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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 upperextremity 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 upperextremity 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 fixation devices and are crucial for the development of safety devices intended to protect the bone-implant interface from damaging loadings.
IN A number of clinical situations, there is a need for a simple semi-quantitative test of upperextremity function. Measurement of function is of particular importance in evaluating the results of hand surgery and upperextremityprosthesis, in following the development of hand deformities in rheumatoid arthritis and neurological diseases, and in judging the effectiveness of different forms of therapy.
Golf is a global sport enjoyed by an estimated 60 million people around the world. Despite the common misconception that the risk of injury during the play of golf is minimal, golfers are subject to a myriad of potential pathologies. While the majority of injuries in golf are attributable to overuse, acute traumatic injuries can also occur. As the body's direct link to the golf club, the upperextremities are especially prone to injury. A thorough appreciation of the risk factors and patterns of injury will afford accurate diagnosis, treatment, and prevention of further injury. PMID:24032581
The purpose of this report is to review the surgical treatment of the upperextremity involved with cerebral palsy over a 25-year period and present our results with regard to changes in upper limb function. Surgical results were assessed by comparison of preoperative and postoperative levels of upperextremity functional use using a previously described 9-level scale. The effect of
Children with limb deficiencies/amputations are best managed by a multidisciplinary team comprised of physicians specializing in their care, prosthetists, and therapists. For a successful functional outcome, the rehabilitation team will need to consider the goals of the child and parents as they select appropriate components that will aid and not overwhelm the child. The prosthesis will need to accommodate growth and development and withstand the rigors of use during play. The child will benefit from a team approach to introduce, train, and problem-solve the process of prosthetic restoration. We examine strategies for decision making for children with upperextremity limb deletions that will allow appropriate component selection to ensure the prosthesis will be accepted and improve function for the child. PMID:21791813
Kelly, Brian M; Davis, Alicia J; Justice, Denise; Miller, Quaintance L; Nelson, Virginia S
Human capacity for physiologic adaptation to cold is minimal; we survive by insulating ourselves with protective clothing. In addition to the irreversible direct injury caused by ice crystallization, the authors have outlined four possible mechanisms by which indirect injury may damage tissue. Other than rapid rewarming, there is no uniformly accepted protocol for the treatment of frostbite injury. Attempting to sort out the world's literature on frostbite in an effort to present a comprehensive treatment protocol is a daunting task. In addition to the probably irreversible direct injury caused by ice crystallization, the authors have outlined at least four possible mechanisms by which indirect injury may damage tissue. The literature is full of various treatment protocols that allegedly are beneficial despite addressing different mechanisms. Mills described 10 different categories of medications, each addressing one of four possible mechanisms, used in the clinical treatment of frostbite injury over a 30-year period. Analyzing this information is even more confusing when one realizes that there is little uniformity in animal models employed to generate these data. This is further complicated by the lack of clinical correlation with the most common experimental model--liquid nitrogen rapid freezing. The risk of frostbite is highest when psychiatric disturbance, intoxication, or unplanned circumstances lead to cold exposure without adequate protective clothing. As tissue freezes, both direct and indirect factors cause injury. Most therapies have been aimed at limiting indirect injury, in an attempt to limit progressive tissue loss. Rapid rewarming is universally accepted, but the benefits of other modalities are still controversial. Traditionally, observation and delayed amputation have been employed to manage frostbite. More recently, triple-phase bone scans have been used to distinguish between tissue that is irreversibly destined for necrosis and tissue that is at-risk for necrosis, but potentially salvageable. Early operation can be used to provide at-risk tissue with a new blood supply and preserve both function and length in the upperextremity. PMID:10791170
Successful surgical reconstruction of the upperextremities paralyzed by poliomyelitis depends largely on the careful analysis of the individual problem and replacement of critical motions of the upperextremity. These replacements or substitutions may be gained by muscle transposition, tendon transplantation, tenodesis, bone block, or arthrodesis.
Schottstaedt, Edwin R.; Larsen, Loren J.; Bost, Frederic C.
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-extremityprosthesis. We have addressed this problem using a novel approach in which persons without amputations are required to perform or learn basic motor tasks using
Stephen A. Wallace; David I. Anderson; Michael Trujillo
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-extremityprosthesis. We have addressed this problem using a novel approach in which persons without…
Wallace, Steve; Anderson, David I.; Trujillo, Michael; Weeks, Douglas L.
|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-extremityprosthesis. We have addressed this problem using a novel approach in which persons without…
Wallace, Steve; Anderson, David I.; Trujillo, Michael; Weeks, Douglas L.
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,
This epidemiologic study of upperextremity musculoskeletal disorders in manufacturing and health care industries collected individual demographic, health, psychosocial, work organizational and physical load exposure information among 733 permanent full-t...
B. Silverstein C. Smith D. Bonauto J. Fan N. Howard P. Spielholz S. Bao
Lipomas are slow-growing soft tissue tumours that rarely reach a size larger than 2 cm. Lesions larger than 5 cm, so-called giant lipomas, can occur anywhere in the body but are seldom found in the upperextremities. The authors present their experiences with eight patients having giant lipomas of the upperextremity. In addition, a review of the literature, and a discussion of the appropriate evaluation and management are included.
Conventional robotic rehabilitation devices for upperextremity are bulky, heavy or lack the ability to provide joint level rehabilitation. Some designs address these issues by replacing rigid links of the exoskeletons with light weight cables. However these designs are controlled in position mode instead of force control which is desirable for rehabilitation. In this paper, a 5 degree-of-freedom cable-driven upper
Dextrous artificial hand design and manipulation is an active research topic. A very interesting practical application is the field of upper limb prosthetics. This paper presents the mechanical design and manipulation aspects of the MANUS-HAND project to develop a multifunctional upper limb prosthesis. The kinematics of our design makes use of the so-called underactuated principle and leads to an innovative
José Luis Pons Rovira; Eduardo Rocon De Lima; R. Ceres; D. Reynaerts; B. Saro; S. Levin; W. Van Moorleghem
There has been a revival of interest in the interaction between arm exercise and ventilation. Although arm ergometry continues to be the gold standard for the testing and training of upperextremities, an increasingly larger body of evidence indicates a more important role for the testing and training of upperextremities in forms that more closely resemble their physiologic adaptation in humans. As our knowledge of the functional anatomy of shoulder girdle muscles improves, so will our capacity to apply this knowledge in more rational, effective exercise regimens. PMID:8088097
All skiers with upperextremity injuries seen at the Henry Ford Hospital between 1983 and 1986 were evaluated in terms of age, sex, skill of the skier, type of snow conditions, pole type, grip type, direction of fall, and mechanism of injury. Our primary objective was to evaluate whether the type of pole used had an effect on the injury
This study identified clinical (e.g., etiology) and demographic factors related to prosthesis use in persons with upper- and lower-limb amputation (ULA and LLA, respectively) and the effect of phantom limb pain (PLP) and residual limb pain (RLP) on prosthesis use. A total of 752 respondents with LLA and 107 respondents with ULA completed surveys. Factors related to greater use (hours per day) for persons with LLA included younger age, full- or part-time employment, marriage, a distal amputation, an amputation of traumatic etiology, and an absence of PLP. Less use was associated with reports that prosthesis use worsened RLP, and greater prosthesis use was associated with reports that prosthesis use did not affect PLP. Having a proximal amputation and reporting lower average PLP were related to greater use in hours per day for persons with an ULA, while having a distal amputation and being married were associated with greater use in days per month. Finally, participants with LLA were significantly more likely to wear a prosthesis than those with ULA. These results underscore the importance of examining factors related to prosthesis use and the differential effect that these variables may have when the etiology and location of amputation are considered.
Raichle, Katherine A.; Hanley, Marisol A.; Molton, Ivan; Kadel, Nancy J.; Campbell, Kellye; Phelps, Emily; Ehde, Dawn; Smith, Douglas G.
Background: The prosthetic rejection rates in children with an upper limb transversal reduction deficiency are considerable. It is unclear whether the timing of the first prescription of the prosthesis contributes to the rejection rates. Objective: To reveal whether scientific evidence is available in literature to confirm the hypothesis that the first prosthesis of children with an upper limb deficiency should
M. Meurs; C. G. B. Maathuis; C. Lucas; M. Hadders-Algra; Sluis van der C. K
Upperextremity deformity of ischemic contracture usually includes elbow flexion, forearm pronation, wrist flexion, thumb flexion and adduction, digital metacarpophalangeal joint extension, and interphalangeal joint flexion. Treatment of mild contractures consists of either nonoperative management with a comprehensive rehabilitation program (to increase range of motion and strenght) or operative management consisting of infarct excision or tendon lengthening. Treatment of moderate-to-severe contractures consists of release of secondary nerve compression, treatment of contractures (with tendon lengthening or recession), tendon or free-tissue transfers to restore lost function, and/or salvage procedures for the severely contracted or neglected extremity. PMID:9742427
Background: Upperextremity composite tissue defects may result from trauma, tumor resection, infection, or congenital malformations.\\u000a When reconstructing these defects the ultimate objectives are to provide adequate soft tissue protection of vital structures,\\u000a and to provide optimal functional and esthetic outcomes. The development of clinical microsurgery has added a large number\\u000a of treatment options to the trauma surgeon's armamentarium – primarily
Iain Whitaker; Ian C. Josty; Vera C. van-Aalst Jr; Joseph C. Banis; John H. Barker
Opinion statement The goals of treating patients with upper-extremity deep vein thrombosis (UEDVT) are to relieve acute symptoms of venous occlusion,\\u000a prevent pulmonary embolism, reduce the likelihood of recurrent thrombosis, and avoid the development of postphlebitic syndrome.\\u000a Although the details of management differ, depending on the underlying cause and precipitating factors, anticoagulant therapy\\u000a should be the first-line treat-ment of choice in
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 upperextremity reconstruction. Seventeen computed tomography angiograms were obtained in 14 patients over a 20-month period. All studies were obtained on
M. A. Bogdan; M. B. Klein; G. D. Rubin; T. R. McAdams; J. Chang
1. Elements critical to a successful medical management program include cumulative trauma disorder (CTD) surveillance, conditioning and rehabilitation programs, and familiarity with OSHA recordkeeping requirements, in addition to recognition, evaluation, and treatment. 2. Occupational health care providers (HCPs) can identify high risk departments, production lines, or jobs through the passive and/or active surveillance systems. 3. The HCP should perform a CTD evaluation of employees assigned to jobs with known ergonomic hazards or areas found to have CTD problems by the surveillance system. These evaluations should consist of a medical and occupational history, and a physical examination of the upperextremities. 4. The treatment algorithm emphasizes that a) symptomatic employees need follow up to determine the effectiveness of the prescribed treatments, b) employees with severe symptoms, positive physical findings, or disorders resistant to treatment need to be referred to a physician for further evaluation, and c) conservative therapy deserves an adequate trial before surgical intervention is contemplated. PMID:1550621
The Pediatric Outcomes Data Collection Instrument (PODCI) questionnaire was used to quantify functional abilities of a group of unilateral upperextremity deficiency (U-UED) patients and compare them with "normal" control children. Sixty-four consecutive patients with U-UED were assessed. Parents and adolescent (ages 11-21) patients responded. Underlying diagnosis, amputation level, and type of prosthesis were recorded. Scores were compared for congenital versus traumatic etiologies for patients with various amputation levels, and for patients using prostheses versus those not using prostheses. In both parent and patient responses, PODCI scores were significantly lower than "normal" for upperextremity function and sports. Scores were similar for congenital and acquired amputees. Responses from adolescent patients showed progressively decreasing scores for upperextremity, transfers, sports, and global function with progressively proximal amputation levels. Patients using prostheses with different terminal devices did not significantly differ. Parent responses for prosthesis wearers showed lower comfort/pain scores (ie, increased pain) than non-prosthesis wearers, but no significant differences in function, including upperextremity function. PMID:15832164
Lerman, Joel A; Sullivan, Elroy; Barnes, Douglas A; Haynes, Richard J
Objective To assess prosthetic use by upperextremity amputees, and their difficulties with prostheses in activities of daily living and occupations. Method This study is based on a survey of 307 subjects, who were using prostheses manufactured in the Center of Prosthetics and Orthotics. The survey questionnaire included items about general demographic characteristics, side and level of amputation, type of prosthesis and its use, and difficulties in the activities of daily living, employment and driving. Results The most common type of prosthesis was the cosmetic hand type (80.2%). There were no statistically significant correlations between satisfaction with prosthesis and the amputation level or type of prosthesis. The most common difficulties in daily living activities experienced by amputees were lacing shoes, removing bottle-tops with a bottle opener, and using scissors. Only 7.3% of amputees received rehabilitation services. Less than half of the amputees (44.7%) used their prostheses for eight or more hours a day, and 76.9% used their prostheses for regular or irregular cosmetic purposes. After amputation, most of the respondents (69.0%) became unemployed or changed workplaces. Conclusion In our study, respondents preferred cosmetic usage to functional usage. Only 30.0% of respondents reported satisfaction with their prostheses. Many of the amputees had difficulties in complex tasks and either changed jobs or became unemployed. Clerical workers were the occupation group, which was most likely to return to work. The development of a more functional prosthetic hand and additional rehabilitation services are required.
Jang, Chul Ho; Yang, Hea Eun; Lee, Seon Yeong; Kwon, Ji Won; Yun, Bong Duck; Choi, Jae Yung; Kim, Seon Nyeo; Jeong, Hae Won
Objective: Upperextremity (UE) transplantation is the most commonly performed composite tissue allotransplantation worldwide. However, there is a lack of imaging standards for pre- and posttransplant evaluation. This study highlights the protocols and findings of UE allotransplantation toward standardization and implementation for clinical trials. Methods: Multimodality imaging protocols for a unilateral hand transplant candidate and a bilateral mid-forearm level UE transplant recipient include radiography, computed tomography (CT), magnetic resonance (MR) imaging, catheter angiography, and vascular ultrasonography. Pre- and posttransplant findings, including dynamic CT and MR performed for assessment of motor activity of transplanted hands, are assessed, and image quality of vessels and bones on CT and MR evaluated. Results: Preoperative imaging demonstrates extensive skeletal deformity and variation in vascular anatomy and vessel patency. Posttransplant images confirm bony union in anatomical alignment and patency of vascular anastomoses. Mild differences in rate of vascular enhancement and extent of vascular networks are noted between the 2 transplanted limbs. Dynamic CT and MR demonstrate a 15° to 30° range of motion at metacarpophalangeal joints and 90° to 110° at proximal interphalangeal joints of both transplanted hands at 8 months posttransplant. Image quality was slightly better for CT than for MR in the first subject, while MR was slightly better in the second subject. Conclusion: Advanced vascular and musculoskeletal imaging play an important role in surgical planning and can provide novel posttransplantation data to monitor the success of the procedure. Implementation of more standardized protocols should enable a more comprehensive assessment to evaluate the efficacy in clinical trials. PMID:23943677
George, Elizabeth; Mitsouras, Dimitrios; Kumamaru, Kanako K; Shah, Nehal; Smith, Stacy E; Schultz, Kurt; Deaver, Pamela M; Mullen, Katherine M; Steigner, Michael L; Gravereaux, Edwin C; Demehri, Shadpour; Bueno, Ericka M; Talbot, Simon G; Pomahac, Bohdan; Rybicki, Frank J
Stroke remains the leading cause of adult disability, with upperextremity motor impairments being the most promi- nent functional deficit in surviving stroke victims. The de- velopment of animal models of upperextremity dysfunction after stroke has enabled investigators to examine the neural mechanisms underlying rehabilitation-dependent motor re- covery as well as the efficacy of various adjuvant therapies for enhancing
Jeffrey A. Kleim; Jeffery A. Boychuk; DeAnna L. Adkins
Quantification of rehabilitation progress is necessary for accurately assessing clinical treatments. A three-dimension (3D) upperextremity (UE) kinematic model was developed to obtain joint angles of the trunk, shoulder and elbow using a Vicon motion analysis system. Strict evaluation confirmed the system's accuracy and precision. As an example of application, the model was used to evaluate the upperextremity movement
Brooke Hingtgen; John R. McGuire; Mei Wang; Gerald F. Harris
We report the development and initial evaluation of a device for robotic assisted upperextremity repetitive therapy (RUPERTtrade). Intense repetitive physical therapies provided by individualized interaction between the patient and a rehabilitation specialist to overcome upperextremity impairment after stroke are beneficial, however, they are expensive and difficult to evaluate quantitatively and objectively. The need is urgent and growing for
Jiping He; E. J. Koeneman; R. S. Schultz; D. E. Herring; J. Wanberg; H. Huang; T. Sugar; R. Herman; J. B. Koeneman
Javelin throwing is technically demanding. Sequences of upper and lower extremity motions are important for javelin throwing performance. The purpose of this study was to determine the general sequences of upper and lower extremity motions of elite male and female javelin throwers. Three-dimensional kinematic data were collected for 32 female and 30 male elite javelin throwers during competitions. Shoulder, elbow,
In most upper-extremity rehabilitation robotics, several components affect the therapy outcome. A common component is gravity compensation which alleviates upper-extremity movements. Gravity compensation by itself could improve motor control further or faster, separate from other effects of robotic therapy. To investigate the rehabilitation value of gravity compensation separately, we created the dedicated gravity compensation system, Freebal. The sling systems with
Amo H. A. Stienen; E. E. G. Hekman; G. B. Prange; M. J. A. Jannink; A. M. M. Aalsma; H. Van der Kooij
Upper-extremity deep venous thrombosis (UEDVT) is an increasingly important clinical problem in children. These events are classified as primary or secondary, with the latter being the most common and usually associated with the presence of a central venous line. Among primary UEDVT, the so-called Paget-Schroetter syndrome, effort-related or exercise-induced upper-extremity thrombotic event represents an extremely rare finding that has never
Leonardo R. Brandão; Suzan Williams; Walter H. A. Kahr; Clodagh Ryan; Michael Temple; Anthony K.C. Chan
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 biomechanical advantages attributed to the reverse shoulder design and show an increase in activity from the deltoid, teres minor, and coracobrachialis muscles. The glenohumeral joint reaction forces estimated for the reverse shoulder are up to 15% lower than those in the normal shoulder anatomy. The data presented here complements previous publications, which, all together, allow researchers to build a biomechanical model of the upper limb including a reverse shoulder prosthesis. PMID:24008920
Acute embolism of the upperextremity is a relatively infrequent event compared to the lower extremity, but it will affect the function of the limb involved and may occasionally lead to amputation. Most upperextremity emboli are of cardiac origin, with the remainder arising from subclavian aneurysm, occlusive disease, or iatrogenic causes. Rarely, crutch-induced repetitive trauma of an upperextremity can produce recurrent embolic events. Frequently, this process is initially diagnosed and treated as a brachial artery embolism; such a misdiagnosis is associated with recurrent embolism. We report herein two uncommon cases of axillobrachial arterial injuries secondary to crutch trauma as a source of recurrent emboli to an upperextremity. PMID:20097518
\\u000a The objectives of this chapter are to review applications and describe protocols of duplex ultrasound arterial mapping (DUAM)\\u000a of the upperextremities. A literature search revealed multiple arterial applications of duplex ultrasound in the upperextremity.\\u000a Situations in which ultrasound may replace arteriography or other techniques actually employed are also mentioned.The examples\\u000a cited expand the role of the noninvasive vascular
The objectives of this chapter are to review applications and describe protocols of duplex ultrasound arterial mapping (DUAM)\\u000a of the upperextremities. A literature search revealed multiple arterial applications of duplex ultrasound in the upperextremity.\\u000a Situations in which ultrasound may replace arteriography or other techniques actually employed are also mentioned. The examples\\u000a cited expand the role of the noninvasive
Background Upperextremity symptoms associated with use of computers and other upperextremity activities are common in students. Research on these disorders requires psychometrically sound measures of health-related student role function; no such meas- ure is available currently. Methods Based upon input from students and clinicians, we developed a 10-item scale to measure student health-related role function. The measure was
Jeffrey N. Katz; Benjamin C. Amick; Nathaniel Hupert; Marissa C. Cortes; Anne H. Fossel; Michelle Robertson; Christopher M. Coley
Forty1 tournament-level tennis players with expert serve technique volunteered to have their serve evaluated to determine relationships between anthropometric data, extremity strength, and functional serve velocity. All players underwent a complete physical examination, a video taped serve analysis, a radar measurement of serve velocity, and a series of upperextremity strength measurements. Statistical analysis was performed to determine which factors
David B. Cohen; Michael A. Mont; Kevin R. Campbell; Barry N. Vogelstein; John W. Loewy
We analyzed the long-term functional outcome in patients with major upperextremity replantations. Two patients had amputations proximal to the elbow joint, two had elbow disarticulations and five patients had amputations at the forearm. The mean age was 24 and the mean follow-up time was 18 years. Six patients have undergone secondary operations. The mean grip strength was restored to 34% of the contralateral extremity. Protective sensation was restored in all patients. According to Chen's functional recovery scale, five patients had excellent, two had good, and two had fair results. Grip strength, two-point discrimination, ranges of motion and Chen's scale did not improve after 5 years. However, Semmes-Weinstein monofilament testing and cold intolerance continued to improve up to 10 and 12 years, respectively. Replantation of an upperextremity proximal to the wrist joint satisfactorily restored the upperextremity function. PMID:22045198
An upperextremityprosthesis for a forequarter amputee was laboratory evaluated. The evaluation consisted of an observation of the functional characteristics with emphasis on cable force and excursion levels, battery life, and cyclic tests. The results o...
Clinical outcomes following upperextremity surgery among workers' compensation patients have traditionally been found to be worse than those of non-workers' compensation patients. In addition, workers' compensation patients take significantly longer to return to their jobs, and they return to their preinjury levels of employment at a lower overall rate. These unfavorable prognoses may stem from the strenuous physical demands placed on the upperextremity in this group of patients. Further, there is a potential financial benefit within this patient population to report severe functional disability following surgery. Orthopaedic upperextremity surgeons who treat workers' compensation patients should be aware of the potentially prolonged period before return to work after surgical intervention and should counsel this group of patients accordingly. Vocational training should be considered if a patient's clinical progress begins to plateau. PMID:23378370
Gruson, Konrad I; Huang, Kevin; Wanich, Tony; Depalma, Anthony A
Background Upperextremity electrical burns are a cause of major morbidity and disability in affected individuals. Anecdotally, we have\\u000a noted changes in the presentation of cases to our institution. We sought to compare current data on upperextremity electrical\\u000a burns in children with our previously published historical data.\\u000a \\u000a \\u000a \\u000a \\u000a Methods Using the Shriners Hospital Boston and American Burn Association databases, we retrospectively analyzed
Angio-and phlebography, as well as pathomorphological studies were made on epiphyseal cartilaginous plate, diaphyseal bone tissue and skin of patients with partial gigantism of upperextremities. Significant developmental anomalies were found in the formation of palmar arches and digital arteries, as well as hypoplasia and aplasia of deep brachial and antebrachial veins. Light and electron microscopy revealed epiphyseal plate dystrophy and dysplasia, tubular bone osteoporosis, subcutaneous fat hyperplasia. The data obtained suggest a pathogenetic relationship between the vascular formation and the development of some malformations and growth abnormalities of upperextremities. PMID:3778237
Objective To compare the efficacy of a repetitive task specific practice regimen integrating a portable, electromyography-controlled brace called the “Myomo” versus usual care repetitive task specific practice in subjects with chronic, moderate upperextremity impairment. Subjects 16 subjects (7 males; mean age = 57.0 ± 11.02 years; mean time post stroke = 75.0 ± 87.63 months; 5 left-sided strokes) exhibiting chronic, stable, moderate upperextremity impairment. Interventions Subjects were administered repetitive task specific practice in which they participated in valued, functional tasks using their paretic upperextremities. Both groups were supervised by a therapist and were administered therapy targeting their paretic upperextremities that was 30-minutes in duration, occurring 3 days/week for 8 weeks. However, one group participated in repetitive task specific practice entirely while wearing the portable robotic while the other performed the same activity regimen manually.. Main Outcome Measures The upperextremity Fugl-Meyer, Canadian Occupational Performance measure and Stroke Impact Scale were administered on two occasions before intervention and once after intervention. Results After intervention, groups exhibited nearly-identical Fugl-Meyer score increases of ? 2.1 points; the group using robotics exhibited larger score changes on all but one of the Canadian occupational performance measure and Stroke Impact Scale subscales, including a 12.5-point increase on the Stroke Impact Scale recovery subscale. Conclusions Findings suggest that therapist-supervised repetitive task specific practice integrating robotics is as efficacious as manual in subjects with moderate upperextremity impairment.
Cybex II lsokinetic Dynamometer (Lumex Corp, Ron konkoma, NY) tests for the upperextremity strength of eight professional baseball players, together with radar gun measurements of their individual throwing speeds, were subjected to statistical analysis. Results of simple and multiple regression analysis showed a relationship between the strength of the elbow exten sion and wrist extension movements and throwing speed.
Larry R. Pedegana; Richard C. Elsner; Diana Roberts; Janice Lang; Vern Farewell
Paget-Schroetter syndrome or effort-related upperextremity deep vein thrombosis is a rare condition that usually afflicts young healthy individuals, most commonly males. The cause is multifactorial but almost always involves extrinsic compression of the subclavian vein at the thoracic inlet, causing venous stenosis from repetitive trauma. The diagnosis of this condition may be difficult, and its delay may contribute to
Leonardo R. Brandão; Suzan Williams; Walter H. A. Kahr; Clodagh Ryan; Michael Temple; Anthony K.C. Chan
We analyzed the long-term functional outcome in patients with major upperextremity replantations. Two patients had amputations proximal to the elbow joint, two had elbow disarticulations and five patients had amputations at the forearm. The mean age was 24 and the mean follow-up time was 18 years. Six patients have undergone secondary operations. The mean grip strength was restored to
The literature indicates that tourniquet-induced neurological injuries are relatively common and frequently occur at a subclinical level. In order to evaluate the pressure transmitted to the major peripheral nerves of the arm by an externally applied pneumatic tourniquet, a fully implantable biomedical pressure transducer was placed adjacent the radial, median and ulnar nerves in six cadaver upperextremities of average
B. GRAHAM; M. J. BREAULT; J. A. McEWEN; R. W. McGRAW
Eosinophilic fasciitis is a rare inflammatory disease associated with peripheral eosinophilia, hyper-gammaglobulinaemia and contractures of any joint in the upperextremity. Although conservative treatments are generally advocated, this study reports the results of surgical intervention. Four patients aged from 20 to 48 years underwent fasciectomy followed by oral administration of prednisolone. All presented with contractures of digits, wrist, or elbow
The purpose of this study was to investigate the effect of upperextremity fatigue on basketball shooting accuracy. Twenty-four elite male basketball players from 2 teams the top 3 Taiwan High Schools were chosen as subjects. After a warm-up and proper practice, they were asked to shoot from 3 varied distance positions before and after fatigue protocols. The protocols used
Wan-ehin Chen; Shin-Liang Lo; Yun-Kwan Lee; Jen-Sen Wang
Spontaneous venous aneurysms of the upperextremities and neck are rare and typically asymptomatic. We present the first reported case of a symptomatic, primary upperextremity venous aneurysm in a patient who initially presented with pulmonary emboli. A 22-year-old patient was admitted with chest pain, dyspnea, and a right axillary mass. Computed tomography revealed diffuse, bilateral pulmonary emboli in addition to a thrombosed axillary vein. Venography confirmed the diagnosis, and also revealed a subclavian vein stenosis at the crossing of the first rib. Pharmacomechanical thrombolysis, catheter-directed thrombolysis, and venoplasty were performed with adequate flow restoration, also revealing the presence of a previously thrombosed proximal brachial/distal axillary venous aneurysm. Hematologic testing showed a positive and persistent lupus anticoagulant. The patient declined surgical reconstruction and opted for long-term anticoagulation. At 24 months, the patient continued to remain symptom-free. PMID:23380560
Wallace, Justin R; Baril, Donald T; Chaer, Rabih A
Atrial myxoma is the most common benign tumor of the heart. Patients who have atrial myxoma usually present with cardiac obstruction, arrhythmia, or peripheral embolization. We encountered an unusual case of acute upperextremity ischemia due to a massive atrial myxoma in a young man. A 38-year-old man was admitted to our hospital with an acute onset of severe, right upperextremity pain and paralysis while working. Neurologic examination yielded normal results, but the patient showed no palpable right radial or ulnar artery. Routine sonographic evaluation revealed acute aortic embolism in his right brachial artery. Because of his young age and otherwise healthy condition, we decided to perform transthoracic echocardiography, which showed a huge left atrial tumor, which we suspected to be myxoma. We then performed urgent concurrent open heart surgery and embolectomy to avoid further embolism. The microscopic findings of the resected tumor and embolism specimens were myxoma. He was discharged without complications. PMID:22293305
Erythromelalgia is known as a rare syndrome of unknown etiology, characterized by redness with burning pain, edema associated\\u000a with increased skin temperature in the upper and\\/or lower extremities. Various treatments such as drug therapies and sympathetic\\u000a blockade were reported. We report two cases including a 57-year-old woman and a 64-year-old woman, showing the successful\\u000a clinical outcome by bilateral thoracoscopic sympathectomy.
Upper-extremity venous thrombosis often presents as unilateral arm swelling. The differential diagnosis includes lesions compressing the veins and causing a functional venous obstruction, venous stenosis, an infection causing edema, obstruction of previously functioning lymphatics, or the absence of sufficient lymphatic channels to ensure effective drainage. The following recommendations are made with the understanding that venous disease, specifically venous thrombosis, is the primary diagnosis to be excluded or confirmed in a patient presenting with unilateral upper-extremity swelling. Contrast venography remains the best reference-standard diagnostic test for suspected upper-extremity acute venous thrombosis and may be needed whenever other noninvasive strategies fail to adequately image the upper-extremity veins. Duplex, color flow, and compression ultrasound have also established a clear role in evaluation of the more peripheral veins that are accessible to sonography. Gadolinium contrast-enhanced MRI is routinely used to evaluate the status of the central veins. Delayed CT venography can often be used to confirm or exclude more central vein venous thrombi, although substantial contrast loads are required. The ACR Appropriateness Criteria(®) are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:22954541
Desjardins, Benoit; Rybicki, Frank J; Kim, Hyun S; Fan, Chieh-Min; Flamm, Scott D; Gerhard-Herman, Marie D; Kalva, Sanjeeva P; Koss, Scott A; Mansour, M Ashraf; Mohler, Emile R; Narra, Vamsi R; Schenker, Matthew P; Tulchinsky, Mark; Weiss, Clifford
Objective To investigate the association between disability and personal\\/lifestyle, medical, and psychosocial risk factors for upper\\u000a extremity musculoskeletal symptoms and disorders (UEMSDs) in medical transcriptionists. Methods A web-based survey involving the Disabilities of the Arm, Shoulder and Hand (DASH), Perceived Stress Scale (PSS) and Overall\\u000a Job Satisfaction (OJS) questionnaires of all medical transcriptionists working at a large healthcare facility. Results
Russell GelfmanTimothy; Timothy J. Beebe; Peter C. AmadioDirk; Dirk R. Larson; Jeffrey R. Basford
Paralysed upperextremity muscles of 24 tetraplegie patients were examined to determine whether their lower motor neuron was intact. Primary emphasis was placed on the forearm finger flexor muscles (Flexor Digitorum Superficialis and Flexor Digitorum Profundus) and finger extensor muscles (Extensor Digitorum Communis and Extensor Indicis). It was found that the vast majority of these muscles in C4, C5 and
Along with resurgence of physical activity during these fitness conscious times, there is increasing participation by people of all ages in sporting activities. Enrollment in organized and recreational sports among young adults and children has increased with as many as 30% of adolescents participating in competitive high school athletics. Despite improvements in equipment, the number of sports-related injuries presenting for medical attention has increased. Injuries to the upperextremities account for more than 25% of all sports-related injuries, but receive disproportionately less attention compared to lower extremity injuries. If neglected, upperextremity injuries can end the career of a professional athlete and cause sufficient damage to hinder daily activities in a recreational participant. Overuse syndromes, brought on by repetitive microtrauma are sports-specific, and often challenging to diagnose. Accurate diagnosis requires a thorough understanding about mechanism of injury, site of pain, and knowledge of the sport. After a thorough physical exam, a variety of radiographic testing is often necessary to promptly diagnose and manage the injury so athletes can return to competition as soon as possible. PMID:9467189
Introduction Upperextremity musculoskeletal disorders influence workers’ quality of life. Workstyle may be one factor to deal with in\\u000a workers with pain in the upperextremity. The objective of this study was to determine if workstyle is a mediating factor\\u000a for upperextremity pain in a changing work environment of office workers over time. Methods Office workers with upperextremity
Eline M. Meijer; Judith K. Sluiter; Monique H. W. Frings-Dresen
Assessments of upperextremity performance typically include qualitative rather than quantitative measures of functional ability. Kinematic analysis is an objective, discriminative measure that quantifies movement biomechanics; however, the use within the poststroke impaired upperextremity is not well established. The purpose of this study was to examine the reliability of upperextremity kinematics in 18 individuals with stroke and 9
Tara S. Patterson; M. D. Bishop; T. E. McGuirk; A. Sethi; L. G. Richards
The temporal relationship between work and signs and symptoms of upperextremity musculoskeletal disorders among workers at risk is relatively unexplored. The study focused on changes in upperextremity circumference, volume, sensory threshold, and reported symptoms after work and rest. All workers (N=50) performed a repetitive poultry processing task and had exhibited upperextremity signs and symptoms in baseline testing
Christine A. Feely; Mary K. Seaton; Cynthia L. Arfken; Dorothy F. Edwards; V. Leroy Young
The acute residual effect of whole body vibration (WBV) on upperextremity 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 upperextremity 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
Stroke remains the leading cause of adult disability, with upperextremity motor impairments being the most prominent functional deficit in surviving stroke victims. The development of animal models of upperextremity dysfunction after stroke has enabled investigators to examine the neural mechanisms underlying rehabilitation-dependent motor recovery as well as the efficacy of various adjuvant therapies for enhancing recovery. Much of this research has focused on rat models of forelimb motor function after experimentally induced ischemic or hemorrhagic stroke. This article provides a review of several different methods for inducing stroke, including devascularization, photothrombosis, chemical vasoconstriction, and hemorrhagia. We also describe a battery of sensorimotor tasks for assessing forelimb motor function after stroke. The tasks range from measures of gross motor performance to fine object manipulation and kinematic movement analysis, and we offer a comparison of the sensitivity for revealing motor deficits and the amount of time required to administer each motor test. In addition, we discuss several important methodological issues, including the importance of testing on multiple tasks to characterize the nature of the impairments, establishing stable baseline prestroke motor performance measures, dissociating the effects of acute versus chronic testing, and verifying lesion location and size. Finally, we outline general considerations for conducting research using rat models of stroke and the role that these models should play in guiding clinical trials. PMID:17712223
Kleim, Jeffrey A; Boychuk, Jeffery A; Adkins, DeAnna L
The objective of the presented study was to motile that cumulative trauma disorders of the upperextremities in recent years leads to arising morbidity and applications for compensation for occupational diseases. This rise is probably not associated with an increase of this disorder but a different awareness of workers and doctors as regards the possible adverse effect of forceful and frequently repeated movements of the upperextremities on their function, extended diagnostics and notification. It is important to master the diagnosis of these diseases and interpretation of auxiliary examinations to prevent inadequate payment of damages to the affected subjects and on the other hand to prevent breakdown or in adequate function of the financial provisions in this area. A number of syndromes of the mentioned conditions has very few objective symptoms and abnormal results of auxiliary examinations. The diagnosis of stenotic syndromes has a compared with other disorders great support in electrophysiological techniques, their high sensitivity and specificity (1, 15). The authors discuss therefore their problems and suggest electrophysiological criteria of medium grade affections in the carpal tunnel syndrome which is the condition for compensation for occupational disease and which so far was defined only roughly in this country. PMID:10510541
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 and demonstrates the importance of cranial ontogeny in evaluating dinosaur diversity and taxonomy. These growth stages reflect a continuum rather than specific developmental steps defined by “known” terminal morphologies.
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 upperextremity deep venous thrombosis (DVT) who was found to have pulmonary embolism.
Upperextremity deep venous thrombosis (UEDVT) occurs either spontaneously, as a consequence of strenuous upper limb activity (also known as the Paget-Schroetter syndrome) or secondary to an underlying cause. Primary and secondary UEDVT differs in long-term sequelae and mortality. This review will focus on the clinical presentation, risk factors, diagnosis, and treatment strategies of UEDVT. In the period from January to October 2012 an electronic literature search was performed in the PubMed/MEDLINE database, and 27 publications were included. Clinical presentation: swelling, pain and functional impairment are typical symptoms of UEDVT, although completely asymptomatic cases have been described. However life-threatening, massive pulmonary embolism (PE) can also be a sign of UEDVT. Risk factors: for the primary condition anatomical abnormalities (Thoracic Outlet Syndrome, TOS) may dispose to the condition. Malignancy and therapeutic interventions are major risk factors for the secondary deep vein thrombosis in combination with the patient's characteristics, comorbidities and prior history of deep vein thrombosis. Complications: recurrent deep venous thrombosis, pulmonary embolism and Post Thrombotic Syndrome (PTS) are the major complications after UEDVT. PTS is a chronic condition leading to significant functional disability and impaired quality of life. Diagnosis: compression ultrasonography is noninvasive and the most frequently used objective test with a high accuracy in experienced hands. Treatment modalities and strategies: the treatment modalities include anticoagulation therapy, catheter-directed thrombolysis, surgical decompression, percutaneous transluminal angioplasty and stenting and they may be combined. However, the optimal treatment and timing of treatment remains controversial. Early diagnosis and treatment is essential to prevent PTS in primary UEDVT; however, there is no consensus on which treatment is the best. Anticoagulation is still considered the treatment of choice for at least 3-6 months, until Randomized Controlled Trials may have demonstrated otherwise. PMID:23903301
Background—One third of cases of upper-extremity deep vein thrombosis (DVT) are primary, ie, they occur in the absence of central venous catheters or cancer. Risk factors for primary upper-extremity DVT are not well established, and the recurrence rate is unknown. Methods and Results—We studied 115 primary upper-extremity DVT patients and 797 healthy controls for the presence of thrombophilia due to
Ida Martinelli; Tullia Battaglioli; Paolo Bucciarelli
Gastroenterologists are at increased risk for developing recurrent thumb, hand, and elbow pain due to colonoscopy procedures. We evaluated forearm muscle loads and wrist postures during routine colonoscopy (N=12 gastroenterologists) to understand distal upperextremity musculoskeletal risk factors associated with the 4 different subtasks of colonoscopy. Bilateral forearm extensor carpiradialis (ECR) and flexor digitorum superficialis (FDS) surface electromyography and bilateral wrist postures were recorded continuously. The mean duration of colonoscopy was 24.2 (± 12.1) minutes and was dominated by the withdrawal subtask [13.7 (± 8.8) min] followed by right colon insertion [5.8 (± 4.8) min], left colon insertion [3.5 (± 3.1) min], and retroflexion [1.2 (± 2.1) min]. Median (APDF50) and peak (APDF90) left forearm muscle activity was significantly greater than right forearm muscle activity across all subtasks. Median and peak ECR muscle activity was significantly greater during the left and right colon insertion subtasks compared to retroflexion. Both wrists were predominantly in wrist extension during all phases of colonoscopy. The left forearm muscle activity was higher than right forearm activity due to differences in wrist posture and grip force. The risk factors for the left hand may be reduced with alternative designs and support mechanisms for the colonoscope head. PMID:22317441
ABSTRACT Purpose: The purpose of this review was to present an analysis of the literature of the outcome studies reported in patients following traumatic upper-extremity (UE) nerve injuries (excluding amputation), to assess the presence of an association between neuropathic pain and outcome in patients following traumatic UE nerve injuries, and to provide recommendations for inclusion of more comprehensive outcome measures by clinicians who treat these patients. Summary of Key Points: A Medline and CINAHL literature search retrieved 48 articles. This review identified very few studies of patients with peripheral nerve injury that reported neuropathic pain. When pain was reported, visual analogue or numeric rating scales were most frequently used; standardized questionnaires measuring pain or psychosocial function were rarely administered. Recent evidence shows substantial long-term disability and pain in patients following peripheral nerve injury. Recommendation: To better understand neuropathic pain in patients following peripheral nerve injury, future outcome studies should include valid, reliable measures of physical impairment, pain, disability, health-related quality of life, and psychosocial functioning.
Background Exercise for people with COPD has focused on leg training, such as walking and cycling. The role and effectiveness of arm training has not been investigated in detail. This review was undertaken to examine the literature for the effectiveness of upperextremity exercise on arm exercise capacity and arm strength in people with COPD. Methods Trials relating to arm endurance and strength training in COPD were located by searching electronic databases and screening the reference lists of pertinent articles. Where possible, effect sizes and 95% CI were determined and meta-analysis used. Results The search strategy yielded 24 articles. Unsupported arm training improved arm endurance capacity (standard mean difference [SMD] =1.25; 95% CI=0.16 to 2.66) and was the optimal mode of arm endurance training. Combined unsupported and supported arm training was also found to have a large positive effect on peak arm exercise capacity (SMD=1.27; 95% CI=0.59 to 1.94). In addition arm strength training produced moderate improvements in arm strength (SMD=0.46; 95% CI=0.10 to 0.81). Conclusion This review suggests that in the short term, arm endurance training improves arm exercise capacity and arm strength training improves arm strength. Further research is required, in people with COPD, to investigate the long-term effects of arm training.
Background The current treatment intervention study determined the effect of coupled bilateral training (i.e., bilateral movements and EMG-triggered neuromuscular stimulation) and resistive load (mass) on upperextremity motor recovery in chronic stroke. Methods Thirty chronic stroke subjects were randomly assigned to one of three behavioral treatment groups and completed 6 hours of rehabilitation in 4 days: (1) coupled bilateral training with a load on the unimpaired hand, (2) coupled bilateral training with no load on the unimpaired hand, and (3) control (no stimulation assistance or load). Results Separate mixed design ANOVAs revealed improved motor capabilities by the coupled bilateral groups. From the pretest to the posttest, both the coupled bilateral no load and load groups moved a higher number of blocks and demonstrated more regularity in the sustained contraction task. Faster motor reaction times across test sessions for the coupled bilateral load group provided additional evidence for improved motor capabilities. Conclusions Together these behavioral findings lend support to the contribution of coupled bilateral training with a load on the unimpaired arm to improved motor capabilities on the impaired arm. This evidence supports a neural explanation in that simultaneously moving both limbs during stroke rehabilitation training appears to activate balanced interhemispheric interactions while an extra load on the unimpaired limb provides stability to the system.
Cauraugh, James H.; Coombes, Stephen A.; Lodha, Neha; Naik, Sagar K.; Summers, Jeffery J.
Subcutaneous emphysema of the upperextremity is rare. Crepitation on physical examination and visible gas on radiographs raise the concern of gas gangrene due to gas-producing bacteria. Rapid establishment of a differential diagnosis is necessary to initiate proper treatment. We present a case of subcutaneous emphysema after elbow arthroscopy caused by a noninfectious genesis. A 59-year-old woman with loose bodies in her left elbow due to mild degenerative joint disease and restricted range of motion was offered an elbow arthroscopy with removal of loose bodies and arthrolysis. Postoperatively, the elbow was actively put alternatively in maximum extension and flexion. On the first postoperative day, rapidly ascending swelling and subcutaneous crepitation starting from the hand to the forearm were noted. There was no clinical evidence of infection. Radiographs showed subcutaneous air. Frequent blood tests and clinical evaluation ruled out a potentially life-threatening bacterial infection, and the signs resolved after 1 week without surgical treatment. Presumably, the intensive postoperative range-of-motion exercises led to a sucking in of air into the wound during each movement. This case illustrates that it is important to differentiate nonbacterial from bacterial causes of soft-tissue gas formation to initiate the appropriate treatment. PMID:21616628
Dexel, Julian; Schneiders, Wolfgang; Kasten, Philip
The experience of phantom limb pain, non-painful phantom limb sensation and telescoping was ascertained by questionnaire in a group of upperextremity amputees wearing a functionally effective Sauerbruch prosthesis which permits extensive use of the affected limb and in a group of patients wearing a cosmetic prosthesis that did little to increase the utilization of the amputation stump. The Sauerbruch
Thomas Weiss; Wolfgang H. R. Miltner; Torsten Adler; Lutz Brückner; Edward Taub
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 upperextremities. 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
This study was conducted to establish whether or not a correlation exists between peak torque production of upperextremity (UE) musculature and throwing speed. Eleven professional baseball players were tested for upperextremity peak torque production using a Cybex II Isokinetic Dynamometer. Throwing speed was meas ured with a radar gun. Results of statistical analysis performed on the data indicate
Lyndon R. Bartlett; Mitchel D. Storey; Bart D. Simons
Computer simulations, dummy experiments with a new enhanced upperextremity and small female cadaver experiments were used to analyze the small female upperextremity response under side airbag loading. After establishing a worst case initial position, three tests were performed with the fifth percentile female hybrid III anthropometric test dummy and six experiments with small female cadaver subjects. A new
Stefan M. Duma; Brian M. Boggess; Jeff R. Crandall; Shepard R. Hurwitz; Kazuhiro Seki; Takashi Aoki
|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)|
Woodard, Rebecca J.; Surburg, Paul R.; Lewis, Colleen A.
The purpose of this study is to determine correlation between MR and nuclear medicine flow studies in the evaluation of upperextremity deep venous thrombosis. We retrospectively reviewed MR and radionuclide venography images obtained in 10 patients with suspected upperextremity venous thrombosis. In nine cases there was complete agreement in the identification of thrombus. In one case, MR images
Julia R. Fielding; J. Stevan Nagel; Oliver Pomeroy
Meat cutting has long been associated with a high incidence rate of upperextremity musculoskeletal disorders. This study examined upperextremity 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
Venous thrombosis of the upperextremity is a rare form of thrombosis, accounting for around 4% of all venous thromboses, and for which only a few risk factors are known. This case-control study investigated the effect of coagulation factors on risk of venous thrombosis of the upperextremity. Patients with venous thrombosis of the arm and partner controls were selected
Linda E. Flinterman; Hylckama Vlieg van Astrid; Frits R. Rosendaal; Carine J. M. Doggen
Stress fractures of the upperextremity and thorax are often unrecognized injuries in athletes and nonathletes. The authors reviewed the causative activities and anatomic distribution of rib and upper-extremity stress fractures. Radiographic and clinical information was reviewed for each case to determine anatomic site and causative activity of each stress fracture. Stress fracture, although an uncommon diagnosis outside the lower extremity and lumbar spine, should be included in the differential diagnosis of patients with pain in the ribs and upperextremity. PMID:22955388
The arteries of the upperextremities are increasingly utilized to gain access for angiography, percutaneous coronary interventions, endovascular therapy, and continuous hemodynamic monitoring. Hence, complications after upper-extremity arterial interventions are increasing in incidence. Similarly, the incidence of upper-extremity deep venous thrombosis is increasing as venous access is increasingly achieved with upper-extremity central line placement. Knowledge of the sonographic appearance of these complications is essential as ultrasound is often the only imaging modality used in the evaluation of suspected vascular injury. This pictorial review demonstrates the spectrum of complications observed following vascular procedures in the upperextremities, including thrombosis, hematoma, pseudoaneurysm, arteriovenous fistula, and arterial dissection. Gray-scale, color, and pulsed Doppler imaging findings are described, and pertinent management issues, including endovascular and surgical therapies, are briefly discussed. PMID:23358215
Millet, John D; Gunabushanam, Gowthaman; Ojili, Vijayanadh; Rubens, Deborah J; Scoutt, Leslie M
Introduction Upperextremity musculoskeletal disorders influence workers’ quality of life. Workstyle may be one factor to deal with in workers with pain in the upperextremity. The objective of this study was to determine if workstyle is a mediating factor for upperextremity pain in a changing work environment of office workers over time. Methods Office workers with upperextremity pain filled out a Workstyle questionnaire (WSF) at baseline (n = 110). After 8 and 12 months follow-up assessment took place. Participants were divided into a good and an adverse workstyle group at baseline. The presence of upperextremity pain in both groups was calculated and relative risks were determined. Chi-square tests were used. Results Eight months after baseline, 80% of the adverse and 45% of the good workstyle group reported pain. The relative risk (RR) of having upperextremity pain for the adverse compared to the good workstyle group was 1.8 (95% CI 1.08–2.86) (P = 0.055). Twelve months after baseline, upperextremity pain was more often presented in the adverse workstyle compared to the good workstyle group (RR = 3.0, (95% CI 1.76–5.11), P = 0.003). Twelve months after baseline, 100% of the adverse workstyle group and 33% of the good workstyle group reported pain in the upperextremity. Conclusion Workstyle seems to be a mediating factor for upperextremity pain in office workers in a changing work environment. It is recommended to assess workstyle among office workers with upperextremity pain, and to include workstyle behaviour in treatments.
Objective: The primary goal was to identify the neuro radiological and neurophysiological risk factors for upper extremity hypertonia in patients with severe ischaemic su pratentorial stroke. Design: Inception cohort. Patients: Fortythree consecutive patients with an acute ischaemic supratentorial stroke and an initial upperextre mity paralysis admitted to an academic hospital recruited over a 1.5year period. Main outcome measures: Upperextremity hypertonia
Annette A. van Kuijk; Henk T. Hendricks; Jaco W. Pasman; Berry H. Kremer; Alexander C. Geurts
Proprioception plays a crucial role in enabling humans to move purposively and interact with their physical surroundings. Current technology in upper-limb prostheses, while beginning to incorporate some haptic feedback, does not provide amputees with proprioceptive information about the state of the limb. Thus, the wearer must visually monitor the limb, which is often inconvenient or even impossible for some tasks.
Amy Blank; Allison M. Okamura; Katherine J. Kuchenbecker
Although there have been many advances in electromyography (EMG) signal processing and pattern recognition (PR) for the control of multi-functional upper-limb prostheses, some the outstanding problems need to be solved before practical PR-based prostheses can be put into service. Some of these are the lack of training and deployment protocols and the provision of the tools required. Therefore, we present a preliminary procedure to personalize the prosthesis deployment. In the first step, we record the demographic information of each individual amputee person and their background. In the second step of the protocol, the EMG signals are acquired. PR algorithms and parameters will be chosen in the 3(rd) step of the protocol. In the 4(th) step, the best number of EMG sensors to achieve the maximal performance with a full set of gestures is identified. The final step involves finding the best set of movements that the amputee person can produce with an accuracy > 95% as well as identifying the movements with the worst performance, which would require further training. This proposed approach is validated with 2 transradial amputees. PMID:24111061
Al-Timemy, Ali H; Escudero, Javier; Bugmann, Guido; Outram, Nicholas
A 27-year-old man presents to the emergency department with a 1-day history of severe right upperextremity pain and swelling. The patient's status is post open reduction internal fixation for a left tibial plateau fracture, which was complicated by methicillin-sensitive Staphylococcus aureus osteomyelitis. A peripherally inserted central catheter (PICC) line was subsequently placed for intravenous antibiotic therapy. Emergency department bedside ultrasound examination of both the right axillary vein and subclavian vein near the PICC line tip revealed deep venous thrombosis of both veins. Bedside upperextremity vascular ultrasonography can assist in the rapid diagnosis of upperextremity deep venous thrombosis in the emergency department.
Time and frequency domain features of the surface electromyogram (EMG) signal acquired from multiple channels have frequently been investigated for use in controlling upper-limb prostheses. A common control method is EMG-based motion classification. We propose the use of EMG signal whitening as a preprocessing step in EMG-based motion classification. Whitening decorrelates the EMG signal and has been shown to be advantageous in other EMG applications including EMG amplitude estimation and EMG-force processing. In a study of ten intact subjects and five amputees with up to 11 motion classes and ten electrode channels, we found that the coefficient of variation of time domain features (mean absolute value, average signal length and normalized zero crossing rate) was significantly reduced due to whitening. When using these features along with autoregressive power spectrum coefficients, whitening added approximately five percentage points to classification accuracy when small window lengths were considered. PMID:23475374
Liu, Lukai; Liu, Pu; Clancy, Edward A; Scheme, Erik; Englehart
CONTENTS: Upperextremity prosthetics research: Experimental investigation of the Heidelberg Pneumatic Arm; experimental investigation of the Northwestern Attitudinal Controlled Elbow; experimental investigation of the French Electric Hand; exploration of...
High-pressure injection injury is well known to hand surgeons. We present a case of low-pressure inflation injury to the upperextremity. Our experience with this injury, its treatment, and the eventual outcome are discussed.
OBJECTIVE. In this article, we focus on the arterial anatomy of the upperextremities, the technical aspects of upperextremity CT angiography (CTA), and CTA use in trauma patients. CONCLUSION. CTA using modern MDCT scanners has evolved into a highly accurate noninvasive diagnostic tool for the evaluation of patients with abnormalities of the upperextremity arterial system. PMID:24059363
Bozlar, Ugur; Ogur, Torel; Norton, Patrick T; Khaja, Minhaj S; All, Jaime; Hagspiel, Klaus D
\\u000a Wheelchair basketball (WCB) is one of the fastest growing competitive team sports. To score points, free-throw shooting (FTS)\\u000a is the easiest shot since it is an uncontested shot. Although previous studies have been investigated kinematic of FTS, kinematics\\u000a of upperextremity has never been reported in Thai WCB players. Understanding upperextremity kinematics is valuable since\\u000a it can help improve
CONTEXT: Upperextremity musculoskeletal disorders are common among dental professionals. The natural history of these disorders is not well-understood. These disorders are more common in older workers, but the prevalence among younger workers has not been well-studied. OBJECTIVE: The objective of this study was to determine if dental\\/dental hygiene students had a similar prevalence of upperextremity musculoskeletal disorders compared
Robert A. Werner; Alfred Franzblau; Nancy Gell; Curt Hamann; Pamela A. Rodgers; Timothy J. Caruso; Frank Perry; Courtney Lamb; Shirley Beaver; David Hinkamp; Kathy Eklund; Christine P. Klausner
Miyaguchi, K and Demura, S. Gender difference in ability using the stretch-shortening cycle in the upperextremities. J Strength Cond Res 23(1): 231-236, 2009—A gender difference in ability using the stretch-shortening cycle (SSC ability) in the upperextremities has not been studied in detail. This study aimed to devise an index to evaluate SSC ability during powerful elbow flexion and
Upperextremity digital subtraction venography with gadoterate meglumine before fistula creation for hemodialysis.BackgroundThe purpose of this study was to evaluate the feasibility, safety, and potential role of gadoterate meglumine (Gd-DOTA) as a contrast agent for upperextremity venography before the creation of an arteriovenous fistula (AVF) for nondialyzed renal insufficiency patients.MethodsOver a 16-month period, 50 venographies were performed on end-stage
Olivier Geoffroy; Marc Tassart; Alain-Ferdinand Le Blanche; Antoine Khalil; Viviane Duédal; Jérôme Rossert; Jean-Michel Bigot; Frank P. Boudghene
We estimated the trial-to-trial variability and the test–retest reliability of several intracortical and corticomotor excitability parameters for the upperextremity in chronic stroke patients. Nine patients with hemiparesis of the upperextremity were enrolled 8–17 months after a unilateral stroke. Transcranial magnetic stimulation was used to obtain repeated measures over a two week interval of motor evoked potential (MEP) recruitment
Lisa Koski; Janice Chien-Ho Lin; Allan D. Wu; Carolee J. Winstein
In the manipulation of radioactive materials in Nuclear Medicine service the body parts of workers that are more displayed to the ionizing radiation are hands, underarm and arm. Therefore is necessary to developing personal dosimeters to monitoring of easy reproduction and low cost with purpose to determine the doses level radiation received by the worker in these extremities. However thermoluminescent
Manual wheelchair propulsion has been linked to a high incidence of overuse injury and pain in the upperextremity, 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 upperextremity 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 upperextremity 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 upperextremity 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 upperextremity demand. Thus, care should be taken in using force effectiveness as a metric to reduce upperextremity demand.
Rankin, Jeffery W.; Kwarciak, Andrew M.; Richter, W. Mark; Neptune, Richard R.
A 49-year-old woman presented with chronic abdominal discomfort, significant weight loss, and chronic intermittent diarrhea. She suddenly developed massive upper gastrointestinal bleeding and was referred for further treatment. Endoscopy indicated a large mass in the upper gastric body with antral and duodenal bulb involvement. Endosonography showed a large well-defined isoechoic gastric subepithelial mass with multiple intra-abdominal and peripancreatic lymphadenopathy, suspected to be malignant on the basis of fine needle aspiration cytology. The tumor was surgically removed, and histopathology showed typical characteristics of a neuroendocrine tumor. On the basis of immunohistochemical staining, somatostatinoma, a rare neuroendocrine tumor, was diagnosed. Gastrointestinal bleeding is a rare presentation and the stomach is an uncommon tumor location.
Upper limb amputees receive no proprioceptive or visual sensory feedback about their absent hand. In this study, we asked\\u000a whether chronic amputees nevertheless retain the ability to accurately plan gripping movements. Fourteen patients and matched\\u000a controls performed two grip selection tasks: overt grip selection (OGS), in which they used their intact hand to grasp an\\u000a object that appeared in different
Two conceptual hydrological models used to simulate the upper Blue Nile flow.Temporal variability of observed and simulated extreme flows was investigated.The sources of temporal variability of high extremes analyzed.The main cause of variability is attributed to (multi-)decadal climate oscillations.The influence of change in catchment behavior is not found to be significant.
|The trend for gross anatomy programs is toward decreasing contact hours. East Tennessee State University reduces dissection hours by having medical students dissect either the upper or lower extremity, but not both. Subsequently, the dissectors study the opposite extremity. A study of examination results indicates that student learning is not…
Background Work related upperextremity musculoskeletal disorders (MSD) result in substantial disability, and expense. Identifying workers\\u000a or jobs with high risk can trigger intervention before workers are injured or the condition worsens.\\u000a \\u000a \\u000a \\u000a Methods We investigated a disability instrument, the QuickDASH, as a workplace screening tool to identify workers at high risk of\\u000a developing upperextremity MSDs. Subjects included workers reporting recurring upper
Bert Stover; Barbara Silverstein; Thomas Wickizer; Diane P. Martin; Joel Kaufman
Objective: To study the incidence and prevalence of neck and upperextremity musculoskeletal complaints in Dutch general practice. Methods: Data were obtained from the second Dutch national survey of general practice. In all, 195 general practitioners (GPs) from 104 practices across the Netherlands recorded all contacts with patients during 12 consecutive months. Incidence densities and consultation rates were calculated. Results: The total number of contacts during the registration period of one year was 1 524 470. The most commonly reported complaint was neck symptoms (incidence 23.1 per 1000 person-years), followed by shoulder symptoms (incidence 19.0 per 1000 person-years). Sixty six GP consultations per 1000 person-years were attributable to a new complaint or new episode of complaint of the neck or upperextremity (incidence density). In all, the GPs were consulted 147 times per 1000 registered persons for complaints of the neck or upperextremity. For most complaints the incidence densities and consultation rates were higher for women than for men. Conclusions: Neck and upperextremity symptoms are common in Dutch general practice. The GP is consulted approximately seven times each week for a complaint relating to the neck or upperextremity; of these, three are new complaints or new episodes. Attention should be paid to training GPs to deal with neck and upper limb complaints, and to research on the prognosis and treatment of these common complaints in primary care.
Bot, S; van der Waal, J M; Terwee, C; van der Windt, D A W M; Schellevis, F; Bouter, L; Dekker, J
The purpose of this article is to describe the adaptation of a method suggested for prevention of fractures of partial removable dental prostheses to the reinforcement of an existing implant-retained fixed complete dental prosthesis (IRFCDP). The patient, an upper limb amputee, had subjected the original IRFCDP to parafunctional forces generated from use as a replacement hand in a compensatory technique commonly taught in rehabilitation. Advantages of the technique are that it provides an alternative to remaking the entire prosthesis, which was otherwise satisfactory; it adapts to a variety of situations involving anterior tooth reinforcement; and it offers a potential solution to anterior prosthetic tooth damage caused by other types of parafunction. It may also be adaptable to the reinforcement of other types of prostheses. A disadvantage is the possible need to provide a new interim prosthesis or modify an existing one while laboratory repair procedures are completed. Following reinforcement of the IRFCDP, no tooth damage was evident after one year of use. (J Prosthet Dent 2012;107:343-345). PMID:22546313
Background The majority of manual wheelchair users will experience upperextremity 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 upperextremity demand during propulsion. However, studies often make comparisons between populations (e.g., able-bodied vs. paraplegic) or do not investigate specific measures of upperextremity 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 upperextremity 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.
Rankin, Jeffery W.; Kwarciak, Andrew M.; Richter, W. Mark; Neptune, Richard R.
The purpose of the study was to evaluate the electromyographic (EMG) activity of muscles in curl-up exercises depending on the position of the upper and lower extremities. From the perspective of biomechanics, different positions of the extremities result in shifting the center of gravity and changing muscular loads in abdominal strength exercises. The subjects of the research were 3 healthy students (body mass 53-56 kg and height 163-165 cm) with no history of low back pain or abdominal surgery. Subjects completed 18 trials for each of the 9 exercises (static curl-up with 3 positions of the upper and 3 position of the lower extremities). The same experiment with the same subjects was conducted on the next day. The EMG activity of rectus abdominis (RA), erector spinae (ES), and quadriceps femoris-long head (rectus femoris [RF]) was examined during the exercises. The surface electrical activity was recorded for the right and left sides of each muscle. The raw data for each muscle were rectified and integrated. The statistical analysis showed that changing the position of upperextremities in the examined exercises affects the EMG activity of RA and ES but does not significantly affect the EMG activity of RF. Additionally, it was found that curl-up exercises with the upperextremities extended behind the head and the lower extremities flexed at 90° in the hip and knee joints involve RA with the greatest intensity, whereas curl-up exercises with the upperextremities extended along the trunk and the lower extremities flexed at 90° in the hip and knee joints involve RA with the lowest intensity. PMID:20940638
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 upperextremity 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 upperextremity 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 upperextremity joint function. PMID:20727523
Interobserver repeatability and validity were assessed for a new semiquantitative, time-based observation method for the estimation of physical loads imposed on the upperextremities. Six risk factors of upperextremity disorders were included in the method: repetitive use of hand, use of hand force, pinch grip, non-neutral wrist posture, elevation of upper arm, local mechanical pressure. Two occupational health nurses
Ritva Ketola; Risto Toivonen IV; Eira Viikari-Juntura II
Slips are frequently the cause of fall-related injuries. Identifying modifiable biomechanical requirements for successful recovery is a key prerequisite to developing task-specific fall preventive training programs. The purpose of this study was to quantify the biomechanical role of the upperextremities during the initial phase of a slip resulting in trunk motion primarily in the sagittal plane. Two groups of adults were examined: adults over age 65 who fell and adults aged 18-40 who avoided falling after slipping. We hypothesized that rapid shoulder flexion could significantly reduce trunk extension velocity, that adults who slipped would implement this as a fall avoidance strategy, and that younger adults who avoided falling would use this strategy more effectively than older adults who fell. The kinematics of the 12 younger adults and eight older adults were analyzed using a three-segment conservation of momentum model developed to represent the trunk, head, and upperextremities. The model was used to estimate the possible contribution of the upperextremities to reducing trunk extension velocity. The model showed that upperextremity motion can significantly reduce trunk extension velocity. Although the upperextremities significantly reduced the trunk extension velocity of both young and older adults (p<0.027), the reduction found for the young adults, 13.6+/-11.4%, was significantly larger than that of the older adults (5.8+/-3.4%, p=0.045). Given the potential for trunk extension velocity to be reduced by rapid shoulder flexion, fall prevention interventions focused on slip-related falls may benefit from including upperextremity motion as an outcome whether through conventional or innovative strategies. PMID:19356766
Troy, Karen L; Donovan, Stephanie J; Grabiner, Mark D
Slips are frequently the cause of fall-related injuries. Identifying modifiable biomechanical requirements for successful recovery is a key prerequisite to developing task-specific fall preventive training programs. The purpose of this study was to quantify the biomechanical role of the upperextremities during the initial phase of a slip resulting in trunk motion primarily in the sagittal plane. Two groups of adults were examined: adults over age 65 who fell and adults age 18–40 who avoided falling after slipping. We hypothesized that rapid shoulder flexion could significantly reduce trunk extension velocity, that adults who slipped would implement this as a fall avoidance strategy, and that younger adults who avoided falling would use this strategy more effectively than older adults who fell. The kinematics of the 12 younger adults and eight older adults were analyzed using a three-segment conservation of momentum model developed to represent the trunk, head and upperextremities. The model was used to estimate the possible contribution of the upperextremities to reducing trunk extension velocity. The model showed that upperextremity motion can significantly reduce trunk extension velocity. Although the upperextremities significantly reduced the trunk extension velocity of both young and older adults (p<0.027), the reduction found for the young adults, 13.6±11.4%, was significantly larger than that of the older adults (5.8±3.4%, p=0.045). Given the potential for trunk extension velocity to be reduced by rapid shoulder flexion, fall prevention interventions focused on slip-related falls may benefit from including upperextremity motion as an outcome whether through conventional or innovative strategies.
Troy, Karen L.; Donovan, Stephanie J.; Grabiner, Mark D.
OBJECTIVE: To evaluate the association between upperextremity soft tissue disorders and exposure to preventable ergonomic stressors in vehicle manufacturing operations. METHODS: A cross sectional study was conducted in one vehicle stamping plant and one engine assembly plant. A standardised physical examination of the upperextremities was performed on all subjects. An interviewer administered questionnaire obtained data on demographics, work history, musculoskeletal symptoms, non-occupational covariates, and psycho-physical (relative intensity) ratings of ergonomic stressors. The primary exposure score was computed by summing the responses to the psychophysical exposure items. Multivariate regression analysis was used to model the prevalence of disorders of the shoulders or upper arms, wrists or hands, and all upperextremity regions (each defined both by symptoms and by physical examination plus symptoms) as a function of exposure quartile. RESULTS: A total of 1315 workers (85% of the target population) was examined. The prevalence of symptom disorders was 22% for the wrists or hands and 15% for the shoulders or upper arms; cases defined on the basis of a physical examination were about 80% as frequent. Disorders of the upperextremities, shoulders, and wrists or hands all increased markedly with exposure score, after adjustment for plant, acute injury, sex, body mass index, systemic disease, and seniority. CONCLUSIONS: Musculoskeletal disorders of the upperextremities were strongly associated with exposure to combined ergonomic stressors. The exposure- response trend was very similar for symptom cases and for physical examination cases. It is important to evaluate all dimensions of ergonomic exposure in epidemiological studies, as exposures often occur in combination in actual workplaces.
Bone is a connective tissue containing cells, fibers and ground substance. There are many functions in the body in which the bone participates, such as storing minerals, providing internal support, protecting vital organs, enabling movement, and providing attachment sites for muscles and tendons. Bone is unique because its collagen framework absorbs energy, while the mineral encased within the matrix allows bone to resist deformation. This article provides an overview of the structure and function of bone tissue from a macroscopic to microscopic level and discusses the physiological processes contributing to upperextremity bone health. It concludes by discussing common conditions influencing upperextremity bone health.
Weatherholt, Alyssa M.; Fuchs, Robyn K.; Warden, Stuart J.
Objective To estimate minimal clinically important difference values of several upperextremity measures early after stroke. Design Data in this report were collected during the VECTORS trial, an acute, single-blind randomized controlled trial of Constraint Induced Movement Therapy. Subjects were tested at the pre-randomization baseline assessment (average of 9.5 days post stroke), and the first post-treatment assessment (25.9 days post stroke). At each time point, the affected upperextremity was evaluated with a battery of 6 tests. At the second assessment, subjects were also asked to provide a global rating of perceived changes in their affected upperextremity. Anchor-based minimal clinically important difference values were calculated separately for the affected dominant upperextremities and the affected non-dominant upperextremities for each of the 6 tests. Setting Inpatient rehabilitation hospital. Participants Fifty-two people with hemiparesis post stroke. Interventions Not applicable. Main Outcome Measures Estimated minimal clinically important difference values for grip strength, composite upperextremity strength, Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT), Motor Activity Log (MAL), and duration of upperextremity use as measured with accelerometry. Results Minimal clinically important difference values for grip strength were 5.0 and 6.2 kg for the affected dominant and non-dominant sides respectively. Minimal clinically important difference values for the ARAT were 12 and 17 points, for the WMFT Function score were 1.0 and 1.2 points, and for the MAL How well score were 1.0 and 1.1 points for the two sides respectively. Minimal clinically important difference values were indeterminate for the dominant (composite strength), the non-dominant (WMFT Time score) or for both affected sides (duration of use) for the other measures. Conclusions Our data provide some of the first estimates of minimal clinically important difference values for upperextremity standardized measures early after stroke. Future studies with larger sample sizes are needed to refine these estimates and to determine if minimal clinically important difference values are modified by time post stroke.
Lang, Catherine E.; Edwards, Dorothy F.; Birkenmeier, Rebecca L.; Dromerick, Alexander W.
Adhesion mechanisms mediated by cytokines have been recognized to play a crucial role in ischaemia–reperfusion mechanisms. Although this phenomenon has been well investigated in organ transplantation, little data is available from upperextremity surgery. Profiles of adhesion molecules (CD11\\/CD18), key cytokines (TNF-? and IL-1), CD4+ and CD8+ lymphocytes, and polymorphonuclear neutrophils were investigated following controlled tourniquet ischaemia of the upper
Computer simulations, dummy experiments with a new enhanced upperextremity and small female cadaver experiments were used to analyze the small female upperextremity response under side airbag loading. After establishing a worst case initial position, three tests were performed with the fifth percentile female hybrid III anthropometric test dummy and six experiments with small female cadaver subjects. A new fifth percentile female enhanced upperextremity was developed for the dummy experiments that included a two-axis wrist load cell in addition to the existing six-axis load cells in both the forearm and humerus. Forearm pronation was also included in the new dummy upperextremity to increase the biofidelity of the interaction with the handgrip. Instrumentation for both the cadaver and dummy tests included accelerometers and MHD angular rate sensors on the forearm, humerus, upper and lower spine. In order to quantify the applied loads to the cadaver hand and wrist from the door mounted handgrip, the handgrip was mounted to the door through a five-axis load cell and instrumented with accelerometers for inertial compensation. All six of the cadaver tests resulted in upperextremity injuries including comminuted mid-shaft humerus fractures, osteochondral fractures of the elbow joint surfaces, a transverse fracture of the distal radius and an osteochondral fracture of the lunate carpal bone. The results from the 6 cadaver tests presented in this study were combined with the results from 12 previous cadaver tests. A multivariate logistic regression analysis was performed to investigate the correlation between observed injuries and measured occupant response. Using inertially compensated force measurements from the dummy mid-shaft forearm load cell, the linear combination of elbow axial force and shear force was significantly (P=0.05) correlated to the observed elbow injuries. PMID:12643959
Duma, Stefan M; Boggess, Brian M; Crandall, Jeff R; Hurwitz, Shepard R; Seki, Kazuhiro; Aoki, Takashi
Introduction Venous thromboembolism (VTE) is an important problem in orthopedic trauma patients. An association between VTE and upperextremity\\u000a injury has not been reported. The purpose of this investigation was to determine whether upperextremity trauma is an independent\\u000a risk factor for lower extremity VTE. This study also attempted to identify associations between VTEs and demographic and injury\\u000a variables in patients
Jason E. Hsu; Surena Namdari; Keith D. Baldwin; John L. Esterhai; Samir Mehta
Background The Closed Kinetic Chain UpperExtremity Stability Test (CKCUEST) is a tool developed and used in the clinic to evaluate progress during upperextremity rehabilitation. A need exists for reference values of CKCUEST for use in a clinical setting. Objectives To calculate reference values for the CKCUEST that may assist clinicians in developing goals and objectives for male collegiate baseball players who are recovering from injuries to the upperextremity. To determine if differences exist in scores according to playing position. Methods The sample consisted of 77 collegiate, male baseball players between the ages of 18 and 22 who reported no recent history of injuries to the shoulder, elbow, or the hand-wrist complex. The CKCUEST was administered three times to the athletes and the number of touches when performing the CKCUEST during the 15-second test was measured and recorded. An average of the three tests was used for data analysis. Results No significant differences existed according to playing position. The data did not differ from the normal distribution; therefore, reference values were calculated and reported for use by clinicians in development of goals and objectives for this population. Discussion and Conclusion The CKCUEST appears to be a clinically useful test for upperextremity function.
Spinal cord stimulation (SCS) has been successfully introduced for treatment of severe peripheral arterial disease of the lower limbs. However, the effect of SCS for treatment of severe vasospastic disease (VD) and peripheral arterial disease (PAD) of the upperextremities remains uncertain. Therefore, the efficacy of SCS for pain reduction and increase of blood supply was studied in four patients
A test program was conducted to evaluate the effectiveness of upperextremity bracing techniques during +G sub z impact acceleration. Fifty human impact tests were performed on the Vertical Deceleration Tower up to an impact level of 10.5 G mean (std dev ...
B. F. Hearon J. H. Raddin J. M. Powers J. W. Brinkley L. A. McGowan
Background: Increased pitch counts have been linked to increased complaints of shoulder and elbow pain in youth baseball pitchers. Improper pitching mechanics have not been shown to adversely affect the upperextremity in youth pitchers.Hypothesis: The correct performance of 5 biomechanical pitching parameters correlates with lower humeral internal rotation torque and elbow valgus load, as well as higher pitching efficiency,
J. T. Davis; Orr Limpisvasti; Derrick Fluhme; Karen J. Mohr; Lewis A. Yocum; Neal S. ElAttrache; Frank W. Jobe
This research aims at the estimation of intention of user arm motion supported by the wearable type robot on upperextremity for assisting to have meal. The algorithm or the estimation was proposed and verified by the experiments to investigate the gaze pattern at selecting food images.
In practice the secondary prevention of work-related upperextremity (WRUE) symptoms generally targets biomechanical risk factors. Psychosocial risk factors have also been shown to play an important role in the development of WRUE symptom severity and future disability. The addition of a stress management component to biomechanically focused interventions may result in greater improvements in WRUE symptoms and functional limitations
Michael Feuerstein; Rena A. Nicholas; Grant D. Huang; Lennart Dimberg; Danielle Ali; Heather Rogers
Factors, such as high repetition, high force and gripping play a role in the development of upperextremity work-related musculoskeletal disorders. The purpose of this study was to systematically examine the effects of push load and frequency on muscle activity with and without concurrent gripping. A total of 10 men and 10 women performed a cyclic bimanual pushing task. All
The high occurrence of upperextremity musculoskeletal disorders (UEMSDS) in Iranian ironwork industries indicates a need to assess the risk factors of the disorders at such workplaces. In order to prevent such disorders, the Occupational Re- petitive Actions (OCRA) carried out to obtain an integrated assessment of the various risk factors, classify different jobs and suggest ergonomic designing solutions. Four
Numerous studies have addressed musculoskeletal disorders in the international working population. The literature indicates that injuries exist at astounding rates with significant economic impact. Attempts have been made by government, private industry, and special interest groups to address the issues related to the occurrence and prevention of musculoskeletal injuries. Because of the limited research on the gastrointestinal (GI) endoscopy nursing sector, this descriptive, correlational study explored the incidence of upperextremity injuries in GI endoscopy nurses and technicians in the United States. A total of 215 subjects were included in the study. Findings show that upperextremity injuries exist among nurses working in GI endoscopy. Twenty-two percent of respondents missed work for upperextremity injuries. The findings also show that the severity of disability is related to the type of work done, type of assistive aids available at work, and whether or not ergonomic or physiotherapy assessments were provided at the place of employment. In reference to rate of injury and the availability of ergonomics and physiotherapy assessments, those who had ergonomic assessments available to them had scores on the Disabilities of the Arm, Shoulder, and Hand (DASH) inventory (indicating upperextremity disability) that were significantly lower (DASH score, 9.96) than those who did not have the assessments available (DASH score, 14.66). The results suggest that there are a significant number of subjects who are disabled to varying degrees and the majority of these are employed in full-time jobs. PMID:24084131
We evaluated the efficacy of a novel electromyogram (EMG)-controlled electrical stimulation system, called the integrated volitional control electrical stimulator (IVES), on the recovery of upperextremity motor functions in patients with chronic hemiparetic stroke. Ten participants in the chronic stage (more than 12 months post-stroke with partial paralysis of their wrist and fingers) received treatment with IVES to the extensor carpi radialis and extensor digitorum communis 6 h/day for 5 days. Before and after the intervention, participants were assessed using upper-extremity Fugl-Meyer motor assessment (FMA), the active range of motion (A-ROM), the nine-hole peg test (NHPT), and surface EMG recordings. The upperextremity FMA showed a statistically significant increase from 50.8 ± 5.8 to 56.8 ± 6.2 after the intervention (P < 0.01). The A-ROM of wrist extension was also significantly improved from 36.0° ± 15.4° to 45.0° ± 15.5° (P < 0.01). The NHPT significantly decreased from 85.3 ± 52.0 to 63.3 ± 29.7 (P = 0.04). EMG measurements demonstrated statistically significant improvements in the coactivation ratios for the wrist flexor and extensor muscles after the intervention. This study suggested that 5 days of IVES treatment yields a noticeable improvement in upperextremity motor functions in patients with chronic hemiparetic stroke. PMID:21964036
This study examined the agreement of subjective ratings of upperextremity exposures with corresponding direct measurements obtained simultaneously from workers. Psychophysical ratings of exposure, based on the Borg CR-10 scale, were obtained for the period of time in which direct measurements were acquired using electrogoniometers (wrist), electroinclinometers (shoulder) and electromyography (grip force). Subjects were selected from workers at two automobile
Bryan Buchholz; Jung-Soon Park; Judith E. Gold; Laura Punnett
Design and validation of a new upperextremity (UE) motion assessment system was completed to evaluate recovery progress during stroke rehabilitation. This UE model was constructed to accurately track the three-dimensional (3-D) orientation of the trunk, shoulder, elbow, and wrist during task performance. Linear static, linear dynamic and angular dynamic validation was completed to determine the resolution and accuracy of
B. A. Hingtgen; J. R. McGuire; M. Wang; G. F. Harris
The use of quantitative models for evaluating upperextremity (UE) dynamics in children with myelomeningocele (MM) is limited. A biomechanical model for assessment of UE dynamics during Lofstrand crutch-assisted gait in children with MM is presented. This pediatric model may be a valuable tool for clinicians to characterize crutch-assisted gait, which may advance treatment monitoring, crutch prescription, and rehabilitation planning
Brooke A. Slavens; Peter F. Sturm; Ruta Bajournaite; Gerald F. Harris
The use of small dose intravenous lidocaine without exsanguination for upperextremity 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
Fatigue is an unavoidable part of a basketball game, which may affect an athlete’s performance. The aim of this study was to investigate the effect of upperextremity fatigue on grip strength and passing accuracy in basketball, and ascertain if the effects of different fatigue protocols on grip strength and passing accuracy are the same. Twenty-four juniors under 18 years old (age: 16.75 ± 0.62 years; body height: 184.5 ± 3.31 cm; body mass: 77.25 ± 3.22 kg) volunteered to participate in the study, and were divided into two groups. After a warm-up, both groups performed the basketball passing test and grip strength was recorded for each group under three different testing conditions: rest, 70% and 90% exercise intensity. The protocol used for the first group was the chest press, and for the second group the wrist curls. Results show that after the upperextremity fatigue protocol all parameters of the study (grip strength and passing accuracy) showed a significant decrease, and there was no significant difference between both groups regarding grip strength and passing accuracy. The study suggested that in order to avoid upperextremity fatigue, basketball trainers and coaches need to include upperextremity conditioning exercises into their training sessions.
The purpose of this study was to investigate severe upperextremity injuries resulting from frontal automobile crashes and to determine the effects of frontal airbags. The National Automotive Sampling System database files from 1993 to 2000 were examined in a study that included 25,464 individual cases that occurred in the United States. An analysis of the cases indicated that occupants
Fatigue is an unavoidable part of a basketball game, which may affect an athlete's performance. The aim of this study was to investigate the effect of upperextremity fatigue on grip strength and passing accuracy in basketball, and ascertain if the effects of different fatigue protocols on grip strength and passing accuracy are the same. Twenty-four juniors under 18 years old (age: 16.75 ± 0.62 years; body height: 184.5 ± 3.31 cm; body mass: 77.25 ± 3.22 kg) volunteered to participate in the study, and were divided into two groups. After a warm-up, both groups performed the basketball passing test and grip strength was recorded for each group under three different testing conditions: rest, 70% and 90% exercise intensity. The protocol used for the first group was the chest press, and for the second group the wrist curls. Results show that after the upperextremity fatigue protocol all parameters of the study (grip strength and passing accuracy) showed a significant decrease, and there was no significant difference between both groups regarding grip strength and passing accuracy. The study suggested that in order to avoid upperextremity fatigue, basketball trainers and coaches need to include upperextremity conditioning exercises into their training sessions. PMID:24146707
Objective A longitudinal cohort of automobile manufacturing workers (n = 1214) was examined for: 1) prevalence and persistence of specific upperextremity musculoskeletal disorders (UEMSDs) such as lateral epicondylitis and de Quervain's disease, and non-specific disorders (NSDs) defined in symptomatic individuals without any specific disorder, and 2) disorder prognoses based on symptom characteristics and other factors. Methods Eight specific disorders were identified through case definitions based on upperextremity physical examinations and symptom surveys administered on three occasions over six years. Results At baseline, 41% of the cohort reported upperextremity symptoms; 18% (n = 214) of these had NSDs. In each survey, tendon-related conditions accounted for over half of the specific morbidity. Twenty-five percent had UEMSDs in multiple anatomical sites, and most with hand/wrist disorders had two or more hand/wrist UEMSDs. Persistence for all specific disorders decreased with length of follow-up. Specific UEMSDs were characterized by greater pain severity and functional impairment, and more lost work days than NSDs. Conclusions Upperextremity symptoms and diagnoses vary over time. NSDs may be the early stages of conditions that will eventually become more specific. NSDs and overlapping specific UEMSDs should be taken into account in UEMSD classification.
d'Errico, Angelo; Katz, Jeffrey N.; Gore, Rebecca; Punnett, Laura
Development of an interactive system to treat patients with movement impairments of the upperextremity 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.
Wood, Krista A. Coleman; Lathan, Corinna E.; Kaufman, Kenton R.
|Aim: The aim of the study was to investigate the construct validity of the Quality of UpperExtremity 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…
BACKGROUND: Low energy trauma to the upperextremity 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 \\
Jonathan T Bravman; Kyros Ipaktchi; Walter L Biffl; Philip F Stahel
Sign language interpreters suffer from high levels of upperextremity disorders and burnout due to the physical and cognitive demands of interpreting. The objective of this research was to quantify the wrist kinematics of interpreting and to assess how speaker pace and psychosocial stress influence wrist kinematics. Professional interpreters interpreted a pre-recorded lecture, while the speaking pace of the lecture
Manual wheelchair propulsion has been linked to a high incidence of overuse injury and pain in the upperextremity, 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
Jeffery W. Rankin; Andrew M. Kwarciak; W. Mark Richter; Richard R. Neptune
Cumulative trauma disorders of upperextremities are one of the most common occupational illnesses in industries. When working surface is raised too high or too low, workers may lead to awkward posture and increased workload. An experiment was conducted to collect the measurements of electromyography (EMG) in the laboratory where an EMG system was executed and subjective data were gathered
The arterial and venous volume blood flow in the dom inant and nondominant upperextremities of five male pitchers, ages 16 to 21, was measured using color flow duplex ultrasound. Blood-flow measurements were ob tained at baseline, after warmup, and after each se quence of 20 pitches until 100 pitches were thrown. Blood flow was additionally determined 1 hour after
Steven C. Bast; John R. Perry; Roberta Poppiti; C. Thomas Vangsness; Fred A. Weaver
OBJECTIVE. CT angiography using modern MDCT scanners has evolved into a highly accurate noninvasive diagnostic tool for the evaluation of patients with pathologic abnormalities of the upperextremity arterial system. CONCLUSION. Here we focus on the use of this modality in patients with nontraumatic vascular pathologic abnormalities. PMID:24059364
Bozlar, Ugur; Ogur, Torel; Khaja, Minhaj S; All, Jaime; Norton, Patrick T; Hagspiel, Klaus D
We sought to determine if tendon inflammatory and histopathological responses increase in aged rats compared to young rats performing a voluntary upperextremity repetitive task, and if these changes are associated with motor declines. Ninety-six female Sprague-Dawley rats were used in the rat model of upperextremity overuse: 67 aged and 29 young adult rats. After a training period of 4 weeks, task rats performed a voluntary high repetition low force (HRLF) handle-pulling task for 2 hrs/day, 3 days/wk for up to 12 weeks. Upperextremity motor function was assessed, as were inflammatory and histomorphological changes in flexor digitorum and supraspinatus tendons. The percentage of successful reaches improved in young adult HRLF rats, but not in aged HRLF rats. Forelimb agility decreased transiently in young adult HRLF rats, but persistently in aged HRLF rats. HRLF task performance for 12 weeks lead to increased IL-1beta and IL-6 in flexor digitorum tendons of aged HRLF rats, compared to aged normal control (NC) as well as young adult HRLF rats. In contrast, TNF-alpha increased more in flexor digitorum tendons of young adult 12-week HRLF rats than in aged HRLF rats. Vascularity and collagen fibril organization were not affected by task performance in flexor digitorum tendons of either age group, although cellularity increased in both. By week 12 of HRLF task performance, vascularity and cellularity increased in the supraspinatus tendons of only aged rats. The increased cellularity was due to increased macrophages and connective tissue growth factor (CTGF)-immunoreactive fibroblasts in the peritendon. In conclusion, aged rat tendons were overall more affected by the HRLF task than young adult tendons, particularly supraspinatus tendons. Greater inflammatory changes in aged HRLF rat tendons were observed, increases associated temporally with decreased forelimb agility and lack of improvement in task success.
Kietrys, David M.; Barr-Gillespie, Ann E.; Amin, Mamta; Wade, Christine K.; Popoff, Steve N.; Barbe, Mary F.
Context: The sensorimotor system controls the balance between upperextremity stability and mobility during athletic performance. Research indicates that fatigue hampers sensorimotor system function; however, few investigators have studied functional fatigue or multijoint, multiplanar measures. Objective: To examine the effect of functional fatigue on upperextremity position reproduction in overhead throwing athletes. 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 from a single knee with maximum velocity (every 5 seconds) and rated their level of upperextremity exertion after every 20 throws. Subjects stopped after reporting above level 14 on the Borg scale and began posttests immediately. Main Outcome Measure(s): We measured active multijoint reproduction of 2 positions: arm cock and ball release. Dependent variables were absolute and variable error for 10 joint motions: scapulothoracic internal-external rotation, upward rotation, and posterior tilt; glenohumeral internal-external rotation, horizontal abduction-adduction, and flexion-extension; elbow pronation-supination and flexion-extension; and wrist ulnar-radial deviation and flexion-extension. We calculated acuity for each joint and the entire upperextremity using 3-dimensional variable error. Results: Fatigue occurred after an average of 62 ± 28 throws and increased 3-dimensional variable error scores (ie, decreased acuity) of the entire upperextremity and all joints in both positions (P < .05) except for the wrist in arm cock. Fatigue increased errors (ranging from 0.6° to 2.3°) at arm cock for scapulothoracic internal-external rotation, upward rotation, and posterior tilt; glenohumeral internal-external rotation and flexion-extension; elbow flexion-extension; and wrist ulnar-radial deviation and at ball release for scapulothoracic internal-external rotation and upward rotation, glenohumeral horizontal abduction-adduction, elbow pronation-supination, and wrist ulnar-radial deviation and flexion-extension (P < .05). Conclusions: Functional fatigue affects the acuity of the entire upperextremity, each individual joint, and multiple joint motions in overhead throwers. Clinicians should consider the deleterious effects of upperextremity fatigue when designing injury prevention and rehabilitation programs and should incorporate multijoint and multiplanar endurance exercises. Compromised neuromuscular control of the scapulohumeral relationship may hold pathologic implications for this population as well.
Generating muscle-driven forward dynamics simulations of human movement using detailed musculoskeletal models can be computationally expensive. This is due in part to the time required to calculate musculotendon geometry (e.g., musculotendon lengths and moment arms), which is necessary to determine and apply individual musculotendon forces during the simulation. Modeling upper-extremity musculotendon geometry can be especially challenging due to the large number of multi-articular muscles and complex muscle paths. To accurately represent this geometry, wrapping surface algorithms and/or other computationally expensive techniques (e.g., phantom segments) are used. This paper provides a set of computationally efficient polynomial regression equations that estimate musculotendon length and moment arms for thirty-two (32) upper-extremity musculotendon actuators representing the major muscles crossing the shoulder, elbow and wrist joints. Equations were developed using a least squares fitting technique based on geometry values obtained from a validated public-domain upper-extremity musculoskeletal model that used wrapping surface elements (Holzbaur et al., 2005). In general, the regression equations fit well the original model values, with an average root mean square difference for all musculotendon actuators over the represented joint space of 0.39 mm (1.1% of peak value). In addition, the equations reduced the computational time required to simulate a representative upper-extremity movement (i.e., wheelchair propulsion) by more than two orders of magnitude (315 versus 2.3 s). Thus, these equations can assist in generating computationally efficient forward dynamics simulations of a wide range of upper-extremity movements. PMID:22520587
Generating muscle-driven forward dynamics simulations of human movement using detailed musculoskeletal models can be computationally expensive. This is due in part to the time required to calculate musculotendon geometry (e.g., musculotendon lengths and moment arms), which is necessary to determine and apply individual musculotendon forces during the simulation. Modeling upper-extremity musculotendon geometry can be especially challenging due to the large number of multi-articular muscles and complex muscle paths. To accurately represent this geometry, wrapping surface algorithms and/or other computationally expensive techniques (e.g., phantom segments) are used. This paper provides a set of computationally efficient polynomial regression equations that estimate musculotendon length and moment arms for thirty-two (32) upper-extremity musculotendon actuators representing the major muscles crossing the shoulder, elbow and wrist joints. Equations were developed using a least squares fitting technique based on geometry values obtained from a validated public-domain upper-extremity musculoskeletal model that used wrapping surface elements (Holzbaur et al., 2005). In general, the regression equations fit well the original model values, with an average root mean square difference for all musculotendon actuators over the represented joint space of 0.39 mm (1.1% of peak value). In addition, the equations reduced the computational time required to simulate a representative upper-extremity movement (i.e., wheelchair propulsion) by more than two orders of magnitude (315 versus 2.3 seconds). Thus, these equations can assist in generating computationally efficient forward dynamics simulations of a wide range of upper-extremity movement tasks.
The purpose of this study is to determine the lengths of motor nerves in the upperextremity. Motor nerves of 27 muscles in 10 cadavers (16 extremities) were dissected from their roots at the level of intervertebral foramen to the entry point of the nerves to the corresponding muscles. Distance between acromion and the lateral epicondyle of the humerus was also measured in all cadavers. Nerve length of the coracobrachialis muscle was the shortest (18.26 ± 1.64 cm), while the longest was the nerve of the extensor indicis (59.51 ± 4.80 cm). The biceps brachii, the extensor digitorum communis, and the brachialis muscles showed highest coefficient of variation that makes these nerve lengths of muscles inconsistent about their lengths. This study also offers quotients using division of the lengths of each nerve to acromion-the lateral epicondyle distance. Knowledge of the nerve lengths in the upperextremity may provide a better understanding the reinnervation sequence and the recovery time in the multilevel injuries such as brachial plexus lesions. Quotients may be used to estimate average lengths of nerves of upperextremity in infants and children. Moreover, reliability of the biceps brachii as a determinant factor for surgery in obstetrical brachial plexus lesions should be reconsidered due to its highest variation coefficient. PMID:21898604
Kendir, Simel; Sen, Tülin; Firat, Tüzün; Leblebicio?lu, A Gürsel; Türker, Tolga; Tekdemir, Ibrahim; Elhan, Alaittin
Introduction: Understanding the relationships between performance tests and sport activity is important to the rehabilitation specialist. The purpose of this study was two- fold: 1) To identify if relationships exist between tests of upper body strength and power (Single Arm Seated Shot Put, Timed Push-Up, Timed Modified Pull-Up, and The Davies Closed Kinetic Chain UpperExtremity Stability Test, and the softball throw for distance), 2) To determine which variable or group of variables best predicts the performance of a sport specific task (the softball throw for distance). Methods: One hundred eighty subjects (111 females and 69 males, aged 18-45 years) performed the 5 upperextremity tests. The Pearson product moment correlation and a stepwise regression were used to determine whether relationships existed between performance on the tests and which upperextremity test result best explained the performance on the softball throw for distance. Results: There were significant correlations (r=.33 to r=.70, p=0.001) between performance on all of the tests. The modified pull-up test was the best predictor of the performance on the softball throw for distance (r2= 48.7), explaining 48.7% of variation in performance. When weight, height, and age were added to the regression equation the r2 values increased to 64.5, 66.2, and 67.5 respectively. Conclusion: The results of this study indicate that several upperextremity tests demonstrate significant relationships with one another and with the softball throw for distance. The modified pull up test was the best predictor of performance on the softball throw for distance.
Hanney, William J.; Kolber, Morey J.; Davies, George J.; Riemann, Bryan
Background—In patients in chronic hemodialysis via upperextremity arteriovenous fistula in whom ipsilateral internal thoracic artery graft was used for myocardial revascularization, hemodynamic interference between the fistula and the graft during dialysis can be hypothesized. Methods and Results—In 5 patients undergoing chronic hemodialysis via upperextremity arteriovenous fistula, ipsilateral to an internal thoracic to left anterior descending graft mammary flow
|This article reports on the content range and measurement precision of an upperextremity (UE) computer adaptive testing (CAT) platform of physical function in children with cerebral palsy. Upperextremity items representing skills of all abilities were administered to 305 parents. These responses were compared with two traditional standardized…
Montpetit, Kathleen; Haley, Stephen; Bilodeau, Nathalie; Ni, Pengsheng; Tian, Feng; Gorton, George, III; Mulcahey, M. J.
Introduction Breast-cancer-related lymphedema affects ?25% of breast cancer (BC) survivors and may impact use of the upper limb during\\u000a activity. The purpose of this study is to compare upperextremity (UE) impairment and activity between women with and without\\u000a lymphedema after BC treatment.\\u000a \\u000a \\u000a \\u000a \\u000a Methods 144 women post BC treatment completed demographic, symptom, and Disability of Arm-Shoulder-Hand (DASH) questionnaires. Objective\\u000a measures included Purdue
Betty Smoot; Josephine Wong; Bruce Cooper; Linda Wanek; Kimberly Topp; Nancy Byl; Marylin Dodd
Current methods for evaluating upperextremity (UE) dynamics during pediatric wheelchair use are limited. We propose a new model to characterize UE joint kinematics and kinetics during pediatric wheelchair mobility. The bilateral model is comprised of the thorax, clavicle, scapula, upper arm, forearm, and hand segments. The modeled joints include: sternoclavicular, acromioclavicular, glenohumeral, elbow and wrist. The model is complete and is currently undergoing pilot studies for clinical application. Results may provide considerable quantitative insight into pediatric UE joint dynamics to improve wheelchair prescription, training and long term care of children with orthopaedic disabilities. PMID:23366999
Kinesthetic sense plays an important role in writing. Children with low vision lack sensory input from the environment given their loss of vision. This study assessed the effect of upperextremity kinesthetic sense on writing function in two groups, one of students with low vision (9 girls and 11 boys, 9.4 +/- 1.9 yr. of age) and one of sighted students (10 girls and 10 boys, 10.1 +/- 1.3 yr. of age). All participants were given the Kinesthesia Test and Jebsen Hand Function Test-Writing subtest. Students with low vision scored lower on kinesthetic perception and writing performance than sighted peers. The correlation between scores for writing performance and upperextremity kinesthetic sense in the two groups was significant (r = -.34). The probability of deficiencies in kinesthetic information in students with low vision must be remembered. PMID:18712218
Introduction Some musculoskeletal disorders of the upperextremity are not readily classified. The study objective was to determine if there were symptom patterns in self-identified repetitive strain injury (RSI) patients. Methods Members (n = 700) of the Dutch RSI Patients Association filled out a detailed symptom questionnaire. Factor analysis followed by cluster analysis grouped correlated symptoms. Results Eight clusters, based largely on symptom severity and quality were formulated. All but one cluster showed diffuse symptoms; the exception was characterized by bilateral symptoms of stiffness and aching pain in the shoulder/neck. Conclusions Case definitions which localize upperextremity musculoskeletal disorders to a specific anatomical area may be incomplete. Future clustering studies should rely on both signs and symptoms. Data could be collected from health care providers prospectively to determine the possible prognostic value of the identified clusters with respect to natural history, chronicity, and return to work.
Piligian, George; Glutting, Joseph J.; Hanlon, Alexandra; Frings-Dresen, Monique H. W.; Sluiter, Judith K.
The aim of this study was to provide the anatomical basis for the skin flap pedicled with the nutrient vessels of the cutaneous\\u000a nerves and cutaneous veins of the upperextremity. Radio-opaque material was injected into the common carotid arteries of\\u000a five fresh cadavers. The skin and the fascia were meticulously dissected, removed, and radiographed. The Photoshop CS and\\u000a Scion
Among the most common causes of upperextremity fracture is a fall on the outstretched hand. Yet few data exist on the biomechanical factors which affect injury risk during this event. In this study, we measured impact forces during low-height (0–5cm), forward falls onto the outstretched hand, and found that these are governed by an initial high-frequency peak and a
Among the most common causes of upperextremity fracture is a fall on the outstretched hand. Yet few data exist on the biomechanical factors which a?ect injury risk during this event. In this study, we measured impact forces during low-height (0—5 cm), forward falls onto the outstretched hand, and found that these are governed by an initial high-frequency peak and
Pediatric upperextremity burns are common. Though current American Burn Association guidelines recommend burn unit referral for burns involving the hands or major joints, many minor injuries are treated in the emergency department (ED) or outpatient setting. Despite the large number of burn patients managed by primary care providers, no large studies have been performed to assess effectiveness. A retrospective 5-year review of the epidemiology and outcomes associated with pediatric upperextremity burns treated at an urban ED was performed. Two hundred sixty-nine patients were identified. The mechanism of burn, percentage of total body surface area (%TBSA) affected, plastic surgery consultations (for wound management recommendations and additional treatment), complications, and surgical interventions were examined. Mechanisms of burn included direct contact (47%), scald (29%), flame (12%), electrical (10%), and friction or chemical (1.5%). Fifty percent of patients suffered from burns over less than 1% TBSA; close to 95% had burns on less than 5% TBSA. Seventy-five percent of patients had second-degree burns, 21% had first-degree burns, and 2% had third-degree burns. Forty patients (15%) had a plastic surgery consult. Seven patients (3%) required skin grafting. Complications occurred in five (2%) patients and included two cases of hypertrophic scarring; two patients with flexor contractures, one case of compartment syndrome requiring fasciotomy, and one late infection. These results suggest that although significant burns are usually cared for in specialized burn centers, the majority of childhood burns to the upperextremity are relatively minor and often treated in the primary care setting. Most patients had small areas of injury and healed without complications. Contact burns are an ever-increasing proportion of childhood burns and should be seemingly preventable. Education to parents and primary care physicians should be reemphasized. It appears that minor upperextremity burns treated by our urban ED staff are handled appropriately and result in favorable outcomes. PMID:18182901
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 upperextremity DVT which necessitated resuscitation and intubation. The power-pulse spray technique should be used with caution when treating DVT.
Tsai, Jason; Georgiades, Christos S.; Hong, Kelvin; Kim, Hyun S. [Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiological Science (United States)], E-mail: firstname.lastname@example.org
Cognitive-behavioral techniques have a great deal to offer in the prevention and remediation of upperextremity cumulative trauma disorder (CTD) in the workplace In relation to prevention, cognitive-behavioral methods offer promise as adjuncts to educational programs and ergonomic practices that aim to increase workers' use of safe work postures, movements, and procedures. Cognitive-behavior therapy (CBT) is also an important component
\\u000a Activities of daily living present difficulties to children with upperextremity disabilities. Among the activities, handwriting\\u000a is considered essential to the children, and occupational therapy is important for them to adapt to the required motor skills.\\u000a In this paper, a virtual-reality based system is developed for training fine motor skills in the context of writing Chinese\\u000a characters. A haptic device
Opinion statement Upperextremity deep venous thrombosis (UEDVT) accounts for between 4% and 10% of all deep venous thromboses, and may be due\\u000a to primary or secondary causes. The incidence of UEDVT is increasing, partly due to the exponential growth in the use of central\\u000a venous catheters and the increasing placement of permanent cardiac pacemaker or defibrillator devices. UEDVT not only
Background and Purpose—Constraint-Induced Movement therapy (CI therapy) is a neurorehabilitation technique developed to improve use of the more affected upperextremity after stroke. A number of studies have reported positive effects for this intervention, but an experiment with a credible placebo control group has not yet been published. Methods—We conducted a placebo-controlled trial of CI therapy in patients with mild
Edward Taub; Gitendra Uswatte; Danna Kay King; David Morris; Jean E. Crago; Anjan Chatterjee
Background—Upper-extremity deep vein thrombosis (UEDVT) occurs spontaneously or sometimes develops as a complication of pacemaker use, long-term use of a central venous catheter (CVC), or cancer. Methods and Results—To improve our understanding of UEDVT, we compared the demographics, symptoms, risk factors, prophylaxis, and initial management of 324 (6%) patients with central venous catheter (CVC)-associated UEDVT, 268 (5%) patients with non-CVC-associated
Extreme precipitation events in the upper Yangtze River Valley (YRV) have recently become an increasingly important focus in China because they often cause droughts and floods. Unfortunately, little is known about the climate processes responsible for these events. This paper investigates factors favorable to frequent extreme precipitation events in the upper YRV. Our results reveal that a weakened South China Sea summer monsoon trough, intensified Eurasian-Pacific blocking highs, an intensified South Asian High, a southward subtropical westerly jet and an intensified Western North Pacific Subtropical High (WNPSH) increase atmospheric instability and enhance the convergence of moisture over the upper YRV, which result in more extreme precipitation events. The snow depth over the eastern Tibetan Plateau (TP) in winter and sea surface temperature anomalies (SSTAs) over three key regions in summer are important external forcing factors in the atmospheric circulation anomalies. Deep snow on the Tibetan Plateau in winter can weaken the subsequent East Asian summer monsoon circulation above by increasing the soil moisture content in summer and weakening the land-sea thermal contrast over East Asia. The positive SSTA in the western North Pacific may affect southwestward extension of the WNPSH and the blocking high over northeastern Asia by arousing the East Asian-Pacific pattern. The positive SSTA in the North Atlantic can affect extreme precipitation event frequency in the upper YRV via a wave train pattern along the westerly jet between the North Atlantic and East Asia. A tripolar pattern from west to east over the Indian Ocean can strengthen moisture transport by enhancing Somali cross-equatorial flow.
This clinical review will describe the epidemiology, clinical presentation, and manage- ment of the following work-related musculoskeletal disorders (WMSDs) of the distal upperextremity: 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
George Piligian; Robin Herbert; Michael Hearns; Jonathan Dropkin; Paul Landsbergis; Martin Cherniack
Stroke is an important disease in Western Society with an estimated incidence of 30.000 patients\\/year in the Netherlands. In approximately 70 to 80% of the stroke survivors upper-extremity motor function is impaired and in almost one third of these patients motor impairments are severe. Among those with severe impairments, two-thirds do not regain the functional use of the affected arm
\\u000a This study aimed to evaluate the effect of the number of fingers used during typing on the biomechanical loading on the upper\\u000a extremity. Six subjects typed in phone numbers using their right hand on a stand-alone numeric keypad in three conditions:\\u000a (1) typing using the index finger; (2) typing using the index and the middle fingers; (3) typing using the
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 upperextremity 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 upperextremity 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 upperextremity RT interventions. PMID:22952203
Daly, Melissa; Vidt, Meghan E; Eggebeen, Joel D; Simpson, W Greg; Miller, Michael E; Marsh, Anthony P; Saul, Katherine R
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 upperextremity 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 upperextremity (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 upperextremity function in chronic stroke.
Nordic walking (NW) was compared with walking (W) and running (R) with respect to upper and lower limb injury risks. 24 NW-instructors performed W, NW, and R trials on a runway covered with artificial turf at controlled speeds. Foot pronation and ground reaction forces were measured as well as shock wave transmission to the right wrist. Comparison of NW and W shows similar results for all of the four chosen velocities (5 km/h, 7 km/h, 8 km/h, 8.5 km/h). Except for the 2nd peak of the vertical ground reaction force, NW results in higher loading rates and horizontal forces as well as higher pronation and pronation velocity values as compared with W. Wrist acceleration values up to 7.6 times gravitational acceleration were recorded in NW. Compared with R at the same speeds (8 km/h and 8.5 km/h), NW can be recommended as low impact sport with 36% lower loading rates and 59% lower pronation velocities. However, the high wrist accelerations in NW reveal that the upperextremities are exposed to considerable repetitive shocks, which may cause overuse injuries of the upperextremities. Thus, additional preventive exercises for the upper limb muscles are recommended as well as using shock absorbing walking poles. PMID:21451179
Context: Research indicates that upperextremity fatigue hampers sensorimotor system acuity. However, no investigators have observed recovery of upperextremity 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 upperextremity 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 upperextremity 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 upperextremity joints. Glenohumeral arm-cocked position reproduction acuity failed to recover within 10 minutes. Research indicates that overhead throwers are vulnerable in this position to the capsulolabral injuries commonly observed in throwing athletes. Future researchers should explore this relationship and the effectiveness of exercises aimed at enhancing sensorimotor system acuity and endurance.
AIMS AND OBJECTIVES: To investigate the incidence and risk factors for peripherally inserted central venous catheters-related upperextremity venous thrombosis in patients with cancer. BACKGROUND: With the widespread use of peripherally inserted central venous catheters, peripherally inserted central venous catheters-related upperextremity venous thrombosis in patients with cancer leads to increasing morbidity and mortality. It is very important to further explore the incidence and risk factors for peripherally inserted central venous catheters-related venous thrombosis. DESIGN AND METHODS: Consecutive patients with cancer who were scheduled to receive peripherally inserted central venous catheters, between September 2009 and May 2012, were prospectively studied in our centre. They were investigated for venous thrombosis by Doppler sonography three times a day within 30 days after catheter insertion. Univariable and multivariable logistic regressions' analyses were performed to identify the risk factors for peripherally inserted central venous catheters-related thrombosis. RESULTS: A total of 89 patients with cancer were studied in our research. Of these, 81 patients were followed up within one month. The mean interval between catheter insertion and the onset of thrombosis was 12·45 ± 6·17 days. The multivariable analyses showed that chemotherapy history, less activities and diabetes were the key risk factors for thrombosis. CONCLUSIONS: Peripherally inserted central venous catheters-related upperextremity venous thrombosis had high incidence rate, and most cases had no significant symptoms. The history of chemotherapy, less activities and diabetes were found to be the key risk factors. It should be routinely scanned in high-risk patients every 3-5 days after catheter insertion, which would then find blood clots in time and reduce the incidence of pulmonary embolism. RELEVANCE TO CLINICAL PRACTICE: Risk factors associated with peripherally inserted central venous catheters-related upperextremity venous thrombosis are of critical importance in improving the quality of patients' life. It is very important to grasp the indications to reduce the incidence rate of peripherally inserted central venous catheters-related upperextremity venous thrombosis. PMID:23710585
Objective To evaluate quality of life (QOL), upperextremity function and the effect of lymphedema treatment in patients with breast cancer related lymphedema. Method The basic data comprised medical records (detailing age, sex, dominant side, location of tumor, cancer stage, operation record, cancer treatment and limb circumferences) and questionnaires (lymphedema duration, satisfaction, self-massage). Further to this, we measured upperextremity function and QOL, administered the DASH (Disabilities of Arm Shoulder and Hand outcome measure) and used the EORTC (European Organization for Research and Treatment of Cancer)-QLQ-C30 and the EORTC-QLQ-Br23. Results of these were calculated as main outcome variables. Results The questionnaire responses and arm circumferences of 59 patients with breast cancer related lymphedema were analyzed. In the DASH questionnaire, it was found that the older the lymphedema patient was, the lower their upperextremity function. On the EORTC-QLQ, patients with metastasis had significantly lower scores in physical functioning and role functioning. In terms of upperextremity circumference, there was a significant upperextremity size reduction after lymphedema treatment. Conclusion There were several dissociations between some subscales of quality of life questionnaires and those of upperextremity functions. Upperextremity function was correlated with the age of breast cancer patients and QOL was influenced by M-stage. Lymphedema treatment was found to be effective in reducing edema in patients with breast cancer related lymphedema.
Background Upperextremity 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 upperextremity 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 upperextremity 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.
Pontillo, Marisa; Kremenic, Ian J.; McHugh, Malachy P.; Mullaney, Michael J.; Tyler, Timothy F.
Four months after insertion of an Angelchik esophageal antireflux prosthesis, a 60-year-old man was seen with epigastric pain and vomiting. Upper gastrointestinal studies demonstrated intragastric migration of the prosthesis. The prosthesis was intact and the straps were untied , and gastroscopic removal was accomplished by pulling out the prosthesis. Surgeons using this prosthesis should be aware of this unique potential complication of erosion into a viscus. PMID:3969627
OBJECTIVES: Peak torque expresses a point output which may, but does not always, correlate well with full range output measures such as work or power, particularly in a rehabilitating muscle. This study evaluates isokinetic performance variables, particularly (a) flexor to extensor work and power output ratios of upper and lower extremities and (b) overall upper to lower extremity work and power ratios, in intercollegiate athletes. The purpose was to ascertain how speeds of 30 and 180 degrees/s influence agonist to antagonist ratios for torque, work, and power and to determine the effects of these speeds on upper to lower limb flexor (F), extensor (E), and combined (F + E) ratios, as a guide to rehabilitation protocols and outcomes after injury. METHODS: Twenty seven athletic men without upper or lower extremity clinical histories were tested isokinetically at slow and moderately fast speeds likely to be encountered in early stages of rehabilitation after injury. Seated knee extensor and flexor outputs, particularly work and power, were investigated, as were full range elbow extensor and flexor outputs. The subjects were morphologically similar in linearity and muscularity (coefficient of variation 4.17%) so that standardisation of isokinetic outputs to body mass effectively normalised for strength differences due to body size. Peak torque (N.m/kg), total work (J/kg), and average power (W/kg) for elbow and knee flexions and extensions were measured on a Cybex 6000 isokinetic dynamometer. With respect to the raw data, the four test conditions (F at 30 degrees/s; E at 30 degrees/s; F at 180 degrees/s; E at 180 degrees/s) were analysed by one way analysis of variance. Reciprocal (agonist to antagonist) F to E ratios of the upper and lower extremities were calculated, as were upper to lower extremity flexor, extensor, and combined (F + E) ratios. Speed related differences between the derived ratios were analysed by Student's t tests (related samples). RESULTS: At the speeds tested all torque responses exhibited velocity related decrements at rates that kept flexor to extensor ratios and upper to lower extremity ratios constant (p > 0.05) for work and power. All upperextremity relative torque, work, and power flexion responses were equal to extension responses (p > 0.05) regardless of speed. Conversely, all lower extremity relative measures of torque, work, and power of flexors were significantly lower than extensor responses. In the case of both upper and lower extremities, work and power F to E ratios were unaffected by speed. Moreover, increasing speed from 30 to 180 degrees/s had no effect on upper to lower extremity work and power ratios, whether for flexion, extension, or flexion and extension combined. CONCLUSIONS: Peak torque responses may not adequately reflect tension development through an extensive range of motion. Total work produced and mean power generated, on the other hand, are highly relevant measures of performance, and these, expressed as F to E ratios, are unaffected by speeds of 30 and 180 degrees/s, whether for upper or lower extremities or for upper to lower extremities. In this sample, regardless of speed, the upperextremity produced 55% of the work and 39% of the power of the lower extremity, when flexor and extensor outputs were combined. Injured athletes are, in the early stages of function restoration, often not able to exert tension at fast speeds. An understanding of upper to lower extremity muscular work and power ratios has important implications for muscle strengthening after injury. Knowledge of normal upper to lower extremity work and power output ratios at slow to moderately fast isokinetic speeds is particularly useful in cases of bilateral upper (or lower) extremity rehabilitation, when the performance of a contralateral limb cannot be used as a yardstick. ???
Objective The study examines temporal variations in upper-extremity musculoskeletal symptoms throughout the day, over a week and throughout the semester. Methods 30 undergraduates were followed in a repeated measures study throughout a semester. Upperextremity musculoskeletal symptoms data were collected on handheld computers randomly throughout the day for seven days over three data collection periods. Multilevel statistical models evaluated associations between time-related predictors and symptoms. Results In adjusted models, pain reported at baseline was associated with increased odds of experiencing both any symptoms (OR = 15.64; 90% CI 7.22–33.88) and moderate or greater symptoms (OR = 16.44; 90% CI 4.57–29.99). Any symptoms were less likely to be reported if responses occurred at 58–76 days (OR = 0.66; 90% CI 0.49–0.86), 77–90 days (OR = 0.29; 90% CI 0.20–0.42) and 91–117 days (OR = 0.54; 90% CI 0.39–0.75) into the semester compared to 35–57 days. Similarly, responding after midnight was associated with greater odds of reporting moderate or greater symptoms (OR = 21.33; 90% CI 6.49–65.97). There was no association observed for day of week and symptoms. Conclusion This pilot work suggests upperextremity musculoskeletal symptoms exhibit temporal variations related to time of day and days into semester. Understanding the natural history of musculoskeletal symptoms and disorders is needed when designing epidemiologic research and/or intervention studies using symptom outcome measures.
Menendez, Cammie Chaumont; Amick, Benjamin C.; Chang, Che-Hsu (Joe); Dennerlein, Jack T.; Harrist, Ronald B.; Jenkins, Mark; Robertson, Michelle; Katz, Jeffrey N.
External feedback of performance is an important component of therapy, especially for children with impairments due to cerebral palsy because they lack intrinsic experience of "good movements" to compare effort and determine performance outcomes. A robotic therapy system was developed to provide feedback for specific upperextremity movements (gestures) which are therapeutically desirable. The purpose of this study was to compare changes in forearm supination/pronation or wrist extension/flexion motion following conventional therapy and gestural robotic feedback therapy intervention. Six subjects with cerebral palsy (ages 5-18, GMFCS level IV--three subjects, level III--one subject, and level I--two subjects) participated in a blinded crossover design study of conventional and robotic feedback therapy targeting either forearm supination or wrist extension. Functional upperextremity motion at baseline and following conventional and robotic feedback therapy interventions were obtained using a motion capture system by personnel blinded to the intervention order. All activities were approved by IRB. Use of the robotic feedback system did result in slightly increased movement in the targeted gesture without change in untargeted motions. Data also suggest a decrease in both agonist and antagonist motion following conventional therapy intervention. Results suggest improved motion when robotic feedback therapy intervention precedes conventional therapy intervention. Robotic feedback therapy is no different than conventional therapy to improve supination or wrist extension function in upperextremity impairments of children with cerebral palsy when changes were considered as aggregate data. In this very small group of diverse patients, individual subject results suggested that intervention order could be responsible for obscuring differences due to intervention type. Outcomes from several individual subjects suggest that results could be different given a more homogeneous group of subjects which future studies should be considered to ultimately determine efficacy of the robotic feedback therapy. Future studies should also address efficacy in other neuromuscular patient populations. PMID:23193461
Wood, Krista Coleman; Lathan, Corinna E; Kaufman, Kenton R
Background Few prospective cohort studies of distal upperextremity 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 upperextremity 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 distal upperextremity musculoskeletal disorders is underway and has successfully enrolled over 1,000 workers to date.
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 upperextremity 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 upperextremity 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 upperextremity rehabilitation in stroke patients.
For children with hemiplegic cerebral palsy, bimanual abilities are central to independent function. Over the last decade, considerable attention has been given to 2 forms of extended practice therapy for the upper limb, constraint-induced movement therapy and intensive bimanual training. This article reviews the varying nature of these 2 approaches and the existing scientific rationale supporting them. Comparisons between these 2 intensive upperextremity training approaches indicate similar improvements in unimanual capacity and bimanual performance outcomes; however, when considering participant and caregiver goal achievement, evidence favors a bimanual approach. Careful selection of either therapy for this population requires consideration of individual and contextual factors in relation to treatment goals. The key ingredients and dose responses remain unknown. Treatment intensity, intrinsic motivation, and individualization of treatment are hypothesized as requisite in either approach. PMID:23948684
Andersen, John C; Majnemer, Annette; O'Grady, Kathleen; Gordon, Andrew M
We present a report of a 58-year-old male patient who suffered from Buerger's disease of the upperextremities verified by microscopy and angiography. Despite medical treatment and repeated thoracic sympathectomy he developed gangrene at the tip of his right thumb and index finger. Pedicled omentum was prepared through midline laparatomy, placed through subcostal incision to the subcutaneous space of the forearm and affected fingers. Rest pain disappeared by the fifth day after surgery. The omental pedicle was ligated six weeks post-operatively and the extremity mobilized. The thumb healed well. The index finger required amputation because of continuing infection. Five years postoperatively the patient has a good functioning hand in which the transferred omentum has retained its viability. PMID:2291315
Four cases of necrotizing soft tissue infections of the upperextremity are presented. Each involved minor wounds to the hand that gradually progressed to fulminant infection. Two of the patients reported a history of alcohol abuse. One patient had psychiatric illness that led to delay in recognizing the infection and seeking intervention. The causative organism in all cases was group A beta hemolytic streptococcus. Fortunately, none of the patients suffered loss of the affected extremity, although long-term function is limited. The necrotizing soft tissue infection encountered in these cases represents a less severe presentation than classic necrotizing fasciitis. Necrotizing soft tissue infections are properly recognized as a spectrum of disease and can, as in these cases, follow a prolonged progression with limited systemic involvement. The current literature regarding diagnosis and treatment of necrotizing soft tissue infections is reviewed. PMID:24063795
Delullo, James A; Lubahn, John D; Loeffler, Oliver P; Dominy, D Dean
Objective This study aimed to examine the suitability of using mean dorsal (hand) skin temperature (MDT) before and after a short typing\\u000a task as an indicator of upperextremity musculoskeletal disorder (UEMSD) severity. In addition, MDT reproducibility in controls\\u000a was assessed for a pre-typing and three post-typing time periods over three trials.\\u000a \\u000a \\u000a \\u000a Methods Asymptomatic office workers (n = 10) and office workers with distal
Judith E. Gold; Martin Cherniack; Alexandra Hanlon; Jack T. Dennerlein; Jonathan Dropkin
Various congenital and acquired disorders can affect the upperextremity in pediatric and adolescent patients. MR imaging can provide unique anatomic and diagnostic information in the evaluation of many of these disorders, including inflammatory, infectious, neoplastic, and arthritic conditions. This article rounds out the issue on pediatric musculoskeletal MR imaging. It focuses on the evaluation of more common congenital disorders, and mainly sports-related injuries of the shoulder, elbow, and wrist in children. MR imaging can be more challenging in diagnosis of some of these disorders. Features of overuse injuries in skeletally immature athletes are a unifying theme throughout the article. PMID:19524202
Quantitative evaluation of upperextremity 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
\\u000a Abstract Motor evoked potentials (MEPs) induced through transcranial magnetic stimulation (TMS) are susceptible to several sources\\u000a of variability including gender, hand dominance, and upperextremity length. Conflicting evidence on the relationship between\\u000a MEPs and subject characteristics has been reported.\\u000a \\u000a \\u000a \\u000a \\u000a Objective The purposes of this study were to determine if MEPs are different between genders and between right- and left-hand dominant\\u000a subjects, and
Scott C. Livingston; Howard P. Goodkin; Christopher D. Ingersoll
We present a series of eight consecutive patients evaluated in our department from 2002 to 2007 with giant lipomatous tumors (as defined in medical studies as greater than 5 cm) of upperextremities. There were three male and five female, ranged in age from 17 to 77 years (mean age of 55). The tumor's size ranged from 5 to 34 cm. All patients underwent total excision of the tumors with free margins. All specimens were sent to pathology: seven patients had benign tumors and one patient had liposarcoma. There were no recurrences of the tumors. Appropriate preoperative evaluation and complete surgical excision are mandatory for successful treatment of these tumors. PMID:21682189
Costea, R; Vasiliu, Eugenia; Zarnescu, N O; Neagu, S
This prospective cohort study investigated the effects of psychosocial factors on long-term employment outcome of a sample\\u000a of chronic work-related upper-extremity pain disorder patients who had completed an interdisciplinary functional restoration\\u000a program. Factors examined included the following: DSM-III-R Axis I and Axis II diagnoses, derived from the Structured Clinical\\u000a Interview for DSM-III-R (SCID); history of childhood abuse experienced as elicited
Purpose Longitudinal studies to evaluate the effect of rehabilitative therapies require an objective, reproducible and quantitative\\u000a means for testing function in vivo. An fMRI assessment tool for upperextremity related brain activation using an MRI-compatible\\u000a manipulandum was developed and tested for use in neurorehabilitation research.\\u000a \\u000a \\u000a \\u000a \\u000a Methods Fifteen healthy, right-handed subjects participated in two fMRI sessions, which were three to four weeks apart.
Ningbo Yu; Natalia Estévez; Marie-Claude Hepp-Reymond; Spyros S. Kollias; Robert Riener
Retraining of the upper limb during neurological rehabilitation often involves preparatory therapeutic exercises of concentric and eccentric nature embedded in purposeful activity. However, empirical baseline studies are lacking to justify efficacy of such training. The purpose of this study was to determine the effect of concentric and eccentric exercises on upperextremity movement pattern in healthy elderly persons during a common daily functional task. Nine young women aged between 22 and 23 years and nine elderly women between 70 and 78 years participated in the musculoskeletal study of lifting a cup of water to sip and then lowering the cup back to a table. Two-dimensional forearm movement kinematics and associated electromyography from biceps and triceps were analysed. Forearm motor performance in the elderly participants were slower and needed more corrections compared to the younger participants. The electromyography revealed that lifting and lowering movements were accomplished by concentric and eccentric muscle firing in the biceps. However, in the elderly the muscle responses were varied suggesting a possible decline in object-related visuomotor co-ordination with age. The results indicate that movement patterns and muscular response decline in elderly people during preparatory therapeutic exercises embedded in purposeful activity. The effect of therapeutic exercises on upper limb functional performance needs to be further investigated in patient populations to explore the effectiveness of embedded therapeutic exercises in movement retraining. Small sample number limits the results of the study to be generalized. In addition, future studies should measure movement of more limb and hand segments to gain understanding of the total upperextremity performance during the task. PMID:15181478
This investigation compared three dimensional upperextremity motion during wheelchair propulsion in persons with 4 levels of spinal cord injury: low paraplegia (n=17), high paraplegia (n=19), C7 tetraplegia (n=16), and C6 tetraplegia (n=17). Upperextremity motion was recorded as subjects manually propelled a wheelchair mounted on a stationary ergometer. For all motions measured, subjects with paraplegia had similar patterns suggesting
Craig J Newsam; Sreesha S Rao; Sara J Mulroy; JoAnne K Gronley; Ernest L Bontrager; Jacquelin Perry
Study design: Survey.Objective: To measure the utilization of upperextremity reconstructive surgery and the clinicians' perceptions of the outcomes provided for persons with tetraplegia across the Model Spinal Cord (SCI) Injury Systems.Setting: Model SCI Systems.Methods:Participants: A clinician from each of the Model Centers. Main outcome measure: A mailed survey eliciting responses with respect to: (1) utilization of upperextremity reconstructive
A M Bryden; K S Wuolle; P K Murray; P Hunter Peckham
Background and Purpose. Recent research has identified Constraint-Induced (Cl) Movement Therapy as a new approach to the rehabilitation of movement of the more affected upperextremity in patients post-stroke. Cl therapy has been shown to increase the quality of movement, speed of movement, and amount of use of the more-affected upperextremity for this patient population. Based on research in
Objective: In a randomized, controlled, single-blind trial, to test the hypothesis that botulinum-A toxin (BTA) injections into the upperextremity of children with spastic hemiplegia improve upperextremity function. Study design: Thirty children with hemiplegia, aged 2.5 to 10 years, were randomly assigned to receive: (1) a BTA injection into 1 or more of 3 muscle groups (biceps, volar forearm
...3500 External assembled lower limb prosthesis. (a) Identification. An external assembled lower limb prosthesis is a device that is intended...purposes and is a preassembled external artificial limb for the lower extremity....
...3500 External assembled lower limb prosthesis. (a) Identification. An external assembled lower limb prosthesis is a device that is intended...purposes and is a preassembled external artificial limb for the lower extremity....
...3500 External assembled lower limb prosthesis. (a) Identification. An external assembled lower limb prosthesis is a device that is intended...purposes and is a preassembled external artificial limb for the lower extremity....
The interactive role of work demands, occupational stressors, and ergonomic risk factors in work-related upperextremity (UE) disorders remains unclear. Professional sign language interpreting, which involves exposure of the upper limbs to a combination of potential ergonomic and psychosocial stressors represents a unique occupational group to investigate the multivariate nature of UE disorders. The present study reports data on the
Michael Feuerstein; Ann Marie Carosella; Lolita M. Burrell; Liza Marshall; James Decaro
Objective: Exposure assessment of individual press workers to risk factors associated with work-related upperextremity muscoluskeletal disorders (UEMSDs). Design: This was a workplace field based, descriptive and analytical study. Place and duration: The study was conducted in presswork shops of an automobile manufacturing industry in Tehran, Iran during 2004-2005. Patients and Methods: Nordic Musculoskeletal Questionnaire (NMQ) and Rapid Upper Limb
Accurate biofidelity for side impact dummies is crucial in order to accurately predict injury of human occupants. One such dummy is the SID- IIs, which represents the 5 th percentile human female. A recent area of concern is the biofidelity of the upperextremity of side impact test dummies. Since the upper arm serves as a load path to the
Males typically have greater upper body strength than do females, which is likely to impact on the rowing techniques adopted by each sex. The aim of this study was to quantify energy contributions and compare the joint power production of upperextremity joints between the sexes. Seven males and eight females performed 60 s trials at five different stroke rates. External
Alison S. Attenborough; Richard M. Smith; Peter J. Sinclair
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 upperextremity (UE) coordination as measured by the phase coordination index (PCI)—only previously measured in gait—and freezing of the upperextremity (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.
Williams, April J.; Peterson, Daniel S.; Ionno, Michele; Pickett, Kristen A.; Earhart, Gammon M.
OBJECTIVES: This study examined the claim incidence rate, cost, and industry distribution of work-related upperextremity 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: Upperextremity 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.
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
Kegel, Gary; Marshall, Astrid; Barron, O Alton; Catalano, Louis W; Glickel, Steven Z; Kuhn, Margaret
Excision of a congenital giant nevus is advised due to the possibility of it degenerating into a malignant melanoma or for aesthetic concerns. Tissue expansion has emerged as the primary treatment of giant congenital nevi because it enables the body to produce extra skin with excellent texture, better colour match, less severe donor-site deformity and repeated usage of an expanding donor-site. We present a multi-staged expansion/local flap technique to treat a case of a circumferential nevus from the acromioclavicular joint and axillary area throughout the upperextremity excluding the hand. The affected skin was approximately 10% of the total body surface area. The patient underwent eight operations and a total of 11 rounds of tissue expansions (500 cc × 9 rounds, 600 cc × 1 round, 300 cc × 1 round) were completed over a 2-year period prior to the removal of the nevus. A good aesthetic and functional outcome in the left upperextremity was gained. It is recommended that the treatment of giant nevi is best if completed at preschool age after taking several factors into consideration. PMID:21795129
Mixing implants with differing metallic compositions has been avoided for fear of galvanic corrosion and subsequent failure of the implants and of bone healing. The purpose of this study was to evaluate upper-extremity fractures treated with open reduction and internal fixation with metallic implants that differed in metallic composition placed on the same bone. The authors studied the effects of using both stainless steel and titanium implants on fracture healing, implant failure, and other complications associated with this method of fixation. Their hypothesis was that combining these metals on the same bone would not cause clinically significant nonunions or undo clinical effects from galvanic corrosion. A retrospective review was performed of 17 patients with upper-extremity fractures fixed with metal implants of differing metallic compositions. The primary endpoint was fracture union. Eight clavicles, 2 proximal humeri, 3 distal humeri, 3 olecranons, and 1 glenoid fracture with an average follow-up 10 months were reviewed. All fractures healed. One patient experienced screw backout, which did not affect healing. This study implies that mixing implants with differing metallic compositions on the same bone for the treatment of fractures does not adversely affect bone healing. No evidence existed of corrosion or an increase in complications with this method of treatment. Contrary to prior belief, small modular hand stainless steel plates can be used to assist in reduction of smaller fracture fragments in combination with anatomic titanium plates to obtain anatomic reduction of the fracture without adversely affecting healing. PMID:24025010
Acevedo, Daniel; Loy, Bo Nasymuth; Lee, Brian; Omid, Reza; Itamura, John
Upperextremity exercise training has been shown to improve clinical outcomes in different chronic health conditions. Arm-operated bicycles are frequently used to facilitate upperextremity 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
In animal models, hundreds of repetitions of upperextremity (UE) task practice promote neural adaptation and functional gain. Recently, we demonstrated improved UE function following a similar intervention for people after stroke. In this secondary analysis, computerized measures of UE task performance were used to identify movement parameters that changed as function improved. Ten people with chronic post-stroke hemiparesis participated in high-repetition UE task-specific training 3 times per week for 6 weeks. Before and after training, we assessed UE function with the Action Research Arm Test (ARAT), and evaluated motor performance using computerized motion capture during a reach-grasp-transport-release task. Movement parameters included the duration of each movement phase, trunk excursion, peak aperture, aperture path ratio, and peak grip force. Group results showed an improvement in ARAT scores (p = 0.003). Although each individual changed significantly on at least one movement parameter, across the group there were no changes in any movement parameter that reached or approached significance. Changes on the ARAT were not closely related to changes in movement parameters. Since aspects of motor performance that contribute to functional change vary across individuals, an individualized approach to upperextremity motion analysis appears warranted.
DeJong, Stacey L.; Birkenmeier, Rebecca L.; Lang, Catherine E.
Assessment of workplace physical exposures by self-reported questionnaires has logistical advantages in population studies but is subject to exposure misclassification. This study measured agreement between eight self-reported and observer-rated physical exposures to the hands and wrists, and evaluated predictors of inter-method agreement. Workers (n=341) from three occupational categories (clerical/technical, construction, and service) completed self-administered questionnaires and worksite assessments. Analyses compared self-reported and observed ratings using a weighted kappa coefficient. Personal and psychosocial factors, presence of upperextremity symptoms and job type were evaluated as predictors of agreement. Weighted kappa values were substantial for lifting (0.67) and holding vibrating tools (0.61), moderate for forceful grip (0.58) and fair to poor for all other exposures. Upperextremity symptoms did not predict greater disagreement between self-reported and observed exposures. Occupational category was the only significant predictor of inter-method agreement. Self-reported exposures may provide a useful estimate of some work exposures for population studies.
Acute hormone responses of growth hormone (GH), total and free testosterone (TT and FT) and cortisol (C) to heavy resistance isometric exercise were examined in ten young men [YM 26.5 (SD 4.8) years] and ten old men [OM 70.0 (SD 3.7) years]. Loading conditions of the same relative intensity were created for the lower and upperextremity actions separately as well as for both of them together lower extremity exercise (LE; knee extension), upperextremity exercise (UE; bench press extension), and lower and upperextremity exercise (LUE) performed simultaneously in a seated position. Single voluntary maximal isometric actions lasting for 5 s were performed repeatedly for ten repetitions (with a recovery of 5 s) for a total of four sets. The recovery time between the sets was 1 min. Each exercise led to large acute decreases in maximal isometric force in both YM (P < 0.001) and OM (P < 0.001) ranging from 41% to 26% with no significant differences between the groups. Serum GH concentrations increased in both YM (P < 0.05-0.01) and OM (P < 0.05) but the postexercise value in YM during LE was greater (P < 0.05) than for OM. The TT increased (P < 0.01-0.001) in YM in all three exercises, while in OM the increase occurred only during LE (P < 0.01). The exercises led to increases in FT in YM (P < 0.05 for LE and LUE), while in OM the increase occurred only during LUE (P < 0.05). The pre and postexercise FT were greater in YM (P < 0.001) than in OM. No significant changes occurred in C either in YM or in OM. The blood lactate concentrations increased during the exercises in both YM (P < 0.001) and OM (P < 0.05-0.001) but the postexercise values during LE and LUE in YM were greater (P < 0.05) than in OM. The present data would indicate that the responses of GH, TT and FT to heavy resistance isometric exercise are lowered with increasing age. The reduced acute hormone response together with the lowered basal values in FT in the older men compared to the young men may indicate decreased anabolic effects on muscles and may explain in part the loss of muscle mass and strength associated with aging. PMID:9562359
Häkkinen, K; Pakarinen, A; Newton, R U; Kraemer, W J
We retrospectively studied the epidemiology of adult patients admitted for possible replantation or revascularisation of an injured upperextremity during the period June 2003 to May 2008. A total of 121 patients were admitted (71 graded severe), mean 24 (14 graded severe), being admitted each year. The annual rate of amputation injuries in the referral area of 1.5 million was 1.5/100 000 and for severe amputation injuries 0.9/100 000. Most injuries occurred in patients aged 41-50. Fifty-eight patients had the accident during working hours (36 severe), and 62 during leisure time (34 severe). The survival rate for subtotal amputations was 77% and for total amputations 55%. Of 15 further vascularisation procedures, two succeeded at the metacarpal level. Most of the accidents occurred during wood-processing with circular saws or powered wood splitters. More efforts should focus on preventing such injuries. PMID:20158426
Parkinson Disease (PD) and Huntington Disease (HD) are degenerative neurological diseases, which can result in impairments and activity limitations affecting the upperextremities 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 upperextremity functional abilities of patients with these degenerative conditions. However to date, investigations of interventions specifically addressing upperextremity 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 upperextremity function. We further review the available literature on the use of outcome measures, and the clinical management of upperextremity 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
Quinn, Lori; Busse, Monica; Dal Bello-Haas, Vanina
Cervical spinal cord injury and acquired brain injury commonly imply a reduction in the upperextremity function which complicates, or even constrains, the performance of basic activities of daily living. Neurological rehabilitation in specialised hospitals is a common treatment for patients with neurological disorders. This study presents a practical methodology for the objective and quantitative evaluation of the upperextremity motion during an activity of daily living of those subjects. A new biomechanical model (with 10 rigid segments and 20 degrees of freedom) was defined to carry out kinematic, dynamic and energetic analyses of the upperextremity motion during a reaching task through data acquired by an optoelectronic system. In contrast to previous upperextremity models, the present model includes the analysis of the grasp motion, which is considered as crucial by clinicians. In addition to the model, we describe a processing and analysis methodology designed to present relevant summaries of biomechanical information to rehabilitation specialists. As an application case, the method was tested on a total of four subjects: three healthy subjects and one pathological subject suffering from cervical spinal cord injury. The dedicated kinematic, dynamic and energetic analyses for this particular case are presented. The resulting set of biomechanical measurements provides valuable information for clinicians to achieve a thorough understanding of the upperextremity motion, and allows comparing the motion of healthy and pathological cases. PMID:23181596
Lobo-Prat, Joan; Font-Llagunes, Josep M; Gómez-Pérez, Cristina; Medina-Casanovas, Josep; Angulo-Barroso, Rosa M
Aims: To estimate the one year cumulative incidence and persistence of upperextremity (UE) soft tissue disorders, in a fixed cohort of automotive manufacturing workers, and to quantify their associations with ergonomic exposures. Methods: At baseline and at follow up, cases of UE musculoskeletal disorders were determined by interviewer administered questionnaire and standardised physical examination of the upperextremities. The interview obtained new data on psychosocial strain and updated the medical and work histories. An index of exposure to ergonomic stressors, obtained at baseline interview, was the primary independent variable. Cumulative incidence and persistence of UE disorders (defined both by symptoms and by physical examination plus symptoms) were analysed in relation to baseline ergonomic exposures, adjusting for other covariates. The incidence of new disorders was modelled using multivariate proportional hazards regression among workers who were not cases in the first year and the prevalence on both occasions was modelled by repeated measures analysis. Results: A total of 820 workers (69% of eligible cohort members) was examined. Follow up varied slightly by department group but not by baseline exposure level or other characteristics. Among the non-cases at baseline, the cumulative incidence of UE disorders was 14% by symptoms and 12% by symptoms plus examination findings. These rates increased with index of physical exposures primarily among subjects who had the same jobs at follow up as at baseline. Increased exposure during follow up increased risk of incidence. The persistence of UE disorders from baseline to follow up examination was nearly 60% and somewhat associated with baseline exposure score. Conclusions: These longitudinal results confirm the previous cross sectional associations of UE musculoskeletal disorders with exposure to combined ergonomic stressors. The exposure-response relation was similar for incident cases defined by symptoms alone and those confirmed by physical examination.
Traditional anticoagulant treatment of deep venous thrombosis (DVT) in the upperextremities (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 upperextremities. 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.
Vik, Anders, E-mail: email@example.com [University Hospital of North Norway, Department of Medicine (Norway); Holme, Pal Andre [Rikshospitalet University Hospital, Division of Haematology, Medical Department (Norway); Singh, Kulbir [University Hospital of North Norway, Department of Radiology (Norway); Dorenberg, Eric [Rikshospitalet University Hospital, Department of Radiology (Norway); Nordhus, Kare Christian; Kumar, Satish [University Hospital of North Norway, Department of Radiology (Norway); Hansen, John-Bjarne [University Hospital of North Norway, Department of Medicine (Norway)
Background Though pedestrian versus motor vehicle (PVMV) accidents are a common cause of trauma admission and subsequent orthopaedic consult, the prevalence of upperextremity fracture (UEF) in such events and its association with lower extremity injury (LEI) is unknown. We sought to describe UEF in PVMV accident patients at the time of orthopaedic consult. Methods A retrospective chart review was conducted for all pedestrian hit by motor vehicle cases for which an orthopaedic consult was performed at Jackson Memorial Hospital between July 2006 and January 2008. Fractures were recorded by location along with relevant clinical information. Logistic regression was used to calculate odds ratios (O.R.) and 95% confidence intervals (C.I.) for variables associated with UEF. Results 336 cases were identified and reviewed. LEI was the most frequent injury type (67% of cases). UEF was also common, found in 25% of cases (humerus 11%, ulna 7%, radius 6%, hand 4%, and wrist 2%). Tibia or fibula fracture, femur fracture, and spine fracture were negatively associated with UEF in univariate analyses and after controlling for other associated factors. Conclusions In PVMV accident populations, UEF is a frequent injury often seen in the absence of any LEI. These findings emphasize the importance of carefully screening all PVMV accident patients for UEF and may call into question the usefulness of currently discussed injury pattern.
Landy, David C.; Norton, Robert A.; Barkin, Jodie A.; Henriques, Stephen; Owens, Patrick; Miki, Roberto A.
Objective The purpose of this case series is to describe the presentation of 2 patients who presented to a chiropractic teaching clinic with Paget-Schroetter syndrome (PSS) and to discuss the potential role for conservative therapy in the management of symptoms. Clinical Features Two patients presented with a vascular and muscular findings suggesting activity-related upperextremity deep vein thrombosis. One patient presented with recent onset of symptoms (pain in the neck with a “pinched nerve sensation” in the left upper trapezius); and the other presented with chronic, low-grade neck pain of 1 year's duration. Intervention and Outcome The initial treatment approach for the patient with acute symptoms included soft tissue therapy. During the second appointment, he was immediately referred for medical evaluation and management because of worsening symptoms. He was diagnosed with thrombus in the left brachial vein, started immediately on a thrombolytic agent, and referred to a thrombosis clinic. Treatment for the second patient with chronic symptoms included soft tissue therapy, spinal manipulative therapy, and active care. Two months after 3 treatments, she reported improved symptoms. She remains under supportive care and has reported continued relief of her symptoms. Conclusion Although a rare condition, PSS has the potential to result in significant morbidity and potentially fatal complications; thus, it is critical that practitioners recognize the signs and symptoms to facilitate appropriate and timely referrals. Clinicians should be aware of the presentation and proposed pathogenesis of PSS, and consider this diagnosis in patients with unilateral upper limb and/or neck pain.
Stainsby, Brynne E.; Muir, Bradley J.; Miners, Andrew L.
Prosthesis loosening is becoming more and more important due to increasing numbers of primary arthroplasty. Especially in patients suffering from rheumatoid arthritis this is a major topic due to younger age and multiple affected joints. A carefully performed diagnostic regimen is essential for ruling out septic loosening of the prosthesis. Preoperative planning is crucial for revision surgery. Revision implants should be available as back-up. Revision arthroplasty is a technically and economically demanding procedure. Costs for revision surgery are much higher than for primary arthroplasty due to longer hospital stay, intensive care, microbiology, histology, diagnostic imaging, implants and antibiotics. Revision arthroplasty should be performed in highly specialized centers. PMID:23138556
Schaumburger, J; Winkler, S; Handel, M; Grifka, J; Baier, C
Somatosensory evoked potential (SSEP) monitoring is used to prevent nerve damage in spine surgery and to detect changes in upperextremity nerve function. Up- per extremity SSEP conduction changes may indicate impending nerve injury. We investigated the effect of operative positioning on upperextremity nerve func- tion retrospectively in 1000 consecutive spine surgeries that used SSEP monitoring. The vast majority
Ihab R. Kamel; Elizabeth T. Drum; Stephen A. Koch; Joseph A. Whitten; John P. Gaughan; Rodger E. Barnette; Woodrow W. Wendling
Objectives To study work-related physical and psychosocial risk factors for sick leave among patients who have visited their general\\u000a practitioner for neck or upperextremity complaints.\\u000a \\u000a \\u000a \\u000a Methods Three hundred and forty two patients with neck or upperextremity complaints completed self-report questionnaires at baseline\\u000a and after 3 months. Cox regression models were used to investigate the association between work-related risk factors and sick
Sandra D. M. Bot; Caroline B. Terwee; Daniëlle A. W. M. van der Windt; Allard J. van der Beek; Lex M. Bouter; Joost Dekker
Free omental tissue transfer is a versatile reconstructive option for trunk, head and neck, and extremity reconstruction.\\u000a Its utility is due to the length and caliber of the vascular pedicle and the malleability and surface area of the flap. We\\u000a report our experience with omental free flap coverage of complex upper-extremity defects. A retrospective analysis of eight\\u000a omental free-tissue transfers
Iris A. Seitz; Craig S. Williams; Thomas A. Wiedrich; Ginard Henry; John G. Seiler; Loren S. Schechter
This paper presents the dynamic injury tolerances for the female humerus and forearm derived from dynamic 3-point bending tests using 22 female cadaver upperextremities. 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 upperextremity 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.
DUMA, STEFAN M.; SCHREIBER, PHIL H.; McMASTER, JOHN D.; CRANDALL, JEFF R.; BASS, CAMERON R.; PILKEY, WALTER D.
Objective?Arteriovenous fistula (AVF) in patients undergoing hemodialysis (HD) may cause coronary left internal mammary artery (IMA) steal. This phenomenon was demonstrated by few prospective studies with limited number of patients and case reports. We aimed to demonstrate with a relatively larger patient population that the AVF may cause ipsilateral IMA steal.Methods?We included 22 prospective patients undergoing HD who had left IMA to left anterior descending artery graft and left upper limb AVF. Right IMA was taken as control. Flows were assessed by using color Doppler ultrasonography.Results?The mean age was 57.8?±?9 years. Statistically nonsignificant increases in AVF flow and decreases in left IMA flow were observed during HD compared with pre-HD. Moreover, fistula localization did not affect median left IMA flows (for peak systolic velocity [PSV] 43.7 versus 70 cm/s, respectively; p?=?0.7, and for end diastolic velocity [EDV] 3.4 versus 6.5 cm/s, respectively; p?=?0.7). We have not detected significant difference in left IMA flows during HD (median values of PSV 58.4 versus 68.4 cm/s, respectively; p?=?0.1, and EDV 6.4 versus 4.4 cm/s, respectively; p?=?0.08). Only three patients experienced dialysis-induced reduction of ipsilateral IMA flow that was accompanied by evidence of hypokinesia of the anterior left ventricular wall without clinical angina.Conclusions?Hemodynamically affected left IMA flow by ipsilateral upperextremity AVF may cause steal phenomenon. Hemodynamic differences between left and right IMAs in patients undergoing HD via left wrist and brachial fistulae are limited. PMID:23344763
Coskun, Isa; Colkesen, Yucel; Altay, Hakan; Ozkan, Ugur; Demirturk, O Saim; Gulcan, Oner; Guvener, Murat
Contents: UpperExtremity Prosthetics Research: Experimental investigation of the Heidelberg Pneumatic Arm; Experimental investigatiion of the Northwestern attitudinally controlled elbow; Experimental investigation of the French electric hand; Exploration...
|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 upperextremity training appear promising. In this review, we first describe two such approaches, constraint-induced movement therapy…
Based on prosthetic hand requirements, a new terminal device for upperextremity prostheses is designed and fabricated, namely the Center Push/Pull Terminal Device. The new hand offers the wearer enhanced positioning capabilities in the form of a three de...
Nineteen distant pedicled flaps, performed during 1989 for posttraumatic upperextremity soft tissue defect cover were reviewed. The pros and cons of distant pedicled flaps were examined with respect to the alternative treatment; namely, free microvascular tissue transfer. The main points considered were the traumatic defect, the donor site and particular problems of each patient. The conclusion was that pedicled
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 upperextremity training appear promising. In this review, we first describe two such approaches, constraint-induced movement therapy (CIMT)…
Forty-one professional baseball players volunteered for upperextremity range of motion measurements and isokinetic testing for internal and external shoulder ro tation. Pitchers demonstrated 9° more external shoul der rotation with the arm abducted, 5° more forearm pronation, and 9° less shoulder extension on the dom inant side compared with the dominant side of position players. Pitchers also demonstrated 9°
Larry P. Brown; Sandra L. Niehues; Andrew Harrah; Patricia Yavorsky; H. Paul Hirshman
Objective: To summarize evidence on the use of upperextremity casting designed to achieve reductions in contracture, tone, pain, function, oedema or spasticity in the elbow, wrist or hand of adults and children with neurological conditions.Data sources: A search was conducted of the Cochrane Database of Systematic Reviews; the electronic databases MEDLINE, EMBASE, CINAHL, PEDro, OT-Seeker; Google Scholar; reference lists
Juvenile muscular atrophy of the distal upperextremity (JMADUE) is postulated to be a type of flexion myelopathy. However, patients with typical clinical features of JMADUE but without evidence of flexion myelopathy have been reported. We recently reported a significant association of JMADUE with airway allergy. Here we report the successful treatment by plasma exchange (PE) of two patients with
Although substantial upperextremity (U\\/E) muscular efforts are required when individuals with spinal cord injury (SCI) perform sitting pivot transfers, little is known about the electromyographic (EMG) activation patterns of key shoulder and elbow muscles solicited during the performance of this functional task. The aims of this study were to examine the EMG activation patterns of U\\/E muscles in 10
The effectiveness of high frequency stimulation of the thalamic nucleus ventralis intermedius (Vim-HFS) for treatment of tremor has been studied by blinded assessment. The effectiveness of thalamotomy for essential tremor of the upperextremity by use of a blinded measure of outcome is now reported. Thalamotomy was performed in 21 patients (three operated on bilaterally) with medically intractable, essential tremor.
The loss of the grasp function in cervical spinal cord injured (SCI) patients leads to life-long dependency on caregivers and to a tremendous decrease of the quality of life. This article introduces the novel non-invasive modular hybrid neuro-orthosis OrthoJacket for the restoration of the restricted or completely lost hand and arm functions in high tetraplegic SCI individuals. The primary goal of the wearable orthosis is to improve the paralysed upperextremity function and, thus, to enhance a patient's independence in activities of daily living. The system combines the advantage of orthotics in mechanically stabilising joints together with the possibilities of functional electrical stimulation for activation of paralysed muscles. In patients with limited capacity, for force generation, flexible fluidic actuators are used to support the movement. Thus, the system is not only intended for functional restoration but also for training. Several sensor systems together with an intelligent signal processing allow for automatic adaptation to the anatomical and neurological individualities of SCI patients. The integration of novel user interfaces based on residual muscle activities and detection of movement intentions by real-time data mining methods will enable the user to autonomously control the system in a natural and cooperative way. PMID:21210758
This study examined the agreement of subjective ratings of upperextremity exposures with corresponding direct measurements obtained simultaneously from workers. Psychophysical ratings of exposure, based on the Borg CR-10 scale, were obtained for the period of time in which direct measurements were acquired using electrogoniometers (wrist), electroinclinometers (shoulder) and electromyography (grip force). Subjects were selected from workers at two automobile manufacturing plants. Significant relationships between subjective ratings of wrist position and measured wrist posture or motion and between ratings of shoulder position and measured shoulder posture were not found. Ratings of manual effort were significantly correlated with directly measured grip force (% maximum voluntary contraction). Ratings of pace were significantly correlated with directly measured wrist motion and this relationship was strengthened with the addition of relative grip force as a covariate. Workers with hand/wrist symptoms provided ratings that were more strongly related to the directly measured exposures than those without symptoms. Self-report by workers is an alternative to more resource-intensive and invasive exposure assessment methods. However, the validity of workers' self-reported exposure assessments has been questioned. The objective of this study was to examine the agreement of selected questionnaire items with corresponding direct measurements from bioinstrumentation and to provide a better understanding of worker self-reports. PMID:18568965
Buchholz, Bryan; Park, Jung-Soon; Gold, Judith E; Punnett, Laura
The objective of this study was to develop an instrumented Lofstrand crutch system, which quantifies three-dimensional (3-D) upperextremity (UE) kinematics and kinetics using an inverse dynamics model. The model describes the dynamics of the shoulders, elbows, wrists, and crutches and is compliant with the International Society of Biomechanics (ISB) recommended standards. A custom designed Lofstrand crutch system with four, six-degree-of-freedom force transducers was implemented with the inverse dynamics model to obtain triaxial UE joint reaction forces and moments. The crutch system was validated statically and dynamically for accuracy of computing joint reaction forces and moments during gait. The root mean square (RMS) error of the system ranged from 0.84 to 5.20%. The system was demonstrated in children with diplegic cerebral palsy (CP), incomplete spinal cord injury (SCI), and type I osteogenesis imperfecta (OI). The greatest joint reaction forces were observed in the posterior direction of the wrist, while shoulder flexion moments were the greatest joint reaction moments. The subject with CP showed the highest forces and the subject with SCI demonstrated the highest moments. Dynamic quantification may help to elucidate UE joint demands in regard to pain and pathology in long-term assistive device users. PMID:21652035
Slavens, Brooke A; Bhagchandani, Neha; Wang, Mei; Smith, Peter A; Harris, Gerald F
Muscle fatigue alters neuromuscular responses. This may lead to increased sensitivity to perturbations and possibly to subsequent injury risk. We studied the effects of muscle fatigue on movement stability during a repetitive upperextremity task. Twenty healthy young subjects performed a repetitive work task, similar to sawing, synchronized with a metronome before and after performing each of two fatiguing tasks. The first fatigue task (“LIFT”) primarily fatigued the shoulder flexor muscles, while the second fatigue task (“SAW”) fatigued all of the muscles of the arm. Subjects performed each task in random order on two different days at least seven days apart. Instantaneous mean EMG frequencies (IMNF) decreased over both fatiguing tasks indicating that subjects did experience significant muscle fatigue. The slopes of the IMNF over time and the decreases in maximum force measurements demonstrated that the LIFT fatigue task successfully fatigued the shoulder flexors to a greater extent than any other muscle. On average, subjects exhibited more locally stable shoulder movements after the LIFT fatigue task (p = 0.035). They also exhibited more orbitally stable shoulder (p = 0.021) and elbow (p = 0.013) movements after the SAW fatigue task. Subjects also had decreased cocontraction at the wrist post-fatigue for both tasks (p = 0.001) and at the shoulder (p < 0.001) for the LIFT fatigue task. Therefore, increased dynamic stability of these repeated movements cannot be explained by subjects movements did not become more dynamically stable as a result of increased muscle cocontraction. Possible alternative mechanisms are discussed.
Muscle fatigue alters neuromuscular responses. This may lead to increased sensitivity to perturbations and possibly to subsequent injury risk. We studied the effects of muscle fatigue on movement stability during a repetitive upperextremity task. Twenty healthy young subjects performed a repetitive work task, similar to sawing, synchronized with a metronome before and after performing each of two fatiguing tasks. The first fatigue task (LIFT) primarily fatigued the shoulder flexor muscles, while the second fatigue task (SAW) fatigued all of the muscles of the arm. Subjects performed each task in random order on two different days at least seven days apart. Instantaneous mean EMG frequencies (IMNF) decreased over both fatiguing tasks indicating that subjects did experience significant muscle fatigue. The slopes of the IMNF over time and the decreases in maximum force measurements demonstrated that the LIFT fatigue task successfully fatigued the shoulder flexors to a greater extent than any other muscle. On average, subjects exhibited more locally stable shoulder movements after the LIFT fatigue task (p=0.035). They also exhibited more orbitally stable shoulder (p=0.021) and elbow (p=0.013) movements after the SAW fatigue task. Subjects also had decreased cocontraction at the wrist post-fatigue for both tasks (p=0.001) and at the shoulder (p<0.001) for the LIFT fatigue task. Therefore, increased dynamic stability of these repeated movements cannot be explained by increased muscle cocontraction. Possible alternative mechanisms are discussed. PMID:19942220
Background-Aim. Upperextremity deep vein thrombosis (UEDVT) is an increasingly recognized problem in the critically ill. We sought to identify the prevalence of and risk factors for UEDVT, and to characterize sonographically detected thrombi in the critical care setting. Patients and Methods. Three hundred and twenty patients receiving a subclavian or internal jugular central venous catheter (CVC) were included. When an UEDVT was detected, therapeutic anticoagulation was started. Additionally, a standardized ultrasound scan was performed to detect the extent of the thrombus. Images were interpreted offline by two independent readers. Results. Thirty-six (11.25%) patients had UEDVT and a complete scan was performed. One (2.7%) of these patients died, and 2 had pulmonary embolism (5.5%). Risk factors associated with UEDVT were presence of CVC [(odds ratio (OR) 2.716, P = 0.007)], malignancy (OR 1.483, P = 0.036), total parenteral nutrition (OR 1.399, P = 0.035), hypercoagulable state (OR 1.284, P = 0.045), and obesity (OR 1.191, P = 0.049). Eight thrombi were chronic, and 28 were acute. We describe a new sonographic sign which characterized acute thrombosis: a double hyperechoic line at the interface between the thrombus and the venous wall; but its clinical significance remains to be defined. Conclusion. Presence of CVC was a strong predictor for the development of UEDVT in a cohort of critical care patients; however, the rate of subsequent PE and related mortality was low.
This clinical review will describe the epidemiology, clinical presentation, and management of the following work-related musculoskeletal disorders (WMSDs) of the distal upperextremity: 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
Piligian, G; Herbert, R; Hearns, M; Dropkin, J; Landsbergis, P; Cherniack, M
Current neuroscience has identified several constructs to increase the effectiveness of upperextremity rehabilitation. One is the use of progressive, skill acquisition-oriented training. Another approach emphasizes the use of bilateral activities. Building on these principles, this paper describes the design and feasibility testing of a robotic / virtual environment system designed to train the arm of persons who have had strokes. The system provides a variety of assistance modes, scalable workspaces and hand-robot interfaces allowing persons with strokes to train multiple joints in three dimensions. The simulations utilize assistance algorithms that adjust task difficulty both online and offline in relation to subject performance. Several distinctive haptic effects have been incorporated into the simulations. An adaptive master-slave relationship between the unimpaired and impaired arm encourages active movement of the subject's hemiparetic arm during a bimanual task. Adaptive anti-gravity support and damping stabilize the arm during virtual reaching and placement tasks. An adaptive virtual spring provides assistance to complete the movement if the subject is unable to complete the task in time. Finally, haptically rendered virtual objects help to shape the movement trajectory during a virtual placement task. A proof of concept study demonstrated this system to be safe, feasible and worthy of further study.
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 upperextremity. 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.
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 upperextremities. 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.
Aerobic exercise training improves endothelial vasomotor function in the coronary circulation of patients with coronary artery disease (CAD), an effect that has been attributed to local repetitive increases in shear stress on the endothelium. To study the effects of exercise on endothelial function in the peripheral circulation, we used vascular ultrasound to examine flow-mediated dilation and nitroglycerin-mediated dilation in the brachial and posterior tibial arteries of 58 subjects with CAD. Studies were performed at baseline and after 10 weeks in 40 subjects (aged 59 +/- 10 years) who participated in a supervised cardiac rehabilitation program that predominantly involved moderate intensity leg exercise (three 30-minute sessions/week), and 18 matched patients who did not exercise and maintained a sedentary lifestyle. Exercise was associated with a 29% increase in functional capacity (7.3 +/- 2.2 vs 9.4 +/- 2.7 METs, p <0.001), and significant improvement in endothelium-dependent, flow-mediated dilation in a conduit artery of the leg, but not the arm. Nitroglycerin-mediated dilation in the upper arm and lower extremity was unaffected. These findings suggest that exercise improves endothelial function in peripheral conduit arteries of patients with CAD and that the beneficial effect may be more marked in the vascular beds of the exercised limbs. PMID:12106840
Gokce, Noyan; Vita, Joseph A; Bader, David S; Sherman, Debra L; Hunter, Liza M; Holbrook, Monika; O'Malley, Carol; Keaney, John F; Balady, Gary J
The purpose of this study was to determine the incidence of central vein stenosis and occlusion following upperextremity 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.Patients with longer catheter dwell time were more likely to develop central vein abnormalities. In order to preserve vascular access for dialysis fistulae and grafts and adhere to Dialysis Outcomes Quality Initiative guidelines, alternative venous access sites should be considered for patients with chronic renal insufficiency and end-stage renal disease.
Gonsalves, Carin F., E-mail: Carin.Gonsalves@mail.tju.edu; Eschelman, David J.; Sullivan, Kevin L.; DuBois, Nancy; Bonn, Joseph [Jefferson MedicalCollege/Thomas Jefferson University Hospital, Suite 4200 GibbonBuilding, 111 South 11th Street, Philadelphia, PA 19107, Department of Radiology (United States)
Lower extremity stress fractures are relatively common among competitive athletes. Stress fractures of the upperextremity, however, are rare and most have been reported in the literature as case reports. We present a case of an adolescent baseball pitcher who had both proximal humeral and ulnar shaft stress fractures, as well as spondylolysis of the lumbar spine. This particular patient also had an underlying endocrine abnormality of secondary hyperparathyroidism with a deficiency in vitamin D. A bone mineral density panel demonstrated a high T score (+2.79 SD above the mean) and the patient's biologic bone age was noted to be 2 years ahead of his chronologic age. The patient was treated with a course of vitamin D and calcium supplementation. After treatment, both the vitamin D and parathyroid hormone returned to normal levels. The upperextremity stress fractures and spondylolysis were managed conservatively and he was able to return to full activity and baseball. For patients who present with multiple stress fractures not associated with consistent high levels of repeated stress, a bone mineral density panel should be considered. If vitamin D deficiency is present, a course of oral supplementation may be considered in the management. An endocrinology consult should also be considered in patients who present with multiple stress fractures. Conservative management of upperextremity stress fractures and spondylolysis was successful in returning this patient back to his previous activity level. PMID:20502233
Li, Xinning; Heffernan, Michael J; Mortimer, Errol S
Sympathetic reflex dystrophy of the upperextremity is among the most serious complications of trauma injuries. The aim of this paper was to assess the effectiveness of mobilization treatment, augmented by cryogenic temperatures of post trauma SRD of the upperextremity. The material comprised 113 patients treated at the Orthopedic Outpatient Clinic of the J. Babi?ski Hospital in Breslau during the years 1987-1995. All patients underwent conservative treatment because of post trauma SRD. The effectiveness of cryo-therapy was based on pre- and post-therapy ROM examination. These results were compared to the ROM of the healthy extremity and the degree of ROM limitation was hence calculated. Limitation of ROM was found in all joints of the upperextremity regardless to the stage of the disease. The greatest limitations were found in the joints directly adjacent to the area were the disease was most pronounced. The applied therapy in these cases was found to increase ROM in all patients, with the greatest increase of ROM during stage I and II of the disease. PMID:12050870
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 upperextremity 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 may be associated.
Myers, Joseph B.; Oyama, Sakiko; Rucinski, Terri Jo; Creighton, R. Alexander
Background Robotic systems are becoming increasingly common in upperextremity stroke rehabilitation. Recent studies have already shown that the use of rehabilitation robots can improve recovery. This paper evaluates the effect of different modes of robot-assistances in a complex virtual environment on the subjects' ability to complete the task as well as on various haptic parameters arising from the human-robot interaction. Methods The MIMICS multimodal system that includes the haptic robot HapticMaster and a dynamic virtual environment is used. The goal of the task is to catch a ball that rolls down a sloped table and place it in a basket above the table. Our study examines the influence of catching assistance, pick-and-place movement assistance and grasping assistance on the catching efficiency, placing efficiency and on movement-dependant parameters: mean reaching forces, deviation error, mechanical work and correlation between the grasping force and the load force. Results The results with groups of subjects (23 subacute hemiparetic subjects, 10 chronic hemiparetic subjects and 23 control subjects) showed that the assistance raises the catching efficiency and pick-and-place efficiency. The pick-and-place movement assistance greatly limits the movements of the subject and results in decreased work toward the basket. The correlation between the load force and the grasping force exists in a certain phase of the movement. The results also showed that the stroke subjects without assistance and the control subjects performed similarly. Conclusions The robot-assistances used in the study were found to be a possible way to raise the catching efficiency and efficiency of the pick-and-place movements in subacute and chronic subjects. The observed movement parameters showed that robot-assistances we used for our virtual task should be improved to maximize physical activity.
Multitasking, where workers are required to perform multiple physical tasks with various levels of cognitive load is common in today's workplace. Simultaneous physical and mental demands are thought to cause task interference and likely increase muscle activity. To test the interfering effects of multitasking, 16 healthy participants performed hand and shoulder exertions with combinations of four grip conditions (no grip, 30% grip with low precision, 30% grip with high precision, and maximal grip) and three shoulder conditions at 90 degrees abduction (maintaining posture, 40% force-controlled moment, 40% posture-controlled moment), with and without the Stroop test while surface EMG was recorded from eight upperextremity muscles. Both 40% MVC shoulder moments increased extrinsic forearm muscle activity by 2-4% MVE (p<0.01). Grip exertion at 30% MVC reduced anterior and middle deltoid activity by 2% MVE (p<0.01). Exerting a constant force against the transducer (force-controlled) required 3-4% MVE greater middle and posterior deltoid activity (p<0.001) compared to supporting an equivalent inertial load at the same shoulder angle (posture-controlled). Performing the mental task (Stroop test) concurrently with either 40% MVC shoulder moments significantly increased trapezius activity by nearly 2% MVE (p<0.05). Interestingly, the Stroop test also reduced all deltoid activity by 1% MVE (p<0.05). The addition of both the Stroop test and force-control shoulder exertion independently reduced maximal grip force by 7% and 10% MVC, respectively. These results suggest that more complex workplace tasks may act to increase muscle load or interfere with task performance. These small but significant findings may play a role in the development of long-term musculoskeletal disorders in the workplace. PMID:16904910
Oliver, GD, Sola, M, Dougherty, C, and Huddleston, S. Quantitative examination of upper and lower extremity muscle activation during common shoulder rehabilitation exercises using the bodyblade. J Strength Cond Res 27(9): 2509-2517, 2013-The kinetic chain approach to shoulder rehabilitation has become a standard of care within sports medicine. Attempting to incorporate the kinetic chain method of proximal stability for distal mobility requires a stable base of not only the lower extremity but also the upperextremity. Therefore, it was the purpose of this study to quantify muscle activation of the upper and lower extremity during common shoulder rehabilitation exercises using the Bodyblade. An observational descriptive study design was used. Thirty healthy collegiate graduate students (age: 23.5 ± 1.34 years; height: 174.4 ± 11.0 cm; weight: 76.6 ± 16.9 kg), regardless of gender, consented to participate. The independent variables were the 2 observational categories of exercise and muscle. The dependent variable was considered muscle activation as presented as percent maximum voluntary isometric contraction. Results revealed moderate to moderately strong activation of both the musculature of the upper and lower extremity while performing the shoulder rehabilitation exercises. The findings of this study demonstrate that any of these exercises may be incorporated into a shoulder rehabilitation program. The muscle activations described in this study are beneficial in choosing appropriate exercises to perform during shoulder rehabilitation. Information from this study can be applied to the kinetic chain approach to shoulder rehabilitation where focus is on the movement pattern. The Bodyblade is a unique rehabilitation tool because a variety of kinetic chain movement pattern exercises allow for scapular control via muscle activation about the hip and shoulder. PMID:23238096
Oliver, Gretchen D; Sola, Mike; Dougherty, Chris; Huddleston, Sean
Clinical Scenario: Extensive research has been conducted on the efficacy of constraint induced movement therapy for increasing upperextremity function in the adult post-stroke population. Little is known regarding the efficacy of this treatment in the pediatric population. The purpose of this critically appraised topic is to determine if constraint induced movement therapy is effective in improving upperextremity function
Overhead work has established links to upperextremity discomfort and disorders. As many jobs incorporate working overhead, this study aimed to identify working conditions requiring relatively lower muscular shoulder load. Eleven upperextremity muscles were monitored with electromyography during laboratory simulations of overhead work tasks. Tasks were defined with three criteria: work configuration (fixed, stature-specific); target angle (?15°, 0°, 15°,
Jaclyn N. Chopp; Steven L. Fischer; Clark R. Dickerson
This investigation compared three dimensional upperextremity motion during wheelchair propulsion in persons with 4 levels of spinal cord injury: low paraplegia (n=17), high paraplegia (n=19), C7 tetraplegia (n=16), and C6 tetraplegia (n=17). Upperextremity motion was recorded as subjects manually propelled a wheelchair mounted on a stationary ergometer. For all motions measured, subjects with paraplegia had similar patterns suggesting that the wheelchair backrest adequately stabilizes the trunk in the absence of abdominal musculature. Compared with paraplegic subjects, those with tetraplegia differed primarily in the strategy used to contact the wheel. This was most evident among subjects with C6 tetraplegia who had greater wrist extension and less forearm pronation. PMID:10567754
Newsam, C J; Rao, S S; Mulroy, S J; Gronley, J K; Bontrager, E L; Perry, J
The study aims the registration and anlaysis of the main facts which occur during recovery of the voluntary movements in the upperextremity, in patients with hemiplegia following cerebrovascular accident, and it also intends to evaluate the prognosis. Of particular interest was the comparative recognition of the spontaneous recovery of voluntary motricity in different segments of the upperextremity in 88 patients, not previously selected, with hemiplegia after cerebrovascular accident, admitted to the hospital at the acute stage. Of the 88 hemiplegic patients studied whose further evolution has been fairly followed 56 cases (group 1) experienced clinical improvement, either with partial or total remission of neurological manifestations and complete recovery of all voluntary movements in the different upperextremity joints, while 32 patients (group 2) with persistent neurological symptoms, particularly spasticity, showed a slighter clinical improvement, as well as only partial recovery of upperextremity movements. The clinical quantification of neurological signs applied in this study, has made possible to report the main significant changes developed during the 88 patients recovery. This criteria has allowed to emphasize the degree of the spontaneous remission of symptoms and the determination of the critical level of stabilization "plateau". The analysis of the data supplied by the two groups led to the following conclusions: a) the critical level of remission of symptoms and the spontaneous recovery of voluntary movements ocurred around the 70th day after the installation of hemiplegia; b) the 256 average score acquired 70 days after the onset of the hemiplegia represents the critical level stabilization (plateau); c) although the presence of early initial movements, immediately after the installation of hemiplegia, is a valuable data for the prognosis, the characterization of early movement patterns is of most important meaning; d) patients with hemiplegia after cerebrovascular acident who present the thumb flexion-extension and opposition movements showed a better prognosis than those whose initial movements were represented by the elbow flexion and/or arm flexion-adduction. PMID:1275794
We sought to assess the clinical effectiveness of a new plate design which offers improved biological and biomechanical features, the limited contact dynamic compression (LCDC) plate. We analysed 114 LCDC plates applied consecutively for upperextremity fractures or reconstruction in 94 patients. Three patients were lost to follow-up, leaving 111 plates in 91 patients followed to definitive fracture\\/osteotomy outcome. Thirty-seven
The purpose of this study was to compare the acute effects of static stretching; dynamic exercises and high volume upperextremity 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 upperextremity 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 upperextremity 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 upperextremity plyometric activities to improve their athletic performance.
Objectives To study work-related physical and psychosocial risk factors for sick leave among patients who have visited their general practitioner for neck or upperextremity complaints. Methods Three hundred and forty two patients with neck or upperextremity complaints completed self-report questionnaires at baseline and after 3 months. Cox regression models were used to investigate the association between work-related risk factors and sick leave (i.e., lost days from work due to neck or upperextremity complaints in 3 months). Effect modification by sick leave at baseline, sex, worrying and musculoskeletal co-morbidity was evaluated by adding product terms to the regression models. Results In the subgroup of patients who scored high on the pain copying scale “worrying” the hazard ratio of sick leave was 1.32 (95% CI 1.07–1.62) per 10% increase in heavy physical work. The subgroup of patients who were sitting for long periods of time had a reduced risk of sick leave as compared to patients who did not spend a lot of time sitting, again only in patients who scored high on the pain coping scale “worrying” (adjusted HR = 0.17, 95%-CI 0.04–0.72). Other work-related risk factors were not significantly related to sick leave. Conclusions Heavy physical work increased the risk of sick leave and prolonged sitting reduced the risk of sick leave in a subgroup of patients who worried much about their pain. Additional large longitudinal studies of sufficiently large size among employees with neck or upperextremity complaints are needed to confirm our results.
Terwee, Caroline B.; van der Windt, Danielle A. W. M.; van der Beek, Allard J.; Bouter, Lex M.; Dekker, Joost
|This study compared the effects of low and high doses of botulinum toxin A (BTX-A) to improve upperextremity 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…
Purpose Supraclavicular brachial plexus block is considered to be one of the most effective anesthetic procedures for upperextremity\\u000a surgeries. Its major drawback is placement of the needle, with inaccurate placement, especially in children, being a risk\\u000a factor for pneumothorax and vascular puncture and failure of the procedure. Ultrasound-guided needle placement may reduce\\u000a the risk of complications and increase the accuracy
Hartmann, H, Bob, A, Wirth, K, and Schmidtbleicher, D. Effects of different periodization models on rate of force development and power ability of the upperextremity. J Strength Cond Res 23(7): 1921-1932, 2009—The purpose of our study was to compare the effects of 2 different periodization models on strength and power variables under dynamic and static con- ditions in the
HAGEN HARTMANN; A NDREAS BOB; K LAUS WIRTH; DIETMAR SCHMIDTBLEICHER
We present an expanded latissimus dorsi musculocutaneus (LDMC) flap to treat circumferential upperextremity defects via resurfacing\\u000a and “spiral reconstruction” in 5 patients during a 17-year period. Five patients with different indications for tissue expansion\\u000a from burns to congenital hairy nevi were operated. The expansion was done in a longitudinal direction, and a rectangular tissue\\u000a expander (TE) was inserted under
Shahram Nazerani; Mohammad Hosein Kalantar Motamedi; Mohammad Reza Keramati; Tara Nazerani
Introduction Fear Avoidance Beliefs (FAB) have been associated with increased pain, dysfunction and difficulty returning to work in Upper\\u000a Extremity (UE) injures. The FABQ is used to assess FAB, but its measurement properties have not been established in UE. The\\u000a purpose of this study is to evaluate the reliability and validity of the FABQ to screen UE compensated injured workers
Peripheral arteriovenous (AV) malformations may present with a plethora of clinical symptoms such as paradoxical emboli, severe hypertension, nerve palsies or pain syndromes. Hemodynamically compromising lesions of the limbs are rare and involve high-flow AV fistulae with marked arteriovenous shunting. A female patient with a high-flow arteriovenous malformation of the left upper-extremity is presented. Preoperative assessment by magnetic resonance imaging
E. Polykandriotis; C. Böhner; R. Hess; U. Kneser; H. Seyhan; B. Loos; A. Bach; J. Kopp; R. E. Horch
Kowalczewski J, Gritsenko V, Ashworth N, Ellaway P, Prochazka A. Upper-extremity functional electric stimulationassisted exercises on a workstation in the sub- acute phase of stroke recovery. Arch Phys Med Rehabil 2007; 88:833-9. Objective: To test the efficacy of functional electric stimu- lation (FES)assisted exercise therapy (FES-ET) on a work- station in the subacute phase of recovery from a stroke. Design:
Jan Kowalczewski; Valeriya Gritsenko; Nigel Ashworth; Peter Ellaway; Arthur Prochazka
Purpose Supraclavicular brachial plexus block is considered as one of the most effective anesthetic methods for upperextremity surgeries.\\u000a Its major drawback, especially in children, is the risk of pneumothorax, vascular puncture, and failure of the procedure due\\u000a to inaccurate placement of the needle. Ultrasound-guided needle placement may reduce the risk of complications and increase\\u000a the accuracy of block, particularly in
Confronted with increasing problems of financing in health care, some question the relevance of certain interventions of high technicality. Today, the limiting factor for practitioners is not any longer situated at the technical and technological level (the survival of macro replantations is assured in 85-90%) but moves slowly and surely towards the economic level. It is true that medicine has a price and that if a technique is expensive, it should at least be justified at the human level and superior to other less expensive therapeutic options which are available. In this article, we will first focus on the long-term outcome of patients and also on the functional benefit which brings them replantation compared to patients who underwent a regularization of their stump and possibly a reconstruction enabling them to be correctly fitted with a prosthesis. PMID:23614320
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 upperextremity 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 upperextremity 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 upperextremity 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.
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.
Background Although inpatient rehabilitation may enhance an individual’s functional ability after stroke, it is not known whether these improvements are accompanied by an increase in daily use of the arms and legs. Objective To determine the change in daily use of the upper and lower extremities of stroke patients during rehabilitation and to compare these values with that of community-dwelling older adults. Methods A total of 60 stroke patients underwent functional assessments and also wore 3 accelerometers for 3 consecutive weekdays on admission to rehabilitation and 3 weeks later prior to hospital discharge. The number of steps and upper-extremity activity counts were measured over the waking hours and during daily use for occupational therapy and physical therapy (PT) sessions. Healthy older adults (n = 40) also wore 3 accelerometers for 5 consecutive days. Results Stroke patients demonstrated a significant increase in mobility function, and this was accompanied by an increase in daily walking over the entire day as well as in PT. However, increases in daily walking were found predominantly in patients who were wheelchair users (and not walkers) at the time of admission. Control walking values (5202 steps) were more than 17 times that of stroke patients. Despite significant improvements in paretic hand function, no increase in daily use of the paretic or nonparetic hand was found over the entire day or in PT. Conclusions. A disparity between functional recovery and increases in daily use of the upper and lower extremities was found during inpatient stroke rehabilitation.
We present mobile health (mHealth) applications utilizing embedded phone sensors as an angle-measuring device for upper-limb range of motion (ROM) and estimation of reachable workspace to assist in evaluation of upper limb functional capacity. Our results show that the phone can record accurate measurements, as well as provide additional functionalities for clinicians. PMID:23400206
Yan, Posu; Kurillo, Gregorij; Bajcsy, Ruzena; Abresch, R Ted; Nicorici, Alina; Johnson, Linda; Han, Jay J
The paper describes a system for controlling an artificial upperextremityprosthesis for above elbow amputees in several degrees of freedom. The system employs microprocessor hardware and is based on time series identification of the voluntary myoelectric signals involved and on subsequent limb-function discrimination via the above parameters. The system requires only 1 to 2 electrode sites and satisfies the
Some recent research on fluvial processes suggests the idea that some hydrological variables, such as flood flows, are upper-bounded.\\u000a However, most probability distributions that are currently employed in flood frequency analysis are unbounded to the right.\\u000a This paper describes an exploratory study on the joint use of an upper-bounded probability distribution and non-systematic\\u000a flood information, within a Bayesian framework. Accordingly,
Wilson Fernandes; Mauro Naghettini; Rosângela Loschi
Analyses of the spatial and temporal distribution of extreme rainfall in the Arkansas River basin above Pueblo, Colorado, are based on volume scan reflectivity observations from the Pueblo WSR-88D radar during the period 1995–2003. A storm catalog of 66 rainfall events during the 9-year period has been developed. Climatological analyses of extreme rainfall are carried out both from an Eulerian
Julie Rose N. Javier; James A. Smith; John England; Mary Lynn Baeck; Matthias Steiner; Alexandros A. Ntelekos
The weight hierarchy of a linear [n,k;q] code C over GF(q) is the sequence (d1,d2,…,dk) where dr is the smallest support weight of an r-dimensional subcode of C. Linear codes may be classified according to a set of chain and non-chain conditions, the extreme cases being codes satisfying the chain condition (due to Wei and Yang) and extremal, non-chain codes
In order to develop an advanced intelligent prosthesis which can help above-knee amputee to walk like healthy people, a test-bed for above-knee intelligent prosthesis has been set up. Mechanism and virtual prototype model are all built. The test-bed consists of a bionic leg (BL) which simulates above-knee prosthesis, an artificial leg (AL) which simulates healthy leg, a simplified upper body
We developed a new, sensitive evaluation method for upperextremity dexterity in patients with hemiparesis after stroke. This evaluation method consists of three types of test: the Finger Individual Movement Test, Hand Pronation and Supination Test, and Finger Tapping Test. In each test, the number of movements that can be performed during a 10-s period is measured. Data obtained by these 10-s tests were compared with those obtained by the Nine-Hole Peg Test (NHPT), and the usefulness of this new method was evaluated. In patients with hemiparesis after stroke, three types of 10-s test and NHPT were performed for the upperextremities on both the affected and unaffected sides. Simple correlation analysis and multiple regression analysis of data obtained by the three types of test and NHPT were performed using the affected/unaffected ratios. Twenty patients participated (54-85 years; 0.23-43.83 months after stroke) with mild upperextremity hemiparesis. Significant correlations exist between Finger Individual Movement Test and NHPT data (r=-0.584, P=0.0068) and between Hand Pronation and Supination Test and NHPT data (r=-0.707, P=0.0005). The multiple regression analysis model using the three types of 10-s test as explanatory variables was significant (P=0.0025) and explained 52.4% of the NHPT results. A significant association was observed between NHPT and the 10-s tests. The 10-s tests require no special examination instruments and can be readily performed in a short period. This evaluation method consisting of the 10-s tests can be a new clinical parameter of dexterity in patients with hemiparesis after stroke. PMID:17762772
OBJECTIVES:: To review outcomes for patients who received intraoperative radiotherapy (IORT) for upper-extremity sarcoma. METHODS:: We identified patients with upper-extremity tumors who were treated with external beam radiotherapy, surgery, and IORT, with or without chemotherapy. Kaplan-Meier estimates for overall survival (OS), central control (CC), local control (LC), and distant control (DC) were obtained. RESULTS:: Sixty-one patients were identified. Median age was 50 years (range, 13 to 95 y). Median follow-up was 5.9 years. Eleven patients had gross (R2; n=1) or microscopic (R1; n=10) disease at the time of IORT. IORT doses ranged from 7.50 to 20.00 Gy. External beam radiotherapy doses ranged from 19.80 to 54.00 Gy. OS at 5 and 10 years was 72% and 58%, respectively. LC at 5 and 10 years was 91% and 88%, respectively. DC at 5 and 10 years was 80% and 77%, respectively. Patients treated for recurrent disease had inferior 5-year OS compared with patients with first diagnoses (63% vs. 74%; P=0.02) and lower 5-year LC (67% vs. 94%; P<0.01). For patients with R1 or R2 resections, LC at 5 and 10 years was 100% and 86%, respectively; for patients with R0 resections, LC was 89% at both 5 and 10 years (P=0.98). Severe toxicity attributable to treatment was noted for 4 patients (7%). CONCLUSIONS:: For upper-extremity sarcoma, treatment including IORT was associated with excellent LC, limb preservation, and survival. LC rates were excellent for patients with positive margins after resection. Patients with recurrent disease had worse outcomes, but limb preservation was achievable for most patients. PMID:23111357
Call, Jason A; Stafford, Scott L; Petersen, Ivy A; Haddock, Michael G
Shi YX, Tian JH, Yang KH, Zhao Y. Modified constraint-induced movement therapy versus traditional rehabilitation in patients with upper-extremity dysfunction after stroke: a systematic review and meta-analysis.
Wu CY, Chen CL, Tang SF, Lin KC, Huang YY. Kinematic and clinical analyses of upper-extremity movements after constraint-induced movement therapy in patients with stroke: a randomized controlled trial.
Ching-yi Wu; Chia-ling Chen; Simon F. Tang; Keh-chung Lin; Ya-ying Huang
Marino RJ, Burns S, Graves DE, Leiby BE, Kirshblum S, Lammertse DP. Upper- and lower-extremity motor recovery after traumatic cervical spinal cord injury: an update from the National Spinal Cord Injury Database.
Ralph J. Marino; Stephen Burns; Daniel E. Graves; Benjamin E. Leiby; Steven Kirshblum; Daniel P. Lammertse
Infantile myofibromatosis (IM) is the most common fibrous tumor of infancy. IM may arise in a solitary or multicentric form, with similar histopathological findings, however, the clinical features and prognoses may vary. The solitary form tends to occur predominantly in males and is typically observed in the dermis, subcutis or deep soft tissues. The reported incidence of solitary osseous myofibromatosis is rare. Furthermore, the majority of solitary IM cases of the bone occur in the craniofacial bones, while the occurrence of solitary osseous myofibromatosis on the extremities has been sporadically reported. The present study describes two cases of solitary IM involving the bones of the upperextremities in females who were over two years old. The cases show unusual symptom presentation and the tumor origin is in a rarely observed location. The study discusses the clinical, radiological and pathological features, in addition to the previously described etiology, prognosis and treatment options for this condition.
Objective. To investigate the characteristics of mechanical energy and power flow of the upper limb during wheelchair propulsion. Design. Mechanical energy and power flow of segments were calculated. Background. Very few studies have taken into account the mechanical energy and power flow of the musculoskeletal system during wheelchair propulsion. Mechanical energy and power flow have proven to be useful tools
Objective. To investigate the characteristics of mechanical energy and power flow of the upper limb during wheelchair propulsion.Design. Mechanical energy and power flow of segments were calculated.Background. Very few studies have taken into account the mechanical energy and power flow of the musculoskeletal system during wheelchair propulsion. Mechanical energy and power flow have proven to be useful tools for investigating
Lan-Yuen Guo; Fong-Chin Su; Hong-Wen Wu; Kai-Nan An
Background: Previous studies have estimated joint torques and electromyogram activity associated with the pitching motion. Although previous studies have investigated the influence of extended pitching (fatigue) on kinematic and kinetic parameters, no attempts have been made to quantify the fatigue associated with a pitching performance.Purpose: Considering previous investigations on muscle activity during pitching, this study investigated muscle fatigue in upper
Michael J. Mullaney; Malachy P. McHugh; Tom M. Donofrio; Stephen J. Nicholas
Background Little is known about the most effective occupational health and safety (OHS) interventions to reduce upperextremity musculoskeletal\\u000a disorders (MSDs) and injuries. Methods A systematic review used a best evidence synthesis approach to address the question: “do occupational health and safety interventions\\u000a have an effect on upperextremity musculoskeletal symptoms, signs, disorders, injuries, claims and lost time?” Results The
Carol A. Kennedy; Benjamin C. Amick III; Jack T. Dennerlein; Shelley Brewer; Starly Catli; Renee Williams; Consol Serra; Fred Gerr; Emma Irvin; Quenby Mahood; Al Franzblau; Dwayne Van Eerd; Bradley Evanoff; David Rempel
There are more than forty million blind individuals in the world whose plight would be greatly ameliorated by creating a visual prosthesis. We begin by outlining the basic operational characteristics of the visual system, as this knowledge is essential for producing a prosthetic device based on electrical stimulation through arrays of implanted electrodes. We then list a series of tenets that we believe need to be followed in this effort. Central among these is our belief that the initial research in this area, which is in its infancy, should first be carried out on animals. We suggest that implantation of area V1 holds high promise as the area is of a large volume and can therefore accommodate extensive electrode arrays. We then proceed to consider coding operations that can effectively convert visual images viewed by a camera to stimulate electrode arrays to yield visual impressions that can provide shape, motion, and depth information. We advocate experimental work that mimics electrical stimulation effects non-invasively in sighted human subjects with a camera from which visual images are converted into displays on a monitor akin to those created by electrical stimulation. PMID:19065857
It has been demonstrated an intrathoracic artificial heart with membrane pump delivering a pulsed flow and connected with an extracorporeal source of energy can keep a cardiotomized animal alive for several months without biological organic disturbances. The next experimental step would be intrathoracic implantation in man of a similar heart with an energy converter connected to an extracorporeal source giving the patient a 6-8 hour period of autonomy. At rest or during the night the batteries attached to the patient's waist would easily be recharged. Current research concentrates on reduction of artificial heart volume and miniaturization of the energy converter and regulatory electronic circuits. Kinetic pumps, which are small and without valvular prosthesis facilitate miniaturization. They deliver a high-speed continuous flow and have not yet been shown in long-term experiments to be free from biological disturbances. The clinical phase of stage II artificial hearts, due to begin in 1990, will be preceded by attempts at implanting hearts animated by an extracorporeal source of energy, pending cardiac replacement. PMID:6219372
Accurate prosthesis classification is critical for total joint arthroplasty surveillance and assessment of comparative effectiveness. Historically, prosthesis classification was based solely on the names of the prosthesis manufacturers. As a result, prosthesis designs changed without corresponding name changes, and other prostheses' names changed over time without substantial design modifications. As the number of prostheses used in total joint arthroplasty on the market increased, catalog and lot numbers associated with prosthesis descriptions were introduced by manufacturers. Currently, these catalog and lot numbers are not standardized, and there is no consensus on categorization of these numbers into brands or subbrands. Classification of the attributes of a prosthesis also varies, limiting comparisons of prostheses across studies and reports. The development of a universal prosthesis classification system would standardize prosthesis classification and enhance total joint arthroplasty research collaboration worldwide. This is a current area of focus for the International Consortium of Orthopaedic Registries (ICOR). PMID:22262428
Robertsson, Otto; Mendenhall, Stan; Paxton, Elizabeth W; Inacio, Maria C S; Graves, Stephen
OBJECTIVE: Electrical stimulation can be applied in a variety of ways to the hemiparetic upperextremity following stroke. The aim of this review is to explore the relationship between characteristics of stimulation and the effect of electrical stimulation on the recovery of upper limb motor control following stroke. METHODS: A systematic literature search was performed to identify clinical trials evaluating
Kroon de Joke R; Maarten J. IJzerman; John Chae; Gustaaf J. Lankhorst; Gerrit Zilvold
Approximately 8,000 automobile occupants are killed and 24,000 seriously injured each year in automotive side impact collisions. In order to accurately predict injury of human occupants, the response of automotive side impact anthropometric test dummies must be as biofidelic as possible. The upper arm serves as a load path to the thorax, and the response characteristics of the upper arm can influence the thoracic response in side impact test dummies. Therefore, the purpose of the study is to characterize the compressive response of male and female humeri with all soft tissue attached, an original SIDIIs arm, and a modified SID-IIs arm to evaluate the biofidelity of the side impact dummy arm. A series of compression tests were performed at two dynamic rates, 2.34 m/s and 3.81 m/s, on a total of eight male and female humeri with all soft tissues attached. Matched compression tests were preformed on the original SID-IIs and a modified SID-IIs upper arm segment using a drop tower. The impact direction for all tests was from lateral to medial in order to simulate an automotive side impact collision. In order to correct for the loss in the cadaver arm tissue thickness resulting from the horizontal test orientation, the upper arms of 35 male and 35 female volunteers were measured. The results show that for both rates the modified Sid-IIs arm force vs. compression response was more representative of the cadaver humeri force vs. compression responses than the original Sid-IIs arm. The more realistic response characteristics of the modified Sid-IIs arm could improve the biofidelity of the overall thoracic response in side impact anthropometric test dummies. PMID:19141902
Motor impairments and cognitive dysfunction are common in multiple sclerosis (MS). We aimed to delineate the relationship between cognitive capacity and upper and lower motor function in 211 MS patients, and 120 healthy volunteers. Lower and upper motor function were assessed with the Timed 25 Foot Walk (T25FW) and the Nine Hole Peg Test (NHPT) as implemented in the Multiple Sclerosis Functional Composite (MSFC). Subjects also underwent neuropsychological evaluation. Hierarchical linear regression analysis was conducted separately for the MS and healthy groups with the T25FW and NHPT serving as the outcome measures. Cognitive performance indices served as predictors. As expected, healthy subjects performed better than the MS group on all measures. Processing speed and executive function tests were significant predictors of lower and upper motor function in both groups. Correlations were more robust in the MS group, where cognitive tests predicted variability in motor function after controlling for disease duration and physical disability. In conclusion, we find evidence of higher order cognitive control of motor function that appears to be particularly salient in this large and representative MS sample. The findings may have implications for risk assessment and treatment of mobility dysfunction in MS. PMID:21486517
Benedict, Ralph H B; Holtzer, Roee; Motl, Robert W; Foley, Frederick W; Kaur, Sukhmit; Hojnacki, David; Weinstock-Guttman, Bianca
We present a critical analysis of the monograph of A.S.D. Synnestvedt (1869) “En anatomisk beskrivelse af de paa over- og underestremiteterne forekommende Bursae mucosae”. The analysis was completed using anatomical information from the historically oldest publications dealing with the bursae of the extremities: Albinus (1734) , Monro (1788) , Rosenmüller (1799) . We are of the opinion that Synnestvedt's publication is important, not only historically but also as a source of information for recent medical practitioners. Synnestvedt's monograph has a wealth of literary citations, unambiguous opinions of seasoned anatomists regarding the structure and function of the synovial membrane, and detailed descriptions of dissections he performed on fetal and adult cadavers. The information in this publication may enhance the diagnosis of bursopathies and enthesopathies of the extremities. PMID:20860444
Musil, Vladimir; Selnes, Christoffer V; Falck, Aleksander T; Sandve, Lars; Shekarchi, Siamek; O'Donnell, Bruce; Kachlik, David
Preoperative assessment of the extent of vascular injury is important in patients with mutilating injuries of the upperextremity. The aim of this report was to discuss the influence of computed tomography angiography (CTA) and digital subtraction angiography (DSA) on the operating room decision-making in mutilating injuries and limb-salvage procedures of the traumatic upperextremity. Four DSA and 3 CTA were performed in 7 patients with a mean age of 28.3 (range, 4-48) years. The results of the DSA and CTA altered the preoperative planning. In 5 patients, the reconstructive decision of the type of flap was altered, whereas in all 7 patients, either the level or type of anastomosis was changed after radiologic investigations. The mean follow-up period was 37.8 months. During the follow-up period, all patients underwent subsequent procedures such as sensory restoration, tendon reconstruction, or capsulotomy. The effects of radiologic results in which flap selection, target donor vessel, and level and type of anastomosis have changed are discussed in correlation with intraoperative findings. PMID:22214801
Objectives This study was conducted to develop a model describing the interaction between lifestyle, job, and postural factors and parts of the upperextremities in shipyard workers. Methods A questionnaire survey was given to 2,140 workers at a shipyard in Ulsan City. The questionnaire consisted of questions regarding the subjects' general characteristics, lifestyle, tenure, physical burden, job control, posture and musculoskeletal symptoms. The overall relationship between variables was analyzed by a structural equation model (SEM). Results The positive rate of upperextremity musculoskeletal symptoms increased in employees who worked longer hours, had severe physical burden, and did not have any control over their job. Work with a more frequent unstable posture and for longer hours was also associated with an increased positive rate of musculoskeletal symptoms. Multiple logistic regression analysis showed that unstable posture and physical burden were closely related to the positive rate of musculoskeletal symptoms after controlling for age, smoking, drinking, exercise, tenure, and job control. In SEM analysis, work-related musculoskeletal disease was influenced directly and indirectly by physical and job stress factors, lifestyle, age, and tenure (p < 0.05). The strongest correlations were found between physical factors and work-related musculoskeletal disease. Conclusion The model in this study provides a better approximation of the complexity of the actual relationship between risk factors and work-related musculoskeletal disorders. Among the variables evaluated in this study, physical factors (work posture) had the strongest association with musculoskeletal disorders.
Methods from two statistical downscaling categories were used to investigate the impact of climate change on high rainfall and flow extremes of the upper Blue Nile basin. The main downscaling differences considered were on the rainfall variable while a generally similar method was applied for temperature. The applied downscaling methods are a stochastic weather generator, LARS-WG, and an advanced change factor method, the Quantile Perturbation Method (QPM). These were applied on 10 GCM runs and two emission scenarios (A1B and B1). The downscaled rainfall and evapotranspiration were input into a calibrated and validated lumped conceptual model. The future simulations were conducted for 2050s and 2090s horizon and were compared with 1980-2000 control period. From the results all downscaling methods agree in projecting increase in temperature for both periods. Nevertheless, the change signal on the rainfall was dependent on the climate model and the downscaling method applied. LARS weather generator was good for monthly statistics although caution has to be taken when it is applied for impact analysis dealing with extremes, as it showed a deviation from the extreme value distribution's tail shape. Contrary, the QPM method was good for extreme cases but only for good quality daily climate model data. The study showed the choice of downscaling method is an important factor to be considered and results based on one downscaling method may not give the full picture. Regardless, the projections on the extreme high flows and the mean main rainy season flow mostly showed a decreasing change signal for both periods. This is either by decreasing rainfall or increasing evapotranspiration depending on the downscaling method.
The aim of this study was to present kinematics of trunk and upperextremities in tennis players who perform one-handed and two-handed backhand strokes. The study aimed to address the question of whether one of those techniques has some important advantage over the other. If so, what makes it superior? The study included 10 tennis coaches with average coaching experience of 9 years. The coaches were asked to hit 15 one-handed and two-handed backhands. The tests were carried out in a laboratory. A sponge ball was used in order to protect the measurement equipment. Video motion analysis was carried out using BTS SMART system; images were recorded with 6 cameras with a rate of 120 frames per second. The analysis of both backhand strokes focused on the second phase of the stroke (acceleration). The use of an eight-element model of human body for description of upper body motion in both techniques revealed kinematic differences in how both backhands are performed. The two-handed backhand was performed in closed kinetic chain with 8 degrees of freedom, whereas the one-handed backhand involved an open kinetic chain with 7 degrees of freedom. Higher rigidity of upperextremities which are connected with trunk in the two-handed backhand, contributes to an elevated trunk effect in this stroke. This is confirmed by higher component velocities for racket handle, which result from trunk rotation in the two-handed backhand and a negative separation angle in the two-handed backhand at the moment of contact of the racket with the ball. The study does not provide a clear-cut answer to the question of advantages of one technique over the other; however, it reveals dissimilar patterns of driving the racket in both techniques, which suggests the need for extending the analysis of techniques of both backhands with additional kinematics of tennis racket in consideration of measurements of ball velocities.
Both frontal and side air bags can inflict injuries to the upperextremities in cases where the limb is close to the air bag module at the time of impact. Current dummy limbs show qualitatively correct kinematics under air bag loading, but they lack biofidelity in long bone bending and fracture. Thus, an effective research tool is needed to investigate the injury mechanisms involved in air bag loading and to judge the improvements of new air bag designs. The objective of this study is to create an efficient numerical model that exhibits both correct global kinematics as well as localized tissue deformation and initiation of fracture under various impact conditions. The development of the model includes the creation of a sufficiently accurate finite element mesh, the adaptation of material properties from literature into constitutive models and the definition of kinematic constraints at articular joint locations. In order to make the model applicable for full-scale simulations, it was coupled with a computationally efficient human model. The model was validated against available cadaver experiments, including static and dynamic three-point-bending tests to the arm and forearm, as well as frontal air bag to forearm impact tests. The sensitivity of the model to changes in air bag properties and upper limb orientation are demonstrated by performing parametric studies. It is shown that the risk of forearm fracture increases substantially with proximity to the deploying frontal air bag and air bag aggressiveness, which corresponds to experimental findings. However, it is shown that increasing the forearm supination angle is protective for the occurrence of forearm fracture. In conclusion, the developed model proves to be a useful research tool to investigate trends in injury severity as a result of a changing frontal air bag to upperextremity loading environment. PMID:17096244
van Rooij, L; Bours, R; van Hoof, J; Mihm, J J; Ridella, S A; Bass, C R; Crandall, J R
Free omental tissue transfer is a versatile reconstructive option for trunk, head and neck, and extremity reconstruction. Its utility is due to the length and caliber of the vascular pedicle and the malleability and surface area of the flap. We report our experience with omental free flap coverage of complex upper-extremity defects. A retrospective analysis of eight omental free-tissue transfers in seven patients with complex upper-extremity defects between 1999 and 2008 was performed. Indications, operative technique, and outcome were evaluated. Patient age ranged from 12 to 59 years with five male and two female patients. Indications included tissue defects due to crush-degloving injuries, pitbull mauling, or necrotizing soft tissue infection. All patients had prior operations including: revascularization, debridement, tendon repair, skin grafts, and/or fixation of associated fractures. One patient sustained severe bilateral crush-degloving injuries requiring free omental hemiflap coverage of both hands. The mean defect size was 291 cm(2) with all patients achieving complete wound coverage. No flap loss or major complications were noted. Laparoscopic-assisted omental free flap harvest was performed in conjunction with the general surgery team in three cases. Mean follow-up was 2 years. The omental free flap is a valuable, often overlooked reconstructive option. The long vascular pedicle and large amount of pliable, well-vascularized tissue allow the flap to be aggressively contoured to meet the needs of complex three-dimensional defects. In addition, laparoscopic-assisted harvest may aid with flap dissection and may result in reduced donor-site morbidity. PMID:19319608
Seitz, Iris A; Williams, Craig S; Wiedrich, Thomas A; Henry, Ginard; Seiler, John G; Schechter, Loren S
Males typically have greater upper body strength than do females, which is likely to impact on the rowing techniques adopted by each sex. The aim of this study was to quantify energy contributions and compare the joint power production of upperextremity joints between the sexes. Seven males and eight females performed 60 s trials at five different stroke rates. External forces were measured at the handle and stretcher, while kinematics were recorded by motion analysis. Joint moments were derived by inverse dynamic calculations, followed by the calculation of joint powers and gross mechanical energy expenditure. Male rowers expended more total external energy per stroke and made a larger percentage contribution of angular shoulder energy to their total external energy expenditure. As stroke rate increased, the contribution from elbow and angular shoulder energy contributions decreased for both males and females. Female rowers decreased their angular shoulder contribution at a slower rate than did males as stroke rate increased. The overall percentage of work done on the stretcher was higher for male rowers, and this difference further increased at higher stroke rates. The results of this study suggest that specific upper body conditioning may be particularly important for female rowers. PMID:22296106
Attenborough, Alison S; Smith, Richard M; Sinclair, Peter J
Dynamic mechanical response parameters (stiffness, damping and effective mass), physiological properties (strength and swelling) and symptoms of the upper limb were measured before power tool operation, immediately following and 24 h after power tool operation. Tool factors, including peak torque (3 Nm and 9 Nm) and torque build-up time (50 ms and 250 ms), were controlled in a full factorial design. Twenty-nine inexperienced power hand tool users were randomly assigned to one of four conditions and operated a pistol grip nutrunner four times per min for 1 h in the laboratory. Isometric strength decreased immediately following tool use (15%) (p < 0.01) and 24 h later (9%) (p < 0.05). Mechanical parameters of stiffness (p < 0.05) and effective mass (p < 0.05) were affected by build-up time. An average decrease in stiffness (43%) and effective mass (57%) of the upper limb was observed immediately following pistol grip nutrunner operation for the long (250 ms) build-up time. A previously developed biomechanical model was used to estimate handle force and displacement associated with the tool factors in the experiment. The conditions associated with the greatest predicted handle force and displacement had the greatest decrease in mechanical stiffness and effective mass, and the greatest increase in localized discomfort. PMID:16076739
In order to determine differences in biomechanical risk factors across computer tasks, a repeated measures laboratory experiment was completed with 30 touch-typing adults (15 females and 15 males). The participants completed five different computer tasks: typing text, completing an html-based form with text fields, editing text within a document, sorting and resizing objects in a graphics task and browsing and navigating a series of intranet web pages. Electrogoniometers and inclinometers measured wrist and upper arm postures, surface electromyography measured muscle activity of four forearm muscles and three shoulder muscles and a force platform under the keyboard and force-sensing computer mouse measured applied forces. Keyboard-intensive tasks were associated with less neutral wrist postures, larger wrist velocities and accelerations and larger dynamic forearm muscle activity. Mouse-intensive tasks (graphics and intranet web page browsing) were associated with less neutral shoulder postures and less variability in forearm muscle activity. Tasks containing a mixture of mouse and keyboard use (form completion and text editing) were associated with higher shoulder muscle activity, larger range of motion and larger velocities and accelerations of the upper arm. Comparing different types of computer work demonstrates that mouse use is prevalent in most computer tasks and is associated with more constrained and non-neutral postures of the wrist and shoulder compared to keyboarding. PMID:16393803
Background The purpose of this study was to investigate whether professional drivers of all-terrain vehicles (ATVs) with neck pain have a different array of neuromusculoskeletal disorders in the neck and upperextremities than a referent group with neck pain from the general population. It is hypothesized that exposure to shock-type vibration and unfavorable working postures in ATVs have the capacity to cause peripheral nervous lesions. Methods This study was based on a case series analyzed according to a case-case comparison design. The study population consisted of 60 male subjects, including professional drivers of forest machines (n = 15), snowmobiles (n = 15), snowgroomers (n = 15) and referents from the general population (n = 15) all of whom had reported neck pain in a questionnaire and underwent an extensive physical examination of the neck and upperextremities. Based on symptom history, symptoms and signs, and in some cases chemical, electroneurographical and radiological findings, subjects were classified as having a nociceptive or neuropathic disorder or a mix of these types. Results The occurrence of asymmetrical and focal neuropathies (peripheral nervous lesion), pure or in a mix with a nociceptive disorder was common among cases in the ATV driver groups (47%–79%). This contrasted with the referents that were less often classified as having asymmetrical and focal neuropathy (27%), but instead had more nociceptive disorders. The difference was most pronounced among drivers of snowgroomers, while drivers of forest machines were more frequently classified as having a nociceptive disorder originating in the muscles. Conclusion This study found a high prevalence of assymetrical and focal neuropathies among drivers with pain in the neck, operating various ATVs. It seems as if exposure to shock-type whole-body vibration (WBV) and appurtenant unfavorable postures in ATVs may be associated to peripheral nervous lesions.
Specific for summer conditions weather situation caused the flood. A cyclone reached the region of Alps, humid air and great instability of stratification produced high precipitation throughout the region in two vawes. The flood has reached historical maxima on the reach between Bratislava Budapest. This is the first flood of this magnitude, which has passed this section of the Danube without breaching the dikes, flood embankments. The peak flow rate attenuated along this section from 10 000 m3s-1 to 8600 m3s-1. Specifics of flood routing conditions are discussed. Barrages and training has changed flood routing patterns along the Austrian and joined Slovak Hungarian sections of the Danube. Increased velocity of wave propagation decreases the impact of superposition of consequent flood waves, but attenuation of flood waves is also less expressed. The most significant impact on the present flood was, that this was the first flood of this magnitude, which has passed this section of the Danube without breaching the flood embankments. Earlier extreme floods including the 1954 and 1965 floods resulted failure of the dikes and spill over of 1.5- 2 million m3 of water to the protected floodplain. This time the flood was contained within the floodberm.
X-ray examinations of the wrists, the elbows and the shoulders were carried out on 67 vibration-exposed foundry workers and on 46 comparable referents performing heavy manual work. Both groups had a mean age of 39.6 years. Musculoskeletal symptoms, such as arthralgias of the wrist and elbow joints, muscle pain and decreased muscular force, were found to be significantly increased in the chipping and grinding workers compared with the referents. After adjustment for age, the prevalence of cysts in the metacarpal and carpal bones was almost the same in the two groups, whereas radiological signs of osteoarthritis in the wrist joint were more frequent among the vibration-exposed workers (P less than 0.025). The overall prevalence of radiographic abnormalities in the elbow joint was higher in the vibration group than in the reference group (P less than 0.025). Olecranon spurs were observed in 50.7% of the exposed operators and in 28.2% of the referents (P less than 0.025). No difference in the prevalence of radiological changes in the should could be demonstrated between the populations studied. In both groups injuries of bones and joints were not associated with age. Among the chipping and grinding operators, a slight but not significant trend in the prevalence of skeletal abnormalities with increasing vibration exposure was observed. The results of this study indicate that the foundry workers using vibrating tools were affected with bone and joint disorders in the elbow and, to a lesser extent, in the wrist, which occurred more frequently than was observed in unexposed referents, who performed solely heavy manual activity. Among the vibration-exposed workers, no relationship between radiological changes in the upper limbs and symptoms of vibration white finger was found, pointing out that different pathogenic mechanisms are involved. PMID:3557627
Combined nerve blocks of the upperextremity and lower limb in same operation rarely performed due to the risk of systemic toxicity of local anesthetics. Therefore, general anesthesia is generally preferred in this operations. However, use of ultrasound allows reliable deposition of the anesthetic around the nerves, potentially lowering the local anesthetic requirement. In this case report, we present a 44-year-old, ASA physical status I, male patient who was operated for upperextremity reconstruction requiring skin graft from anterolateral thigh region under ultrasound-guided infraclavicular brachial plexus block and lateral femoral cutaneous nerve block. The block was successful and no block-related complications were noted. We think that combining an ultrasound guided infraclavicular brachial plexus block and a lateral femoral cutaneous nerve block is a clinically useful and safe technique and an alternative anesthetic method for procedures requiring skin grafts for the upperextremity. PMID:24104536
Background Upper-extremity exercise is for pulmonary rehabilitation. The 6-minute pegboard and ring test (6PBRT) was developed to evaluate arm exercise capacity in patients with chronic obstructive pulmonary disease (COPD). The purpose of this study was to characterize the 6PBRT and evaluate its relationship with upper-extremity activities of daily living (ADLs) in COPD patients. Methods Twenty outpatients with mild to very severe COPD underwent the 6PBRT and spirometry, and their maximal inspiratory and expiratory pressures and grip strength were measured. For the 6PBRT, subjects were asked to move as many rings as possible in 6 minutes, and the score was the number of moved rings during the 6-minute period. Upper-extremity ADLs were evaluated with the upperextremity activities subdomain of the modified Pulmonary Functional Status and Dyspnea Questionnaire. Upper-extremity ADLs were also measured objectively by using a wrist accelerometer every day for 1 week. Results There was a positive correlation between 6PBRT score and inspiratory capacity (r = 0.71, P , 0.001), inspiratory capacity/total lung capacity predicted (r = 0.68, P , 0.01), and forced vial capacity (r = 0.57, P , 0.01). There was also a positive correlation between 6PBRT score and accelerometer count (r = 0.54, P , 0.05) and a negative correlation between 6PBRT score and arm activity score (? = ?0.49, P , 0.05). Conclusion The 6PBRT may be a predictive test to maintain and improve upper-extremity ADL during pulmonary rehabilitation in patients with COPD.
OBJECTIVES.Constraint-induced (CI) movement therapy has been shown recently to be promising for improving upper-limb function in children with cerebral palsy (CP). Because little is known about patient characteristics predicting treatment efficacy, not all children may benefit from this intervention. Here we examine the relationship between efficacy of a child-friendly form of CI therapy and age on involved upper-extremity function. DESIGN.Twenty
Background The motivation of patients during robot-assisted rehabilitation after neurological disorders that lead to impairments of motor functions is of great importance. Due to the increasing number of patients, increasing medical costs and limited therapeutic resources, clinicians in the future may want patients to practice their movements at home or with reduced supervision during their stay in the clinic. Since people only engage in an activity and are motivated to practice if the outcome matches the effort at which they perform, an augmented feedback application for rehabilitation should take the cognitive and physical deficits of patients into account and incorporate a mechanism that is capable of balancing i.e. adjusting the difficulty of an exercise in an augmented feedback application to the patient's capabilities. Methods We propose a computational mechanism based on Fitts' Law that balances i.e. adjusts the difficulty of an exercise for upper-extremity rehabilitation. The proposed mechanism was implemented into an augmented feedback application consisting of three difficulty conditions (easy, balanced, hard). The task of the exercise was to reach random targets on the screen from a starting point within a specified time window. The available time was decreased with increasing condition difficulty. Ten subacute stroke patients were recruited to validate the mechanism through a study. Cognitive and motor functions of patients were assessed using the upperextremity section of the Fugl-Meyer Assessment, the modified Ashworth scale as well as the Addenbrookes cognitive examination-revised. Handedness of patients was obtained using the Edinburgh handedness inventory. Patients' performance during the execution of the exercises was measured twice, once for the paretic and once for the non-paretic arm. Results were compared using a two-way ANOVA. Post hoc analysis was performed using a Tukey HSD with a significance level of p < 0.05. Results Results show that the mechanism was capable of balancing the difficulty of an exercise to the capabilities of the patients. Medians for both arms show a gradual decrease and significant difference of the number of successful trials with increasing condition difficulty (F2;60 = 44.623; p < 0.01; ?2 = 0.623) but no significant difference between paretic and non-paretic arm (F1;60 = 3.768; p = 0.057; ?2 = 0.065). Post hoc analysis revealed that, for both arms, the hard condition significantly differed from the easy condition (p < 0.01). In the non-paretic arm there was an additional significant difference between the balanced and the hard condition (p < 0.01). Reducing the time to reach the target, i.e., increasing the difficulty level, additionally revealed significant differences between conditions for movement speeds (F2;59 = 6.013; p < 0.01; ?2 = 0.185), without significant differences for hand-closing time (F2;59 = 2.620; p = 0.082; ?2 = 0.09), reaction time (F2;59 = 0.978; p = 0.383; ?2 = 0.036) and hand-path ratio (F2;59 = 0.054; p = 0.947; ?2 = 0.002). The evaluation of a questionnaire further supported the assumption that perceived performance declined with increased effort and increased exercise difficulty leads to frustration. Conclusions Our results support that Fitts' Law indeed constitutes a powerful mechanism for task difficulty adaptation and can be incorporated into exercises for upper-extremity rehabilitation.
Increasing frequency of catastrophic flash floods and extreme droughts in recent years results in an urgent need of solving of flood protection questions and measures leading to discharge increase in dry periods. Flattening of discharge call for the use of untraditional practices as a suitable complement to classical engineering methods. These measures could be represented by gradual increase of river catchment retention capacity in headstream areas. Very favorable conditions for this research solution are concentrated to the upper part of Otava River basin (Vltava River left tributary, Šumava Mts., southwestern Czechia) representing the core zone of a number of extreme floods in Central Europe and the area with high peat land proportion. A number of automatic ultrasound and hydrostatic pressure water level gauges, climatic stations and precipitation gauges and utilization of modern equipment and methods were used in chosen experimental catchments to assess the landscape retention potential and to find out rainfall-runoff relations in this area. Successively, the detailed analysis of peat land hydrological function was carried out. The peat bogs influence on runoff conditions were assessed by thorough comparison of runoff regimes in subcatchments with different peat land proportion. The peat bog influence on hydrological process can be considered also with respect to its affecting of water quality. Therefore, hydrological monitoring was completed by ion, carbon (TOC) and oxygen isotopes balance observing within periods of high or low discharges in order to precise runoff phases separation by means of anion deficiency. Pedological survey of different soil types and textures was carried out to precise the estimation of its water capacity. Detailed analyses of extreme runoff ascending and descending phases and minimum discharges in profiles closing several subcatchments with different physical-geographic conditions show higher peak flow frequency and their shorter reaction to causal amount of precipitation in the case of highly peaty areas, therefore more distinct runoff variability of streams draining peat land localities. These findings were affirmed by geochemical approach laboratory outcomes within the meaning of significant contribution of runoff from peat lands to the total runoff during extreme flood situations. An important component of rainfall-runoff process in source areas of czech rivers represented by snow conditions was analyses very in detail by means of monitoring of snow cover height and its water equivalent in chosen experimental catchments. Outcomes of this study should markedly help with significant precising of estimation of water storage retained in a snow cover. Consecutive runoff simulations using mathematical techniques would then improve a hydrological forecast. In terms of present dyking of former channels draining peat land represented by so called peat bog revitalization partial findings refer to positive effect during mean runoff situations but their considerably negative influence on runoff process in cases of extremely high discharges. In order to achieve retention potential enhancement in source areas of czech rivers an evaluation of possible former accumulative reservoirs (used for wood floating in former times) restoration which could function for example as dry (green) polders should be considered. The system of such small storage bins could function as an alternative and supplement to greater dam reservoirs. Possible spaces for water retention are measured by geodetic total station and modelled by suitable methods in GIS software. Existing outcomes advert to the fact that the effectiveness of such reservoir system would not have to be neglecting. By implementation of these unforceable measures realized in river headstream areas it could be contributed to reduction of peak flows and to increase of water resources during extreme droughts in future.
Electrical spinal neuromodulation in the form of spinal cord stimulation is currently used for treating chronic painful conditions such as complex regional pain syndrome, diabetic neuropathy, postherpetic neuralgia, peripheral ischemia, low back pain, and other conditions refractory to more conservative treatments. To date, there are very few published reports documenting the use of spinal cord stimulation in the treatment of head/neck and upper limb pain. This paper reports a case series of 5 consecutive patients outlining the use of spinal cord stimulation to treat upperextremity pain. All subjects had previously undergone cervical fusion surgery to treat chronic neck and upper limb pain. Patients were referred following failure of the surgery to manage their painful conditions. Spinal cord stimulators were placed in the cervical epidural space through a thoracic needle placement. Stimulation parameters were adjusted to capture as much of the painful area(s) as possible. In total, 4 out of 5 patients moved to implantation. In all cases, patients reported significant (70-90%) reductions in pain, including axial neck pain and upperextremity pain. Interestingly, 2 patients with associated headache and lower extremity pain obtained relief after paresthesia-steering reportedly covered those areas. Moreover, 2 patients reported that cervical spinal cord stimulation significantly improved axial low back pain. Patients continue to report excellent pain relief up to 9 months following implantation. This case series documents the successful treatment of neck and upperextremity pain following unsuccessful cervical spine fusion surgery. Given this initial success, prospective, controlled studies are warranted to more adequately assess the long term utility and cost effectiveness of electrical neuromodulation treatment of chronic neck and upperextremity pain. PMID:17387353
Complex regional pain syndrome (CRPS) is a pathologic condition in which the painful experience is disproportionate in time and intensity in comparison with the inciting event. At present, the pathophysiology of CRPS is not well understood. Several studies have indicated that cortical reorganization plays a role in the persistence of the symptoms. A new promising approach, graded motor imagery (GMI), seems to be effective, but there are limited data for the CRPS-1 upperextremity population. The aim of this study was to demonstrate the effectiveness of a modified GMI (mGMI) protocol based on the work of Moseley to reduce pain and enhance functional capacities for a population with nonchronic CRPS-1 of the upperextremity. The following outcome measures were used to assess the clinical effectiveness: pain (short form of the McGill Pain Questionnaire), grip force (Martin vigorimeter), perception of upperextremity function (Disabilities of the Arm, Shoulder and Hand Questionnaire), and patient's global impression of change. All outcomes at T4 were compared with the baseline data (T0) using the Mann-Whitney test and the ? test (nonparametric tests). Seven patients were recruited for the study. At the end of the mGMI (T4), we obtained significant results for the decrease in the pain experienced in the last 7 days (visual analog scale; P=0.046), improvement in the affected extremity grip force (P=0.042), and the patient's global impression of change (P=0.015). However, the data of the perception of upperextremity function (Disabilities of the Arm, Shoulder and Hand Questionnaire) were not clinically or statistically significant. Our results indicate that this mGMI protocol seems to be a promising therapeutic modality to reduce pain. However, more investigations are needed to determine whether mGMI has a significant impact on upperextremity function. PMID:22436440
INTRODUCTION Kirschner wires (K-wires) are immensely versatile in fracture fixation in the paediatric population. Complications associated with the K-wiring procedure vary from minor to a life-threatening. The aim of this study was to analyse the outcome of fracture fixation using K-wires in all types of upper-extremity fractures in children in order to assess the incidence and type of complication critically. PATIENTS AND METHODS Between September 1999 and September 2001, we retrospectively reviewed a consecutive series of 105 fractures in 103 paediatric trauma cases (below 12 years) treated with K-wires in a university teaching hospital. The case notes and radiographs were reviewed by an independent single assessor. All paediatric, acute, upper-extremity, displaced and unstable fractures were included. All elective procedures using K-wires were excluded. RESULTS We observed an overall 32.3% complication rate associated with the K-wiring procedure affecting 34 pins (24 patients). Wound-related complications included over-granulation in 13 cases, pin tract infection in 6 cases and hypersensitive scar in 1 case. Neurapraxia was found in 3 patients and axonotmesis in 1 patient. Wire loosening at the time of removal in 14 cases and retrograde wire migration in 4 cases were observed. There were 2 cases of penetrating tendonitis and 1 case of osteomyelitis. There was a higher complication rate in terms of wire loosening and pin tract infection when the K-wires: (i) were left outside the skin compared with those placed under the skin; (ii) stayed longer in the patients; and (iii) did not traverse both cortices. There were more complications in complex operations performed by senior surgeons (P = 0.056). The duration of K-wire stay, associated co-morbidity and anatomical location were statistically insignificant. CONCLUSIONS Complications are part of operative procedures; an important point to consider is what causes them in order to take preventative measures. We recommend that the risks and complications should be explained to parents during the consenting process to allay their anxiety, irrespective of the fact that most complications are minor and of short duration.
Background/Objective: To determine whether a new upperextremity exercise device integrated with a video game (GameCycle) requires sufficient metabolic demand and effort to induce an aerobic training effect and to explore the feasibility of using this system as an exercise modality in an exercise intervention. Design: Pre-post intervention. Setting: University-based research facility. Subject Population: A referred sample of 8 adolescent subjects with spina bifida (4 girls, 15.5 ± 0.6 years; 4 boys, 17.5 ± 0.9 years) was recruited to participate in the project. All subjects had some level of mobility impairment that did not allow them to participate in mainstream sports available to their nondisabled peers. Five subjects used a wheelchair full time, one used a wheelchair occasionally, but walked with forearm crutches, and 2 were fully ambulatory, but had impaired gait. Main Outcome Measures: Peak oxygen uptake, maximum work output, aerobic endurance, peak heart rate, rating of perceived exertion, and user satisfaction. Results: Six of the 8 subjects were able to reach a Vo2 of at least 50% of their Vo2 reserve while using the GameCycle. Seven of the 8 subjects reached a heart rate of at least 50% of their heart rate reserve. One subject did not reach either 50% of Vo2 reserve or 50% of heart rate reserve. Seven of the 8 subjects increased their maximum work capability after training with the GameCycle at least 3 times per week for 16 weeks. Conclusions: The data suggest that the GameCycle seems to be adequate as an exercise device to improve oxygen uptake and maximum work capability in adolescents with lower extremity disability caused by spinal cord dysfunction. The subjects in this study reported that the video game component was enjoyable and provided a motivation to exercise.
Widman, Lana M; McDonald, Craig M; Abresch, R. Ted
The Même implant may result in fewer capsular contractures. However, difficulty with insertion of this prosthesis may discourage the surgeon and result in the abandonment of a useful prosthesis. A simple technique has been evolved which allows for easy insertion and placement of this implant. PMID:6701223
Velopharyngeal defects are common problem encountered in dentistry, different prosthetic designs can be used; however, the prosthesis should be comfortable and function properly. Surgical treatment is the treatment of choice, but there are few patients who are not able to receive the surgical intervention; in such cases prosthetic management is considered using speech bulb prosthesis to overcome nasal twang and nasal regurgitation. PMID:23861283
OBJECTIVES: To study the effectiveness of using a computer mouse with a feedback signal for upperextremity musculoskeletal symptoms in office workers. METHODS: A randomised controlled trial with 8 months of follow-up was carried out. The intervention consisted of a computer mouse with a feedback signal. In total, 354 subjects were allocated to the intervention group or the control group.
E. M. Meijer; J. K. Sluiter; M. H. W. Frings-Dresen
Since its original description by Keizo Hirayama in 1959, “juvenile muscular atrophy of the unilateral upperextremity” has been described under many nomenclatures from the east. Hirayama disease (HD), also interchangeably referred to as monomelic amyotrophy, has been more frequently recognised in the west only in the last two decades. HD presents in adolescence and young adulthood with insidious onset unilateral or bilateral asymmetric atrophy of hand and forearm with sparing of brachioradialis giving the characteristic appearance of oblique amyotrophy. Symmetrically bilateral disease has also been recognized. Believed to be a cervical flexion myelopathy, HD differs from motor neuron diseases because of its nonprogressive course and pathologic findings of chronic microcirculatory changes in the lower cervical cord. Electromyography shows features of acute and/or chronic denervation in C7, C8, and T1 myotomes in clinically affected limb and sometimes also in clinically unaffected contralateral limb. Dynamic forward displacement of dura in flexion causes asymmetric flattening of lower cervical cord. While dynamic contrast magnetic resonance imaging is diagnostic, routine study has high predictive value. There is a need to lump all the nomenclatures under the rubric of HD as prognosis in this condition is benign and prompt diagnosis is important to institute early collar therapy.
Little is known about whether and how multimodal representations of the body (BRs) and of the space around the body (Peripersonal Space, PPS) adapt to amputation and prosthesis implantation. In order to investigate this issue, we tested BR in a group of upper limb amputees by means of a tactile distance perception task and PPS by means of an audio-tactile interaction task. Subjects performed the tasks with stimulation either on the healthy limb or the stump of the amputated limb, while wearing or not wearing their prosthesis. When patients performed the tasks on the amputated limb, without the prosthesis, the perception of arm length shrank, with a concurrent shift of PPS boundaries towards the stump. Conversely, wearing the prosthesis increased the perceived length of the stump and extended the PPS boundaries so as to include the prosthetic hand, such that the prosthesis partially replaced the missing limb.
Canzoneri, Elisa; Marzolla, Marilena; Amoresano, Amedeo; Verni, Gennaro; Serino, Andrea
Little is known about whether and how multimodal representations of the body (BRs) and of the space around the body (Peripersonal Space, PPS) adapt to amputation and prosthesis implantation. In order to investigate this issue, we tested BR in a group of upper limb amputees by means of a tactile distance perception task and PPS by means of an audio-tactile interaction task. Subjects performed the tasks with stimulation either on the healthy limb or the stump of the amputated limb, while wearing or not wearing their prosthesis. When patients performed the tasks on the amputated limb, without the prosthesis, the perception of arm length shrank, with a concurrent shift of PPS boundaries towards the stump. Conversely, wearing the prosthesis increased the perceived length of the stump and extended the PPS boundaries so as to include the prosthetic hand, such that the prosthesis partially replaced the missing limb. PMID:24088746
Canzoneri, Elisa; Marzolla, Marilena; Amoresano, Amedeo; Verni, Gennaro; Serino, Andrea
The complexity of managing large soft-tissue defects at the elbow region by conventional techniques arises from the difficulty of providing sufficient tissue with adequate elasticity and durability. Reconstruction options that allow early mobilisation and avoid the risk of functional loss should be considered to achieve defect closure at the elbow region. A 21-year-old man presented with a congenital giant hairy nevus on his left upperextremity. The nevus was excised and the resulting raw surface after the excision was covered with a split-thickness skin graft except for the elbow region. The elbow was covered in one stage with an ipsilateral 24 cm long pedicled thoracodorsal artery perforator (TDAP) flap. The follow-up examination 3 years after total reconstruction demonstrated durable elbow support provided by the TDAP flap. The patient revealed no complaint considering pain or sensitivity even when exposed to mechanical stress. Split-thickness skin grafting of the large superficial defects is almost always possible; however, impairment of the function on joint areas due to gradual contraction and skin graft propensity to ulcers under mechanical stresses can be devastating. The elbow is a weight-bearing area of the body. Elbow defects require durable and thin soft-tissue coverage and the tissue cover must possess excellent elastic properties to re-establish elbow mobility. The TDAP flap is an ideal choice for elbow soft-tissue defects. The longest pedicle length reported for the TDAP flap is 23 cm. In our case, the pedicle length was 24 cm and it was possible to transfer this flap to the elbow on its pedicle. A pedicled TDAP skin flap so as to provide elbow coverage in one stage is a useful choice to retain in one's armamentarium. PMID:22959307
Oksüz, Sinan; Ulkür, Ersin; Tuncer, Serhan; Sever, Celalettin; Karagöz, Hüseyin
To formally assess changes in language, affected UE movement, and motor functional activation changes via functional magnetic resonance imaging (fMRI) following participation in motor therapy without any accompanying language intervention. Pre-post case series. Five subjects with stroke exhibiting chronic, stable UE hemiparesis. The upperextremity section of the Fugl-Meyer (FM), the Western Aphasia Battery (WAB), and functional magnetic resonance imaging (fMRI), administered during performance of an affected UE motor task. All subjects were administered six weeks of repetitive task specific training (RTP), performed for approximately 2.5 hours per day, split into two sessions. For the first four weeks of the intervention period, RTP was administered every weekday, whereas, for the subsequent two weeks, RTP was administered 3 days/week. Epidural cortical stimulation was co-administered with the RTP via an electrode array and implanted pulse generator. For all sessions, one subject worked with a single therapist. Four weeks before and four weeks after the intervention period, all subjects were administered the FM, WAB, and fMRI. Three of the subjects exhibited clinically significant language changes on the WAB. These individuals exhibited the largest motor changes as measured by the FM. Functional MRI revealed distinct motor activation patterns in these subjects, characterized by more strongly right lateralized focal BOLD activity or a shift in activation toward the right hemisphere. Language changes appear to co-occur with motor changes after UE RTP. Understanding the underlying mechanisms of these findings may lead to more efficient and synergistic rehabilitative therapy delivery. PMID:21989635
Harnish, Stacy; Meinzer, Marcus; Trinastic, Jonathan; Fitzgerald, David; Page, Stephen
Text Version... June 27 and 28, 2012 Cormet Hip Resurfacing Prosthesis Page 2. ... (Hydroxyapatite) over unalloyed titanium coating Device Description ... More results from www.fda.gov/downloads/advisorycommittees/committeesmeetingmaterials
A new high performance tool, the disc prosthesis, endows the degenerative cervical rachidian pathology. It allows us to fill\\u000a the fusions’ lacunas by protecting the adjacent levels from an accelerated degeneration while preserving the anatomical and\\u000a physiological characteristics of the cervical spine, especially its mobility. At the present time, there exist several models\\u000a of cervical disc prosthesis on the market.
M. Benmekhbi; J. Mortada; G. Lungu; D. Eichler; R. Srour; J. M. Vital
Background The aim of this study was to determine the prevalence and the predictors of musculoskeletal symptoms in the upperextremities and neck at visual display terminal (VDT) workstations. Methods In a cross-sectional study 1,065 employees working at VDT > 1 h/d completed a standardised questionnaire. Workstation conditions were documented in a standardised checklist, and a subgroup of 82 employees underwent a physical examination. Results Using the Nordic Questionnaire, the 12-month prevalence of symptoms of the neck, shoulder region, hand/wrist, or elbow/lower arm was 55%, 38%, 21%, and 15% respectively. The duration of VDT work had a significant impact on the frequency of neck symptoms in employees performing such work > 6 h/d. Conclusion With regard to musculoskeletal symptoms of the upperextremities, preventive measures at VDT workstations should be focused on neck and shoulder symptoms (e.g. ergonomic measures, breaks to avoid sitting over long periods).
Klussmann, Andre; Gebhardt, Hansjuergen; Liebers, Falk; Rieger, Monika A
ObjectivesTo evaluate the agreement between job-title based estimates for upperextremity physical work exposures and exposure estimates from work observation and worker self-report.MethodsSelf-reported exposure questionnaires were completed by 972 workers, and exposure estimates based on worksite observation were completed for a subset of 396 workers. Job-title based estimates were obtained from O*NET, an American database of job demands. Agreement between
Bethany T Gardner; David A Lombardi; Ann Marie Dale; Alfred Franzblau; Bradley A Evanoff
The aims of the study were to assess the effectiveness of enzyme replacement therapy (ERT) with laronidase on the range of\\u000a motion (ROM) of upperextremities and influence on activities of daily living (ADLs) of patients with mucopolysaccharidosis\\u000a type I (MPS I). The ROM of 17 patients with MPS I was followed from the first year of life until the introduction of ERT
Anna Tylki-Szymanska; Jolanta Marucha; Agnieszka Jurecka; Malgorzata Syczewska; Barbara Czartoryska
BACKGROUND: The aim of this study was to determine the prevalence and the predictors of musculoskeletal symptoms in the upperextremities and neck at visual display terminal (VDT) workstations. METHODS: In a cross-sectional study 1,065 employees working at VDT > 1 h\\/d completed a standardised questionnaire. Workstation conditions were documented in a standardised checklist, and a subgroup of 82 employees
André Klussmann; Hansjuergen Gebhardt; Falk Liebers; Monika A Rieger
Gordon AM, Charles J, Wolf SL. Methods of constraint-induced movement therapy for children with hemiplegic cerebral palsy: development of a child-friendly intervention for improving upper-extremity function. Arch Phys Med Rehabil 2005;86:837-44.We delineate the methodology for constraint-induced movement therapy (CIMT) modified for children with hemiplegic cerebral palsy (CP) and describe important considerations that need to be made when testing this intervention
Aims: To describe the presence of musculoskeletal co-morbidity of the neck and upperextremities among industrial workers with low back pain, and to examine whether it has an impact on healthcare utilisation and sickness absence for low back pain. Methods: A self administered questionnaire was used to collect data from 505 industrial workers (response 86%). Results: The 12 month prevalence of low back pain was 50%. Among subjects with low back pain the 12 month prevalence of musculoskeletal co-morbidity of the neck and upperextremities was 68%. Among workers with low back pain, subjects with high pain intensity or disabling low back pain were more likely to have musculoskeletal co-morbidity. In comparison to the subjects who report back pain only, subjects with co-morbidity showed worse general health and health related quality of life. No impact of upperextremity co-morbidity was found on healthcare utilisation, and sickness absence due to low back pain. Conclusions: This study provides no evidence that musculoskeletal co-morbidity of the neck and upperextremities influences the choice to seek care or take sick leave due to low back pain among industrial manual workers. For occupational health practitioners the finding of a high co-morbidity is important to consider when implementing workplace interventions aimed at the reduction of specific musculoskeletal complaints, since the controls for one musculoskeletal complaint may impact adversely on another musculoskeletal complaint. Researchers who perform low back pain intervention studies using generic health measures, should take into account the impact of musculoskeletal co-morbidity on these measures.
BackgroundTo summarize systematic reviews that 1) assessed the evidence for causal relationships between computer work and the occurrence of carpal tunnel syndrome (CTS) or upperextremity musculoskeletal disorders (UEMSDs), or 2) reported on intervention studies among computer users\\/or office workers.Methodology\\/Principal FindingsPubMed, Embase, CINAHL and Web of Science were searched for reviews published between 1999 and 2010. Additional publications were provided
Johan H. Andersen; Nils Fallentin; Jane F. Thomsen; Sigurd Mikkelsen; Ulrich Thiem
The summary form only given. The new high effective ozone\\/NO ultrasonic method in complicated postoperative wound treatment of post-radiation fibroses and lymphedema of upperextremity after combined treatment of milk gland cancer is designed and introduced in clinic practice. Method uses ultrasonic and ozone\\/NO-generating devices which is resolved for clinical application and provides the possibility for treatment the patients with
Vadim N. Mironenko; V. V. Pedder; V. K. Kosenok; M. V. Naboka; S. V. Dmitrienko; I. V. Surgutskova
The purpose of this study was to determine the optimal load for the maximal power output during the acceleration phase of a power movement in bench press (BP) exercises of highly trained soccer players at the beginning of a competition period. Fifteen professional male soccer players with an average age of 26.1 ± 3.9 years, an average height of 183.3 ± 6.7 cm, an average body mass of 78.8 ± 7.2 kg, and an average 1 repetition maximum (1RM) of 83.3 ± 11.2 kg were employed as subjects in this study. Maximal mean power output during a BP at 0, 10, 30, 50, 70, and 90% of their 1RM was measured to determine whether an optimal load exists that allows for the attainment of maximal power output. Three-dimensional upperextremity kinematic data were collected. Two force plates embedded in the floor and positioned below the bench were used to measure contact forces between the bench and ground during the lift. A repeated-measures analysis of variance was performed to determine power output differences at different percentages of the 1RM. The results of this study indicated that loads of 50% of the 1RM resulted in greater mean power output during the complete positive power movement. Loads at 30 and 50% of the 1RM resulted in greater mean power output computed from the acceleration phase of the lift than did all loads and were not statistically different from each other. However, individual soccer players did not reach the maximum power output with the same relative load. In conclusion, when soccer players develop muscular power toward the end of when the most important competitions are scheduled, dynamic effort strength training with the range of load from 30 to 50% of 1RM BP should be used. During the competition period, a load of 50% of a 1RM should be used in a BP to maintain muscular power over a wide load range. PMID:21912283
Major replantation of the upperextremity is defined as replantation at or above the level of the wrist. Selection of appropriate candidates is complex and requires consideration of many patient- and injury-associated factors including patient age, associated injuries, patient desire, mechanism of injury, ischemia time, wound condition, and presence of multiple-level injury. With respect to age, younger patients, especially children, are deemed to have a distinct advantage over more elderly patients due to improved nerve regeneration, and many advocate making every effort to replant this population. The risks of major upper-extremity replantation are significant and include bleeding, depletion of coagulation factors, secondary infection, and sepsis. As a result, major systemic illness and significant associated injuries are accepted as contraindications to limb salvage in this patient population. Herein we describe the use of an extracorporeal membrane oxygenation (ECMO) circuit as a potential bridge for short-term preservation of the extremity in a young patient with an acute, concomitant systemic illness. In the authors' opinion, use of ECMO perfusion is a viable means of maintaining extremity perfusion over hours or even days and may lead to broadened replant criteria in patients with associated injuries. PMID:20697991
Greaney, Patrick J; Cordisco, Michael; Rodriguez, Daniel; Newberger, Jordanna; Legatt, Alan D; Garfein, Evan S
Dislocation of a hip prosthesis is a common complication. In usual cases of hip prosthesis dislocation, the prosthetic femoral head comes out from either the natural acetabular cavity in a bipolar hemiarthroplasty or the prosthetic acetabulum in a total hip arthroplasty. Only a few cases of bipolar hip prosthesis dislocation due to dissociation between the polyethylene and inner head of the prosthesis have been reported. We describe a rare case of disassembly of the inner head from the bipolar outer prosthesis in an osteoarthritic acetabulum. A 72-year-old woman had undergone bipolar hemiarthroplasty due to fracture of the left femoral neck about 10 years previously. Recently, she sustained an injury after falling from a chair, and examinations revealed an unusual disassembly-dislocation of the bipolar hip prosthesis. We classified this failure in our patient as a type II failure, representing extreme varus position of the outer head in the acetabulum, dislocation of the inner head from the outer head, and a detached locking ring around the stem neck. This mechanism of failure as shown in our patient rarely occurs in the bipolar prosthesis of the self-centering system. Osteoarthritic change of the acetabulum would place the outer head in the varus position, increasing wear on the beveled rim by impinging the femoral stem neck and causing dislodgment of the inner locking ring and consequent disassembly-dislocation of the inner head. PMID:18218583
A 5-year-old female infant with a extremely rare combination of Pierre Robin syndrome and multiple malformations of the limbs and kidneys is presented. Orthopaedic, hearing, intellectual and speech disabilities and treatment difficulties are discussed.
A continuing challenge for prostheses developers is to replace the sensory function of the hand. This includes tactile sensitivity such as finger contact, grip force, object slippage, surface texture and temperature, as well as proprioceptive sense. One approach is sensory substitution whereby an intact sensory system such as vision, hearing or cutaneous sensation elsewhere on the body is used as an input channel for information related to the prosthesis. A second technique involves using electrical stimulation to deliver sensor derived information directly to the peripheral afferent nerves within the residual limb. Stimulation of the relevant afferent nerves can ultimately come closest to restoring the original sensory perceptions of the hand, and to this end, researchers have already demonstrated some degree of functionality of the transected sensory nerves in studies with amputee subjects. This paper provides an overview of different types of nerve interface components and the advantages and disadvantages of employing each of them in sensory feedback systems. Issues of sensory perception, neurophysiology and anatomy relevant to hand sensation and function are discussed with respect to the selection of the different types of nerve interfaces. The goal of this paper is to outline what can be accomplished for implementing sensation into artificial arms in the near term by applying what is present or presently attainable technology. PMID:10665673
This study was designed to investigate separately the inhibitory response capacity and the lateralization effect in children with developmental coordination disorder (DCD) in the endogenous and exogenous modes of orienting attention. Children with DCD on the lower extremities (DCD-LEs), along with age-matched controls, completed four tasks that involved various applications of asynchronous stimuli to the feet or hands at various intervals. The results demonstrated that children with DCD-LEs had a significantly longer reaction time than the controls for all tasks, and were not alert to the appearance of the target. However, they displayed a deficit in volitional shifts of attention (endogenous mode), but not in automatic dislocation of attention (exogenous mode), whenever they performed the tasks with either their lower or their upper-limbs-even 6 months after the initial study. These findings confirm the deficit in the inhibitory response capacity in terms of volitional movement of attention by children with DCD. Additionally, the negative effect of lateralization on the bilateral extremities was not present in children with DCD-LEs. Significantly differences in response ability were detected only between the dominant and non-dominant sides of upper-limbs, but not between the lower-limbs, suggesting a future avenue for further experimentation on bilateral extremities. PMID:18762360
This study aims at investigating pre-instrumental tree-ring based winter thermal conditions from Upper Silesia, southern Poland. The Scots pine, pedunculate oak and sessile oak ring widths and the extreme index were used to reconstruct winter mean temperature back to A.D. 1770. The climate response analysis showed that the pine is the most sensitive to February (0.36) and March (0.41) temperature, the oaks were found to be sensitive to the previous December (0.27) and January (0.23) temperature. It was found out that the combination of temperature sensitive species and an additional extreme index in regression can improve the reconstruction, with an emphasis on more reliable reconstruction of extreme values. The elimination of variance reduction and precise reconstruction of actual values of temperature is possible by scaling. The obtained calibration/verification results suggest that, through the application of the long-term composite chronologies a detailed study of the climate variability in Upper Silesia in past centuries can be provided.
Background The purpose of this study was to evaluate the association between upper-extremity musculoskeletal symptoms (MS) and diminished physical health related quality of life (PHRQoL) in a population of women, mostly African-American working in poultry processing and other low-wage jobs in rural northeastern North Carolina. Methods A cross-sectional analysis was performed on baseline data of self-reported PHRQoL and musculoskeletal symptoms for 291 poultry processing workers and 299 community comparison women. Logarithmic binomial regression was performed to assess the relationship between moderate to severe MS on low PHRQoL. Results Prevalence of poor PHRQoL was 35.5% among poultry processing workers, and 14.7% among community comparison group. Moderate to severe upper-extremity musculoskeletal symptoms were present in 34.4% of the poultry workers and 10.7% of the comparison group. After adjusting for age and other chronic conditions, moderate to severe musculoskeletal symptoms were associated with low PHRQoL in both groups. Although the observed effect was stronger among the comparison group (Adjusted prevalence ratios (95% confidence interval): poultry workers= 1.89 (1.36,2.64), community comparison= 4.26 (2.51,7.24), the population attributable risk percent was similar (poultry workers=28.9, community comparison=31.3%) due to the higher prevalence of moderate to severe symptoms in the poultry workers. Conclusions Significant upperextremity musculoskeletal symptoms were associated with poor PHRQoL among both groups of women employed in low-wage jobs. Nationwide, poultry work is over-represented by minorities and immigrants. Though challenging, we need to search for ways to improve the conditions of these women as a matter of social justice.
Seasonally-changes in wind pattern, monsoon, sometimes results in severe droughts and intense flooding in many parts of the world including South Asian countries like Pakistan. The livelihood of a vast population in Pakistan depends on agriculture and land use is strongly influenced by water-based ecosystems that depend on the monsoon rains. Furthermore, climate change studies undertaken so far reveal that action is essential in order to prevent long term damage to water cycle and thus of great concern to the community and stakeholders. Pakistan Summer Monsoon (PSM) is generally affected by both the disturbances from the tropical and the extratropical regions; however there is lack of understanding of physical mechanisms of PSM compared to other regional studies i.e. Indian Summer Monsoon (ISM) and South-East Asian Monsoon (SEAM). In our study, we applied heat and vorticity budgets and wave train analysis to reveal the mechanisms of the extremely dry and wet PSM events associated with the anomalous upper tropospheric circulation. We found that the extremely dry (wet) PSM events are closely related with the strengthening(weakening) of the upper-tropospheric central Asian high. We also found that in addition to Rossby-wave (Matsuno-Gill) type atmospheric response, the Rossby wave train along the Asian Jet originating from northwestern Europe or North Atlantic Ocean strengthened(weakened) the upper-tropospheric central Asian high. Therefore strong convection anomalies resulting in severe flooding (drought) events over the PSM region are induced by both the tropical and extratropical processes. Key Words: Pakistan, Extremes Monsoon Events, Physical Processes, Heat Budget, Vorticity, Wave Train
Objective: The main aim of the study was to determine the nature and extent of work-related upperextremity musculoskeletal disorders (MSDs) and physiological stress among the blacksmiths involved in surgical instrument industry. Materials and Methods: In the present investigation, 50 male blacksmiths of each skilled and unskilled groups of the forging section had been selected. For the symptom survey, a questionnaire on discomfort symptoms was performed. Repetitiveness of work and hand grip strength of both the groups were measured. Results: It was revealed that upper limb MSD was a major problem among both group of blacksmith, primarily involving the hand, wrist, fingers, and shoulder. From this study it was found that 66% (33) skilled and 80% (40) unskilled blacksmith workers are feeling discomfort. The most commonly affected regions among the skilled and unskilled blacksmith workers were lower back (skilled 65% and unskilled 80%), neck (skilled 60% and unskilled 80%), and hand (skilled 50% and unskilled).
Increasing frequency of catastrophic flash floods and extreme droughts in recent years results in an urgent need of solving of flood protection questions and measures leading to discharge increase in dry periods. Flattening of discharge call for the use of untraditional practices as a suitable complement to classical engineering methods. These measures could be represented by gradual increase of river
The purpose of this study was to characterize responses in oxygen uptake ( V·O2), heart rate (HR), perceived exertion (OMNI scale) and integrated electromyogram (iEMG) readings during incremental Nordic walking (NW) and level walking (LW) on a treadmill. Ten healthy adults (four men, six women), who regularly engaged in physical activity in their daily lives, were enrolled in the study. All subjects were familiar with NW. Each subject began walking at 60?m/min for 3?minutes, with incremental increases of 10?m/min every 2?minutes up to 120?m/min V·O2 , V·E and HR were measured every 30?seconds, and the OMNI scale was used during the final 15?seconds of each exercise. EMG readings were recorded from the triceps brachii, vastus lateralis, biceps femoris, gastrocnemius, and tibialis anterior muscles. V·O2 was significantly higher during NW than during LW, with the exception of the speed of 70?m/min (P?0.01). V·E and HR were higher during NW than LW at all walking speeds (P?0.05 to 0.001). OMNI scale of the upperextremities was significantly higher during NW than during LW at all speeds (P?0.05). Furthermore, the iEMG reading for the VL was lower during NW than during LW at all walking speeds, while the iEMG reading for the BF and GA muscles were significantly lower during NW than LW at some speeds. These data suggest that the use of poles in NW attenuates muscle activity in the lower extremities during the stance and push-off phases, and decreases that of the lower extremities and increase energy expenditure of the upper body and respiratory system at certain walking speeds.
Objective: Implant surgery is the most acceptable curative choice for patients with erectile dysfunction and their partners, since the results are excellent with regard to the couple’s pleasure and the materials used are extremely manageable Materials and Methods: We performed 46 prosthesis implantations in patients with erectile dysfunction: in 22 patients we implanted soft prostheses; in 20 malleable prostheses; in
Massimo Porena; Luigi Mearini; Ettore Mearini; Marco Marzi; Alessandro Zucchi
...Devices Â§ 878.3610 Esophageal prosthesis. (a) Identification. An esophageal prosthesis is a rigid, flexible, or expandable tubular device made of a...esophagus. The metal esophageal prosthesis may be uncovered or...
...Devices Â§ 878.3610 Esophageal prosthesis. (a) Identification. An esophageal prosthesis is a rigid, flexible, or expandable tubular device made of a...esophagus. The metal esophageal prosthesis may be uncovered or...
...Devices Â§ 878.3720 Tracheal prosthesis. (a) Identification. The tracheal prosthesis is a rigid, flexible, or expandable tubular device made of a...branches. The metal tracheal prosthesis may be uncovered or...
...Devices Â§ 878.3720 Tracheal prosthesis. (a) Identification. The tracheal prosthesis is a rigid, flexible, or expandable tubular device made of a...branches. The metal tracheal prosthesis may be uncovered or...
This study investigated in-vivo changes in upper limb dynamic mechanical properties and magnetic resonance imaging (MRI) parameters following short-term power hand tool operation. Previous studies have found reduction in mechanical properties following short-term power tool usage at long build-up times. This study advances that work by having participants operate a simulated pistol grip power hand tool and evaluating changes in mechanical properties, strength, discomfort level and MRI prior to tool operation and daily for 3 d after tool operation. Twenty-four participants were randomly assigned to operate a simulated power hand tool for either a high peak reaction force of 123 N (peak torque=8 Nm, build-up time=250 ms) or at a low peak reaction force of 5 N (peak torque=2 Nm, build-up time=50 ms). Subjects operated the tool for 60 min at the rate of six times per min. A reduction in stiffness (27%, p<0.05) was observed 24 h after tool operation for the high force group and this change persisted (26%, p<0.05) up to 72 h after tool operation. Similar changes were not observed for the low force group. No changes were observed in mass moment of inertia, damping, isometric strength and damping for either group (p>0.05). There was a signal intensity increase (12%, CI 19%, 5.06%) in the supinator muscle MRI for both groups 24 h after tool operation but only the high force group remained elevated (10%, CI 13.7%, 0.06%) 72 h after tool operation. Persistent short-term changes in mechanical and MRI parameters at high force levels could indicate increased strain on the upper limb and may negatively affect ability to react during rapid forceful loading of the upper limb. This research can ultimately lead to better ergonomic interventions through quantitative power hand tool design guidelines and work practices based on understanding the damaging effects of exposure to specific levels of reaction force, build-up time and repetition, as well as providing new outcome measures for epidemiological studies. PMID:19308816
Chourasia, Amrish O; Sesto, Mary E; Block, Walter F; Radwin, Robert G
Background Reduced upperextremity function is one of the most common impairments after stroke and has previously been reported in approximately 70-80% of patients in the acute stage. Acute care for stroke has changes over the last years, with more people being admitted to a stroke unit as well as use of thrombolysis. The aim of the present study was to describe baseline characteristics, care pathway and discharge status in an unselected group of patients with first occasion of stroke who were at a stroke unit within 72 hours after stroke and also to investigate the frequency of impaired arm and hand function. A second aim was to explore factors associated with impaired upperextremity function and the impact of impairment on the patient’s outcome. Methods Patients over 18 years of age with first ever stroke, living in a geographical catchment area, being at the stroke unit within 72 hours after onset, with no prior upperextremity impairment were included. Baseline characteristics, arm and hand function within 72 hours, stroke outcome and care pathway in the acute phase were described, by gathering information retrospectively from the patients’ charts. Ischemic strokes were categorized according to the Bamford classification and the Trial of Org 10172 in Acute Stroke Treatment criteria. Results Of the 969 patients with first ever stroke who were screened, 642 patients fulfilled the inclusion criteria. According to the National Institutes of Health Stroke Scale (NIHSS), the patients had a mean score of 6.0, median 3.0, at arrival to the hospital. Ischemic stroke was most frequent in the anterior circulation (87.7%). Within 72 hours after stroke onset 48.0% of the patients had impaired arm and hand function and this was positively associated with higher age (p?0.004), longer stay in the acute care (p?0.001) and mortality in acute care (p?0.001). Directly admitted to the stroke unit were 89.1% of the patients and 77.1% received hospital care on same day as stroke onset. Mean length of stay in the stroke unit was 9.9 days, 56.8% of the patients were discharged directly home from the stroke unit. Mortality within 72 hours after stroke onset was 5.0%. Conclusion Impaired arm and hand function is present in 48% of the patients in a non selected population with first ever stroke, estimated within 72 hours after onset. This is less than previously reported. Impaired arm and hand function early after stroke is associated with higher age, longer stay in the acute care, and higher mortality within the acute hospital care.
At least 90% of individuals of limb amputees experience phantom limb pain (PLP). Recent clinical research suggests that providing patients with the mirror image representation of the amputated limb may alleviate PLP. However, mirror therapy cannot be used with bilateral amputees, as visual feedback is dependent on the movement of the intact limb. To overcome this limitation, we designed a novel myoelectric-controlled virtual reality (VR) system for the treatment of phantom limb pain in trans-radial upperextremity amputees. The proposed system allows the patient to directly control the virtual limb by recognizing stump muscle patterns recorded with EMG sensors. The hypothesis behind this strategy is that the VR image of the amputated limb induces better limb imagery than the reflected image of their intact limb and, therefore, is more effective in reducing PLP. A research protocol to test this hypothesis is described. PMID:20543301
Gaggioli, Andrea; Amoresano, Amedeo; Gruppioni, Emanuele; Verni, Gennaro; Riva, Giuseppe
There is a need for time-efficient, valid measures of distal paretic upperextremity (UE) movement. The purposes of this study were to: (a) determine the psychometric properties of the wrist stability and mobility and hand items of the upperextremity scale of the Fugl-Meyer (w/h UE FM) as a “stand alone” measure of distal UE movement; and (b) provide detailed instructions on w/h UE FM administration and scoring. The UE FM and Action Research Arm Test (ARAT) were administered on 2 separate occasions to each of 29 subjects exhibiting stable, mild, UE hemiparesis (23 males; age (mean (sd)) 60.8 (12.3) years; mean time since stroke onset for subjects in the sample: 36.0 months). Fifty-eight observations were collected on each measure. w/h UE FM internal consistency levels (measured by Cronbach’s alpha) were high (0.90 and 0.88 for first and second testing sessions, respectively). The intraclass correlation coefficients for the UE FM was 0.98, while the intraclass correlation coefficient for the w/h UE FM was 0.97. Concurrent validity measured by Spearman’s correlation was moderately high between the w/h UE FM and ARAT (.72 p < .0001). From these data, it appears that the w/h UE FM is a promising tool to measure distal UE movement in minimally impaired stroke, although more research with a larger sample is needed. A standardized approach to UE test administration is critical to accurate score interpretation across patients and trials. Thus, the article also provides instructions and pictures for w/h UE FM administration and scoring.
One of the hopes, of the scientific frontier domains tangent with the artificial intelligence is and will probably remain for a long time, the realization of the artificial prosthesis and organs which could compensate for the people the incurable consequences of some accidents or severe diseases. From all the types of prosthesis existent on the market in the present, only
Traian Balan; E. Franti; T. Alexa; D. Tufis; G. Stefan; N. Claudia; P. L. Milea; C. Slav; R. Demco
The discovery that neurons can be photostimulated via genetic incorporation of artificial opsins offers potential for many new forms of neural prosthesis. In this work, we demonstrate a photostimulator which has both the irradiance requirement and the spatial resolution for retinal prosthesis. We characterise its electrical and optical properties and show its ability to accurately stimulate individual action potentials.
N. Grossman; K. Nikolic; V. Poher; B. McGovern; E. Drankasis; M. Neil; C. Toumazou; P. Degenaar
Background Compartment syndrome of any extremity is a limb-threatening emergency requiring an emergent surgical management. Thus, ruling out compartment syndrome is often high on the list of priorities when treating high-energy injuries and fractures. However, even in the most seemingly benign injuries, this dangerous diagnosis must always remain on the differential and suspicion must remain high. Case presentation 23-year-old factory worker presents after a low energy entrapment injury to his left forearm. Initial work-up and evaluation noted an isolated radial head dislocation with a normal physical motor and sensory exam. However, maintaining high suspicion for compartment syndrome despite serial normal physical exams, led objective compartment pressure measurement leading to definitive diagnosis. Emergent surgical intervention via compartment fasciotomies was performed, along with closed reduction and ligament repair. At 1 year follow-up, the patient was well-healed, back to work with full range of motion and not activity limitations. Conclusion Despite a seemingly benign injury pattern, and a relatively low energy mechanism, vigilant concern for compartment syndrome following any kind of entrapment injury should initiate serial examinations and compartment pressure measurements especially in circumstances with continued swelling and inability to perform an accurate clinical assessment due to an obtunded or medicated patient.
Long-term nipple projection remains the elusive ingredient for measuring the success of a nipple reconstruction. Augmentation of this projection without sacrifice of autogenous donor tissues may be achieved using a polyurethane-coated silicone gel implant affectionately and descriptively called the "gumdrop" nipple. Two patients who agreed to implantation with this device have each been observed over a one-year period with no loss of projection. The role of an internal nipple prosthesis, although perhaps of some value as a salvage procedure, appears to offer few advantages over other accepted methods of reconstruction that do not use any foreign body. PMID:2301890
Objective To investigate the ability of the New Jersey Institute of Technology Robot Assisted Virtual Rehabilitation (NJIT-RAVR) system training to elicit changes in upperextremity (UE) function in children with hemiplegia secondary to cerebral palsy. Methods Nine children (mean age 9 years, three males) participated in three pilots. Subjects trained 1 hour, 3 days a week for 3 weeks. Two groups performed this protocol as their only intervention. The third group also performed 5–6 hours of constraint-induced movement therapy. Results All subjects participated in a short programme of nine, 60-minute training sessions without adverse effects. As a group, subjects demonstrated statistically significant improvements in Melbourne Assessment of Unilateral Upper Limb Function Test, a composite of three timed UE tasks and several measurements of reaching kinematics. Several subjects demonstrated clinically significant improvements in active shoulder abduction and flexion as well as forearm supination. Conclusion Three small pilots of NJIT-RAVR training demonstrated measurable benefit with no complications, warranting further examination.
FLUET, GERARD G.; QIU, QINYIN; KELLY, DONNA; PARIKH, HETA D.; RAMIREZ, DIEGO; SALEH, SOHA; ADAMOVICH, SERGEI V.
Objective Experts disagree about the optimal classification of upper limb disorders (ULDs). To explore whether differential response to treatments offers a basis for choosing between case definitions, we analysed previously published research. Methods We screened 183 randomised controlled trials (RCTs) of treatments for ULDs, identified from the bibliographies of 10 Cochrane reviews, four other systematic reviews, and a search in Medline, Embase, and Google Scholar to June 2010. From these, we selected RCTs which allowed estimates of benefit (expressed as relative risks (RRs)) for >1 case definition to be compared when other variables (treatment, comparison group, follow-up time, outcome measure) were effectively held constant. Comparisons of RRs for paired case definitions were summarised by their ratios, with the RR for the simpler and broader definition as the denominator. Result Two RCT reports allowed within-trial comparison of RRs and thirteen others allowed between-trial comparisons. Together these provided 17 ratios of RRs (five for shoulder treatments, 12 for elbow treatments, none for wrist/hand treatments). The median ratio of RRs was 1.0 (range 0.3 to 1.7; interquartile range 0.6 to 1.3). Conclusion Although the evidence base is limited, our findings suggest that for musculoskeletal disorders of the shoulder and elbow, clinicians in primary care will often do best to apply simpler and broader case definitions. Researchers should routinely publish secondary analyses for subgroups of patients by different diagnostic features at trial entry, to expand the evidence base on optimal case definitions for patient management.
Palmer, Keith T; Harris, E Clare; Linaker, Cathy; Ntani, Georgia; Cooper, Cyrus; Coggon, David
...Silicone inflatable breast prosthesis. 878...DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic...Silicone inflatable breast prosthesis. (a...November 17, 1999, for any silicone inflatable breast prosthesis...
...Silicone inflatable breast prosthesis. 878...DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic...Silicone inflatable breast prosthesis. (a...November 17, 1999, for any silicone inflatable breast prosthesis...
Bilateral transtibial amputee (BTA) gait has been investigated less and is not as well understood compared to that of their unilateral counterparts. Relative to able-bodied individuals, BTAs walk with reduced self-selected speeds, increased step width, hip-hiking, and greater metabolic cost. The clinically observed upper body motions of these individuals have not been quantified, but appear substantially different from able-bodied ambulators and may impact upright balance. Therefore, the objective of this study was to characterize the upperextremity kinematics of BTAs during steady-state walking. We measured medial-lateral ground reaction forces, step width and extrapolated center-of-mass (XCoM) trajectory, and observed effects of walking speed and increased prosthetic ankle range-of-motion (ROM) on these parameters. Significantly, BTAs display greater lateral trunk flexion ROM and shoulder abduction than able-bodied individuals when walking at similar speeds, and the inclusion of prosthetic adaptors for increasing passive ankle ROM slightly reduced step width. Overall, exaggerated lateral trunk flexion ROM was invariant with step width. Results suggest that lateral trunk motion is useful for shifting the body center-of-mass laterally onto the leading stance limb while simultaneously unloading the trailing limb. However, exaggerated lateral trunk flexion may introduce an unstable scenario if the XCoM is displaced beyond the lateral base-of-support. Further studies would be useful to identify if either prostheses that assist limb advancement and/or gait training may be effective in reducing this lateral sway while still maintaining efficient ambulation. PMID:23680427
Major, Matthew J; Stine, Rebecca L; Gard, Steven A
The mechanical requirements before satisfactory muscular balance in a total wrist prosthesis have been studied in 25 cadavers. The centre of rotation was determined in X-Rays; it was localised in the sagittal plane crossing the axis of the forearm and in the frontal plane situated in front of the axis of the forearm. A graphic model of the wrist was then established. A total prosthesis was then designed, made up of two components with a torus surface. This prosthesis was found to be compatible with the wrist model. Movement required forces only slightly greater than normal muscular activity. One male was operated on using this prosthesis. The result was satisfactory after one year. PMID:3749550
Many procedures have been proposed for the treatment of traumatic painful instabilities of the Distal Radio-Ulnar Joint (DRUJ). Moore-Darrach, Milch, Baldwin, Bowers, Kapandji-Sauvé. Except for the Milch procedure, the risk of painful instability of the ulnar stump is real, but not very frequent if the technique is correctly applied. When this complication occurs, the best way to ensure the ulnar stump stabilization is mechanical, by mean of a DRUJ Prosthesis which we were the first to imagine and build. Used in two cases, with or without remnant ulnar head, these two types of prosthesis seem to have been favourable. Obviously, it is too early to know the final value of this prosthesis, based only on two cases, but it seemed important to make it known as an additional possibility in the treatment of the DRUJ problems. These two types of prosthesis are conceived on original principles: cementless fixation but with screws and nuts giving immediate and definitive stability and allowing a fast rehabilitation. The articular pieces are composite, metal on H.D. Polythylene. The articular surface is spherical permitting all the mobilities of this complex joint. The two articular surfaces are supported by two pieces: the proximal part, holding a hollow hemisphere, inserted in the ulna and the same for the two types of prosthesis, and a distal part, holding the sphere; this part is different according to the type of the prosthesis. We are well aware that in time and with clinical experience, some of its secondary characteristics will evolve, mainly its fixation system. At the present time this prosthesis is indicated in two "second look" situations: painful ulnar stump instability after a Kapandji-Sauvé procedure, and after a Moore-Darrach procedure. Perhaps it will be used in unstable stumps after a Bowers procedure? It is possible that this prosthesis will be used primarlly in the future when its reliability has been definitively established. We are working towards this objective. PMID:1280973
During the period February 1989-September 1991, 15 patients with absent or defective pinna were treated with a bone-anchored auricular prosthesis at the ENT-department, Rigshospitalet, Copenhagen. These patients were followed up from the hospital records and by means of a questionnaire. Altogether 40 titanium implants have been inserted, of which one implant was found not to be integrated at the time of the second-stage surgery. Five patients underwent additional surgery, one patient because of non-integration of a screw, and four patients on account of soft-tissue reactions. From the questionnaire replies it appears that all patients found the cosmetic result and the technique concerning mounting of the prosthesis very satisfactory. Nearly half the patients found that the care of the skin around the abutments caused considerable problems. Three patients had experienced unintended losses of the prosthesis. In conclusion, treatment with a bone anchored auricular prosthesis has considerable advantages compared to treatment with a prosthesis attached by adhesive. Furthermore the use of a bone-anchored prosthesis should be considered a viable alternative to surgical reconstruction because of the outstanding aesthetic result and because the surgical procedure puts less strain on the patient. The disadvantage of the method is the lifelong daily care of the skin and the dependence on the health services. PMID:7985274
Bille, M; Homøe, P; Vesterhauge, S; Rixen, M; Bretlau, P
The increasing trends of cumulative trauma disorders of the upperextremities (CTDUEs) in US industry is well established; however, systematic examination of potential reasons for these trends has been lacking. Data from the United States Bureau of Labor Statistics and from Liberty Mutual Group workers' compensation claims were used to count CTDUEs. The proportions of all Bureau of Labor Statistics' cases and Liberty Mutual Group workers' compensation claims that resulted from CTDUEs were estimated for the years 1986 to 1993. The proportions by occupation (job classification code), gender, potential video display unit use, and in the meat-packing industry are described. Both data systems show a steady increase in cases and claims from less than 1% in 1986 to about 4% in 1993. Women and specific occupational categories are over-represented with respect to CTDUEs. A shift to service industry work and video display unit use do not appear to be strongly related to the increased reporting of CTDUEs, whereas increased productivity, an increased number of women in the work force and general awareness of CTDUEs in the media and health care system may be related. Coding and definition problems still limit these conclusions, however. PMID:8925325
Fibromuscular dysplasia (FMD) is a noninflammatory, nonatherosclerotic sistemic disease of unknown etiology, primarily affecting muscular arteries of intermediate size. It has been most commonly observed in the renal, carotid, and intracerebral arteries, although it has been reported in other arterial beds. However, being an uncommon disease in general, the manifestation of FMD in the upperextremities is exceedingly rare. The authors report the case of a 69 years old female admitted with ischemia of the right hand, secondary to fibromuscular dysplasia of the midbrachial artery. The patient presented to vascular surgery clinic with a 4 month history of numbness, pain, and coolness of her right hand, with a small necrotic lesion on her right index finger. Peripheral pulses were barely palpable, and doppler-derived brachial and radial systolic pressures suggested midbrachial artery stenosis. Arteriography showed a normal arch and normal innominate, subclavian, and axillary arteries. The midbrachial artery was markedly abnormal and had alternating areas of stenosis and aneurysm formation - "string-of-beads" appearance. The patient underwent surgical excision of the abnormal right brachial artery, and reconstruction was accomplished with a reversed saphenous vein graft. Distal pulses were restored postoperatively. Pathologic examination confirmed the diagnosis of fibromuscular dysplasia. A review of the literature on the topic was made. PMID:19305884
Ministro, Augusto; Evangelista, Ana; Damião, Angélica; Fernandes, Afonso; Dinis da Gama, A
The aims of this randomized, single-blind crossover trial were to investigate the effect of adding a simulated bowling video game via the Nintendo Wii(®) gaming system to the standard exercise regimen of cognitively intact residents of long-term care (LTC) with upperextremity dysfunction and to identify individual characteristics that might predict improvement. Residents (n=34) were recruited through two LTC facilities in southwestern Ontario and were randomized into a standard exercise (SG) or standard exercise plus Wii bowling (Wii) arm. After 4 weeks of intervention, the groups were crossed over to the opposite arm. Outcomes included measures of pain intensity and bothersomeness, physical activity enjoyment, and a six-item measure of functional capacity designed specifically for residents of LTC. Results suggest that subjects improved on all outcomes from pre- to postintervention but that only enjoyment of activity showed a significant difference between the SG and Wii groups. Effect sizes (Cohen's d) ranged from small (0.30 for bothersomeness) to large (1.77 for functional capacity). Responders, defined as those subjects who reported any degree of improvement following the Wii intervention, were less likely to complain of stiffness or shoulder symptoms and were more likely to complain of hand symptoms than non-responders. Limitations in interpretation and recommendations for future research are presented. PMID:20698793
Hsu, Jason K; Thibodeau, Richard; Wong, Stephanie J; Zukiwsky, Daniel; Cecile, Sara; Walton, David M
Contents: Electronic circuits for multifunctional prostheses with bioelectric control; Modes of controlling multifunctional bioelectrical prostheses; Design requirements for a feedback scheme for sensing grasping force in bioelectrical prostheses; Distrib...
Prosthetic shoulder replacement is impeded by two main obstacles: the articular cavity is very shallow, and the small glenoid surface rests on a narrow neck to which prosthetic pieces are difficult to attach. The principal, currently used prostheses are non-retentive models which reproduce the anatomy of the joint. They differ from each other mainly in the glenoid piece pattern which may be sealed only to the glenoid cavity or also fixed onto the acromion. On the whole, the clinical results reported are encouraging, particularly as regards the absence of pain, but the radiological course of the glenoidal sealing is a source of concern. Obvious unsealing is rare, but cracks between bone and cement are very frequent and some of them become wider as time goes by. In addition, there is still no satisfactory solution to the problem of big rotator cuff tears. This type of prosthesis must be envisaged with caution and should be reserved to very painful shoulders, but it would be wise not to wait until the rotator cuff is destroyed. The best indications are glenohumeral osteoarthritis, rheumatoid arthritis and necrosis of the tumoral head. PMID:2188340
...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices Â§ 878.3680 Nose prosthesis. (a) Identification. A nose prosthesis...
...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices Â§ 878.3550 Chin prosthesis. (a) Identification. A chin prosthesis...
...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices Â§ 878.3590 Ear prosthesis. (a) Identification. An ear prosthesis...
Pattern recognition-based multifunction prosthesis control strategies have largely been demonstrated with subsets of typical able-bodied hand movements. These movements are often unnatural to the amputee, necessitating significant user training and do not maximally exploit the potential of residual muscle activity. This paper presents a real-time electromyography (EMG) classifier of user-selected intentional movements rather than an imposed subset of standard movements. EMG signals were recorded from the forearm extensor and flexor muscles of seven able-bodied participants and one congenital amputee. Participants freely selected and labeled their own muscle contractions through a unique training protocol. Signals were parameterized by the natural logarithm of root mean square values, calculated within 0.2 s sliding and non overlapping windows. The feature space was segmented using fuzzy C-means clustering. With only 2 min of training data from each user, the classifier discriminated four different movements with an average accuracy of 92.7% +/- 3.2%. This accuracy could be further increased with additional training data and improved user proficiency that comes with practice. The proposed method may facilitate the development of dynamic upperextremityprosthesis control strategies using arbitrary, user-preferred muscle contractions. PMID:18198711
Shunt surgery is not universally successful toward detumescence, may lead to erectile dysfunction, and can make eventual penile prosthesis insertion difficult. Penile prosthesis insertion during a priapistic episode alleviates ischemic pain, allows the patient to resume sexual function sooner, and prevents corporal scarring and shortening that makes subsequent prosthesis implantation difficult. PMID:23905940
Tausch, Timothy J; Mauck, Ryan; Zhao, Lee C; Morey, Allen F
With the demand of active prosthesis continuing to rise, the necessity of developing stable humanoid robots and intelligent leg prosthesis becomes more and more important. This paper presents a closed-loop position servo system of the powered prosthesis, which is designed according to the moving feature of human leg, and consists of the position, velocity and current feedback. Based on bionics
Constraints on the Os-isotopic composition of the upper mantle derive mainly from studies of abyssal peridotites and ophiolite massifs. Os-isotopes in abyssal and ophiolite peridotites are heterogeneous and generally sub-chondritic (0.120<187Os\\/188Os<0.130), reflecting Re removal from the upper mantle through crust formation (and subduction). It is unclear whether these samples accurately reflect the range and average composition of the upper mantle.
In thirty-two unilateral upperextremity amputees with and without phantom limb pain, various phantom limb phenomena were investigated. In general, the incidence of non-painful phantom limb sensations was higher in patients with phantom limb pain than in pain-free amputees. Kinesthetic and kinetic phantom limb sensations were reported more frequently than exteroceptive cutaneous sensations. There was a significant positive correlation between
Pedro Montoya; Wolfgang Larbig; Norbert Grulke; Herta Flor; Edward Taub; Niels Birbaumer
Fall-related wrist fractures are common at any age. We used a seven-link, sagittally symmetric, biomechanical model to test the hypothesis that systematically alterations in the configuration of the body during a forward fall from standing height can significantly influence the impact force on the wrists. Movement of each joint was accomplished by a pair of agonist and antagonist joint muscle torque actuators with assigned torque-angle, torque-velocity, and neuromuscular latency properties. Proportional-derivative joint controllers were used to achieve desired target body segment configurations in the pre- andor postground contact phases of the fall. Outcome measures included wrist impact forces and whole-body kinetic energy at impact in the best, and worst, case impact injury risk scenarios. The results showed that peak wrist impact force ranged from less than 1 kN to more than 2.5 kN, reflecting a fourfold difference in whole-body kinetic energy at impact (from less than 40 J to more than 160 J) over the range of precontact hip and knee joint angles used at impact. A reduction in the whole-body kinetic energy at impact was primarily associated with increasing negative work associated with hip flexion. Altering upperextremity configuration prior to impact significantly reduced the peak wrist impact force by up to 58% (from 919 N to 2212 N). Increased peak wrist impact forces associated greater shoulder flexion and less elbow flexion. Increasing postcontact arm retraction can reduce the peak wrist impact force by 28% (from 1491 N to 1078 N), but postcontact hip and knee rotations had a relatively small effect on the peak wrist impact force (8% reduction; from 1411 N to 1303 N). In summary, the choice of the joint control strategy during a forward fall can significantly affect the risk of wrist injury. The most effective strategy was to increase the negative work during hip flexion in order to dissipate kinetic energy thereby reducing the loss in potential energy prior to first impact. Extended hip or elbow configurations should be avoided in order to reduce forearm impact forces. PMID:18601457
Most of current concepts for a visual prosthesis are based on neuronal electrical stimulation at different locations along the visual pathways within the central nervous system. The different designs of visual prostheses are named according to their locations (i.e., cortical, optic nerve, subretinal, and epiretinal). Visual loss caused by outer retinal degeneration in diseases such as retinitis pigmentosa or age-related
Eyal Margalit; Mauricio Maia; James D Weiland; Robert J Greenberg; Gildo Y Fujii; Gustavo Torres; Duke V Piyathaisere; Thomas M O'Hearn; Wentai Liu; Gianluca Lazzi; Gislin Dagnelie; Dean A Scribner; Eugene de Juan; Mark S Humayun
... amputation to return to their family and/or workplace, they must be accurately fit with a prosthesis that matches their own anatomy; one that is constructed in such a way as to maximize their current or potential physical needs and activity level. Each amputee has unique needs, from the ...
Snowboarding with a below-knee prosthesis is compromised by the limited rotation capabilities of the existing below-knee prostheses, which are designed for use in normal walking. Based on snowboarding range of motion analyses, a novel below-knee prosthesis was designed with the aim to achieve similar range of motions like able-bodied snowboarders. The new prosthesis allows for passive inversion/eversion, passive plantarflexion/dorsiflexion and additional 'voluntary' plantarflexion/dorsiflexion initiated by lateral or medial rotation of the upper leg and knee. A prototype was built and was subsequently tested on a single subject, a highly professional snowboarder and candidate for the Olympic Winter Games. The movements of the subject were recorded on video, analyzed and compared to the recorded movements of an able-bodied snowboarder, and a snowboarder with a traditional below-knee prosthesis. The results indicated an increased similarity of inversion/eversion and plantarflexion/dorsiflexion between the snowboarder with the new below-knee prosthesis and the able-bodied snowboarder, whereas the snowboarder with the traditional below-knee prosthesis and the able-bodied snowboarder differed considerably. These results indicate that snowboarding with the new prosthesis is more comparable to able-bodied snowboarding. On a subjective basis this is confirmed by the test subject who stated that: "snowboarding with the new prosthesis is like it was before the amputation!". PMID:19658016
In this paper, we report on our pilot evaluation of a prototype foot/ankle prosthesis. This prototype has been designed and fabricated with the intention of providing decreased ankle joint stiffness during the middle portion of the stance phase of gait, and increased (i.e., more normal) knee range of motion during stance. Our evaluation involved fitting the existing prototype foot/ankle prosthesis, as well as a traditional solid ankle cushioned heel (SACH) foot, to an otherwise healthy volunteer with a below-knee (BK) amputation. We measured this individual's lower extremity joint kinematics and kinetics during walking using a video motion analysis system and force platform. These measurements permitted direct comparison of prosthetic ankle joint stiffness and involved side knee joint motion, as well as prosthetic ankle joint moment and power. PMID:10779119
PURPOSE: An electronic implant that can bypass the damaged photoreceptors and electrically stimulate the remaining retinal neurons to restore useful vision has been proposed. A number of key questions remain to make this approach feasible. The goal of this thesis is to address the following 2 specific null hypotheses: (1) Stimulus parameters make no difference in the electrically elicited retinal responses. (2) Just as we have millions of photoreceptors, so it will take a device that can generate millions of pixels/light points to create useful vision. METHODS: For electrophysiologic experiments, 2 different setups were used. In the first setup, charge-balanced pulses were delivered to the retinal surface via electrodes inserted through an open sky approach in normal or blind retinal degenerate (rd) mice. In the second setup, the rabbit retina was removed under red light conditions from an enucleated eye and then maintained in a chamber while being superfused with oxygenated, heated Ames media. In both setups, stimulating electrodes and recording electrodes were positioned on the retinal surface to evaluate the effect of varying stimulation parameters on the orthodromic retinal responses (i.e., recording electrode placed between stimulating electrodes and optic nerve head). For psychophysical experiments, visual images were divided into pixels of light that could be projected in a pattern on the retina in up to 8 sighted volunteers. Subjects were asked to perform various tasks ranging from reading and face recognition to various activities of daily living. RESULTS: Electrophysiologic experiments: In a normal mouse, a single cycle of a 1-kHz sine wave was significantly more efficient than a 1-kHz square wave (P < .05), but no such difference was noted in either of the 8- or 16-week-old rd mouse groups (8-week-old, P = .426; 16-week-old, P = .078). Charge threshold was significantly higher in 16-week-old rd mouse versus both 8-week-old rd and normal mouse for every stimulus duration (P < .05). In all groups, short duration pulses (40, 80, and 120 microseconds) were more efficient in terms of total charge (the product of pulse amplitude and pulse duration) than longer (500 and 1,000 microseconds) pulses (P < .05). In all groups, applying a pulse train did not lead to more efficient charge usage (P < .05). Psychophysical experiments: In high-contrast tests, facial recognition rates of over 75% were achieved for all subjects with dot sizes of up to 31.5 minutes of arc when using a 25 x 25 grid with 4.5 arc minute gaps, a 30% dropout rate, and 6 gray levels. Even with a 4 x 4 array of pixels, some subjects were able to accurately describe 2 of the objects. Subjects who were able to read the 4-pixel letter height sentences (on the 6 x 10 and 16 x 16 array) seemed to have a good scanning technique. Scanning at the proper velocity tends to bring out more contrast in the lettering. The reading speed for the 72-point font is a bit slower than for the next smaller font. This may be due to the limited number of letters (3) visible in the window with this large font. CONCLUSIONS: Specific parameters needed to stimulate the retina were identified. Delineating the optimum parameters will decrease the current requirements. Psychophysical tests show that with limited pixels and image processing, useful vision is possible. Both these findings should greatly simplify the engineering of an electronic retinal prosthesis.
Although properly treated, patients with Complex Regional Pain Syndrome type 1 (CRPS type 1) of upper limb may continue to\\u000a have sequel signs and symptoms of the disease in long-term. The aim of this study is to analyse the effect of the sequel findings\\u000a of CRPS type 1 on upper limb disability and quality of life. Thirty patients with CRPS
Serpil Sava?; Hale Hekim Balo?lu; Gökçen Ay; Sevim Süreyya Çerçi
The present paper, explains the evaluation system used in candidates to use a myoelectric prosthesis control, for upper limb amputation above the elbow joint. Which bases its operation on strength levels as a result to voluntary isometric contractions, generated by both biceps and triceps muscles. This system is classified into 2 methods of evaluation; online and evaluation by processing data.
Barraza-Madrigal Jose Antonio; Munoz-Guerrero Roberto
The control of shoulder disarticulation prostheses remains a challenging problem. Recently, a novel method, using targeted muscle reinnervation to develop additional myoelectric control sites, has improved the control of myoelectric upper limb prosthesis in a patient with bilateral amputations at the shoulder disarticulation level. Encouraged by this achievement, we recorded high density surface electromyogram (EMG) signals from the patient's reinnervated
Ping Zhou; Madeleine M. Lowery; Julius P. A. Dewald; Todd A. Kuiken
The thesis contains five chapters, which describe the design of an innovative pneumatically powered, hand prosthesis. Chapter 1, Introduction, starts with a definition of the notion prosthesis. After presenting a very brief review of the development of up...
From 1995 to 2000, five microvascular toe-to-hand transfers were performed in three children who were simultaneously undergoing lower extremity amputations. Their ages at time of transfer ranged from 4 to 10 years and the types of lower extremity amputation included toe amputation, foot amputation and through-knee amputation. The resulting toe-to-hand transfers included three great toe-to-thumb transfers and one combined great
Cannulas and voice prostheses are mechanical aids for patients who had to undergo tracheotomy or laryngectomy for different reasons. For better understanding of the function of those artificial devices, first the indications and particularities of the previous surgical intervention are described in the context of this review. Despite the established procedure of percutaneous dilatation tracheotomy e.g. in intensive care units, the application of epithelised tracheostomas has its own position, especially when airway obstruction is persistent (e.g. caused by traumata, inflammations, or tumors) and a longer artificial ventilation or special care of the patient are required. In order to keep the airways open after tracheotomy, tracheostomy cannulas of different materials with different functions are available. For each patient the most appropriate type of cannula must be found. Voice prostheses are meanwhile the device of choice for rapid and efficient voice rehabilitation after laryngectomy. Individual sizes and materials allow adaptation of the voice prostheses to the individual anatomical situation of the patients. The combined application of voice prostheses with HME (Head and Moisture Exchanger) allows a good vocal as well as pulmonary rehabilitation. Precondition for efficient voice prosthesis is the observation of certain surgical principles during laryngectomy. The duration of the prosthesis mainly depends on material properties and biofilms, mostly consisting of funguses and bacteries. The quality of voice with valve prosthesis is clearly superior to esophagus prosthesis or electro-laryngeal voice. Whenever possible, tracheostoma valves for free-hand speech should be applied. Physicians taking care of patients with speech prostheses after laryngectomy should know exactly what to do in case the device fails or gets lost.
Late hematoma is an extremely rare complication after augmentation mammaplasty with silicone prostheses. The authors present a case of late hematoma after breast augmentation with textured gel-filled silicone prostheses, which appeared after intense physical effort 1 year after the implantation of the prosthesis. The hematoma was drained in three subsequent ultrasound-guided percutaneous needle aspirations, with no need for removal of
Daniela Francescato Veiga; Joel Veiga Filho; Caroline Sormanti Schnaider; Ivanildo Archangelo Jr
Dose measurements were conducted in a phantom which simulates breast tissue and in another phantom which simulates a breast containing a silicone prosthesis. No detectable difference was found when the irradiations were carried out with tangential beams of /sup 60/Co radiation. The degree of backscatter and absorption of radiation by the prosthesis and phantom were also similar. A slight decrease in dose of approximately 8% was found at the interface between the prosthesis and muscle-equivalent material.
Electronic retinal prostheses seek to restore sight in patients with retinal degeneration by delivering pulsed electric currents to retinal neurons via an array of microelectrodes. Most implants use inductive or optical transmission of information and power to an intraocular receiver, with decoded signals subsequently distributed to retinal electrodes through an intraocular cable. Surgical complexity could be minimized by an "integrated" prosthesis, in which both power and data are delivered directly to the stimulating array without any discrete components or cables. We present here an integrated retinal prosthesis system based on a photodiode array implant. Video frames are processed and imaged onto the retinal implant by a video goggle projection system operating at near-infrared wavelengths (~ 900 nm). Photodiodes convert light into pulsed electric current, with charge injection maximized by specially optimized series photodiode circuits. Prostheses of three different pixel densities (16 pix/mm2, 64 pix/mm2, and 256 pix/mm2) have been designed, simulated, and prototyped. Retinal tissue response to subretinal implants made of various materials has been investigated in RCS rats. The resulting prosthesis can provide sufficient charge injection for high resolution retinal stimulation without the need for implantation of any bulky discrete elements such as coils or tethers. In addition, since every pixel functions independently, pixel arrays may be placed separately in the subretinal space, providing visual stimulation to a larger field of view.
Background Measuring the orientation of acetabular cup after total hip arthroplasty is important for prognosis. The verification of these measurement methods will be easier and more feasible if we can synthesize prosthesis radiographs in each simulated condition. One reported method used an expensive mechanical device with an indeterminable precision. We thus develop a program, THR Simulator, to directly synthesize digital radiographs of prostheses for further analysis. Under Windows platform and using Borland C++ Builder programming tool, we developed the THR Simulator. We first built a mathematical model of acetabulum and femoral head. The data of the real dimension of prosthesis was adopted to generate the radiograph of hip prosthesis. Then with the ray tracing algorithm, we calculated the thickness each X-ray beam passed, and then transformed to grey scale by mapping function which was derived by fitting the exponential function from the phantom image. Finally we could generate a simulated radiograph for further analysis. Results Using THR Simulator, the users can incorporate many parameters together for radiograph synthesis. These parameters include thickness, film size, tube distance, film distance, anteversion, abduction, upper wear, medial wear, and posterior wear. These parameters are adequate for any radiographic measurement research. This THR Simulator has been used in two studies, and the errors are within 2° for anteversion and 0.2 mm for wearing measurement. Conclusion We design a program, THR Simulator that can synthesize prosthesis radiographs. Such a program can be applied in future studies for further analysis and validation of measurement of various parameters of pelvis after total hip arthroplasty.
Purpose We have experienced 23 patients who had underwent cervical disc replacement with Mobi-C disc prosthesis and analyzed their radiological results to evaluate its efficacy. Patients and Methods This study was performed on 23 patients with degenerative cervical disc disease who underwent CDR with Mobi-C disc prosthesis from March 2006 to June 2006. Results The age of the study population ranged from 31 to 62 years with mean of 43 years, and 16 male and 7 female cases. Regarding axial pain, the average preoperative VAS score was 6.47 ± 1.4, while at final follow-up it was 1.4 ± 0.7 (p < 0.001). The preoperatively VAS score for radiculopathy was 6.7 ± 0.7 compared with an average score of 0 ± 0 at the final follow-up (p < 0.001). At postoperative 6th month, Odom's criteria were excellent, good, or fair for all 23 patients (100%). 7 patients (30.4%) were classified as excellent, 15 patients (65.2%) as good, and 1 patients (4.4%) as fair. Prolo economic and functional rating scale was average 8.9 ± 0.7 at postoperative 6th month. ROM in C2-7, ROM of FSU, and ROM in upper adjacent level were well preserved after CDR. Conclusion This report would be the first document about the CDR with Mobi-C disc prosthesis in the treatment of degenerative cervical disc disease. CDR with Mobi-C disc prosthesis provided a favorable clinical and radiological outcome in this study. However, Long-term follow-up studies are required to prove its efficacy and ability to prevent adjacent segment disease.
Kim, Sang Hyun; Shin, Hyun Chul; Shin, Dong Ah; Kim, Keung Nyun
The aim of the present study was to determine the user satisfaction of the EyeToy for the training of the upper limb in children with cerebral palsy (CP). User satisfaction was measured in 12 children with CP, using a postexperience questionnaire, primarily based on a presence questionnaire. In general, children with CP were satisfied with and motivated by the EyeToy
Michiel J. A. Jannink; Wilden van der Gelske J; Dorine W. Navis; Gerben Visser; Jeanine Gussinklo; Maarten IJzerman
|This study was designed to investigate separately the inhibitory response capacity and the lateralization effect in children with developmental coordination disorder (DCD) in the endogenous and exogenous modes of orienting attention. Children with DCD on the lower extremities (DCD-LEs), along with age-matched controls, completed four tasks that…
This case report is a case history of a femoral prosthesis infection caused by Rhodotorula mucilaginosa in a human immunodeficiency virus patient. Though the pathogenicity of this organism for bone tissue has been previously reported, this is the first reported case of an orthopedic prosthesis infection by this species of the genus Rhodotorula.
Penile prosthesis implantation is the oldest effective treatment for erectile dysfunction. This review examines the past, present and future of penile prosthesis implantation. Advances in prosthetic design and implantation techniques have resulted today in devices that produce nearly normal flaccid and erect states, and have remarkable freedom from mechanical failure. The future of prosthetic design holds promises for even more
A new finger joint prosthesis is being developed for the proximal and distal interphalangeal positions. Currently available "joint spacer" prostheses provide relief from pain and cosmetic improvement, but relatively poor long-term function. The new prosthesis employs a mechanical hinge at the joint. It is fabricated from titanium alloy (6A14V). The hinge mechanism avoids direct metal to metal contact by using high density polyethylene bearings. In vitro tests of the hinge mechanism have passed 75 million cycles of continuous flexure without failure (n = 12). The hinge also incorporates a mechanical limit stop to prevent hyperextension. The hinge mechanism is enclosed in a sealed elastomeric jacket that isolates the hinge from connective tissue ingrowth. The jacket, equivalent to an artificial synovial membrane, has an integrally textured exterior surface designed to promote tissue attachment to the implant to stabilize tissue capsule formation around the joint. To test the in vivo efficacy of the new design, a series of 12 devices were implanted in the knee joint position of adult rabbits. A jacketed prosthesis was implanted on one side, whereas 2 weeks later an unjacketed control was implanted contralaterally. The animals then were maintained for an 8 week period. At sacrifice, the implants were removed, and the response of the surrounding tissues was studied histologically. At the time of implantation, the range of motion of the joints was approximately 100-105 degrees. There was a progressive loss in range of motion observed in both groups. The fibrous tissue capsule around the jacketed implants, however, was significantly reduced in thickness compared with the controls (mean thickness, 1.5 mm vs. 4.5 mm).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8268583
Whalen, R L; Bowen, M A; Sarrasin, M J; Fukumura, F; Harasaki, H
To obtain more insight into how the skill level of an upper-limb myoelectric prosthesis user is composed, the current study aimed to (1) portray prosthetic handling at different levels of description, (2) relate results of the clinical level to kinematic measures, and (3) identify specific parameters in these measures that characterize the skill level of a prosthesis user. Six experienced transradial myoelectric prosthesis users performed a clinical test (Southampton Hand Assessment Procedure [SHAP]) and two grasping tasks. Kinematic measures were end point kinematics, joint angles, grasp force control, and gaze behavior. The results of the clinical and kinematic measures were in broad agreement with each other. Participants who scored higher on the SHAP showed overall better performance on the kinematic measures. They had smaller movement times, had better grip force control, and needed less visual attention on the hand. The results showed that time was a key parameter in prosthesis use and should be one of the main focus aspects of rehabilitation. The insights from this study are useful in rehabilitation practice because they allow therapists to specifically focus on certain parameters that may result in a higher level of skill for the prosthesis user. PMID:23408215
Bouwsema, Hanneke; Kyberd, Peter J; Hill, Wendy; van der Sluis, Corry K; Bongers, Raoul M
A new type of testicular prosthesis made of silastic with an elliptical shape to mimic a normal testis was developed by our team and submitted for patenting in China. The prosthesis was produced in different sizes to imitate the normal testis of the patient. To investigate the effects and safety of the testicular prosthesis, 20 patients receiving testicular prosthesis implantation
Ye Ning; Zhikang Cai; Huixing Chen; Ping Ping; Peng Li; Zhong Wang; Zheng Li
This study assesses how well the Community Climate System Model version 4 (CCSM4) simulates the large scale conditions needed for extreme hot surface temperatures in the California Central Valley (CV). Extreme hot summer days in the CV are associated with a large scale meteorological pattern (LSMP) described in Grotjahn and Faure (2008). The strength and sign of that pattern are assessed using a circulation index developed in Grotjahn (2011). The circulation index is strongly linked to daily maximum surface temperature normalized anomalies at stations spanning the CV. (Extreme heat events in the CV also affect a wider area of California and United States west coast). This study makes two primary points. First, the approach used in Grotjahn (2011) can be applied as a novel tool to evaluate how skillfully a model simulates conditions present during CV hot spells by evaluating how well the LSMP is simulated. The circulation index is calculated from historical simulations by CCSM4 and its distribution compared with that of the observed circulation index. Second, values of the CCSM4 based circulation index have smaller standard deviation than observed in reanalysis data. CCSM4 can generate a few comparably large circulation index values (implying high surface temperature anomalies) but not as often as in reanalysis data. Correct simulation of this large scale pattern is a necessary condition for successful simulation of California extreme hot days by a regional climate model. Also, the CCSM4 topography does not have a CV, but a broad topographic slope instead. Various choices of CCSM4 grid points were tested and none satisfactorily represented the CV maximum temperatures. These results should discourage use of CCSM4 surface data directly but encourage use of a regional climate model driven by the CCSM4 to capture hot spells in the CV.
The goal of prosthetic rehabilitation is to compensate for the loss of a limb by amputation by, in the case of a lower limb, encouraging walking, and to achieve the same level of autonomy as prior to the amputation. However, because of difficulties walking, elderly amputees may use their prosthesis to a greater or lesser degree or simply stop using it during the rehabilitation period. The objective of this research was to study factors such as physical and mental health, rehabilitation, physical independence and satisfaction with the prosthesis to understand why amputees use their prosthesis or not. The sample was composed of 65 unilateral vascular amputees 60 years old or over living at home. The information was collected from medical records, by telephone interview and by mail questionnaire. Prosthesis use was measured by a questionnaire on amputee activities developed by Day (1981). Eighty-one per cent (81%) of the subjects wore their prosthesis every day and 89% of this group wore it 6 hours or more per day. Less use of the prosthesis was significantly related to age, female gender, possession of a wheelchair, level of physical disability, cognitive impairment, poorer self-perceived health and the amputee's dissatisfaction. A multiple regression analysis showed that satisfaction, not possessing a wheelchair and cognitive integrity explained 46% of the variance in prosthesis use. PMID:11061199
The design of lower limb prostheses requires definitive geometric data to customize socket shape. Optical surface imaging and spiral x-ray computed tomography were applied to geometric analysis of limb residua in below knee (BK) amputees. Residua (limb remnants after amputation) of BK amputees were digitized and measured. Surface (optical) and volumetric (CT) data of the residuum were used to generate solid models and specify socket shape in (SDRC I-DEAS) CAD software. Volume measurements on the solid models were found to correspond within 2% of surface models and direct determinations made using Archimedean weighing. Anatomic 3D reconstruction of the residuum by optical surface and spiral x-ray computed tomography imaging are feasible modalities for prosthesis design.
Bhatia, Gulab H.; Commean, Paul K.; Smith, Kirk E.; Vannier, Michael W.
Some surgeons are beginning to doubt the reliability of bone cement in joint replacements. In 1967 Robert Mathys conceived the idea of an isoelastic prosthesis made of plastic, which would anchor into the bone without cement. He developed the idea by extensive tests in animals and, in 1973, the first human RM cementless hip prosthesis was inserted by E Morscher. In this paper the concept of the cementless isoelastic prosthesis is developed by Robery Mathys, and Professor Bombelli records his experience with the prosthesis between 1977 and 1981. ImagesFigure 1Figure 2Figure 3Figure 7Figure 10Figure 11Figure 12Figure 14Figure 15Figure 19Figure 21Figure 22Figure 24.
A tubular prosthesis formed by an assembly of electrode segments enclosing an elongated inner chamber, is inserted into the inner ear of a patient for piezoelectric generation of electrical impulses and localized injection thereof in response to externall...
This is a clinical case report of a 52-year-old male patient with four partially missing fingers of the left hand. The article describes the clinical and laboratory procedure of making prosthesis with modern silicone material. A wax pattern was fabricated using the right hand of the patient. A special type of wax was formulated to make the pattern so that it can be easily moulded and carved. Intrinsic and extrinsic staining was also performed to match the adjacent skin colour. The patient was given the finger prosthesis and was asked to use a half glove (sports) to mask the junction between the prosthesis and the normal tissue. It also provides additional retention to the artificial fingers. The patient felt his social acceptance improved after wearing the finger prosthesis. PMID:23988821
The goal of palliative care is the achievement of the best quality of life for patients and their families. Eyes are generally the first features of the face to be noticed. Loss of an eye is a traumatic event which has a crippling effect on the psychology of the patient. Several ocular and orbital disorders require surgical intervention that may result in ocular defects. An ocular prosthesis is fabricated to restore the structure, function, and cosmetics of the defects created by such conditions. Although an implant eye prosthesis has a superior outcome, due to economic factors it may not be a feasible option for all patients. Therefore, a custom-made ocular prosthesis is a good alternative. This case report presents a palliative treatment for a patient with an enucleated eye by fabricating a custom ocular prosthesis which improved his psychological, physical, social, functional, emotional and spiritual needs.
...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices Â§ 878.3720 Tracheal prosthesis. (a) Identification. The...
...c) Date premarket approval application (PMA) or notice of product development protocol (PDP) is required. A PMA or notice of completion of a PDP...testicular prosthesis shall have an approved PMA or a declared completed PDP in effect...
Today most men with erectile dysfunction (ED) can be effectively treated with less invasive means than penile prosthesis implantation.\\u000a Nevertheless, there remain men who do not respond to simple treatments such as systemic medication and who either do not respond\\u000a to or reject intermediate treatment such as penile injection therapy. For these men, penile prosthesis implantation remains\\u000a a reasonable option.
Electromyography (EMG) is widely used throughout the world for different study such as clinical diagnosis and for movement\\u000a analysis. One of the applications of EMG is in the development of myoelectric prosthesis. It is intended by all the biomechanics\\u000a engineer in order to provide better living to the amputees since the current prosthesis are limited. It is principally operated\\u000a based
Zunaidi Ibrahim; R. Nagarajan; M. Rizon; D. Hazry; D. Ruslizam; C. O. Azlin
This paper reports an integrated 256-channel epiretinal prosthesis integrated circuit (IC). This epiretinal prosthesis system consists of a power telemetry subsystem to deliver 100 mW power, a data telemetry subsystem to transfer 2 Mbps data, digital controllers to decode stimulation patterns, and a 256-channel stimulator to generate user programmable bi-phasic current stimuli. In this study, dual-band telemetry is adopted to
Kuanfu Chen; Zhi Yang; Linh Hoang; James Weiland; Mark Humayun; Wentai Liu
As a contribution toward the goal of adaptable, intelligent artificial limbs, this work introduces a continuous actor-critic reinforcement learning method for optimizing the control of multi-function myoelectric devices. Using a simulated upper-arm robotic prosthesis, we demonstrate how it is possible to derive successful limb controllers from myoelectric data using only a sparse human-delivered training signal, without requiring detailed knowledge about
Patrick M. Pilarski; Michael R. Dawson; Thomas Degris; Farbod Fahimi; Jason P. Carey; Richard S. Sutton
Intuitively and efficiently controlling multiple degrees of freedom is a major hurdle in the field of upper limb prosthetics. A virtual reality myoelectric transhumeral prosthesis simulator has been developed for cost-effectively testing novel control algorithms and devices. The system acquires EMG commands and residual limb kinematics, simulates the prosthesis dynamics, and displays the combined residual limb and prosthesis movements in a virtual reality environment that includes force-based interactions with virtual objects. A virtual Box and Block Test is demonstrated. Three normally-limbed subjects performed the simulated test using a sequential and a synchronous control method. With the sequential method, subjects moved on average 6.7±1.9 blocks in 120 seconds, similar to the number of blocks transhumeral amputees are able to move with their physical prostheses during clinical evaluation. With the synchronous method, subjects moved 6.7±2.2 blocks. The virtual reality prosthesis simulator is thus a promising tool for developing and evaluating control methods, prototyping novel prostheses, and training amputees.
Lambrecht, Joris M.; Pulliam, Christopher L.; Kirsch, Robert F.
The importance of an accurately fitting fixed prosthesis or a removable prosthesis is essential for the success of the restoration. Ill-fitting prosthesis may cause mechanical failures of the prosthesis, implant systems, or biologic complications of the surrounding tissue. There are several causes related to improper seating of the prosthesis. Some of which can be corrected and the others need to be repeated. Hence the clinician must carefully evaluate the adaptation of the prosthesis using the clinical techniques and combination of the available materials and evaluation methods to optimize the fit of prosthesis. This article reviews the various clinical methods that have been suggested for evaluating the fit of the fixed and removable prosthesis.
... FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices Â§ 872.3960 Mandibular condyle prosthesis. (a) Identification. A mandibular condyle prosthesis...
The reconstruction of maxillofacial bone defects by the intraoperative modeling of implants may reduce the predictability of the esthetic result, leading to more invasive surgery and increased surgical time. To improve the maxillofacial surgery outcome, modern manufacturing methods such as rapid prototyping (RP) technology and methods based on reverse engineeing (RE) and medical imaging data are applicable to the manufacture of custom-made maxillary prostheses. After acquisition of data, an individual computer-based 3D model of the bony defect is gernerated. These data are tranferrred into RE software to create the prosthesis using a computer-aided design (CAD) model, which is directed into the RP machine for the production of the physical model. The precise fit of the prosthesis is evaulated using the prosthesis and skull model. The prosthesis is then directly used in investment casting such as "Quick Cast" pattern to produce the titanium model. In the clincical reports presented here, reconstructions of two patients with large maxillary bone defects during the operations, and surgery time was reduced. These cases show that the prefabrication of a prosthesis using modern manufacturing technology is an effective method for maxillofacial defect reconstruction. PMID:17971119
Spiral x-ray computed tomography (SXCT) volumetric imaging was applied to in situ goodness of fit evaluation for lower extremity (LE) prostheses with and without axial loading. SXCT data was obtained (Siemens Somatom PLUS-S) with and without the prosthesis in place. An algorithm was developed to map and measure the residuum bony and soft tissue structure and their relationship to the rigid prosthesis socket. A transform was applied along the main axis of the structure to estimate the local soft tissue thickness relative to bone and map it from a Cartesian coordinate voxel array into cylindrical and spherical (Lambert projection) maps. Interval changes in the soft tissue envelope relative to the underlying skeleton were measured by comparing maps obtained from serial examinations. The test-retest repeatability and validity of SXCT methods was assessed using cadaver parts, phantom test objects, and human volunteers. The soft tissue envelope of lower limb residua were successfully determined, and the precision (repeatability) of SXCT was consistently better than 90%. Soft tissue SXCT mapping of a lower limb residuum is feasible with the prosthesis in situ and provides comprehensive information on the geometry and tissue characteristics for static evaluation of prosthesis fit.
Vannier, Michael W.; Smith, Kirk E.; Commean, Paul K.; Bhatia, Gulab H.
Background. Reconstruction of a long section of the trachea is clinically problematic. Tracheal reconstructions using prostheses have met with limited success due to local infection, hemorrhage, luminal stenosis and prosthesis dislocation.Methods. We have designed a porous type of tracheal prosthesis in which the mesh is sealed with collagen sponge. We used this prosthesis (50 mm in length) to reconstruct the
Intelligent prosthesis is a self-regulated robotic joint system. Iterative learning controller, ILC, is used to build up a decision-making expert system according to the repetition and periodicity in the motion of human prosthesis system. The historical data is used in ILC for optima control effect. As small error margin is permitted in prosthesis control, so the motion of human can
Maxillofacial prosthesis is an art and science which not only replaces the lost structure sometimes it restores the functions also. Pharyngeal obturator is a prosthesis which closes the palatal and pharyngeal defects and improving the speech and other function. The following case report discusses palatopharyngeal insufficiency, impression procedures, fabrication of prosthesis and improvements in speech. PMID:23204726
Kasim Mohamed, K; Anand Kumar, V; Devi, N; Padmanaban, T V