, Kudret; Ors, Sevgi; Aydoğan, Harun; Gülcü, Nebahat; Boyaci, Adem

    2007-01-01

    The aim of this retrospective study is to evaluate the upper and the lower extremity amputations with regard to phantom pain, phantom sensation and stump pain. A questionnaire consisting of 23 questions was send to the patients who underwent upper or lower extremity amputation surgery between 1996- 2005. The patients were questioned for the presence of phantom pain and sensations and if they existed for the frequency, intensity, cause of amputation, pre-amputation pain, stump pain, usage of artificial limb. Totally 147 patients were included and the response rate was 70 %. The incidence of phantom pain in Upper Extremity Group was 60 % and 65.8% in Lower Extremity Group. The incidence of phantom sensations was 70.7% in Upper Extremity Group and 75.6% in Lower Extremity Group. There was no significant difference between two groups considering in phantom pain and phantom sensations. The phantom pain was significantly higher in patients who lost dominant hand, experienced pre amputation pain and suffered stump pain. There were no significant differences in regard to phantom pain and sensation between upper and lower extremity amputations. However the presence of preamputation pain, stump pain and amputation of dominant hand were found as risk factors for the development of phantom pain. PMID:17457707

  19. Multiple Concomitant Injuries in One Upper Extremity: A Case Report

    PubMed Central

    Abutalib, Raid A.; Khoshhal, Khalid I.

    2016-01-01

    Patient: Male, 36 Final Diagnosis: Multiple concomitant right upper limb fractures Symptoms: — Medication: — Clinical Procedure: Open reduction and internal fixation of right upper limb fractures Specialty: Orthopedics and Traumatology Objective: Rare co-existance of disease or pathology Background: This report is about unusual multiple upper extremity concomitant injuries in an adult after a fall from a height. To the best of our knowledge this is the first reported case of concomitant ipsilateral occurrence of multiple common injuries, uncommonly occurring together in a single traumatic episode. Case Report: A 36-year-old right-handed man fell through a skylight to the floor about 4 meters below. He presented with multiple concomitant injuries in his right upper extremity: elbow dislocation with radial head fracture associated with distal radius, ulnar styloid, and scaphoid fractures. Conclusions: The probable mechanism of injury along with the surgical treatment of these previously undescribed injuries is discussed to emphasize the need to clinically examine the whole upper extremity in severe injuries. The awareness of such an association for early recognition is paramount for excellent clinical results. PMID:26732673

  20. Upper extremity hemodynamics and sensation with backpack loads.

    PubMed

    Kim, Sae Hoon; Neuschwander, Timothy B; Macias, Brandon R; Bachman, Larry; Hargens, Alan R

    2014-05-01

    Heavy backpacks are often used in extreme environments, for example by military during combat, therefore completion of tasks quickly and efficiently is of operational relevance. The purpose of this study was to quantify hemodynamic parameters (brachial artery Doppler and microvascular flow by photoplethysmography; tissue oxygenation by near-infrared spectroscopy; arterial oxygen saturation by pulse oximeter) and sensation in upper extremities and hands (Semmes-Weinstein monofilament test and 2-point discrimination test) while wearing a loaded backpack (12 kg) in healthy adults for 10 min. All values were compared to baseline before wearing a backpack. Moderate weight loaded backpack loads significantly decreased upper extremity sensation as well as all macrovascular and microvascular hemodynamic values. Decreased macrovascular and microvascular hemodynamics may produce neurological dysfunction and consequently, probably affect fine motor control of the hands. PMID:24075289

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

    PubMed Central

    Ege, Tolga; Unlu, Aytekin; Tas, Huseyin; Bek, Dogan; Turkan, Selim; Cetinkaya, Aytac

    2015-01-01

    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 score for

  2. A hybrid joint based controller for an upper extremity exoskeleton

    NASA Astrophysics Data System (ADS)

    Mohd Khairuddin, Ismail; Taha, Zahari; Majeed, Anwar P. P. Abdul; Hakeem Deboucha, Abdel; Azraai Mohd Razman, Mohd; Aziz Jaafar, Abdul; Mohamed, Zulkifli

    2016-02-01

    This paper presents the modelling and control of a two degree of freedom upper extremity exoskeleton. The Euler-Lagrange formulation was used in deriving the dynamic modelling of both the human upper limb as well as the exoskeleton that consists of the upper arm and the forearm. The human model is based on anthropometrical measurements of the upper limb. The proportional-derivative (PD) computed torque control (CTC) architecture is employed in this study to investigate its efficacy performing joint-space control objectives specifically in rehabilitating the elbow and shoulder joints along the sagittal plane. An active force control (AFC) algorithm is also incorporated into the PD-CTC to investigate the effectiveness of this hybrid system in compensating disturbances. It was found that the AFC- PD-CTC performs well against the disturbances introduced into the system whilst achieving acceptable trajectory tracking as compared to the conventional PD-CTC control architecture.

  3. New Options for Vascularized Bone Reconstruction in the Upper Extremity

    PubMed Central

    Houdek, Matthew T.; Wagner, Eric R.; Wyles, Cody C.; Nanos, George P.; Moran, Steven L.

    2015-01-01

    Originally described in the 1970s, vascularized bone grafting has become a critical component in the treatment of bony defects and non-unions. Although well established in the lower extremity, recent years have seen many novel techniques described to treat a variety of challenging upper extremity pathologies. Here the authors review the use of different techniques of vascularized bone grafts for the upper extremity bone pathologies. The vascularized fibula remains the gold standard for the treatment of large bone defects of the humerus and forearm, while also playing a role in carpal reconstruction; however, two other important options for larger defects include the vascularized scapula graft and the Capanna technique. Smaller upper extremity bone defects and non-unions can be treated with the medial femoral condyle (MFC) free flap or a vascularized rib transfer. In carpal non-unions, both pedicled distal radius flaps and free MFC flaps are viable options. Finally, in skeletally immature patients, vascularized fibular head epiphyseal transfer can provide growth potential in addition to skeletal reconstruction. PMID:25685100

  4. Soft Tissue Coverage of the Mangled Upper Extremity

    PubMed Central

    Ng, Zhi Yang; Salgado, Christopher J.; Moran, Steven L.; Chim, Harvey

    2015-01-01

    Mangled upper extremity injuries usually involve high-impact trauma with crushing and tearing of the limb and its associated soft tissue structures. Such trauma is particularly mutilating because of the nature of the injury and the involvement of structures vital for proper function. Although advancements in flap technique and improvements in bone fixation methods have enabled good functional and clinical outcomes in limb salvage reconstruction, this remains a challenging area. Attempts at limb preservation should be fully exhausted before consideration is given for amputation, which results in significantly decreased function. Here the authors focus on the various modalities of soft tissue coverage available including allogenic substitutes, the adjunctive use of negative pressure wound therapy, and the design and utilization of flaps to address various defect configurations for the goals of wound healing, aesthetics, and functional restoration in the mangled upper extremity. PMID:25685103

  5. Increased mortality after upper extremity fracture requiring inpatient care

    PubMed Central

    Somersalo, Axel; Paloneva, Juha; Kautiainen, Hannu; Lönnroos, Eija; Heinänen, Mikko; Kiviranta, Ilkka

    2015-01-01

    Background and purpose Increased mortality after hip fracture is well documented. The mortality after hospitalization for upper extremity fracture is unknown, even though these are common injuries. Here we determined mortality after hospitalization for upper extremity fracture in patients aged ≥16 years. Patients and methods We collected data about the diagnosis code (ICD10), procedure code (NOMESCO), and 7 additional characteristics of 5,985 patients admitted to the trauma ward of Central Finland Hospital between 2002 and 2008. During the study, 929 women and 753 men sustained an upper extremity fracture. The patients were followed up until the end of 2012. Mortality rates were calculated using data on the population at risk. Results By the end of follow-up (mean duration 6 years), 179 women (19%) and 105 men (14%) had died. The standardized mortality ratio (SMR) for all patients was 1.5 (95% CI: 1.4–1.7). The SMR was higher for men (2.1, CI: 1.7–2.5) than for women (1.3, CI: 1.1–1.5) (p < 0.001). The SMR decreased with advancing age, and the mortality rate was highest for men with humerus fractures. Interpretation In men, the risk of death related to proximal humerus fracture was even higher than that reported previously for hip fracture. Compared to the general population, the SMR was double for humerus fracture patients, whereas wrist fracture had no effect on mortality. PMID:25909341

  6. Modelling and control of an upper extremity exoskeleton for rehabilitation

    NASA Astrophysics Data System (ADS)

    Taha, Zahari; Majeed, Anwar P. P. Abdul; Tze, Mohd Yashim Wong Paul; Abdo Hashem, Mohammed; Mohd Khairuddin, Ismail; Azraai Mohd Razman, Mohd

    2016-02-01

    This paper presents the modelling and control of a two degree of freedom upper extremity exoskeleton for rehabilitation. The Lagrangian formulation was employed to obtain the dynamic modelling of both the anthropometric based human upper limb as well as the exoskeleton that comprises of the upper arm and the forearm. A proportional-derivative (PD) architecture is employed to investigate its efficacy performing a joint task trajectory tracking in performing flexion/extension on the elbow joint as well as the forward adduction/abduction on the shoulder joint. An active force control (AFC) algorithm is also incorporated into the aforementioned controller to examine its effectiveness in compensating disturbances. It was found from the study that the AFC-PD performed well against the disturbances introduced into the system without compromising its tracking performances as compared to the conventional PD control architecture.

  7. Modeling the postural disturbances caused by upper extremity movements.

    PubMed

    Triolo, R J; Werner, K N; Kirsch, R F

    2001-06-01

    This paper describes the design, validation, and application of a dynamic, three-dimensional (3-D) model of the upper extremity for the purpose of estimating postural disturbances generated by movements of the arms. The model consists of two links representing the upper and lower arms, with the shoulder and elbow modeled as gimbal joints to allow three rotational degrees of freedom. With individualized segment inertial parameters based on anthropometric measurements, the model performs inverse dynamic analysis of recorded arm movements to calculate reaction forces and moments acting on the body at the shoulder in three dimensions. The method was validated by comparing the output of the model to estimates obtained from ground reaction loads during stereotypical and free form unilateral movements at various velocities and with different loads carried by human subjects while seated on biomechanical force platforms. The correlation between predicted and measured reaction forces and moments was very good under all conditions and across all subjects, with average rms errors less than 8% of measured peak-to-peak values. The model was then applied to bimanual activities representative of functional movements that would typically be performed while standing at a counter. The resulting estimates were consistent and adequate for the purpose of evaluating postural disturbances caused by upper extremity movements. PMID:11474966

  8. Hip and upper extremity kinematics in youth baseball pitchers.

    PubMed

    Holt, Taylor; Oliver, Gretchen D

    2016-05-01

    The purpose of this study was to examine the relationship between dynamic hip rotational range of motion and upper extremity kinematics during baseball pitching. Thirty-one youth baseball pitchers (10.87 ± 0.92 years; 150.03 ± 5.48 cm; 44.83 ± 8.04 kg) participated. A strong correlation was found between stance hip rotation and scapular upward rotation at maximum shoulder external rotation (r = 0.531, P = 0.002) and at ball release (r = 0.536, P = 0.002). No statistically significant correlations were found between dynamic hip rotational range of motion and passive hip range of motion. Hip range of motion deficits can constrain pelvis rotation and limit energy generation in the lower extremities. Shoulder pathomechanics can then develop as greater responsibility is placed on the shoulder to generate the energy lost from the proximal segments, increasing risk of upper extremity injury. Additionally, it appears that passive seated measurements of hip range of motion may not accurately reflect the dynamic range of motion of the hips through the progression of the pitch cycle. PMID:26256828

  9. A review of bilateral training for upper extremity hemiparesis.

    PubMed

    Stoykov, Mary Ellen; Corcos, Daniel M

    2009-01-01

    Upper extremity hemiparesis is the most common post-stroke disability. Longitudinal studies have indicated that 30-66% of stroke survivors do not have full arm function 6 months post-stroke. The current gold standard for treatment of mild post-stroke upper limb impairment is constraint-induced therapy but, because of the inclusion criteria, alternative treatments are needed which target more impaired subjects. Bilateral arm training has been investigated as a potential rehabilitation intervention. Bilateral arm training encompasses a number of methods including: (1) bilateral isokinematic training; (2) mirror therapy using bilateral training; (3) device-driven bilateral training; and (4) bilateral motor priming. Neural mechanisms mediating bilateral training are first reviewed. The key bilateral training studies that have demonstrated evidence of efficacy will then be discussed. Finally, conclusions are drawn concerning clinical implications based on the reviewed literature. PMID:19517519

  10. Satisfaction with upper extremity surgery in individuals with tetraplegia

    PubMed Central

    Gregersen, Hanne; Lybæk, Mille; Lauge Johannesen, Inger; Leicht, Pernille; Nissen, Ulla Vig; Biering-Sørensen, Fin

    2015-01-01

    Objective To supplement the scant information available regarding the satisfaction of patients with tetraplegia following upper extremity reconstructive surgery for such individuals with spinal cord injury (SCI). Study design Retrospective study with questionnaire follow-up. Setting The Danish Spinal Cord Injury Centers. Material and methods In the initial review period, 119 upper extremity surgeries were performed on patients with tetraplegia (n = 49). Seven died and the remaining 42 were invited to complete a follow-up questionnaire with a five-level scale ranging from strongly agree to strongly disagree regarding satisfaction. Forty patients completed the questionnaire. Results Median time from first surgery was 13 years (2–36). Sixty-five percent of the sample had a C5–C6 SCI, with 64% experiencing complete injury. Initially, 76% of the sample expressed general satisfaction with life, but only 28% of the sample reported that hand appearance improved after surgery. Interestingly, those having surgery from 1991 to 2008 reported significantly greater satisfaction (P < 0.001) and were significantly more satisfied with activities of daily living (ADL) (P < 0.001) than those having surgery between the years 1973 and 1990. In particular, gain of independence was obtained with pinch/specific hand surgery compared to triceps activation. Accordingly, the pinch/specific hand surgery group was significantly more satisfied than the triceps group on the ADL (P = 0.027), and the independence questions (P < 0.001). Conclusion Overall satisfaction with upper extremity surgery is high. It can have a positive impact on life in general, ability to perform ADL, as well as supplying an increased level of independence. PMID:25243666

  11. Mirror therapy enhances upper extremity motor recovery in stroke patients.

    PubMed

    Mirela Cristina, Luca; Matei, Daniela; Ignat, Bogdan; Popescu, Cristian Dinu

    2015-12-01

    The purpose of this study was to evaluate the effects of mirror therapy program in addition with physical therapy methods on upper limb recovery in patients with subacute ischemic stroke. 15 subjects followed a comprehensive rehabilitative treatment, 8 subjects received only control therapy (CT) and 7 subjects received mirror therapy (MT) for 30 min every day, five times a week, for 6 weeks in addition to the conventional therapy. Brunnstrom stages, Fugl-Meyer Assessment (upper extremity), the Ashworth Scale, and Bhakta Test (finger flexion scale) were used to assess changes in upper limb motor recovery and motor function after intervention. After 6 weeks of treatment, patients in both groups showed significant improvements in the variables measured. Patients who received MT showed greater improvements compared to the CT group. The MT treatment results included: improvement of motor functions, manual skills and activities of daily living. The best results were obtained when the treatment was started soon after the stroke. MT is an easy and low-cost method to improve motor recovery of the upper limb. PMID:25850528

  12. Management of catheter-associated upper extremity deep venous thrombosis.

    PubMed

    Crawford, Jeffrey D; Liem, Timothy K; Moneta, Gregory L

    2016-07-01

    Central venous catheters or peripherally inserted central catheters are major risk factors for upper extremity deep venous thrombosis (UEDVT). The body and quality of literature evaluating catheter-associated (CA) UEDVT have increased, yet strong evidence on screening, diagnosis, prevention, and optimal treatment is limited. We herein review the current evidence of CA UEDVT that can be applied clinically. Principally, we review the anatomy and definition of CA UEDVT, identification of risk factors, utility of duplex ultrasound as the preferred diagnostic modality, preventive strategies, and an algorithm for management of CA UEDVT. PMID:27318061

  13. Electrodiagnosis of brachial plexopathies and proximal upper extremity neuropathies.

    PubMed

    Simmons, Zachary

    2013-02-01

    This article describes the normal anatomy of the brachial plexus and its major terminal branches, as well as the major causes and clinical presentations of lesions of these structures. An approach to electrodiagnosis of brachial plexopathies and proximal upper extremity neuropathies is provided, with an emphasis on those nerve conduction studies and portions of the needle examination, which permit localization of lesions to specific trunks, cords, and terminal branches. The importance of specific sensory nerve conduction studies for differentiating plexopathies from radiculopathies and mononeuropathies is emphasized. PMID:23177028

  14. Free Functional Muscle Transfers to Restore Upper Extremity Function.

    PubMed

    Krauss, Emily M; Tung, Thomas H; Moore, Amy M

    2016-05-01

    Free functional muscle transfer provides an option for functional restoration when nerve reconstruction and tendon transfers are not feasible. To ensure a successful outcome, many factors need to be optimized, including proper patient selection, timing of intervention, donor muscle and motor nerve selection, optimal microneurovascular technique and tension setting, proper postoperative management, and appropriate rehabilitation. Functional outcomes of various applications to the upper extremity and the authors' algorithm for the use of free functional muscle transfer are also included in this article. PMID:27094895

  15. Effect of whole body vibration applied on upper extremity muscles.

    PubMed

    Gyulai, G; Rácz, L; Di Giminiani, R; Tihanyi, József

    2013-03-01

    The acute residual effect of whole body vibration (WBV) on upper extremity muscles and testosterone secretion was studied. Eight highly (G1), nine moderately trained gymnasts (G2) and seven physically active persons (CG) were recruited for the investigation. The intervention occurred in push-up position with the elbow flexed at 90°. G1 and G2 received 30 s, 30 Hz and 6 mm amplitude vibration repeated five times. Subjects were tested before and after one and ten minutes intervention in push-up movement. Contact time (Tc), fly time (Tf), TF/Tc ratio and impulse was measured from the ground reaction force-time curves recorded during self-selected (SSRM) and full range of motion (FRM). Testosterone level in urine was also determined. Tf increased significantly in SSRM for G1 and decreased in SSRM and FRM for G2. Tf/Tc ratio in FRM and impulse in SSRM increased significantly for G1 only. No significant alteration in testosterone level was observed. We concluded that WBV is a reasonable training modality for influencing dynamic work of upper extremity muscle, but the reaction to WBV is training and individual dependent. It seems that WBV do not influence dynamic work through increased testosterone secretion because of the relatively low mass of the involved muscles. PMID:23232701

  16. Approach to complex upper extremity injury: an algorithm.

    PubMed

    Ng, Zhi Yang; Askari, Morad; Chim, Harvey

    2015-02-01

    Patients with complex upper extremity injuries represent a unique subset of the trauma population. In addition to extensive soft tissue defects affecting the skin, bone, muscles and tendons, or the neurovasculature in various combinations, there is usually concomitant involvement of other body areas and organ systems with the potential for systemic compromise due to the underlying mechanism of injury and resultant sequelae. In turn, this has a direct impact on the definitive reconstructive plan. Accurate assessment and expedient treatment is thus necessary to achieve optimal surgical outcomes with the primary goal of limb salvage and functional restoration. Nonetheless, the characteristics of these injuries places such patients at an increased risk of complications ranging from limb ischemia, recalcitrant infections, failure of bony union, intractable pain, and most devastatingly, limb amputation. In this article, the authors present an algorithmic approach toward complex injuries of the upper extremity with due consideration for the various reconstructive modalities and timing of definitive wound closure for the best possible clinical outcomes. PMID:25685098

  17. Clavicular fracture and upper-extremity deep venous thrombosis.

    PubMed

    Peivandi, Mohammad Taghi; Nazemian, Zohreh

    2011-03-01

    Upper-extremity deep venous thrombosis (DVT) is considered an uncommon clinical event with considerable potential for morbidity. This article presents a case of upper-extremity DVT following a clavicular fracture. A 25-year-old man presented with pain and distortion of the left midclavicular area after falling on his left shoulder during martial arts practice. Following physical examination and radiography, he was diagnosed with a simple displaced clavicle fracture at the middle third. The patient had no previous surgery or medical problem, and did not smoke. No family history of blood clotting disorders were present and neurovascular examination appeared normal on the symmetric contralateral side. A figure-of-8 bandage was applied to support the arm and the patient was discharged. One week later, he returned with swelling and severe pain in his left arm. On examination, a DVT was suspected and the figure-of-8 brace was removed. A Doppler ultrasonography was performed and the presence of a thrombus extending from the brachial axillary veins to the distal subclavian vein with no flow in that segment was revealed. The patient was placed in a sling instead of a figure-of-8 bandage to immobilize the arm, while anticoagulation therapy with enoxaparin was started (1 mg/kg every 12 hours, 80 mg subcutaneous daily for 3 months). The swelling was reduced after 5 days. At 2-week follow-up, the patient had no pain and the swelling had completely disappeared. PMID:21410116

  18. Videotapes in evaluating work-related upper extremity symptoms.

    PubMed

    Sollender, J L; Rayan, G M

    1999-03-01

    Thirteen patients with upper extremity symptoms that were claimed to have occurred in the course of employment were evaluated to determine the role of videotapes in their evaluation and management. Videotapes were of two types: work demonstration by patient or coworker (8 tapes) and surveillance tapes obtained by a private investigator (5 tapes). Four of eight work station videotapes demonstrated significant repetitive motion that could have contributed to their symptoms. Four of eight work station videotapes demonstrated that the tasks were neither forceful nor repetitive in nature. Return to work recommendations were made based on both clinical grounds and job site information provided on tape. After viewing five surveillance videotapes, two fraudulent claims were settled soon after medical opinions were rendered. Two patients were declared able to return to work; one returned to work and the other was dismissed. The videotape of patient No. 13 was not crucial for the decision and he was authorized to have surgery. The opinions formed concerning the causality of alleged claims of injury were often altered by viewing the content of the videotapes. Videotapes are a valuable tool and useful adjunct in the overall management of the workers with upper extremity symptoms. PMID:10087671

  19. Extreme Cranial Ontogeny in the Upper Cretaceous Dinosaur Pachycephalosaurus

    PubMed Central

    Horner, John R.; Goodwin, Mark B.

    2009-01-01

    Background Extended neoteny and late stage allometric growth increase morphological disparity between growth stages in at least some dinosaurs. Coupled with relatively low dinosaur density in the Upper Cretaceous of North America, ontogenetic transformational representatives are often difficult to distinguish. For example, many hadrosaurids previously reported to represent relatively small lambeosaurine species were demonstrated to be juveniles of the larger taxa. Marginocephalians (pachycephalosaurids + ceratopsids) undergo comparable and extreme cranial morphological change during ontogeny. Methodology/Principal Findings Cranial histology, morphology and computer tomography reveal patterns of internal skull development that show the purported diagnostic characters for the pachycephalosaurids Dracorex hogwartsia and Stygimoloch spinifer are ontogenetically derived features. Coronal histological sections of the frontoparietal dome of an adult Pachycephalosaurus wyomingensis reveal a dense structure composed of metaplastic bone with a variety of extremely fibrous and acellular tissue. Coronal histological sections and computer tomography of a skull and frontoparietal dome of Stygimoloch spinifer reveal an open intrafrontal suture indicative of a subadult stage of development. These dinosaurs employed metaplasia to rapidly grow and change the size and shape of their horns, cranial ornaments and frontoparietal domes, resulting in extreme cranial alterations during late stages of growth. We propose that Dracorex hogwartsia, Stygimoloch spinifer and Pachycephalosaurus wyomingensis are the same taxon and represent an ontogenetic series united by shared morphology and increasing skull length. Conclusions/Significance Dracorex hogwartsia (juvenile) and Stygimoloch spinifer (subadult) are reinterpreted as younger growth stages of Pachycephalosaurus wyomingensis (adult). This synonymy reduces the number of pachycephalosaurid taxa from the Upper Cretaceous of North America

  20. Upper Extremity Assessment in Tetraplegia: The Importance of Differentiating Between Upper and Lower Motor Neuron Paralysis.

    PubMed

    Bryden, Anne M; Hoyen, Harry A; Keith, Michael W; Mejia, Melvin; Kilgore, Kevin L; Nemunaitis, Gregory A

    2016-06-01

    Scientific advances are increasing the options for improved upper limb function in people with cervical level spinal cord injury (SCI). Some of these interventions rely on identifying an aspect of paralysis that is not uniformly assessed in SCI: the integrity of the lower motor neuron (LMN). SCI can damage both the upper motor neuron and LMN causing muscle paralysis. Differentiation between these causes of paralysis is not typically believed to be important during SCI rehabilitation because, regardless of the cause, the muscles are no longer under voluntary control by the patient. Emerging treatments designed to restore upper extremity function (eg, rescue microsurgical nerve transfers, motor learning-based interventions, functional electrical stimulation) all require knowledge of LMN status. The LMN is easily evaluated using surface electrical stimulation and does not add significant time to the standard clinical assessment of SCI. This noninvasive evaluation yields information that contributes to the development of a lifetime upper extremity care plan for maximizing function and quality of life. Given the relative simplicity of this assessment and the far-reaching implications for treatment and function, we propose that this assessment should be adopted as standard practice for acute cervical SCI. PMID:27233597

  1. Multibody model of the human upper extremity for fracture simulation

    PubMed Central

    Milanowicz, Marcin; Kędzior, Krzysztof

    2016-01-01

    About 3.8 million people are injured in accidents at work in Europe every year. The resulting high costs are incurred by the victims themselves, their families, employers and society. We have used a numerical simulation to reconstruct accidents at work for several years. To reconstruct these accidents MADYMO R7.5 with a numerical human model (pedestrian model) is used. However, this model is dedicated to the analysis of car-to-pedestrian accidents and thus cannot be fully used for reconstructing accidents at work. Therefore, we started working on the development of a numerical model of the human body for the purpose of simulating accidents at work. Developing a new numerical model which gives an opportunity to simulate fractures of the upper extremity bones is a stage of that work. PMID:26651896

  2. Multibody model of the human upper extremity for fracture simulation.

    PubMed

    Milanowicz, Marcin; Kędzior, Krzysztof

    2016-09-01

    About 3.8 million people are injured in accidents at work in Europe every year. The resulting high costs are incurred by the victims themselves, their families, employers and society. We have used a numerical simulation to reconstruct accidents at work for several years. To reconstruct these accidents MADYMO R7.5 with a numerical human model (pedestrian model) is used. However, this model is dedicated to the analysis of car-to-pedestrian accidents and thus cannot be fully used for reconstructing accidents at work. Therefore, we started working on the development of a numerical model of the human body for the purpose of simulating accidents at work. Developing a new numerical model which gives an opportunity to simulate fractures of the upper extremity bones is a stage of that work. PMID:26651896

  3. Tumors involving the skin of the upper extremity.

    PubMed

    Fleegler, E J

    1987-05-01

    This review can only introduce the subject of tumors found involving the skin of the upper extremity. Many benign masses as well as some malignant tumors have to be considered when a patient calls to the physician's attention a lump, firm area, color change, ulcer, or other alteration in the skin. In response, the physician must have a high index of suspicion, take a careful history, and carry out a thorough examination in order to develop a safe approach. Thought has to be given to the complex anatomy of this area. Understanding of the pathophysiology of tumors and of possible later additional therapy is needed to plan an appropriate biopsy. In the brief discussions of treatment, the difficulty in choosing margins of resection and assessing the efficacy of lymph node dissection is mentioned. An open mind and assessment of future reports of studies in progress may be helpful. Whatever treatment is applied to the malignant tumors under consideration, it is my opinion that one must persist in this until one obtains tumor-free margins. The surgeon undertaking this responsibility must apply the same tumor techniques including operating room discipline that would be applied to any serious malignancy. Consultation and careful work with colleagues that are able to assess the potential for response to chemotherapy, immunotherapy, and/or radiotherapy, should be sought. Subtle hazards in our environment, such as changing risk of sun exposure, industrial chemicals, and irradiation should be pointed out to our patients. These are a challenge to the student of this subject, just as tobacco products are to those involved with malignancies of the head and neck, respiratory, and other systems. All of the previously mentioned methods must be used in the anatomically complex upper extremity to preserve function while ridding the patient of the burden of a disfiguring or painful benign process, or even a life-threatening malignancy. PMID:3034925

  4. Upper Extremity Injuries in NASCAR Drivers and Pit Crew

    PubMed Central

    Wertman, Gary; Gaston, R. Glenn; Heisel, William

    2016-01-01

    Background: Understanding the position-specific musculoskeletal forces placed on the body of athletes facilitates treatment, prevention, and return-to-play decisions. While position-specific injuries are well documented in most major sports, little is known about the epidemiology of position-specific injuries in National Association for Stock Car Automobile Racing (NASCAR) drivers and pit crew. Purpose: To investigate position-specific upper extremity injuries in NASCAR drivers and pit crew members. Study Design: Descriptive epidemiological study. Methods: A retrospective chart review was performed to assess position-specific injuries in NASCAR drivers and pit crew members. Included in the study were patients seen by a single institution between July 2003 and October 2014 with upper extremity injuries from race-related NASCAR events or practices. Charts were reviewed to identify the diagnosis, mechanism of injury, and position of each patient. Results: A total of 226 NASCAR team members were treated between July 2003 and October 2014. Of these, 118 injuries (52%) occurred during NASCAR racing events or practices. The majority of these injuries occurred in NASCAR changers (42%), followed by injuries in drivers (16%), carriers (14%), jack men (11%), fuel men (9%), and utility men (8%). The majority of the pit crew positions are at risk for epicondylitis, while drivers are most likely to experience neuropathies, such as hand-arm vibration syndrome. The changer sustains the most hand-related injuries (42%) on the pit crew team, while carriers commonly sustain injuries to their digits (29%). Conclusion: Orthopaedic injuries in NASCAR vary between positions. Injuries in NASCAR drivers and pit crew members are a consequence of the distinctive forces associated with each position throughout the course of the racing season. Understanding these forces and position-associated injuries is important for preventive measures and facilitates diagnosis and return-to-play decisions

  5. Automated Assessment of Upper Extremity Movement Impairment due to Stroke

    PubMed Central

    Olesh, Erienne V.; Yakovenko, Sergiy; Gritsenko, Valeriya

    2014-01-01

    Current diagnosis and treatment of movement impairment post-stroke is based on the subjective assessment of select movements by a trained clinical specialist. However, modern low-cost motion capture technology allows for the development of automated quantitative assessment of motor impairment. Such outcome measures are crucial for advancing post-stroke treatment methods. We sought to develop an automated method of measuring the quality of movement in clinically-relevant terms from low-cost motion capture. Unconstrained movements of upper extremity were performed by people with chronic hemiparesis and recorded by standard and low-cost motion capture systems. Quantitative scores derived from motion capture were compared to qualitative clinical scores produced by trained human raters. A strong linear relationship was found between qualitative scores and quantitative scores derived from both standard and low-cost motion capture. Performance of the automated scoring algorithm was matched by averaged qualitative scores of three human raters. We conclude that low-cost motion capture combined with an automated scoring algorithm is a feasible method to assess objectively upper-arm impairment post stroke. The application of this technology may not only reduce the cost of assessment of post-stroke movement impairment, but also promote the acceptance of objective impairment measures into routine medical practice. PMID:25100036

  6. Thermograpic study of upper extremities in patients with cerebral palsy

    NASA Astrophysics Data System (ADS)

    Lampe, R.; Kawelke, S.; Mitternacht, J.; Turova, V.; Blumenstein, T.; Alves-Pinto, A.

    2015-03-01

    Trophic disorders like reduced skin blood circulation are well-known epiphenomenon of cerebral palsy (CP). They can influence quality of life and can lead to skin damages and, as a consequence, to decubitus. Therefore, it is important to analyse temperature regulation in patients with CP. Thermal imaging camera FLIR BCAM SD was used to study the dependency of skin blood circulation in upper extremities of patients with CP on hand dominance, hand force and hand volume. The hand force was evaluated using a conventional dynamometer. The hand volume was measured with a volumeter. A cold stress test for hands was applied in 22 patients with CP and 6 healthy subjects. The warming up process after the test was recorded with the thermal camera. It was confirmed that the hands of patients warm up slower comparing to healthy persons. The patients' working hands warm up faster than non-working ones. A slight correlation was established between the hand grip force of the working hands and their warm up time. No correlation was found between the warming up time and the volume of the hand. The results confirm our assumption that there is a connection of peripheral blood circulation to upper limb motor functions.

  7. Physical demands and injuries to the upper extremity associated with the space program.

    PubMed

    Viegas, Steven F; Williams, David; Jones, Jeffrey; Strauss, Samuel; Clark, Jonathan

    2004-05-01

    Hand and upper-extremity overuse and repetitive injuries in astronauts have been and continue to be a common problem in the space program. The demands on upper-extremity use in the astronaut training program, the zero-gravity environment, the extreme temperature conditions of space, the effects of space travel on human physiology/anatomy, and the constraints and pressures of space suits and gloves all can negatively impact upper-extremity function in ways that can result in overuse/repetitive injuries. Future plans for space exploration include endeavors that will continue and even increase the demands on the hand and upper extremity. PMID:15140472

  8. Technetium-99m red blood cell venography in upper extremity deep venous thrombosis

    SciTech Connect

    Silverstein, A.M.; Turbiner, E.H.

    1987-06-01

    The efficacy of Tc-99m RBC venography has been demonstrated with respect to the study of lower extremity deep venous thrombosis. A case is presented where Tc-99m RBC venography was used to study the upper as well as lower extremities in a patient with upper extremity deep venous thrombosis (DVT) who was found to have pulmonary embolism.

  9. Technetium-99m red blood cell venography in upper extremity deep venous thrombosis.

    PubMed

    Silverstein, A M; Turbiner, E H

    1987-06-01

    The efficacy of Tc-99m RBC venography has been demonstrated with respect to the study of lower extremity deep venous thrombosis. A case is presented where Tc-99m RBC venography was used to study the upper as well as lower extremities in a patient with upper extremity deep venous thrombosis (DVT) who was found to have pulmonary embolism. PMID:3595023

  10. Recognizing Complex Upper Extremity Activities Using Body Worn Sensors

    PubMed Central

    Lemmens, Ryanne J. M.; Janssen-Potten, Yvonne J. M.; Timmermans, Annick A. A.; Smeets, Rob J. E. M.; Seelen, Henk A. M.

    2015-01-01

    To evaluate arm-hand therapies for neurological patients it is important to be able to assess actual arm-hand performance objectively. Because instruments that measure the actual quality and quantity of specific activities in daily life are lacking, a new measure needs to be developed. The aims of this study are to a) elucidate the techniques used to identify upper extremity activities, b) provide a proof-of-principle of this method using a set of activities tested in a healthy adult and in a stroke patient, and c) provide an example of the method’s applicability in daily life based on readings taken from a healthy adult. Multiple devices, each of which contains a tri-axial accelerometer, a tri-axial gyroscope and a tri-axial magnetometer were attached to the dominant hand, wrist, upper arm and chest of 30 healthy participants and one stroke patient, who all performed the tasks ‘drinking’, ‘eating’ and ‘brushing hair’ in a standardized environment. To establish proof-of-principle, a prolonged daily life recording of 1 participant was used to identify the task ‘drinking’. The activities were identified using multi-array signal feature extraction and pattern recognition algorithms and 2D-convolution. The activities ‘drinking’, ‘eating’ and ‘brushing hair’ were unambiguously recognized in a sequence of recordings of multiple standardized daily activities in a healthy participant and in a stroke patient. It was also possible to identify a specific activity in a daily life recording. The long term aim is to use this method to a) identify arm-hand activities that someone performs during daily life, b) determine the quantity of activity execution, i.e. amount of use, and c) determine the quality of arm-hand skill performance. PMID:25734641

  11. Motor learning perspectives on haptic training for the upper extremities.

    PubMed

    Williams, Camille K; Carnahan, Heather

    2014-01-01

    Recent developments in neurorehabilitation have spawned numerous new robotic rehabilitation therapies. However, many of the concepts upon which these therapies are based are not fully understood and it may be necessary to explore some of the motor learning principles that apply to the use of haptics for motor learning in non-clinical scenarios/populations. We conducted a review of studies that utilized a haptic training paradigm teaching healthy participants to perform a motor skill involving the upper extremities. We discuss studies in the context of four important motor learning concepts: performance versus learning, feedback, observational learning, and functional task difficulty. Additionally, we note that the proliferation of research in haptic training has led to an extensive vocabulary of terms, some of which may be misnomers or redundant. We propose a classification of terms describing haptic training in an effort to provide clarity and further contextualize the studies. We believe that making connections to motor learning principles and clarifying meanings will facilitate a fuller understanding of the outcomes of studies in basic science research and allow for more directed applications of these training techniques to clinical populations. PMID:24968385

  12. Upper extremity deep vein thrombosis in a TV cameraman.

    PubMed

    Beasley, R; Braithwaite, I; Evans, R

    2015-06-01

    We report the case of a 40-year-old right-handed man who developed a right subclavian vein thrombosis due to work as a TV cameraman. He presented with a sudden onset of marked swelling and blue discolouration of his right arm 3 weeks after the most strenuous and prolonged episode of TV camera work that he had ever undertaken. This involved carrying a 9kg camera on his shoulder, with his right arm flexed and abducted, for a 60min period with provocation of severe pain and marked discomfort persisting during the subsequent 3 weeks before presentation. A clinical diagnosis of upper extremity deep vein thrombosis (UEDVT) was made, with the diagnosis confirmed by ultrasound. He was treated with catheter-induced thrombolysis and a 3 month course of anticoagulation. He was advised that his UEDVT was caused by his occupation and that he should no longer work as a cameraman. This case shows the importance of identifying any occupational cause of UEDVT. PMID:25733529

  13. Validity of Body-Worn Sensor Acceleration Metrics to Index Upper Extremity Function in Hemiparetic Stroke

    PubMed Central

    Urbin, M.A.; Bailey, Ryan R.; Lang, Catherine E.

    2015-01-01

    Background and Purpose In people with stroke, real-world use of the paretic upper extremity influences function. Therefore, measures of real-world use are of value for guiding rehabilitation. We undertook a study to identify the acceleration characteristics that have a stable association with upper extremity function and sensitivity to within-participant fluctuations in function over multiple sessions of task-specific training. Methods Twenty-seven adults > 6 months post stroke with upper extremity paresis participated. Signals from wrist-worn accelerometers were sampled at 30 Hz during seven sessions of task-specific training. Paretic upper extremity function was evaluated with the Action Research Arm Test (ARAT). We used Spearman correlations to examine within-session associations between acceleration metrics and ARAT performance. A mixed model was used to determine which metrics were sensitive to within-participant fluctuations in upper extremity function across the seven training sessions. Results Upper extremity function correlated with bilateral acceleration variability and use ratio during five and six session, respectively. Time accelerating between 76-100% of peak acceleration correlated with function in six sessions. Variability of the paretic upper extremity acceleration and the ratio of acceleration variability between upper extremities were associated with function during all seven sessions. Variability in both the acceleration of the paretic upper extremity, and acceleration of the paretic and non-paretic extremities combined were sensitive to within-participant fluctuations in function across training sessions. Conclusion Multiple features of the acceleration profile track with upper extremity function within and across sessions of task-specific training. It may be possible to monitor these features with accelerometers to index upper extremity function outside of clinical settings. PMID:25742378

  14. Nerve conduction studies in upper extremities: skin temperature corrections.

    PubMed

    Halar, E M; DeLisa, J A; Soine, T L

    1983-09-01

    The relationship of skin to near nerve (NN) temperature and to nerve conduction velocity (NCV) and distal latency (DL) was studied in 34 normal adult subjects before and after cooling both upper extremities. Median and ulnar motor and sensory NCV, DL, and NN temperature were determined at ambient temperature (mean X skin temp = 33 C) and after cooling, at approximately 26, 28, and 30 C of forearm skin temperature. Skin temperatures on the volar side of the forearm, wrist, palm, and fingers and NN temperature at the forearm, midpalm, and thenar or hypothenar eminence were compared with respective NCV and DL. Results showed a significant linear correlation between skin temperature and NN temperature at corresponding sites (r2 range, 0.4-0.84; p less than 0.005). Furthermore, both skin and NN temperatures correlated significantly with respective NCV and DL. Midline wrist skin temperature showed the best correlation to NCV and DL. Median motor and sensory NCV were altered 1.5 and 1.4m/sec/C degree and their DL 0.2 msec/C degree of wrist skin temperature change, respectively. Ulnar motor and sensory NCV were changed 2.1 and 1.6m/sec/C degree respectively, and 0.2 msec/C degree wrist temperature for motor and sensory DL. Average ambient skin temperature at the wrist (33 C) was used as a standard skin temperature in the temperature correction formula: NCV or DL(temp corrected) = CF(Tst degree - Tm degree) + obtained NCV or DL, where Tst = 33 C for wrist, Tm = the measured skin temperature, and CF = correction factor of tested nerve. Use of temperature correction formula for NCV and DL is suggested in patients with changed wrist skin temperature outside 29.6-36.4C temperature range. PMID:6615178

  15. Upper and Lower Extremity Midline Crossing Effects upon Adults with Mild to Moderate Mental Retardation.

    ERIC Educational Resources Information Center

    Woodard, Rebecca J.; Surburg, Paul R.; Lewis, Colleen A.

    1998-01-01

    This study examined whether midline crossing inhibition (MCI) was present in 13 adults with mild to moderate mental retardation when crossing the midline of the body with both the upper and lower extremities. Results indicated that participants exhibited MCI with both the upper and lower extremities. (Author/CR)

  16. Motor Cortex Stimulation for the Treatment of Chronic Facial, Upper Extremity, and Throat Pain.

    ClinicalTrials.gov

    2016-08-29

    Trigeminal Neuralgia (Burchiel Type I); Trigeminal Neuralgia (Burchiel Type II); Trigeminal Neuropathic Pain; Trigeminal Deafferentation Pain; Complex Regional Pain Syndrome (Types I and II, Involving the Upper Extremity); Glossopharyngeal Neuralgia; Upper Extremity Pain Due to Deafferentation of the Cervical Spine; Central Pain Syndromes

  17. Predictive factors of hypertonia in the upper extremity of chronic stroke survivors

    PubMed Central

    Lee, GyuChang; An, SeungHeon; Lee, YunBok; Lee, DongGeon; Park, Dong-sik

    2015-01-01

    [Purpose] Muscle tone is known to predict the motor function of the upper extremity within 12 months after onset in stroke survivors. The aim of this study was to investigate whether motor function of the upper extremity can predict the risk of hypertonia in chronic stroke survivors, and to analyze the correlation between the two variables to determine the predictive validity. [Subjects and Methods] Forty-three chronic stroke survivors were assessed using the Modified Ashworth Scale (MAS) for elbow flexor tone, the Fugl-Meyer assessment of the upper extremity (FM-UE), and the Action Research Arm Test (ARAT) for upper extremity motor recovery and function. [Results] Elbow flexor tone (MAS≥1+) increased by 0.246 compared with the baseline muscle tone even at month 12 and appeared to negatively affect the motor function of the upper extremity. The cutoff value for predicting muscle tone (MAS≥1+) was 24 for FM-UE and 15.5 for ARAT. FM-UE had the biggest impact on elbow flexor tone (MAS≥1+), and the risk of elbow flexor hypertonia (MAS≥1+) increased 0.764-fold for a cutoff value of FM-UE≤24 compared with a cutoff value of FM-UE>24. [Conclusion] The results show that the most important variable for predicting muscle tone of the elbow flexor in stroke survivors is the FM assessment of the upper extremity. PMID:26357437

  18. The Influence of Altering Push Force Effectiveness on Upper Extremity Demand during Wheelchair Propulsion

    PubMed Central

    Rankin, Jeffery W.; Kwarciak, Andrew M.; Richter, W. Mark; Neptune, Richard R.

    2010-01-01

    Manual wheelchair propulsion has been linked to a high incidence of overuse injury and pain in the upper extremity, which may be caused by the high load requirements and low mechanical efficiency of the task. Previous studies have suggested that poor mechanical efficiency may be due to a low effective handrim force (i.e. applied force that is not directed tangential to the handrim). As a result, studies attempting to reduce upper extremity demand have used various measures of force effectiveness (e.g. fraction effective force, FEF) as a guide for modifying propulsion technique, developing rehabilitation programs and configuring wheelchairs. However, the relationship between FEF and upper extremity demand is not well understood. The purpose of this study was to use forward dynamics simulations of wheelchair propulsion to determine the influence of FEF on upper extremity demand by quantifying individual muscle stress, work and handrim force contributions at different values of FEF. Simulations maximizing and minimizing FEF resulted in higher average muscle stresses (23% and 112%) and total muscle work (28% and 71%) compared to a nominal FEF simulation. The maximal FEF simulation also shifted muscle use from muscles crossing the elbow to those at the shoulder (e.g. rotator cuff muscles), placing greater demand on shoulder muscles during propulsion. The optimal FEF value appears to represent a balance between increasing push force effectiveness to increase mechanical efficiency and minimizing upper extremity demand. Thus, care should be taken in using force effectiveness as a metric to reduce upper extremity demand. PMID:20674921

  19. Proof of Concept of the Ability of the Kinect to Quantify Upper Extremity Function in Dystrophinopathy

    PubMed Central

    Lowes, Linda P; Alfano, Lindsay N; Yetter, Brent A; Worthen-Chaudhari, Lise; Hinchman, William; Savage, Jordan; Samona, Patrick; Flanigan, Kevin M; Mendell, Jerry R

    2013-01-01

    Introduction: Individuals with dystrophinopathy lose upper extremity strength in proximal muscles followed by those more distal. Current upper extremity evaluation tools fail to fully capture changes in upper extremity strength and function across the disease spectrum as they tend to focus solely on distal ability. The Kinect by Microsoft is a gaming interface that can gather positional information about an individual’s upper extremity movement which can be used to determine functional reaching volume, velocity of movement, and rate of fatigue while playing an engaging video game. The purpose of this study was to determine the feasibility of using the Kinect platform to assess upper extremity function in individuals with dystrophinopathy across the spectrum of abilities. Methods: Investigators developed a proof-of-concept device, ACTIVE (Abilities Captured Through Interactive Video Evaluation), to measure functional reaching volume, movement velocity, and rate of fatigue. Five subjects with dystrophinopathy and 5 normal controls were tested using ACTIVE during one testing session. A single subject with dystrophinopathy was simultaneously tested with ACTIVE and a marker-based motion analysis system to establish preliminary validity of measurements. Results: ACTIVE proof-of-concept ranked the upper extremity abilities of subjects with dystrophinopathy by Brooke score, and also differentiated them from performance of normal controls for the functional reaching volume and velocity tests. Preliminary test-retest reliability of the ACTIVE for 2 sequential trials was excellent for functional reaching volume (ICC=0.986, p<0.001) and velocity trials (ICC=0.963, p<0.001). Discussion: The data from our pilot study with ACTIVE proof-of-concept demonstrates that newly available gaming technology has potential to be used to create a low-cost, widely-accessible and functional upper extremity outcome measure for use with children and adults with dystrophinopathy. PMID:23516667

  20. Tendinopathies in the upper extremity: a paradigm shift.

    PubMed

    Ashe, Maureen C; McCauley, Tracey; Khan, Karim M

    2004-01-01

    Epicondylitis and de Quervain's tenosynovitis are two common diagnoses seen by hand therapists in clinical practice. Traditionally, these conditions have been viewed as being due to an inflammatory process and treated as such. New research shows that tendons exhibit areas of degeneration and a distinct lack of inflammatory cells. Tendinosis is degeneration of the collagen tissue due to aging, microtrauma, or vascular compromise. This article reviews key literature related to tendinopathies in the lower extremity and comments on the dearth of similar articles for the elbow and forearm. Hand therapists are encouraged to embrace this new terminology and to engage in research in this difficult area to improve treatment regimens and outcome measures. PMID:15273673

  1. Injuries sustained to the upper extremity due to modern warfare and the evolution of care.

    PubMed

    Hofmeister, Eric P; Mazurek, Michael; Ingari, Jack

    2007-10-01

    The formation of the American Society for Surgery of the Hand was related to world conflicts and hostilities. Therefore, it is appropriate that upper-extremity surgeons understand injuries resulting from modern-day combat. Because of ongoing warfare, many countries have experienced a large increase in the number of wounded service members and civilians, particularly wounds of the extremities. As a result of increased rate of survival in battlefield trauma in part because of the use of modern body armor, there is increasing complexity of extremity injuries that require complex reconstructions. Decreased mortality and a consequent increase in the incidence of injured extremities underline the need for the development of new treatment options. The purpose of this presentation is to describe upper-extremity injury patterns in modern warfare, the levels of care available, and the treatment at each level of care based on the experience of the United States Military Medical Support System. PMID:17923293

  2. Effect of purposeful action observation on upper extremity function in stroke patients

    PubMed Central

    Kim, Eunjoo; Kim, KyeongMi

    2015-01-01

    [Purpose] The purpose of this study was to identify the effect of purposeful action observation on upper extremity function in patients with stroke. [Subjects and Methods] Twelve subjects were randomly to either the experimental group or control group. The experimental group underwent occupational therapy and a purposeful action observation program. The control group underwent occupational therapy and placebo treatment in which the subjects performed a purposeful action observation program without actually observing the purposeful actions. The Wolf Motor Function Test was used to measure upper extremity function before and after the intervention in both groups. [Results] Both the experimental and control groups demonstrated improved upper extremity function after the intervention, but there was no significant difference between groups. Compared with before the intervention, the experimental group showed significantly improved upper extremity function after the intervention. [Conclusion] Based on these results, a purposeful action observation program can improve upper extremity function in patients with stroke. In future research, more subjects should be included for evaluation of different treatments. PMID:26504313

  3. Morphological and functional relationships with ultrasound measured muscle thickness of the upper extremity and trunk

    PubMed Central

    Loenneke, Jeremy P.; Thiebaud, Robert S.; Loftin, Mark

    2014-01-01

    Unless a subject’s muscle is relatively small, a single image from a standard ultrasound can only measure muscle thickness (MT). Thus, it is important to know whether MT is related to morphological and functional characteristics of individual muscles of the extremity and trunk. In this review, we summarize previously published articles in the upper extremity and trunk demonstrating the relationships between ultrasound-measured MT and muscle morphology (cross-sectional area, CSA and muscle volume, MV) and muscular or respiratory function. The linear relationship between MT and muscle CSA or MV has been observed in biceps brachii, triceps brachii, pectoralis major, psoas major, and supraspinatus muscles. Previous studies suggest that MT in the upper arm and trunk may reflect muscle CSA and MV for the individual muscles. Unfortunately, few studies exist regarding the functional relationship with ultrasound MT in the upper extremity and trunk. Future research is needed to investigate these findings further.

  4. Three-dimensional motion of the upper extremity joints during various activities of daily living.

    PubMed

    Aizawa, Junya; Masuda, Tadashi; Koyama, Takayuki; Nakamaru, Koji; Isozaki, Koji; Okawa, Atsushi; Morita, Sadao

    2010-11-16

    Highly reliable information on the range of motion (ROM) required to perform activities of daily living (ADL) is important to allow rehabilitation professionals to make appropriate clinical judgments of patients with limited ROM of the upper extremity joints. There are, however, no data available that take full account of corrections for gimbal-lock and soft tissue artifacts, which affect estimation errors for joint angles. We used an electromagnetic three-dimensional tracking system (FASTRAK) to measure the three-dimensional ROM of the upper extremity joints of healthy adults (N=20, age range 18-34) during 16 ADL movement tasks. The ROM required for the performance of each movement was shown in terms of the joint angle at the completion of the task, using a new definition of joint angle and regression analysis to compensate for estimation errors. The results of this study may be useful in setting goals for the treatment of upper extremity joint function. PMID:20727523

  5. Upper extremity neuro-rehabilitation through the use of power mobility.

    PubMed

    Damiao, John; Kean, Danielle

    2016-01-01

    Power mobility is typically used as an accommodative form of assistive technology allowing individuals with impaired ambulation to remain mobile. While research has focused on the cognitive development and social benefits of power mobility for individuals with developmental disabilities, research is lacking on using this technology to rehabilitate physical dysfunction. Recent technology, such as robot-mediated neuro-rehabilitation, is proving effective in upper extremity rehabilitation, but lacks the movement feedback of power mobility. This article presents a case study of a client with cerebral palsy who experienced severe neural impairment following a motor vehicle accident. As a previous power mobility user, the client identified returning to using power mobility with the affected upper extremity as a key functional goal. This case study describes the series of steps that returned the client to independent mobility and increased upper extremity function. PMID:26565130

  6. Exploring Occupational Therapists’ Perceptions of the Usefulness of Musculoskeletal Sonography in Upper-Extremity Rehabilitation

    PubMed Central

    McLaughlin Gray, Julie; Frank, Gelya; Wolkoff, Monique

    2015-01-01

    OBJECTIVE. To identify the potential utility of musculoskeletal sonographic imaging in upper-extremity rehabilitation. METHOD. Two occupational therapists in an outpatient hand rehabilitation clinic were recruited by convenience, were trained in the use of sonography, and implemented sonographic imaging in their clinical practice. Qualitative data were obtained during and after the implementation period by means of questionnaires and interviews. Data collection, analysis, and interpretation were completed in an iterative process that culminated in a thematic analysis of the therapists’ perceptions. RESULTS. The data indicate four potential areas of utility for musculoskeletal sonography in upper-extremity rehabilitation: (1) mastering anatomy and pathology, (2) augmenting clinical reasoning, (3) supplementing intervention, and (4) building evidence. CONCLUSION. Numerous potential uses were identified that would benefit both therapist and client. Further exploration of complexities and efficacy for increasing patient outcomes is recommended to determine best practices for the use of musculoskeletal sonography in upper-extremity rehabilitation. PMID:26114469

  7. System Characterization of MAHI EXO-II: A Robotic Exoskeleton for Upper Extremity Rehabilitation

    PubMed Central

    French, James A.; Rose, Chad G.; O'Malley, Marcia K.

    2015-01-01

    This paper presents the performance characterization of the MAHI Exo-II, an upper extremity exoskeleton for stroke and spinal cord injury (SCI) rehabilitation, as a means to validate its clinical implementation and to provide depth to the literature on the performance characteristics of upper extremity exoskeletons. Individuals with disabilities arising from stroke and SCI need rehabilitation of the elbow, forearm, and wrist to restore the ability to independently perform activities of daily living (ADL). Robotic rehabilitation has been proposed to address the need for high intensity, long duration therapy and has shown promising results for upper limb proximal joints. However, upper limb distal joints have historically not benefitted from the same focus. The MAHI Exo-II, designed to address this shortcoming, has undergone a static and dynamic performance characterization, which shows that it exhibits the requisite qualities for a rehabilitation robot and is comparable to other state-of-the-art designs. PMID:25984380

  8. The Incidence of Upper and Lower Extremity Surgery for Rheumatoid Arthritis Among Medicare Beneficiaries

    PubMed Central

    Waljee, Jennifer; Zhong, Lin; Baser, Onur; Yuce, Huseyin; Fox, David A.; Chung, Kevin C.

    2015-01-01

    Background: For elderly patients with rheumatoid arthritis, aggressive immunosuppression can be difficult to tolerate, and surgery remains an important treatment option for joint pain and deformity. We sought to examine the epidemiology of surgical reconstruction for rheumatoid arthritis among older individuals who were newly diagnosed with the disorder. Methods: We identified a 5% random sample of Medicare beneficiaries (sixty-six years of age and older) newly diagnosed with rheumatoid arthritis from 2000 to 2005, and followed these patients longitudinally for a mean of 4.6 years. We used univariate analysis to compare the time from the diagnosis of rheumatoid arthritis to the first operation among the 360 patients who underwent surgery during the study period. Results: In our study cohort, 589 procedures were performed among 360 patients, and 132 patients (37%) underwent multiple procedures. The rate of upper extremity reconstruction was 0.9%, the rate of lower extremity reconstruction was 1.2%, and knee arthroplasty was the most common procedure performed initially (31%) and overall (29%). Upper extremity procedures were performed sooner than lower extremity procedures (fourteen versus twenty-five months; p = 0.02). In multivariable analysis, surgery rates declined with age for upper and lower extremity procedures (p < 0.001). Conclusions: Knee replacement remains the most common initial procedure among patients with rheumatoid arthritis. However, upper extremity procedures are performed earlier than lower extremity procedures. Understanding the patient and provider factors that underlie variation in procedure rates can inform future strategies to improve the delivery of care to patients with rheumatoid arthritis. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. PMID:25740031

  9. A Piano Training Program to Improve Manual Dexterity and Upper Extremity Function in Chronic Stroke Survivors

    PubMed Central

    Villeneuve, Myriam; Penhune, Virginia; Lamontagne, Anouk

    2014-01-01

    Objective: Music-supported therapy was shown to induce improvements in motor skills in stroke survivors. Whether all stroke individuals respond similarly to the intervention and whether gains can be maintained over time remain unknown. We estimated the immediate and retention effects of a piano training program on upper extremity function in persons with chronic stroke. Methods: Thirteen stroke participants engaged in a 3-week piano training comprising supervised sessions (9 × 60 min) and home practice. Fine and gross manual dexterity, movement coordination, and functional use of the upper extremity were assessed at baseline, pre-intervention, post-intervention, and at a 3-week follow-up. Results: Significant improvements were observed for all outcomes at post-intervention and follow-up compared to pre-intervention scores. Larger magnitudes of change in manual dexterity and functional use of the upper extremity were associated with higher initial levels of motor recovery. Conclusion: Piano training can result in sustainable improvements in upper extremity function in chronic stroke survivors. Individuals with a higher initial level of motor recovery at baseline appear to benefit the most from this intervention. PMID:25202258

  10. Influences of a Hand Positioning Device on Upper-Extremity Control of Children with Cerebral Palsy.

    ERIC Educational Resources Information Center

    Reid, Denise T.; Sochaniwskyj, Alex

    1992-01-01

    This study investigated the effects of a hand positioning device on aspects of upper extremity movement control and muscular activity and visual motor performance in 10 children with cerebral palsy. Although no significant results were found, individual subject data revealed a trend toward increased numbers of movement units, slower movements, and…

  11. Regional lidocaine anesthesia without exsanguination for outpatient management of upper extremity fractures.

    PubMed Central

    Brown, G. A.; Hayes, W. M.; Cornwal, R.

    1995-01-01

    The use of small dose intravenous lidocaine without exsanguination for upper extremity fractures in children and adults is described. A twenty-plus year experience with this technique in the outpatient setting has shown it to be effective and safe. Attention to detail is essential and inadvertent tourniquet release must be avoided. Images Figure 1 PMID:7634037

  12. Gender-related Factors Associated with Upper Extremity Function in Workers

    PubMed Central

    Kim, Min Gi

    2010-01-01

    Objectives This study aimed to find gender distinctions in terms of the sociology of the population; to determine work-related factors; to analyze gender differences in daily living, work, sports, and art performances; and to identify gender-related factors that limited performance of daily living and work activities. Methods A questionnaire was designed that included disabilities of the arm, shoulder, and hand (DASH), accident history, disease history, work duration at current workplace, marital status, job satisfaction, job autonomy, and physical demands of the job. Out of 1,853 workers surveyed, 1,173 questionnaires (63.3%; 987 males, 186 females) included responses to DASH disability and DASH optional work and were judged acceptable for analysis. Results Upper extremity functional limitation during work and daily living was higher for females than males. The limitations for males increased according to their household work time, accident history, work duration, job satisfaction, physical demand, and job autonomy. Meanwhile, female workers' upper extremity discomfort was influenced by their disease history, job satisfaction, and physical demands. In addition, the size of the company affected male workers' upper extremity function, while marriage and hobbies influenced that of female workers. Conclusion This study addressed sociodemographic factors and work-related factors that affect each gender's upper extremity function during daily living and working activities. Each factor had a different influence. Further studies are needed to identify the effect that role changes, not being influenced by risks at work, have on musculoskeletal disorders. PMID:22953176

  13. Construct Validity of the Quality of Upper Extremity Skills Test for Children with Cerebral Palsy

    ERIC Educational Resources Information Center

    Thorley, Megan; Lannin, Natasha; Cusick, Anne; Novak, Iona; Boyd, Roslyn

    2012-01-01

    Aim: The aim of the study was to investigate the construct validity of the Quality of Upper Extremity Skills Test (QUEST) in children with cerebral palsy (CP). Method: A total of 170 QUEST assessments from a convenience sample of 94 children with CP involved in clinical and research treatment programmes (54 males, 40 females; mean age 6y 10mo, SD…

  14. Rehabilitation of the Upper Extremity Following Nerve and Tendon Reconstruction: When and How

    PubMed Central

    Novak, Christine B.; von der Heyde, Rebecca L.

    2015-01-01

    Following upper extremity nerve and tendon reconstruction, rehabilitation is necessary to achieve optimal function and outcome. In this review, the authors present current evidence and literature regarding the strategies and techniques of rehabilitation following peripheral nerve and tendon reconstruction. PMID:25685106

  15. Development of an Interactive Upper Extremity Gestural Robotic Feedback System: From Bench to Reality

    PubMed Central

    Wood, Krista A. Coleman; Lathan, Corinna E.; Kaufman, Kenton R.

    2010-01-01

    Development of an interactive system to treat patients with movement impairments of the upper extremity is described. Gestures and movement of patients as instructed by therapists are detected by accelerometers and feedback is provided directly to the patient via a robot. PMID:19964144

  16. Brief Assessment of Motor Function: Content Validity and Reliability of the Upper Extremity Gross Motor Scale

    ERIC Educational Resources Information Center

    Cintas, Holly Lea; Parks, Rebecca; Don, Sarah; Gerber, Lynn

    2011-01-01

    Content validity and reliability of the Brief Assessment of Motor Function (BAMF) Upper Extremity Gross Motor Scale (UEGMS) were evaluated in this prospective, descriptive study. The UEGMS is one of five BAMF ordinal scales designed for quick documentation of gross, fine, and oral motor skill levels. Designed to be independent of age and…

  17. Osteochondral defects of the upper extremity treated with particulated juvenile cartilage transfer.

    PubMed

    Dunn, John C; Kusnezov, Nicholas; Orr, Justin; Mitchell, Justin S

    2015-12-01

    We present the novel use of particulated juvenile cartilage transfer in the upper extremity. Our patient is an active duty solider with an osteochondral defect (OCD) of the capitellum that he sustained after an improvised explosive devise injury to his left elbow. PMID:26568723

  18. The biomechanics of upper extremity kinematic and kinetic modeling: applications to rehabilitation engineering.

    PubMed

    Slavens, Brooke A; Harris, Gerald F

    2008-01-01

    Human motion analysis has evolved from the lower extremity to the upper extremity. Rehabilitation engineering is reliant upon three-dimensional biome-chanical models for a thorough understanding of upper body motions and forces in order to improve treatment methods, rehabilitation strategies and to prevent injury. Due to the complex nature of upper body movements, a standard biomechanical model does not exist. This paper reviews several kinematic and kinetic rehabilitation engineering models from the literature. These models may capture a single joint; multijoints such as the shoulder, elbow and wrist; or a combination of joints and an ambulatory aid, which serves as the extension of the upper arm. With advances in software and hardware, new models continuously arise due to the clinical questions at hand. When designing a biomechanical upper extremity model, several key components must be determined. These include deciding on the anatomic segments of the model, the number of markers and placement on bony landmarks, the definition of joint coordinate systems, and the description of the joint motions. It is critical to apply the proper model to further our understanding of pathologic populations. PMID:19740069

  19. An intelligent active force control algorithm to control an upper extremity exoskeleton for motor recovery

    NASA Astrophysics Data System (ADS)

    Hasbullah Mohd Isa, Wan; Taha, Zahari; Mohd Khairuddin, Ismail; Majeed, Anwar P. P. Abdul; Fikri Muhammad, Khairul; Abdo Hashem, Mohammed; Mahmud, Jamaluddin; Mohamed, Zulkifli

    2016-02-01

    This paper presents the modelling and control of a two degree of freedom upper extremity exoskeleton by means of an intelligent active force control (AFC) mechanism. The Newton-Euler formulation was used in deriving the dynamic modelling of both the anthropometry based human upper extremity as well as the exoskeleton that consists of the upper arm and the forearm. A proportional-derivative (PD) architecture is employed in this study to investigate its efficacy performing joint-space control objectives. An intelligent AFC algorithm is also incorporated into the PD to investigate the effectiveness of this hybrid system in compensating disturbances. The Mamdani Fuzzy based rule is employed to approximate the estimated inertial properties of the system to ensure the AFC loop responds efficiently. It is found that the IAFC-PD performed well against the disturbances introduced into the system as compared to the conventional PD control architecture in performing the desired trajectory tracking.

  20. The role of the upper extremity surgeon in the management of tetraplegia.

    PubMed

    Zlotolow, Dan A

    2011-05-01

    Despite its demonstrated benefits, the majority of patients with tetraplegia do not have upper extremity surgery. Many upper extremity surgeons are unfamiliar with the techniques, long-term care providers are often unaware of the options or are biased against surgery, and patients might resist surgery based on lack of awareness, misinformation, or hope of a cure. Although it is not without its challenges, some consensus as to a general algorithm for the care of the tetraplegic patient does exist. At the recent 10th International Meeting on Surgical Rehabilitation of the Tetraplegic Upper Limb, there was little disagreement about when and what surgery to perform. The physical examination tools, clinical decision making, and surgical skills required to treat this population should, therefore, be accessible to the vast majority of hand surgeons who wish to take on these rewarding cases. Patients with specific, realistic, functional goals will realize the best self-perceived outcomes. PMID:21527147

  1. The influence of wheelchair propulsion hand pattern on upper extremity muscle power and stress.

    PubMed

    Slowik, Jonathan S; Requejo, Philip S; Mulroy, Sara J; Neptune, Richard R

    2016-06-14

    The hand pattern (i.e., full-cycle hand path) used during manual wheelchair propulsion is frequently classified as one of four distinct hand pattern types: arc, single loop, double loop or semicircular. Current clinical guidelines recommend the use of the semicircular pattern, which is based on advantageous levels of broad biomechanical metrics implicitly related to the demand placed on the upper extremity (e.g., lower cadence). However, an understanding of the influence of hand pattern on specific measures of upper extremity muscle demand (e.g., muscle power and stress) is needed to help make such recommendations, but these quantities are difficult and impractical to measure experimentally. The purpose of this study was to use musculoskeletal modeling and forward dynamics simulations to investigate the influence of the hand pattern used on specific measures of upper extremity muscle demand. The simulation results suggest that the double loop and semicircular patterns produce the most favorable levels of overall muscle stress and total muscle power. The double loop pattern had the lowest full-cycle and recovery-phase upper extremity demand but required high levels of muscle power during the relatively short contact phase. The semicircular pattern had the second-lowest full-cycle levels of overall muscle stress and total muscle power, and demand was more evenly distributed between the contact and recovery phases. These results suggest that in order to decrease upper extremity demand, manual wheelchair users should consider using either the double loop or semicircular pattern when propelling their wheelchairs at a self-selected speed on level ground. PMID:27062591

  2. Upper extremity coordination strategies depending on task demand during a basic daily activity.

    PubMed

    Ricci, Flávia Pessoni F M; Santiago, Paulo Roberto Pereira; Zampar, Ana Carolina; Pinola, Lívia Nahas; Fonseca, Marisa de Cássia Registro

    2015-10-01

    Injury conditions affecting the upper extremity may lead to severe functional impairment and an accurate evaluation is needed in order to select the most effective treatment in a rehabilitation program. This study focused on simultaneous electromyographic and kinematic analysis to assess movement patterns of upper extremity during a basic daily activity, considering different demands existing within the task. Twenty-five healthy subjects, average age 19.8 ys SD 1.7 ys, with no upper extremity impairment, were assessed by means of electromyography (EMG) and a 3D motion capture system while performing a task that required reach, transport and release. Integrated EMG (iEMG), timing of muscle onset and active range of motion (AROM) were calculated for each subject. Data were compared within each phase and between the three phases and a repeated measure ANOVA was used for statistical analysis. We found early activation of upper trapezius associated with high activity of serratus anterior for proximal stability while anterior deltoid and triceps brachii performed shoulder flexion and elbow extension, in Reach phase. In Transport phase there was early and higher activation of upper trapezius, higher muscle activity of almost all muscles and increased AROM of all joints. No change in flexion/extension wrist posture with increased forearm muscles activity were identified as the main control strategy to keep optimal grasping. Triceps brachii was found to act as an important synergist in shoulder abduction and extension in free load conditions. Such information can lead clinicians to more specific assessment and subsequent better intervention in upper extremity rehabilitation. PMID:26282047

  3. The Influence of Wheelchair Propulsion Technique on Upper Extremity Muscle Demand: A Simulation Study

    PubMed Central

    Rankin, Jeffery W.; Kwarciak, Andrew M.; Richter, W. Mark; Neptune, Richard R.

    2012-01-01

    Background The majority of manual wheelchair users will experience upper extremity injuries or pain, in part due to the high force requirements, repetitive motion and extreme joint postures associated with wheelchair propulsion. Recent studies have identified cadence, contact angle and peak force as important factors for reducing upper extremity demand during propulsion. However, studies often make comparisons between populations (e.g., able-bodied vs. paraplegic) or do not investigate specific measures of upper extremity demand. The purpose of this study was to use a musculoskeletal model and forward dynamics simulations of wheelchair propulsion to investigate how altering cadence, peak force and contact angle influence individual muscle demand. Methods Forward dynamics simulations of wheelchair propulsion were generated to emulate group-averaged experimental data during four conditions: 1) self-selected propulsion technique, and while 2) minimizing cadence, 3) maximizing contact angle and 4) minimizing peak force using biofeedback. Simulations were used to determine individual muscle mechanical power and stress as measures of muscle demand. Results Minimizing peak force and cadence had the lowest muscle power requirements. However, minimizing peak force increased cadence and recovery power, while minimizing cadence increased average muscle stress. Maximizing contact angle increased muscle stress and had the highest muscle power requirements. Interpretation Minimizing cadence appears to have the most potential for reducing muscle demand and fatigue, which could decrease upper extremity injuries and pain. However, altering any of these variables to extreme values appears to be less effective; instead small to moderate changes may better reduce overall muscle demand. PMID:22835860

  4. Influence of Inter-Training Intervals on Intermanual Transfer Effects in Upper-Limb Prosthesis Training: A Randomized Pre-Posttest Study

    PubMed Central

    Romkema, Sietske; Bongers, Raoul M.; van der Sluis, Corry K.

    2015-01-01

    Improvement in prosthetic training using intermanual transfer (the transfer of motor skills from the trained, “unaffected” hand to the untrained, “affected” hand) has been shown in previous studies. The aim of this study is to determine the influence of the inter-training interval on the magnitude of the intermanual transfer effects. This was done using a mechanistic, randomized, single-blinded pretest-posttest design. Sixty-four able-bodied, right-handed participants were randomly assigned to the Short and Long Interval Training Groups and the Short and Long Interval Control Groups. The Short and Long Interval Training Groups used a prosthesis simulator in their training program. The Short and Long Interval Control Groups executed a sham training program, that is, a dummy training program in which the same muscles were trained as with the prosthesis simulator. The Short Interval Training Group and the Short Interval Control Groups trained on consecutive days, while the Long Interval Training Group and Long Interval Control Group trained twice a week. To determine the improvement in skills, a test was administered before, immediately after, and at two points in time after the training. Training was performed with the “unaffected” arm; tests were performed with the “affected” arm. The outcome measurements were: the movement time (the time from the beginning of the movement until completion of the task); the duration of maximum hand opening, (the opening of the prosthetic hand while grasping an object); and the grip-force control (the error from the required grip-force during a tracking task). Intermanual transfer was found in movement times, but not in hand opening or grip-force control. The length of the inter-training interval did not affect the magnitude of intermanual transfer effects. No difference in the intermanual transfer effect in upper-limb prosthesis training was found for training on a daily basis as compared to training twice a week

  5. Using Free Internet Videogames in Upper Extremity Motor Training for Children with Cerebral Palsy

    PubMed Central

    Sevick, Marisa; Eklund, Elizabeth; Mensch, Allison; Foreman, Matthew; Standeven, John; Engsberg, Jack

    2016-01-01

    Movement therapy is one type of upper extremity intervention for children with cerebral palsy (CP) to improve function. It requires high-intensity, repetitive and task-specific training. Tedium and lack of motivation are substantial barriers to completing the training. An approach to overcome these barriers is to couple the movement therapy with videogames. This investigation: (1) tested the feasibility of delivering a free Internet videogame upper extremity motor intervention to four children with CP (aged 8–17 years) with mild to moderate limitations to upper limb function; and (2) determined the level of intrinsic motivation during the intervention. The intervention used free Internet videogames in conjunction with the Microsoft Kinect motion sensor and the Flexible Action and Articulated Skeleton Toolkit software (FAAST) software. Results indicated that the intervention could be successfully delivered in the laboratory and the home, and pre- and post- impairment, function and performance assessments were possible. Results also indicated a high level of motivation among the participants. It was concluded that the use of inexpensive hardware and software in conjunction with free Internet videogames has the potential to be very motivating in helping to improve the upper extremity abilities of children with CP. Future work should include results from additional participants and from a control group in a randomized controlled trial to establish efficacy. PMID:27338485

  6. Using Free Internet Videogames in Upper Extremity Motor Training for Children with Cerebral Palsy.

    PubMed

    Sevick, Marisa; Eklund, Elizabeth; Mensch, Allison; Foreman, Matthew; Standeven, John; Engsberg, Jack

    2016-01-01

    Movement therapy is one type of upper extremity intervention for children with cerebral palsy (CP) to improve function. It requires high-intensity, repetitive and task-specific training. Tedium and lack of motivation are substantial barriers to completing the training. An approach to overcome these barriers is to couple the movement therapy with videogames. This investigation: (1) tested the feasibility of delivering a free Internet videogame upper extremity motor intervention to four children with CP (aged 8-17 years) with mild to moderate limitations to upper limb function; and (2) determined the level of intrinsic motivation during the intervention. The intervention used free Internet videogames in conjunction with the Microsoft Kinect motion sensor and the Flexible Action and Articulated Skeleton Toolkit software (FAAST) software. Results indicated that the intervention could be successfully delivered in the laboratory and the home, and pre- and post- impairment, function and performance assessments were possible. Results also indicated a high level of motivation among the participants. It was concluded that the use of inexpensive hardware and software in conjunction with free Internet videogames has the potential to be very motivating in helping to improve the upper extremity abilities of children with CP. Future work should include results from additional participants and from a control group in a randomized controlled trial to establish efficacy. PMID:27338485

  7. Extremely rare presentation of soft tissue metastasis from carcinoma breast as a massive swelling of upper extremity.

    PubMed

    Purkayastha, Abhishek; Sharma, Neelam

    2016-04-01

    Soft tissue metastasis from any primary malignancy is considered very rare and a breast carcinoma metastasizing to soft tissue is still rarer. To the best of our knowledge, carcinoma breast with soft tissue metastasis to upper extremity is very uncommon with only six cases been reported in world literature till date and our case is the seventh such case in an 80-year-old female, previously treated for carcinoma right breast 15 years ago. The patient presented with progressive painful massive swelling of right upper arm measuring 21 cm × 17 cm, of 2 months duration. Histopathological examination of the swelling showed metastatic deposits from a poorly differentiated adenocarcinoma. Further immunohistochemical (IHC) analysis revealed tumor cells staining positive for estrogen and progesterone receptors while negative for HER 2-Nu, desmin, epithelial membrane antigen, CK7 and thyroid transcription factor-1 (TTF-1), suggestive of metastasis from a primary breast carcinoma. Only few case series and isolated cases reports have been published regarding any primary malignancy or breast carcinoma metastasizing to soft tissues. A thorough review of literature also reveals that our case is the largest soft tissue metastatic swelling from breast carcinoma ever reported. We hereby present this case with review of literature to highlight its extreme rarity, unusual presentation, clinicopathological characteristics and its overall prognosis. PMID:27121743

  8. Free style perforator based propeller flaps: Simple solutions for upper extremity reconstruction!

    PubMed Central

    Panse, Nikhil; Sahasrabudhe, Parag

    2014-01-01

    Background: The introduction of perforator flaps by Koshima et al. was met with much animosity in the plastic surgery fraternity. The safety concerns of these flaps following the intentional twist of the perforators have prevented widespread adoption of this technique. Use of perforator based propeller flaps in the lower extremity is gradually on the rise, but their use in upper extremity reconstruction is infrequently reported, especially in the Indian subcontinent. Materials and Methods: We present a retrospective series of 63 free style perforator flaps used for soft tissue reconstruction of the upper extremity from November 2008 to June 2013. Flaps were performed by a single surgeon for various locations and indications over the upper extremity. Patient demographics, surgical indication, defect features, complications and clinical outcome are evaluated and presented as an uncontrolled case series. Results: 63 free style perforator based propeller flaps were used for soft tissue reconstruction of 62 patients for the upper extremity from November 2008 to June 2013. Of the 63 flaps, 31 flaps were performed for trauma, 30 for post burn sequel, and two for post snake bite defects. We encountered flap necrosis in 8 flaps, of which there was complete necrosis in 4 flaps, and partial necrosis in four flaps. Of these 8 flaps, 7 needed a secondary procedure, and one healed secondarily. Although we had a failure rate of 12-13%, most of our failures were in the early part of the series indicative of a learning curve associated with the flap. Conclusion: Free style perforator based propeller flaps are a reliable option for coverage of small to moderate sized defects. Level of Evidence: Therapeutic IV. PMID:24987209

  9. Content Range and Precision of a Computer Adaptive Test of Upper Extremity Function for Children with Cerebral Palsy

    ERIC Educational Resources Information Center

    Montpetit, Kathleen; Haley, Stephen; Bilodeau, Nathalie; Ni, Pengsheng; Tian, Feng; Gorton, George, III; Mulcahey, M. J.

    2011-01-01

    This article reports on the content range and measurement precision of an upper extremity (UE) computer adaptive testing (CAT) platform of physical function in children with cerebral palsy. Upper extremity items representing skills of all abilities were administered to 305 parents. These responses were compared with two traditional standardized…

  10. The first results of the development and implementation of the upper extremity exoskeleton "EXAR"

    NASA Astrophysics Data System (ADS)

    Vorobiev, A. A.; Krivonozhkina, P. S.; Zasypkina, O. A.; Andrewshenko, F. A.

    2015-11-01

    This research considers the first results of the development and implementation of the upper extremity exoskeleton "EXAR". Made anatomical parameterization developed the device the testing of the apparatus have been conducted in accordance with the bioethics regulations with the girl I. Sh. at the age of 4 years suffering the artrogryposis. The parameters of the exoskeleton "EXAR" selected according to our methods allowed us to conduct its use in the period of 4 months. There have been no defects at all. By the analysis of the first results of the passive upper limb skeleton EXAR development we should consider them as positive and worthy of the widespread adoption in the remedial practice.

  11. Constraint Induced Movement Techniques To Facilitate Upper Extremity Use in Stroke Patients.

    PubMed

    Taub, E; Wolf, S L

    1997-01-01

    A new therapeutic approach to the rehabilitation of movement after stroke, termed constraint-induced (CI) movement therapy, has been derived from basic research with monkeys given somatosensory deafferentation. CI movement therapy consists of a family of therapies; their common element is that they induce stroke patients to greatly increase the use of an affected upper extremity for many hours a day over a period of 10 to 14 consecutive days. The signature intervention involves motor restriction of the contralateral upper extremity in a sling and training of the affected arm. The therapies result in large changes in amount of use of the affected arm in the activities of daily living outside of the clinic that have persisted for the 2 years measured to date. Patients who will benefit from Cl therapy can be identified before the beginning of treatment. PMID:27620374

  12. Correlations between statistical models of robotically collected kinematics and clinical measures of upper extremity function.

    PubMed

    Rohafza, Maryam; Fluet, Gerard G; Qiu, Qinyin; Adamovich, Sergei

    2012-01-01

    One of the obstacles in the development of rehabilitation robotics has been inadequacy in the measurement of treatment effects due to interventions. A measurement tool that will efficiently produce a large reliable sample of measurements collected during a single session that can also produce a rich set of data which reflects a subject's ability to perform meaningful functional activities has not been developed. This paper presents three linear regression models generated from seven kinematic measures collected during the performance of virtually simulated rehabilitation activities that were integrated with haptic robots by 19 persons with upper extremity hemiparesis due to chronic stroke. One of these models demonstrated a statistically significant correlation with the subjects' scores on the Jebsen Test of Hand Function (JTHF), a battery of six standardized upper extremity functional activities. The second and third models demonstrated a statistically significant correlation with the subjects' change scores on the JTHF. PMID:23366834

  13. ASSESSMENT OF UPPER EXTREMITY IMPAIRMENT, FUNCTION, AND ACTIVITY FOLLOWING STROKE: FOUNDATIONS FOR CLINICAL DECISION MAKING

    PubMed Central

    Lang, Catherine E.; Bland, Marghuretta D.; Bailey, Ryan R.; Schaefer, Sydney Y.; Birkenmeier, Rebecca L.

    2012-01-01

    The purpose of this review is to provide a comprehensive approach for assessing the upper extremity (UE) after stroke. First, common upper extremity impairments and how to assess them are briefly discussed. While multiple UE impairments are typically present after stroke, the severity of one impairment, paresis, is the primary determinant of UE functional loss. Second, UE function is operationally defined and a number of clinical measures are discussed. It is important to consider how impairment and loss of function affect UE activity outside of the clinical environment. Thus, this review also identifies accelerometry as an objective method for assessing UE activity in daily life. Finally, the role that each of these levels of assessment should play in clinical decision making is discussed in order to optimize the provision of stroke rehabilitation services. PMID:22975740

  14. Upper extremity tumor embolization using a transradial artery approach: technical note.

    PubMed

    Zaw, Taryar; Ni, Jason C; Park, Jonathan K; Walsworth, Matthew

    2016-09-01

    Transradial access is being used with increasing frequency for interventional radiology procedures and offers several key advantages, including decreased access site complications and increased patient comfort. We report the technique of using transradial access to perform preoperative embolization of a humeral renal cell carcinoma metastasis and pathologic fracture. A transradial approach for performing humeral preoperative tumor embolization has not been previously reported, to our knowledge. In the appropriately selected patient, this approach may be safely used to perform upper extremity embolization. PMID:27594948

  15. Segmental neurofibromatosis of the hand and upper extremity: a case report.

    PubMed

    Ilyas, Asif M; Nourissat, Geoffroy; Jupiter, Jesse B

    2007-12-01

    A case of segmental neurofibromatosis of the upper extremity is presented. Multiple neurofibromas involving different peripheral nerves limited to a single body part or limb is a rare form of neurofibromatosis. The clinical, genetic, and histologic findings of segmental neurofibromatosis are described. The criteria for segmental neurofibromatosis are reviewed, and the differentiation of neurofibromatosis types 1 and 2 and schwannomatosis is also briefly reviewed. PMID:18070641

  16. Presumed Pulmonary Embolism Following Power-Pulse Spray Thrombectomy of Upper Extremity Venous Thrombosis

    SciTech Connect

    Tsai, Jason; Georgiades, Christos S.; Hong, Kelvin; Kim, Hyun S.

    2006-08-15

    To achieve more effective thrombolysis in a shorter treatment time, percutaneous mechanical thrombectomy has been increasingly used in the treatment of deep venous thrombosis (DVT). The power-pulse spray is a new technique to combine chemical and rheolytic effects on clots. We present a case of presumed pulmonary embolism following power-pulse spray treatment for upper extremity DVT which necessitated resuscitation and intubation. The power-pulse spray technique should be used with caution when treating DVT.

  17. Perfusion Assessment with the SPY System after Arterial Venous Reversal for Upper Extremity Ischemia

    PubMed Central

    2014-01-01

    Background: The timing and pattern of reperfusion following arterial- venous reversal (AVR) in patients with terminal ischemia of an upper extremity is not well understood. Methods: The current case series describes the timing and pattern of reperfusion observed in patients with terminal upper extremity ischemia who underwent AVR and repeated postoperative indocyanine green (ICG) angiography between 2004 and 2009. For all included patients, the SPY Near-Infrared Perfusion Assessment System permitted visualization of ICG-labeled blood flow for 60-second sampling periods at scheduled postoperative time points; outflow and rate and amplitude of inflow were objectively quantified with SPY-Q Analysis Toolkit image analysis software. Results: The series comprised 6 male patients (mean age, 46 years) who presented with upper extremity ischemia related to hypothenar hammer syndrome (n = 2), embolism with patent foramen ovale (n = 2), atherosclerosis (n = 1), and avulsion amputation of the thumb (n = 1); the patient with the avulsion amputation was diagnosed with thromboangiitis obliterans at the time of replantation. AVR was successful in all 6 patients. In 5 of 6 patients, ICG angiography and SPY-based visualization/quantification showed that venous outflow and arterial inflow gradually normalized (versus unaffected digits) between postoperative days (PODs) 0 and 3 and was maintained at long-term follow-up (≥3 months); for the patient who underwent thumb replantation, perfusion normalized between POD 3 and month 5 follow-up. Conclusions: AVR effectively reestablished blood flow in patients with terminal upper extremity ischemia. ICG angiography with SPY technology revealed that, in most cases, kinetic curves, timing, and patterns of perfusion gradually normalized over several PODs. PMID:25426368

  18. Yoga Improves Upper-Extremity Function and Scapular Posturing in Persons with Hyperkyphosis

    PubMed Central

    Wang, Man-Ying; Greendale, Gail A.; Kazadi, Leslie; Salem, George J.

    2013-01-01

    Objective Hyperkyphosis (excess thoracic spine curvature) is associated with upper-extremity functional limitations and altered scapular posturing. The purpose of this study was to quantify the changes in upper-extremity function and scapular posturing following a 6-month yogaintervention in persons with hyperkyphosis. Methods Twenty-one older adults with hyperkyphosis (75.5+7.4 yrs) enrolled in the UCLA Yoga for Kyphosis randomized controlled trial, elected to participate in this uncontrolled, prepost substudy of upper-extremity function. They were measured at baseline and after a 24-week yoga intervention. Maximum vertical reach and timed book tests were used to evaluate upper-extremity function. Scapular posturing was quantified using a motion analysis system and data was obtained under 4 conditions: 1) quiet-standing, 2) normal walking, 3) fast walking, and 4) seated. Paired t-tests were used to test for changes between baseline and 6-month follow-up measures and Cohen’s d was calculated to examine effect sizes. Results Following the 6-month yoga intervention, participants improved their book test performance by 26.4% (p < 0.001; d = 1.5). Scapular protraction decreased by 2.9% during the static-sitting condition (p < 0.001; d = 0.5) and the overall excursion of the scapulae decreased for both fast (25.0%, p < 0.05; d = 0.6) and self-selected walking (29.4%, p < 0.01; d = 0.9). There were no changes in maximum vertical reach. Conclusion Subjects demonstrated significant improvements with small to large effect sizes in the timed book test and scapular posturing to a less protracted position during both static and dynamic conditions after the intervention. These adaptations are likely to reduce the risk of scapular impingement and help preserve functional independence in older adults. PMID:24678442

  19. Unilateral upper extremity lymphedema deteriorates the postural stability in breast cancer survivors

    PubMed Central

    Karadibak, Didem; Yavuzşen, Tuğba; Demirbüken, İlkşan

    2014-01-01

    Aim of the study There is little known about any change in postural balance caused by asymmetrical volume increase due to unilateral upper extremity lymphedema in patients who underwent breast surgery. The aim of this study was to determine whether there is a change in postural balance by measuring postural sway velocity (PSV), center of gravity (CoG) displacement and directional control (DCL) in patients with unilateral upper extremity lymphedema in breast cancer survivors. Material and methods Eighteen females 38–60 (M = 53) years old diagnosed with upper extremity lymphedema due to breast cancer surgery, and 18 healthy females with similar ages (M = 52.5) were assessed using the Balance Master system (Neuro Com, Clackamas, USA). Unilateral stance (US) and bilateral stance (BS) tests in eyes open and closed conditions and the limit of stability (LOS) test were applied to quantify postural sway velocity (PSV), CoG displacement, and directional control (DCL). Results The lymphedema group showed a significant increase in PSV in the US test on the ipsilateral leg with eyes open (p = 0.02) and eyes closed (p = 0.005) as well as on the contralateral leg with eyes open (p = 0.004) and eyes closed (p = 0.0001). Average displacement and position of the CoG were 25% of LOS (p = 0.0001) towards the lymphedema side and 60.6 degrees respectively. DCL in the lymphedema group was significantly lower in forward (p = 0.0001), back (p = 0.003), ipsilateral (p = 0.002), and contralateral (p = 0.03) directions. Conclusions These findings suggest that unilateral upper extremity lymphedema may have challenging effects on postural balance. PMID:25258587

  20. Sensory feedback by peripheral nerve stimulation improves task performance in individuals with upper limb loss using a myoelectric prosthesis

    NASA Astrophysics Data System (ADS)

    Schiefer, Matthew; Tan, Daniel; Sidek, Steven M.; Tyler, Dustin J.

    2016-02-01

    Objective. Tactile feedback is critical to grip and object manipulation. Its absence results in reliance on visual and auditory cues. Our objective was to assess the effect of sensory feedback on task performance in individuals with limb loss. Approach. Stimulation of the peripheral nerves using implanted cuff electrodes provided two subjects with sensory feedback with intensity proportional to forces on the thumb, index, and middle fingers of their prosthetic hand during object manipulation. Both subjects perceived the sensation on their phantom hand at locations corresponding to the locations of the forces on the prosthetic hand. A bend sensor measured prosthetic hand span. Hand span modulated the intensity of sensory feedback perceived on the thenar eminence for subject 1 and the middle finger for subject 2. We performed three functional tests with the blindfolded subjects. First, the subject tried to determine whether or not a wooden block had been placed in his prosthetic hand. Second, the subject had to locate and remove magnetic blocks from a metal table. Third, the subject performed the Southampton Hand Assessment Procedure (SHAP). We also measured the subject’s sense of embodiment with a survey and his self-confidence. Main results. Blindfolded performance with sensory feedback was similar to sighted performance in the wooden block and magnetic block tasks. Performance on the SHAP, a measure of hand mechanical function and control, was similar with and without sensory feedback. An embodiment survey showed an improved sense of integration of the prosthesis in self body image with sensory feedback. Significance. Sensory feedback by peripheral nerve stimulation improved object discrimination and manipulation, embodiment, and confidence. With both forms of feedback, the blindfolded subjects tended toward results obtained with visual feedback.

  1. Prosthesis coupling

    NASA Technical Reports Server (NTRS)

    Reswick, J. B.; Mooney, V.; Bright, C. W.; Owens, L. J. (Inventor)

    1979-01-01

    A coupling for use in an apparatus for connecting a prosthesis to the bone of a stump of an amputated limb is described which permits a bio-compatible carbon sleeve forming a part of the prosthesis connector to float so as to prevent disturbing the skin seal around the carbon sleeve. The coupling includes a flexible member interposed between a socket that is inserted within an intermedullary cavity of the bone and the sleeve. A lock pin is carried by the prosthesis and has a stem portion which is adapted to be coaxially disposed and slideably within the tubular female socket for securing the prosthesis to the stump. The skin around the percutaneous carbon sleeve is able to move as a result of the flexing coupling so as to reduce stresses caused by changes in the stump shape and/or movement between the bone and the flesh portion of the stump.

  2. Validity and reliability of upper extremity three-dimensional kinematics during a typing task.

    PubMed

    Levanon, Yafa; Gefen, Amit; Lerman, Yehuda; Givon, Uri; Ratzon, Navah Z

    2010-10-01

    Computer use continues to be considered a risk factor for work-related musculoskeletal disorders despite a greater awareness of the risk associated with excessive use, the implementation of safety features and the introduction of extensive interventional programs. Better understanding of risk factors in movement patterns is needed. This study identified the most suitable variable for work-related upper extremity motion analysis as being peak-to-peak range of motion. Assessment was by three-dimensional motion analysis for upper extremity ergonomics. The study was designed to validate and examine the reliability of these parameters in the setting of keyboarding. Sixty-two right-hand dominant participants (non-skilled typists) were recruited. Motion analysis was performed using the Cartesian Optoelectronic Dynamic Anthropometric CX-1 (CODA) system with markers which were attached to the right hand, elbow, wrist and fingers. Range of motion and angular velocity were recorded while the subjects repeatedly typed a predetermined sentence five times. The re-test examination was repeated after an interval of one week. The findings clearly demonstrated discriminative validity in wrist range of motion (p<.01), test-re-test, reliability (.83>ICC>.70) and inter-rater reliability (.95>ICC>.70) for most variables. The CODA system has considerable potential for understanding movement patterns in the upper extremities. These findings can provide the basis for future studies on the efficacy of ergonomic intervention programs. PMID:20678936

  3. Neurological Deficits before and after Surgical Resection of Schwannomas in the Upper Extremities.

    PubMed

    Mizushima, Hideyuki

    2016-06-01

    Background Schwannomas are the most common primary solitary tumor among peripheral nerve sheath tumors. The occurrence of transient or permanent neurological deficits after schwannoma resection is more common than previously recognized. Here, the neurological deficits before and after surgical resection of schwannomas in the upper extremities were examined. Methods The study included 43 upper-extremity schwannomas that were treated surgically between January 2000 and July 2013. The neurological status of each patient (such as pain, sensory disturbances, and motor disturbances) was evaluated preoperatively, immediately postoperatively, and at the final postoperative follow-up. Results Out of the 43 cases, 34 cases exhibited neurological symptoms before the operation, and in 31 of the 34 cases, neurological symptoms were either reduced or disappeared after the surgery. In 20 of the 43 cases, new neurological deficits that had not been observed preoperatively were noted immediately postoperatively; the newly acquired neurological deficits disappeared over time in 5 of the 20 cases. Significantly, more newly acquired neurological deficits remained in cases where the tumor was located in the upper arm and elbow than in cases where the tumor was located in the distal forearm. Conclusion New neurological deficits occurred after surgery in about half of the cases. This ratio was higher than expected, suggesting that schwannoma resection is not always a complication-free operation. Therefore, patients should be informed preoperatively about the possibility of neurological deficits. Furthermore, extreme care should be taken not to damage the affected and uninvolved nerves during surgery. PMID:26872028

  4. Playing Piano Can Improve Upper Extremity Function after Stroke: Case Studies

    PubMed Central

    Villeneuve, Myriam; Lamontagne, Anouk

    2013-01-01

    Music-supported therapy (MST) is an innovative approach that was shown to improve manual dexterity in acute stroke survivors. The feasibility of such intervention in chronic stroke survivors and its longer-term benefits, however, remain unknown. The objective of this pilot study was to estimate the short- and long-term effects of a 3-week piano training program on upper extremity function in persons with chronic stroke. A multiple pre-post sequential design was used, with measurements taken at baseline (week0, week3), prior to (week6) and after the intervention (week9), and at 3-week follow-up (week12). Three persons with stroke participated in the 3-week piano training program that combined structured piano lessons to home practice program. The songs, played on an electronic keyboard, involved all 5 digits of the affected hand and were displayed using a user-friendly MIDI program. After intervention, all the three participants showed improvements in their fine (nine hole peg test) and gross (box and block test) manual dexterity, as well as in the functional use of the upper extremity (Jebsen hand function test). Improvements were maintained at follow-up. These preliminary results support the feasibility of using an MST approach that combines structured lessons to home practice to improve upper extremity function in chronic stroke. PMID:23533954

  5. Playing piano can improve upper extremity function after stroke: case studies.

    PubMed

    Villeneuve, Myriam; Lamontagne, Anouk

    2013-01-01

    Music-supported therapy (MST) is an innovative approach that was shown to improve manual dexterity in acute stroke survivors. The feasibility of such intervention in chronic stroke survivors and its longer-term benefits, however, remain unknown. The objective of this pilot study was to estimate the short- and long-term effects of a 3-week piano training program on upper extremity function in persons with chronic stroke. A multiple pre-post sequential design was used, with measurements taken at baseline (week0, week3), prior to (week6) and after the intervention (week9), and at 3-week follow-up (week12). Three persons with stroke participated in the 3-week piano training program that combined structured piano lessons to home practice program. The songs, played on an electronic keyboard, involved all 5 digits of the affected hand and were displayed using a user-friendly MIDI program. After intervention, all the three participants showed improvements in their fine (nine hole peg test) and gross (box and block test) manual dexterity, as well as in the functional use of the upper extremity (Jebsen hand function test). Improvements were maintained at follow-up. These preliminary results support the feasibility of using an MST approach that combines structured lessons to home practice to improve upper extremity function in chronic stroke. PMID:23533954

  6. Upper Extremity Muscle Volumes and Functional Strength After Resistance Training in Older Adults

    PubMed Central

    Daly, Melissa; Vidt, Meghan E.; Eggebeen, Joel D.; Simpson, W. Greg; Miller, Michael E.; Marsh, Anthony P.; Saul, Katherine R.

    2014-01-01

    Aging leads to a decline in strength and an associated loss of independence. The authors examined changes in muscle volume, maximum isometric joint moment, functional strength, and 1-repetition maximum (1RM) after resistance training (RT) in the upper extremity of older adults. They evaluated isometric joint moment and muscle volume as predictors of functional strength. Sixteen healthy older adults (average age 75 ± 4.3 yr) were randomized to a 6-wk upper extremity RT program or control group. The RT group increased 1RM significantly (p < .01 for all exercises). Compared with controls, randomization to RT led to greater functional pulling strength (p = .003), isometric shoulder-adduction moment (p = .041), elbow-flexor volume (p = .017), and shoulder-adductor volume (p = .009). Shoulder-muscle volumes and isometric moments were good predictors of functional strength. The authors conclude that shoulder strength is an important factor for performing functional reaching and pulling tasks and a key target for upper extremity RT interventions. PMID:22952203

  7. Critical review of the impact of core stability on upper extremity athletic injury and performance

    PubMed Central

    Silfies, Sheri P.; Ebaugh, David; Pontillo, Marisa; Butowicz, Courtney M.

    2015-01-01

    BACKGROUND: Programs designed to prevent or rehabilitate athletic injuries or improve athletic performance frequently focus on core stability. This approach is based upon the theory that poor core stability increases the risk of poor performance and/or injury. Despite the widespread use of core stability training amongst athletes, the question of whether or not sufficient evidence exists to support this practice remains to be answered. OBJECTIVES: 1) Open a dialogue on the definition and components of core stability. 2) Provide an overview of current science linking core stability to musculoskeletal injuries of the upper extremity. 3) Provide an overview of evidence for the association between core stability and athletic performance. DISCUSSION: Core stability is the ability to control the position and movement of the trunk for optimal production, transfer, and control of forces to and from the upper and lower extremities during functional activities. Muscle capacity and neuromuscular control are critical components of core stability. A limited body of evidence provides some support for a link between core stability and upper extremity injuries amongst athletes who participate in baseball, football, or swimming. Likewise, few studies exist to support a relationship between core stability and athletic performance. CONCLUSIONS: A limited body of evidence exists to support the use of core stability training in injury prevention or performance enhancement programs for athletes. Clearly more research is needed to inform decision making when it comes to inclusion or emphasis of core training when designing injury prevention and rehabilitation programs for athletes. PMID:26537806

  8. A checklist for evaluating ergonomic risk factors associated with upper extremity cumulative trauma disorders.

    PubMed

    Keyserling, W M; Stetson, D S; Silverstein, B A; Brouwer, M L

    1993-07-01

    A two-page checklist for determining the presence of ergonomic risk factors associated with the development of upper extremity cumulative trauma disorders (e.g., repetitiveness, local mechanical contact stresses, forceful manual exertions, awkward postures, and hand tool usage) was developed and evaluated as part of a joint labour-management ergonomics intervention programme. This checklist was used by plant personnel at four work sites to assess the presence of upper extremity risk factors in 335 manufacturing and warehouse jobs. In addition, results generated by the checklist were compared to the results of ergonomic analyses performed by persons with advanced training (Masters degree) in occupational ergonomics for a subset of 51 jobs. Most of the jobs included in the survey were found to have significant exposures to upper extremity risk factors. Awkward work postures were common, with 90% of the jobs requiring wrist deviations outside the neutral range-of-motion. The jobs were also highly repetitive and frequently required workers to exert high hand forces. Results generated by the checklist were generally in agreement with results generated by the ergonomic analysts; however, the checklist was found to be more sensitive in identifying the presence of risk factors. The checklist was found to be an effective rapid-screening instrument for identifying jobs that expose workers to potentially harmful ergonomic stresses. However, the checklist methodology did not include sufficient documentation of work methods to identify specific job attributes associated with these exposures. PMID:8339720

  9. Upper extremity 3D reachable workspace analysis in dystrophinopathy using Kinect

    PubMed Central

    Han, Jay J.; Kurillo, Gregorij; Abresch, Richard T.; de Bie, Evan; Nicorici, Alina; Bajcsy, Ruzena

    2015-01-01

    Introduction An innovative upper extremity 3D reachable workspace outcome measure acquired using Kinect sensor is applied towards Duchenne/Becker muscular dystrophy (DMD/BMD). The validity, sensitivity, and clinical meaningfulness of the novel outcome is examined. Methods Upper extremity function assessment (Brooke scale, NeuroQOL questionnaire) and Kinect-based reachable workspace analyses were conducted in 43 individuals with dystrophinopathy (30-DMD, 13-BMD; ages 7–60) and 46 controls (ages 6–68). Results The reachable workspace measure reliably captured a wide-range of upper extremity impairments encountered in both pediatric and adult, as well as ambulatory and non-ambulatory individuals with dystrophinopathy. Reduced reachable workspaces were noted for the dystrophinopathy cohort compared to controls, and they correlated with Brooke grades. Additionally, progressive reduction in reachable workspace directly correlated with worsening ability to perform activities of daily living, as self-reported on the NeuroQOL. Discussion This study demonstrates the utility and potential of the novel sensor-acquired reachable workspace outcome measure in dystrophinopathy. PMID:25597487

  10. EFFECT OF INTENSE FUNCTIONAL TASK TRAINING UPON TEMPORAL STRUCTURE OF VARIABILITY OF UPPER EXTREMITY POST STROKE

    PubMed Central

    Sethi, Amit; Davis, Sandra; McGuirk, Theresa; Patterson, Tara S.; Richards, Lorie G.

    2012-01-01

    Study Design Quasi-experimental design Introduction Although the effectiveness of constraint induced movement therapy (CIMT) in upper extremity (UE) rehabilitation post stroke is well known, the efficacy of CIMT to enhance the temporal structure of variability in upper extremity movement is not known. Purpose The purpose of this study was to investigate whether CIMT could enhance temporal structure of variability in upper extremity movement in individuals with chronic stroke. Methods Six participants with chronic stroke underwent CIMT for 4 hours/day for 2 weeks. Participants performed three trials of functional reach-to-grasp before and after CIMT. Temporal structure of variability was determined by calculating approximate entropy (ApEn) in shoulder, elbow and wrist flexion/extension joint angles. Results ApEn increased post CIMT, however, statistical significance was not achieved (p > 0.0167). Conclusion Future studies with larger sample size are warranted to investigate the effect of CIMT upon temporal structure of variability in UE movement. PMID:23084461

  11. Two-point discrimination of the upper extremities of healthy Koreans in their 20's.

    PubMed

    Koo, Ja-Pung; Kim, Soon-Hee; An, Ho-Jung; Moon, Ok-Gon; Choi, Jung-Hyun; Yun, Young-Dae; Park, Joo-Hyun; Min, Kyoung-Ok

    2016-03-01

    [Purpose] The present study attempted to measure two-point discrimination in the upper extremities of healthy Koreans in their 20's. [Subjects and Methods] Using a three-point esthesiometer, we conducted an experiment with a group of 256 college students (128 male and 128 female), attending N University in Chonan, Republic of Korea. [Results] Females showed two-point discrimination at a shorter distance than males at the following points: (i) 5 cm above the elbow joint, the middle part, and 5 cm below the shoulder joint of the anterior upper arm; (ii) 5 cm above the elbow joint and 5 cm below the shoulder joint of the posterior upper arm; (iii) 5 cm above the front of the wrist joint of the forearm; 5 cm below the elbow joint, the palmar part of the distal interphalangeal joint of the thumb, the dorsal part of the distal interphalangeal joint of the middle and little fingers. It was also found that females showed greater two-point discrimination than males in distal regions rather than proximal regions. [Conclusion] The findings of this study will help establish normal values for two-point discrimination of upper extremities of young Koreans in their 20's. PMID:27134375

  12. Recovery of Upper Extremity Sensorimotor System Acuity in Baseball Athletes After a Throwing-Fatigue Protocol

    PubMed Central

    Tripp, Brady L; Yochem, Eric M; Uhl, Timothy L

    2007-01-01

    Context: Research indicates that upper extremity fatigue hampers sensorimotor system acuity. However, no investigators have observed recovery of upper extremity acuity after fatigue. Objective: To observe recovery of active position reproduction acuity in overhead throwers after a throwing-fatigue protocol. Design: Single-session, repeated-measures design. Setting: University musculoskeletal laboratory. Patients or Other Participants: Sixteen healthy collegiate baseball players (age = 21.0 ± 1.6 years, height = 175.8 ± 10.2 cm, mass = 82.8 ± 4.3 kg). Intervention(s): Subjects threw a baseball with maximum velocity (every 5 seconds) from a single knee. Every 20 throws, subjects rated their upper extremity exertion on a Borg scale until reporting a level of more than 14. Main Outcome Measure(s): We used an electromagnetic tracking system to measure active multijoint position reproduction acuity at 5 intervals: prefatigue; immediately postfatigue; and after 4, 7, and 10 minutes of recovery. Blindfolded subjects reproduced their arm-cocked and ball-release positions. Dependent variables were 3-dimensional variable errors of scapulothoracic, glenohumeral, elbow, and wrist joints; endpoint (ie, hand) position error represented overall upper extremity acuity. The independent variable was time (measured prefatigue and at 4 postfatigue intervals). Results: Fatigue significantly affected acuity of scapulothoracic, glenohumeral, and elbow joints and endpoint error for both positions (P < .001). Fatigue significantly affected wrist acuity only for ball release (P < .001). For arm-cocked reproduction, each measure of acuity, except that of the glenohumeral joint, recovered by 7 minutes; for ball release, each measure of acuity recovered within 4 minutes (P > .05). Conclusions: The sensorimotor system deficits that we observed after fatigue recovered within 7 minutes in most upper extremity joints. Glenohumeral arm-cocked position reproduction acuity failed to recover within

  13. Early Cocking Phase Mechanics and Upper Extremity Surgery Risk in Starting Professional Baseball Pitchers

    PubMed Central

    Douoguih, Wiemi A.; Dolce, Donald L.; Lincoln, Andrew E.

    2015-01-01

    Background: Early cocking phase pitching mechanics may affect risk of upper extremity injury requiring surgery in professional baseball players. Purpose: To assess the occurrence of inverted-W arm positioning and early trunk rotation in Major League Baseball (MLB) pitchers and to determine whether this throwing position is associated with upper extremity injury requiring surgery. Study Design: Cross-sectional study; Level of evidence, 3. Methods: For 250 MLB pitchers in the 2010 season, 15 to 20 pitches from the start and end of an outing were reviewed using slow-motion game video for presence of an inverted-W position and early trunk rotation. Previous or current incidence of upper extremity injury requiring surgery for each player was determined using the MLB injury database, minor league injury records, available collegiate data, and publicly available online injury databases. Upper extremity surgery associated with an injury was considered to result from pitching. Results: Consensus between investigators was achieved for 99% of players for inverted-W positioning (248 players) and in 97% of players for early trunk rotation (243 players) for videos reviewed independently. Rate of surgery with and without inverted-W position was 28 of 93 (30%) and 42 of 155 (27%), respectively. Rate of surgery with and without early trunk rotation was 37 of 111 (33%) and 30 of 132 (23%), respectively. Using a Cox proportional hazards model for risk analysis using the measured number of innings pitched at time of surgery as an approximate index of exposure and adjusting for age and fastball speed at time of surgery, early trunk rotation was associated with significantly increased risk of shoulder and/or elbow surgery with hazard ratio estimate of 1.69 (95% CI, 1.02-2.80). Presence of the inverted-W position was not associated with significantly increased risk (hazard ratio, 1.30; 95% CI, 0.79-2.14). Conclusion: The inverted-W throwing position was not associated with significantly

  14. Shoulder Musculature Activity and Stabilization During Upper Extremity Weight-Bearing Activities

    PubMed Central

    Pontillo, Marisa; Kremenic, Ian J.; McHugh, Malachy P.; Mullaney, Michael J.; Tyler, Timothy F.

    2007-01-01

    Background Upper extremity weight-bearing exercises are routinely used in physical therapy for patients with shoulder pathology. However, little evidence exists regarding the demand on the shoulder musculature. Objective To examine changes in shoulder muscle activity and center of pressure during upper extremity weight-bearing exercises of increasing difficulty. Methods Electromyographic (EMG) and kinetic data were recorded from both shoulders of 15 healthy subjects (10 male and 5 female). Participants were tested in a modified tripod position under three conditions of increasing difficulty: (1) hand directly on the force plate, (2) on a green Stability Trainer™ and (3) on a blue Stability Trainer™. Ground reaction forces were recorded for each trial. Surface EMG was recorded from the serratus anterior, pectoralis major, upper trapezius, lower trapezius, infraspinatus, anterior deltoid, posterior deltoid, and the lateral head of the triceps muscles. Results Mean deviation from center of pressure significantly increased when using the Stability Trainer™ pads. The activities of the triceps, serratus anterior, and anterior deltoid muscles significantly increased as each trial progressed, irrespective of stability condition. Additionally, activity in the anterior deltoid, lower trapezius, and serratus anterior muscles significantly decreased with increasing difficulty, whereas activity in the triceps muscles significantly increased. Discussion and Conclusion Balancing on a foam pad made it more difficult to maintain the upper extremity in a stable position. However, this activity did not alter the proprioceptive stimulus enough to elicit an increase in shoulder muscle activation. While the results on this study support the use of different level Stability Trainers™ to facilitate neuromuscular re-education, a less compliant unstable surface may produce larger training effects. PMID:21522206

  15. The effects of smartphone use on upper extremity muscle activity and pain threshold.

    PubMed

    Lee, Minkyung; Hong, Yunkyung; Lee, Seunghoon; Won, Jinyoung; Yang, Jinjun; Park, Sookyoung; Chang, Kyu-Tae; Hong, Yonggeun

    2015-06-01

    [Purpose] The purpose of this study was to determine whether muscle activity and pressure-induced pain in the upper extremities are affected by smartphone use, and to compare the effects of phone handling with one hand and with both hands. [Subjects] The study subjects were asymptomatic women 20-22 years of age. [Methods] The subjects sat in a chair with their feet on the floor and the elbow flexed, holding a smartphone positioned on the thigh. Subsequently, the subjects typed the Korean anthem for 3 min, one-handed or with both hands. Each subject repeated the task three times, with a 5-min rest period between tasks to minimize fatigue. Electromyography (EMG) was used to record the muscle activity of the upper trapezius (UT), extensor pollicis longus (EPL), and abductor pollicis (AP) during phone operation. We also used a dolorimeter to measure the pressure-induced pain threshold in the UT. [Results] We observed higher muscle activity in the UT, AP, and EPL in one-handed smartphone use than in its two-handed use. The pressure-induced pain threshold of the UT was lower after use of the smartphone, especially after one-handed use. [Conclusion] Our results show that smartphone operation with one hand caused greater UT pain and induced increased upper extremity muscle activity. PMID:26180311

  16. Psychological and social consequences after reconstruction of upper extremity trauma: methods of detection and management.

    PubMed

    Galanakos, Spyridon P; Bot, Arjan G J; Zoubos, Aristides B; Soucacos, Panayotis N

    2014-03-01

    Upper extremity trauma and resulting disability is a stressful event and can affect a patient's personality. Several studies have shown that this injury type has serious psychological and/or social consequences. We systematically reviewed the evidence on the consequences of disability after a complex trauma (combination of soft tissue, osseous, vascular, and nerve involvement) of the upper extremity. We tried to find out the potential crucial factors that could determine the final hand function. In addition, we considered the challenges that need to be addressed to eliminate the adverse or negative effects that arise from upper limb trauma. In the literature, there is a growing interest to study changes in patients' quality of life and return to work. Psychological morbidity is an important part of patients' perceived general health. These issues could play an important role in the final functional outcome of the therapy. An early identification and treatment of trauma-related distress in patients may prevent progression of psychological pathology and mitigate negative effects on general health status. It may be important to evaluate the amount of psychological distress when caring for patients with hand injuries. PMID:24347334

  17. Vascular Access Effects on Motor Performance and Anthropometric Indices of Upper Extremities.

    PubMed

    Bučar Pajek, Maja; Čuk, Ivan; Pajek, Jernej

    2016-06-01

    A decrement of upper extremity motor performance is a concern with vascular access creation. We analyzed differences in handgrip strength, tapping test and anthropometric indices of arms with and without vascular access (N = 87) and compared them to bilateral differences in control subjects (N = 140). Fistula harboring arms had weaker grip strength than contralateral arms of 2.7 kg and this difference was statistically marginally larger than the difference between non-dominant and dominant arms in controls of 1.6 kg (mean difference 1.1 kg, P = 0.06). No difference in the magnitude of inferiority of fistula arms compared to control non-dominant arms was present in the tapping test. Absolute results of both motor tests on any side were significantly worse in dialysis patients. Although weaker and slower, fistula arms showed larger mean upper-arm and forearm circumferences of 0.4-0.6 cm. Our results show no significant negative effect of arteriovenous access on motor performance of upper extremities. PMID:27312918

  18. Evaluation of negative viscosity as upper extremity training for stroke survivors

    PubMed Central

    Huang, Felix C.; Patton, James L.

    2016-01-01

    With stroke survivors (n=30) as the test population, we investigated how upper extremity training with negative viscosity affects coordination in unassisted conditions. Using a planar force-feedback device, subjects performed exploratory movements within an environment that simulated 1) negative viscosity added to elbow and shoulder joints 2) augmented inertia to the upper and lower arm combined with negative viscosity, or 3) a null force field (control). After training, we evaluated each subject’s ability to perform circular movements in the null field. Negative viscosity training resulted in greater within-day reductions in error compared with the combined field training. Negative viscosity promoted greater distributions of accelerations during free exploration, especially in the sagittal axis, while combined field training diminished overall activity. Both force field training groups exhibited next day retention, while this was not observed for the control group. The improvement in performance suggests that greater range of kinematic experiences contribute to learning, even despite novel force field environments. These findings provide support for the use of movement amplifying environments for upper extremity rehabilitation, allowing greater access to training while maintaining user engagement. PMID:22275710

  19. The effects of smartphone use on upper extremity muscle activity and pain threshold

    PubMed Central

    Lee, Minkyung; Hong, Yunkyung; Lee, Seunghoon; Won, Jinyoung; Yang, Jinjun; Park, Sookyoung; Chang, Kyu-Tae; Hong, Yonggeun

    2015-01-01

    [Purpose] The purpose of this study was to determine whether muscle activity and pressure-induced pain in the upper extremities are affected by smartphone use, and to compare the effects of phone handling with one hand and with both hands. [Subjects] The study subjects were asymptomatic women 20–22 years of age. [Methods] The subjects sat in a chair with their feet on the floor and the elbow flexed, holding a smartphone positioned on the thigh. Subsequently, the subjects typed the Korean anthem for 3 min, one-handed or with both hands. Each subject repeated the task three times, with a 5-min rest period between tasks to minimize fatigue. Electromyography (EMG) was used to record the muscle activity of the upper trapezius (UT), extensor pollicis longus (EPL), and abductor pollicis (AP) during phone operation. We also used a dolorimeter to measure the pressure-induced pain threshold in the UT. [Results] We observed higher muscle activity in the UT, AP, and EPL in one-handed smartphone use than in its two-handed use. The pressure-induced pain threshold of the UT was lower after use of the smartphone, especially after one-handed use. [Conclusion] Our results show that smartphone operation with one hand caused greater UT pain and induced increased upper extremity muscle activity. PMID:26180311

  20. Applying PROMIS to Assess Upper Extremity Function Among Children with Congenital Hand Differences

    PubMed Central

    Waljee, Jennifer F.; Carlozzi, Noelle; Franzblau, Lauren E.; Zhong, Lin; Chung, Kevin C.

    2016-01-01

    Purpose Few studies have evaluated self-assessment tools among children with congenital hand differences. We compared three upper extremity disability instruments with the Patient Reported Outcomes Measurement Information System (PROMIS®) Pediatric Upper Extremity Item Bank. Methods Thirty-three children (ages 6–17) with congenital hand differences completed the Pediatric Outcomes Data Collection Instrument (PODCI), the Michigan Hand Outcomes Questionnaire (MHQ), the Disability of the Arm, Shoulder, and Hand (DASH), and the PROMIS® Upper Extremity short form (SF) and computerized adaptive test (CAT). Hand function was also assessed using grip and pinch strength and the Nine-Hole Peg Test. We used Spearman correlation coefficients to determine construct validity, and examined feasibility by comparing completion time, reading level, need for assistance, and patient preference among the instruments. Results PROMIS® demonstrated good construct validity. SF and CAT versions of PROMIS® were highly correlated with DASH scores (r > 0.80, p<0.001) and all PODCI domains except sports (r>0.70, p<0.001). Correlations with the MHQ were moderate (r> 0.40, p < 0.05). PROMIS® SF and CAT scores also correlated with grip strength (r≥0.60, p<0.001) and pinch strength (r>0.50, p<0.001). Compared to the other questionnaires, PROMIS® was much more feasible. It took the least time to complete, fewer children required assistance, and it is written at a lower, more age-appropriate reading level than the MHQ and DASH. Conclusions PROMIS® is highly correlated with both functional tests and traditional hand function questionnaires. Our results provide encouraging evidence that PROMIS® may be an efficient, feasible option to capture hand function among children with congenital hand differences. Level of Evidence: III PMID:26218394

  1. Upper extremity rehabilitation of stroke: Facilitation of corticospinal excitability using virtual mirror paradigm

    PubMed Central

    2012-01-01

    Background Several experimental studies in stroke patients suggest that mirror therapy and various virtual reality programs facilitate motor rehabilitation. However, the underlying mechanisms for these therapeutic effects have not been previously described. Objectives We attempted to delineate the changes in corticospinal excitability when individuals were asked to exercise their upper extremity using a real mirror and virtual mirror. Moreover, we attempted to delineate the role of visual modulation within the virtual environment that affected corticospinal excitability in healthy subjects and stroke patients. Methods A total of 18 healthy subjects and 18 hemiplegic patients were enrolled into the study. Motor evoked potential (MEP)s from transcranial magnetic stimulation were recorded in the flexor carpi radialis of the non-dominant or affected upper extremity using three different conditions: (A) relaxation; (B) real mirror; and (C) virtual mirror. Moreover, we compared the MEPs from the virtual mirror paradigm using continuous visual feedback or intermittent visual feedback. Results The rates of amplitude increment and latency decrement of MEPs in both groups were higher during the virtual mirror task than during the real mirror. In healthy subjects and stroke patients, the virtual mirror task with intermittent visual feedback significantly facilitated corticospinal excitability of MEPs compared with continuous visual feedback. Conclusion Corticospinal excitability was facilitated to a greater extent in the virtual mirror paradigm than in the real mirror and in intermittent visual feedback than in the continuous visual feedback, in both groups. This provides neurophysiological evidence supporting the application of the virtual mirror paradigm using various visual modulation technologies to upper extremity rehabilitation in stroke patients. PMID:23035951

  2. An electromyographic study of strength and upper extremity muscle activity in simulated meat cutting tasks.

    PubMed

    Grant, K A; Habes, D J

    1997-04-01

    Meat cutting has long been associated with a high incidence rate of upper extremity musculoskeletal disorders. This study examined upper extremity muscle activities and force exertion capabilities to identify postures which have potential for causing overexertion injuries. Fifteen subjects exerted force against a handle in postures similar to those observed in the meatpacking industry. Exertion level, direction of exertion, handle height, reach distance and grip type were varied. Activity in the posterior deltoid, biceps brachii, triceps brachii, extensor digitorum and flexor digitorum superficialis was monitored via surface electromyography (EMG). The ratio of normalized EMG activity to force produced during the exertion was computed for each muscle under each condition. The results showed that handle position had a significant effect on force exertion capability and the EMG/force ratio in all muscles. Force exertion capability was maximized, and the EMG/force ratio was generally minimized when participants pulled downward on a handle positioned at full arm's reach above the shoulder. For vertical cuts, force decreased and muscle activity generally increased as the handle height was lowered. For horizontal cuts, the full reach distance tended to allow greater force exertion with lower EMG/force ratios. The stab grip also tended to be associated with higher forces and lower EMG/force ratios than the slice grip. This study supports the premise that musculoskeletal stresses in meatpacking tasks can be altered through tool and workstation redesign. The data provided herein may be useful in selecting design modifications that reduce biomechanical stress on the upper extremities. PMID:9414348

  3. The WISTAH hand study: A prospective cohort study of distal upper extremity musculoskeletal disorders

    PubMed Central

    2012-01-01

    Background Few prospective cohort studies of distal upper extremity musculoskeletal disorders have been performed. Past studies have provided somewhat conflicting evidence for occupational risk factors and have largely reported data without adjustments for many personal and psychosocial factors. Methods/design A multi-center prospective cohort study was incepted to quantify risk factors for distal upper extremity musculoskeletal disorders and potentially develop improved methods for analyzing jobs. Disorders to analyze included carpal tunnel syndrome, lateral epicondylalgia, medial epicondylalgia, trigger digit, deQuervain’s stenosing tenosynovitis and other tendinoses. Workers have thus far been enrolled from 17 different employment settings in 3 diverse US states and performed widely varying work. At baseline, workers undergo laptop administered questionnaires, structured interviews, two standardized physical examinations and nerve conduction studies to ascertain demographic, medical history, psychosocial factors and current musculoskeletal disorders. All workers’ jobs are individually measured for physical factors and are videotaped. Workers are followed monthly for the development of musculoskeletal disorders. Repeat nerve conduction studies are performed for those with symptoms of tingling and numbness in the prior six months. Changes in jobs necessitate re-measure and re-videotaping of job physical factors. Case definitions have been established. Point prevalence of carpal tunnel syndrome is a combination of paraesthesias in at least two median nerve-served digits plus an abnormal nerve conduction study at baseline. The lifetime cumulative incidence of carpal tunnel syndrome will also include those with a past history of carpal tunnel syndrome. Incident cases will exclude those with either a past history or prevalent cases at baseline. Statistical methods planned include survival analyses and logistic regression. Discussion A prospective cohort study of

  4. Salvage of replanted upper extremities with major soft-tissue complications.

    PubMed

    Cavadas, Pedro C

    2007-01-01

    Soft-tissue complications in the replantation wound, either septic or non-septic, are the main cause of failure in major extremity replantations. In the presence of necrosis or infection, vascular errosion or thrombosis readily develops and can lead to limb loss. Very aggressive surgical treatment has been recommended to salvage the replanted limb in these highly unstable clinical situations. Over a 10-year period, 423 amputated parts were replanted, 56 of which were replants proximal to the wrist. The experience of the author in treating 11 cases of critical soft-tissue necrosis (four septic and seven non-septic) after major replantation of the upper extremity with aggressive debridement and flap coverage, is reported. All flaps and limbs survived. PMID:17478136

  5. Evaluation and medical management of fragility fractures of the upper extremity.

    PubMed

    Gutowski, Christina J; Ilyas, Asif M

    2014-04-01

    Osteoporosis continues to be a major health condition plaguing the aging population. The major manifestation of osteoporosis, the development of fragility fractures, is a burden both clinically and economically on patients and the nation's health care system, with up to half of all American women sustaining a fragility fracture in their older years. The high frequency of injuries to the distal radius and proximal humerus should lead upper extremity surgeons to take pause and recognize the magnitude of impact these fractures have on their patient population. Recommended interventions span a spectrum of aggressiveness and have various financial implications. PMID:24684917

  6. Rule based artificial intelligence expert system for determination of upper extremity impairment rating.

    PubMed

    Lim, I; Walkup, R K; Vannier, M W

    1993-04-01

    Quantitative evaluation of upper extremity impairment, a percentage rating most often determined using a rule based procedure, has been implemented on a personal computer using an artificial intelligence, rule-based expert system (AI system). In this study, the rules given in Chapter 3 of the AMA Guides to the Evaluation of Permanent Impairment (Third Edition) were used to develop such an AI system for the Apple Macintosh. The program applies the rules from the Guides in a consistent and systematic fashion. It is faster and less error-prone than the manual method, and the results have a higher degree of precision, since intermediate values are not truncated. PMID:8334872

  7. Soft Tissue Coverage of the Hand and Upper Extremity: The Reconstructive Elevator.

    PubMed

    Miller, Erin Anne; Friedrich, Jeffrey

    2016-07-01

    Soft tissue reconstruction of the upper extremity is a complex topic because every defect has multiple potential solutions. Whereas the often-cited reconstructive ladder advised selection of the simplest reconstruction of the defect, the newer concept of the reconstructive elevator allows freedom to choose a more complex reconstruction to account for specialized function and aesthetic outcome. An algorithm for assessment of the defect is presented and demonstrated in this review, using 6 case examples to highlight key concepts. Representative flaps are presented and a discussion of functional and aesthetic outcomes is undertaken to provide a framework for achieving the patient's and surgeon's goals of reconstruction. PMID:27288305

  8. Clear cell adenocarcinoma of the renal pelvis: an extremely rare neoplasm of the upper urinary tract.

    PubMed

    Liu, K-W; Lin, V C-H; Chang, I-W

    2013-12-01

    Clear cell adenocarcinoma (CCA) in the urinary tract is a rare neoplasm morphologically identical to the Müllerian counterpart. Clear cell adenocarcinoma is extremely rare in the upper urinary tract. We present a case with CCA of the renal pelvis. Microscopically, the tumor exhibited exophytic growth with predominantly tubulocystic structures, as well as solid and papillary patterns. The neoplastic cells were cuboidal with clear to pale eosinophilic cytoplasm and abundant intracellular and extracellular eosinophilic hyaline globules. By immunohistochemically, the tumor was labeled by cytokeratins and hepatocyte nuclear factor-1β. The patient was still alive without evidence of recurrence in the follow-up period of nineteen months after diagnosis. PMID:24375047

  9. Preconditioning electromyographic data for an upper extremity model using neural networks

    NASA Technical Reports Server (NTRS)

    Roberson, D. J.; Fernjallah, M.; Barr, R. E.; Gonzalez, R. V.

    1994-01-01

    A back propagation neural network has been employed to precondition the electromyographic signal (EMG) that drives a computational model of the human upper extremity. This model is used to determine the complex relationship between EMG and muscle activation, and generates an optimal muscle activation scheme that simulates the actual activation. While the experimental and model predicted results of the ballistic muscle movement are very similar, the activation function between the start and the finish is not. This neural network preconditions the signal in an attempt to more closely model the actual activation function over the entire course of the muscle movement.

  10. Principles of Nerve Repair in Complex Wounds of the Upper Extremity

    PubMed Central

    Moore, Amy M.; Wagner, I. Janelle; Fox, Ida K.

    2015-01-01

    Peripheral nerve injuries are common in the setting of complex upper extremity trauma. Early identification of nerve injuries and intervention is critical for maximizing return of function. In this review, the principles of nerve injury, patient evaluation, and surgical management are discussed. An evidence-based approach to nerve reconstruction is reviewed, including the benefits and limitations of direct repair and nerve gap reconstruction with the use of autografts, processed nerve allografts, and conduits. Further, the principles and indications of commonly used nerve transfers in proximal nerve injuries are also addressed. PMID:25685102

  11. The effect of the action observation physical training on the upper extremity function in children with cerebral palsy.

    PubMed

    Kim, Jin-Young; Kim, Jong-Man; Ko, Eun-Young

    2014-06-01

    The purpose this study was to investigate the effect of action observation physical training (AOPT) on the functioning of the upper extremities in children with cerebral palsy (CP), using an evaluation framework based on that of the International Classification of Functioning, Disability and Health (ICF). The subjects were divided into an AOPT group and a physical training (PT) group. AOPT group practiced repeatedly the actions they observed on video clips, in which normal child performed an action with their upper extremities. PT group performed the same actions as the AOPT group did after observing landscape photographs. The subjects participated in twelve 30-min sessions, 3 days a week, for 4 weeks. Evaluation of upper extremity function using the following: the power of grasp and Modified Ashworth Scale for body functions and structures, a Box and Block test, an ABILHAND-Kids questionnaire, and the WeeFIM scale for activity and participation. Measurements were performed before and after the training, and 2 weeks after the end of training. The results of this study showed that, in comparison with the PT group, the functioning of the upper extremities in the AOPT group was significantly improved in body functions and activity and participation according to the ICF framework. This study demonstrates that AOPT has a positive influence on the functioning of the upper extremities in children with CP. It is suggested that this alternative approach for functioning of the upper extremities could be an effective method for rehabilitation in children with CP. PMID:25061598

  12. Brief Assessment of Motor Function: Content Validity and Reliability of the Upper Extremity Gross Motor Scale

    PubMed Central

    Cintas, Holly Lea; Parks, Rebecca; Don, Sarah; Gerber, Lynn

    2011-01-01

    Content validity and reliability of the Brief Assessment of Motor Function (BAMF) Upper Extremity Gross Motor Scale (UEGMS) were evaluated in this prospective, descriptive study. The UEGMS is one of five ordinal scales designed for quick documentation of gross, fine and oral motor skill levels. Designed to be independent of age and diagnosis, it is intended for use for infants through young adults. An expert panel of 17 physical therapists and 13 occupational therapists refined the content by responding to a standard questionnaire comprised of questions which asked whether each item should be included, is clearly worded, should be reordered higher or lower, is functionally relevant, and is easily discriminated. Ratings of content validity exceeded the criterion except for two items which may represent different perspectives of physical and occupational therapists. The UEGMS was modified using the quantitative and qualitative feedback from the questionnaires. For reliability, five raters scored videotaped motor performances of ten children. Coefficients for inter-rater (0.94) and intra-rater (0.95) reliability were high. The results provide evidence of content validity and reliability of the UEGMS for assessment of upper extremity gross motor skill. PMID:21599568

  13. Evolving Role of Ultrasound in Therapeutic Injections of the Upper Extremity.

    PubMed

    Wilson, David J; Scully, William F; Rawlings, John M

    2015-11-01

    Ultrasound machines are creating more refined pictures and becoming more user-friendly and readily accessible. As a result, ultrasound is being increasingly used for therapeutic purposes. One example involves the use of ultrasound guidance in musculoskeletal interventional procedures, such as joint injections, tendon sheath injections, and peripheral nerve blocks. Technical considerations and therapeutic results have been described for multiple locations about the upper extremities, with varying levels of success. The implementation of ultrasound-guided injections in the orthopedist's clinic has therapeutic, financial, and provider role implications. Given these potential benefits, orthopedic providers, both in practice and residency, would benefit from increased exposure and education in ultrasound use. Ultrasound provides the benefit of real-time, dynamic imaging without the radiation exposure of fluoroscopy, and ultrasound-guided injections can be performed in the office, as opposed to the operating room, which is frequently required when using fluoroscopy. A basic knowledge of the principles and terms used in ultrasound is required. With these simple principles, a practitioner can review techniques for specific areas of the musculoskeletal system and begin using ultrasound to guide injections. Many locations for diagnostic and/or therapeutic injections in the upper extremities have improved accuracy and benefit with the use of ultrasound vs blind techniques, although a few have not been shown to have a significant difference in the literature. The educational and professional implications can be significant, but these potential benefits need to be carefully weighed against costs by each orthopedic practice. PMID:26558666

  14. Steroid injections in the upper extremity: experienced clinical opinion versus evidence-based practices.

    PubMed

    Kegel, Gary; Marshall, Astrid; Barron, O Alton; Catalano, Louis W; Glickel, Steven Z; Kuhn, Margaret

    2013-09-01

    A survey regarding upper-extremity steroid injection practices was distributed to all active members of the American Society for Surgery of the Hand (ASSH) and American Shoulder and Elbow Surgeons (ASES) using SurveyMonkey. Response rates for the ASSH and ASES were 26% and 24%, respectively. The potency-adjusted dose of steroid injected for common hand and wrist injections ranged from 0.375 to 133.33 mg and for shoulder injections ranged from 0.375 to 250 mg. These ranges span 356-fold and 667-fold differences, respectively. Potency-adjusted doses differed significantly between steroid types for all injections evaluated in this study. American Society for Surgery of the Hand members gave significantly smaller doses of steroid for the glenohumeral and acromioclavicular joints than ASES members. Only 9% of respondents based injection practice on a scientific reference. Sixteen percent of ASSH and 31% of ASES respondents reported no specific rationale for their steroid injection practice; 78% of ASSH and 52% of ASES respondents attributed their rationale to some kind of instruction from their mentors or colleagues. Upper-extremity surgeons demonstrate substantial variability in their practice of steroid injections, with up to a 667-fold range in steroid dose. Experienced clinical opinion is the principal rationale for these injection practices; little rationale is based on formal scientific evidence. PMID:24025004

  15. Computer work and musculoskeletal disorders of the neck and upper extremity: A systematic review

    PubMed Central

    2010-01-01

    Background This review examines the evidence for an association between computer work and neck and upper extremity disorders (except carpal tunnel syndrome). Methods A systematic critical review of studies of computer work and musculoskeletal disorders verified by a physical examination was performed. Results A total of 22 studies (26 articles) fulfilled the inclusion criteria. Results show limited evidence for a causal relationship between computer work per se, computer mouse and keyboard time related to a diagnosis of wrist tendonitis, and for an association between computer mouse time and forearm disorders. Limited evidence was also found for a causal relationship between computer work per se and computer mouse time related to tension neck syndrome, but the evidence for keyboard time was insufficient. Insufficient evidence was found for an association between other musculoskeletal diagnoses of the neck and upper extremities, including shoulder tendonitis and epicondylitis, and any aspect of computer work. Conclusions There is limited epidemiological evidence for an association between aspects of computer work and some of the clinical diagnoses studied. None of the evidence was considered as moderate or strong and there is a need for more and better documentation. PMID:20429925

  16. Factors Associated With Upper Extremity Motor Recovery After Repetitive Transcranial Magnetic Stimulation in Stroke Patients

    PubMed Central

    Lee, Jong Hwa; Kim, Sang Beom; Lee, Kyeong Woo; Kim, Min Ah; Lee, Sook Joung

    2015-01-01

    Objective To determine factors associated with motor recovery of the upper extremity after repetitive transcranial magnetic stimulation (rTMS) treatment in stroke patients. Methods Twenty-nine patients with subacute stroke participated in this study. rTMS was applied to the hand motor cortex for 10 minutes at a 110% resting motor threshold and 10 Hz frequency for two weeks. We evaluated the biographical, neurological, clinical, and functional variables, in addition to the motor-evoked potential (MEP) response. The Manual Function Test (MFT) was performed before, immediately after, and two weeks after, the treatment. Patients were divided into a responder and non-responder group according to their respective improvements on the MFT. Data were compared between the two groups. Results Patients with exclusively subcortical stroke, absence of aphasia, the presence of a MEP response, high scores on the Mini-Mental Status Examination, Motricity Index arm score, Functional Independence Measure, and Functional Ambulatory Classification; and a shorter period from stroke onset to rTMS were found to be significantly associated with a response to rTMS. Conclusion The results of this study suggest that rTMS may have a greater effect on upper extremity motor recovery in stroke patients who have a MEP response, suffer an exclusively subcortical stroke, mild paresis, and have good functional status. Applying rTMS early would have additional positive effects in the patients with the identified characteristics. PMID:25932424

  17. Computer-assisted upper extremity training using interactive biking exercise (iBikE) platform.

    PubMed

    Jeong, In Cheol; Finkelstein, Joseph

    2012-01-01

    Upper extremity exercise training has been shown to improve clinical outcomes in different chronic health conditions. Arm-operated bicycles are frequently used to facilitate upper extremity training however effective use of these devices at patient homes is hampered by lack of remote connectivity with clinical rehabilitation team, inability to monitor exercise progress in real time using simple graphical representation, and absence of an alert system which would prevent exertion levels exceeding those approved by the clinical rehabilitation team. We developed an interactive biking exercise (iBikE) platform aimed at addressing these limitations. The platform uses a miniature wireless 3-axis accelerometer mounted on a patient wrist that transmits the cycling acceleration data to a laptop. The laptop screen presents an exercise dashboard to the patient in real time allowing easy graphical visualization of exercise progress and presentation of exercise parameters in relation to prescribed targets. The iBikE platform is programmed to alert the patient when exercise intensity exceeds the levels recommended by the patient care provider. The iBikE platform has been tested in 7 healthy volunteers (age range: 26-50 years) and shown to reliably reflect exercise progress and to generate alerts at pre-setup levels. Implementation of remote connectivity with patient rehabilitation team is warranted for future extension and evaluation efforts. PMID:23367319

  18. Reliability and validity of the kinematic dystonia measure for children with upper extremity dystonia.

    PubMed

    Kawamura, Anne; Klejman, Sue; Fehlings, Darcy

    2012-07-01

    This study was conducted to determine the test-retest reliability and construct validity of the Kinematic Dystonia Measure, a quantitative measure of upper extremity dystonia. To determine the effectiveness of various treatments, reliable and valid measures of dystonia are required. Test-retest reliability of the Kinematic Dystonia Measure using the intraclass correlation coefficient was excellent for the hand-tapping task (0.95) and substantial for the eye-blinking task (0.74). Construct validity testing for the hand-tapping task revealed that Kinematic Dystonia Measure scores correlated with total Barry-Albright Dystonia Scale scores (Pearson r = 0.79, P = .003), affected arm Barry-Albright Dystonia Scale subscores (Pearson r = 0.76, P = .0.007), and negatively correlated with Quality of Upper Extremity Skills Test scores (Pearson r = -0.60, P = .05). The Kinematic Dystonia Measure has excellent test-retest reliability and good construct validity using the hand-tapping task. When combined with functional outcome measures, the Kinematic Dystonia Measure can effectively measure dystonia in children. PMID:22535705

  19. Upper Extremity Freezing and Dyscoordination in Parkinson's Disease: Effects of Amplitude and Cadence Manipulations

    PubMed Central

    Williams, April J.; Peterson, Daniel S.; Ionno, Michele; Pickett, Kristen A.; Earhart, Gammon M.

    2013-01-01

    Purpose. Motor freezing, the inability to produce effective movement, is associated with decreasing amplitude, hastening of movement, and poor coordination. We investigated how manipulations of movement amplitude and cadence affect upper extremity (UE) coordination as measured by the phase coordination index (PCI)—only previously measured in gait—and freezing of the upper extremity (FO-UE) in people with Parkinson's disease (PD) who experience freezing of gait (PD + FOG), do not experience FOG (PD-FOG), and healthy controls. Methods. Twenty-seven participants with PD and 18 healthy older adults made alternating bimanual movements between targets under four conditions: Baseline; Fast; Small; SmallFast. Kinematic data were recorded and analyzed for PCI and FO-UE events. PCI and FO-UE were compared across groups and conditions. Correlations between UE PCI, gait PCI, FO-UE, and Freezing of Gait Questionnaire (FOG-Q) were determined. Results. PD + FOG had poorer coordination than healthy old during SmallFast. UE coordination correlated with number of FO-UE episodes in two conditions and FOG-Q score in one. No differences existed between PD−/+FOG in coordination or number of FO-UE episodes. Conclusions. Dyscoordination and FO-UE can be elicited by manipulating cadence and amplitude of an alternating bimanual task. It remains unclear whether FO-UE and FOG share common mechanisms. PMID:24027652

  20. Wearing a Wetsuit Alters Upper Extremity Motion during Simulated Surfboard Paddling

    PubMed Central

    Nessler, J. A.; Silvas, M.; Carpenter, S.; Newcomer, S. C.

    2015-01-01

    Surfers often wear wetsuits while paddling in the ocean. This neoprene covering may be beneficial to upper extremity movement by helping to improve proprioceptive acuity, or it may be detrimental by providing increased resistance. The purpose of this study was to evaluate the effects of wearing a wetsuit on muscle activation, upper extremity motion, heart rate, and oxygen consumption during simulated surfboard paddling in the laboratory. Twelve male, recreational surfers performed two paddling trials at a constant workload on a swim bench ergometer both with and without a wetsuit. Kinematic data and EMG were acquired from the right arm via motion capture, and oxygen consumption and heart rate were recorded with a metabolic cart and heart rate monitor. Wearing a wetsuit had no significant effect on oxygen consumption or heart rate. A significant increase in EMG activation was observed for the middle deltoid but not for any of the other shoulder muscle evaluated. Finally, approximate entropy and estimates of the maximum Lyapunov exponent increased significantly for vertical trajectory of the right wrist (i.e. stroke height) when a wetsuit was worn. These results suggest that a 2mm wetsuit has little effect on the energy cost of paddling at lower workloads but does affect arm motion. These changes may be the result of enhanced proprioceptive acuity due to mechanical compression from the wetsuit. PMID:26551321

  1. Upper extremity deep venous thrombosis and pulmonary embolus after ovarian hyperstimulation.

    PubMed

    Cramer, Anne Catherine Miller; McLean, Anna Warszawa; Ahari, Jalil

    2016-01-01

    A healthy female presented with upper extremity (UE) swelling of several days duration. Admission laboratories were normal except for an elevated D-dimer. An UE ultrasound with Doppler revealed a thrombus in the right subclavian vein. A subsequent chest CT angiogram further characterised the subclavian vein thrombus and also identified a pulmonary embolus. A thorough history and laboratory evaluation showed that her only risk factors were long-time contraceptive pills and a recent cycle of ovarian hyperstimulation (OH) 7 weeks prior to presentation. Anticoagulation treatment was started and the patient's remaining outpatient work-up was negative for all other hereditary causes. A complete anatomic work-up showed bilateral thoracic outlet syndrome (TOS). A review of the literature on the occurrence of upper extremity deep venous thrombosis suggests that these usually occur in the presence of a predisposing factor, including catheters, indwelling devices and active malignancies. OH has been shown to precipitate venous thromboembolism events; however, the diagnosis of bilateral TOS as a predisposing risk factor has not been described in a patient who had recently undergone recent OH and in one who was not actively pregnant. PMID:27530880

  2. Comparing severity of impairment for different permanent upper extremity musculoskeletal injuries.

    PubMed

    Reville, Robert T; Neuhauser, Frank W; Bhattacharya, Jayanta; Martin, Craig

    2002-09-01

    The labor market impact of upper extremity musculoskeletal injuries that result in permanent disability was estimated using data from the State of California. Administrative data on disability evaluations and resulting ratings was matched to data on the earnings of over 7000 injured workers. Using these data, labor market experience pre- and postinjury was tracked. Each injured worker was matched to a set of control workers who worked at the same firm, had the same tenure at the firm, and earned the same income at the time of injury. By comparing the injured and uninjured workers, lost earnings and the impact of injury on return to work was estimated. Evidence of considerable lost earnings resulting from injury was found. The results are compared to "disability ratings" that are used to set compensation under California's workers' compensation program. The disability rating was also found to predict poorly differences across upper extremity injuries in losses. In particular, those with shoulder injuries have larger losses than those with elbow or wrist injuries, despite receiving the same disability ratings. PMID:12228950

  3. A model of the upper extremity for simulating musculoskeletal surgery and analyzing neuromuscular control.

    PubMed

    Holzbaur, Katherine R S; Murray, Wendy M; Delp, Scott L

    2005-06-01

    Biomechanical models of the musculoskeletal system are frequently used to study neuromuscular control and simulate surgical procedures. To be broadly applicable, a model must be accessible to users, provide accurate representations of muscles and joints, and capture important interactions between joints. We have developed a model of the upper extremity that includes 15 degrees of freedom representing the shoulder, elbow, forearm, wrist, thumb, and index finger, and 50 muscle compartments crossing these joints. The kinematics of each joint and the force-generating parameters for each muscle were derived from experimental data. The model estimates the muscle-tendon lengths and moment arms for each of the muscles over a wide range of postures. Given a pattern of muscle activations, the model also estimates muscle forces and joint moments. The moment arms and maximum moment-generating capacity of each muscle group (e.g., elbow flexors) were compared to experimental data to assess the accuracy of the model. These comparisons showed that moment arms and joint moments estimated using the model captured important features of upper extremity geometry and mechanics. The model also revealed coupling between joints, such as increased passive finger flexion moment with wrist extension. The computer model is available to researchers at http://nmbl.stanford.edu. PMID:16078622

  4. Upper Extremity 3D Reachable Workspace Assessment in ALS by Kinect sensor

    PubMed Central

    Oskarsson, Bjorn; Joyce, Nanette C.; de Bie, Evan; Nicorici, Alina; Bajcsy, Ruzena; Kurillo, Gregorij; Han, Jay J.

    2016-01-01

    Introduction Reachable workspace is a measure that provides clinically meaningful information regarding arm function. In this study, a Kinect sensor was used to determine the spectrum of 3D reachable workspace encountered in a cross-sectional cohort of individuals with ALS. Method Bilateral 3D reachable workspace was recorded from 10 subjects with ALS and 23 healthy controls. The data were normalized by each individual's arm length to obtain a reachable workspace relative surface area (RSA). Concurrent validity was assessed by correlation with ALSFRSr scores. Results The Kinect-measured reachable workspace RSA differed significantly between the ALS and control subjects (0.579±0.226 vs. 0.786±0.069; P<0.001). The RSA demonstrated correlation with ALSFRSr upper extremity items (Spearman correlation ρ=0.569; P=0.009). With worsening upper extremity function as categorized by the ALSFRSr, the reachable workspace also decreased progressively. Conclusions This study demonstrates the feasibility and potential of using a novel Kinect-based reachable workspace outcome measure in ALS. PMID:25965847

  5. Upper extremity nerve block: how can benefit, duration, and safety be improved? An update

    PubMed Central

    Brattwall, Metha; Jildenstål, Pether; Warrén Stomberg, Margareta; Jakobsson, Jan G.

    2016-01-01

    Upper extremity blocks are useful as both sole anaesthesia and/or a supplement to general anaesthesia and they further provide effective postoperative analgesia, reducing the need for opioid analgesics. There is without doubt a renewed interest among anaesthesiologists in the interscalene, supraclavicular, infraclavicular, and axillary plexus blocks with the increasing use of ultrasound guidance. The ultrasound-guided technique visualising the needle tip and solution injected reduces the risk of side effects, accidental intravascular injection, and possibly also trauma to surrounding tissues. The ultrasound technique has also reduced the volume needed in order to gain effective block. Still, single-shot plexus block, although it produces effective anaesthesia, has a limited duration of postoperative analgesia and a number of adjuncts have been tested in order to prolong analgesia duration. The addition of steroids, midazolam, clonidine, dexmedetomidine, and buprenorphine has been studied, all being off-label when administered by perineural injection, and the potential neurotoxicity needs further study. The use of perineural catheters is an effective option to improve and prolong the postoperative analgesic effect. Upper extremity plexus blocks have an obvious place as a sole anaesthetic technique or as a powerful complement to general anaesthesia, reducing the need for analgesics and hypnotics intraoperatively, and provide effective early postoperative pain relief. Continuous perineural infusion is an effective option to prolong the effects and improve postoperative quality. PMID:27239291

  6. The Chauvet 2014 Meeting Report: Psychiatric and Psychosocial Evaluation and Outcomes of Upper Extremity Grafted Patients.

    PubMed

    Jowsey-Gregoire, Sheila G; Kumnig, Martin; Morelon, Emmanuel; Moreno, Elisa; Petruzzo, Palmina; Seulin, Christian

    2016-07-01

    Under the auspices for the International Society on Hand and Composite Tissue Allotransplantation, a section of The Transplantation Society (IHCTAS), a meeting was convened on March 21-22, 2014 in Paris to review the following areas that were deemed significant in the understanding of the psychosocial evaluation and outcomes of upper extremity transplant recipients: required domains of the evaluation, screening instruments, clinical monitoring pretransplant, clinical monitoring posttransplant, patient and team expectations, body image, psychiatric complications, functional goals and quality of life, ethics and media relations. Experts in the fields of psychiatry and psychology, transplantation, social work, ethics, and transplant administration met and reviewed center experiences and literature. The attendees highlighted the importance and the complexity of the psychiatric assessment in this field of transplantation. Moreover, the necessity to develop common instruments and evaluation protocols to predict psychosocial outcomes as well as to understand whether we are transplanting the right patients and how the transplantation is affecting the patients were pointed out. Psychiatric complications in upper extremity transplanted patients have been reported by the majority of teams. Preexisting psychiatric difficulties, the initial trauma of amputation, or adjusting to the transplantation process itself (especially the medical follow-up and rehabilitation process) appeared to be important factors. Monitoring during the whole follow-up was recommended to detect psychiatric issues and to facilitate and ensure long-term adherence. The participants proposed an annual meeting format to build upon the findings of this inaugural meeting to be called the Chauvet Workgroup meeting. PMID:26636738

  7. Claims incidence of work-related disorders of the upper extremities: Washington state, 1987 through 1995.

    PubMed Central

    Silverstein, B; Welp, E; Nelson, N; Kalat, J

    1998-01-01

    OBJECTIVES: This study examined the claim incidence rate, cost, and industry distribution of work-related upper extremity disorders in Washington. METHODS: Washington State Fund workers' compensation claims from 1987 to 1995 were abstracted and categorized into general and specific disorders of gradual or sudden onset. RESULTS: Accepted claims included 100,449 for hand/wrist disorders (incidence rate: 98.2/10,000 full-time equivalents; carpal tunnel syndrome rate: 27.3), 30,468 for elbow disorders (incidence rate: 29.7; epicondylitis rate: 11.7), and 55,315 for shoulder disorders (incidence rate: 54.0; rotator cuff syndrome rate: 19.9). Average direct workers' compensation claims costs (medical treatment and indemnity) were $15,790 (median: $6774) for rotator cuff syndrome, $12,794 for carpal tunnel syndrome (median: $4190), and $6593 for epicondylitis (median: $534). Construction and food processing were among the industries with the highest rate ratios for all disorders (> 4.0). CONCLUSIONS: Upper extremity disorders represent a large and costly problem in Washington State industry. Industries characterized by manual handling and repetitive work have high rate ratios. The contingent workforce appears to be at high risk. PMID:9842381

  8. Characterization and Intervention for Upper Extremity Exploration & Reaching Behaviors in Infancy

    PubMed Central

    Lobo, M.A.; Galloway, J.C.; Heathcock, J.C

    2014-01-01

    The purpose of this article is to: 1) highlight general exploration, reaching, and object exploration behaviors as key activities of daily living in infancy, 2) describe how knowledge of early warning signs for these behaviors may improve early assessment, and 3) discuss interventions that may advance performance of these behaviors. Early intervention for at-risk infants and their families should focus on improving performance of these behaviors for several reasons. First, these early, interrelated upper extremity behaviors serve an integral role in global learning and development in infancy. Second, among at-risk populations, differences have been observed in the quantity and quality of performance of these behaviors. In many cases, these differences are in turn associated with additional perceptual-motor and cognitive delays. This article fills a gap in the literature by summarizing how early assessment and intervention can target these key early behaviors in populations at risk for upper extremity disabilities, such as those born preterm, with Down syndrome, brachial plexus palsy, or arthrogryposis multiplex congentia. PMID:25835251

  9. Trans-radial upper extremity amputees are capable of adapting to a novel dynamic environment.

    PubMed

    Schabowsky, Christopher N; Dromerick, Alexander W; Holley, Rahsaan J; Monroe, Brian; Lum, Peter S

    2008-07-01

    This study investigated differences in adaptation to a novel dynamic environment between eight trans-radial upper extremity (UE) prosthetic users and eight naive, neurologically intact subjects. Participants held onto the handle of a robotic manipulandum and executed reaching movements within a horizontal plane following a pseudo-random sequence of targets. Curl field perturbations were imposed by the robot motors, and we compared the rate and quality of adaptation between the prosthetic and control subjects. Adaptation was quantitatively assessed by peak error, defined as the maximum orthogonal distance between an observed trajectory and an ideal straight trajectory. Initial exposure to the curl field resulted in large errors, and as the subjects adapted to the novel environment, the errors decreased. During the early phase of adaptation, group differences in the rate of motor adaptation were not significant. However, during late learning, both error magnitude and variability were larger in the prosthetic group. The quality of adaptation, as indicated by the magnitude of the aftereffects, was similar between groups. We conclude that in persons with trans-radial arm amputation, motor adaptation to curl fields during reaching is similar to unimpaired individuals. These findings are discussed in relation to mechanisms of motor adaptation, neural plasticity following an upper extremity amputation (UEA), and potential motor recovery therapies for prosthetic users. PMID:18443766

  10. Effect of a Task-Oriented Rehabilitation Program on Upper Extremity Recovery Following Motor Stroke

    PubMed Central

    Winstein, Carolee J.; Wolf, Steven L.; Dromerick, Alexander W.; Lane, Christianne J.; Nelsen, Monica A.; Lewthwaite, Rebecca; Cen, Steven Yong; Azen, Stanley P.

    2016-01-01

    IMPORTANCE Clinical trials suggest that higher doses of task-oriented training are superior to current clinical practice for patients with stroke with upper extremity motor deficits. OBJECTIVE To compare the efficacy of a structured, task-oriented motor training program vs usual and customary occupational therapy (UCC) during stroke rehabilitation. DESIGN, SETTING, AND PARTICIPANTS Phase 3, pragmatic, single-blind randomized trial among 361 participants with moderate motor impairment recruited from 7 US hospitals over 44 months, treated in the outpatient setting from June 2009 to March 2014. INTERVENTIONS Structured, task-oriented upper extremity training (Accelerated Skill Acquisition Program[ASAP]; n = 119); dose-equivalent occupational therapy (DEUCC; n = 120); or monitoring-only occupational therapy (UCC; n = 122). The DEUCC group was prescribed 30 one-hour sessions over 10 weeks; the UCC group was only monitored, without specification of dose. MAIN OUTCOMES AND MEASURES The primary outcome was 12-month change in log-transformed Wolf Motor Function Test time score (WMFT, consisting of a mean of 15 timed arm movements and hand dexterity tasks). Secondary outcomes were change in WMFT time score (minimal clinically important difference [MCID] = 19 seconds) and proportion of patients improving ≥25 points on the Stroke Impact Scale (SIS) hand function score (MCID = 17.8 points). RESULTS Among the 361 randomized patients (mean age, 60.7 years; 56% men; 42% African American; mean time since stroke onset, 46 days), 304 (84%) completed the 12-month primary outcome assessment; in intention-to-treat analysis, mean group change scores (log WMFT, baseline to 12 months) were, for the ASAP group, 2.2 to 1.4 (difference, 0.82); DEUCC group, 2.0 to 1.2 (difference, 0.84); and UCC group, 2.1 to 1.4 (difference, 0.75), with no significant between-group differences (ASAP vs DEUCC:0.14; 95% CI, −0.05 to 0.33; P = .16; ASAP vs UCC: −0.01; 95% CI, −0.22 to 0.21; P = .94; and

  11. A case report of sudden-onset upper and lower extremity weakness.

    PubMed

    Haddad, Heba; Rotblatt, Michael

    2015-02-01

    Thyrotoxic hypokalemic periodic paralysis is characterized by acute attacks of muscle paralysis, hypokalemia, and thyrotoxicosis. It is a medical emergency, as fatal and life-threatening ventricular arrhythmia associated with hypokalemia has been reported. A 24-year-old man presented with severe lower extremity weakness, which progressed to his trunk and arms. He denied any associated symptoms and had no history of a similar episode or predisposing condition. The physical examination was significant for bilateral extremity weakness, more severe in the lower as compared to the upper extremities. The rest of the neurologic exam was normal. A small, smooth, nontender goiter was palpated. Laboratory data was significant for a potassium level of 2.0 mEq/L. Final lab data revealed a thyroid panel consistent with hyperthyroidism. Once the patient's potassium level normalized after repletion, he recovered his strength and was able to walk again. He was diagnosed with thyrotoxic hypokalemic periodic paralysis, a potentially lethal complication of hyperthyroidism. Because it is reversible with treatment of hyperthyroidism, it is imperative that this condition be considered, recognized and managed appropriately. PMID:25556330

  12. Reliability and Validity of Two Versions of the Upper Extremity Functional Index

    PubMed Central

    Hamilton, Clayon B.; Walton, David M.; Benoit, Melissa; Blake, Tracy A.; Bredy, Heather; Burns, Cameron; Chan, Lianne; Frey, Elizabeth; Gillies, Graham; Gravelle, Teresa; Ho, Rick; Holmes, Robert; Lavallée, Roland L.J.; MacKinnon, Melanie; Merchant, Alishah (Jamal); Sherman, Tammy; Spears, Kelly; Yardley, Darryl

    2014-01-01

    ABSTRACT Purpose: To examine the reliability, validity, and sensitivity to change of the 20-item version and the Rasch-refined 15-item version of the Upper Extremity Functional Index (UEFI-20 and UEFI-15, respectively) and to determine the impact of arm dominance on the positive minimal clinically important difference (pMCID). Methods: Adults with upper-extremity (UE) dysfunction completed the UEFI-20, Upper Extremity Functional Scale (UEFS), Pain Limitation Scale, and Pain Intensity Scale at their initial physiotherapy assessment (Time 1); 24–48 hours later (Time 2); and 3 weeks into treatment or at discharge, whichever came first (Time 3). Demographics, including working status, were obtained at Time 1. Global ratings of change (GRC) were provided by the treating physiotherapist and patient at Time 3. The UEFI-15 was calculated from relevant items in the UEFI-20. The intra-class correlation coefficient (ICC) and minimal detectable change (MDC) quantified test–retest reliability (Time 1–Time 2). Cross-sectional convergent validity was determined by the association (Pearson's r) between Time 1 measures of function and pain. Known-groups validity was evaluated with a one-way ANOVA across three levels of working status. Longitudinal validity was determined by the association (Pearson's r) between function and pain change scores (Time 1–Time 3). Receiver operating characteristic (ROC) curves estimated the pMCID using Time 1–Time 3 change scores and average patient/therapist GRC. Results: Reliability for the UEFI-20 and UEFI-15 was the same (ICC=0.94 for both measures). MDC values were 9.4/80 for the UEFI-20 and 8.8/100 for the UEFI-15. Cross-sectional, known-groups, and longitudinal validity were confirmed for both UEFI measures. pMCID values were 8/80 for the UEFI-20 and 6.7/100 for the UEFI-15; pMCID was higher for people whose non-dominant arm was affected. Conclusions: Both UEFI measures show acceptable reliability and validity. Arm dominance affects p

  13. Concurrent neuromechanical and functional gains following upper-extremity power training post-stroke

    PubMed Central

    2013-01-01

    Background Repetitive task practice is argued to drive neural plasticity following stroke. However, current evidence reveals that hemiparetic weakness impairs the capacity to perform, and practice, movements appropriately. Here we investigated how power training (i.e., high-intensity, dynamic resistance training) affects recovery of upper-extremity motor function post-stroke. We hypothesized that power training, as a component of upper-extremity rehabilitation, would promote greater functional gains than functional task practice without deleterious consequences. Method Nineteen chronic hemiparetic individuals were studied using a crossover design. All participants received both functional task practice (FTP) and HYBRID (combined FTP and power training) in random order. Blinded evaluations performed at baseline, following each intervention block and 6-months post-intervention included: Wolf Motor Function Test (WMFT-FAS, Primary Outcome), upper-extremity Fugl-Meyer Motor Assessment, Ashworth Scale, and Functional Independence Measure. Neuromechanical function was evaluated using isometric and dynamic joint torques and concurrent agonist EMG. Biceps stretch reflex responses were evaluated using passive elbow stretches ranging from 60 to 180º/s and determining: EMG onset position threshold, burst duration, burst intensity and passive torque at each speed. Results Primary outcome: Improvements in WMFT-FAS were significantly greater following HYBRID vs. FTP (p = .049), regardless of treatment order. These functional improvements were retained 6-months post-intervention (p = .03). Secondary outcomes: A greater proportion of participants achieved minimally important differences (MID) following HYBRID vs. FTP (p = .03). MIDs were retained 6-months post-intervention. Ashworth scores were unchanged (p > .05). Increased maximal isometric joint torque, agonist EMG and peak power were significantly greater following HYBRID vs. FTP (p < .05) and effects were

  14. Electrical stimulation applied to bone and nerve injuries in the upper extremity.

    PubMed

    Osterman, A L; Bora, F W

    1986-07-01

    In conclusion, electrical stimulation of bone has advanced from the laboratory to clinical reality. Despite the lack of good double-blind clinical studies, it is impossible to ignore the excellent results reported from numerous multicenter trials. Doubts and controversies will and should continue. Electrical stimulation has a definite place in the treatment of scaphoid nonunion as well as other failures of osteogenic biology in the upper extremity. The future may realize the enormous potential of electrical stimulation in areas of nerve repair, wound healings, or osteoporosis. The hand surgeon may soon be operating in the age of biophysics where he or she can charge by the kilowatt hour. Yet one should not become a mere technician, but understand the basic science of what one is doing and, above all, maintain a balanced and critical approach. PMID:3526231

  15. Severe Upper Extremity Dysfunction After 4CMenB Vaccination in a Young Infant.

    PubMed

    Tenenbaum, Tobias; Niessen, Johanna; Schroten, Horst

    2016-01-01

    The 4-component meningococcal serogroup B vaccine 4CMenB (Bexsero) is the first vaccine against this serogroup and has been approved by licensing authorities in Europe, Canada and Australia. Therefore, the vaccine may enter soon nationwide vaccine recommendation schemes. We report on a case of a 5-month-old infant who developed prolonged upper extremity dysfunction after the second injection of the 4CMenB vaccine in the left deltoid muscle and was concomitantly applied with 2 routine vaccinations. Myositis, periostitis, (peri-) vasculitis and axillary inflammation were confirmed by magnetic resonance imaging. Two months after initial initiation of an anti-inflammatory and an antibiotic treatment, symptoms completely resolved. Administration of 3 vaccines requires clear recommendations for the preferred injection site in infants because increased reactogenicity of 4CMenB may lead to local severe adverse events. PMID:26379162

  16. Neurological Recovery of Upper Extremity in Stroke Woman after 5 Years: A Case Report.

    PubMed

    Vejabhuti, Chayanin

    2016-02-01

    Strokes are common neurological disorders in Thailand. Rehabilitation programs significantly improve arm function outcomes if performed during the sub-acute period of stroke rehabilitation, within 6 months of the attack. This report describes the case of a stroke patient who gained upper extremity motor recovery after 5 years, which is beyond the normal recovery period. Although the patient does not have functionality, she has partial motor recovery, and she is enthusiastic about learning to gain better use of her hand. However there is still limited evidence to use in designing effective intervention and proper timing of rehabilitation administered by personnel in training chronic stroke patients. Therefore, evidence based on neuroplasticity and neurological recovery in chronic stroke patients, including rehabilitation intervention, is presented in this report. PMID:27266238

  17. Prosthesis Material

    NASA Technical Reports Server (NTRS)

    1995-01-01

    In this photograph, Sandra Rossi user her NASA-developed prosthesis for the first time. Derived from foam insulation technology used to protect the Space Shuttle External Tank from excessive heat, FAB/CAD, a subsidiary of the Harshberger Prosthetic and Orthotic Center, utilized the technology to replace the heavy, fragile plaster they used to produce master molds for prosthetics. The new material was lighter, cheaper and easier to manufacture than plaster, resulting in lower costs to the customer.

  18. Prosthesis Material

    NASA Technical Reports Server (NTRS)

    1995-01-01

    In this photograph, James Carden uses a NASA-developed prosthesis to moved planks around his home. Derived from foam insulation technology used to protect the Space Shuttle External Tank from excessive heat, FAB/CAD, a subsidiary of the Harshberger Prosthetic and Orthotic Center, utilized the technology to replace the heavy, fragile plaster they used to produce master molds for prosthetics. The new material was lighter, cheaper and easier to manufacture than plaster, resulting in lower costs to the customer.

  19. Prosthesis Material

    NASA Technical Reports Server (NTRS)

    2004-01-01

    In this photograph, Amputee Amie Bradly uses a NASA-developed prosthesis to paint her fingernails. Derived from foam insulation technology used to protect the Space Shuttle External Tank from excessive heat, FAB/CAD, a subsidiary of the Harshberger Prosthetic and Orthotic Center, utilized the technology to replace the heavy, fragile plaster they used to produce master molds for prosthetics. The new material was lighter, cheaper and easier to manufacture than plaster, resulting in lower costs to the customer.

  20. Cortical reorganization after macroreplantation at the upper extremity: a magnetoencephalographic study.

    PubMed

    Blume, Kathrin R; Dietrich, Caroline; Huonker, Ralph; Götz, Theresa; Sens, Elisabeth; Friedel, Reinhard; Hofmann, Gunther O; Miltner, Wolfgang H R; Weiss, Thomas

    2014-03-01

    With the development of microsurgical techniques, replantation has become a feasible alternative to stump treatment after the amputation of an extremity. It is known that amputation often induces phantom limb pain and cortical reorganization within the corresponding somatosensory areas. However, whether replantation reduces the risk of comparable persisting pain phenomena as well as reorganization of the primary somatosensory cortex is still widely unknown. Therefore, the present study aimed to investigate the potential development of persistent pain and cortical reorganization of the hand and lip areas within the sensory cortex by means of magnetoencephalographic dipole analyses after replantation of a traumatically amputated upper limb proximal to the radiocarpal joint. Cortical reorganization was investigated in 13 patients with limb replantation using air puff stimulation of the phalanges of both thumbs and both corners of the lower lip. Displacement of the centre of gravity of lip and thumb representations and increased cortical activity were found in the limb and face areas of the primary somatosensory cortex contralateral to the replanted arm when compared to the ipsilateral hemisphere. Thus, cortical reorganization in the primary somatosensory cortex also occurs after replantation of the upper extremity. Patients' reports of pain in the replanted body part were negatively correlated with the amount of cortical reorganization, i.e. the more pain the patients reported, the less reorganization of the subjects' hand representation within the primary somatosensory cortex was observed. Longitudinal studies in patients after macroreplantation are necessary to assess whether the observed reorganization in the primary somatosensory cortex is a result of changes within the representation of the replanted arm and/or neighbouring representations and to assess the relationship between the development of persistent pain and reorganization. PMID:24480484

  1. Catheter-Directed Thrombolysis for Treatment of Deep Venous Thrombosis in the Upper Extremities

    SciTech Connect

    Vik, Anders; Holme, Pal Andre; Singh, Kulbir; Dorenberg, Eric; Nordhus, Kare Christian; Kumar, Satish; Hansen, John-Bjarne

    2009-09-15

    Traditional anticoagulant treatment of deep venous thrombosis (DVT) in the upper extremities (UEDVT) is associated with a relatively high incidence of postthrombotic syndrome (PTS). Catheter-directed thrombolysis (CDT) for UEDVT would provide efficient thrombolysis with less subsequent PTS than during traditional anticoagulation. Primary efficacy, complications, and long-term results after CDT are reported in a retrospective cohort (2002-2007) of patients (n = 30) with DVT in the upper extremities. PTS was assessed by a modified Villalta scale. UEDVT was unprovoked in 11 (37%) cases and effort related in 9 (30%) cases. The median duration of symptoms prior to CDT was 7.0 days (range, 1-30); median duration of thrombolysis treatment, 70 h (range, 24-264 h); and the median amount of rt-PA infused during CDT, 52 mg (range, 19-225 mg). Major bleeding was registered in three (9%) patients, and CDT was stopped prematurely in three patients due to local hematoma. No intracerebral bleeding, clinical pulmonary embolism, or deaths occurred during treatment. Grade II (>50%) or III (>90%) lysis was present in 29 patients (97%) at the end of CDT. Bleeding complications increased by each day of delay from the debut of symptoms to the start of treatment (OR, 1.20; 95% CI, 1.01-1.42). At follow-up (n = 29; median, 21 months; range, 5-58 months), 11 (38%) patients had occluded veins, whereas 18 (62%) had patent veins. However, stenosis of varying severity was present in eight of those with a patent vein. No patients had severe PTS, whereas six (21%) experienced mild PTS. In conclusion, our retrospective cohort study of patients with UEDVT showed that treatment restored venous drainage, with a subsequent low frequency of mild PTS at follow-up. Early intervention with CDT prevented bleeding complications.

  2. A musculoskeletal model of the upper extremity for use in the development of neuroprosthetic systems

    PubMed Central

    Blana, Dimitra; Hincapie, Juan G.; Chadwick, Edward K.; Kirsch, Robert F.

    2008-01-01

    Upper extremity neuroprostheses use functional electrical stimulation (FES) to restore arm motor function to individuals with cervical level spinal cord injury. For the design and testing of these systems, a biomechanical model of the shoulder and elbow has been developed, to be used as a substitute for the human arm. It can be used to design and evaluate specific implementations of FES systems, as well as FES controllers. The model can be customized to simulate a variety of pathological conditions. For example, by adjusting the maximum force the muscles can produce, the model can be used to simulate an individual with tetraplegia and to explore the effects of FES of different muscle sets. The model comprises six bones, five joints, nine degrees of freedom, and 29 shoulder and arm muscles. It was developed using commercial, graphics-based modeling and simulation packages that are easily accessible to other researchers and can be readily interfaced to other analysis packages. It can be used for both forward-dynamic (inputs: muscle activation and external load; outputs:motions) and inverse-dynamic (inputs: motions and external load; outputs: muscle activation) simulations. Our model was verified by comparing the model-calculated muscle activations to electromyographic signals recorded from shoulder and arm muscles of five subjects. As an example of its application to neuroprosthesis design, the model was used to demonstrate the importance of rotator cuff muscle stimulation when aiming to restore humeral elevation. It is concluded that this model is a useful tool in the development and implementation of upper extremity neuroprosthetic systems. PMID:18420213

  3. Comparison of upper extremity function, pain, and tactile sense between the uneffected side of hemiparetic patients and healthy subjects.

    PubMed

    Balcı, Nilay Comuk; Dogru, Esra; Aytar, Aydan; Gokmen, Ozge; Depreli, Ozde

    2016-07-01

    [Purpose] The aim of this study was to compare the unaffected upper extremity of patients with hemiparesis with that of healthy subjects in terms of function, pain, and tactile sense. [Subjects and Methods] Upper extremity evaluation parameters of 20 patients with hemiparesis were compared with an age-matched control group of 20 healthy subjects. A shorter version of the Disability of Arm and Shoulder Questionnaire, Upper Extremity Functional Index, and Simple Shoulder Test were used to evaluate the upper extremity functionality. The Visual Analog Scale was used to measure pain severity at rest, at night, and during activity. Tactile sensation levels were assessed by Semmes-Weinstein monofilaments at four palmar areas. [Results] A statistically significant difference was found in the upper extremity functionality between the groups. Pain severity at rest was significantly higher in the hemiparetic group. There was no significant difference in night and activity pain severities or tactile sensation levels between the groups. [Conclusion] According to our results, the unaffected side of patients with hemiparesis differs in functionality and pain at rest compared with that of healthy persons. Studies with larger sample size and various evaluation tests are needed to further investigate the unaffected side of patients with hemiparesis. PMID:27512250

  4. Comparison of upper extremity function, pain, and tactile sense between the uneffected side of hemiparetic patients and healthy subjects

    PubMed Central

    Balcı, Nilay Comuk; Dogru, Esra; Aytar, Aydan; Gokmen, Ozge; Depreli, Ozde

    2016-01-01

    [Purpose] The aim of this study was to compare the unaffected upper extremity of patients with hemiparesis with that of healthy subjects in terms of function, pain, and tactile sense. [Subjects and Methods] Upper extremity evaluation parameters of 20 patients with hemiparesis were compared with an age-matched control group of 20 healthy subjects. A shorter version of the Disability of Arm and Shoulder Questionnaire, Upper Extremity Functional Index, and Simple Shoulder Test were used to evaluate the upper extremity functionality. The Visual Analog Scale was used to measure pain severity at rest, at night, and during activity. Tactile sensation levels were assessed by Semmes-Weinstein monofilaments at four palmar areas. [Results] A statistically significant difference was found in the upper extremity functionality between the groups. Pain severity at rest was significantly higher in the hemiparetic group. There was no significant difference in night and activity pain severities or tactile sensation levels between the groups. [Conclusion] According to our results, the unaffected side of patients with hemiparesis differs in functionality and pain at rest compared with that of healthy persons. Studies with larger sample size and various evaluation tests are needed to further investigate the unaffected side of patients with hemiparesis. PMID:27512250

  5. Management of upper extremity dysfunction in people with Parkinson disease and Huntington disease: facilitating outcomes across the disease lifespan.

    PubMed

    Quinn, Lori; Busse, Monica; Dal Bello-Haas, Vanina

    2013-01-01

    Parkinson Disease (PD) and Huntington Disease (HD) are degenerative neurological diseases, which can result in impairments and activity limitations affecting the upper extremities from early in the disease process. The progressive nature of these diseases poses unique challenges for therapists aiming to effectively maximize physical functioning and minimize participation restrictions in these patient groups. Research is underway in both diseases to develop effective disease-modifying agents and pharmacological interventions, as well as mobility-focused rehabilitation protocols. Rehabilitation, and in particular task-specific interventions, has the potential to influence the upper extremity functional abilities of patients with these degenerative conditions. However to date, investigations of interventions specifically addressing upper extremity function have been limited in both PD, and in particular HD. In this paper, we provide an update of the known pathological features of PD and HD as they relate to upper extremity function. We further review the available literature on the use of outcome measures, and the clinical management of upper extremity function in both conditions. Due to the currently limited evidence base in both diseases, we recommend utilization of a clinical management framework specific for degenerative conditions that can serve as a guideline for disease management. PMID:23231827

  6. Upper extremity kinematic and kinetic adaptations during a fatiguing repetitive task.

    PubMed

    Qin, Jin; Lin, Jia-Hua; Faber, Gert S; Buchholz, Bryan; Xu, Xu

    2014-06-01

    Repetitive low-force contractions are common in the workplace and yet can lead to muscle fatigue and work-related musculoskeletal disorders. The current study aimed to investigate potential motion adaptations during a simulated repetitive light assembly work task designed to fatigue the shoulder region, focusing on changes over time and age-related group differences. Ten younger and ten older participants performed four 20-min task sessions separated by short breaks. Mean and variability of joint angles and scapular elevation, joint net moments for the shoulder, elbow, and wrist were calculated from upper extremity kinematics recorded by a motion tracking system. Results showed that joint angle and joint torque decreased across sessions and across multiple joints and segments. Increased kinematic variability over time was observed in the shoulder joint; however, decreased kinematic variability over time was seen in the more distal part of the upper limb. The changes of motion adaptations were sensitive to the task-break schedule. The results suggested that kinematic and kinetic adaptations occurred to reduce the biomechanical loading on the fatigued shoulder region. In addition, the kinematic and kinetic responses at the elbow and wrist joints also changed, possibly to compensate for the increased variability caused by the shoulder joint while still maintaining task requirements. These motion strategies in responses to muscle fatigue were similar between two age groups although the older group showed more effort in adaptation than the younger in terms of magnitude and affected body parts. PMID:24642235

  7. Temperature Changes in Deep Muscles of Humans During Upper and Lower Extremity Exercise

    PubMed Central

    Wirth, Valerie J.; Van Lunen, Bonnie L.; Mistry, Dilaawar; Saliba, Ethan; McCue, Frank C.

    1998-01-01

    Objective: To examine the effect of 15 minutes of upper and lower extremity exercise on raising intramuscular temperature in the triceps surae to 39 ° C to 45 ° C (the therapeutic range). Design and Setting: Intramuscular temperature was measured 5 cm deep in the triceps surae using a 23-gauge thermistor needle microprobe connected to a monitor. Each subject was tested under 3 conditions: 15 minutes of rest, 15 minutes of jogging on a treadmill, and 15 minutes of handpedaling an upper-body ergometer. Exercise bouts were performed at 70% of each subject's maximum heart rate. Subjects: Six males, either sedentary or recreational athletes (age = 21.3 ± 2.9 years; ht = 176.8 ± 6.0 cm; wt = 72.7 ± 11.6 kg; resting heart rate = 57.8 ± 6.74 bpm; target heart rate = 156.5 ± 3.0 bpm), volunteered to participate in this experiment. Measurements: Intramuscular temperature was measured at a depth of 5 cm before and after each test condition. Results: Data analyses consisted of analyses of variance with repeated measures and a Tukey post hoc test (P < .05). The results showed a significant temperature increase over baseline after exercise on the treadmill (2.2 ° C ± 0.63 ° C); however, it did not yield temperature increases ≥ 39 ° C. No significant temperature change occurred after exercise on the upper-body ergometer (-0.45 ° C ± 0.80 ° C). Conclusions: Active exercise increased intramuscular temperature in working muscles but did not affect intramuscular temperature in nonworking muscles. In addition, 15 minutes of jogging on a treadmill at 70% of maximum heart rate was not sufficient to raise intramuscular temperature to 39 ° C to 45 ° C. ImagesFigure 1.Figure 2. PMID:16558512

  8. Upper extremity impairments in women with or without lymphedema following breast cancer treatment

    PubMed Central

    Wong, Josephine; Cooper, Bruce; Wanek, Linda; Topp, Kimberly; Byl, Nancy; Dodd, Marylin

    2010-01-01

    Introduction Breast-cancer-related lymphedema affects ∼25% of breast cancer (BC) survivors and may impact use of the upper limb during activity. The purpose of this study is to compare upper extremity (UE) impairment and activity between women with and without lymphedema after BC treatment. Methods 144 women post BC treatment completed demographic, symptom, and Disability of Arm-Shoulder-Hand (DASH) questionnaires. Objective measures included Purdue pegboard, finger-tapper, Semmes-Weinstein monofilaments, vibration perception threshold, strength, range of motion (ROM), and volume. Results Women with lymphedema had more lymph nodes removed (p < .001), more UE symptoms (p < .001), higher BMI (p = .041), and higher DASH scores (greater limitation) (p < .001). For all participants there was less strength (elbow flexion, wrist flexion, grip), less shoulder ROM, and decreased sensation at the medial upper arm (p < .05) in the affected UE. These differences were greater in women with lymphedema, particularly in shoulder abduction ROM (p < .05). Women with lymphedema had bilaterally less elbow flexion strength and shoulder ROM (p < .05). Past diagnosis of lymphedema, grip strength, shoulder abduction ROM, and number of comorbidities contributed to the variance in DASH scores (R2 of 0.463, p < .001). Implications for cancer survivors UE impairments are found in women following treatment for BC. Women with lymphedema have greater UE impairment and limitation in activities than women without. Many of these impairments are amenable to prevention measures or treatment, so early detection by health care providers is essential. PMID:20373044

  9. Variables associated with upper extremity function in patients with Duchenne muscular dystrophy.

    PubMed

    Janssen, Mariska M H P; Hendriks, Jan C M; Geurts, Alexander C H; de Groot, Imelda J M

    2016-09-01

    Preserving upper extremity (UE) function in patients with Duchenne muscular dystrophy (DMD) is extremely important as it is related to independence and quality of life. For clinical decision making, knowledge of variables associated with UE function is necessary. This knowledge is, however, limited. Therefore, this study aims to gain more insight into the variables associated with UE function in DMD. Data from an international web-based questionnaire on UE function, obtained from 213 DMD patients, were used. Six dependent variables regarding UE function were used in multivariable linear regression analyses. In addition, 26 independent variables regarding patient characteristics, medication, therapy, supportive aids, pain, stiffness and participation were used. Twelve independent variables showed a significant relation to UE function. Variables with a negative relation to UE function were: later disease stage, occurrence of scoliosis, higher age, use of UE splints, more frequent stiffness complaints, more limitations due to stiffness, more frequent elbow pain, and having physical therapy. A positive relation with UE function was seen for going to school or work, use of corticosteroids, higher BMI, and higher age at diagnosis. These variables explained 56-81 % of the variation of the different measures of UE function. Knowledge of variables associated with UE function is very important in the clinical management of DMD patients. The results of this study suggest that corticosteroid use and participation in school and work related activities are positively related to UE function in DMD patients, as well as reducing pain and stiffness and preventing scoliosis. PMID:27314968

  10. Solar Wind Interaction with the Martian Upper Atmosphere at Early Mars/Extreme Solar Conditions

    NASA Astrophysics Data System (ADS)

    Dong, C.; Bougher, S. W.; Ma, Y.; Toth, G.; Lee, Y.; Nagy, A. F.; Tenishev, V.; Pawlowski, D. J.; Combi, M. R.

    2014-12-01

    The investigation of ion escape fluxes from Mars, resulting from the solar wind interaction with its upper atmosphere/ionosphere, is important due to its potential impact on the long-term evolution of Mars atmosphere (e.g., loss of water) over its history. In the present work, we adopt the 3-D Mars cold neutral atmosphere profiles (0 ~ 300 km) from the newly developed and validated Mars Global Ionosphere Thermosphere Model (M-GITM) and the 3-D hot oxygen profiles (100 km ~ 5 RM) from the exosphere Monte Carlo model Adaptive Mesh Particle Simulator (AMPS). We apply these 3-D model output fields into the 3-D BATS-R-US Mars multi-fluid MHD (MF-MHD) model (100 km ~ 20 RM) that can simulate the interplay between Mars upper atmosphere and solar wind by considering the dynamics of individual ion species. The multi-fluid MHD model solves separate continuity, momentum and energy equations for each ion species (H+, O+, O2+, CO2+). The M-GITM model together with the AMPS exosphere model take into account the effects of solar cycle and seasonal variations on both cold and hot neutral atmospheres. This feature allows us to investigate the corresponding effects on the Mars upper atmosphere ion escape by using a one-way coupling approach, i.e., both the M-GITM and AMPS model output fields are used as the input for the multi-fluid MHD model and the M-GITM is used as input into the AMPS exosphere model. In this study, we present M-GITM, AMPS, and MF-MHD calculations (1-way coupled) for 2.5 GYA conditions and/or extreme solar conditions for present day Mars (high solar wind velocities, high solar wind dynamic pressure, and high solar irradiance conditions, etc.). Present day extreme conditions may result in MF-MHD outputs that are similar to 2.5 GYA cases. The crustal field orientations are also considered in this study. By comparing estimates of past ion escape rates with the current ion loss rates to be returned by the MAVEN spacecraft (2013-2016), we can better constrain the

  11. The effect of task-oriented training on the muscle activation of the upper extremity in chronic stroke patients.

    PubMed

    Park, JuHyung

    2016-04-01

    [Purpose] The aim of this study was to determine the effects of task-oriented training on upper extremity muscle activation in daily activities performed by chronic stoke patients. [Subjects and Methods] In this research, task-oriented training was conducted by 2 chronic hemiplegic stroke patients. Task-oriented training was conducted 5 times a week, 30 minutes per day, for 2 weeks. Evaluation was conducted 3 times before and after the intervention. The Change of muscle activation in the upper extremity was measured using a BTS FreeEMG 300. [Results] The subjects' root mean square values for agonistic muscles for the reaching activity increased after the intervention. All subjects' co-coordination ratios decreased after the intervention in all movements of reaching activity. [Conclusion] Through this research, task-oriented training was proven to be effective in improving the muscle activation of the upper extremity in chronic hemiplegic stroke patients. PMID:27190488

  12. The effect of task-oriented training on the muscle activation of the upper extremity in chronic stroke patients

    PubMed Central

    Park, JuHyung

    2016-01-01

    [Purpose] The aim of this study was to determine the effects of task-oriented training on upper extremity muscle activation in daily activities performed by chronic stoke patients. [Subjects and Methods] In this research, task-oriented training was conducted by 2 chronic hemiplegic stroke patients. Task-oriented training was conducted 5 times a week, 30 minutes per day, for 2 weeks. Evaluation was conducted 3 times before and after the intervention. The Change of muscle activation in the upper extremity was measured using a BTS FreeEMG 300. [Results] The subjects’ root mean square values for agonistic muscles for the reaching activity increased after the intervention. All subjects’ co-coordination ratios decreased after the intervention in all movements of reaching activity. [Conclusion] Through this research, task-oriented training was proven to be effective in improving the muscle activation of the upper extremity in chronic hemiplegic stroke patients. PMID:27190488

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

    SciTech Connect

    Madaric, Juraj; Klepanec, Andrej; Mistrik, Martin; Altaner, Cestmir; Vulev, Ivan

    2013-04-15

    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. The effects of very early mirror therapy on functional improvement of the upper extremity in acute stroke patients.

    PubMed

    Yeldan, Ipek; Huseyınsınoglu, Burcu Ersoz; Akıncı, Buket; Tarakcı, Ela; Baybas, Sevim; Ozdıncler, Arzu Razak

    2015-11-01

    [Purpose] The aim of the study was to evaluate the effects of a very early mirror therapy program on functional improvement of the upper extremity in acute stroke patients. [Subjects] Eight stroke patients who were treated in an acute neurology unit were included in the study. [Methods] The patients were assigned alternatively to either the mirror therapy group receiving mirror therapy and neurodevelopmental treatment or the neurodevelopmental treatment only group. The primary outcome measures were the upper extremity motor subscale of the Fugl-Meyer Assessment, Motricity Index upper extremity score, and the Stroke Upper Limb Capacity Scale. Somatosensory assessment with the Ayres Southern California Sensory Integration Test, and the Barthel Index were used as secondary outcome measures. [Results] No statistically significant improvements were found for any measures in either group after the treatment. In terms of minimally clinically important differences, there were improvements in Fugl-Meyer Assessment and Barthel Index in both mirror therapy and neurodevelopmental treatment groups. [Conclusion] The results of this pilot study revealed that very early mirror therapy has no additional effect on functional improvement of upper extremity function in acute stroke patients. Multicenter trials are needed to determine the results of early application of mirror therapy in stroke rehabilitation. PMID:26696729

  15. The effects of very early mirror therapy on functional improvement of the upper extremity in acute stroke patients

    PubMed Central

    Yeldan, Ipek; Huseyınsınoglu, Burcu Ersoz; Akıncı, Buket; Tarakcı, Ela; Baybas, Sevim; Ozdıncler, Arzu Razak

    2015-01-01

    [Purpose] The aim of the study was to evaluate the effects of a very early mirror therapy program on functional improvement of the upper extremity in acute stroke patients. [Subjects] Eight stroke patients who were treated in an acute neurology unit were included in the study. [Methods] The patients were assigned alternatively to either the mirror therapy group receiving mirror therapy and neurodevelopmental treatment or the neurodevelopmental treatment only group. The primary outcome measures were the upper extremity motor subscale of the Fugl-Meyer Assessment, Motricity Index upper extremity score, and the Stroke Upper Limb Capacity Scale. Somatosensory assessment with the Ayres Southern California Sensory Integration Test, and the Barthel Index were used as secondary outcome measures. [Results] No statistically significant improvements were found for any measures in either group after the treatment. In terms of minimally clinically important differences, there were improvements in Fugl-Meyer Assessment and Barthel Index in both mirror therapy and neurodevelopmental treatment groups. [Conclusion] The results of this pilot study revealed that very early mirror therapy has no additional effect on functional improvement of upper extremity function in acute stroke patients. Multicenter trials are needed to determine the results of early application of mirror therapy in stroke rehabilitation. PMID:26696729

  16. Validity, Reliability, and Sensitivity of a 3D Vision Sensor-based Upper Extremity Reachable Workspace Evaluation in Neuromuscular Diseases

    PubMed Central

    Han, Jay J.; Kurillo, Gregorij; Abresch, R. Ted; Nicorici, Alina; Bajcsy, Ruzena

    2013-01-01

    Introduction: One of the major challenges in the neuromuscular field has been lack of upper extremity outcome measures that can be useful for clinical therapeutic efficacy studies. Using vision-based sensor system and customized software, 3-dimensional (3D) upper extremity motion analysis can reconstruct a reachable workspace as a valid, reliable and sensitive outcome measure in various neuromuscular conditions where proximal upper extremity range of motion and function is impaired. Methods: Using a stereo-camera sensor system, 3D reachable workspace envelope surface area normalized to an individual’s arm length (relative surface area: RSA) to allow comparison between subjects was determined for 20 healthy controls and 9 individuals with varying degrees of upper extremity dysfunction due to neuromuscular conditions. All study subjects were classified based on Brooke upper extremity function scale. Right and left upper extremity reachable workspaces were determined based on three repeated measures. The RSAs for each frontal hemi-sphere quadrant and total reachable workspaces were determined with and without loading condition (500 gram wrist weight). Data were analyzed for assessment of the developed system and validity, reliability, and sensitivity to change of the reachable workspace outcome. Results: The mean total RSAs of the reachable workspace for the healthy controls and individuals with NMD were significantly different (0.586 ± 0.085 and 0.299 ± 0.198 respectively; p<0.001). All quadrant RSAs were reduced for individuals with NMDs compared to the healthy controls and these reductions correlated with reduced upper limb function as measured by Brooke grade. The upper quadrants of reachable workspace (above the shoulder level) demonstrated greatest reductions in RSA among subjects with progressive severity in upper extremity impairment. Evaluation of the developed outcomes system with the Bland-Altman method demonstrated narrow 95% limits of agreement (LOA

  17. Prosthesis Material

    NASA Technical Reports Server (NTRS)

    1995-01-01

    FAB/CAM, a subsidiary of the Harshberger Prosthetic and Orthotic Center, Inc., approached Marshall for help in replacing the heavy, fragile plaster they used to produce master molds for prosthetics. Concurrently, Marshall and Martin Marietta were creating a commercial derivative of the foam insulation used to protect the Space Shuttle External Tank from excessive heat. FAB/CAM found the foam blanks to be lighter, cheaper and easier to manufacture than plaster, resulting in lower costs to the consumer. Martin Marietta markets the foam system, MARCORE, for the prosthesis market. The system also has commercial potential in high temperature insulation and structural applications.

  18. Retinal Prosthesis

    PubMed Central

    Weiland, James D.; Humayun, Mark S.

    2015-01-01

    Retinal prosthesis have been translated from the laboratory to the clinical over the past two decades. Currently, two devices have regulatory approval for the treatment of retinitis pigmentosa. These devices provide partial sight restoration and patients use this improved vision in their everyday lives. Improved mobility and object detection are some of the more notable findings from the clinical trials. However, significant vision restoration will require both better technology and improved understanding of the interaction between electrical stimulation and the retina. This paper reviews the recent clinical trials, highlights technology breakthroughs that will contribute to next generation of retinal prostheses. PMID:24710817

  19. Shoulder muscle recruitment patterns and related biomechanics during upper extremity sports.

    PubMed

    Escamilla, Rafael F; Andrews, James R

    2009-01-01

    Understanding when and how much shoulder muscles are active during upper extremity sports is helpful to physicians, therapists, trainers and coaches in providing appropriate treatment, training and rehabilitation protocols to these athletes. This review focuses on shoulder muscle activity (rotator cuff, deltoids, pectoralis major, latissimus dorsi, triceps and biceps brachii, and scapular muscles) during the baseball pitch, the American football throw, the windmill softball pitch, the volleyball serve and spike, the tennis serve and volley, baseball hitting, and the golf swing. Because shoulder electromyography (EMG) data are far more extensive for overhead throwing activities compared with non-throwing upper extremity sports, much of this review focuses on shoulder EMG during the overhead throwing motion. Throughout this review shoulder kinematic and kinetic data (when available) are integrated with shoulder EMG data to help better understand why certain muscles are active during different phases of an activity, what type of muscle action (eccentric or concentric) occurs, and to provide insight into the shoulder injury mechanism. Kinematic, kinetic and EMG data have been reported extensively during overhead throwing, such as baseball pitching and football passing. Because shoulder forces, torques and muscle activity are generally greatest during the arm cocking and arm deceleration phases of overhead throwing, it is believed that most shoulder injuries occur during these phases. During overhead throwing, high rotator cuff muscle activity is generated to help resist the high shoulder distractive forces approximately 80-120% bodyweight during the arm cocking and deceleration phases. During arm cocking, peak rotator cuff activity is 49-99% of a maximum voluntary isometric contraction (MVIC) in baseball pitching and 41-67% MVIC in football throwing. During arm deceleration, peak rotator cuff activity is 37-84% MVIC in baseball pitching and 86-95% MVIC in football

  20. A prospective study for upper-extremity cumulative trauma disorders of workers in aircraft manufacturing.

    PubMed

    Melhorn, J M

    1996-12-01

    Occupational diseases affect 15 to 20% of all Americans. Cumulative trauma disorders (CTDs) account for 56% of all occupational injuries. The recognition and control of occupational injuries has become a major concern of employees, employers, medicine, and the federal government because of health risk and related costs. Upper-extremity CTDs are identified by the National Institute for Occupational Safety and Health as one of the ten most significant occupational health problems in the United States. It is estimated by the year 2000 that 50 cents on the dollar will be spent on CTDs. Although enlightened aircraft employers have developed primary prevention strategies, primary prevention can never be expected to eliminate 100% of the cases. To evaluate several preventive activities, a CTD risk-assessment program was developed and implemented in cooperation with a major aircraft manufacturer employing over 8000 workers. This program was focused on objectively identifying the relationship of work and other activities to an individual worker experiencing CTDs. Early identification has been linked, when applicable, to intervention algorithms for medical care, job task modification, workplace accommodation, and training. A prospective study group of 212 workers who used rivet guns was placed into a four-way experimental design for ergonomic posture training, exercise training, and rivet-gun type (primary factors). A statistical model was developed for the level of CTD risk and evaluated using the SAS software program (SAS Institute, Inc, Carry, NC). Statistical analysis of the primary factors without regard to associated variables (covariates) demonstrated that only posture training had a beneficial risk reduction for the individual. The impact (beneficial or detrimental) for exercise training and for vibration-dampening rivet guns was probably obscured because of the large variability of the responses regarding the associated variables (covariates). When the covariates

  1. Musculoskeletal Disorders of the Upper Extremities Due to Extensive Usage of Hand Held Devices

    PubMed Central

    2014-01-01

    Objective The use of hand held devices (HHD) such as mobile phones, game controls, tablets, portable media players and personal digital assistants have increased dramatically in past decade. While sending a text message or using the controls of the HHD the users need to use their thumb and other palm muscles extensively. The objective of this study was to describe the risk factors and clinical features of the musculoskeletal disorders (MSDs) arising due to usage of hand held devices and to evaluate the effectiveness of a sequenced rehabilitation protocol. Methods A retrospective report analysis of 70 subjects, who were diagnosed to have a MSD affecting the upper extremities, was conducted. Medical charts from a tertiary level rehabilitation centre from 2005–2013 were analysed. All the subjects reported pain in their upper extremities following extensive usage of HHD and were examined and diagnosed to have a MSD by an orthopaedic and rehabilitation physician. After the assessment and diagnosis, all the patients underwent rehabilitation using a sequenced protocol. Results All the subjects reported pain in the thumb and forearm with associated burning, numbness and tingling around the thenar aspect of the hand, and stiffness of wrist and hand. 43 subjects had symptoms on the right side; 9 on left and 18 had bilateral symptoms. Correlation was found between hand dominance and MSD. 33 subjects complained of onset of symptoms following extensive text messaging. All the subjects were diagnosed to have tendinosis of Extensor Pollicis Longus and Myofascial Pain Syndrome affecting the 1st interossei, thenar group of muscles and Extensor Digitorum Communis. 23 of the subjects were senior executives, among these 7 were CEO’s of major multinational companies in India. All the subjects recovered completely following the rehabilitation. Conclusions The study concluded that mobile phones and gadgets that promoted the predominant usage of thumb or only one finger while texting

  2. Nerve allograft transplantation for functional restoration of the upper extremity: case series

    PubMed Central

    Elkwood, Andrew I.; Holland, Neil R.; Arbes, Spiros M.; Rose, Michael I.; Kaufman, Matthew R.; Ashinoff, Russell L.; Parikh, Mona A.; Patel, Tushar R.

    2011-01-01

    Background Major trauma to the spinal cord or upper extremity often results in severe sensory and motor disturbances from injuries to the brachial plexus and its insertion into the spinal cord. Functional restoration with nerve grafting neurotization and tendon transfers is the mainstay of treatment. Results may be incomplete due to a limited supply of autologous material for nerve grafts. The factors deemed most integral for success are early surgical intervention, reconstruction of all levels of injury, and maximization of the number of axonal conduits per nerve repair. Objective To report the second series of nerve allograft transplantation using cadaveric nerve graft and our experience with living-related nerve transplants. Participants Eight patients, seven men and one woman, average age 23 years (range 18–34), with multi-level brachial plexus injuries were selected for transplantation using either cadaveric allografts or living-related donors. Methods Grafts were harvested and preserved in the University of Wisconsin Cold Storage Solution at 5°C for up to 7 days. The immunosuppressive protocol was initiated at the time of surgery and was discontinued at approximately 1 year, or when signs of regeneration were evident. Parameters for assessment included mechanism of injury, interval between injury and treatment, level(s) of deficit, post-operative return of function, pain relief, need for revision surgery, complications, and improvement in quality of life. Results Surgery was performed using living-related donor grafts in six patients, and cadaveric grafts in two patients. Immunosuppression was tolerated for the duration of treatment in all but one patient in whom early termination occurred due to non-compliance. There were no cases of graft rejection as of most recent follow-up. Seven patients showed signs of regeneration, demonstrated by return of sensory and motor function and/or a migrating Tinel's sign. One patient was non-compliant with the post

  3. Dynamic injury tolerances for long bones of the female upper extremity

    PubMed Central

    DUMA, STEFAN M.; SCHREIBER, PHIL H.; McMASTER, JOHN D.; CRANDALL, JEFF R.; BASS, CAMERON R.; PILKEY, WALTER D.

    1999-01-01

    This paper presents the dynamic injury tolerances for the female humerus and forearm derived from dynamic 3-point bending tests using 22 female cadaver upper extremities. Twelve female humeri were tested at an average strain rate of 3.7±1.3%/s. The strain rates were chosen to be representative of those observed during upper extremity interaction with frontal and side airbags. The average moment to failure when mass scaled for the 5th centile female was 128±19 Nm. Using data from the in situ strain gauges during the drop tests and geometric properties obtained from pretest CT scans, an average dynamic elastic modulus for the female humerus was found to be 24.4±3.9 GPa. The injury tolerance for the forearm was determined from 10 female forearms tested at an average strain rate of 3.94±2.0%/s. Using 3 matched forearm pairs, it was determined that the forearm is 21% stronger in the supinated position (92±5 Nm) versus the pronated position (75±7 Nm). Two distinct fracture patterns were seen for the pronated and supinated groups. In the supinated position the average difference in fracture time between the radius and ulna was a negligible 0.4±0.3 ms. However, the pronated tests yielded an average difference in fracture time of 3.6±1.2 ms, with the ulna breaking before the radius in every test. This trend implies that in the pronated position, the ulna and radius are loaded independently, while in the supinated position the ulna and radius are loaded together as a combined structure. To produce a conservative injury criterion, a total of 7 female forearms were tested in the pronated position, which resulted in the forearm injury criterion of 58±12 Nm when scaled for the 5th centile female. It is anticipated that these data will provide injury reference values for the female forearm during driver air bag loading, and the female humerus during side air bag loading. PMID:10386782

  4. Assessing Upper Extremity Motor Function in Practice of Virtual Activities of Daily Living

    PubMed Central

    Adams, Richard J.; Lichter, Matthew D.; Krepkovich, Eileen T.; Ellington, Allison; White, Marga; Diamond, Paul T.

    2015-01-01

    A study was conducted to investigate the criterion validity of measures of upper extremity (UE) motor function derived during practice of virtual activities of daily living (ADLs). Fourteen hemiparetic stroke patients employed a Virtual Occupational Therapy Assistant (VOTA), consisting of a high-fidelity virtual world and a Kinect™ sensor, in four sessions of approximately one hour in duration. An Unscented Kalman Filter-based human motion tracking algorithm estimated UE joint kinematics in real-time during performance of virtual ADL activities, enabling both animation of the user’s avatar and automated generation of metrics related to speed and smoothness of motion. These metrics, aggregated over discrete sub-task elements during performance of virtual ADLs, were compared to scores from an established assessment of UE motor performance, the Wolf Motor Function Test (WMFT). Spearman’s rank correlation analysis indicates a moderate correlation between VOTA-derived metrics and the time-based WMFT assessments, supporting the criterion validity of VOTA measures as a means of tracking patient progress during an UE rehabilitation program that includes practice of virtual ADLs. PMID:25265612

  5. Evaluation and management of chronic work-related musculoskeletal disorders of the distal upper extremity.

    PubMed

    Piligian, G; Herbert, R; Hearns, M; Dropkin, J; Landsbergis, P; Cherniack, M

    2000-01-01

    This clinical review will describe the epidemiology, clinical presentation, and management of the following work-related musculoskeletal disorders (WMSDs) of the distal upper extremity: deQuervain's disease, extensor and flexor forearm tendinitis/tendinosis, lateral and medial epicondylitis, cubital tunnel syndrome, and hand-arm vibration syndrome (HAVS). These conditions were selected for review either because they were among the most common WMSDs among patients attending the New York State Occupational Health Clinics (NYSOHC) network, or because there is strong evidence for work-relatedness in the clinical literature. Work-related carpal tunnel syndrome is discussed in an accompanying paper. In an attempt to provide evidence-based treatment recommendations, literature searches on the treatment of each condition were conducted via Medline for the years 1985-1999. There was a dearth of studies evaluating the efficacy of specific clinical treatments and ergonomic interventions for WMSDs. Therefore, many of the treatment recommendations presented here are based on a consensus of experienced public health-oriented occupational medicine physicians from the NYSOHC network after review of the pertinent literature. A summary table of the clinical features of the disorders is presented as a reference resource. PMID:10573598

  6. Antiphospholipid antibodies in patients with upper-extremity deep vein thrombosis

    PubMed Central

    Nikolov, Krasimir V.; Baleva, Marta P.; Savov, Alexey S.

    2015-01-01

    The levels of antibodies to cardiolipin and β2-glycoprotein I and polymorphic variants G1691A of Factor V (factor V Leiden, FVL) and G20210A of prothrombin gene (G20210A) were studied in 16 patients with upper-extremity deep vein thrombosis (UEDVT). Most of patients with this syndrome have elevated values of these antibodies. Two of these patients are heterozygous carriers for G20210A and 1 – for FVL. Three patients with UEDVT and systemic lupus erythematosus (SLE) are positive for ANA and two others (one of them with Raynaud syndrome) have border line titre 1: 80 for ANA. All 3 patients with SLE are women and the interval between the development of the UEDVT and the onset of SLE was 1-4 years. We would like to suggest that: 1) UEDVT could be the first clinical symptom of Antiphospholipid syndrome, and 2) UEDVT may be the first clinical manifestation of SLE preceding the development of the systemic autoimmune disease by several years. PMID:26648774

  7. Spoof surface plasmon-based bandpass filter with extremely wide upper stopband

    NASA Astrophysics Data System (ADS)

    Xiaoyong, Liu; Lei, Zhu; Yijun, Feng

    2016-03-01

    We investigate the guiding modes of spoof surface plasmon polaritons (SPPs) on a symmetric ultra-thin plasmonic structure. From the analysis, we deduce the operating frequency region of the single-mode propagation. Based on this property, a spoof SPPs lowpass filter is then constituted in the microwave frequency. By introducing a transmission zero at the lower frequency band using a pair of stepped-impedance stubs, a wide passband filter is further realized. The proposed filter is fed by a transducer composed of a microstrip line with a flaring ground. The simulated results show that the presented filter has an extremely wide upper stopband in addition to excellent passband filtering characteristics such as low loss, wide band, and high square ratio. A prototype passband filter is also fabricated to validate the predicted performances. The proposed spoof-SPPs filter is believed to be very promising for other surface waveguide components in microwave and terahertz bands. Project supported by the Key Grant Project of Ministry of Education of China (Grant No. 313029), the FDCT Research Grant from Macao Science and Technology Development Fund, China (Grant No. 051/2014/A1), and the Multi-Year Research Grant from University of Macau, Macau SAR, China (Grant No. MYRG2014-00079-FST).

  8. Management of disorders of the rotator cuff: proceedings of the ISAKOS upper extremity committee consensus meeting.

    PubMed

    Arce, Guillermo; Bak, Klaus; Bain, Gregory; Calvo, Emilio; Ejnisman, Benno; Di Giacomo, Giovanni; Gutierrez, Vicente; Guttmann, Dan; Itoi, Eiji; Ben Kibler, W; Ludvigsen, Tom; Mazzocca, Augustus; de Castro Pochini, Alberto; Savoie, Felix; Sugaya, Hiroyuki; Uribe, John; Vergara, Francisco; Willems, Jaap; Yoo, Yon Sik; McNeil, John W; Provencher, Matthew T

    2013-11-01

    The goal of this article is to consolidate the International Society of Arthroscopy, Knee Surgery & Orthopaedic Sports Medicine (ISAKOS) Upper Extremity Committee's (UEC's) current knowledge on rotator cuff disease and management, as well as highlight key unresolved issues. The rotator cuff is an anatomically complex structure important for providing glenohumeral function and stability as part of a closed chain system. Current consensus suggests rotator cuff injuries are most accurately diagnosed, at levels similar to diagnosis by magnetic resonance imaging, with a combination of cuff- and impingement-specific clinical tests. Updates in the understanding of acromion morphology, the insertional anatomy of the rotator cuff, and the role of suprascapular nerve release may require changes to current classification systems and surgical strategies. Although initial management focuses on nonoperative protocols, discussion continues on whether surgery for isolated impingement is clinically more beneficial than rehabilitation. However, clear indications have yet to be established for the use of single- versus double-row repair because evidence confirms neither is clinically efficacious than the other. Biceps tenodesis, however, in non-isolated cuff tears has proven more successful in addressing the etiology of shoulder pain and yields improved outcomes over tenotomy. Data reviewing the benefits of tendon transfers, shoulder prostheses, and mechanical scaffolds, as well as new research on the potential benefit of platelet-rich plasma, pluripotential stem cells, and gene therapies, will also be presented. PMID:24041864

  9. Does Upper Extremity Training Influence Body Composition after Spinal Cord Injury?

    PubMed Central

    Fisher, Justin A.; McNelis, Meredith A.; Gorgey, Ashraf S.; Dolbow, David R.; Goetz, Lance L.

    2015-01-01

    Spinal cord injury (SCI) leads to serious body composition adaptations characterized by increasing whole body fat mass and decreased soft tissue lean mass (LM). These adaptations in body composition may lead to several cardio-metabolic disorders that reduce the quality of life, increase patients’ and caregivers’ burden and eventually leads to mortality. Exercise, an appropriate dietary regimen, and an active lifestyle may alleviate several of the negative effects on body composition after a SCI. Today however, there is no established consensus on the recommended dose, frequency or type of exercise to ameliorate several of the body composition sequelae after an acute SCI. Resistance training has been previously recommended as an effective strategy to restore soft tissue LM and decrease fat mass (FM). The strategy can be simply implemented as a routine home-based training program using free weights or resistance bands after a SCI. Additionally, upper extremity (UE) circuit resistance training has been previously used to improve cardiovascular and metabolic parameters after a SCI; however compared to the vast knowledge regarding the able-bodied (AB) population, the effects of UE circuit resistance training on body composition after a SCI is not well established. In summary, the available evidence does not support the rationale that UE circuit resistance training can lead to positive adaptations in body composition after a SCI. Further studies are suggested to examine the effects of UE circuit resistance training on body composition. PMID:26236549

  10. Feasibility of EMG-Based Neural Network Controller for an Upper Extremity Neuroprosthesis

    PubMed Central

    Hincapie, Juan Gabriel; Kirsch, Robert F.

    2013-01-01

    The overarching goal of this project is to provide shoulder and elbow function to individuals with C5/C6 Spinal Cord Injury (SCI) using functional electrical stimulation (FES), increasing the functional outcomes currently provided by a hand neuroprosthesis. The specific goal of this study was to design a controller based on an artificial neural network (ANN) that extracts information from the activity of muscles that remain under voluntary control sufficient to predict appropriate stimulation levels for several paralyzed muscles in the upper extremity. The ANN was trained with activation data obtained from simulations using a musculoskeletal model of the arm that was modified to reflect C5 SCI and FES capabilities. Several arm movements were recorded from able-bodied subjects and these kinematics served as the inputs to inverse dynamic simulations that predicted muscle activation patterns corresponding to the movements recorded. A system identification procedure was used to identify an optimal reduced set of voluntary input muscles from the larger set that are typically under voluntary control in C5 SCI. These voluntary activations were used as the inputs to the ANN and muscles that are typically paralyzed in C5 SCI were the outputs to be predicted. The neural network controller was able to predict the needed FES paralyzed muscle activations from “voluntary” activations with less than a 3.6% RMS prediction error. PMID:19211327

  11. Force Myography to Control Robotic Upper Extremity Prostheses: A Feasibility Study

    PubMed Central

    Cho, Erina; Chen, Richard; Merhi, Lukas-Karim; Xiao, Zhen; Pousett, Brittany; Menon, Carlo

    2016-01-01

    Advancement in assistive technology has led to the commercial availability of multi-dexterous robotic prostheses for the upper extremity. The relatively low performance of the currently used techniques to detect the intention of the user to control such advanced robotic prostheses, however, limits their use. This article explores the use of force myography (FMG) as a potential alternative to the well-established surface electromyography. Specifically, the use of FMG to control different grips of a commercially available robotic hand, Bebionic3, is investigated. Four male transradially amputated subjects participated in the study, and a protocol was developed to assess the prediction accuracy of 11 grips. Different combinations of grips were examined, ranging from 6 up to 11 grips. The results indicate that it is possible to classify six primary grips important in activities of daily living using FMG with an accuracy of above 70% in the residual limb. Additional strategies to increase classification accuracy, such as using the available modes on the Bebionic3, allowed results to improve up to 88.83 and 89.00% for opposed thumb and non-opposed thumb modes, respectively. PMID:27014682

  12. User perceptions of gaming interventions for improving upper extremity motor function in persons with chronic stroke.

    PubMed

    Finley, Margaret; Combs, Stephanie

    2013-04-01

    Finding ways to engage patients with stroke in repetitive intervention protocols long-term is poorly understood, particularly from the patients' perspective. Limited information exists that combines clinical expertise as well as user feedback on improving gaming interaction. The purpose of this study was to utilize input from focus groups of gaming intervention users with chronic stroke to identify characteristics of gaming that influence user/patient engagement in the activity. Two focus groups (n = 10) were conducted with each group participant playing two different gaming systems. Following exposure to the two systems, guided group interview sessions occurred that consisted of open-ended questions encompassing areas of overall gaming system preference, aspects that were liked or disliked, background appearance, music options, feedback provided, as well as recommendations for change. Findings revealed that participants enjoyed playing the gaming systems. Three primary themes emerged differentiating the systems: (1) musical encouragement; (2) focus and attention; and (3) motivation provided by performance feedback. It was concluded that when selecting a gaming system for upper extremity rehabilitation, a clinician should select a system that provides user-relevant music options with a modifiable background appearance for progression from basic to more challenging, providing appropriate feedback in an effort to encompass to a variety of user performance levels. PMID:22924427

  13. Extrinsic and intrinsic index finger muscle attachments in an OpenSim upper-extremity model.

    PubMed

    Lee, Jong Hwa; Asakawa, Deanna S; Dennerlein, Jack T; Jindrich, Devin L

    2015-04-01

    Musculoskeletal models allow estimation of muscle function during complex tasks. We used objective methods to determine possible attachment locations for index finger muscles in an OpenSim upper-extremity model. Data-driven optimization algorithms, Simulated Annealing and Hook-Jeeves, estimated tendon locations crossing the metacarpophalangeal (MCP), proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints by minimizing the difference between model-estimated and experimentally-measured moment arms. Sensitivity analysis revealed that multiple sets of muscle attachments with similar optimized moment arms are possible, requiring additional assumptions or data to select a single set of values. The most smooth muscle paths were assumed to be biologically reasonable. Estimated tendon attachments resulted in variance accounted for (VAF) between calculated moment arms and measured values of 78% for flex/extension and 81% for ab/adduction at the MCP joint. VAF averaged 67% at the PIP joint and 54% at the DIP joint. VAF values at PIP and DIP joints partially reflected the constant moment arms reported for muscles about these joints. However, all moment arm values found through optimization were non-linear and non-constant. Relationships between moment arms and joint angles were best described with quadratic equations for tendons at the PIP and DIP joints. PMID:25281408

  14. Soluble IL-1RII and IL-18 are associated with incipient upper extremity soft tissue disorders.

    PubMed

    Rechardt, Martti; Shiri, Rahman; Matikainen, Sampsa; Viikari-Juntura, Eira; Karppinen, Jaro; Alenius, Harri

    2011-05-01

    Previous studies suggest a role for IL-1β in the pathophysiology of upper extremity soft tissue disorders (UESTDs). We studied the levels of interleukin-1 family members in patients with incipient UESTDs and compared them with healthy controls. In this case control study, we included 163 patients with UESTDs and symptom duration shorter than 1 month and 42 healthy controls matched for age and gender at the group level. Serum levels of cytokines IL-1α, IL-1β, IL-1Ra, IL-6, IL-8, IL-18, IL-33, TNFα and sensitized C-reactive protein as well as IL-1 family soluble receptors sIL-1RII and sST2 were assessed. We used unconditional logistic regression models to study the associations between cytokines and UESTDs. After adjustment for potential confounders, the serum levels of sIL-1RII (p<0.001) and sST2 (p=0.014) were higher in the patients than the controls. The level of IL-18 was lower in the patients than the controls (p=0.005). There were no significant differences between the patients and controls regarding the levels of IL-1α, IL-1β, IL-1Ra, IL-33, IL-6, IL-8, TNFα, or sensitized C-reactive protein. The levels of circulating sIL-1RII and IL-18 are associated with incipient UESTDs, suggesting an important role for these IL-1 family members in the early course of UESTDs. PMID:21371906

  15. [Disorders of the cervical spine and the upper extremities and occupations].

    PubMed

    Krapac, L

    1989-12-01

    A chronological review of damage to the spine and upper extremities associated with work was carried out in a sample of 120 retired disabled workers. Examination of risk factors for cervicobrachial syndrome (CBS) showed that the forced, bent position of the body at work contributed significantly to the frequency of the disease, particularly in women (70.0% against 38% in controls P less than 0.01). The lifting of heavy loads was also frequently observed in women with CBS (12% compared to 6% in the control group (P less than 0.05). Repeated movements during work were claimed by 52.9% of the males and 80% of the females with CBS and by only 41.4% of the males and 50% of the females without it (P less than 0.01). The heaviest load lifted by subjects with CBS at work exceeded significantly that of control subjects. It is considered that there is a causal link between excessive burden and the occurrence of CBS in women. For early diagnosis of CBS, tiredness, pain in the cervical spine, reduced strength in the hands and poor ability to endure manual work are signs to be looked for. Early recognition of disease, improved working conditions and recreation can help prevent the disease or slow down its progress. PMID:2637664

  16. Ergonomic task reduction prevents bone osteopenia in a rat model of upper extremity overuse

    PubMed Central

    BARBE, Mary F.; JAIN, Nisha X.; MASSICOTTE, Vicky S.; POPOFF, Steven N.; BARR-GILLESPIE, Ann E.

    2015-01-01

    We evaluated the effectiveness of ergonomic workload reduction of switching rats from a high repetition high force (HRHF) lever pulling task to a reduced force and reach rate task for preventing task-induced osteopenic changes in distal forelimb bones. Distal radius and ulna trabecular structure was examined in young adult rats performing one of three handle-pulling tasks for 12 wk: 1) HRHF, 2) low repetition low force (LRLF); or 3) HRHF for 4 wk and than LRLF thereafter (HRHF-to-LRLF). Results were compared to age-matched controls rats. Distal forelimb bones of 12-wk HRHF rats showed increased trabecular resorption and decreased volume, as control rats. HRHF-to-LRLF rats had similar trabecular bone quality as control rats; and decreased bone resorption (decreased trabecular bone volume and serum CTX1), increased bone formation (increased mineral apposition, bone formation rate, and serum osteocalcin), and decreased osteoclasts and inflammatory cytokines, than HRHF rats. Thus, an ergonomic intervention of HRHF-to-LRLF prevented loss of trabecular bone volume occurring with prolonged performance of a repetitive upper extremity task. These findings support the idea of reduced workload as an effective approach to management of work-related musculoskeletal disorders, and begin to define reach rate and load level boundaries for such interventions. PMID:25739896

  17. A longitudinal study of industrial and clerical workers: predictors of upper extremity tendonitis.

    PubMed

    Werner, Robert A; Franzblau, Alfred; Gell, Nancy; Ulin, Sheryl S; Armstrong, Thomas J

    2005-03-01

    Upper extremity tendonitis (UET) associated with work activity is common but the true incidence and risk factors can best be determined by a prospective cohort study. This study followed a cohort of 501 active workers for an average of 5.4 years. Incident cases were defined as workers who were asymptomatic at baseline testing and had no prior history of UET and went on to be diagnosed with an UET during the follow-up period or at the follow-up evaluation. The incident cases were compared to the subset of the cohort who also had no history of an UET and did not develop tendonitis during the study. The cumulative incidence in this cohort was 24.3% or 4.5% annually. The factors found to have the highest predictive value for identifying a person who is likely to develop an UET in the near future included age over 40, a BMI over 30, a complaint at baseline of a shoulder or neck discomfort, a history of CTS and a job with a higher shoulder posture rating. The risk profile identifies both ergonomic and personal health factors as risks and both categories of factors may be amenable to prevention strategies. PMID:15794495

  18. Clinical tools to facilitate workplace accommodation after treatment for an upper extremity disorder.

    PubMed

    Shaw, W S; Feuerstein, M; Miller, V I; Lincoln, A E

    2001-01-01

    Failure to implement work site accommodations for work-related upper extremity disorders (WRUEDs) may be a factor contributing to delayed functional recovery and relapse. The present study describes the use of the 38-item Job Requirements and Physical Demands (JRPD) scale, a self-report measure of ergonomic exposure, and other case management tools to improve accommodation efforts for 101 workers (75 women, 26 men) returning to work after lost time related to a WRUED. Items were categorized into five subscales based on item content: administrative, computer-related, workstation design, environmental, and equipment. Administrative risk factors were elevated among office clerks, whereas postal clerks and letter carriers reported more workstation design risk factors, and letter carriers and electrical/mechanical workers cited more equipment-related risk factors (p < 0.05). All occupational categories rated computer-related risk factors highest. The Integrated Case Management (ICM) approach, which relies on the JRPD scale to guide recommendations, was used with a subgroup of these workers (n = 53), resulting in 1.4 times more workplace accommodations per worker than with a non-ICM approach. Clinical use of the self-reported exposure measure within the overall workplace accommodation process may have been a factor contributing to more frequent accommodation in the ICM group. This study of a subgroup of workers' compensation cases highlights the need for additional investigation of tools to integrate ergonomic approaches within the workplace accommodation process. PMID:12530837

  19. Feasibility of EMG-based neural network controller for an upper extremity neuroprosthesis.

    PubMed

    Hincapie, Juan Gabriel; Kirsch, Robert F

    2009-02-01

    The overarching goal of this project is to provide shoulder and elbow function to individuals with C5/C6 spinal cord injury (SCI) using functional electrical stimulation (FES), increasing the functional outcomes currently provided by a hand neuroprosthesis. The specific goal of this study was to design a controller based on an artificial neural network (ANN) that extracts information from the activity of muscles that remain under voluntary control sufficient to predict appropriate stimulation levels for several paralyzed muscles in the upper extremity. The ANN was trained with activation data obtained from simulations using a musculoskeletal model of the arm that was modified to reflect C5 SCI and FES capabilities. Several arm movements were recorded from able-bodied subjects and these kinematics served as the inputs to inverse dynamic simulations that predicted muscle activation patterns corresponding to the movements recorded. A system identification procedure was used to identify an optimal reduced set of voluntary input muscles from the larger set that are typically under voluntary control in C5 SCI. These voluntary activations were used as the inputs to the ANN and muscles that are typically paralyzed in C5 SCI were the outputs to be predicted. The neural network controller was able to predict the needed FES paralyzed muscle activations from "voluntary" activations with less than a 3.6% RMS prediction error. PMID:19211327

  20. Lymphaticovenous Bypass Decreases Pathologic Skin Changes in Upper Extremity Breast Cancer-Related Lymphedema

    PubMed Central

    Torrisi, Jeremy S.; Joseph, Walter J.; Ghanta, Swapna; Cuzzone, Daniel A.; Albano, Nicholas J.; Savetsky, Ira L.; Gardenier, Jason C.; Skoracki, Roman; Chang, David

    2015-01-01

    Abstract Introduction: Recent advances in microsurgery such as lymphaticovenous bypass (LVB) have been shown to decrease limb volumes and improve subjective symptoms in patients with lymphedema. However, to date, it remains unknown if these procedures can reverse the pathological tissue changes associated with lymphedema. Therefore, the purpose of this study was to analyze skin tissue changes in patients before and after LVB. Methods and Results: Matched skin biopsy samples were collected from normal and lymphedematous limbs of 6 patients with unilateral breast cancer-related upper extremity lymphedema before and 6 months after LVB. Biopsy specimens were fixed and analyzed for inflammation, fibrosis, hyperkeratosis, and lymphangiogenesis. Six months following LVB, 83% of patients had symptomatic improvement in their lymphedema. Histological analysis at this time demonstrated a significant decrease in tissue CD4+ cell inflammation in lymphedematous limb (but not normal limb) biopsies (p<0.01). These changes were associated with significantly decreased tissue fibrosis as demonstrated by decreased collagen type I deposition and TGF-β1 expression (all p<0.01). In addition, we found a significant decrease in epidermal thickness, decreased numbers of proliferating basal keratinocytes, and decreased number of LYVE-1+ lymphatic vessels in lymphedematous limbs after LVB. Conclusions: We have shown, for the first time, that microsurgical LVB not only improves symptomatology of lymphedema but also helps to improve pathologic changes in the skin. These findings suggest that the some of the pathologic changes of lymphedema are reversible and may be related to lymphatic fluid stasis. PMID:25521197

  1. Minimal Depression: How Does It Relate to Upper-Extremity Impairment and Function in Stroke?

    PubMed Central

    Weaver, Lindy L.; Sheffler, Lynne; Chae, John

    2013-01-01

    OBJECTIVE. We sought to determine the association between minimal depression, upper-extremity (UE) impairment, and UE motor function in a cohort of participants with subacute stroke. METHOD. We conducted a retrospective, secondary analysis of an interventional study. Correlational analyses were performed using the following outcome measures: the UE section of the Fugl-Meyer Assessment (FM), the functional ability section of the Arm Motor Ability Test (AMAT), and the Beck Depression Inventory (BDI–II). RESULTS. We found a negative correlation between BDI–II and both the FM (−.120, p = .196) and the AMAT (−.110, p = .275); however, this correlation was not statistically significant. Women exhibited higher depression scores (8.75 ± 0.78) than men (6.29 ± 0.46; p = .008). CONCLUSION. Low levels of depression are not associated with UE motor impairment and function in people with minimal to moderate UE disability levels. Poststroke depression occurs more frequently in women, warranting additional research on sex-specific differences. Given the proliferation of UE therapies targeting this group, this information is important for effective therapy planning and implementation. PMID:23968793

  2. A comparison of acromion marker cluster calibration methods for estimating scapular kinematics during upper extremity ergometry.

    PubMed

    Richardson, R Tyler; Nicholson, Kristen F; Rapp, Elizabeth A; Johnston, Therese E; Richards, James G

    2016-05-01

    Accurate measurement of joint kinematics is required to understand the musculoskeletal effects of a therapeutic intervention such as upper extremity (UE) ergometry. Traditional surface-based motion capture is effective for quantifying humerothoracic motion, but scapular kinematics are challenging to obtain. Methods for estimating scapular kinematics include the widely-reported acromion marker cluster (AMC) which utilizes a static calibration between the scapula and the AMC to estimate the orientation of the scapula during motion. Previous literature demonstrates that including additional calibration positions throughout the motion improves AMC accuracy for single plane motions; however this approach has not been assessed for the non-planar shoulder complex motion occurring during UE ergometry. The purpose of this study was to evaluate the accuracy of single, dual, and multiple AMC calibration methods during UE ergometry. The orientations of the UE segments of 13 healthy subjects were recorded with motion capture. Scapular landmarks were palpated at eight evenly-spaced static positions around the 360° cycle. The single AMC method utilized one static calibration position to estimate scapular kinematics for the entire cycle, while the dual and multiple AMC methods used two and four static calibration positions, respectively. Scapulothoracic angles estimated by the three AMC methods were compared with scapulothoracic angles determined by palpation. The multiple AMC method produced the smallest RMS errors and was not significantly different from palpation about any axis. We recommend the multiple AMC method as a practical and accurate way to estimate scapular kinematics during UE ergometry. PMID:26976228

  3. Upper extremity neurodynamic tests: range of motion asymmetry may not indicate impairment.

    PubMed

    Covill, Laura G; Petersen, Shannon M

    2012-10-01

    Upper extremity (UE) neurodynamic tests are used to examine neural tissue in patients with neuro-musculoskeletal disorders. Although comparisons between involved and uninvolved limbs are made clinically, minimal data exist reflecting the normal variation between sides. The purpose of this study was to determine if within-subject differences exist between limbs in the UE component of neurodynamic tests of the median, radial, and ulnar nerves. Sixty-one healthy subjects were examined. Difference between limbs for the median nerve-biased test was significant (right=16.4° ± 11.4°, left=20.1° ± 13.7°; p=0.045). There was no significant difference between limbs for the radial or ulnar nerve-biased tests. Correlation between limbs was poor for all tests (median r(2) =0.14; radial r(2) =0.20; ulnar r(2) =0.13). Lower-bound scores were calculated to determine the amount of difference needed to consider asymmetry beyond measurement error; the scores for each neurodynamic test were as follows: median 27°, radial 20°, and ulnar 21°. The results of this study show that between-limb values have low correlation and that it may be normal for an individual to have range of motion differences between limbs with neurodynamic tests. PMID:22201643

  4. Influence of Perspective of Action Observation Training on Residual Limb Control in Naïve Prosthesis Usage.

    PubMed

    Lawson, Delisa T; Cusack, William F; Lawson, Regan; Hardy, Ashley; Kistenberg, Robert; Wheaton, Lewis A

    2016-01-01

    Prior work in amputees and partial limb immobilization have shown improved neural and behavioral outcomes in using their residual limb with prosthesis when undergoing observation-based training with a prosthesis-using actor compared to an intact limb. It was posited that these improvements are due to an alignment of user with the actor. It may be affected by visual angles that allow emphasis of critical joint actions which may promote behavioral changes. The purpose of this study was to examine how viewing perspective of observation-based training effects prosthesis adaptation in naïve device users. Twenty nonamputated prosthesis users learned how to use an upper extremity prosthetic device while viewing a training video from either a sagittal or coronal perspective. These views were chosen as they place visual emphasis on different aspects of task performance to the device. The authors found that perspective of actions has a significant role in adaptation of the residual limb while using upper limb prostheses. Perspectives that demonstrate elbow adaptations to prosthesis usage may enhance the functional motor outcomes of action observation therapy. This work has potential implications on how prosthetic device operation is conveyed to persons adapting to prostheses through action observation based therapy. PMID:27253208

  5. Acute Bouts of Assisted Cycling Improves Cognitive and Upper Extremity Movement Functions in Adolescents with Down Syndrome

    ERIC Educational Resources Information Center

    Ringenbach, Shannon D. R; Albert, Andrew R.; Chen, Chih-Chia; Alberts, Jay L.

    2014-01-01

    The aim of this study was to examine the effectiveness of 2 modes of exercise on cognitive and upper extremity movement functioning in adolescents with Down syndrome (DS). Nine participants randomly completed 3 interventions over 3 consecutive weeks. The interventions were: (a) voluntary cycling (VC), in which participants cycled at their…

  6. Upper extremity muscle tone and response of tidal volume during manually assisted breathing for patients requiring prolonged mechanical ventilation

    PubMed Central

    Morino, Akira; Shida, Masahiro; Tanaka, Masashi; Sato, Kimihiro; Seko, Toshiaki; Ito, Shunsuke; Ogawa, Shunichi; Yokoi, Yuka; Takahashi, Naoaki

    2015-01-01

    [Purpose] The aim of the present study was to examine, in patients requiring prolonged mechanical ventilation, if the response of tidal volume during manually assisted breathing is dependent upon both upper extremity muscle tone and the pressure intensity of manually assisted breathing. [Subjects] We recruited 13 patients on prolonged mechanical ventilation, and assessed their upper extremity muscle tone using the modified Ashworth scale (MAS). The subjects were assigned to either the low MAS group (MAS≤2, n=7) or the high MAS group (MAS≥3, n=6). [Methods] The manually assisted breathing technique was applied at a pressure of 2 kgf and 4 kgf. A split-plot ANOVA was performed to compare the tidal volume of each pressure during manually assisted breathing between the low and the high MAS groups. [Results] Statistical analysis showed there were main effects of the upper extremity muscle tone and the pressure intensity of the manually assisted breathing technique. There was no interaction between these factors. [Conclusion] Our findings reveal that the tidal volume during the manually assisted breathing technique for patients with prolonged mechanical ventilation depends upon the patient’s upper extremity muscle tone and the pressure intensity. PMID:26357431

  7. Reliability of the Quality of Upper Extremity Skills Test for Children with Cerebral Palsy Aged 2 to 12 Years

    ERIC Educational Resources Information Center

    Thorley, Megan; Lannin, Natasha; Cusick, Anne; Novak, Iona; Boyd, Roslyn

    2012-01-01

    Aim: To investigate reliability of the Quality of Upper Extremity Skills Test (QUEST) scores for children with cerebral palsy (CP) aged 2-12 years. Method: Thirty-one QUESTs from 24 children with CP were rated once by two raters and twice by one rater. Internal consistency of total scores, inter- and intra-rater reliability findings for total,…

  8. To Constrain or Not to Constrain, and Other Stories of Intensive Upper Extremity Training for Children with Unilateral Cerebral Palsy

    ERIC Educational Resources Information Center

    Gordon, Andrew M.

    2011-01-01

    Impaired hand function is among the most functionally disabling symptoms of unilateral cerebral palsy. Evidence-based treatment approaches are generally lacking. However, recent approaches providing intensive upper extremity training appear promising. In this review, we first describe two such approaches, constraint-induced movement therapy (CIMT)…

  9. The effect of mirror therapy on upper-extremity function and activities of daily living in stroke patients

    PubMed Central

    Park, Jin-Young; Chang, Moonyoung; Kim, Kyeong-Mi; Kim, Hee-Jung

    2015-01-01

    The purpose of this study was to examine the effects of mirror therapy on upper-extremity function and activities of daily living in chronic stroke patients. [Subjects and Methods] Fifteen subjects were each assigned to a mirror therapy group and a sham therapy group. The Fugl-Meyer Motor Function Assessment and the Box and Block Test were performed to compare paretic upper-extremity function and hand coordination abilities. The functional independence measurement was conducted to compare abilities to perform activities of daily living. [Results] Paretic upper-extremity function and hand coordination abilities were significantly different between the mirror therapy and sham therapy groups. Intervention in the mirror therapy group was more effective than in the sham therapy group for improving the ability to perform activities of daily living. Self-care showed statistically significant differences between the two groups. [Conclusion] Mirror therapy is effective in improving paretic upper-extremity function and activities of daily living in chronic stroke patients. PMID:26180297

  10. The effects of mirror therapy with tasks on upper extremity function and self-care in stroke patients.

    PubMed

    Park, Youngju; Chang, Moonyoung; Kim, Kyeong-Mi; An, Duk-Hyun

    2015-05-01

    [Purpose] The purpose of this study was to determine the effects of mirror therapy with tasks on upper extremity unction and self-care in stroke patients. [Subjects] Thirty participants were randomly assigned to either an experimental group (n=15) or a control group (n=15). [Methods] Subjects in the experimental group received mirror therapy with tasks, and those in the control group received a sham therapy; both therapies were administered, five times per week for six weeks. The main outcome measures were the Manual Function Test for the paralyzed upper limb and the Functional Independence Measure for self-care performance. [Results] The experimental group had more significant gains in change scores compared with the control group after the intervention. [Conclusion] We consider mirror therapy with tasks to be an effective form of intervention for upper extremity function and self-care in stroke patients. PMID:26157249

  11. Stretch due to Penile Prosthesis Reservoir Migration

    PubMed Central

    Baten, E.; Vandewalle, T.; van Renterghem, K.

    2016-01-01

    A 43-year old patient presented to the emergency department with stretch, due to impossible deflation of the penile prosthesis, 4 years after successful implant. A CT-scan showed migration of the reservoir to the left rectus abdominis muscle. Refilling of the reservoir was inhibited by muscular compression, causing stretch. Removal and replacement of the reservoir was performed, after which the prosthesis was well-functioning again. Migration of the penile prosthesis reservoir is extremely rare but can cause several complications, such as stretch. PMID:26793592

  12. Incidence of Central Vein Stenosis and Occlusion Following Upper Extremity PICC and Port Placement

    SciTech Connect

    Gonsalves, Carin F. Eschelman, David J.; Sullivan, Kevin L.; DuBois, Nancy; Bonn, Joseph

    2003-04-15

    The purpose of this study was to determine the incidence of central vein stenosis and occlusion following upper extremity placement of peripherally inserted central venous catheters(PICCs) and venous ports. One hundred fifty-four patients who underwent venography of the ipsilateral central veins prior to initial and subsequent venous access device insertion were retrospectively identified. All follow-up venograms were interpreted at the time of catheter placement by one interventional radiologist over a 5-year period and compared to the findings on initial venography. For patients with central vein abnormalities, hospital and home infusion service records and radiology reports were reviewed to determine catheter dwelltime and potential alternative etiologies of central vein stenosis or occlusion. The effect of catheter caliber and dwell time on development of central vein abnormalities was evaluated. Venography performed prior to initial catheter placement showed that 150 patients had normal central veins. Three patients had central vein stenosis, and one had central vein occlusion. Subsequent venograms (n = 154)at the time of additional venous access device placement demonstrated 8 patients with occlusions and 10 with stenoses. Three of the 18 patients with abnormal follow-up venograms were found to have potential alternative causes of central vein abnormalities. Excluding these 3 patients and the 4 patients with abnormal initial venograms, a 7% incidence of central vein stenosis or occlusion was found in patients with prior indwelling catheters and normal initial venograms. Catheter caliber showed no effect on the subsequent development of central vein abnormalities. Patients who developed new or worsened central vein stenosis or occlusion had significantly (p =0.03) longer catheter dwell times than patients without central vein abnormalities. New central vein stenosis or occlusion occurred in 7% of patients following upper arm placement of venous access devices

  13. Challenging the Dogma of Tourniquet Pressure Requirements for Upper Extremity Surgery.

    PubMed

    Sarfani, Shumaila; Cantwell, Sean; Shin, Alexander Y; Kakar, Sanjeev

    2016-05-01

    Background Traditional teaching supports upper extremity tourniquet pressure to be set at 250 mm Hg. Complications have been associated with increased pressure and duration of tourniquet use. We hypothesized that there will be no significant difference in intraoperative variables between tourniquet pressures of 125, 150, 175, or 200 mm Hg as compared with the current practice of 250 mm Hg during mini-open carpal tunnel release. Case Description A retrospective review was conducted of patients undergoing open carpal tunnel release from June 2009 to June 2012. Those undergoing surgery with a tourniquet pressure of 250 mm Hg were compared with those with lower tourniquet pressures regarding their demographics, operative and anesthesia time, and whether the tourniquet pressure needed to be increased to 250 mm Hg during surgery. Literature Review A total of 432 patients underwent carpal tunnel release over the 3-year period. There were no differences with respect to patient demographics. There was no significant difference between operative or anesthesia time between different tourniquet pressure groups. There were no reported problems with breakthrough bleeding or difficulty with visualization of structures in any of the pressure groups. None of the patients with lower tourniquet pressures needed the tourniquet pressure to be adjusted during surgery. Clinical Relevance This study demonstrated that using lower tourniquet pressures had no effect on the operation for open carpal tunnel release including effect on operative or anesthesia time, breakthrough bleeding, or complications directly related to tourniquet pressures. Orthopedic surgeons may consider reducing tourniquet pressures during carpal tunnel release. PMID:27104077

  14. Selection of acupoints for managing upper-extremity spasticity in chronic stroke patients

    PubMed Central

    Wang, Bi-Huei; Lin, Chien-Lin; Li, Te-Mao; Lin, Shih-Din; Lin, Jaung-Geng; Chou, Li-Wei

    2014-01-01

    Background This study investigated the clinical efficacy of electroacupuncture (EA) in inhibiting upper-extremity spasticity in chronic stroke patients, and also in mapping a unique preliminary acupoint-selection protocol. Methods Fifteen patients were divided into two groups: patients in the control group (n=6) received minimal acupuncture (MA), and those in the experimental group (n=9) received EA. Four acupoints, which include Neiguan (PC6), Shaohai (HT3), Zeqian (Ex-UE, A32), and Shounizhu (EX-UE), were treated near the motor points of the muscles for elbow flexion, forearm pronation, and finger flexion. Both groups were treated for twelve sessions, 20 minutes per session, for 6 weeks (two sessions per week). The outcome measures in this study included angle of muscle reaction (R1), passive range of motion (R2), and dynamic component (R2–R1). Results In the experimental group, the R2–R1 of the elbow joint was significantly decreased at 1 (P=0.0079), 3 (P=0.0013), and 6 weeks (P=0.0149) after treatment compared with pretreatment levels (P<0.05). The between-group difference in the R2–R1 of the elbow joint after the 6-week treatment was statistically significant. Conclusion Combining the 6-week EA and standard rehabilitation treatment reduced the spasticity of the elbow for chronic stroke survivors. However, no significant effect was observed in the spasticity of the wrist joints. The choice of acupoints and the frequency of EA have to be taken into account to achieve a positive treatment effect. The correlation between acupoints and motor points provides a model of acupoint selection to improve spasticity. PMID:24453485

  15. The effects of rear-wheel camber on the kinematics of upper extremity during wheelchair propulsion

    PubMed Central

    2012-01-01

    Background The rear-wheel camber, defined as the inclination of the rear wheels, is usually used in wheelchair sports, but it is becoming increasingly employed in daily propulsion. Although the rear-wheel camber can increase stability, it alters physiological performance during propulsion. The purpose of the study is to investigate the effects of rear-wheel cambers on temporal-spatial parameters, joint angles, and propulsion patterns. Methods Twelve inexperienced subjects (22.3±1.6 yr) participated in the study. None had musculoskeletal disorders in their upper extremities. An eight-camera motion capture system was used to collect the three-dimensional trajectory data of markers attached to the wheelchair-user system during propulsion. All participants propelled the same wheelchair, which had an instrumented wheel with cambers of 0°, 9°, and 15°, respectively, at an average velocity of 1 m/s. Results The results show that the rear-wheel camber significantly affects the average acceleration, maximum end angle, trunk movement, elbow joint movement, wrist joint movement, and propulsion pattern. The effects are especially significant between 0° and 15°. For a 15° camber, the average acceleration and joint peak angles significantly increased (p < 0.01). A single loop pattern (SLOP) was adopted by most of the subjects. Conclusions The rear-wheel camber affects propulsion patterns and joint range of motion. When choosing a wheelchair with camber adjustment, the increase of joint movements and the base of support should be taken into consideration. PMID:23173938

  16. Finger muscle attachments for an OpenSim upper-extremity model.

    PubMed

    Lee, Jong Hwa; Asakawa, Deanna S; Dennerlein, Jack T; Jindrich, Devin L

    2015-01-01

    We determined muscle attachment points for the index, middle, ring and little fingers in an OpenSim upper-extremity model. Attachment points were selected to match both experimentally measured locations and mechanical function (moment arms). Although experimental measurements of finger muscle attachments have been made, models differ from specimens in many respects such as bone segment ratio, joint kinematics and coordinate system. Likewise, moment arms are not available for all intrinsic finger muscles. Therefore, it was necessary to scale and translate muscle attachments from one experimental or model environment to another while preserving mechanical function. We used a two-step process. First, we estimated muscle function by calculating moment arms for all intrinsic and extrinsic muscles using the partial velocity method. Second, optimization using Simulated Annealing and Hooke-Jeeves algorithms found muscle-tendon paths that minimized root mean square (RMS) differences between experimental and modeled moment arms. The partial velocity method resulted in variance accounted for (VAF) between measured and calculated moment arms of 75.5% on average (range from 48.5% to 99.5%) for intrinsic and extrinsic index finger muscles where measured data were available. RMS error between experimental and optimized values was within one standard deviation (S.D) of measured moment arm (mean RMS error = 1.5 mm < measured S.D = 2.5 mm). Validation of both steps of the technique allowed for estimation of muscle attachment points for muscles whose moment arms have not been measured. Differences between modeled and experimentally measured muscle attachments, averaged over all finger joints, were less than 4.9 mm (within 7.1% of the average length of the muscle-tendon paths). The resulting non-proprietary musculoskeletal model of the human fingers could be useful for many applications, including better understanding of complex multi-touch and gestural movements. PMID:25853869

  17. Finger Muscle Attachments for an OpenSim Upper-Extremity Model

    PubMed Central

    Lee, Jong Hwa; Asakawa, Deanna S.; Dennerlein, Jack T.; Jindrich, Devin L.

    2015-01-01

    We determined muscle attachment points for the index, middle, ring and little fingers in an OpenSim upper-extremity model. Attachment points were selected to match both experimentally measured locations and mechanical function (moment arms). Although experimental measurements of finger muscle attachments have been made, models differ from specimens in many respects such as bone segment ratio, joint kinematics and coordinate system. Likewise, moment arms are not available for all intrinsic finger muscles. Therefore, it was necessary to scale and translate muscle attachments from one experimental or model environment to another while preserving mechanical function. We used a two-step process. First, we estimated muscle function by calculating moment arms for all intrinsic and extrinsic muscles using the partial velocity method. Second, optimization using Simulated Annealing and Hooke-Jeeves algorithms found muscle-tendon paths that minimized root mean square (RMS) differences between experimental and modeled moment arms. The partial velocity method resulted in variance accounted for (VAF) between measured and calculated moment arms of 75.5% on average (range from 48.5% to 99.5%) for intrinsic and extrinsic index finger muscles where measured data were available. RMS error between experimental and optimized values was within one standard deviation (S.D) of measured moment arm (mean RMS error = 1.5 mm < measured S.D = 2.5 mm). Validation of both steps of the technique allowed for estimation of muscle attachment points for muscles whose moment arms have not been measured. Differences between modeled and experimentally measured muscle attachments, averaged over all finger joints, were less than 4.9 mm (within 7.1% of the average length of the muscle-tendon paths). The resulting non-proprietary musculoskeletal model of the human fingers could be useful for many applications, including better understanding of complex multi-touch and gestural movements. PMID:25853869

  18. Testing the concurrent validity of a naturalistic upper extremity reaching task.

    PubMed

    Schaefer, S Y; Hengge, C R

    2016-01-01

    Point-to-point reaching has been widely used to study upper extremity motor control. We have been developing a naturalistic reaching task that adds tool manipulation and object transport to this established paradigm. The purpose of this study was to determine the concurrent validity of a naturalistic reaching task in a sample of healthy adults. This task was compared to the criterion measure of standard point-to-point reaching. Twenty-eight adults performed unconstrained out-and-back movements in three different directions relative to constant start location along midline using their nondominant arm. In the naturalistic task, participants manipulated a tool to transport objects sequentially between physical targets anchored to the planar workspace. In the standard task, participants moved a digital cursor sequentially between virtual targets, veridical to the planar workspace. In both tasks, the primary measure of performance was trial time, which indicated the time to complete 15 reaches (five cycles of three reaches/target). Two other comparator tasks were also designed to test concurrent validity when components of the naturalistic task were added to the standard task. Spearman's rank correlation coefficients indicated minimal relationship between the naturalistic and standard tasks due to differences in progressive task difficulty. Accounting for this yielded a moderate linear relationship, indicating concurrent validity. The comparator tasks were also related to both the standard and naturalistic task. Thus, the principles of motor control and learning that have been established by the wealth of point-to-point reaching studies can still be applied to the naturalistic task to a certain extent. PMID:26438508

  19. Humeral Retrotorsion in Collegiate Baseball Pitchers With Throwing-Related Upper Extremity Injury History

    PubMed Central

    Myers, Joseph B.; Oyama, Sakiko; Rucinski, Terri Jo; Creighton, R. Alexander

    2011-01-01

    Background: Collegiate baseball pitchers, as well as position players, exhibit increased humeral retrotorsion compared with individuals with no history of overhead sport participation. Whether the humeral retrotorsion plays a role in the development of throwing-related injuries that are prevalent in collegiate baseball pitchers is unknown. Hypotheses: Humeral retrotorsion will be significantly different in collegiate pitchers with throwing-related shoulder or elbow injury history compared with pitchers with no injury history. Humeral retrotorsion can also discriminate participants with and without shoulder or elbow injury. Study Design: Cross-sectional study. Methods: Comparisons of ultrasonographically-obtained humeral retrotorsion were made between 40 collegiate pitchers with and without history of throwing-related shoulder or elbow injury. The ability of humeral retrotorsion to discriminate injury history was determined from the receiver operating characteristic area under the curve. Results: Participants with an elbow injury history demonstrated a greater humeral retrotorsion limb difference (mean difference = 7.2°, P = 0.027) than participants with no history of upper extremity injury. Participants with shoulder injury history showed no differences in humeral torsion compared with participants with no history of injury. Humeral retrotorsion limb difference exhibited a fair ability (receiver operating characteristic area under the curve = 0.74) to discriminate elbow injury history. Conclusions: Collegiate pitchers with a history of elbow injury exhibited a greater limb difference in humeral retrotorsion compared with pitchers with no history of injury. No differences in humeral retrotorsion variables were present in participants with and without shoulder injury history. Clinical Relevance: Baseball players with a history of elbow injury demonstrated increased humeral retrotorsion, suggesting that the amount of retrotorsion and the development of elbow injury

  20. Effects of kinesiology taping on the upper-extremity function and activities of daily living in patients with hemiplegia

    PubMed Central

    Kim, Eung-beom; Kim, Young-dong

    2015-01-01

    [Purpose] This study determined the effects of kinesiology taping on the upper-extremity function and activities of daily living of patients with hemiplegia. [Subjects] The experimental group and control group comprised 15 hemiplegia patients each. [Methods] This study was performed from June 4 to December 22, 2012, involving 30 hemiplegia patients. The experimental and controls groups performed task practices for 30 minutes, 3 times per week for 28 weeks with and without taping, respectively. [Results] After treatment, there were significant differences in every outcome measures within each group except for the Brunnstrom recovery stage of the hand. However, there was a significant difference in functional independence movements between the groups. [Conclusion] Task practice has the same effectiveness regardless of the taping of the upper extremities. Nevertheless, taping is helpful for improving both the functions and activities of daily living in patients with hemiplegia. PMID:26157239

  1. Peripheral nerve blocks on the upper extremity: Technique of landmark-based and ultrasound-guided approaches.

    PubMed

    Steinfeldt, T; Volk, T; Kessler, P; Vicent, O; Wulf, H; Gottschalk, A; Lange, M; Schwartzkopf, P; Hüttemann, E; Tessmann, R; Marx, A; Souquet, J; Häger, D; Nagel, W; Biscoping, J; Schwemmer, U

    2015-11-01

    The German Society of Anaesthesiology and Intensive Care Medicine (Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin, DGAI) established an expert panel to develop preliminary recommendations for the application of peripheral nerve blocks on the upper extremity. The present recommendations state in different variations how ultrasound and/or electrical nerve stimulation guided nerve blocks should be performed. The description of each procedure is rather a recommendation than a guideline. The anaesthesiologist should select the variation of block which provides the highest grade of safety according to his individual opportunities. The first section comprises recommendations regarding dosages of local anaesthetics, general indications and contraindications for peripheral nerve blocks and informations about complications. In the following sections most common blocks techniques on the upper extremity are described. PMID:26408023

  2. Prevalence of Symptoms of Depression, Anxiety, and Posttraumatic Stress Disorder in Workers With Upper Extremity Complaints.

    PubMed

    Degen, Ryan M; MacDermid, Joy C; Grewal, Ruby; Drosdowech, Darren S; Faber, Kenneth J; Athwal, George S

    2016-07-01

    Study Design Cross-sectional cohort study. Background Symptoms of depression, panic disorder (PD), and posttraumatic stress disorder (PTSD) have been associated with musculoskeletal complaints and could represent barriers to recovery in injured workers. Objectives To determine the prevalence of symptoms of depression, PD, and PTSD utilizing the Patient Health Questionnaire (PHQ) in a cohort of patients presenting to an upper extremity injured-worker clinic; secondarily, to identify any relationships between patients screening positive and patient-reported outcome measures. Methods In 2010, 418 patients completed the PHQ during their initial evaluation. Patients with PHQ scores exceeding threshold values for symptoms of depression, PD, or PTSD were compared based on patient-reported outcome scores, including the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) and Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). The prevalence of symptoms, and their relationship with presenting complaints and patient-reported outcomes, were calculated. Results Thirty-one percent of patients scored above thresholds for symptoms of at least 1 mental health disorder. Of those who screened positive, 67% screened positive for depression, 44% for PTSD, and 50% for PD, with 43% of patients positive for multiple symptoms. Patients experiencing neck pain had significantly higher screening rates of depressive symptoms (62.5% versus 20.1%, P = .004) and PD (37.5% versus 12.9%, P = .044) compared with other presenting complaints. Similarly, patients with chronic pain had higher rates of depression (54.5% versus 20.1%, P = .006), PD (63.6% versus 12%, P<.001), and PTSD (36.4% versus 14.8%, P = .05) compared with other presenting complaints. Patients endorsing depressive symptoms had significantly lower SF-36 mental component summary scores (26.3 ± 10.7 versus 37.6 ± 9.9, P<.001) and higher shortened-version DASH (72.3 ± 16.7 versus 61.5 ± 11.1, P = .003) and

  3. Upper Extremity Functional Evaluation by Fugl-Meyer Assessment Scoring Using Depth-Sensing Camera in Hemiplegic Stroke Patients

    PubMed Central

    Baek, Dongyoub; Bang, Hyunwoo; Paik, Nam-Jong

    2016-01-01

    Virtual home-based rehabilitation is an emerging area in stroke rehabilitation. Functional assessment tools are essential to monitor recovery and provide current function-based rehabilitation. We developed the Fugl-Meyer Assessment (FMA) tool using Kinect (Microsoft, USA) and validated it for hemiplegic stroke patients. Forty-one patients with hemiplegic stroke were enrolled. Thirteen of 33 items were selected for upper extremity motor FMA. One occupational therapist assessed the motor FMA while recording upper extremity motion with Kinect. FMA score was calculated using principal component analysis and artificial neural network learning from the saved motion data. The degree of jerky motion was also transformed to jerky scores. Prediction accuracy for each of the 13 items and correlations between real FMA scores and scores using Kinect were analyzed. Prediction accuracies ranged from 65% to 87% in each item and exceeded 70% for 9 items. Correlations were high for the summed score for the 13 items between real FMA scores and scores obtained using Kinect (Pearson’s correlation coefficient = 0.873, P<0.0001) and those between total upper extremity scores (66 in full score) and scores using Kinect (26 in full score) (Pearson’s correlation coefficient = 0.799, P<0.0001). Log transformed jerky scores were significantly higher in the hemiplegic side (1.81 ± 0.76) compared to non-hemiplegic side (1.21 ± 0.43) and showed significant negative correlations with Brunnstrom stage (3 to 6; Spearman correlation coefficient = -0.387, P = 0.046). FMA using Kinect is a valid way to assess upper extremity function and can provide additional results for movement quality in stroke patients. This may be useful in the setting of unsupervised home-based rehabilitation. PMID:27367518

  4. Upper Extremity Multifocal Neuropathy in a 10-Year-Old Boy Associated With NS6S Disaccharide Antibodies.

    PubMed

    Edelman, Frederick; Naddaf, Elie; Waclawik, Andrew J

    2015-06-01

    We present a 10-year-old boy with a predominantly motor multifocal neuropathy with demyelinating and axonal changes with sensory involvement, affecting only one upper extremity. Laboratory studies revealed an elevated titer of immunoglobulin M (IgM) antibodies against the NS6S antigen. He responded to treatment with high dose intravenous immunoglobulins. Focal or multifocal immune-mediated neuropathies are not common in children and may be underdiagnosed. PMID:25038124

  5. Acute Effects of Static Stretching, Dynamic Exercises, and High Volume Upper Extremity Plyometric Activity on Tennis Serve Performance

    PubMed Central

    Gelen, Ertugrul; Dede, Muhittin; Bingul, Bergun Meric; Bulgan, Cigdem; Aydin, Mensure

    2012-01-01

    The purpose of this study was to compare the acute effects of static stretching; dynamic exercises and high volume upper extremity plyometric activity on tennis serve performance. Twenty-six elite young tennis players (15.1 ± 4.2 years, 167.9 ± 5.8 cm and 61.6 ± 8.1 kg) performed 4 different warm-up (WU) routines in a random order on non-consecutive days. The WU methods consisted of traditional WU (jogging, rally and serve practice) (TRAD); traditional WU and static stretching (TRSS); traditional WU and dynamic exercise (TRDE); and traditional WU and high volume upper extremity plyometric activity (TRPLYP). Following each WU session, subjects were tested on a tennis serve ball speed test. TRAD, TRSS, TRDE and TRPLYO were compared by repeated measurement analyses of variance and post-hoc comparisons. In this study a 1 to 3 percent increase in tennis serve ball speed was recorded in TRDE and TRPLYO when compared to TRAD (p< 0.05). However, no significant change in ball speed performance between TRSS and TRAD. (p> 0.05). ICCs for ball speed showed strong reliability (0.82 to 0.93) for the ball speed measurements.The results of this study indicate that dynamic and high volume upper extremity plyometric WU activities are likely beneficial to serve speed of elite junior tennis players. Key points After the traditional warm up in tennis, static stretching has no effect on serve speed. Tennis players should perform dynamic exercises and/or high volume upper extremity plyometric activities to improve their athletic performance. PMID:24150068

  6. A Randomized Controlled Trial Comparing Botulinum Toxin A Dosage in the Upper Extremity of Children with Spasticity

    ERIC Educational Resources Information Center

    Kawamura, Anne; Campbell, Kent; Lam-Damji, Sophie; Fehlings, Darcy

    2007-01-01

    This study compared the effects of low and high doses of botulinum toxin A (BTX-A) to improve upper extremity function. Thirty-nine children (22 males, 17 females) with a mean age of 6 years 2 months (SD 2y 9mo) diagnosed with spastic hemiplegia or triplegia were enrolled into this double-blind, randomized controlled trial. The high-dose group…

  7. Vascular injuries after minor blunt upper extremity trauma: pitfalls in the recognition and diagnosis of potential "near miss" injuries

    PubMed Central

    Bravman, Jonathan T; Ipaktchi, Kyros; Biffl, Walter L; Stahel, Philip F

    2008-01-01

    Background Low energy trauma to the upper extremity is rarely associated with a significant vascular injury. Due to the low incidence, a high level of suspicion combined with appropriate diagnostic algorithms are mandatory for early recognition and timely management of these potentially detrimental injuries. Methods Review of the pertinent literature, supported by the presentation of two representative "near miss" case examples. Results A major diagnostic pitfall is represented by the insidious presentation of significant upper extremity arterial injuries with intact pulses and normal capillary refill distal to the injury site, due to collateral perfusion. Thus, severe vascular injuries may easily be missed or neglected at the upper extremity, leading to a long-term adverse outcome with the potential need for a surgical amputation. Conclusion The present review article provides an outline of the diagnostic challenges related to these rare vascular injuries and emphasizes the necessity for a high level of suspicion, even in the absence of a significant penetrating or high-velocity trauma mechanism. PMID:19032757

  8. Overuse injuries of the upper extremity in the competitive athlete: magnetic resonance imaging findings associated with repetitive trauma.

    PubMed

    Banks, Kevin P; Ly, Justin Q; Beall, Douglas P; Grayson, David E; Bancroft, Laura W; Tall, Michael A

    2005-01-01

    Overuse injuries are a very common cause of pain in athletes, accounting for a significant loss of training time and missed competitions. Magnetic resonance imaging (MRI) is playing an increasing role in facilitating the expeditious and safe return of these individuals to their preinjury level of physical performance by allowing accurate diagnosis. Sports physicians are increasingly relying on the exquisite anatomic detail afforded by this technique to formulate diagnoses that assist with the optimal management of these athletic injuries. Some upper extremity overuse entities are well recognized; two examples are medial epicondylitis, classically appearing in baseball pitchers, and lateral epicondylitis, in tennis players. Other less well-known injuries of the upper extremity, such as intersection syndrome in rowers and distal clavicular stress fractures in weightlifters, are frequent occurrences in certain circles of athletes. The following article is a pictorial review of the MRI findings of upper extremity overuse injuries encountered in the competitive athlete, with an emphasis on the sports scenarios in which they occur. We will depict mechanisms of injury and applicable anatomy and show characteristic imaging findings. A wide range of entities are addressed, including but not limited to overuse injuries occurring in baseball, swimming, gymnastics, weightlifting, bowling, and cycling. PMID:16012484

  9. Refining the Sensory and Motor Ratunculus of the Rat Upper Extremity Using fMRI and Direct Nerve Stimulation

    PubMed Central

    Cho, Younghoon R.; Pawela, Christopher P.; Li, Rupeng; Kao, Dennis; Schulte, Marie L.; Runquist, Matthew L.; Yan, Ji-Geng; Matloub, Hani S.; Jaradeh, Safwan S.; Hudetz, Anthony G.; Hyde, James S.

    2008-01-01

    It is well understood that the different regions of the body have cortical representations in proportion to the degree of innervation. Our current understanding of the rat upper extremity has been enhanced using functional MRI (fMRI), but these studies are often limited to the rat forepaw. The purpose of this study is to describe a new technique that allows us to refine the sensory and motor representations in the cerebral cortex by surgically implanting electrodes on the major nerves of the rat upper extremity and providing direct electrical nerve stimulation while acquiring fMRI images. This technique was used to stimulate the ulnar, median, radial, and musculocutaneous nerves in the rat upper extremity using four different stimulation sequences that varied in frequency (5 Hz vs. 10 Hz) and current (0.5 mA vs. 1.0 mA). A distinct pattern of cortical activation was found for each nerve. The higher stimulation current resulted in a dramatic increase in the level of cortical activation. The higher stimulation frequency resulted in both increases and attenuation of cortical activation in different regions of the brain, depending on which nerve was stimulated. PMID:17969116

  10. Effects of Below-knee Assembly Work at Different Reach Distances on Upper-extremity Muscle Activity.

    PubMed

    Shin, Seung-Je; Yoo, Won-Gyu

    2014-08-01

    [Purpose] We investigated upper-extremity muscle activity during below-knee assembly work performed by healthy adults at three different reach distances evaluate the physical risk factors associated with neck and shoulder disorders of reach distances. [Subjects] Sixteen young male workers were recruited. [Methods] Activities of the right upper trapezius, anterior deltoid, and biceps brachii muscles were measured during below-knee assembly work at the three different reach distances. [Results] The normalized EMG data of the upper trapezius, anterior deltoid, and biceps brachii muscles generally increased significantly as the reach distance at which the assembly work was performed increased. [Conclusion] Below-knee workers should engage in work that involves shorter (nearer) reach distances. PMID:25202196