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Sample records for upper extremity prosthesis

  1. Liquid-fueled actuation for an anthropomorphic upper extremity prosthesis.

    PubMed

    Fite, Kevin B; Withrow, Thomas J; Wait, Keith W; Goldfarb, Michael

    2006-01-01

    This paper describes the design of a 21 degree-of-freedom, nine degree-of-actuation, gas-actuated arm prosthesis for transhumeral amputees. The arm incorporates a direct-drive elbow and three degree-of-freedom wrist, in addition to a 17 degree-of-freedom underactuated hand effected by five actuators. The anthropomorphic device includes full position and force sensing capability for each actuated degree of freedom and integrates a monopropellant-powered gas generator to provide on-board power for untethered operation. Design considerations addressed in this paper include the sizing of pneumatic actuators based on the requisite output energy at each joint; the development of small low-power servovalves for use with hot/cold gases; the design of compact joints with integrated position sensing; and the packaging of the actuators, on-board power, and skeletal structure within the volumetric envelope of a normal human forearm and elbow. The resulting arm prototype approaches the dexterous manipulation capabilities of its anatomical counterpart while delivering approximately 50% of the force and power output of an average human arm. PMID:17947158

  2. Upper extremity limb loss: functional restoration from prosthesis and targeted reinnervation to transplantation.

    PubMed

    Carlsen, Brian T; Prigge, Pat; Peterson, Jennifer

    2014-01-01

    For several decades, prosthetic use was the only option to restore function after upper extremity amputation. Recent years have seen advances in the field of prosthetics. Such advances include prosthetic design and function, activity-specific devices, improved aesthetics, and adjunctive surgical procedures to improve both form and function. Targeted reinnervation is one exciting advance that allows for more facile and more intuitive function with prosthetics following proximal amputation. Another remarkable advance that holds great promise in nearly all fields of medicine is the transplantation of composite tissue, such as hand and face transplantation. Hand transplantation holds promise as the ultimate restorative procedure that can provide form, function, and sensation. However, this procedure still comes with a substantial cost in terms of the rehabilitation and toxic immunosuppression and should be limited to carefully selected patients who have failed prosthetic reconstruction. Hand transplantation and prosthetic reconstruction should not be viewed as competing options. Rather, they are two treatment options with different risk/benefit profiles and different indications and, hence vastly different implications. PMID:24397947

  3. Prosthetic usage in major upper extremity amputations.

    PubMed

    Wright, T W; Hagen, A D; Wood, M B

    1995-07-01

    Patterns of use of contemporary prostheses by 135 patients with major upper extremity amputations were evaluated by questionnaire. Eighty-four percent of the patients were male and 16% were female. Amputation levels represented were below elbow, 44%; above elbow, 40%; and shoulder disarticulations or forequarter amputations, 16%. The follow-up interval averaged 12 years (range, 1-67 years). One hundred and thirteen patients were fitted with either a myoelectric or body-powered prosthesis. The overall rejection rate was 38%. Thirty-nine of 42 in the below-elbow amputation group used the prosthesis and appeared to benefit the most. Eight of 141 in the wrist disarticulation group used the prosthesis: as did 9 of 21 in the above-elbow amputation group. In contrast, all bilateral amputees used their prostheses. Stiff shoulders and brachial plexus injury were both predictors for poor prosthetic usage. PMID:7594289

  4. Management of Major Traumatic Upper Extremity Amputations.

    PubMed

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

    2016-01-01

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

  5. Upper Extremity Regional Anesthesia

    PubMed Central

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

    2009-01-01

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

  6. [Tests of hand functionality in upper limb amputation with prosthesis].

    PubMed

    Bazzini, G; Orlandini, D; Moscato, T A; Nicita, D; Panigazzi, M

    2007-01-01

    The need for standardized instruments for clinical measurements has become pressing in the fields of occupational rehabilitation and ergonomics. This is particularly the case for instruments that allow a quantitative evaluation of upper limb function, and especially hand function in patients who have undergone an amputation and then application of an upper limb prosthesis. This study presents a review of the main tests used to evaluate hand function, with a critical analysis of their use in subjects with an upper limb prosthesis. The tests are divided into: tests to evaluate strength, tests to evaluate co-ordination and dexterity, tests of global or overall function, and tests proposed specifically for subjects with an upper limb prosthesis. Of the various tests presented, the authors give their preference to the Bimanual Functional Assessment, Abilhand and/or the ADL Questionnaire, because of the practical usefulness, clinimetric features, simplicity and ease of administration of these tests. PMID:17886763

  7. Upper Extremity Amputations and Prosthetics

    PubMed Central

    Ovadia, Steven A.; Askari, Morad

    2015-01-01

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

  8. Feasibility of a biomechatronic EPP Upper Limb Prosthesis Controller.

    PubMed

    Moutopoulou, Efie; Bertos, Georgios A; Mablekos-Alexiou, Anestis; Papadopoulos, Evangelos G

    2015-08-01

    In this paper, we examine the feasibility of an implantable topology of a Biomechatronic Extended Physiological Proprioception (EPP) Upper Limb Prosthesis Controller. Initial findings support the hypothesis that the topology is safe and feasible. This novel controller topology can maintain the advantages of EPP, but without its inherent disadvantages i.e. of the existence of unaesthetic cables, or mechanical linkages. PMID:26736790

  9. Functional and Clinical Outcomes of Upper Extremity Amputation.

    PubMed

    Fitzgibbons, Peter; Medvedev, Gleb

    2015-12-01

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

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

    ERIC Educational Resources Information Center

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

    2005-01-01

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

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

    ERIC Educational Resources Information Center

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

    2005-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2007-11-01

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

  13. Sleep Disturbance and Upper-Extremity Disability

    PubMed Central

    Peters, Rinne Marijn; Menendez, Mariano Esteban; Mellema, Jos Jasper; Ring, David; Vranceanu, Ana-Maria

    2016-01-01

    Background: Although upper-extremity disability correlates with psychosocial aspects of illness the association with sleep disturbance in upper extremity disability is less certain. To evaluate whether sleep disturbance is associated with upper-extremity disability among patients with upper extremity illness, accounting for sociodemographic, condition-related, and psychosocial factors. Methods: A cohort of 111 new or follow-up patients presenting to an urban academic hospital-based hand surgeon completed a sociodemographic survey and measures of sleep disturbance (PROMIS Sleep Disturbance), disability (PROMIS Upper-Extremity Physical Function), ineffective coping strategies (PROMIS Pain Interference), and depression (PROMIS Depression). Bivariate and multivariable linear regression modeling were performed. Results: Sleep disturbance correlated with disability (r=-0.38; P<0.001) in bivariate analysis. Symptoms of depression (r=-0.44; P<0.001) and ineffective coping strategies (r=-0.71; P<0.001) also correlated with upper-extremity specific disability in bivariate analysis. Pain Interference was the only factor associated with disability in multivariable analysis. Conclusions: Sleep disturbance is not as strongly or directly associated with symptom intensity and magnitude of disability as ineffective coping strategies. Interventions to reduce pain interference (e.g. cognitive behavioral therapy) hold great potential to decrease musculoskeletal symptom intensity and magnitude of disability, and perhaps even sleep disturbance. PMID:26894216

  14. Upper Extremity Problems in Doner Kebab Masters

    PubMed Central

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

    2014-01-01

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

  15. Experimental development of a sensory control system for an upper limb myoelectric prosthesis with cosmetic covering.

    PubMed

    Tura, A; Lamberti, C; Davalli, A; Sacchetti, R

    1998-01-01

    A sensory control system based on the force-sensing resistor (FSR) for an upper limb prosthesis has been designed for application to a commercial prosthetic hand of proven reliability. In particular, FSR sensors have been used to control the strength of the grip on objects. Moreover, the problem of the object possibly slipping from the grip has been addressed by a system based on an optical sensor for detecting movement. Tests on different everyday objects have shown the feasibility of the above approach, given the constraints of the limited dimensions of the prosthesis and the presence of a cosmetic glove. PMID:9505249

  16. Treatment of upper-extremity outflow thrombosis.

    PubMed

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

    2016-03-01

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

  17. Clinical Differentiation of Upper Extremity Pain Etiologies.

    PubMed

    Ponnappan, Ravi K; Khan, Mustafa; Matzon, Jonas L; Sheikh, Emran S; Tucker, Bradford S; Pepe, Matthew D; Tjoumakaris, Fotios P; Nassr, Ahmad N

    2015-08-01

    Upper extremity pain can result from many overlapping etiologies. These can be categorized into anatomic regions and specific organ systems. Anatomically, pain etiologies are classified into four major groups: neurologic, musculoskeletal, vascular, and other (eg, tumor, infection). Knowledge of the characteristic clinical presentation and physical examination findings of each group can help distinguish the source of the patient's complaints quickly so that an accurate clinical diagnosis can facilitate appropriate diagnostic measures and treatment. A focus on the neurologic causes of upper extremity pain (ie, cervical spine pathology, peripheral nerve compression, neuropathy) and musculoskeletal causes of shoulder and elbow pain (eg, adhesive capsulitis, calcific tendinitis, biceps tendinitis, synovitis) and the distinguishing characteristics (eg, periscapular pain, two-point discrimination, signal intensity on T2-weighted MRI) helps determine the appropriate diagnosis. PMID:26116851

  18. Upper extremity injuries in Homer's Iliad.

    PubMed

    Hutchison, Richard L; Hirthler, Maureen A

    2013-09-01

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

  19. Computed Tomography Angiography of the Upper Extremities.

    PubMed

    Dave, Radhika B; Fleischmann, Dominik

    2016-01-01

    Upper extremity computed tomography angiography is a powerful tool in the evaluation of acute and nonacute arterial pathology. Technical principles including patient positioning, choice of contrast injection site and rate of administration, and physiologic considerations must be optimized to achieve a high-quality angiographic study. The use of computed tomography angiography in the setting of trauma has been recognized. However, it's less well-known and varied clinical applications in the subacute setting are also important. Volume-rendered, maximum intensity projection, and multiplanar reformat images are indispensable for evaluating the data set. PMID:26654394

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

    PubMed

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

    2015-06-01

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

  1. Replantation of upper extremity, hand and digits.

    PubMed

    Bumbasirevi?, Marko Z; Vuckovi?, Cedo D; Vuceti?, Cedomir; Manojlovi?, Radovan; Andjelkovic, Sladjana Z; Palibrk, Tomislav D; Milutinovi?, Suzana M; Raspopovi?, Emilija Dubljanin

    2013-01-01

    Replantation is defined as reattachment of the part that has been completely amputated and there is no connection between the severed part and the patient. In Boston in 1962 Malt successfully replanted a completely amputated arm of a 12-year-old boy. Komatsu and Tamai reported the first successful replantation of an amputated digit by microvascular technique. There are no strict indications and contraindications for replantation. It's on surgeon to explain to the patient the chances of success of viability, expected function, length of operation, hospitalization and long rehabilitation protocol. Survival and useful function in replantation of upper extremity amputations is questionable. Success depends on microvascular anastomoses, but the final function is related with tendon, nerve, bone and joint repair. PMID:24298734

  2. Automated upper extremity progressive resistive exercise system.

    PubMed

    Roemer, R B; Culler, M A; Swartt, T

    1978-02-01

    This paper describes a semiautomated, motorized skateboard and skate system for use in progressive resistive arm exercises. This experimental system has been evaluated in an occupational therapy clinic for the past two years and found to be valuable in the treatment of impaired upper extremity function. It is superior in function and design to the previously used apparatus and provides the following features: adjustable load (force), adjustable range of motion limits, an automatic method of counting the correct repetitions of the prescribed exercise, the visual feedback to patients regarding their performance. Based on therapists' evaluations, the system's three main advantages are: a decrease in the amount of therapist/attendant time needed for the exercise program, improved performances by the patients, and a better, quantitative measure of the patients' progress. PMID:629182

  3. Upper extremity function and its relation with hand sensation and upper extremity strength in patients with multiple sclerosis.

    PubMed

    Guclu-Gunduz, Arzu; Citaker, Seyit; Nazliel, Bijen; Irkec, Ceyla

    2012-01-01

    The purpose of this study was to investigate the relationships between the upper extremity functions, upper extremity strength and hand sensation in patients with Multiple Sclerosis (MS). Twenty-two patients with MS (mean age: 38.5 8.31 years, median Expanded Disability Status Scale (EDSS): 2) and 10 healthy subjects were included. Upper extremity function was measured with the Nine-hole peg test, upper extremity strength (shoulder flexion-abduction, elbow flexion, pinch and grip) with hand-held dynamometer, hand grip dynamometer and manual pinch meter, threshold of light touch-pressure with Semmes-Weinstein monofilament, duration of vibration with 128-Hz frequency tuning fork, and distance of two-point discrimination with an aesthesiometer. Strength and functional level of the upper extremity, light touch-pressure, two-point discrimination, vibration sensations of the hand were lower in patients with MS compared with healthy controls (p < 0.05). Light touch-pressure sensation of thumb and index fingers, two-point discrimination of index finger and elbow flexion strength were found to be related with upper extremity function in patients with MS (p< 0.05). These results indicate that the hand sensation, upper extremity strength and function were affected in MS patients. Additionally upper extremity functions seem to be related with light touch-pressure and two-point discrimination sensations of the hand and elbow flexion strength. Upper extremity strengthening and sensorial training of the hand may contribute to the upper extremity function in patients with MS. PMID:22672953

  4. Use of Powered Prosthesis for Children with Upper Limb Deficiency at Hyogo Rehabilitation Center

    PubMed Central

    Shibata, Yaeko; Mizobe, Futoshi

    2015-01-01

    Background There has been no research investigating the use of powered prosthetic for children in Japan. Objective To gain better insight into the state of powered prosthesis usage and identify a ratio of rejection among children. Methods Subjects were 37 unilateral below elbow amputees between the ages of 0 and 16 at the time of their first experienced fitting with a powered prosthesis at our Center. The information was collected from medical records and through face-to-face interviews, and we examined rejection rate and the factors affecting the use of powered prosthesis. Results The rate of discontinuation was 21.6% as 8 of the 37 children stopped using powered prosthesis. All of them were fitted their prosthesis after 2 years of age, and they rejected prosthesis between 5 to 19 years. We found that the level of amputation had no influence on the use of a powered prosthesis. Conclusions Children fitted before 2 years of age tend to accept their powered prosthesis than those fitted after 2 years. Multidisciprinary team approach, adequate rehabilitation, detailed follow-up and involvement of parents are quite important for introducing powered prosthesis for children. PMID:26125974

  5. Upper extremity function: What's posture got to do with it?

    PubMed

    Harbourne, Regina; Kamm, Kathi

    2015-01-01

    This perspective paper reviews the linkage between developing postural control and upper extremity function. We suggest updated principles for guiding clinical practice, based on current views from motor learning, motor development, and motor control research. Using three clinical examples, we illustrate principles focusing on the use of variability, the importance of errors in learning movement, task specific exploration and practice, and the critical timing necessary to build skill of the upper extremity in a variety of postures. These principles differ from historic approaches in therapeutic exercise, which treated posture as a separate system and a precursor for extremity skill building. We maintain that current movement science supports the tight interaction of posture and upper extremity function through developmental time and in real time, such that one system cannot be considered separate from the other. Specific suggestions for clinical practice flow from the guiding principles outlined in this paper. PMID:25840492

  6. Motor imagery training improves upper extremity performance in stroke patients

    PubMed Central

    Kim, Seong-Sik; Lee, Byoung-Hee

    2015-01-01

    [Purpose] The purpose of this study was to investigate whether motor imagery training has a positive influence on upper extremity performance in stroke patients. [Subjects and Methods] Twenty-four patients were randomly assigned to one of the following two groups: motor imagery (n = 12) or control (n = 12). Over the course of 4 weeks, the motor imagery group participated in 30 minutes of motor imagery training on each of the 18 tasks (9 hours total) related to their daily living activities. After the 4-week intervention period, the Fugl-Meyer Assessment-Upper Extremity outcomes and Wolf Motor Function Test outcomes were compared. [Results] The post-test score of the motor imagery group on the Fugl-Meyer Assessment-Upper Extremity outcomes was significantly higher than that of the control group. In particular, the shoulder and wrist sub-items demonstrated improvement in the motor imagery group. [Conclusion] Motor imagery training has a positive influence on upper extremity performance by improving functional mobility during stroke rehabilitation. These results suggest that motor imagery training is feasible and beneficial for improving upper extremity function in stroke patients. PMID:26311968

  7. Mucosal topography around implants in edentulous upper jaws. Photogrammetric three-dimensional measurements of the effect of replacement of a removable prosthesis with a fixed prosthesis.

    PubMed

    Jemt, T; Book, K; Lie, A; Börjesson, T

    1994-12-01

    A photogrammetric technique was tested to measure the topography of the mucosa around implants, placed in edentulous upper jaws. Photographs were taken of casts from 6 patients, who all had used a removable overdenture for one year. Another series of photographs was taken on new casts after the use of a fixed prosthesis for a second year. The 6 pairs of photographs were measured and compared in an analytical stereo plotter for surface contour and implant positions. The results from the measurements indicated a trend of general recession of the mucosa after one year with fixed prosthesis, both on the buccal as well as on the palatal side. The mean volume of recession was 222.4 mm3, corresponding to an average of 0.4 mm3/mm2 of mucosa. More recession was generally observed on the palatal side, but obvious variations between the patients were present. In conclusion, the photogrammetric technique was considered to be well suited for analysing tissue contours in various dental situations. PMID:7640336

  8. Predicting Recovery of Voluntary Upper Extremity Movement in Subacute Stroke Patients with Severe Upper Extremity Paresis

    PubMed Central

    Koh, Chia-Lin; Pan, Shin-Liang; Jeng, Jiann-Shing; Chen, Bang-Bin; Wang, Yen-Ho; Hsueh, I-Ping; Hsieh, Ching-Lin

    2015-01-01

    Background and Objective Prediction of voluntary upper extremity (UE) movement recovery is largely unknown in patients with little voluntary UE movement at admission. The present study aimed to investigate (1) the extent and variation of voluntary UE movement recovery, and (2) the best predictive model of the recovery of voluntary UE movement by clinical variables in patients with severe UE paresis. Design Prospective cohort study. Methods 140 (out of 590) stroke patients with severe UE paresis completed all assessments. Voluntary UE movement was assessed using the UE subscale of the Stroke Rehabilitation Assessment of Movement (STREAM-UE). Two outcome measures, STREAM-UE scores at discharge (DCSTREAM-UE) and changes between admission and discharge (?STREAM-UE), were investigated to represent the final states and improvement of the recovery of voluntary UE movement. Stepwise regression analyses were used to investigate 19 clinical variables and to find the best predictive models of the two outcome measures. Results The participants showed wide variation in both DCSTREAM-UE and ?STREAM-UE. 3.6% of the participants almost fully recovered at discharge (DCSTREAM-UE > 15). A large improvement (?STREAM-UE >= 10) occurred in 16.4% of the participants, while 32.9% of the participants did not have any improvement. The four predictors for the DCSTREAM-UE (R2 = 35.0%) were baseline STREAM-UE score, hemorrhagic stroke, baseline National Institutes of Health Stroke Scale (NIHSS) score, and cortical lesion excluding primary motor cortex. The three predictors for the ?STREAM-UE (R2 = 22.0%) were hemorrhagic stroke, baseline NIHSS score, and cortical lesion excluding primary motor cortex. Conclusions Recovery of voluntary UE movement varied widely in patients with severe UE paresis after stroke. The predictive power of clinical variables was poor. Both results indicate the complex nature of voluntary UE movement recovery in patients with severe UE paresis after stroke. PMID:25973919

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

    PubMed

    Abutalib, Raid A; Khoshhal, Khalid I

    2016-01-01

    BACKGROUND This report is about unusual multiple upper extremity concomitant injuries in an adult after a fall from a height. To the best of our knowledge this is the first reported case of concomitant ipsilateral occurrence of multiple common injuries, uncommonly occurring together in a single traumatic episode. CASE REPORT A 36-year-old right-handed man fell through a skylight to the floor about 4 meters below. He presented with multiple concomitant injuries in his right upper extremity: elbow dislocation with radial head fracture associated with distal radius, ulnar styloid, and scaphoid fractures. CONCLUSIONS The probable mechanism of injury along with the surgical treatment of these previously undescribed injuries is discussed to emphasize the need to clinically examine the whole upper extremity in severe injuries. The awareness of such an association for early recognition is paramount for excellent clinical results. PMID:26732673

  10. Trans-femoral thromboaspiration for upper extremity ischemia

    PubMed Central

    Gordhan, Ajeet

    2015-01-01

    Introduction Endovascular trans-femoral access catheter aspiration of thrombus within the proximal subclavian, brachial, radial and ulnar arteries for symptomatic upper extremity ischemic pain has not been previously reported. We describe a case in which a successful clinical outcome was achieved using long length neuro-endovascular aspiration catheters. Presentation of case A 45 year old female presented with diffuse left upper limb pain. Sonography revealed compromised upper extremity blood flow. Thrombus was identified in the proximal left subclavian artery by CT angiography. Surgical retrograde brachial artery access thrombectomy was performed. Occlusion of the left vertebral artery with embolic infarcts of the cerebellar hemispheres was noted post-procedurally. Trans-femoral mechanical aspiration thrombectomy and angioplasty of the subclavian, brachial, ulnar and radial arteries was subsequently performed with successful recanalization. Conclusion Recanalization of vasculature to the upper arm through safer femoral access can be achieved with thrombo-aspiration catheters of sufficient length. PMID:26708945

  11. Black breast cancer survivors experience greater upper extremity disability.

    PubMed

    Dean, Lorraine T; DeMichele, Angela; LeBlanc, Mously; Stephens-Shields, Alisa; Li, Susan Q; Colameco, Chris; Coursey, Morgan; Mao, Jun J

    2015-11-01

    Over one-third of breast cancer survivors experience upper extremity disability. Black women present with factors associated with greater upper extremity disability, including: increased body mass index (BMI), more advanced disease stage at diagnosis, and varying treatment type compared with Whites. No prior research has evaluated the relationship between race and upper extremity disability using validated tools and controlling for these factors. Data were drawn from a survey study among 610 women with stage I-III hormone receptor positive breast cancer. The disabilities of the arm, shoulder and hand (QuickDASH) is an 11-item self-administered questionnaire that has been validated for breast cancer survivors to assess global upper extremity function over the past 7days. Linear regression and mediation analysis estimated the relationships between race, BMI and QuickDASH score, adjusting for demographics and treatment types. Black women (n=98) had 7.3 points higher average QuickDASH scores than White (n=512) women (p<0.001). After adjusting for BMI, age, education, cancer treatment, months since diagnosis, and aromatase inhibitor status, Black women had an average 4-point (95% confidence interval 0.18-8.01) higher QuickDASH score (p=0.04) than White women. Mediation analysis suggested that BMI attenuated the association between race and disability by 40%. Even several years post-treatment, Black breast cancer survivors had greater upper extremity disability, which was partially mediated by higher BMIs. Close monitoring of high BMI Black women may be an important step in reducing disparities in cancer survivorship. More research is needed on the relationship between race, BMI, and upper extremity disability. PMID:26420404

  12. Ultrasonography for nerve compression syndromes of the upper extremity

    PubMed Central

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

    2015-01-01

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

  13. Use of diagnostic modalities for assessing upper extremity vascular pathology.

    PubMed

    Grasu, Beatrice L; Jones, Christopher M; Murphy, Michael S

    2015-02-01

    Vascular pathology of the upper extremity requires consideration of constitutional, anatomic, and functional factors. The medical history and physical examination are essential. The Allen test can be performed alongside a handheld Doppler for arterial mapping. Useful studies include digital-brachial index measurements, digital plethysmography, laser Doppler, and color ultrasounds. Three-phase bone scintigraphy still plays a role in the evaluation of vascularity after of frostbite injury. Angiogram remains the gold standard radiographic instrument to evaluate vascular pathology of the upper extremity, but computed tomography and magnetic resonance scans have an increasing role in diagnosis of vascular pathology. PMID:25455352

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

    PubMed

    Capers, Quinn; Phillips, John

    2011-08-01

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

  15. Vascular injuries in the upper extremity in athletes.

    PubMed

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

    2015-02-01

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

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

    PubMed Central

    Abutalib, Raid A.; Khoshhal, Khalid I.

    2016-01-01

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

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

    PubMed Central

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

    2015-01-01

    Background: Decision of limb salvage or amputation is generally aided with several trauma scoring systems such as the mangled extremity severity score (MESS). However, the reliability of the injury scores in the settling of open fractures due to explosives and missiles is challenging. Mortality and morbidity of the extremity trauma due to firearms are generally associated with time delay in revascularization, injury mechanism, anatomy of the injured site, associated injuries, age and the environmental circumstance. The purpose of the retrospective study was to evaluate the extent of extremity injuries due to ballistic missiles and to detect the reliability of mangled extremity severity score (MESS) in both upper and lower extremities. Materials and Methods: Between 2004 and 2014, 139 Gustillo Anderson Type III open fractures of both the upper and lower extremities were enrolled in the study. Data for patient age, fire arm type, transporting time from the field to the hospital (and the method), injury severity scores, MESS scores, fracture types, amputation levels, bone fixation methods and postoperative infections and complications retrieved from the two level-2 trauma center's data base. Sensitivity, specificity, positive and negative predictive values of the MESS were calculated to detect the ability in deciding amputation in the mangled limb. Results: Amputation was performed in 39 extremities and limb salvage attempted in 100 extremities. The mean followup time was 14.6 months (range 6–32 months). In the amputated group, the mean MESS scores for upper and lower extremity were 8.8 (range 6–11) and 9.24 (range 6–11), respectively. In the limb salvage group, the mean MESS scores for upper and lower extremities were 5.29 (range 4–7) and 5.19 (range 3–8), respectively. Sensitivity of MESS in upper and lower extremities were calculated as 80% and 79.4% and positive predictive values detected as 55.55% and 83.3%, respectively. Specificity of MESS score for upper and lower extremities was 84% and 86.6%; negative predictive values were calculated as 95.45% and 90.2%, respectively. Conclusion: MESS is not predictive in combat related extremity injuries especially if between a score of 6–8. Limb ischemia and presence or absence of shock can be used in initial decision-making for amputation. PMID:26806974

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

    NASA Astrophysics Data System (ADS)

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

    2016-02-01

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

  19. Driving with upper extremity immobilization: a comprehensive review.

    PubMed

    Sandvall, Brinkley K; Friedrich, Jeffrey B

    2015-05-01

    Driving with upper extremity immobilization can be potentially dangerous. The aim of this article is to review current medical literature, state laws, and guidelines on driving with upper extremity immobilization and appraise the available evidence. A literature search was conducted to identify citations related to driving with upper extremity immobilization and included a law literature search. Each state's Department of Motor Vehicle handbook was reviewed. Fourteen studies were reviewed and 5 provided subjective and/or objective assessments of upper limb immobilization. Of 2 studies that evaluated only below-elbow immobilization, 1 found driving in a wrist splint had no perceptible effect on driving ability, and the other supported safe driving under normal conditions. The studies that evaluated both below- and above-elbow immobilization recommended against driving with left arm above-elbow immobilization. Two of them found a trend toward worse driving performance in both below- and above-elbow splints. The following organizations' policies on driving are (1) The American Medical Association and National Highway Traffic Association have a joint recommendation for older drivers recommending referral to a rehabilitation specialist, (2) the U.S. Public Health Service recommends normal motor function and adequate mobility of both upper extremities and a performance examination when impaired, and (3) the U.S. Department of Transportation recommends a performance evaluation to determine fitness of commercial motor vehicle drivers. There are no state statutes or multijurisdictional surveys on the topic. This review finds that driving is hindered in some splints, there are substantial variations in physician practice patterns, there are no formal guidelines for physicians and patients to consider, and there is a paucity of published literature on this topic in the United States. Both physicians and patients would benefit from evidence-based recommendations or practice guidelines. PMID:24909565

  20. Free anterolateral thigh flaps for upper extremity soft tissue reconstruction

    PubMed Central

    Spindler, Nick; Al-Benna, Sammy; Ring, Andrej; Homann, Heinz; Steinsträsser, Lars; Steinau, Hans-Ulrich; Langer, Stefan

    2015-01-01

    Introduction: Limb-threatening wounds of the upper extremity pose a challenge to the micro vascular surgeon. The aim of this study is to analyze the outcome of free anterolateral thigh flaps for upper extremity soft tissue reconstruction. Methods: A retrospective review of patients undergoing this procedure from 2005 to 2012 was performed. Case note analysis was performed to determine demographic and perioperative factors, and complications and outcomes. Results: Thirty-two patients with a mean age of 53 years (9–84 yrs) underwent upper extremity reconstruction with an anterolateral thigh (ALT) flap. There were 24 (75%) males and 8 (25%) females. The etiology of the soft tissue defects was: infection (44.6%); post-tumor ablation (40%); and trauma (15.6%). The defect site was most commonly in the forearm (53.1%), followed by the elbow (12.5 %), arm (12.5%) and hand (21.9%). The mean timing of free flap transfer was 6.8 days after admission to our institution (minimum 1 days, maximum 9 days). Mean operative time of surgery was 4 h 39 min (minimum 3 h 2 min, maximum 6 h 20 min). The mean hospitalization was 24.8 days (minimum 5, maximum 85). The ALT success rate was at 92.3%. Partial flap necrosis was documented in five cases (15.6%). Complete flap loss occurred in two post-traumatic cases who both lost their limbs. Discussion: This flap, in the hands of experienced surgeons, provides reliable coverage of upper extremity defects. PMID:26504734

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

    NASA Astrophysics Data System (ADS)

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

    2016-02-01

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

  2. Is There Any Association between PEEP and Upper Extremity DVT?

    PubMed Central

    Gupta, Ena; Siddiqi, Furqan; Faisal, Muhammad; Jones, Lisa M.; Louis, Mariam; Cury, James D.; Bajwa, Abubakr A.

    2015-01-01

    Background. We hypothesized that positive end-exploratory pressure (PEEP) may promote venous stasis in the upper extremities and predispose to upper extremity deep vein thrombosis (UEDVT). Methods. We performed a retrospective case control study of medical intensive care unit patients who required mechanical ventilation (MV) for >72 hours and underwent duplex ultrasound of their upper veins for suspected DVT between January 2011 and December 2013. Results. UEDVT was found in 32 (28.5%) of 112 patients. Nineteen (67.8%) had a central venous catheter on the same side. The mean SD duration of MV was 13.2 9.5 days. Average PEEP was 7.13 2.97?cm H2O. Average PEEP was ?10?cm H2O in 23 (20.5%) patients. Congestive heart failure (CHF) significantly increased the odds of UEDVT (OR 4.53, 95% CI 1.1318.11; P = 0.03) whereas longer duration of MV (?13 vs. <13 days) significantly reduced it (OR 0.29, 95% CI 0.110.8; P = 0.02). Morbid obesity showed a trend towards significance (OR 3.82, 95% CI 0.9515.4; P = 0.06). Neither PEEP nor any of the other analyzed predictors was associated with UEDVT. Conclusions. There is no association between PEEP and UEDVT. CHF may predispose to UEDVT whereas the risk of UEDVT declines with longer duration of MV. PMID:25922762

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

    PubMed

    Holt, Taylor; Oliver, Gretchen D

    2016-05-01

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

  4. Satisfaction with upper extremity surgery in individuals with tetraplegia

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2015-12-01

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

  6. Pharmacologic Management of Upper Extremity Chronic Nerve Pain.

    PubMed

    Carroll, Ian

    2016-02-01

    The treatment of pain is a complex process that requires a team approach. This article provides an overview of the pharmaceutical treatments available. It gives providers treating upper extremity disorders more tools to treat their patients with chronic pain. Another goal is to improve hand providers' understanding of the medications their pain colleagues prescribe in shared patients. Pharmaceuticals are an important component in the treatment of chronic pain and opioids are often not a good solution. Knowing what other medications are available can improve the care for these challenging patients. PMID:26611389

  7. Surgical management of combat-related upper extremity injuries.

    PubMed

    Mathieu, L; Bertani, A; Gaillard, C; Chaudier, P; Ollat, D; Bauer, B; Rigal, S

    2014-06-01

    This review presents the current surgical management of combat-related upper extremity injuries during the acute phase. The strategy consists of saving the life, saving the limb and retaining function. Surgical tactics are based on damage control orthopaedics techniques of haemorrhage control, wound debridement, and temporary bone stabilization prior to evacuation out of the combat zone. Features of the definitive management of local casualties in battlefield medical facilities are also discussed. In this situation, reconstructive procedures have to take into account the limited resources and operational constraints. PMID:24798097

  8. Isolated Upper Extremity Posttransplant Lymphoproliferative Disorder in a Child

    PubMed Central

    Halula, Sarah E.; Leino, Daniel G.; Patel, Manish N.; Racadio, John M.; Lungren, Matthew P.

    2015-01-01

    Posttransplant lymphoproliferative disorder (PTLD) is a well-described complication of solid organ and bone marrow transplants. The most common presentation is intra-abdominal lymphadenopathy or single or multiple intraparenchymal masses involving the liver, spleen, or kidneys. Here we describe the imaging and pathology findings of an unusual case of PTLD appearing as an intramuscular forearm lesion in a pediatric male. The manifestation of PTLD as an isolated upper extremity mass in a pediatric patient has to our knowledge not been described. PMID:26167324

  9. Approach to Complex Upper Extremity Injury: An Algorithm

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2015-02-01

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

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

    PubMed

    Peivandi, Mohammad Taghi; Nazemian, Zohreh

    2011-03-01

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

  12. Radical reduction of upper extremity lymphedema with preservation of perforators.

    PubMed

    Salgado, Christopher J; Sassu, Paolo; Gharb, Bahar Bassiri; Spanio di Spilimbergo, Stefano; Mardini, Samir; Chen, Hung-Chi

    2009-09-01

    Excisional procedures have been successfully utilized by different authors in multistage treatment of upper extremity lymphedema. We have used microsurgical principles of perforator flap surgery in order to develop a one-stage procedure that enables a radical reduction of the lymphedematous tissue with preservation of the vascular supply to the overlying skin.Between March 2000 and February 2007, 11 patients affected by late stage II lymphedema underwent radical reduction of the affected tissues with preservation of perforators. Perforator vessels from the radial and posterior interosseous arteries were identified and through medial and lateral forearm incisions, skin flaps were raised off the underlying lymphedematous tissue and the affected tissue was removed off the deep fascia. At a mean follow-up of 17.8 months the average percentage reductions above and below the elbow, at the wrist, and the hand were 15.1%, 20.7%, 0.5%, and 3.6%, respectively. Statistical analysis showed significant circumference reduction above and below the elbow (P = 0.048 and 0.022, respectively) but not at the wrist and hand. There were no cases of wound breakdown, skin necrosis, or cellulitis in the postoperative period. Four patients complained of mild numbness confined to the vicinity of the surgical incisions.Microvascular principles applied to the radical excision of the subcutaneous tissue seems to offer a new promising one-stage surgical procedure in patients affected by upper extremity lymphedema that has failed conservative therapy. PMID:19692901

  13. Extreme Cranial Ontogeny in the Upper Cretaceous Dinosaur Pachycephalosaurus

    PubMed Central

    Horner, John R.; Goodwin, Mark B.

    2009-01-01

    Background Extended neoteny and late stage allometric growth increase morphological disparity between growth stages in at least some dinosaurs. Coupled with relatively low dinosaur density in the Upper Cretaceous of North America, ontogenetic transformational representatives are often difficult to distinguish. For example, many hadrosaurids previously reported to represent relatively small lambeosaurine species were demonstrated to be juveniles of the larger taxa. Marginocephalians (pachycephalosaurids + ceratopsids) undergo comparable and extreme cranial morphological change during ontogeny. Methodology/Principal Findings Cranial histology, morphology and computer tomography reveal patterns of internal skull development that show the purported diagnostic characters for the pachycephalosaurids Dracorex hogwartsia and Stygimoloch spinifer are ontogenetically derived features. Coronal histological sections of the frontoparietal dome of an adult Pachycephalosaurus wyomingensis reveal a dense structure composed of metaplastic bone with a variety of extremely fibrous and acellular tissue. Coronal histological sections and computer tomography of a skull and frontoparietal dome of Stygimoloch spinifer reveal an open intrafrontal suture indicative of a subadult stage of development. These dinosaurs employed metaplasia to rapidly grow and change the size and shape of their horns, cranial ornaments and frontoparietal domes, resulting in extreme cranial alterations during late stages of growth. We propose that Dracorex hogwartsia, Stygimoloch spinifer and Pachycephalosaurus wyomingensis are the same taxon and represent an ontogenetic series united by shared morphology and increasing skull length. Conclusions/Significance Dracorex hogwartsia (juvenile) and Stygimoloch spinifer (subadult) are reinterpreted as younger growth stages of Pachycephalosaurus wyomingensis (adult). This synonymy reduces the number of pachycephalosaurid taxa from the Upper Cretaceous of North America 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. PMID:19859556

  14. Practical methods for controlling powered upper-extremity prostheses.

    PubMed

    Williams, T W

    1990-01-01

    Myoelectric pickups (electrodes and processors for detecting the signal that is recorded as an electromyogram) are the most important human-machine interface for controlling powered upper-extremity prostheses. This article presents a simple explanation of myoelectric signal acquisition and then discusses how these signals are used to control the small motors in electric hands, elbows, wrist rotators, and other similar equipment. The less-familiar switch-based and proportional position-sensing controls are also explained. A complete listing of the major suppliers and products available will aid in understanding a discussion of the criteria for using external power instead of, or along with, body power to control and activate prosthetic function. PMID:10149040

  15. Upper extremity impedance plethysmography in patients with venous access devices.

    PubMed

    Horne, M K; Mayo, D J; Alexander, H R; Steinhaus, E P; Chang, R C; Whitman, E; Gralnick, H R

    1994-10-01

    Central venous access devices (VADs) are often associated with thrombotic obstruction of the axillary-subclavian venous system. To explore the accuracy of impedance plethysmography (IPG) in identifying this complication we performed IPG on 35 adult cancer patients before their VADs were placed and approximately 6 weeks later. At the time of the second IPG the patients also underwent contrast venography of the axillary-subclavian system. The venograms revealed partial venous obstruction in 12 patients (34%) and complete obstruction in two (5.7%). Although the IPG results from venographically normal and abnormal patients overlapped extensively, mean measurements of venous outflow were significantly lower in the patient population with abnormal venograms (P = 0.052 for Vo; P = 0.0036 for Vo/Vc). In our hands, therefore, upper extremity IPG cannot be used to make clinical decisions about individual patients with VADs, but it can distinguish venographically normal and abnormal populations. PMID:7878628

  16. Upper Extremity Injuries in NASCAR Drivers and Pit Crew

    PubMed Central

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

    2016-01-01

    Background: Understanding the position-specific musculoskeletal forces placed on the body of athletes facilitates treatment, prevention, and return-to-play decisions. While position-specific injuries are well documented in most major sports, little is known about the epidemiology of position-specific injuries in National Association for Stock Car Automobile Racing (NASCAR) drivers and pit crew. Purpose: To investigate position-specific upper extremity injuries in NASCAR drivers and pit crew members. Study Design: Descriptive epidemiological study. Methods: A retrospective chart review was performed to assess position-specific injuries in NASCAR drivers and pit crew members. Included in the study were patients seen by a single institution between July 2003 and October 2014 with upper extremity injuries from race-related NASCAR events or practices. Charts were reviewed to identify the diagnosis, mechanism of injury, and position of each patient. Results: A total of 226 NASCAR team members were treated between July 2003 and October 2014. Of these, 118 injuries (52%) occurred during NASCAR racing events or practices. The majority of these injuries occurred in NASCAR changers (42%), followed by injuries in drivers (16%), carriers (14%), jack men (11%), fuel men (9%), and utility men (8%). The majority of the pit crew positions are at risk for epicondylitis, while drivers are most likely to experience neuropathies, such as hand-arm vibration syndrome. The changer sustains the most hand-related injuries (42%) on the pit crew team, while carriers commonly sustain injuries to their digits (29%). Conclusion: Orthopaedic injuries in NASCAR vary between positions. Injuries in NASCAR drivers and pit crew members are a consequence of the distinctive forces associated with each position throughout the course of the racing season. Understanding these forces and position-associated injuries is important for preventive measures and facilitates diagnosis and return-to-play decisions so that each team can function at its maximal efficiency. PMID:26962541

  17. Control of a pneumatic orthosis for upper extremity stroke rehabilitation.

    PubMed

    Wolbrecht, Eric T; Leavitt, John; Reinkensmeyer, David J; Bobrow, James E

    2006-01-01

    A key challenge in rehabilitation robotics is the development of a lightweight, large force, high degrees-of-freedom device that can assist in functional rehabilitation of the arm. Pneumatic actuators can potentially help meet this challenge because of their high power-to-weight ratio. They are currently not widely used for rehabilitation robotics because they are difficult to control. This paper describes the control development of a pneumatically actuated, upper extremity orthosis for rehabilitation after stroke. To provide the sensing needed for good pneumatic control, position and velocity of the robot are estimated by a unique implementation of a Kalman filter using MEMS accelerometers. To compensate for the nonlinear behavior of the pneumatic servovalves, force control is achieved using a new method for air flow mapping using experimentally measured data in a least-squares regression. To help patients move with an inherently compliant robot, a high level controller that assists only as needed in reaching exercises is developed. This high level controller differs from traditional trajectory-based, position controllers, allowing free voluntary movements toward a target while resisting movements away from the target. When the target cannot be reached voluntarily, the controller slowly builds up force, pushing the arm toward the target. As each target position is reached, the controller builds an internal model of the subject's capability, learning the forces necessary to complete movements. Preliminary testing performed on a non-disabled subject demonstrated the ability of the orthosis to complete reaching movements with graded assistance and to adapt to the effort level of the subject. Thus, the orthosis is a promising tool for upper extremity rehabilitation after stroke. PMID:17946132

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

    PubMed Central

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

    2014-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2015-03-01

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

  20. Focal Dystonias of the Hand and Upper Extremity

    PubMed Central

    Torres-Russotto, Diego; Perlmutter, Joel S.

    2009-01-01

    Hand dystonia can cause substantial functional disability and is frequently misdiagnosed. In general, dystonia is a disabling disorder of motor control characterized by excessive muscle contractions that can produce involuntary movements and abnormal postures. Prevalence of dystonia can be as high as 1 in 2500 people. Dystonias can be classified based on etiology, age of onset, anatomical part affected, and their tempo. Etiologically, they are classified as primary when the dystonia is the main sign and the cause is genetic or unknown and secondary when there are other disease manifestations and the cause may be identifiable. Dystonias that start before 27 years of age are called childhood-onset dystonia; they usually start in the lower limbs, trunk, or upper extremities and frequently spread to the rest of the body. Adult-onset dystonias usually begin in the upper half of the body, and the risk of progression to other body parts depends on the anatomic site of onset.1 Anatomically, dystonias can be focal (1 body part), segmental (2 or more contiguous body parts), multifocal (2 noncontiguous areas), hemidystonia, or generalized. Based on their tempo, dystonias can be constant, intermittent, or situational, the latter including task-specific dystonias. The rest of the review focuses on the clinical manifestations, differential diagnosis, pathophysiology, and treatment of hand dystonia. PMID:18984354

  1. Complete 3D kinematics of upper extremity functional tasks.

    PubMed

    van Andel, Carolien J; Wolterbeek, Nienke; Doorenbosch, Caroline A M; Veeger, DirkJan H E J; Harlaar, Jaap

    2008-01-01

    Upper extremity (UX) movement analysis by means of 3D kinematics has the potential to become an important clinical evaluation method. However, no standardized protocol for clinical application has yet been developed, that includes the whole upper limb. Standardization problems include the lack of a single representative function, the wide range of motion of joints and the complexity of the anatomical structures. A useful protocol would focus on the functional status of the arm and particularly the orientation of the hand. The aim of this work was to develop a standardized measurement method for unconstrained movement analysis of the UX that includes hand orientation, for a set of functional tasks for the UX and obtain normative values. Ten healthy subjects performed four representative activities of daily living (ADL). In addition, six standard active range of motion (ROM) tasks were executed. Joint angles of the wrist, elbow, shoulder and scapula were analyzed throughout each ADL task and minimum/maximum angles were determined from the ROM tasks. Characteristic trajectories were found for the ADL tasks, standard deviations were generally small and ROM results were consistent with the literature. The results of this study could form the normative basis for the development of a 'UX analysis report' equivalent to the 'gait analysis report' and would allow for future comparisons with pediatric and/or pathologic movement patterns. PMID:17459709

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

    SciTech Connect

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

    1987-06-01

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

  3. Recognizing complex upper extremity activities using body worn sensors.

    PubMed

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

    2015-01-01

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

  4. Recognizing Complex Upper Extremity Activities Using Body Worn Sensors

    PubMed Central

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

    2015-01-01

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

  5. Effect of upper extremity exercise in people with COPD

    PubMed Central

    Kathiresan, Ganesan; Jeyaraman, Senthil Kumar; Jaganathan, Jayachandran

    2010-01-01

    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 upper extremity 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. PMID:22263051

  6. Vascularised composite allotransplants: Transplant of upper extremities and face

    PubMed Central

    Iyer, Subramania

    2015-01-01

    Transplantation of solid organs and bone marrow has become a highly acceptable and often the only available clinical solution in many situations. It has been practiced across the globe for quite a long time since the first kidney transplant in 1954. Transplantation of tissues other than these, which was termed composite tissue allotransplantation and currently as vascularised composite allotransplantation (VCA) is gaining acceptance as a solution for complex reconstructive problems. This involves the transfer of multiple types of tissue such as bone, muscle, nerve, skin and blood vessels. The advantage of these over the conventional reconstructive methods is its ability to give aesthetically and functionally superior equal composite substitute to the missing or deformed part. The composite tissues transplanted commonly include the upper extremities, face and abdominal wall. Among these, hand transplants were the first to be done and have been carried out more than any other VCA. This article reviews the current scenario of VCA especially of the hand and face, in the light of experience of the two bilateral hand transplants done recently in India. PMID:26424972

  7. Neuropathic Pain in Patients with Upper-Extremity Nerve Injury

    PubMed Central

    Katz, Joel

    2010-01-01

    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. PMID:21629596

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

    PubMed

    Williams, Camille K; Carnahan, Heather

    2014-01-01

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

  9. Vascularised composite allotransplants: Transplant of upper extremities and face.

    PubMed

    Iyer, Subramania

    2015-01-01

    Transplantation of solid organs and bone marrow has become a highly acceptable and often the only available clinical solution in many situations. It has been practiced across the globe for quite a long time since the first kidney transplant in 1954. Transplantation of tissues other than these, which was termed composite tissue allotransplantation and currently as vascularised composite allotransplantation (VCA) is gaining acceptance as a solution for complex reconstructive problems. This involves the transfer of multiple types of tissue such as bone, muscle, nerve, skin and blood vessels. The advantage of these over the conventional reconstructive methods is its ability to give aesthetically and functionally superior equal composite substitute to the missing or deformed part. The composite tissues transplanted commonly include the upper extremities, face and abdominal wall. Among these, hand transplants were the first to be done and have been carried out more than any other VCA. This article reviews the current scenario of VCA especially of the hand and face, in the light of experience of the two bilateral hand transplants done recently in India. PMID:26424972

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

    ClinicalTrials.gov

    2016-02-22

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

  11. Reinforcement of an existing implant-retained complete dental prosthesis for use in compensatory techniques by a patient missing an upper limb.

    PubMed

    Baker, Philip S; Nahlah, Esam Abou

    2012-05-01

    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

  12. Comparison of the Effects of Walking with and without Nordic Pole on Upper Extremity and Lower Extremity Muscle Activation

    PubMed Central

    Shim, Je-myung; Kwon, Hae-yeon; Kim, Ha-roo; Kim, Bo-in; Jung, Ju-hyeon

    2014-01-01

    [Purpose] The aim of this study was to assess the effect of Nordic pole walking on the electromyographic activities of upper extremity and lower extremity muscles. [Subjects and Methods] The subjects were randomly divided into two groups as follows: without Nordic pole walking group (n=13) and with Nordic pole walking group (n=13). The EMG data were collected by measurement while the subjects walking on a treadmill for 30 minutes by measuring from one heel strike to the next. [Results] Both the average values and maximum values of the muscle activity of the upper extremity increased in both the group that used Nordic poles and the group that did not use Nordic poles, and the values showed statistically significant differences. There was an increase in the average value for muscle activity of the latissimus dorsi, but the difference was not statistically significant, although there was a statistically significant increase in its maximum value. The average and maximum values for muscle activity of the lower extremity did not show large differences in either group, and the values did not show any statistically significant differences. [Conclusion] The use of Nordic poles by increased muscle activity of the upper extremity compared with regular walking but did not affect the lower extremity. PMID:24409018

  13. Comparison of the Effects of Walking with and without Nordic Pole on Upper Extremity and Lower Extremity Muscle Activation.

    PubMed

    Shim, Je-Myung; Kwon, Hae-Yeon; Kim, Ha-Roo; Kim, Bo-In; Jung, Ju-Hyeon

    2013-12-01

    [Purpose] The aim of this study was to assess the effect of Nordic pole walking on the electromyographic activities of upper extremity and lower extremity muscles. [Subjects and Methods] The subjects were randomly divided into two groups as follows: without Nordic pole walking group (n=13) and with Nordic pole walking group (n=13). The EMG data were collected by measurement while the subjects walking on a treadmill for 30 minutes by measuring from one heel strike to the next. [Results] Both the average values and maximum values of the muscle activity of the upper extremity increased in both the group that used Nordic poles and the group that did not use Nordic poles, and the values showed statistically significant differences. There was an increase in the average value for muscle activity of the latissimus dorsi, but the difference was not statistically significant, although there was a statistically significant increase in its maximum value. The average and maximum values for muscle activity of the lower extremity did not show large differences in either group, and the values did not show any statistically significant differences. [Conclusion] The use of Nordic poles by increased muscle activity of the upper extremity compared with regular walking but did not affect the lower extremity. PMID:24409018

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

    PubMed

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

    2015-08-01

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

  15. Recapitulating flesh with silicon and steel: advancements in upper extremity robotic prosthetics.

    PubMed

    Lee, Brian; Attenello, Frank J; Liu, Charles Y; McLoughlin, Michael P; Apuzzo, Michael L J

    2014-01-01

    With the loss of function of an upper extremity because of stroke or spinal cord injury or a physical loss from amputation, an individual's life is forever changed, and activities that were once routine become a magnitude more difficult. Much research and effort have been put into developing advanced robotic prostheses to restore upper extremity function. For patients with upper extremity amputations, previously crude prostheses have evolved to become exceptionally functional. Because the upper extremities can perform a wide variety of activities, several types of upper extremity prostheses are available ranging from passive cosmetic limbs to externally powered robotic limbs. In addition, new developments in brain-machine interface are poised to revolutionize how patients can control these advanced prostheses using their thoughts alone. For patients with spinal cord injury or stroke, functional electrical stimulation promises to provide the most sophisticated prosthetic limbs possible by reanimating paralyzed arms of these patients. Advances in technology and robotics continue to help patients recover vital function. This article examines the latest neurorestorative technologies for patients who have either undergone amputation or lost the use of their upper extremities secondary to stroke or spinal cord injury. PMID:24631910

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

    PubMed Central

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

    2015-01-01

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

  17. The stump and the prosthesis.

    PubMed Central

    Day, H. J.

    1980-01-01

    In performing amputations the surgeon must bear in mind the biomechanical and other constraints of the prosthesis likely to be fitted and, so far as possible, should fashion the stump accordingly. The various types of prosthesis and their features are discussed in relation to amputations of the lower and upper limbs at all levels. PMID:7377694

  18. A Comparison of Upper-Extremity Reaction Forces between the Yurchenko Vault and Floor Exercise.

    PubMed

    Seeley, Matthew K; Bressel, Eadric

    2005-06-01

    The purpose of this study was to examine reaction forces transmitted to the upper extremities of high-level gymnasts during the round-off phase of the Yurchenko vault. A secondary purpose of this study was to compare reaction forces during the Yurchenko vault to reaction forces observed in a tumbling pass during the floor exercise. Ten high-level, female gymnasts volunteered to participate. Conditions of the independent variable were the Yurchenko vault and floor exercise; dependent variables were peak vertical and peak anterior-posterior reaction forces. Each participant performed three trials of both conditions with the trail hand contacting a force platform. Vertical and anterior-posterior reaction forces, normalized to body weight, were greater (p < 0.05) during the round-off phase of the Yurchenko vault (2.38) than during the floor exercise round-off (2.15). Vertical reaction forces during the round-off phase of the Yurchenko vault and floor exercise round-off are similar to reaction forces transmitted to upper extremities during other gymnastic skills and ground reaction forces transmitted to lower extremities while running and walking at various speeds. Results of this study reveal a need for further research considering methods aimed at reducing reaction forces transmitted to the upper extremities during the Yurchenko vault and floor exercise. Key PointsDespite high difficulty and increased risk, a dearth of information exists concerning reaction forces transmitted to upper-extremities of high-level gymnasts performing the Yurchenko vault.Reaction forces experienced by high-level gymnasts performing the Yurchenko vault are relatively high; aforementioned forces are comparable to forces transmitted to lower-extremities during various activities and may be responsible for upper-extremity injury.Reaction forces observed during this study will serve as a baseline in the evaluation of methods purporting to reduce forces transmitted to upper-extremities during the Yurchenko vault. PMID:24431965

  19. A Comparison of Upper-Extremity Reaction Forces between the Yurchenko Vault and Floor Exercise

    PubMed Central

    Seeley, Matthew K.; Bressel, Eadric

    2005-01-01

    The purpose of this study was to examine reaction forces transmitted to the upper extremities of high-level gymnasts during the round-off phase of the Yurchenko vault. A secondary purpose of this study was to compare reaction forces during the Yurchenko vault to reaction forces observed in a tumbling pass during the floor exercise. Ten high-level, female gymnasts volunteered to participate. Conditions of the independent variable were the Yurchenko vault and floor exercise; dependent variables were peak vertical and peak anterior-posterior reaction forces. Each participant performed three trials of both conditions with the trail hand contacting a force platform. Vertical and anterior-posterior reaction forces, normalized to body weight, were greater (p < 0.05) during the round-off phase of the Yurchenko vault (2.38) than during the floor exercise round-off (2.15). Vertical reaction forces during the round-off phase of the Yurchenko vault and floor exercise round-off are similar to reaction forces transmitted to upper extremities during other gymnastic skills and ground reaction forces transmitted to lower extremities while running and walking at various speeds. Results of this study reveal a need for further research considering methods aimed at reducing reaction forces transmitted to the upper extremities during the Yurchenko vault and floor exercise. Key PointsDespite high difficulty and increased risk, a dearth of information exists concerning reaction forces transmitted to upper-extremities of high-level gymnasts performing the Yurchenko vault.Reaction forces experienced by high-level gymnasts performing the Yurchenko vault are relatively high; aforementioned forces are comparable to forces transmitted to lower-extremities during various activities and may be responsible for upper-extremity injury.Reaction forces observed during this study will serve as a baseline in the evaluation of methods purporting to reduce forces transmitted to upper-extremities during the Yurchenko vault. PMID:24431965

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

    PubMed

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

    2007-10-01

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

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

    PubMed Central

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

    2015-01-01

    Improvement in prosthetic training using intermanual transfer (the transfer of motor skills from the trained, unaffected hand to the untrained, affected hand) has been shown in previous studies. The aim of this study is to determine the influence of the inter-training interval on the magnitude of the intermanual transfer effects. This was done using a mechanistic, randomized, single-blinded pretest-posttest design. Sixty-four able-bodied, right-handed participants were randomly assigned to the Short and Long Interval Training Groups and the Short and Long Interval Control Groups. The Short and Long Interval Training Groups used a prosthesis simulator in their training program. The Short and Long Interval Control Groups executed a sham training program, that is, a dummy training program in which the same muscles were trained as with the prosthesis simulator. The Short Interval Training Group and the Short Interval Control Groups trained on consecutive days, while the Long Interval Training Group and Long Interval Control Group trained twice a week. To determine the improvement in skills, a test was administered before, immediately after, and at two points in time after the training. Training was performed with the unaffected arm; tests were performed with the affected arm. The outcome measurements were: the movement time (the time from the beginning of the movement until completion of the task); the duration of maximum hand opening, (the opening of the prosthetic hand while grasping an object); and the grip-force control (the error from the required grip-force during a tracking task). Intermanual transfer was found in movement times, but not in hand opening or grip-force control. The length of the inter-training interval did not affect the magnitude of intermanual transfer effects. No difference in the intermanual transfer effect in upper-limb prosthesis training was found for training on a daily basis as compared to training twice a week. Trial Registration Nederlands Trial Register NTR3888 PMID:26075396

  2. Grading and Quantification of Upper Extremity Function in Children with Spasticity.

    PubMed

    Wallen, Margaret; Stewart, Kirsty

    2016-02-01

    The World Health Organization's International Classification of Functioning, Disability and Health (ICF) provides an ideal framework within which to conceptualize grading and quantification of upper extremity function for children with spasticity. In this article the authors provide an overview of assessments and classification tools used to (1) understand upper extremity function associated with spasticity and the factors that contribute to dysfunction, (2) guide the selection of appropriate interventions, (3) identify specific muscles to target using surgical interventions and botulinum toxin-A injections, and (4) measure the outcomes of upper extremity interventions. Assessments of upper extremity function are briefly described and categorized as to whether they (1) measure children's best ability or actual performance in daily life, (2) are clinician administered or are a child/proxy report, (3) assist in planning intervention and/or measuring outcomes, and (4) evaluate unimanual or bimanual ability. In addition, measures of spasticity and hypertonicity, and classifications of static and dynamic upper extremity postures are summarized. PMID:26869858

  3. Prevalence of upper extremity symptoms and possible risk factors in workers handling paper currency.

    PubMed

    Holness, D L; Beaton, D; House, R A

    1998-05-01

    The prevalence of upper extremity symptoms in the workforce is high, particularly in industries characterized by forceful, repetitive or awkward movements. A study was undertaken to assess the prevalence of upper extremity symptoms in bank workers in a paper currency processing operation and to examine the role of possible risk factors for these complaints. Thirty-nine workers of a total workforce of 47 were assessed with a questionnaire and physical examination. The questionnaire collected information about demographics, health status, symptom reporting, psychosocial work stressors and other work exposure characteristics. Overall, 59% of the workers reported having significant work-related upper extremity musculoskeletal symptoms in the preceding year, including 49% with neck and shoulder symptoms and 49% with arm and wrist symptoms. In this study the key predictive factor for upper extremity musculoskeletal symptoms was psychological job demands. The workers had similar ergonomic stressors (with little gradient of exposure) and therefore our results do not contradict the importance of ergonomic factors in the development of upper extremity symptoms. However, the results do suggest that within a group exposed to similar ergonomic stressors, psychological job demands may be an important factor associated with musculoskeletal symptoms. PMID:9800421

  4. A Study of Upper Extremity Training for Patients with Stroke Using a Virtual Environment System

    PubMed Central

    Tanaka, Toshiaki; Kudo, Akira; Sugihara, Syunichi; Izumi, Takashi; Maeda, Yusuke; Kato, Norio; Miyasaka, Tomoya; Holden, Maureen K.

    2013-01-01

    [Purpose] A virtual environment (VE) system was designed to facilitate the retraining of motor control by feedback of movement trajectory to patients with neurological impairments, such as stroke victims or those with an acquired brain injury. In this study, we quantitatively assessed motion trajectory of the upper extremity during VE in order to further understand the effect of paralyzed upper extremity movement in VE for each patient as well as the functional clinical evaluations. [Subjects and Methods] Six patients with stroke were participated in this study. The VE system consisted of a computer, an electromagnetic motion tracking device, which monitored and displayed patient movement on the computer, and the VE software, which provided the tools for creating training scenes. This system was used to facilitate motor relearning of the upper extremity for six patients with stroke. [Results] The results showed there were improvements in variability and accuracy of the arm movement in motion trajectory. In addition, the scores of clinical evaluations improved, and VE did not hinder motor relearning of the upper extremity, which is necessary for activities of daily living. [Conclusion] This VE system might be effective at facilitating motor relearning of the upper extremity for stroke patients. PMID:24259805

  5. Robot-Assisted Reach Training for Improving Upper Extremity Function of Chronic Stroke.

    PubMed

    Cho, Ki Hun; Song, Won-Kyung

    2015-01-01

    Stroke, as a major risk factor for chronic impairment of upper limb function, can severely restrict the activities of daily living. Recently, robotic devices have been used to enhance the functional upper extremity movement of stroke patients. The purpose of the current study was to assess whether a robot-assisted reach training program using a whole arm manipulator (WAM) could improve upper extremity kinematic performance and functional movement for chronic stroke patients. Using a single-group design, this study followed 10 people with chronic stroke (6 men, 61.5 years; Mini-Mental State Examination score: 27.0; onset duration: 8.9 years). WAM with seven degrees of freedom for the shoulder, elbow, and wrist joints was used during robot-assisted reach exercises. Subjects participated in the training program for 40 minutes per day, 2 times a week, for 4 weeks. The main outcome measures were upper extremity kinematic performance (movement velocity) for three directions and functional movement (Action Research Arm Test). Upper extremity kinematic performance and functional movement measures were performed three times: at baseline, during intervention (at 2 weeks), and post intervention. Upper extremity kinematic performance and functional movement showed improvement after two weeks (P < 0.05) and four weeks (P < 0.05) of training compared to baseline. The findings of the current study demonstrated the positive effects of short-term robot-assisted reach training on upper extremity kinematic performance as well as functional movement in individuals with chronic stroke. In addition, the findings of the current study may provide valuable information for subsequent randomized controlled trials. PMID:26460793

  6. Climatology of extreme rainfall and flooding from orographic thunderstorm systems in the upper Arkansas River basin

    NASA Astrophysics Data System (ADS)

    Javier, Julie Rose N.; Smith, James A.; England, John; Baeck, Mary Lynn; Steiner, Matthias; Ntelekos, Alexandros A.

    2007-10-01

    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 perspective, in which distributional aspects of rainfall at fixed locations are examined, and from a Lagrangian perspective, in which distributional aspects of rainfall are based on storm-tracking algorithms. Of particular interest is the spatial heterogeneity of extreme rainfall in the complex terrain of the upper Arkansas River basin. Lagrangian analyses are used to characterize the spatially varying distribution of storm initiation, storm motion, and storm structure. Climatological analyses indicate that convective rainfall in the Arkansas River basin above Canon City (drainage area of 8070 km2) does not contribute to the extreme flood response of the Arkansas River at Pueblo (drainage area of 12,140 km2). There is pronounced diurnal variation in warm season rainfall in the Arkansas River basin, and this feature of extreme rainfall is a key element of flood response in the upper Arkansas River basin. Climatological analyses of extreme rainfall in the upper Arkansas River basin are examined relative to the spatial and temporal properties of rainfall for extreme flood events that have occurred in the basin, including major flood episodes in June 1921 and June 1965.

  7. Upper extremity muscle activation during drinking from a glass in subjects with chronic stroke

    PubMed Central

    Lee, Jung Ah; Hwang, Pil Woo; Kim, Eun Joo

    2015-01-01

    [Purpose] The purpose of this study was to compare the muscle activities of upper extremities during a drinking task between the stroke-affected and less-affected sides. [Subjects] Eight stroke patients (8 men; age 45.3?years; stroke duration 21.9 months) participated in this study. [Methods] Electromyography (EMG) was used to measure nine muscle activities of the upper extremity. The drinking task was divided into 5 phases. [Results] Analysis of the EMG data showed that the percentage of maximum voluntary isometric contraction (%MVIC) across all phases of drinking differed between the affected and less-affected sides. Participants used relatively higher levels of %MVIC in the anterior deltoid, flexor muscles, brachioradialis, and infraspinatus on the stoke-affected side. [Conclusion] The difference in muscle activation across all phases of the drinking movement allowed us to determine how upper extremity muscle activation may influence drinking performance on the stroke-affected and less-affected sides. PMID:25931712

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

    PubMed Central

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

    2015-01-01

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

  9. Understanding the importance of natural neuromotor strategy in upper extremity neuroprosthetic control.

    PubMed

    Nathan, Dominic E; Prost, Robert W; Guastello, Stephen J; Jeutter, Dean C

    2014-01-01

    A key challenge in upper extremity neuroprosthetics is variable levels of skill and inconsistent functional recovery. We examine the feasibility and benefits of using natural neuromotor strategies through the design and development of a proof-of-concept model for a feed-forward upper extremity neuroprosthetic controller. Developed using Artificial Neural Networks, the model is able to extract and classify neural correlates of movement intention from multiple brain regions that correspond to functional movements. This is unique compared to contemporary controllers that record from limited physiological sources or require learning of new strategies. Functional MRI (fMRI) data from healthy subjects (N = 13) were used to develop the model, and a separate group (N = 4) of subjects were used for validation. Results indicate that the model is able to accurately (81%) predict hand movement strictly from the neural correlates of movement intention. Information from this study is applicable to the development of upper extremity technology aided interventions. PMID:24589839

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

    PubMed Central

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

    2015-01-01

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

  11. Theoretical contribution of the upper extremities to reducing trunk extension following a laboratory-induced slip.

    PubMed

    Troy, Karen L; Donovan, Stephanie J; Grabiner, Mark D

    2009-06-19

    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 upper extremities 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 upper extremities. The model was used to estimate the possible contribution of the upper extremities to reducing trunk extension velocity. The model showed that upper extremity motion can significantly reduce trunk extension velocity. Although the upper extremities 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 upper extremity motion as an outcome whether through conventional or innovative strategies. PMID:19356766

  12. Vascularized fibular graft for management of severe osteomyelitis of the upper extremity.

    PubMed

    Mattar Jnior, J; Azze, R J; Ferreira, M C; Starck, R; Canedo, A C

    1994-01-01

    The authors analyzed 14 patients with severe osteomyelitis of the upper extremity between 1985 and 1992, managed with the vascularized fibular graft. Eleven radii, two humeri and one ulna were reconstructed. Bone loss after resection ranged from 6 to 12 cm (mean 8.14 cm). Follow-up ranged from 8 months to 7 years and 10 months (mean 3 years and 3 months). The therapeutic applications of the vascularized fibular graft in severe bone infections of the upper extremity were discussed and the good results of this surgical procedure established it as a good option for treatment. Morbidity at the donor site was minimal. PMID:8133765

  13. Specialized connective tissue: bone, the structural framework of the upper extremity

    PubMed Central

    Weatherholt, Alyssa M.; Fuchs, Robyn K.; Warden, Stuart J.

    2011-01-01

    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 upper extremity bone health. It concludes by discussing common conditions influencing upper extremity bone health. PMID:22047807

  14. Postcontraction hyperemia after electrical stimulation: potential utility in rehabilitation of patients with upper extremity paralysis.

    PubMed

    Shibata, Nobusuke; Matsunaga, Toshiki; Kudo, Daisuke; Sasaki, Kana; Mizutani, Takashi; Sato, Mineyoshi; Chida, Satoaki; Hatakeyama, Kazutoshi; Watanabe, Motoyuki; Shimada, Yoichi

    2016-01-01

    The purpose of this study was to compare postcontraction hyperemia after electrical stimulation between patients with upper extremity paralysis caused by upper motor neuron diseases and healthy controls. Thirteen healthy controls and eleven patients with upper extremity paralysis were enrolled. The blood flow in the basilic vein was measured by ultrasound before the electrical stimulation of the biceps brachii muscle and 30 s after the stimulation. The stimulation was performed at 10 mA and at a frequency of 70 Hz for 20 s. The mean blood flow in the healthy control group and in upper extremity paralysis group before the electrical stimulation was 60 ± 20 mL/min (mean ± SD) and 48 ± 25 mL/min, respectively. After the stimulation, blood flow in both groups increased to 117 ± 23 mL/min and 81 ± 41 mL/min, respectively. We show that it is possible to measure postcontraction hyperemia using an ultrasound system. In addition, blood flow in both groups increased after the electrical stimulation because of postcontraction hyperemia. These findings suggest that evaluating post contraction hyperemia in patients with upper extremity paralysis can assess rehabilitation effects. PMID:26912142

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

    PubMed Central

    Villeneuve, Myriam; Penhune, Virginia; Lamontagne, Anouk

    2014-01-01

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

  16. Vascularized Nerve Grafts and Vascularized Fascia for Upper Extremity Nerve Reconstruction

    PubMed Central

    Kostopoulos, Vasileios K.

    2009-01-01

    Since 1976, experimental and clinical studies have suggested the superiority of vascularized nerve grafts. In this study, a 27-year experience of the senior author is presented regarding vascularized nerve grafts and fascia for complex upper extremity nerve reconstruction. The factors influencing outcomes as well as a comparison with conventional nerve grafts is presented. Since 1981, 21 vascularized nerve grafts, other than vascularized ulnar nerve, were used for reconstruction of nerve injuries in the upper extremity. Indications were prolonged denervation time, failure of the previously used conventional nerve grafts, and excessive scar in the recipient site. Injury was in the hand/wrist area (n = 5), in the forearm (n = 4), in the elbow (n = 2), in the arm (n = 4), or in the plexus (n = 6). Vascularized sural (n = 9), saphenous (n = 8), superficial radial (n = 3), and peroneal (superficial and deep) nerves were used. The mean follow-up was 31.4 months. Vascularized nerve grafts for upper extremity injuries provided good to excellent sensory return in severely scarred upper extremities in patients in whom conventional nerve grafts had failed. They have also provided relief of causalgia after painful neuroma resection and motor function recovery in selective cases even for above the elbow injuries. Small diameter vascularized nerve grafts should be considered for bridging long nerve gaps in regions of excessive scar or for reconstructions where conventional nerve grafts have failed. PMID:19381727

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

    ERIC Educational Resources Information Center

    Reid, Denise T.; Sochaniwskyj, Alex

    1992-01-01

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

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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

  1. Targeted Muscle Reinnervation in the Upper Extremity Amputee: A Technical Roadmap.

    PubMed

    Gart, Michael S; Souza, Jason M; Dumanian, Gregory A

    2015-09-01

    Targeted muscle reinnervation (TMR) offers the potential for improved prosthetic function by reclaiming the neural control information that is lost as a result of upper extremity amputation. In addition to the prosthetic control benefits, TMR is a potential treatment for postamputation neuroma pain. Here, we present our surgical technique for TMR nerve transfers in transhumeral and shoulder disarticulation patients. PMID:26314220

  2. Reference Values for the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST) for Collegiate Baseball Players

    PubMed Central

    Kitamura, Jared; Waits, Michael Chad

    2007-01-01

    Background The Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST) is a tool developed and used in the clinic to evaluate progress during upper extremity 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 upper extremity. 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 upper extremity function. PMID:21522211

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

    PubMed Central

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

    2015-01-01

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

  4. Weak grip strength does not predict upper extremity musculoskeletal symptoms or injuries among new workers

    PubMed Central

    Dale, Ann Marie; Addison, Lesley; Lester, Josh; Kaskutas, Vicki; Evanoff, Bradley

    2016-01-01

    Purpose Grip strength is often tested during post-offer pre-placement screening for workers in hand-intensive jobs. The purpose of this study was to evaluate the association between grip strength and upper extremity symptoms, work disability, and upper extremity musculoskeletal disorders (UE MSD) in a group of workers newly employed in both high and low hand intensive work. Methods 1107 recently-hired workers completed physical examinations including grip strength measurements. Repeated surveys obtained over 3 years described the presence of upper extremity symptoms, report of physician-diagnosed musculoskeletal disorders (MSD), and job titles. Baseline measured grip values were used in analytic models as continuous and categorized values to predict upper extremity symptoms, work disability, or UE MSD diagnosis. Results Twenty-six percent of males and 20% of females had low baseline hand strength compared to normative data. Multivariate logistic regression analyses showed no consistent associations between grip strength and three health outcomes (UE symptoms, work disability, and musculoskeletal disorders) in this young cohort (mean age: 30 years). Past MSD and work type were significant predictors of these outcomes. Conclusions Physical hand strength testing was not useful for identifying workers at risk for developing UE MSDs, and may be an inappropriate measure for post-offer job screens. PMID:23857165

  5. [Possible modification of circulatory parameters of the upper extremity--using electrostimulation with the "Jogger" electrostimulator].

    PubMed

    Bhligen, U; Brock, D; Standke, M

    1993-01-01

    Circulatory disturbances of the upper extremities may be affected by blockade of the ganglion stellatum. This blockade is possible by electrical stimulation with pocket stimulators. Frequent blockades of the ganglion stellatum are possible, simple, free from pain and without drugs. Rheographic resurges and check up with skin thermographie will demonstrate the effectiveness of this method. PMID:8259322

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

    NASA Astrophysics Data System (ADS)

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

    2016-02-01

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

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

    PubMed

    Ricci, Flvia Pessoni F M; Santiago, Paulo Roberto Pereira; Zampar, Ana Carolina; Pinola, Lvia Nahas; Fonseca, Marisa de Cssia Registro

    2015-10-01

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

  8. Precipitation extremes in the Mediterranean region and associated upper-level synoptic-scale flow structures

    NASA Astrophysics Data System (ADS)

    Toreti, Andrea; Giannakaki, Paraskevi; Martius, Olivia

    2015-12-01

    A non-stationary analysis of daily precipitation extremes over the Mediterranean region and the associated upper-level atmospheric dynamics is presented for autumn, winter and spring. An Extreme Value Theory approach is applied to identify homogeneous areas in terms of precipitation extremes and to characterise the spatio-temporal behaviour of precipitation extremes. Results reveal a high spatial variability of extremes in the region as a whole, while the eastern Mediterranean shows a lower variability compared to the western part. The temporal variability of the estimated 5-year return levels also varies significantly across the basin especially in autumn. The synoptic-scale flow structures associated with these extreme events are then investigated. Significant upper-level flow anomalies in the form of troughs and cut-offs are found for all regions/seasons. Moreover, in many areas the associated low-level flow is directed against the local topography pointing to the relevant role of orographic lifting. Finally, significant precursor signals, 2-3 days before the events, are identified for most of the areas.

  9. Steal syndrome complicating upper extremity hemoaccess procedures: incidence and risk factors

    PubMed Central

    Davidson, Dion; Louridas, George; Guzman, Randolph; Tanner, John; Weighell, Wendy; Spelay, Jodi; Chateau, Dan

    2003-01-01

    Introduction Steal syndrome is a potentially grave complication of upper extremity hemoaccess (HA) in patients with renal failure. To determine the incidence and risk factors for steal in these patients at the St. Boniface Hospital, Winnipeg, a tertiary care centre for vascular surgery and dialysis, we reviewed data from patients requiring hemodialysis between September 1986 and July 2000. Patients and methods We excluded all venous catheter and lower extremity procedures. There remained 325 upper extremity procedures in 217 patients. Data were collected from the patients' charts or by interview. First by univariate analysis and then by multivariate analysis for independent risk factors, we studied the effect on the development of steal of age, sex, race diabetes mellitus, hypertension, coronary artery disease or cerebrovascular disease, smoking, proximal procedures based on the brachial artery, distal procedures based on the radial artery, the use of prosthetic graft material and the creation of autologous fistulas. Results The incidence of steal was 6.2%. The significant independent risk factors were diabetes mellitus (odds ratio [OR] 5.00, 95% confidence interval [CI] 1.3918.08, p = 0.01) and Aboriginal race (OR 3.59, 95% CI 1.0712.04, p = 0.04). An increasing risk for each year of advancing age at the time of procedure was suggested but was not significant (OR 1.04, 95% CI 1.001.09 p = 0.07). Conclusions Patients who are diabetic or Aboriginal are at increased risk for steal with upper extremity HA procedures. This knowledge can guide discussion of dialysis options and informed consent. If upper extremity HA procedures are undertaken in patients at risk, they should be closely monitored and early intervention applied if necessary. PMID:14680346

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

    NASA Astrophysics Data System (ADS)

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

    2015-11-01

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

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

  13. Ocular prosthesis.

    PubMed

    Raizada, Kuldeep; Rani, Deepa

    2007-07-01

    Loss of an eye or a disfigured eye has a far-reaching impact on an individual's psyche'. Additionally it affects one's social and professional life. Cosmetic rehabilitation with custom made prosthetic devices gives such individuals professional and social acceptance and alleviates problems. This article aims at enhance awareness of the cosmetic benefits of custom designed ocular prosthesis. Ocularistry, the science of making ocular prosthesis, has undergone phenomenal growth in recent times. Ocularistry is fast evolving in India. "Ocularist" is the skilled individual involved in fabricating the ocular prosthesis. PMID:17320467

  14. Cluster Analysis of Symptoms Among Patients with Upper Extremity Musculoskeletal Disorders

    PubMed Central

    Piligian, George; Glutting, Joseph J.; Hanlon, Alexandra; Frings-Dresen, Monique H. W.; Sluiter, Judith K.

    2010-01-01

    Introduction Some musculoskeletal disorders of the upper extremity 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 upper extremity 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. PMID:20414797

  15. The effects of music on pain perception of stroke patients during upper extremity joint exercises.

    PubMed

    Kim, Soo Ji; Koh, Iljoo

    2005-01-01

    The purpose of this study was to determine the effects of music therapy on pain perception of stroke patients during upper extremity joint exercises. Ten stroke patients (1 male and 9 females) ranging in age from 61 to 73 participated in the study. Music conditions used in the study consisted of: (a) song, (b) karaoke accompaniment (same music to condition A except singers' voices), and (c) no music. Exercise movements in this study included hand, wrist, and shoulder joints. During the 8-week period music therapy sessions, subjects repeated 3 conditions according to the randomized orders and subjects rated their perceived pain on a scale immediately after each condition. The General Linear Model (GLM) Repeated Measures ANOVA revealed that there were no significant differences in pain rating across the three music conditions. However, positive affects and verbal responses, while performing upper extremity exercises with both music and karaoke accompaniment music, were observed using video observations. PMID:15839735

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

    PubMed Central

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

    2012-01-01

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

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

    PubMed Central

    2014-01-01

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

  18. Validation of Upper Extremity Post-Thrombotic Syndrome Outcome Measurement in Children

    PubMed Central

    Goldenberg, Neil A.; Pounder, Elizabeth; Knapp-Clevenger, R.; Manco-Johnson, Marilyn J.

    2010-01-01

    Using the Manco-Johnson instrument in a derivation cohort of 107 children with/without central venous catheters, upper extremity (UE) physical findings of post-thrombotic syndrome were absent and pain score was zero in all but one child. Inter-rater reliability in an independent validation cohort (n=38) of children with/without UE DVT was 97-100%. PMID:20797729

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

    SciTech Connect

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

    2006-08-15

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

  20. A case report of a patient with upper extremity symptoms: differentiating radicular and referred pain

    PubMed Central

    Daub, Clifford W

    2007-01-01

    Background Similar upper extremity symptoms can present with varied physiologic etiologies. However, due to the multifaceted nature of musculoskeletal conditions, a definitive diagnosis using physical examination and advanced testing is not always possible. This report discusses the diagnosis and case management of a patient with two episodes of similar upper extremity symptoms of different etiologies. Case Presentation On two separate occasions a forty-four year old female patient presented to a chiropractic office with a chief complaint of insidious right-sided upper extremity symptoms. During each episode she reported similar pain and parasthesias from her neck and shoulder to her lateral forearm and hand. During the first episode the patient was diagnosed with a cervical radiculopathy. Conservative treatment, including manual cervical traction, spinal manipulation and neuromobilization, was initiated and resolved the symptoms. Approximately eighteen months later the patient again experienced a severe acute flare-up of the upper extremity symptoms. Although the subjective complaint was similar, it was determined that the pain generator of this episode was an active trigger point of the infraspinatus muscle. A diagnosis of myofascial referred pain was made and a protocol of manual trigger point therapy and functional postural rehabilitative exercises improved the condition. Conclusion In this case a thorough physical evaluation was able to differentiate between radicular and referred pain. By accurately identifying the pain generating structures, the appropriate rehabilitative protocol was prescribed and led to a successful outcome for each condition. Conservative manual therapy and rehabilitative exercises may be an effective treatment for certain cases of cervical radiculopathy and myofascial referred pain. PMID:17640388

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

    NASA Astrophysics Data System (ADS)

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

    2016-02-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

    Villeneuve, Myriam; Lamontagne, Anouk

    2013-01-01

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

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

    PubMed Central

    Villeneuve, Myriam; Lamontagne, Anouk

    2013-01-01

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

  5. Interventions for the prevention and management of neck/upper extremity musculoskeletal conditions: a systematic review

    PubMed Central

    Boocock, M G; McNair, P J; Larmer, P J; Armstrong, B; Collier, J; Simmonds, M; Garrett, N

    2007-01-01

    Considered from medical, social or economic perspectives, the cost of musculoskeletal injuries experienced in the workplace is substantial, and there is a need to identify the most efficacious interventions for their effective prevention, management and rehabilitation. Previous reviews have highlighted the limited number of studies that focus on upper extremity intervention programmes. The aim of this study was to evaluate the findings of primary, secondary and/or tertiary intervention studies for neck/upper extremity conditions undertaken between 1999 and 2004 and to compare these results with those of previous reviews. Relevant studies were retrieved through the use of a systematic approach to literature searching and evaluated using a standardised tool. Evidence was then classified according to a “pattern of evidence” approach. Studies were categorised into subgroups depending on the type of intervention: mechanical exposure interventions; production systems/organisational culture interventions and modifier interventions. 31 intervention studies met the inclusion criteria. The findings provided evidence to support the use of some mechanical and modifier interventions as approaches for preventing and managing neck/upper extremity musculoskeletal conditions and fibromyalgia. Evidence to support the benefits of production systems/organisational culture interventions was found to be lacking. This review identified no single‐dimensional or multi‐dimensional strategy for intervention that was considered effective across occupational settings. There is limited information to support the establishment of evidence‐based guidelines applicable to a number of industrial sectors. PMID:16973739

  6. The influence of dynamic orthosis training on upper extremity function after stroke: a pilot study.

    PubMed

    de Arajo, Rodrigo Cappato; Rocha, Daniel Neves; Pitangui, Ana Carolina Rodarti; Pinotti, Marcos

    2014-01-01

    The goal of this study was to assess the use of a dynamic orthosis on upper extremity function in chronic stroke patients. A case series approach was utilized, with provision of a training program (3x/week, 50 minutes/session for 8 weeks) and employment of a dynamic orthosis. Six volunteers with persistent hemiparesis due to a single, unilateral stroke performed task-oriented movements with the aid of a dynamic orthosis. Tests were administered before and after training. Functional capacity was assessed using the TEMPA (Test d'valuation des Membres Suprieurs de Personnes ges) test. The Wilcoxon test was used for pre-training and post-training comparisons of TEMPA scores. The volunteers showed significant improvement of upper extremity function in the performance of a bilateral task (p = 0.01) and three unilateral tasks (p = 0.04). This pilot study suggests that the dynamic orthosis associated with the performance of functional tasks can have positive outcomes regarding the improvement of functional capacity of upper extremity. PMID:24691386

  7. Objective measurement of synergistic movement patterns of the upper extremity following stroke: an explorative study.

    PubMed

    Krabben, T; Prange, G B; Molier, B I; Rietman, J S; Buurke, J H

    2011-01-01

    The majority of stroke survivors have to cope with deficits in arm function, which is often monitored with subjective clinical scales during stroke rehabilitation. The aim of this study is to examine whether robotic outcome measures obtained during circle drawing are suitable to objectively measure upper extremity function of stroke survivors, especially regarding synergistic movement patterns. Stroke survivors (n = 16) and healthy subjects (n = 20) drew circles, as big and as round as possible, above a table top. Joint angles and positions of the shoulder and elbow were measured. Synergistic movement patterns were identified based on simultaneous changes of the shoulder elevation angle and elbow angle. Stroke survivors moved significantly more within synergistic movement patterns, compared to healthy subjects. Strong correlations between the proximal upper extremity part of the Fugl-Meyer (FM) scale and the use of synergistic movement patterns were found. The proposed outcome measures seem to be suitable measures to objectively quantify the occurrence of synergistic movement patterns of the upper extremity following stroke. PMID:22275631

  8. Handgrip strength as a diagnostic tool in work-related upper extremity musculoskeletal disorders in women.

    PubMed

    Alperovitch-Najenson, Deborah; Carmeli, Eli; Coleman, Raymond; Ring, Haim

    2004-03-01

    The aim of this study was to determine if handgrip strength might be used as a diagnostic tool in musculoskeletal disorders of the upper extremities in women working in an industrial environment. The setting was an electronic factory with four groups of women (n = 101) in a factory assembling electronic components. Handgrip strength was measured using a Jamar hydraulic hand dynamometer. The study investigated grip strength in managers-engineers, cable wiring, circuit board assembly, integrated circuits women at 90 degrees elbow flexion and 180 elbow extension. Women seeking or receiving medical care for musculoskeletal disorders of the upper extremities or neck showed significant declines (p < 0.01) in handgrip strength and these also related to the type of work and the level of perceived physical exertion. Women in the managerial-engineering group showed fewer musculoskeletal disorders of the upper extremity compared with the other groups and also had significantly stronger handgrip. Our findings encourage us to recommend hand dynamometer testing as a useful diagnostic tool to determine loss of handgrip strength. PMID:15010565

  9. Measurement and analysis of the perforator arteries in upper extremity for the flap design.

    PubMed

    Chen, Sheng-hua; Xu, Da-chuan; Tang, Mao-lin; Ding, Hong-mei; Sheng, Wei-chao; Peng, Tian-hong

    2009-11-01

    The aim of this study was to provide the anatomical basis for the skin flap pedicled with the nutrient vessels of the cutaneous nerves and cutaneous veins of the upper extremity. Radio-opaque material was injected into the common carotid arteries of five fresh cadavers. The skin and the fascia were meticulously dissected, removed, and radiographed. The Photoshop CS and Scion image 4.02 were used to analyze the cutaneous arteries, the density of vessels, and the vascular territories of the perforator arteries. The results showed that the cutaneous arteries of the upper extremity came from 16 original arteries, and accordingly, the superficial tissue of the upper extremity could be divided into 16 vascular territories. The external diameter and the area of blood supply of each perforator were growing downwards from the proximum to the distal end. But the points at which the perforator arteries came out from the deep tissue were concentrated near the cutaneous nerves and cutaneous veins, and the arteries formed vascular chains. The density of the arteries near the cutaneous nerves and cutaneous veins was much higher than that of other areas. This article discussed the regularity of the nutrient vessels of the cutaneous nerves and veins on the basis of the experimental results. PMID:19390765

  10. Lower and upper extremity loading in nordic walking in comparison with walking and running.

    PubMed

    Hagen, Marco; Hennig, Ewald M; Stieldorf, Peter

    2011-02-01

    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 upper extremities are exposed to considerable repetitive shocks, which may cause overuse injuries of the upper extremities. Thus, additional preventive exercises for the upper limb muscles are recommended as well as using shock absorbing walking poles. PMID:21451179

  11. Prosthesis coupling

    NASA Technical Reports Server (NTRS)

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

    1979-01-01

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

  12. Factors Affecting Outcomes in Patients Treated Surgically for Upper Extremity Tumors and Tumor-Like Lesions

    PubMed Central

    Otero, Jesse E; Graves, Christopher M; TeKippe, Ashley; Buckwalter, Joseph A; Miller, Benjamin J

    2013-01-01

    There is little data available regarding outcomes of patients who have undergone surgery for tumors of the upper extremity. Functional data after surgery for upper extremity tumors would aid in guiding patient expectations in the peri-operative period. The purpose of this study was to identify patient, tumor, and surgery-related characteristics associated with patient-reported physical and emo-tional function before and after surgery for tumors of the upper extremity. Pre- and post-operative mental and physical Medical Outcomes Study Short Form 36 (SF-36) scores were collected from 79 patients with benign and malignant neoplasms of the upper extremity. A retrospective chart review was performed to ascertain whether tumor behavior, type, location, patient sex, age, surgical specimen size, or type of surgery were correlated with differing outcomes. Our outcome measure was patient-reported physi-cal and mental score (SF-36) at less than one year, one to two years, and greater than two years post-operatively. We found that patients with tumors proximal to the elbow and patients with right-sided tumors had statistically significantly lower post-operative physical scores at minimum two-year follow-up (p=0.02). Additionally, lower physical scores were associated with age greater than 50 (p=0.03) and tumor resection rather than curettage (p=0.01). The subset of patients with hereditary multiple exostoses had significantly lower post-operative physical scores than other patient sub-populations. There was no difference in physical function after surgery between patients with benign and malig-nant tumors, patients with tumors larger than 5 cm and less than 5 cm in greatest dimension, and patients with bone versus soft tissue tumors. Inter-estingly, we found that there was no difference in mental function scores between any comparisons. Our results suggest that patient age, tumor location, and type of surgery are correlated with patient-reported physical function following sur-gery. These findings could be helpful in counsel-ing patients undergoing surgery for tumors of the upper extremity. PMID:24027471

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

    PubMed Central

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

    2007-01-01

    Context: Research indicates that upper extremity fatigue hampers sensorimotor system acuity. However, no investigators have observed recovery of upper extremity acuity after fatigue. Objective: To observe recovery of active position reproduction acuity in overhead throwers after a throwing-fatigue protocol. Design: Single-session, repeated-measures design. Setting: University musculoskeletal laboratory. Patients or Other Participants: Sixteen healthy collegiate baseball players (age = 21.0 ± 1.6 years, height = 175.8 ± 10.2 cm, mass = 82.8 ± 4.3 kg). Intervention(s): Subjects threw a baseball with maximum velocity (every 5 seconds) from a single knee. Every 20 throws, subjects rated their upper extremity exertion on a Borg scale until reporting a level of more than 14. Main Outcome Measure(s): We used an electromagnetic tracking system to measure active multijoint position reproduction acuity at 5 intervals: prefatigue; immediately postfatigue; and after 4, 7, and 10 minutes of recovery. Blindfolded subjects reproduced their arm-cocked and ball-release positions. Dependent variables were 3-dimensional variable errors of scapulothoracic, glenohumeral, elbow, and wrist joints; endpoint (ie, hand) position error represented overall upper extremity acuity. The independent variable was time (measured prefatigue and at 4 postfatigue intervals). Results: Fatigue significantly affected acuity of scapulothoracic, glenohumeral, and elbow joints and endpoint error for both positions (P < .001). Fatigue significantly affected wrist acuity only for ball release (P < .001). For arm-cocked reproduction, each measure of acuity, except that of the glenohumeral joint, recovered by 7 minutes; for ball release, each measure of acuity recovered within 4 minutes (P > .05). Conclusions: The sensorimotor system deficits that we observed after fatigue recovered within 7 minutes in most upper extremity joints. Glenohumeral arm-cocked position reproduction acuity failed to recover within 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. PMID:18174932

  14. Role of Anomalous States of Upper Tropospheric Circulation on Extremely Dry and Wet Summer Monsoon Events

    NASA Astrophysics Data System (ADS)

    Ahmad, S.; Koike, T.; Nishii, K.; Shrestha, M.

    2011-12-01

    Seasonal changes in wind pattern, monsoon, sometimes result 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 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 conditions. We found that the extremely dry (wet) PSM events were closely related with the anomalous cyclonic (anticyclonic) upper-tropospheric circulation around northwest of Pakistan, and mid-upper tropospheric cooling (warming) anomaly around Pakistan and to its north/northwest. We also found in addition to Rossby wave response due to the suppressed (enhanced) convective activities around monsoon regions, the midlatitude wave energy propagation emanating around cyclonic/anticyclonic anomaly around northwestern Atlantic, northeastern Atlantic, Europe or Mediterranean regions induced/reinforced/maintained the anomalous upper tropospheric cyclonic (anticyclonic) circulation around northwest of Pakistan during extremely dry (wet) PSM events. Therefore, devastating drought (flood) events over the PSM region resulting from weak (strong) convection anomalies are induced by both the tropical and extratropical processes.

  15. Quality of Life, Upper Extremity Function and the Effect of Lymphedema Treatment in Breast Cancer Related Lymphedema Patients

    PubMed Central

    Park, Ji Eung; Jang, Hye Jin

    2012-01-01

    Objective To evaluate quality of life (QOL), upper extremity 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 upper extremity 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 upper extremity function. On the EORTC-QLQ, patients with metastasis had significantly lower scores in physical functioning and role functioning. In terms of upper extremity circumference, there was a significant upper extremity size reduction after lymphedema treatment. Conclusion There were several dissociations between some subscales of quality of life questionnaires and those of upper extremity functions. Upper extremity 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. PMID:22639749

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

    PubMed

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

    2015-06-01

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

  17. A Novel Arm Sleeve for Upper Extremity Lymphedema: A Pilot Study

    PubMed Central

    2014-01-01

    Objective: To investigate the safety and efficacy of a novel arm sleeve composed of a conventional arm sleeve extending to a wider area of the body. Materials and Methods: Five subjects with post-mastectomy upper extremity lymphedema, who had already been using their own arm sleeve, used a brand-new conventional arm sleeve for 2 weeks, followed by a novel arm sleeve for 2 weeks. The adverse events, arm-related symptoms, interface pressures, and subcutaneous fluid distributions observed by magnetic resonance imaging (MRI) were assessed. Results: The use of the novel arm sleeve resulted in a graduated compression extending to the shoulder (forearm, 21.8 3.7 mmHg; upper arm, 15.2 3.3 mmHg; shoulder, 8.8 3.1 mmHg). By eliminating the wring seen in the conventional arm sleeve, the disturbed proximal diffusion of the subcutaneous fluid and venous occlusion were successfully avoided, as confirmed by MRI. No adverse event or worsening of arm-related symptoms was reported. Conclusion: The novel arm sleeve seemed to provide graduated compression to a wider area, allowing improved subcutaneous fluid and venous drainage without any adverse events. Therefore, the novel arm sleeve may be recommended as a compression therapy option for upper extremity lymphedema. PMID:24995057

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

    PubMed Central

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

    2015-01-01

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

  19. Identifying sources of temporal variability in hydrological extremes of the upper Blue Nile basin

    NASA Astrophysics Data System (ADS)

    Taye, Meron Teferi; Willems, Patrick

    2013-08-01

    It is known that changes in catchment runoff variability are a function of changes in climate as well as catchment behavior. For proper management of a certain watershed it is important to have a good understanding of the main causes of variability. Specifically, changes in extreme conditions of water resources are imperative as their consequences are far reaching. This paper attempts to identify the cause of hydrological extremes variability in the upper Blue Nile basin of Ethiopia. A method is proposed to utilize conceptual hydrological models to simulate long term (41 years) hydro-meteorological data and analyse the outputs using the Quantile Perturbation Method (QPM) specially designed for investigation of the temporal variability of extreme values in time series over multi-annual to (multi-)decadal time scales. Two conceptual hydrological models were calibrated and evaluated for their performance to simulate extreme high flows and changes in these flows for corresponding changes in rainfall conditions. The temporal variability results show similar patterns for simulated and observed extreme flows. This indicates the major influence of climate variability in extreme flows as demonstrated by the rainfall input in the models. There is no discernible change in the catchment response, e.g. quick runoff coefficient as a function of soil saturation state, between periods of the 1960-1970s, the 1980s and the 1990-2000s, which are attributed to land policy changes. This shows the influence of changes in catchment characteristics is minimal. (Multi-)decadal climate variability is identified as the main cause of temporal variation in hydrological extremes of the Blue Nile basin.

  20. Upper extremity blood flow in collegiate and high school baseball pitchers A preliminary report.

    PubMed

    Bast, S C; Perry, J R; Poppiti, R; Vangsness, C T; Weaver, F A

    1996-01-01

    The arterial and venous volume blood flow in the dominant and nondominant upper extremities of five male pitchers, ages 16 to 21, was measured using color flow duplex ultrasound. Blood-flow measurements were obtained at baseline, after warm-up, and after each sequence of 20 pitches until 100 pitches were thrown. Blood flow was additionally determined 1 hour after the last pitch. The velocity of each pitch was recorded with a speed gun. Anthropomorphic measurements of the upper extremity were obtained at baseline and immediately after Pitch 100 using a standard measuring tape. The highest average arterial volume flow in the pitching arm occurred after 40 pitches, reaching a peak of 549 ml/min (56% increase from baseline). Thereafter, the average arterial blood flow steadily declined, reaching an average of 402 ml/min after the 100th pitch (14% increase from baseline). In contrast, the arterial blood flow in the nonpitching arm increased only slightly from baseline, reaching a maximal volume flow of 448 ml/min immediately after the warm-up period (10% increase from baseline). The volume flow then persistently fell to a level 30% below baseline after the 100th pitch. Although this small pilot study does not demonstrate causation between a decline in pitching performance and arterial blood flow, it suggests arterial flow in the dominant extremity falls as the pitch count increases. PMID:8947410

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

    PubMed Central

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

    2016-01-01

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

  2. The reliability of side to side measurements of upper extremity activity levels in healthy subjects

    PubMed Central

    2010-01-01

    Background In both clinical and occupational settings, ambulatory sensors are becoming common for assessing all day measurements of arm motion. In order for the motion of a healthy, contralateral side to be used as a control for the involved side, the inherent side to side differences in arm usage must be minimal. The goal of the present study was to determine the reliability of side to side measurements of upper extremity activity levels in healthy subjects. Methods Thirty two subjects with no upper extremity pathologies were studied. Each subject wore a triaxial accelerometer on both arms for three and a half hours. Motion was assessed using parameters previously reported in the literature. Side to side differences were compared with the intraclass correlation coefficient, standard error of the mean, minimal detectable change scores and a projected sample size analysis. Results The variables were ranked based on their percentage of minimal detectable change scores and sample sizes needed for paired t-tests. The order of these rankings was found to be identical and the top ranked parameters were activity counts per hour (MDC% = 9.5, n = 5), jerk time (MDC% = 15.8, n = 8) and percent time above 30 degrees (MDC% = 34.7, n = 9). Conclusions In general, the mean activity levels during daily activities were very similar between dominant and non-dominant arms. Specifically, activity counts per hour, jerk time, and percent time above 30 degrees were found to be the variables most likely to reveal significant difference or changes in both individuals and groups of subjects. The use of ambulatory measurements of upper extremity activity has very broad uses for occupational assessments, musculoskeletal injuries of the shoulder, elbow, wrist and hand as well as neurological pathologies. PMID:20650006

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

    PubMed Central

    2012-01-01

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

  4. Upper-Extremity Transplantation Using a Cell-Based Protocol to Minimize Immunosuppression

    PubMed Central

    Schneeberger, Stefan; Gorantla, Vijay S.; Brandacher, Gerald; Zeevi, Adriana; Demetris, Anthony J.; Lunz, John G.; Metes, Diana M.; Donnenberg, Albert D.; Shores, Jaimie T.; Dimartini, Andrea F.; Kiss, Joseph E.; Imbriglia, Joseph E.; Azari, Kodi; Goitz, Robert J.; Manders, Ernest K.; Nguyen, Vu T.; Cooney, Damon S.; Wachtman, Galen S.; Keith, Jonathan D.; Fletcher, Derek R.; Macedo, Camila; Planinsic, Raymond; Losee, Joseph E.; Shapiro, Ron; Starzl, Thomas E.; Andrew Lee, W. P.

    2014-01-01

    Objective To minimize maintenance immunosuppression in upper-extremity transplantation to favor the risk-benefit balance of this procedure. Background Despite favorable outcomes, broad clinical application of reconstructive transplantation is limited by the risks and side effects of multidrug immunosuppression. We present our experience with upper-extremity transplantation under a novel, donor bone marrow (BM) cell-based treatment protocol (Pittsburgh protocol). Methods Between March 2009 and September 2010, 5 patients received a bilateral hand (n = 2), a bilateral hand/forearm (n = 1), or a unilateral (n = 2) hand transplant. Patients were treated with alemtuzumab and methylprednisolone for induction, followed by tacrolimus monotherapy. On day 14, patients received an infusion of donor BM cells isolated from 9 vertebral bodies. Comprehensive follow-up included functional evaluation, imaging, and immunomonitoring. Results All patients are maintained on tacrolimus monotherapy with trough levels ranging between 4 and 12 ng/mL. Skin rejections were infrequent and reversible. Patients demonstrated sustained improvements in motor function and sensory return correlating with time after transplantation and level of amputation. Side effects included transient increase in serum creatinine, hyperglycemia managed with oral hypoglycemics, minor wound infection, and hyperuricemia but no infections. Immunomonitoring revealed transient moderate levels of donor-specific antibodies, adequate immunocompetence, and no peripheral blood chimerism. Imaging demonstrated patent vessels with only mild luminal narrowing/occlusion in 1 case. Protocol skin biopsies showed absent or minimal perivascular cellular infiltrates. Conclusions Our data suggest that this BM cell-based treatment protocol is safe, is well tolerated, and allows upper-extremity transplantation using low-dose tacrolimus monotherapy. PMID:23001085

  5. Design and control of RUPERT: a device for robotic upper extremity repetitive therapy.

    PubMed

    Sugar, Thomas G; He, Jiping; Koeneman, Edward J; Koeneman, James B; Herman, Richard; Huang, H; Schultz, Robert S; Herring, D E; Wanberg, J; Balasubramanian, Sivakumar; Swenson, Pete; Ward, Jeffrey A

    2007-09-01

    The structural design, control system, and integrated biofeedback for a wearable exoskeletal robot for upper extremity stroke rehabilitation are presented. Assisted with clinical evaluation, designers, engineers, and scientists have built a device for robotic assisted upper extremity repetitive therapy (RUPERT). Intense, repetitive physical rehabilitation has been shown to be beneficial overcoming upper extremity deficits, but the therapy is labor intensive and expensive and difficult to evaluate quantitatively and objectively. The RUPERT is developed to provide a low cost, safe and easy-to-use, robotic-device to assist the patient and therapist to achieve more systematic therapy at home or in the clinic. The RUPERT has four actuated degrees-of-freedom driven by compliant and safe pneumatic muscles (PMs) on the shoulder, elbow, and wrist. They are programmed to actuate the device to extend the arm and move the arm in 3-D space. It is very important to note that gravity is not compensated and the daily tasks are practiced in a natural setting. Because the device is wearable and lightweight to increase portability, it can be worn standing or sitting providing therapy tasks that better mimic activities of daily living. The sensors feed back position and force information for quantitative evaluation of task performance. The device can also provide real-time, objective assessment of functional improvement. We have tested the device on stroke survivors performing two critical activities of daily living (ADL): reaching out and self feeding. The future improvement of the device involves increased degrees-of-freedom and interactive control to adapt to a user's physical conditions. PMID:17894266

  6. Assessment of the relationship between Quality of Life and Upper Extremity Impairment Due to Occupational Injuries

    PubMed Central

    Golchin, Mahdie; Attarchi, Mirsaeed; Mirzamohammadi, Elham; Ghaffari, Mostafa; Mohammadi, Saber

    2014-01-01

    Background: Severe upper extremity injuries can affect the quality of life in patients and cause multi-factorial and long-term costs of disease. The aim of this study was to assess quality of life in patients with upper extremity injuries caused by work-related accidents. Methods: In this study cross-sectional method was used in patients referred to the Occupational medicine Clinic of Rasoul Akram Hospital to determine their impairments. Patient's information including demographic variables, calculation of the impairment rate based on AMA Guide book (in terms of WPI), returning to work, and location of injury, work experience and type of injury. Then the quality of their life was assessed and interpreted using SF36 questionnaire. Results: 203 patients were evaluated. Different aspects of the patients life were not associated with age, gender and education of patients based on The SF-36 questionnaire. There was an inverse relationship between the percentage of patients impairment and different aspects of life quality; there were also a significance correlation between impairment rate and physical performance of patients (p<0.001, r= -0.26), social performance of patients (p= 0.001, r= -0.24), pain (p= 0.005, r= -0.2), emotional health of patients (p= 0.006, r= -0.29), energy / fatigue in patients (p<0.001, r= -0.29) and the patient's general health (p<0.001, r= -0.27). Conclusion: This study shows that upper extremity impairment due to occupational injuries has an inverse and significant association with various aspects of quality of life. PMID:25250260

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

    PubMed

    Grant, K A; Habes, D J

    1997-04-01

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

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

    NASA Technical Reports Server (NTRS)

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

    1994-01-01

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

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

    PubMed

    Gutowski, Christina J; Ilyas, Asif M

    2014-04-01

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

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

    PubMed Central

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

    2015-01-01

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

  11. Does prophylactic anticoagulation prevent PICC-related upper extremity venous thrombosis? A case-control study.

    PubMed

    Wilson, James D; Alred, Steven C

    2014-01-01

    The evidence regarding the value of prophylactic anticoagulation to prevent peripherally inserted central catheter-related upper extremity venous thrombosis (PRUEVT) is inconsistent. The authors reviewed 3 years of data, identifying all cases of PRUEVT at a facility in Texas, and individually matched each for risk factors with 2 controls. Not being on any form of anticoagulant or antiplatelet agent was associated with a modestly increased risk of PRUEVT (odds ratio 1.93, P = .036, 95% confidence interval, 1.025-3.602). Each approach to thrombosis prevention showed a trend toward a protective effect, but none reached statistical significance individually. PMID:25191821

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

    PubMed

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

    2014-06-01

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

  13. Wartime upper extremity injuries: experience from the Kabul International Airport combat support hospital.

    PubMed

    Mathieu, L; Bertani, A; Gaillard, C; Ollat, D; Rigal, S; Rongiras, F

    2014-06-01

    Few epidemiologic studies have been published about the surgical management of wartime upper extremity injuries (UEIs). The purpose of the present report was to analyze upper extremity combat-related injuries (CRIs) and non-combat related injuries (NCRIs) treated in the Kabul International Airport Combat Support Hospital. A retrospective study was conducted using the French surgical database OpEX (French military health service) from June 2009 to January 2013. During this period, 491 patients with a mean age of 28.7 13 years were operated on because of an UEI. Among them, 244 (49.7%) sustained CRIs and 247 (50.3%) sustained NCRIs. A total number of 558 UEIs were analyzed. Multiple UEIs and associated injuries were significantly more common in the CRIs group. Debridement was the most common procedure in both groups. External fixator application, delayed primary closure and flap coverage were predominant in the CRIs group, as well as internal fracture fixation and tendon repair in the NCRIs group. The overall number of surgical episodes was significantly higher in the CRIs group. Due to the high frequency of UEIs in the theatres of operations, deployed orthopedic surgeons should be trained in basic hand surgery. Although the principles of CRIs treatment are well established, management of hand NCRIs remains controversial in this setting. PMID:24857707

  14. Biomechanic Evaluation of Upper-Extremity Symmetry Manual Wheelchair Propulsion Over Varied Terrain

    PubMed Central

    Hurd, Wendy J.; Morrow, Melissa M.; Kaufman, Kenton R.; An, Kai-Nan

    2014-01-01

    Objective To evaluate upper-extremity symmetry during wheelchair propulsion across multiple terrain surfaces. Design Case series. Setting A biomechanics laboratory and the community. Participants Manual wheelchair users (N=12). Interventions Not applicable. Main Outcome Measures Symmetry indexes for the propulsion moment, total force, tangential force, fractional effective force, time-to-peak propulsion moment, work, length of push cycle, and power during wheelchair propulsion over outdoor and indoor community conditions, and in conditions. Results Upper-extremity asymmetry was present within each condition. There were no differences in the magnitude of asymmetry when comparing laboratory with indoor community conditions. Outdoor community wheelchair propulsion asymmetry was significantly greater than asymmetry measured during laboratory conditions. Conclusions Investigators should be aware that manual wheelchair propulsion is an asymmetrical act, which may influence interpretation when data is collected from a single limb or averaged for both limbs. The greater asymmetry identified during outdoor versus laboratory conditions the emphasizes need to evaluate wheelchair biomechanics in the users natural environment. PMID:18929029

  15. Upper Extremity Muscle Activation during Recovery of Reaching in Subjects with Post-stroke Hemiparesis

    PubMed Central

    Wagner, Joanne M.; Dromerick, Alexander W.; Sahrmann, Shirley A.; Lang, Catherine E.

    2007-01-01

    Objective To investigate upper extremity muscle activation and recovery during the first few months after stroke. Methods Subjects with hemiparesis following stroke were studied performing a reaching task at an acute time point (mean = 9 days post-stroke) and then again at a subacute time point (mean = 109 days post-stroke). We recorded kinematics and electromyographic activity of 6 upper extremity muscles. Results At the acute time point, the hemiparetic group had delayed muscle onsets, lower modulation ratios, and higher relative levels of muscle activation (%MVIC) during reaching than controls. From the acute to the subacute time points, improvements were noted in all three variables. By the subacute phase, muscle onsets were similar to controls, while modulation ratios remained lower than controls and %MVIC showed a trend toward being greater in the hemiparetic group. Changes in muscle activation were differentially related to changes in reaching performance. Conclusions Our data show that improvements in muscle timing and decreases in the relative level of volitional activation may underlie improved reaching performance in the early months after stroke. Significance Given that stroke is one of the leading causes of persistent physical disability, it is important to understand how the ability to activate muscles changes during the early phases of recovery after injury. PMID:17097340

  16. Paleohydrologic bounds and extreme flood frequency of the Upper Arkansas River, Colorado, USA

    NASA Astrophysics Data System (ADS)

    England, J. F., Jr.; Godaire, J. E.; Klinger, R. E.; Bauer, T. R.; Julien, P. Y.

    2010-12-01

    The Upper Arkansas River basin has experienced notable large floods, including the event of 2-6 June 1921 that devastated the city of Pueblo, Colorado. We investigated flood and paleoflood hydrology at strategic sites to determine the frequency and geographic extent of extreme floods within the basin for a dam safety application. Streamgage, historical, and paleoflood data were utilized to develop frequency curves at sites near Salida, Cotopaxi, Parkdale, and Pueblo. Soil/stratigraphic descriptions, radiocarbon dating, and hydraulic modeling were used to estimate paleoflood nonexceedance bounds at the four sites, which ranged from 400 to 2200 YBP for late Holocene surfaces to late Pleistocene surfaces near Cotopaxi. Peak-flow data are from lower-magnitude snowmelt runoff in May and June in the upper basin and from high-magnitude rainfall runoff from June to August in the lower basin. Flood frequency curves reflect this transition near Parkdale from snowmelt to extreme rainfall-runoff. For similar return periods, paleoflood peak discharges increase from about 480 m 3/s upstream at Loma Linda to about 4250 m 3/s downstream near Pueblo. This increase is attributed to the larger rainfall component derived from lower elevations between Loma Linda and Pueblo. Return periods for design floods at Pueblo Dam exceeded 10,000 years based on paleoflood frequency curve extrapolations.

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

    PubMed

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

    2015-11-01

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

  18. Upper extremity strength and range of motion and their relationship to function in breast cancer survivors.

    PubMed

    Harrington, Shana; Padua, Darin; Battaglini, Claudio; Michener, Lori A

    2013-10-01

    The impact upper extremity impairments (UE) have on UE function in breast cancer survivors (BCS) is unclear. The purpose of this study was to evaluate the associations between upper extremity active range of motion (AROM), passive range of motion (PROM), and strength with self-reported function in BCS. BCS (n = 24) completed the Disabilities of Arm, Shoulder and Hand (DASH) and the Pennsylvania Shoulder Score (PSS). AROM and PROM of shoulder flexion, extension, external rotation (ER) at 0 and 90 of abduction, and internal rotation (IR) at 90 of abduction were measured using a digital inclinometer. Strength was measured using a hand-held dynamometer for scapular abduction and upward rotation, scapular depression and adduction, flexion, IR, ER, scaption, and horizontal adduction. All constructs of AROM, PROM, and strength were correlated with the DASH and PSS. DASH was moderately to highly correlated with 2 of 5 AROM, 2 of 5 PROM, and 6 of 7 shoulder strength measures. PSS was moderately to highly correlated with 2 of 5 AROM, 2 of 5 PROM, and 4 of 7 shoulder strength measures. Regression analysis showed that AROM explained 40% of the DASH scores and strength explained 20% of scores on the PSS. This study characterizes the impact that shoulder motion, flexibility, and strength losses have on shoulder function in BCS. Deficits in AROM and shoulder strength explained the greatest proportion of shoulder disability. Future clinical trials should consider incorporating AROM and strengthening techniques to improve shoulder use after breast cancer treatments. PMID:23343035

  19. Person-specific changes in motor performance accompany upper extremity functional gains after stroke.

    PubMed

    DeJong, Stacey L; Birkenmeier, Rebecca L; Lang, Catherine E

    2012-07-01

    In animal models, hundreds of repetitions of upper extremity (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 poststroke 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 = .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 upper extremity motion analysis appears warranted. PMID:21975170

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

    PubMed Central

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

    2015-01-01

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

  1. Multidetector CT and three-dimensional CT angiography of upper extremity arterial injury.

    PubMed

    Fritz, Jan; Efron, David T; Fishman, Elliot K

    2015-06-01

    Successful management of upper extremity arterial injury requires fast and accurate diagnosis. The rate of limb preservation depends on the location, severity, and time of ischemia. Indications for diagnostic imaging depend on the mechanism and type of injury, clinical signs, cardiovascular stability, and clinical suspicion. Because of ease of access, speed, and high accuracy for this diagnosis, multidetector computed tomographic (MDCT) angiography is often used as the first line imaging modality. MDCT systems with 64 slice configuration and more afford high temporal and spatial high-resolution, isotropic data acquisition and integration with whole-body trauma MDCT protocols. The use of individual injection timing protocols ensures high diagnostic image quality. Several strategies are available to reduce radiation exposure. Direct MDCT angiography findings of arterial injuries include active extravasation, luminal narrowing, lack of luminal contrast opacification, filling defect, arteriovenous fistula, and pseudoaneurysm. Important descriptors are location and length of defect, degree of luminal narrowing, and presence of distal arterial supply reconstitution. Proximal arterial injuries include the subclavian, axillary, and brachial arteries. Distal arterial injuries include the ulnar and radial arteries, as well as the palmar arterial arches. Concomitant venous injury, musculoskeletal injury, and nerve damage are common. In this exhibit, we outline the role of MDCT angiography in the diagnosis and management of upper extremity arterial injury, discuss strategies for MDCT angiography acquisition and concepts of data visualization, and illustrate various types of injuries. PMID:25504031

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

    PubMed

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

    2015-01-01

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

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  5. Nuts and bolts: dimensions of commonly utilized screws in upper extremity surgery.

    PubMed

    Douglass, Nathan; Yao, Jeffrey

    2015-02-01

    A plethora of screw designs and sizes are available from multiple companies for use in upper extremity surgery. Knowing the dimensions of screws is critical in the treatment of bone of varying dimensions for fractures, osteotomies, or arthrodeses. Although many screws are named by their major thread diameter, this is not always true. Because of this confusing nomenclature and vast number of options, we sought to review the most commonly used screws and codify their dimensions into a readily available article and reference chart. This article highlights the basic dimensions of commonly used headless screws, stand-alone lag screws, non-locking and locking screws for plating, and biocomposite screws. Commonly described treatments using these screws include fixation of elbow, wrist, carpal, metacarpal, and phalangeal fractures and osteotomies, as well as arthrodeses of upper extremity joints. This article and its tables are by no means exhaustive of all commercially available implants. The focus is on the most commonly used implants in the United States as of 2014. PMID:25617959

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

    PubMed Central

    2010-01-01

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

  7. Effects of purposeful action observation on kinematic patterns of upper extremity in individuals with hemiplegia.

    PubMed

    Kim, Eunjoo; Kim, KyeongMi

    2015-06-01

    [Purpose] This study investigated the effects of purposeful action observation on upper extremity kinematic patterns in individuals with hemiplegia. [Subjects and Methods] Twelve patients were recruited in accordance with the inclusion criteria. The experimental group (n=6) was trained with a purposeful action observation program. The control group (n=6) was trained with only purposeful action without action observation. The programs were performed 30?min/session, 5 times per week for 30 sessions in 6 weeks of training. Upper extremity kinematic patterns were measured by a 3-dimensional motion analysis system before and after training, and the results were analyzed. [Results] The experimental group and the control group showed improvements in average velocity, trajectory ratio, and movement degree, but no statistically significant differences were observed between the groups. The experimental group showed statistically significant improvements in average velocity, trajectory ratio after the intervention. The experimental group also showed an improvement in movement degree, but the post-intervention difference was not significant. [Conclusion] The results of this study show that purposeful action observation training program improved the average velocity and trajectory ratio of stroke patients. Further research should enroll more subjects divided into more specific groups for treatment. PMID:26180326

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

    PubMed Central

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

    2016-01-01

    IMPORTANCE Clinical trials suggest that higher doses of task-oriented training are superior to current clinical practice for patients with stroke with upper extremity motor deficits. OBJECTIVE To compare the efficacy of a structured, task-oriented motor training program vs usual and customary occupational therapy (UCC) during stroke rehabilitation. DESIGN, SETTING, AND PARTICIPANTS Phase 3, pragmatic, single-blind randomized trial among 361 participants with moderate motor impairment recruited from 7 US hospitals over 44 months, treated in the outpatient setting from June 2009 to March 2014. INTERVENTIONS Structured, task-oriented upper extremity training (Accelerated Skill Acquisition Program[ASAP]; n = 119); dose-equivalent occupational therapy (DEUCC; n = 120); or monitoring-only occupational therapy (UCC; n = 122). The DEUCC group was prescribed 30 one-hour sessions over 10 weeks; the UCC group was only monitored, without specification of dose. MAIN OUTCOMES AND MEASURES The primary outcome was 12-month change in log-transformed Wolf Motor Function Test time score (WMFT, consisting of a mean of 15 timed arm movements and hand dexterity tasks). Secondary outcomes were change in WMFT time score (minimal clinically important difference [MCID] = 19 seconds) and proportion of patients improving ≥25 points on the Stroke Impact Scale (SIS) hand function score (MCID = 17.8 points). RESULTS Among the 361 randomized patients (mean age, 60.7 years; 56% men; 42% African American; mean time since stroke onset, 46 days), 304 (84%) completed the 12-month primary outcome assessment; in intention-to-treat analysis, mean group change scores (log WMFT, baseline to 12 months) were, for the ASAP group, 2.2 to 1.4 (difference, 0.82); DEUCC group, 2.0 to 1.2 (difference, 0.84); and UCC group, 2.1 to 1.4 (difference, 0.75), with no significant between-group differences (ASAP vs DEUCC:0.14; 95% CI, −0.05 to 0.33; P = .16; ASAP vs UCC: −0.01; 95% CI, −0.22 to 0.21; P = .94; and DEUCC vs UCC: −0.14; 95% CI, −0.32 to 0.05; P = .15). Secondary outcomes for the ASAP group were WMFT change score, −8.8 seconds, and improved SIS, 73%; DEUCC group, WMFT, −8.1 seconds, and SIS, 72%; and UCC group, WMFT, −7.2 seconds, and SIS, 69%, with no significant pairwise between-group differences (ASAP vs DEUCC: WMFT, 1.8 seconds; 95% CI, −0.8 to 4.5 seconds; P = .18; improved SIS, 1%; 95% CI, −12% to 13%; P = .54; ASAP vs UCC: WMFT, −0.6 seconds, 95% CI, −3.8 to 2.6 seconds; P = .72; improved SIS, 4%; 95% CI, −9% to 16%; P = .48; and DEUCC vs UCC: WMFT, −2.1 seconds; 95% CI, −4.5 to 0.3 seconds; P = .08; improved SIS, 3%; 95% CI, −9% to 15%; P = .22). A total of 168 serious adverse events occurred in 109 participants, resulting in 8 patients withdrawing from the study. CONCLUSIONS AND RELEVANCE Among patients with motor stroke and primarily moderate upper extremity impairment, use of a structured, task-oriented rehabilitation program did not significantly improve motor function or recovery beyond either an equivalent or a lower dose of UCC upper extremity rehabilitation. These findings do not support superiority of this program among patients with motor stroke and primarily moderate upper extremity impairment. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00871715 PMID:26864411

  9. Effectiveness of Stellate Ganglion Block Under Fuoroscopy or Ultrasound Guidance in Upper Extremity CRPS

    PubMed Central

    Imani, Farnad; Hemati, Karim; Kazemi, Mohamad Reza; Hejazian, Kokab

    2016-01-01

    Introduction Stellate Ganglion Block (SGB) is an effective technique which may be used to manage upper extremities pain due to Chronic Regional Pain Syndrome (CRPS), in this study we tried to evaluate the effectiveness of this procedure under two different guidance for management of this syndrome. Aim The purpose of this study was to evaluate the effectiveness of ultrsound guide SGB by comparing it with the furoscopy guided SGB in upper extermities CRPS patients in reducing pain & dysfuction of the affected link. Materials and Methods Fourteen patients with sympathetic CRPS in upper extremities in a randomized method with block randomization divided in two equal groups (with ultrasound or fluoroscopic guidance). First group was blocked under fluoroscopic guidance and second group blocked under ultrasound guidance. After correct positioning of the needle, a mixture of 5 ml bupivacaine 0.25% and 1 mL of triamcinolone was injected. Results These data represent no meaningful statistical difference between the two groups in terms of the number of pain attacks before the blocks, a borderline correlation between two groups one week and one month after the block and a significant statistical correlation between two groups three month after the block. These data represent no meaningful statistical difference between the patients of any group in terms of the pain intensity (from one week to six months after block), p-value = 0.61. These data represent a meaningful statistical difference among patients of any group and between the two groups in terms of the pain intensity (before the block until six months after block), p-values were 0.001, 0.031 respectively. Conclusion According the above mentioned data, in comparison with fluoroscopic guidance, stellate ganglion block under ultrasound guidance is a safe and effective method with lower complication and better improvement in patient’s disability indexes. PMID:26894152

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

    PubMed Central

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

    2010-01-01

    Introduction Breast-cancer-related lymphedema affects ?25% of breast cancer (BC) survivors and may impact use of the upper limb during activity. The purpose of this study is to compare upper extremity (UE) impairment and activity between women with and without lymphedema after BC treatment. Methods 144 women post BC treatment completed demographic, symptom, and Disability of Arm-Shoulder-Hand (DASH) questionnaires. Objective measures included Purdue pegboard, finger-tapper, Semmes-Weinstein monofilaments, vibration perception threshold, strength, range of motion (ROM), and volume. Results Women with lymphedema had more lymph nodes removed (p?upper arm (p?

  11. Effect of Wrist Joint Restriction on Forearm and Shoulder Movement during Upper Extremity Functional Activities

    PubMed Central

    Jung, Hye-Young; Chang, Moonyoung; Kim, Kyeong-Mi; Yoo, Wongyu; Jeon, Byoung-Jin; Hwang, Gi-Chul

    2013-01-01

    [Purpose] This study measured %isolation and investigated whether it shows a difference between the presence and absence of wrist joint restriction, as well as changes in muscle activity patterns. [Methods] Twenty subjects performed upper extremity functional movement in the Manual Function Test (MFT) with and without wrist restriction, and the muscle activities of the trapezius, middle deltoid, biceps brachii, triceps brachii, extensor carpi radialis, and flexor carpi radialis were recorded. When there were differences in muscle activation, %isolation was implemented and the changes in the muscle activity patterns were noted. [Results] In the grasping and pinching tasks, there was a significant increase in %isolation of the upper trapezius and a significant decrease in %isolation of the extensor carpi radialis. Carrying a cube task, %isolation of the upper trapezius and middle deltoid significantly increased, whereas %isolation of the triceps brachii and extensor carpi radialis significantly decreased. In the pegboard task, the %isolation values of the extensor carpi radialis and flexor carpi radialis significantly decreased. [Conclusion] The data of this study should be useful for therapists, who can employ the information as material for the education and treatment of patients with wrist joint restriction. Therapists may thus look for ways to improve the quality of mobility by predicting the complement mobility depending on the activity performed and then determine whether to facilitate or restrict mobility. PMID:24396200

  12. A Multi-Class Proportional Myocontrol Algorithm for Upper Limb Prosthesis Control: Validation in Real-Life Scenarios on Amputees.

    PubMed

    Amsuess, Sebastian; Goebel, Peter; Graimann, Bernhard; Farina, Dario

    2015-09-01

    Functional replacement of upper limbs by means of dexterous prosthetic devices remains a technological challenge. While the mechanical design of prosthetic hands has advanced rapidly, the human-machine interfacing and the control strategies needed for the activation of multiple degrees of freedom are not reliable enough for restoring hand function successfully. Machine learning methods capable of inferring the user intent from EMG signals generated by the activation of the remnant muscles are regarded as a promising solution to this problem. However, the lack of robustness of the current methods impedes their routine clinical application. In this study, we propose a novel algorithm for controlling multiple degrees of freedom sequentially, inherently proportionally and with high robustness, allowing a good level of prosthetic hand function. The control algorithm is based on the spatial linear combinations of amplitude-related EMG signal features. The weighting coefficients in this combination are derived from the optimization criterion of the common spatial patterns filters which allow for maximal discriminability between movements. An important component of the study is the validation of the method which was performed on both able-bodied and amputee subjects who used physical prostheses with customized sockets and performed three standardized functional tests mimicking daily-life activities of varying difficulty. Moreover, the new method was compared in the same conditions with one clinical/industrial and one academic state-of-the-art method. The novel algorithm outperformed significantly the state-of-the-art techniques in both subject groups for tests that required the activation of more than one degree of freedom. Because of the evaluation in real time control on both able-bodied subjects and final users (amputees) wearing physical prostheses, the results obtained allow for the direct extrapolation of the benefits of the proposed method for the end users. In conclusion, the method proposed and validated in real-life use scenarios, allows the practical usability of multifunctional hand prostheses in an intuitive way, with significant advantages with respect to previous systems. PMID:25296406

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

    PubMed

    Haddad, Heba; Rotblatt, Michael

    2015-02-01

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

  14. [Normal D-dimer in two patients with pacemaker and deep venous thrombosis in an upper extremity].

    PubMed

    Byrne, Christina; Abdulla, Jawdat; Christensen, Jan Kim

    2015-01-26

    Danish guidelines recommend the use of D-dimer to exclude deep venous thrombosis (DVT) in the lower extremities. However, guidelines are lacking for DVT in the upper extremities. We describe two young women with transvenous pacemaker electrodes and symptomatic DVT in related veins. Despite a normal D-dimer, DVT was verified by colour Doppler ultrasound in both cases. The guidelines of American College of Chest Physicians recommend initial evaluation using colour Doppler ultrasound as front-line examination. Accordingly, we suggest a similar revision of Danish guidelines incorporating upper extremity DVT as well. PMID:25612945

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

    PubMed Central

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

    2014-01-01

    ABSTRACT Purpose: To examine the reliability, validity, and sensitivity to change of the 20-item version and the Rasch-refined 15-item version of the Upper Extremity Functional Index (UEFI-20 and UEFI-15, respectively) and to determine the impact of arm dominance on the positive minimal clinically important difference (pMCID). Methods: Adults with upper-extremity (UE) dysfunction completed the UEFI-20, Upper Extremity Functional Scale (UEFS), Pain Limitation Scale, and Pain Intensity Scale at their initial physiotherapy assessment (Time 1); 2448 hours later (Time 2); and 3 weeks into treatment or at discharge, whichever came first (Time 3). Demographics, including working status, were obtained at Time 1. Global ratings of change (GRC) were provided by the treating physiotherapist and patient at Time 3. The UEFI-15 was calculated from relevant items in the UEFI-20. The intra-class correlation coefficient (ICC) and minimal detectable change (MDC) quantified testretest reliability (Time 1Time 2). Cross-sectional convergent validity was determined by the association (Pearson's r) between Time 1 measures of function and pain. Known-groups validity was evaluated with a one-way ANOVA across three levels of working status. Longitudinal validity was determined by the association (Pearson's r) between function and pain change scores (Time 1Time 3). Receiver operating characteristic (ROC) curves estimated the pMCID using Time 1Time 3 change scores and average patient/therapist GRC. Results: Reliability for the UEFI-20 and UEFI-15 was the same (ICC=0.94 for both measures). MDC values were 9.4/80 for the UEFI-20 and 8.8/100 for the UEFI-15. Cross-sectional, known-groups, and longitudinal validity were confirmed for both UEFI measures. pMCID values were 8/80 for the UEFI-20 and 6.7/100 for the UEFI-15; pMCID was higher for people whose non-dominant arm was affected. Conclusions: Both UEFI measures show acceptable reliability and validity. Arm dominance affects pMCID. The UEFI-15 is recommended because it measures only one dimension: UE function. PMID:25125777

  16. [Variations in the intraoral electromotive force in the electrotherapy of the upper extremities].

    PubMed

    Patra?, E; Vataman, M; Sorin, A; Patra?, A

    1995-01-01

    We tested the intraoral microwaves under applied electrotherapy in cephalic neuralgia. The tests have been undertaken on 40 patients divided in 4 groups, according to the nature of the metallic components of the prosthetic appliances. There have been withdrawn practical conclusions regarding fixed prosthesis and the use of electrotherapy in the cephalic neuralgia. PMID:9455353

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

    PubMed

    Tenenbaum, Tobias; Niessen, Johanna; Schroten, Horst

    2016-01-01

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

  18. Feasibility of high-repetition, task-specific training for individuals with upper-extremity paresis.

    PubMed

    Waddell, Kimberly J; Birkenmeier, Rebecca L; Moore, Jennifer L; Hornby, T George; Lang, Catherine E

    2014-01-01

    OBJECTIVE. We investigated the feasibility of delivering an individualized, progressive, high-repetition upper-extremity (UE) task-specific training protocol for people with stroke in the inpatient rehabilitation setting. METHOD. Fifteen patients with UE paresis participated in this study. Task-specific UE training was scheduled for 60 min/day, 4 days/wk, during occupational therapy for the duration of a participant's inpatient stay. During each session, participants were challenged to complete ?300 repetitions of various tasks. RESULTS. Participants averaged 289 repetitions/session, spending 47 of 60 min in active training. Participants improved on impairment and activity level outcome measures. CONCLUSION. People with stroke in an inpatient setting can achieve hundreds of repetitions of task-specific training in 1-hr sessions. As expected, all participants improved on functional outcome measures. Future studies are needed to determine whether this high-repetition training program results in better outcomes than current UE interventions. PMID:25005508

  19. Mental PracticeTriggered Electrical Stimulation in Chronic, Moderate, Upper-Extremity Hemiparesis After Stroke

    PubMed Central

    Levine, Peter; Hill, Valerie

    2015-01-01

    OBJECTIVE. To determine the feasibility and impact of home-based, mental practicetriggered electrical stimulation among stroke survivors exhibiting moderate upper-extremity (UE) impairment. METHOD. Five participants with moderate, stable UE hemiparesis were administered the Fugl-Meyer Assessment, the Box and Block Test, and the Activities of Daily Living, Hand Function, and overall recovery domains of the Stroke Impact Scale (Version 3). They were then administered an 8-wk regimen consisting of 1 hr of mental practicetriggered electrical stimulation every weekday in their home. At the end of every 2 wk, participants attended supervised stimulation to progress therapeutic exercises and stimulation levels and monitor compliance. RESULTS. Six instances of device noncompliance were reported. Participants exhibited reduced UE motor impairment and increased UE dexterity and participation in valued activities. CONCLUSION. The regimen appears feasible and had a substantial impact on UE impairment, dexterity, and participation in valued activities as well as perceptions of recovery. PMID:25553754

  20. Review of supplemental views and stress radiography in musculoskeletal trauma: upper extremity.

    PubMed

    Friedman, Michael V; Smith, Chris; Hillen, Travis J; Baker, Jonathan C

    2015-10-01

    The standard radiographic series is not always sufficient to diagnose and characterize subtle musculoskeletal injuries. Missed or delayed diagnoses can negatively affect patient acute morbidity and long-term outcomes. Similarly, management based on erroneous diagnoses may lead to unnecessary treatment and restrictions. Body part or joint specific supplemental radiographic views and stress radiography offer an alternative for further evaluation of subtle injuries in specific clinical situations and may obviate the need for the added cost and potential ionizing radiation exposure of further cross-sectional imaging. Familiarity with these complementary exams allows radiologists to play an important role in patient care, as their utilization can improve diagnostic accuracy, clarify subtle or uncertain findings, and direct timely patient management. This review highlights important supplemental views and stress radiographic examinations useful in the evaluation of emergent upper extremity musculoskeletal trauma. PMID:25850394

  1. Upper extremity deep vein thrombosis (Paget-Schroetter syndrome) after surfing: a case report.

    PubMed

    Keene, David J

    2015-04-01

    This case report summarises the presentation of a 28-year-old female with signs and symptoms characteristic of thoracic outlet syndrome, but who was later found to have an effort-induced Upper Extremity Deep Vein Thrombosis (UEDVT), otherwise known as Paget-Schroetter syndrome. Effort-induced UEDVT is rare, but the similarity between the signs and symptoms of thoracic outlet syndrome and this type of thrombosis can result in patients with this condition presenting to musculoskeletal therapists. The key features of the case are described, followed by an overview of UEDVT and the importance of recognising this condition in musculoskeletal therapy practice. The role of therapists in referring for early medical diagnostics is key to ensuring management of the thrombosis is instigated early, therefore reducing the risk of life threatening consequences such as pulmonary embolism. PMID:25220111

  2. The influences of obesity and age on functional performance during intermittent upper extremity tasks.

    PubMed

    Cavuoto, Lora A; Nussbaum, Maury A

    2014-01-01

    In this study, the main and interactive effects of obesity and age on functional performance were assessed during intermittent exertions involving the upper extremity. The prevalence of obesity has doubled over the past 30 years and this increase is associated with higher health care costs, rates of workplace injury, and lost workdays. Obesity and aging can modify job demands and affect worker capacity in terms of muscular and psychomotor function. However, there is a lack of empirical studies quantifying the work-relevant (or ergonomic) impacts related to task demands, capacities, and their potential imbalance. Eight obese and eight non-obese participants from each of two age groups (18-25 and 50-65 years) completed three endurance tasks involving fixed levels of task demands: hand grip, shoulder flexion, and a simulated assembly task using the upper extremity. Measures of functional performance including endurance, discomfort, motor control, and task performance were recorded for each of the task conditions. Endurance times were ?60% longer for the non-obese group, and older participants had longer endurance times; however there was no evidence of interactive effects of obesity and age. Obesity also impaired functional performance, as indicated by higher rates of strength loss, increases in discomfort, and declines in task performance. These observed impairments may reflect underlying physiological differences among individuals who are obese, but that are independent of age. Obesity-related impairments may have implications for the design of work duration and demand level to prevent fatigue development for workers who are obese. PMID:24484265

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

    SciTech Connect

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

    2009-09-15

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

  4. Reliability, minimal detectable change, and normative values for tests of upper extremity function and power.

    PubMed

    Negrete, Rodney J; Hanney, William J; Kolber, Morey J; Davies, George J; Ansley, Megan K; McBride, Amanda B; Overstreet, Amber L

    2010-12-01

    The purpose of this study was to examine the test-retest reliability, minimal detectable change (MDC), and determine normative values of 3 upper extremity (UE) tests of function and power. One hundred eighty participants, men (n = 69) and women (n = 111), were tested on 3 UE strength and power maneuvers in a multicenter study to determine baseline normative values. Forty-six subjects returned for a second day of testing within 5 days of the initial assessment for the reliability component of the investigation. Explosive power was assessed via a seated shot-put test for the dominant and nondominant arms. Relationships between the dominant and nondominant arms were also analyzed. A push-up and modified pull-up were performed to measure the amount of work performed in short (15-second) bursts of activity. The relationship between the push-up and modified pull-up was also determined. Analysis showed test-retest reliability for the modified pull-up, timed push-up, dominant single-arm seated shot-put tests, and nondominant single-arm seated shot-put tests to be intraclass correlation coefficient(3,1) 0.958, 0.989, 0.988, and 0.971, respectively. The MDC for both the push-up and modified pull-up was 2 repetitions. The MDCs for the shot put with the dominant arm and the nondominant arm were 17 and 18 in., respectively. The result of this study indicates that these field tests possess excellent reliability. Normative values have been identified, which require further validation. These tests demonstrate a practical and effective method to measure upper extremity functional power. PMID:21088548

  5. [The most common overuse injury syndromes of the upper extremity associated with work activity].

    PubMed

    Krapac, L

    2001-12-01

    Repetitive use of upper extremities, non-physiological body posture, especially of cervical spine, shoulders, lower arms, and fists are still present in modern technological processes. Innate deformities, weakness of connective tissue, accompanying morbidity (radicular symptoms, neuropathies, superior thoracic aperture syndrome, vasopathies and neuroses) are significant pathogenic overuse syndromes. Other causes of overuse syndromes are non-ergonomic tools, musical instruments, furniture, or keyboards. Lack of training for jobs involving repetitive movements, as well as job dissatisfaction are additional aggravating factors of the overuse syndrome. Polypragmasy with drug and physical therapy, insufficient rehabilitation, and questionable medical prognosis of working capacity are challenges to public health of even in richer societies. This paper describes the most common overuse syndromes of upper extremities. The aetiology of reflex dystrophy syndrome, carpal tunnel, and myofascial painful syndrome are still insufficiently explained. The paper also presents data collected in a group of 40 metal workers exposed to significant shoulder strain. They more often reported pain in the cervical spine than the control group of workers under moderate strain (45% v. 7.5%; P < 0.01), as well as pain in the shoulders (12.5% v. 5.0%) and stiffened hand (22.5%:7.5%). Symptoms were significantly more frequent in the dominant hand. A common diagnosis in a sample of 110 musicians was a change in the shoulder joint, which was more distinct in the right shoulder (10%) than in the left (7%) and comparable in the elbows (8%). The paper proceeds with cases of advanced overuse syndrome in a textile worker and cases of dissimulation in a physician and a guitarist. The paper stresses the importance of quantification of morphological and functional changes in overuse syndromes and discusses the necessity of prevention, education, early diagnosis, pharmacological and physical therapy, and rehabilitation of overuse syndromes. PMID:11831124

  6. Assessment of upper extremity function in multiple sclerosis: review and opinion.

    PubMed

    Kraft, George H; Amtmann, Dagmar; Bennett, Susan E; Finlayson, Marcia; Sutliff, Matthew H; Tullman, Mark; Sidovar, Matthew; Rabinowicz, Adrian L

    2014-09-01

    Upper extremity (UE) dysfunction may be present in up to ~80% of individuals with multiple sclerosis (MS), although its importance may be under-recognized relative to walking impairment, which is the hallmark symptom of MS. Upper extremity dysfunction affects independence and can impact the ability to use walking aids. Under-recognition of UE dysfunction may result in part from limited availability of performance-based and patient self-report measures that are validated for use in MS and that can be readily incorporated into clinical practice for screening and regularly scheduled assessments. In addition to the 9-Hole Peg Test, which is part of the Multiple Sclerosis Functional Composite, there are several performance-based measures that are generally used in the rehabilitation setting. These measures include the Box and Block Test, the Action Research Arm Test, the Test d'Evaluation de la performance des Membres Suprieurs des Personnes Ages, and the Jebsen-Taylor Test of Hand Function. Several of these measures were developed for use in stroke, although in contrast to stroke, which is characterized by unilateral dysfunction, UE impairment in MS is generally bilateral, and should be assessed as such. Similarly, patient-reported UE measures are available, including Disabilities of the Arm, Shoulder, and Hand (DASH) and its shorter version, QuickDASH, the Manual Ability Measure, and ABILHAND, although none has been psychometrically validated for MS. Recently, item response theory was used to develop a Neuro-QOL (Quality of Life) UE measure and a Patient-Reported Outcomes Measurement Information System UE measure; neither of these have demonstrated sensitivity to change, limiting their use for longitudinal assessment. Consequently, although work is still needed to develop and validate performance-based and patient-reported measures of UE function that are suitable for use in daily MS clinical practice, currently available UE measures can be recommended for incorporation into MS management, albeit with an understanding of their limitations. PMID:25295653

  7. Prosthesis Material

    NASA Technical Reports Server (NTRS)

    1995-01-01

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

  8. Prosthesis Material

    NASA Technical Reports Server (NTRS)

    1995-01-01

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

  9. Prosthesis Material

    NASA Technical Reports Server (NTRS)

    2004-01-01

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

  10. New biomechanical model for clinical evaluation of the upper extremity motion in subjects with neurological disorders: an application case.

    PubMed

    Lobo-Prat, Joan; Font-Llagunes, Josep M; Gmez-Prez, Cristina; Medina-Casanovas, Josep; Angulo-Barroso, Rosa M

    2014-08-01

    Cervical spinal cord injury and acquired brain injury commonly imply a reduction in the upper extremity 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 upper extremity 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 upper extremity motion during a reaching task through data acquired by an optoelectronic system. In contrast to previous upper extremity 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 upper extremity motion, and allows comparing the motion of healthy and pathological cases. PMID:23181596

  11. Biomechanical Model for Evaluation of Pediatric Upper Extremity Joint Dynamics during Wheelchair Mobility

    PubMed Central

    Schnorenberg, Alyssa J.; Slavens, Brooke A.; Wang, Mei; Vogel, Lawrence; Smith, Peter; Harris, Gerald F.

    2014-01-01

    Pediatric manual wheelchair users (MWU) require high joint demands on their upper extremity (UE) during wheelchair mobility, leading them to be at risk of developing pain and pathology. Studies have examined UE biomechanics during wheelchair mobility in the adult population; however, current methods for evaluating UE joint dynamics of pediatric MWU are limited. An inverse dynamics model is proposed to characterize three-dimensional UE joint kinematics and kinetics during pediatric wheelchair mobility using a SmartWheel instrumented handrim system. The bilateral model comprises thorax, clavicle, scapula, upper arm, forearm, and hand segments and includes the sternoclavicular, acromioclavicular, glenohumeral, elbow and wrist joints. A single 17 year-old male with a C7 spinal cord injury (SCI) was evaluated while propelling his wheelchair across a 15-meter walkway. The subject exhibited wrist extension angles up to 60, large elbow ranges of motion and peak glenohumeral joint forces up to 10% body weight. Statistically significant asymmetry of the wrist, elbow, glenohumeral and acromioclavicular joints was detected by the model. As demonstrated, the custom bilateral UE pediatric model may provide considerable quantitative insight into UE joint dynamics to improve wheelchair prescription, training, rehabilitation and long-term care of children with orthopaedic disabilities. Further research is warranted to evaluate pediatric wheelchair mobility in a larger population of children with SCI to investigate correlations to pain, function and transitional changes to adulthood. PMID:24309622

  12. Biomechanical model for evaluation of pediatric upper extremity joint dynamics during wheelchair mobility.

    PubMed

    Schnorenberg, Alyssa J; Slavens, Brooke A; Wang, Mei; Vogel, Lawrence C; Smith, Peter A; Harris, Gerald F

    2014-01-01

    Pediatric manual wheelchair users (MWU) require high joint demands on their upper extremity (UE) during wheelchair mobility, leading them to be at risk of developing pain and pathology. Studies have examined UE biomechanics during wheelchair mobility in the adult population; however, current methods for evaluating UE joint dynamics of pediatric MWU are limited. An inverse dynamics model is proposed to characterize three-dimensional UE joint kinematics and kinetics during pediatric wheelchair mobility using a SmartWheel instrumented handrim system. The bilateral model comprises thorax, clavicle, scapula, upper arm, forearm, and hand segments and includes the sternoclavicular, acromioclavicular, glenohumeral, elbow and wrist joints. A single 17 year-old male with a C7 spinal cord injury (SCI) was evaluated while propelling his wheelchair across a 15-meter walkway. The subject exhibited wrist extension angles up to 60, large elbow ranges of motion and peak glenohumeral joint forces up to 10% body weight. Statistically significant asymmetry of the wrist, elbow, glenohumeral and acromioclavicular joints was detected by the model. As demonstrated, the custom bilateral UE pediatric model may provide considerable quantitative insight into UE joint dynamics to improve wheelchair prescription, training, rehabilitation and long-term care of children with orthopedic disabilities. Further research is warranted to evaluate pediatric wheelchair mobility in a larger population of children with SCI to investigate correlations to pain, function and transitional changes to adulthood. PMID:24309622

  13. Upper extremity deep vein thrombosis presenting to a chiropractic clinic: a description of 2 cases

    PubMed Central

    Stainsby, Brynne E.; Muir, Bradley J.; Miners, Andrew L.

    2012-01-01

    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 upper extremity 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. PMID:23843762

  14. Arterial Pressure Gradient of Upper Extremity Arteriovenous Access Steal Syndrome: Treatment Implications

    PubMed Central

    Reifsnyder, Thomas; Arnaoutakis, George J

    2011-01-01

    Purpose Treatment options after arteriovenous fistula(AVF) associated steal include: ligation, banding, and distal revascularization-interval ligation(DRIL). The purpose of this study was to evaluate arterial pressure gradients in upper extremity steal syndrome. Methods Pre-operative arteriography and sequential intra-arterial pressure readings were performed on consecutive AVF patients with hand ischemia. Analysis of variance(ANOVA) with repeated measures analyzed inter-subject comparisons, and post-hoc analysis identified anatomic locations with highest inflow pressures. Results Nine patients presented with ischemic hand symptoms after AVF. Pullback arterial pressure measurements revealed gradual increases in systolic and mean pressures as the catheter position was moved proximally from the AVF anastomosis. Post-hoc analysis after ANOVA revealed higher axillary artery systolic pressure compared to proximal brachial artery(153vs116.8,p=0.007). Conclusion AVF-related steal syndrome decreases arterial inflow pressure of the affected extremity more proximally than previously thought. When performing a DRIL procedure, consideration should be given to placing the anastomosis as proximally as possible. PMID:20675320

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

    NASA Astrophysics Data System (ADS)

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

    2014-12-01

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

  16. Hydrogen-dominated upper atmosphere of an exoplanet: Heating by stellar radiation from soft X-rays to extreme ultraviolet

    NASA Astrophysics Data System (ADS)

    Ionov, D. E.; Shematovich, V. I.

    2015-09-01

    A study is presented of how the upper atmosphere of a planet is heated by extreme radiation from the parent star, depending on the distribution of the radiation flux in the soft X-ray and extreme ultraviolet (EUV) ranges. Calculations are performed to find the efficiency of heating by stellar X-ray to EUV radiation in a hydrogen-dominated upper atmosphere for the extrasolar gas giant HD 209458b. It is shown that heating efficiency by extreme stellar UV radiation in a hydrogen-dominated upper atmosphere does not exceed 20-25% at the main thermospheric heights given that the calculation takes into account the photoelectron impact. It is found that an increase in the X-ray flux by several orders of magnitude leads to a slight decrease in the heating efficiency.

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

    SciTech Connect

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

    2013-04-15

    Induction of therapeutic angiogenesis by autologous bone marrow mononuclear cell transplantation has been identified as a potential new option in patients with advanced lower-limb ischemia. There is little evidence of the benefit of intra-arterial cell application in upper-limb critical ischemia. We describe a patient with upper-extremity critical limb ischemia with digital gangrene resulting from hypothenar hammer syndrome successfully treated by intra-arterial autologous bone marrow mononuclear cell transplantation.

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

    PubMed

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

    2015-11-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2013-01-01

    Introduction: One of the major challenges in the neuromuscular field has been lack of upper extremity outcome measures that can be useful for clinical therapeutic efficacy studies. Using vision-based sensor system and customized software, 3-dimensional (3D) upper extremity motion analysis can reconstruct a reachable workspace as a valid, reliable and sensitive outcome measure in various neuromuscular conditions where proximal upper extremity range of motion and function is impaired. Methods: Using a stereo-camera sensor system, 3D reachable workspace envelope surface area normalized to an individuals arm length (relative surface area: RSA) to allow comparison between subjects was determined for 20 healthy controls and 9 individuals with varying degrees of upper extremity dysfunction due to neuromuscular conditions. All study subjects were classified based on Brooke upper extremity function scale. Right and left upper extremity reachable workspaces were determined based on three repeated measures. The RSAs for each frontal hemi-sphere quadrant and total reachable workspaces were determined with and without loading condition (500 gram wrist weight). Data were analyzed for assessment of the developed system and validity, reliability, and sensitivity to change of the reachable workspace outcome. Results: The mean total RSAs of the reachable workspace for the healthy controls and individuals with NMD were significantly different (0.586 0.085 and 0.299 0.198 respectively; p<0.001). All quadrant RSAs were reduced for individuals with NMDs compared to the healthy controls and these reductions correlated with reduced upper limb function as measured by Brooke grade. The upper quadrants of reachable workspace (above the shoulder level) demonstrated greatest reductions in RSA among subjects with progressive severity in upper extremity impairment. Evaluation of the developed outcomes system with the Bland-Altman method demonstrated narrow 95% limits of agreement (LOA) around zero indicating high reliability. In addition, the intraclass correlation coefficient (ICC) was 0.97. Comparison of the reachable workspace with and without loading condition (wrist weight) showed significantly greater RSA reduction in the NMD group than the control group (p<0.012), with most of the workspace reduction occurring in the ipsilateral upper quadrant relative to the tested arm (p<0.001). Reduction in reachable workspace due to wrist weight was most notable in those subjects with NMD with marginal strength reserve and moderate degree of impairment (Brooke = 2) rather than individuals with mild upper extremity impairment (Brooke = 1) or individuals who were more severely impaired (Brooke =3). Discussion: The developed reachable workspace evaluation method using scalable 3D vision technology appears promising as an outcome measure system for clinical studies. A rationally-designed combination of upper extremity outcome measures including a region-specific global upper extremity outcome measure, such as the reachable workspace, complemented by targeted disease- or function-specific endpoints, may be optimal for future clinical efficacy trials. PMID:24459607

  1. An unusual complication of a myoelectric prosthesis.

    PubMed

    Selvarajah, K; Datta, D

    2001-12-01

    This clinical note describes an unusual and previously unreported complication of wearing a myoelectric prosthesis in a child with congenital upper limb deficiency. After an initial period of wearing a cosmetic prosthesis, he was provided with a child's trans-radial myoelectric prosthesis with a Steeper Scamp Electric hand at the age of 21 months. After successful and uncomplicated use of this prosthesis for 2 years--a sudden onset of burns of the skin of the stump underlying the single electrode site was noted. The cause of the burns was thought to be due to heat generated from electrical failure possibly from ingress of moisture. This complication has not before been experienced in the authors' centre, nor has it been reported in the literature. While constant improvements are being made in the field of electrically powered prosthesis, the rehabilitation team should be aware of this unusual complication. PMID:11860099

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

    PubMed

    Escamilla, Rafael F; Andrews, James R

    2009-01-01

    Understanding when and how much shoulder muscles are active during upper extremity sports is helpful to physicians, therapists, trainers and coaches in providing appropriate treatment, training and rehabilitation protocols to these athletes. This review focuses on shoulder muscle activity (rotator cuff, deltoids, pectoralis major, latissimus dorsi, triceps and biceps brachii, and scapular muscles) during the baseball pitch, the American football throw, the windmill softball pitch, the volleyball serve and spike, the tennis serve and volley, baseball hitting, and the golf swing. Because shoulder electromyography (EMG) data are far more extensive for overhead throwing activities compared with non-throwing upper extremity sports, much of this review focuses on shoulder EMG during the overhead throwing motion. Throughout this review shoulder kinematic and kinetic data (when available) are integrated with shoulder EMG data to help better understand why certain muscles are active during different phases of an activity, what type of muscle action (eccentric or concentric) occurs, and to provide insight into the shoulder injury mechanism. Kinematic, kinetic and EMG data have been reported extensively during overhead throwing, such as baseball pitching and football passing. Because shoulder forces, torques and muscle activity are generally greatest during the arm cocking and arm deceleration phases of overhead throwing, it is believed that most shoulder injuries occur during these phases. During overhead throwing, high rotator cuff muscle activity is generated to help resist the high shoulder distractive forces approximately 80-120% bodyweight during the arm cocking and deceleration phases. During arm cocking, peak rotator cuff activity is 49-99% of a maximum voluntary isometric contraction (MVIC) in baseball pitching and 41-67% MVIC in football throwing. During arm deceleration, peak rotator cuff activity is 37-84% MVIC in baseball pitching and 86-95% MVIC in football throwing. Peak rotator cuff activity is also high is the windmill softball pitch (75-93% MVIC), the volleyball serve and spike (54-71% MVIC), the tennis serve and volley (40-113% MVIC), baseball hitting (28-39% MVIC), and the golf swing (28-68% MVIC). Peak scapular muscle activity is also high during the arm cocking and arm deceleration phases of baseball pitching, with peak serratus anterior activity 69-106% MVIC, peak upper, middle and lower trapezius activity 51-78% MVIC, peak rhomboids activity 41-45% MVIC, and peak levator scapulae activity 33-72% MVIC. Moreover, peak serratus anterior activity was approximately 60% MVIC during the windmill softball pitch, approximately 75% MVIC during the tennis serve and forehand and backhand volley, approximately 30-40% MVIC during baseball hitting, and approximately 70% MVIC during the golf swing. In addition, during the golf swing, peak upper, middle and lower trapezius activity was 42-52% MVIC, peak rhomboids activity was approximately 60% MVIC, and peak levator scapulae activity was approximately 60% MVIC. PMID:19530752

  3. Retinal Prosthesis

    PubMed Central

    Weiland, James D.; Humayun, Mark S.

    2015-01-01

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

  4. Prosthesis Material

    NASA Technical Reports Server (NTRS)

    1995-01-01

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

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

    PubMed Central

    2014-01-01

    Objective The use of hand held devices (HHD) such as mobile phones, game controls, tablets, portable media players and personal digital assistants have increased dramatically in past decade. While sending a text message or using the controls of the HHD the users need to use their thumb and other palm muscles extensively. The objective of this study was to describe the risk factors and clinical features of the musculoskeletal disorders (MSDs) arising due to usage of hand held devices and to evaluate the effectiveness of a sequenced rehabilitation protocol. Methods A retrospective report analysis of 70 subjects, who were diagnosed to have a MSD affecting the upper extremities, was conducted. Medical charts from a tertiary level rehabilitation centre from 20052013 were analysed. All the subjects reported pain in their upper extremities following extensive usage of HHD and were examined and diagnosed to have a MSD by an orthopaedic and rehabilitation physician. After the assessment and diagnosis, all the patients underwent rehabilitation using a sequenced protocol. Results All the subjects reported pain in the thumb and forearm with associated burning, numbness and tingling around the thenar aspect of the hand, and stiffness of wrist and hand. 43 subjects had symptoms on the right side; 9 on left and 18 had bilateral symptoms. Correlation was found between hand dominance and MSD. 33 subjects complained of onset of symptoms following extensive text messaging. All the subjects were diagnosed to have tendinosis of Extensor Pollicis Longus and Myofascial Pain Syndrome affecting the 1st interossei, thenar group of muscles and Extensor Digitorum Communis. 23 of the subjects were senior executives, among these 7 were CEOs of major multinational companies in India. All the subjects recovered completely following the rehabilitation. Conclusions The study concluded that mobile phones and gadgets that promoted the predominant usage of thumb or only one finger while texting or using the controls were associated with a higher prevalence of MSDs. Treatment using a sequenced rehabilitation protocol was found to be effective. PMID:25852936

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

    PubMed Central

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

    2011-01-01

    Background Major trauma to the spinal cord or upper extremity often results in severe sensory and motor disturbances from injuries to the brachial plexus and its insertion into the spinal cord. Functional restoration with nerve grafting neurotization and tendon transfers is the mainstay of treatment. Results may be incomplete due to a limited supply of autologous material for nerve grafts. The factors deemed most integral for success are early surgical intervention, reconstruction of all levels of injury, and maximization of the number of axonal conduits per nerve repair. Objective To report the second series of nerve allograft transplantation using cadaveric nerve graft and our experience with living-related nerve transplants. Participants Eight patients, seven men and one woman, average age 23 years (range 18–34), with multi-level brachial plexus injuries were selected for transplantation using either cadaveric allografts or living-related donors. Methods Grafts were harvested and preserved in the University of Wisconsin Cold Storage Solution at 5°C for up to 7 days. The immunosuppressive protocol was initiated at the time of surgery and was discontinued at approximately 1 year, or when signs of regeneration were evident. Parameters for assessment included mechanism of injury, interval between injury and treatment, level(s) of deficit, post-operative return of function, pain relief, need for revision surgery, complications, and improvement in quality of life. Results Surgery was performed using living-related donor grafts in six patients, and cadaveric grafts in two patients. Immunosuppression was tolerated for the duration of treatment in all but one patient in whom early termination occurred due to non-compliance. There were no cases of graft rejection as of most recent follow-up. Seven patients showed signs of regeneration, demonstrated by return of sensory and motor function and/or a migrating Tinel's sign. One patient was non-compliant with the post-operative regimen and experienced minimal return of function despite a reduction in pain. Conclusions Despite the small number of subjects, it appears that nerve allograft transplantation may be performed safely, permitting non-prioritized repair of long-segment peripheral nerve defects and maximizing the number of axonal conduits per nerve repair. For patients with long, multi-level brachial plexus injuries or combined upper and lower extremity nerve deficits, the use of nerve allograft allows a more complete repair that may translate into greater functional restoration than autografting alone. PMID:21675363

  7. Risk factors for upper-extremity musculoskeletal disorders in the working population

    PubMed Central

    Roquelaure, Yves; Ha, Catherine; Rouillon, Clarisse; Fouquet, Natacha; Leclerc, Annette; Descatha, Alexis; Touranchet, Annie; Goldberg, Marcel; Imbernon, Ellen

    2009-01-01

    SUMMARY Objective The study aimed to assess the relative importance of personal and occupational risk factors for upper-extremity musculoskeletal disorders (UEMSDs) in the working population. Methods A total of 3,710 workers (58% of men) participating in a surveillance program of MSDs in a French region in 20022005 were included. UEMSDs were diagnosed by 83 trained occupational physicians performing a standardized physical examination. Personal factors and work exposure were assessed by a self-administered questionnaire. Statistical associations between MSDs, personal and occupational factors were analyzed using logistic regression modeling. Results A total of 472 workers suffered from at least one UEMSD. The risk of UEMSDs increased with age for both genders (P<0.001) (O.R. up to 4.9 in men and 5.0 and in women) and in cases of prior history of UEMSDs (OR 3.1 and 5.0, P<0.001). In men, UEMSDs were associated with obesity (OR 2.2, P=0.014), high level of physical demand (OR 2.0, P<0.001), high repetitiveness of the task (OR 1.5, P=0.027), postures with the arms at or above shoulder level (OR 1.7, P=0.009) or with full elbow flexion (OR 1.6, P=0.006), and high psychological demand (O.R. 1.5, P=0.005). In women, UEMSDs were associated with diabetes mellitus (O.R. 4.9, P=0.001), postures with extreme wrist bending (OR 2.0, P<0.001), use of vibrating hand tools (O.R. 2.2, P=0.025) and low level of decision authority (OR 1.4, P=0.042). Conclusion The study showed that personal and work-related physical and psychosocial factors were strongly associated with clinically-diagnosed UEMSDs. PMID:19790112

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

    PubMed Central

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

    2016-01-01

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

  9. Assessing upper extremity motor function in practice of virtual activities of daily living.

    PubMed

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

    2015-03-01

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

  10. Increase in upper extremity fractures in young male soccer players in the Netherlands, 1998-2009.

    PubMed

    de Putter, C E; van Beeck, E F; Burdorf, A; Borsboom, G J J M; Toet, H; Hovius, S E R; Selles, R W

    2015-08-01

    Young male soccer players have been identified as a target group for injury prevention, but studies addressing trends and determinants of injuries within this group are scarce. The goal of this study was to analyze age-specific trends in hospital-treated upper extremity fractures (UEF) among boys playing soccer in the Netherlands and to explore associated soccer-related factors. Data were obtained from a national database for the period 1998-2009. Rates were expressed as the annual number of UEF per 1000 soccer players. Poisson's regression was used to explore the association of UEF with the number of artificial turf fields and the number of injuries by physical contact. UEF rates increased significantly by 19.4% in boys 5-10?years, 73.2% in boys 11-14?years, and 38.8% in boys 15-18?years old. The number of injuries by physical contact showed a significant univariate association with UEF in boys 15-18?years old. The number of artificial turf fields showed a significant univariate association with UEF in all age groups, and remained significant for boys aged 15-18?years in a multivariate model. This study showed an increase of UEF rates in boys playing soccer, and an independent association between artificial turf fields and UEF in the oldest boys. PMID:24990273

  11. Management of the spastic upper extremity in the neurologically impaired adult.

    PubMed

    Keenan, M A

    1988-08-01

    Spasticity that interferes with upper extremity function is common in adults following stroke, brain injury, or anoxia. During the period of neurologic recovery definitive surgical procedures are avoided. Techniques to temporarily reduce spasticity include the implantation of a MicroPort reservoir and catheter for repeated branchial plexus blocks and phenol nerve blocks, which provide longer lasting relief of noxious muscle tone. Percutaneous blocks of the musculocutaneous and recurrent median nerves and motor point blocks of the pectoralis major, the brachioradialis, and forearm flexor muscles are easily performed at bedside. The motor branch of the ulnar nerve can be injected surgically with phenol to diminish intrinsic spasticity. When neurologic recovery has plateaued, hand placement can be improved in many patients following proximal release of the brachioradialis muscle and lengthening of the biceps and branchialis tendons. Hand function is enhanced by fractional lengthening of spastic wrist and finger flexors. Intrinsic spasticity must be addressed at the same time by phenol block or intrinic release. When extensor function is lacking, a tenodesis of the wrist extensors is helpful. The thumb-in-palm deformity requires proximal release of the thenar muscles as well as lengthening of the flexor pollicis longus. Contracture releases in the nonfunctional arm improve hygiene and ease care. PMID:3042230

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

    Finley, Margaret; Combs, Stephanie

    2013-04-01

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

  14. Incidence and prevalence of upper-extremity musculoskeletal disorders. A systematic appraisal of the literature

    PubMed Central

    Huisstede, Bionka MA; Bierma-Zeinstra, Sita MA; Koes, Bart W; Verhaar, Jan AN

    2006-01-01

    Background A systematic appraisal of the worldwide incidence and prevalence rates of UEDs available in scientific literature was executed to gauge the range of these estimates in various countries and to determine whether the rates are increasing in time. Methods Studies that recruited at least 500 people, collected data by using questionnaires, interviews and/or physical examinations, and reported incidence or prevalence rates of the whole upper-extremity including neck, were included. Results No studies were found with regard to the incidence of UEDs and 13 studies that reported prevalence rates of UEDs were included. The point prevalence ranged from 1.653%; the 12-months prevalence ranged from 2.341%. One study reported on the lifetime prevalence (29%). We did not find evidence of a clear increasing or decreasing pattern over time. The case definitions for UEDs used in the studies, differed enormously. Therefore, it was not possible to pool the data. Conclusion There are substantial differences in reported prevalence rates on UEDs. Main reason for this is the absence of a universally accepted way of labelling or defining UEDs. If we want to make progress in this field, the first requirement is to agree on unambiguous terminology and classification of EUDs. PMID:16448572

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

    PubMed Central

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

    2015-01-01

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

  16. Bone multicentric epithelioid hemangioendothelioma of the lower and upper extremities with pulmonary metastases: A case report

    PubMed Central

    ZHANG, HUA; FU, YANBIAO; YE, ZHAOMING

    2015-01-01

    The present study reports a rare case of bone multicentric epithelioid hemangioendothelioma (EH) involving the upper and lower extremities simultaneously, with visceral involvement of the lung. Osteolytic lesions were first identified in the right distal femur and proximal tibia. Slight increased radionuclide uptake was observed in the right shoulder joint on bone scintigraphy, however, this was ignored, as no clinical symptoms were present. The patient was initially misdiagnosed with multifocal chondroblastoma, and an extra-articular curettage of lesions was performed in the proximal tibia and medial femoral condyle, which was filled with bone cement. The histopathological diagnosis was corrected post-operatively following immunohistochemical analysis, which indicated EH, and subsequently, an amputation of the right leg at thigh level was performed. In addition, multiple lytic lesions in the right shoulder joint and pulmonary metastases were identified on whole-body radiological examination. Radiotherapy was administered to the right shoulder joint, however, the patient refused chemotherapy or further surgery. At 15 months after the initial surgery, the patient currently remains alive. This case indicates that an improved understanding with regard to the clinical features of this disease may prevent misdiagnosis and improve EH treatment. PMID:26137035

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

    NASA Astrophysics Data System (ADS)

    Xiaoyong, Liu; Lei, Zhu; Yijun, Feng

    2016-03-01

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

  18. Subjective ratings of upper extremity exposures: inter-method agreement with direct measurement of exposures.

    PubMed

    Buchholz, Bryan; Park, Jung-Soon; Gold, Judith E; Punnett, Laura

    2008-07-01

    This study examined the agreement of subjective ratings of upper extremity 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

  19. Solitary necrobiotic xanthogranuloma of an upper extremity in association with multiple myeloma.

    PubMed

    Bain, E Eugene; Meehan, Shane A; Hale, Elizabeth K

    2014-05-01

    Necrobiotic xanthogranuloma (NXG) is an uncommon granulomatous disorder of unknown pathogenesis that often presents with yellowish plaques in a periorbital distribution. While a majority of cases are associated with an underlying paraproteinemia of the IgG kappa type, a much smaller number are found to be associated with an underlying multiple myeloma. We present a case of a 78-year-old male with an isolated lesion of NXG on his right upper extremity. Following his diagnosis of NXG, further investigation for underlying systemic disorders with serum immunofixation revealed a monoclonal IgG kappa immunoglobulin with an M-spike of 1.2 g/dL. A PET-CT demonstrated bone destruction in the left proximal fifth rib, left scapula, the anterior lumbar I (L1) vertebrae, the left lumbar III (L3) vertebrae posterior elements and possibly left sacrum. A bone marrow biopsy revealed 18 % plasma cells. With these findings he was diagnosed with stage I multiple myeloma. Though clinically unimpressive and atypical in location for NXG, early biopsy and diagnosis of this solitary lesion led to the discovery of his hematopoietic disorder. PMID:24809886

  20. Hand and upper extremity trauma in high-level instrumentalists: epidemiology and outcomes.

    PubMed

    Dawson, W J

    1996-01-01

    Hand and upper extremity injuries to the professional or serious amateur musician may cause significant disability and time away from one's instrument. This article reviewed 222 instrumentalists; 201 were followed to an end result of their injuries. 80% played strings or keyboard instruments. Sports or a direct fall were the most common causes of injury. The spectrum of diagnoses made was typical of hand trauma in general; fractures, sprains, muscle strains and lacerations were the most numerous. Final results after treatment in 201 patients included complete relief of symptoms in 137 (68.2%) and improvement in another 61 (30.3%). Return to performance was complete in 155 patients (77.1%) and in a modified fashion in 42 (20.9%). Only three performers had to stop playing as a result of trauma or it's sequelae. The 46 patients presenting with late sequelae of injury were less likely to achieve full restoration of function and complete return to musical activity than those who suffered acute trauma. Division of nerves or tendons, seen in 13 of 28 patients who sustained lacerations, was more likely to result in very long-term disability and/or incomplete recovery. PMID:24441687

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

    PubMed Central

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

    2015-01-01

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

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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

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

    ERIC Educational Resources Information Center

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

    2014-01-01

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

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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

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

    ERIC Educational Resources Information Center

    Gordon, Andrew M.

    2011-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  7. Outcomes of Botulinum Toxin Type A Injection Followed by Rehabilitation in Cases of Cerebral Palsy With Upper Extremity Involvement.

    PubMed

    Karaca, Burcu; nl, Ece; Kse, Gl?en; Gnen, Emel; akc?, Aytl

    2016-03-01

    We evaluated the efficiency of botulinum toxin type A injection followed by a rehabilitation program including individual therapy, group therapy, and occupational therapy in cases of cerebral palsy with upper extremity involvement. A total of 29 injections were performed on 25 patients, and the patients were placed on rehabilitation program. At 3-month and 6-month assessments, there was a significant improvement in lateral grip strength, 9 Hole Peg test, Upper Limb Physician's Rating Scale and pediatric functional independence measure total scores. There were significant decreases in active range of motion in elbow extension, supination, and wrist extension, and Modified Ashworth Scale in elbow flexion, elbow pronation, and wrist flexion at 6-week, 3-month, and 6-month assessments. Combination of group therapy with traditional therapy methods after injection is effective in cases of cerebral palsy with upper extremity involvement. PMID:26239492

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

    PubMed Central

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

    2015-01-01

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

  9. Stretch due to Penile Prosthesis Reservoir Migration

    PubMed Central

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

    2016-01-01

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

  10. Stretch due to Penile Prosthesis Reservoir Migration.

    PubMed

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

    2016-03-01

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

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

    SciTech Connect

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

    2003-04-15

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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  14. Upper extremity bioimpedance before and after treadmill testing in women post breast cancer treatment

    PubMed Central

    Smoot, Betty; Zerzan, Sarah; Krasnoff, Joanne; Wong, Josephine; Cho, Maria; Dodd, Marylin

    2014-01-01

    Research on the effect of cardiorespiratory (CR) exercise on upper extremity (UE) limb volume is limited in women with breast cancer-related lymphedema (BCRL). The aim of this study was to compare changes in UE volume immediately following a symptom-limited CR treadmill test in women with and without BCRL. As part of a cross-sectional study, 133 women post unilateral BC treatment completed symptom-limited treadmill testing. Bioimpedance spectroscopy (BIS) was used to measure UE resistance before and immediately following treadmill testing. Resistance ratios >1 (unaffected side/affected side) indicate greater volume in the affected limb. T-tests and repeated measures ANOVA were performed to evaluate differences between and within groups. Mean age was 56.2 years (SD 9.4); BMI was 26.13 kg m?2 (SD 5.04). For women with previously diagnosed BCRL (n = 63), the resistance ratio was 1.116 (SD 0.160) pre-treadmill and 1.108 (SD 0.155) post-treadmill. For women without BCRL (n = 70), the resistance ratio was 0.990 (SD 0.041) pre-treadmill and 1.001 (SD 0.044) post-treadmill. Resistance ratios for women with BCRL were higher than those for women without BCRL at both time points (main effect of group: p < 0.001). No main effects were found for time (p = 0.695). A statistically significant effect was found for the time-by-group interaction (p = 0.002). 78 % of the women with BCRL wore a compression garment during testing. Following testing, the women with BCRL demonstrated a non-statistically significant decrease in the resistance ratio, suggesting an immediate decrease in interlimb volume difference. The women without BCRL demonstrated an increase in the resistance ratio. PMID:25338320

  15. Soft-tissue sarcomas of the upper extremity: surgical treatment and outcome.

    PubMed

    Popov, Pentscho; Tukiainen, Erkki; Asko-Seljavaara, Sirpa; Huuhtanen, Riikka; Virolainen, Martti; Virkkunen, Pekka; Blomqvist, Carl

    2004-01-01

    The objective of this retrospective follow-up study was to evaluate the outcome of patients with soft-tissue sarcoma treated by the authors' protocol, which consists of a selective combination of conservative surgery and radiotherapy. Patients who relapsed were especially evaluated to improve treatment results. The authors examined 80 patients with local soft-tissue sarcoma in the upper extremity referred to their multidisciplinary group. Fifteen patients were referred for first or subsequent local recurrence, and 65 patients were treated for primary tumor. The goal of treatment was local control and preservation of a functional limb. Wide excision was attempted. If the margin was less than 2.5 cm, postoperative radiotherapy was administered. Eighty-five percent of the patients were treated by limb salvage. Thirty patients needed reconstructive procedures such as pedicled (20 patients) or free flaps (10 patients). No free flaps were lost. The 5-year disease-specific overall survival rate was 75 percent, the local recurrence-free survival rate was 79 percent, and the metastasis-free survival rate was 68 percent. In univariate analysis, prognostic factors for local recurrence were extracompartmental site; for development of metastases, large size and extracompartmental site; and for decreased disease-specific overall survival, large size and extracompartmental site. Intramuscular, cutaneous, and subcutaneous tumors had a 5-year local control rate of 100 percent, and extracompartmental tumors had a local control rate of 69 percent. Extracompartmental tumors clearly have the worst prognosis and should be the main target for improving treatment strategies. After exclusion of patients with inadequate treatment according to the authors' protocol, the local control rate at 5 years was 90 percent. Strict adherence to treatment protocol should be practiced. PMID:14707640

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

    PubMed Central

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

    2011-01-01

    Background: Collegiate baseball pitchers, as well as position players, exhibit increased humeral retrotorsion compared with individuals with no history of overhead sport participation. Whether the humeral retrotorsion plays a role in the development of throwing-related injuries that are prevalent in collegiate baseball pitchers is unknown. Hypotheses: Humeral retrotorsion will be significantly different in collegiate pitchers with throwing-related shoulder or elbow injury history compared with pitchers with no injury history. Humeral retrotorsion can also discriminate participants with and without shoulder or elbow injury. Study Design: Cross-sectional study. Methods: Comparisons of ultrasonographically-obtained humeral retrotorsion were made between 40 collegiate pitchers with and without history of throwing-related shoulder or elbow injury. The ability of humeral retrotorsion to discriminate injury history was determined from the receiver operating characteristic area under the curve. Results: Participants with an elbow injury history demonstrated a greater humeral retrotorsion limb difference (mean difference = 7.2, P = 0.027) than participants with no history of upper extremity injury. Participants with shoulder injury history showed no differences in humeral torsion compared with participants with no history of injury. Humeral retrotorsion limb difference exhibited a fair ability (receiver operating characteristic area under the curve = 0.74) to discriminate elbow injury history. Conclusions: Collegiate pitchers with a history of elbow injury exhibited a greater limb difference in humeral retrotorsion compared with pitchers with no history of injury. No differences in humeral retrotorsion variables were present in participants with and without shoulder injury history. Clinical Relevance: Baseball players with a history of elbow injury demonstrated increased humeral retrotorsion, suggesting that the amount of retrotorsion and the development of elbow injury may be associated. PMID:23016031

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

    PubMed

    Schaefer, S Y; Hengge, C R

    2016-01-01

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

  18. Management of major penetrating glass injuries to the upper extremities in children and adolescents.

    PubMed

    Iconomou, T G; Zuker, R M; Michelow, B J

    1993-01-01

    Penetrating glass injuries are a common cause of severe neurovascular damage, both in adults and in children. Frequently, an innocent skin wound disguises the extensive nature of the injuries beneath. Nineteen children and adolescents (ages 3-16 years) with a mean age of 9 years who sustained upper extremity penetrating glass wounds were evaluated retrospectively in order (1) to determine the incidence of unappreciated significant neurologic, musculotendonous, or vascular injury; (2) to provide indications for intraoperative evaluation under anesthesia; and (3) to further define the role of microneurorrhaphy in this population. Twelve patients sustained injuries above the elbow and seven patients injuries distal to the elbow. Above the elbow, the structures injured in order of frequency were the median nerve (75%), the brachial artery (58%), the ulnar nerve (50%), the musculocutaneous nerve (33%), sensory nerves of the arm and forearm and venae commitantes (42% each), the radial nerve (25%), and the chords of the brachial plexus (8%). Distal to the elbow, the ulnar nerve was the most frequently involved (71%), followed by the ulnar artery (57%), the flexor carpi ulnaris (57%), the superficialis and profundus flexor tendons (43%), the median nerve (43%), and the palmaris longus and flexor carpi radialis (14% each). Early exploration is critical to successful management. Vascular repairs and or microneurorrhaphy were necessary in all cases. A detailed follow-up evaluation to assess the results of these repairs was carried out from 4 to 9 years postsurgery. There were no clinical problems related to the vascular reconstructions. The results of the nerve repairs in this small series of children and adolescents were remarkably good.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8469109

  19. Acceleration metrics are responsive to change in upper extremity function of stroke survivors

    PubMed Central

    Urbin, M.A.; Waddell, Kimberly J.; Lang, Catherine E.

    2015-01-01

    Objectives The primary purpose of this study was to determine if acceleration metrics derived from monitoring outside of treatment are responsive to change in upper extremity (UE) function. The secondary purposes were two-fold: The first was to compare metric values during task-specific training and while in the free-living environment. The second was to establish metric associations with an in-clinic measure of movement capabilities. Design Before-After Observational Study Setting Inpatient Hospital (primary purpose); Outpatient Hospital (secondary purpose) Participants Individuals (n=8) with UE hemiparesis < 30 days post stroke (primary purpose); Individuals (n=27) with UE hemiparesis ≥ 6 months post stroke (secondary purpose). Methods The inpatient sample was evaluated for UE movement capabilities and monitored with wrist-worn accelerometers for 22 hours outside of treatment before and after multiple sessions of task-specific training. The outpatient sample was evaluated for UE movement capabilities and monitored during a single session of task-specific training and the subsequent 22 hours outside of clinical settings. Main Outcome Measures Action Research Arm Test and acceleration metrics quantified from accelerometer recordings. Results Five metrics improved in the inpatient sample, along with UE function as measured on the ARAT: use ratio, magnitude ratio, variation ratio, median paretic UE acceleration magnitude, and paretic UE acceleration variability. Metric values were greater during task-specific training than in the free-living environment, and each metric was strongly associated with ARAT score. Conclusions Multiple metrics that characterize different aspects of UE movement are responsive to change in function. Metric values are different during training than in the free-living environment, providing further evidence that what the paretic UE does in the clinic may not generalize to what it does in everyday life. PMID:25497517

  20. Functional Measures Developed for Clinical Populations Identified Impairment Among Active Workers with Upper Extremity Disorders.

    PubMed

    Gardner, Bethany T; Dale, Ann Marie; Buckner-Petty, Skye; Rachford, Robert; Strickland, Jaime; Kaskutas, Vicki; Evanoff, Bradley

    2016-03-01

    Purpose Few studies have explored measures of function across a range of health outcomes in a general working population. Using four upper extremity (UE) case definitions from the scientific literature, we described the performance of functional measures of work, activities of daily living, and overall health. Methods A sample of 573 workers completed several functional measures: modified recall versions of the QuickDASH, Levine Functional Status Scale (FSS), DASH Work module (DASH-W), and standard SF-8 physical component score. We determined case status based on four UE case definitions: (1) UE symptoms, (2) UE musculoskeletal disorders (MSD), (3) carpal tunnel syndrome (CTS), and (4) work limitations due to UE symptoms. We calculated effect sizes for each case definition to show the magnitude of the differences that were detected between cases and non-cases for each case definition on each functional measure. Sensitivity and specificity analyses showed how well each measure identified functional impairments across the UE case definitions. Results All measures discriminated between cases and non-cases for each case definition with the largest effect sizes for CTS and work limitations, particularly for the modified FSS and DASH-W measures. Specificity was high and sensitivity was low for outcomes of UE symptoms and UE MSD in all measures. Sensitivity was high for CTS and work limitations. Conclusions Functional measures developed specifically for use in clinical, treatment-seeking populations may identify mild levels of impairment in relatively healthy, active working populations, but measures performed better among workers with CTS or those reporting limitations at work. PMID:26091980

  1. Muscle fatigue does not lead to increased instability of upper extremity repetitive movements

    PubMed Central

    Gates, Deanna H.; Dingwell, Jonathan B.

    2009-01-01

    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 upper extremity 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. PMID:19942220

  2. Evaluation of upper extremity robot-assistances in subacute and chronic stroke subjects

    PubMed Central

    2010-01-01

    Background Robotic systems are becoming increasingly common in upper extremity 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. PMID:20955566

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

    PubMed

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

    2015-11-01

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

  4. Evaluation of Upper Extremity Movement Characteristics during Standardized Pediatric Functional Assessment with a Kinect-Based Markerless Motion Analysis System

    PubMed Central

    Rammer, Jacob R.; Krzak, Joseph J.; Riedel, Susan A.; Harris, Gerald F.

    2015-01-01

    A recently developed and evaluated upper extremity (UE) markerless motion analysis system based on the Microsoft Kinect has potential for improving functional assessment of patients with hemiplegic cerebral palsy. 12 typically-developing adolescents ages 1217 were evaluated using both the Kinect-based system and the Shriners Hospitals for Children Upper Extremity Evaluation (SHUEE), a validated measure of UE motion. The study established population means of UE kinematic parameters for each activity. Statistical correlation analysis was used to identify key kinematic metrics used to develop automatic scoring algorithms. The Kinect motion analysis platform is technically sound and can be applied to standardized task-based UE evaluation while providing enhanced sensitivity in clinical analysis and automation through scoring algorithms. PMID:25570504

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

    PubMed Central

    Kim, Eung-beom; Kim, Young-dong

    2015-01-01

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

  6. Choosing a Breast Prosthesis

    MedlinePLUS

    ... shape, depending on a woman's preferences. Q: Why did you decide to wear a breast form/prosthesis ... could wear it with my prosthetic. Q: How did having a mastectomy and then wearing a prosthesis ...

  7. Short-Term Change of Handgrip Strength After Trigger Point Injection in Women With Muscular Pain in the Upper Extremities

    PubMed Central

    Lee, Soo Jin; Ahn, Dong Heun; Jung, Ji Hun; Kim, Yong Rok

    2014-01-01

    Objective To determine overall handgrip strength (HGS), we assessed the short-term change of HGS after trigger point injection (TPI) in women with muscular pain in the upper extremities by comparison with established pain scales. Methods The study enrolled 50 female patients (FMS with MPS group: 29 patients with combined fibromyalgia [FMS] and myofascial pain syndrome [MPS]; MPS group: 21 patients with MPS) who presented with muscular pain in the upper extremities at Konyang University Hospital. In addition, a total of 9 healthy women (control group) were prospectively enrolled in the study. We surveyed the three groups using the following established pain scales: the Fibromyalgia Impact Questionnaire (FIQ), the 36-Item Short Form Health Survey (SF-36), and the Short Form McGill Pain Questionnaire (MPQ). HGS was measured in both hands of study participants using a handgrip dynamometer. We performed TPI (0.5% lidocaine, total 10 mL, injected at the pain site of upper extremities). After 20 minutes, we remeasured the patient's HGS and MPQ score. Results ANOVA analysis was conducted among groups. Based on Tukey multiple comparison test, the majority of FIQ and SF-36 subscales, total FIQ and SF-36 scores, MPQ and HGS were significantly different between FMS with MPS and the other groups. There was no statistically significant difference between MPS and control groups. Higher HGS was positively associated with enhanced physical function, negatively associated with total FIQ and MPQ scores, and positively associated with the total SF-36 score calculated using Spearman correlation. Post-TPI MPQ decreased and HGS increased. In patient groups, a negative correlation was found between MPQ and HGS. Conclusion The HGS test might potentially be a complementary tool in assessing the short-term treatment effects of women with muscular pain in the upper extremities. PMID:24855619

  8. Age Differences in Energy Absorption in the Upper Extremity During a Descent Movement: Implications for Arresting a Fall

    PubMed Central

    Stotz, Paula J.; Normandin, Sarah C.; Robinovitch, Stephen N.

    2010-01-01

    Background Falls are the number one cause of unintentional injury in older adults. The protective response of breaking the fall with the outstretched hand is often essential for avoiding injury to the hip and head. In this study, we compared the ability of young and older women to absorb the impact energy of a fall in the outstretched arms. Methods Twenty young (mean age = 21 years) and 20 older (M = 78 years) women were instructed to slowly lower their body weight, similar to the descent phase of a push-up, from body lean angles ranging from 15 to 90. Measures were acquired of peak upper extremity energy absorption, arm deflection, and hand contact force. Results On average, older women were able to absorb 45% less energy in the dominant arm than young women (1.7 0.5% vs 3.1 0.4% of their body weight body height; p < .001). These results suggest that, even when both arms participate equally, the average energy content of a forward fall exceeds by 5-fold the average energy that our older participants could absorb and exceeds by 2.7-fold the average energy that young participants could absorb. Conclusions During a descent movement that simulates fall arrest, the energy-absorbing capacity of the upper extremities in older women is nearly half that of young women. Absorbing the full energy of a fall in the upper extremities is a challenging task even for healthy young women. Strengthening of upper extremity muscles should enhance this ability and presumably reduce the risk for injury to the hip and head during a fall. PMID:19861641

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

    ERIC Educational Resources Information Center

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

    2007-01-01

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

  10. Towards the development of a wearable feedback system for monitoring the activities of the upper-extremities

    PubMed Central

    2014-01-01

    Background Body motion data registered by wearable sensors can provide objective feedback to patients on the effectiveness of the rehabilitation interventions they undergo. Such a feedback may motivate patients to keep increasing the amount of exercise they perform, thus facilitating their recovery during physical rehabilitation therapy. In this work, we propose a novel wearable and affordable system which can predict different postures of the upper-extremities by classifying force myographic (FMG) signals of the forearm in real-time. Methods An easy to use force sensor resistor (FSR) strap to extract the upper-extremities FMG signals was prototyped. The FSR strap was designed to be placed on the proximal portion of the forearm and capture the activities of the main muscle groups with eight force input channels. The non-kernel based extreme learning machine (ELM) classifier with sigmoid based function was implemented for real-time classification due to its fast learning characteristics. A test protocol was designed to classify in real-time six upper-extremities postures that are needed to successfully complete a drinking task, which is a functional exercise often used in constraint-induced movement therapy. Six healthy volunteers participated in the test. Each participant repeated the drinking task three times. FMG data and classification results were recorded for analysis. Results The obtained results confirmed that the FMG data captured from the FSR strap produced distinct patterns for the selected upper-extremities postures of the drinking task. With the use of the non-kernel based ELM, the postures associated to the drinking task were predicted in real-time with an average overall accuracy of 92.33% and standard deviation of 3.19%. Conclusions This study showed that the proposed wearable FSR strap was able to detect eight FMG signals from the forearm. In addition, the implemented ELM algorithm was able to correctly classify in real-time six postures associated to the drinking task. The obtained results therefore point out that the proposed system has potential for providing instant feedback during functional rehabilitation exercises. PMID:24397984

  11. Effect of mirror therapy with tDCS on functional recovery of the upper extremity of stroke patients

    PubMed Central

    Cho, Hyuk-Shin; Cha, Hyun-gyu

    2015-01-01

    [Purpose] This study aimed to determine the effect of mirror therapy (MT) with transcranial direct current stimulation (tDCS) on the recovery of the upper extremity function of chronic stroke patients. [Subjects] Twenty-seven patients at least 6 months after stroke onset were divided randomly into an experimental group (14 patients) and a control group (13 patients). [Methods] All subjects received tDCS for 20?min followed by a 5?min rest. Then the experimental group received MT while the control group conducted the same exercises as the experimental group using a mirror that did not show the non-paretic upper extremity. The groups performed the same exercises for 20?min. All subjects received this intervention for 45-min three times a week for 6 weeks. [Results] After the intervention, the experimental group showed significant improvements in the box and block test (BBT), grip strength, and the Fugl-Meyer assessment (FMA), and a significant decrease in the Jebsen-Taylor test. The control group showed a significant increase in grip strength after the intervention, and a significant decrease in the Jebsen-Taylor test. Comparison of the result after the intervention revealed that the experimental group showed more significant increases in the BBT and grip strength than the control group. [Conclusion] These results show that MT with tDCS has a positive effect on the functional recovery of the upper extremity of stroke patients, through activating motor regions in the brain, and thus plays an important role in recovery of neuroplasticity. PMID:25995552

  12. Acute Limb Shortening for Major Near and Complete Upper Extremity Amputations with Associated Neurovascular Injury: A Review of the Literature.

    PubMed

    Kusnezov, Nicholas; Dunn, John C; Stewart, Jeremy; Mitchell, Justin S; Pirela-Cruz, Miguel

    2015-11-01

    In the setting a near or complete upper extremity amputations with significant soft tissue loss and neurovascular compromise, upper extremity surgeons are faced with the challenge of limb salvage. There are a multitude of treatment options for managing skeletal and soft tissue injuries including provisional fixation, staged reconstruction, and an acute shortening osteotomy with primary rigid internal fixation. However, many complications are associated with these techniques. Complications of provisional fixation include pin tract infection and loosening, tethering of musculotendinous units, nonunion, and additional surgeries. Staged reconstruction includes a variety of techniques: distraction osteogenesis, bone transport, or vascularized and non-vascularized structural autograft or allograft, but the risks often outweigh the benefits. Risks include nonunion, postoperative vascular complications necessitating reoperation, and the inability to return to the previous level of function at an average of 24 months. Acute shortening osteotomy with internal fixation offers the advantage of a single-stage procedure that provides for decreasing the soft tissue loss, provides a rigid platform to protect the delicate neurovascular repair, and alleviates unwanted tension at the repair sites. This review discusses the literature on the surgical treatment of severe upper extremity trauma with associated neurovascular injury over the past 75 years, and aims to evaluate the indications, surgical techniques, clinical and functional outcomes, and complications associated with acute shortening osteotomy with rigid internal fixation. Although this technique is not without risks, it is well-tolerated in the acute setting with a complication profile comparable to other techniques of fixation while remaining a single procedure. PMID:26792651

  13. A Synthesis of Best Evidence for the Restoration of Upper-Extremity Function in People with Tetraplegia

    PubMed Central

    Verrier, Mary C.

    2011-01-01

    ABSTRACT Purpose: Because upper-limb function represents overall function for individuals with tetraplegia, the restoration of upper-extremity function is exceedingly important for this population. The purpose of this review was to identify interventions that optimize upper-limb function after tetraplegia based on best available evidence. Methods: A search of MEDLINE, AMED, and PubMed with the search terms hand function AND tetraplegia and upper limb function AND tetraplegia found 384 articles. After elimination of duplicates and review of titles and abstracts, 43 studies were found to be applicable. Study quality of all applicable studies was assessed with a modified version of the Scottish Intercollegiate Guidelines Network for Cohort Studies methodology. Results: The applicable studies were organized into three categories: conventional therapies (CT), electrical stimulation therapies (ES), and surgical interventions (SI). The proportion of papers in each category that presented with sufficient methodological quality to contribute to best evidence was as follows: CT: 0/2; ES: 10/21; SI: 6/20. Conclusions: ES therapies are beneficial as assistive technologies and as therapeutic intervention in the subacute phase of recovery. SIs are suitable for individuals who meet very specific criteria for tendon-transfer surgery. Further clinical trials are warranted for ES and SI therapies to substantiate prescription of therapeutics. PMID:22942526

  14. Extreme Lateral Approach to Ventral and Ventrolaterally Situated Lesions of the Lower Brainstem and Upper Cervical Cord

    PubMed Central

    Kumar, C.V. Ravi; Satyanarayana, Satish; Rao, B. Ravi Mohan; Palur, Ravikanth S.

    2001-01-01

    Lesions situated ventrally and ventrolaterally to the lower brainstem and upper cervical spinal cord test the skills of neurosurgeons. We present our experience with eight such patients who underwent the extreme lateral craniocervical approach. The pathologies encountered include three distal vertebral aneurysms, one prepontine epidermoid, one anterior foramen magnum meningioma, and three high cervical dumbbell neurofibromas. All lesions were treated effectively. Postoperatively, the patients improved significantly. Complications included transient lower cranial nerve paresis in three patients, meningitis in one patient, and a pseudomeningocele in two patients. All complications improved with therapy. We conclude that the extreme lateral approach offers excellent visualization and access with minimal neural retraction for treating these difficult lesions. ImagesFigure 1Figure 2Figure 3Figure 4Figure 5Figure 6 PMID:17167629

  15. Right Aortic Arch with Aplasia of the Left Brachiocephalic Trunk Presented as Systolic Blood Pressure Difference Between Upper Extremities

    PubMed Central

    Babińska, Anna; Wawrzynek, Wojciech; Kukawska-Sysio, Karolina; Skupiński, Jarosław; Nowak, Patrycja

    2016-01-01

    Summary Background The right aortic arch with mirror-image of branching arteries without coexisting congenital heart disease is a very rare anomaly. Case Report We report a case of the right-sided aortic arch with aplasia of the left brachiocephalic trunk in a 64-year-old women, presenting difference in systolic blood pressure between upper extremities. The history of the patient and angio-CT findings were described and visualized with images. Conclusions The knowledge of vascular variations is important for the clinical and therapeutic aspects. PMID:26966474

  16. Placement of a Retrievable Guenther Tulip Filter in the Superior Vena Cava for Upper Extremity Deep Venous Thrombosis

    SciTech Connect

    Nadkarni, Sanjay; Macdonald, Sumaira; Cleveland, Trevor J.; Gaines, Peter A.

    2002-12-15

    A retrievable Guenther Tulip caval filter(William Cook, Europe) was successfully placed and retrieved in the superior vena cava for upper extremity deep venous thrombosis in a 56-year-old woman. Bilateral subclavian and internal jugular venous thromboses thought secondary to placement of multiple central venous catheters were present. There have been reports of the use of permanent Greenfield filters and a single case report of a temporary filter in the superior vena cava. As far as we are aware this is the first reported placement and successful retrieval of a filter in these circumstances.

  17. Effects of task-oriented training on upper extremity function and performance of daily activities in chronic stroke patients with impaired cognition

    PubMed Central

    Park, JuHyung

    2016-01-01

    [Purpose] This study aimed to determine the effects of task-oriented training on upper extremity function and performance of daily activities in chronic stroke patients with impaired cognition. [Subjects and Methods] In this study, 2 chronic hemiplegic stroke patients underwent task-oriented training. The training was conducted once a day for 30 minutes, 5 times/week, for 2 weeks. The patients were evaluated 3 times before and after the task-oriented training. Changes in upper extremity function were assessed using the manual function test, and changes in the ability to carry out daily activities were assessed using the functional independence measure. [Results] The patients showed improvement in both the upper extremity function and ability to perform daily activities after task-oriented training. [Conclusion] Task-oriented training was proven effective in improving upper extremity function and ability to perform daily activities in chronic hemiplegic stroke patients with impaired cognition. PMID:26957782

  18. Imaging of blunt arterial trauma of the upper extremity in children.

    PubMed

    Hodina, M; Gudinchet, F; Reinberg, O; Schnyder, P

    2001-08-01

    We report four patients with blunt arterial trauma of the upper limb following unusual mechanisms of injury in two patients (one fell on the handlebars of his bicycle, the second was crushed by a moving lawn mower) and due to bicycle accidents in two further patients. The use of digital subtraction angiography (DSA) in all patients, together with colour Doppler imaging (CDI) in one patient, provided optimum preoperative identification and localisation of the arterial lesions. PMID:11550768

  19. An important Norwegian contribution to the study of the bursae of the upper and lower extremities

    PubMed Central

    2010-01-01

    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), Rosenmller (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

  20. Age and gender effects on the proximal propagation of an impulsive force along the adult human upper extremity.

    PubMed

    Lee, Yunju; Ashton-Miller, James A

    2014-01-01

    We tested the null hypotheses that neither age, gender nor muscle pre-cocontraction state affect the latencies of changes in upper extremity kinematics or elbow muscle activity following an impulsive force to the hand. Thirty-eight healthy young and older adult volunteers lay prone on an apparatus with shoulders flexed 75 and arms slightly flexed. The non-dominant hand was subjected to three trials of impulsive loading with arm muscles precontracted to 25, 50, or 75% of maximum pre-cocontraction levels. Limb kinematic data and upper extremity electromyographic (EMG) activity were acquired. The results showed that pre-cocontraction muscle level (p < 0.001) and gender (p < 0.05 for wrist and shoulder) affected joint displacement onset times and age affected EMG onset times (p < 0.05). The peak applied force (F1) occurred a mean ( SD) 27 ( 2) ms after impact. The latencies for the wrist, elbow, and shoulder displacements were 21 3, 29 5, and 34 7 ms, respectively. Because the latencies for elbow flexion and lateral triceps EMG were 23 5 and 84 8 ms, respectively, muscle pre-activation rather than stretch reflexes prevent arm buckling under impulsive end loads. PMID:23979475

  1. Effects of adjustment of transcranial direct current stimulation on motor function of the upper extremity in stroke patients

    PubMed Central

    Lee, Dong-Geol; Lee, Dong-Yeop

    2015-01-01

    [Purpose] The purpose of this study was to examine the effects of transcranial direct current stimulation (tDCS) applied to the cerebral cortex motor area on the upper extremity functions of hemiplegic patients. [Subjects and Methods] Twenty four Patients with hemiplegia resulting from a stroke were divided into two groups: a tDCS group that received tDCS and physical therapy and a control group that received only physical therapy. A functional evaluation of the two groups was performed, and an electrophysiological evaluation was conducted before and after the experiment. Statistical analyses were performed to verify differences before and after the experiment. All statistical significance levels were set at 0.05. [Results] The results showed that functional evaluation scores for the elbow joint and hand increased after the treatment in both the experimental group and the control group, and the increases were statistically significantly different. [Conclusion] tDCS was effective in improving the upper extremity motor function of stroke patients. Additional research is warranted on the usefulness of tDCS in the rehabilitation of stroke patients in the clinical field. PMID:26696727

  2. Effects of adjustment of transcranial direct current stimulation on motor function of the upper extremity in stroke patients.

    PubMed

    Lee, Dong-Geol; Lee, Dong-Yeop

    2015-11-01

    [Purpose] The purpose of this study was to examine the effects of transcranial direct current stimulation (tDCS) applied to the cerebral cortex motor area on the upper extremity functions of hemiplegic patients. [Subjects and Methods] Twenty four Patients with hemiplegia resulting from a stroke were divided into two groups: a tDCS group that received tDCS and physical therapy and a control group that received only physical therapy. A functional evaluation of the two groups was performed, and an electrophysiological evaluation was conducted before and after the experiment. Statistical analyses were performed to verify differences before and after the experiment. All statistical significance levels were set at 0.05. [Results] The results showed that functional evaluation scores for the elbow joint and hand increased after the treatment in both the experimental group and the control group, and the increases were statistically significantly different. [Conclusion] tDCS was effective in improving the upper extremity motor function of stroke patients. Additional research is warranted on the usefulness of tDCS in the rehabilitation of stroke patients in the clinical field. PMID:26696727

  3. Risk Factors of Work-related Upper Extremity Musculoskeletal Disorders in Male Shipyard Workers: Structural Equation Model Analysis

    PubMed Central

    Park, Byung-Chan; Kim, Eun-A; Kim, Soo Geun

    2010-01-01

    Objectives This study was conducted to develop a model describing the interaction between lifestyle, job, and postural factors and parts of the upper extremities 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 upper extremity 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. PMID:22953172

  4. To constrain or not to constrain, and other stories of intensive upper extremity training for children with unilateral cerebral palsy.

    PubMed

    Gordon, Andrew M

    2011-09-01

    Impaired hand function is among the most functionally disabling symptoms of unilateral cerebral palsy. Evidence-based treatment approaches are generally lacking. However, recent approaches providing intensive upper extremity training appear promising. In this review, we first describe two such approaches, constraint-induced movement therapy (CIMT) and bimanual training (hand-arm bimanual intensive therapy). We then summarize findings across more than 100 participants in our CIMT/bimanual training studies since 1997. We show that (1) at high intensities, CIMT and bimanual training improve dexterity and bimanual upper extremity use; (2) bimanual training may allow direct practice of functionally meaningful goals, and such practice may transfer to unpracticed goals and improve bimanual coordination; (3) 90 hours of CIMT and bimanual training leads to greater improvements than 60 hours of the same treatments; (4) higher doses may be required for bimanual training; (5) increased dosing frequency and shaping may be needed for older children; and (6) combined CIMT/bimanual approaches may be useful, but require sufficient intensity. Together these findings suggest that dosage (treatment amount and frequency), more so than ingredients, may well be the key to successful training protocols, especially for older children. Such rehabilitation efforts should be 'child-friendly', and as least invasive as possible, especially because these approaches may be provided throughout development. PMID:21950396

  5. Upper Extremity-Specific Measures of Disability and Outcomes in Orthopaedic Surgery

    PubMed Central

    Smith, Matthew V.; Calfee, Ryan P.; Baumgarten, Keith M.; Brophy, Robert H.; Wright, Rick W.

    2012-01-01

    Outcome measures may consist of simple questions or they may be more complex instruments that evaluate multiple interrelated domains that influence patient function. Outcome measures should be relevant to patients, easy to use, reliable, valid, and responsive to clinical changes. The Disabilities of the Arm, Shoulder and Hand score can be used to measure disability for any region of the upper limb. Joint and disease-specific outcome measures have been developed for the shoulder, the elbow, and the wrist and hand. Many of these measures would benefit from further research into their validity, reliability, and optimal applicability. PMID:22298061

  6. The kinematics of trunk and upper extremities in one-handed and two-handed backhand stroke.

    PubMed

    St?pie?, Adam; Bober, Tadeusz; Zawadzki, Jerzy

    2011-12-01

    The aim of this study was to present kinematics of trunk and upper extremities 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 upper extremities 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. PMID:23486650

  7. Reinforced Feedback in Virtual Environment for Rehabilitation of Upper Extremity Dysfunction after Stroke: Preliminary Data from a Randomized Controlled Trial

    PubMed Central

    Kiper, Paweł; Luque-Moreno, Carlos; Tonin, Paolo

    2014-01-01

    Objectives. To study whether the reinforced feedback in virtual environment (RFVE) is more effective than traditional rehabilitation (TR) for the treatment of upper limb motor function after stroke, regardless of stroke etiology (i.e., ischemic, hemorrhagic). Design. Randomized controlled trial. Participants. Forty-four patients affected by stroke. Intervention. The patients were randomized into two groups: RFVE (N = 23) and TR (N = 21), and stratified according to stroke etiology. The RFVE treatment consisted of multidirectional exercises providing augmented feedback provided by virtual reality, while in the TR treatment the same exercises were provided without augmented feedbacks. Outcome Measures. Fugl-Meyer upper extremity scale (F-M UE), Functional Independence Measure scale (FIM), and kinematics parameters (speed, time, and peak). Results. The F-M UE (P = 0.030), FIM (P = 0.021), time (P = 0.008), and peak (P = 0.018), were significantly higher in the RFVE group after treatment, but not speed (P = 0.140). The patients affected by hemorrhagic stroke significantly improved FIM (P = 0.031), time (P = 0.011), and peak (P = 0.020) after treatment, whereas the patients affected by ischemic stroke improved significantly only speed (P = 0.005) when treated by RFVE. Conclusion. These results indicated that some poststroke patients may benefit from RFVE program for the recovery of upper limb motor function. This trial is registered with NCT01955291. PMID:24745024

  8. Superconductivity with extremely large upper critical fields in Nb2Pd0.81S5

    PubMed Central

    Zhang, Q.; Li, G.; Rhodes, D.; Kiswandhi, A.; Besara, T.; Zeng, B.; Sun, J.; Siegrist, T.; Johannes, M. D.; Balicas, L.

    2013-01-01

    Here, we report the discovery of superconductivity in a new transition metal-chalcogenide compound, i.e. Nb2Pd0.81S5, with a transition temperature Tc ? 6.6?K. Despite its relatively low Tc, it displays remarkably high and anisotropic superconducting upper critical fields, e.g. ?0Hc2 (T ? 0?K) > 37?T for fields applied along the crystallographic b-axis. For a field applied perpendicularly to the b-axis, ?0Hc2 shows a linear dependence in temperature which coupled to a temperature-dependent anisotropy of the upper critical fields, suggests that Nb2Pd0.81S5 is a multi-band superconductor. This is consistent with band structure calculations which reveal nearly cylindrical and quasi-one-dimensional Fermi surface sheets having hole and electron character, respectively. The static spin susceptibility as calculated through the random phase approximation, reveals strong peaks suggesting proximity to a magnetic state and therefore the possibility of unconventional superconductivity. PMID:23486091

  9. Influence of bench angle on upper extremity muscular activation during bench press exercise.

    PubMed

    Lauver, Jakob D; Cayot, Trent E; Scheuermann, Barry W

    2016-04-01

    This study compared the muscular activation of the pectoralis major, anterior deltoid and triceps brachii during a free-weight barbell bench press performed at 0°, 30°, 45° and -15° bench angles. Fourteen healthy resistance trained males (age 21.4 ± 0.4 years) participated in this study. One set of six repetitions for each bench press conditions at 65% one repetition maximum were performed. Surface electromyography (sEMG) was utilised to examine the muscular activation of the selected muscles during the eccentric and concentric phases. In addition, each phase was subdivided into 25% contraction durations, resulting in four separate time points for comparison between bench conditions. The sEMG of upper pectoralis displayed no difference during any of the bench conditions when examining the complete concentric contraction, however differences during 26-50% contraction duration were found for both the 30° [122.5 ± 10.1% maximal voluntary isometric contraction (MVIC)] and 45° (124 ± 9.1% MVIC) bench condition, resulting in greater sEMG compared to horizontal (98.2 ± 5.4% MVIC) and -15 (96.1 ± 5.5% MVIC). The sEMG of lower pectoralis was greater during -15° (100.4 ± 5.7% MVIC), 30° (86.6 ± 4.8% MVIC) and horizontal (100.1 ± 5.2% MVIC) bench conditions compared to the 45° (71.9 ± 4.5% MVIC) for the whole concentric contraction. The results of this study support the use of a horizontal bench to achieve muscular activation of both the upper and lower heads of the pectoralis. However, a bench incline angle of 30° or 45° resulted in greater muscular activation during certain time points, suggesting that it is important to consider how muscular activation is affected at various time points when selecting bench press exercises. PMID:25799093

  10. Two applications of end-to-side nerve neurorrhaphy in severe upper-extremity nerve injuries.

    PubMed

    Yüksel, Fuat; Peker, Fatih; Celiköz, Bahattin

    2004-01-01

    End-to-side and side-to-side techniques (what we call alternative nerve repair techniques) have been investigated in detail in both experimental and clinical studies. There have not been any large series, but only some case reports describing either successful or disappointing functional results in the recent literature. Two cases presented here were of two extreme examples of nerve injuries that had no chance for direct repair; alternative choices were performed. One was a side-to-side neurorrhaphy between the ulnar and median nerves, and the other was an end-to-side nerve repair of the median and radial nerves to the ulnar nerve. Both patients regained their diminished protective sensation and returned to their occupations. Based on these results and our review of the current literature, we consider alternative nerve repair techniques to be reasonable, prudent, and scientific choices for the treatment of some challenging nerve injury cases. PMID:15378581

  11. A kinematic analysis of an upper extremity ballistic skill: the windmill pitch.

    PubMed

    Alexander, M J; Haddow, J B

    1982-09-01

    The purposes of this study were (1) to determine the relative motions of the upper limb segments during the execution of the softball windmill pitch (2) to attempt to determine the effect of these motions on the performance of the skill. High speed motion picture film was used to calculate the kinematic parameters of the pitching arm segments during the pitch. Four highly-skilled pitchers were used as subjects. Each performed at least ten trials of the pitch, which were recorded by two motion picture cameras. The two trials with the fastest ball velocity for each of the four subjects were analyzed from a sagittal aspect only. The resulting kinematic analysis indicated that there was a definite proximal-to-distal sequence of these motions, with decelerations occurring in the proximal segments prior to release of the ball. It was concluded that one of the critical factors in highly-skilled performance of ballistic skills is the ability to decelerate such segments, which likely require very strong eccentric contractions of antagonistic muscle groups. PMID:7127656

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

    PubMed Central

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

    2013-01-01

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

  13. Bilateral ultrasound-guided supraclavicular block in a patient with severe electrocution injuries of the upper extremities.

    PubMed

    Gelpi, Brian; Telang, Pavan R; Samuelson, Christian G; Hamilton, Craig S; Billiodeaux, Seth

    2014-01-01

    The performance of bilateral supraclavicular brachial plexus nerve blocks is controversial. We present the challenging case of a 29-year-old male who suffered bilateral high-voltage electrocution injuries to the upper extremities, resulting in severe tissue damage, sensory and motor deficits, and wounds in both axillae. This injury necessitated bilateral below-elbow amputations. His postoperative course was complicated by pain refractory to intravenous narcotics. The decision was made to attempt bilateral supraclavicular brachial plexus blocks. Our concerns with this approach included the risks of pneumothorax and respiratory failure due to phrenic nerve block. Initial attempts at brachial plexus blockade using nerve stimulation were unsuccessful; therefore, ultrasound guidance was employed. With vigilant monitoring in an intensive care unit setting, we were able to safely perform bilateral continuous supraclavicular brachial plexus nerve blocks with an excellent analgesic response and no noted complications. PMID:25075596

  14. In-flight estimation of gyro noise on the Upper Atmosphere Research Satellite (UARS) and Extreme Ultraviolet Explorer (EUVE) missions

    NASA Technical Reports Server (NTRS)

    Lee, M.; Crouse, P.; Harman, R.; Leid, Terry; Davis, W.; Underwood, S.

    1994-01-01

    This paper characterizes the low-frequency noise response of the Teledyne dry rotor inertial reference unit (DRIRU) gyroscopes on the Upper Atmosphere Research Satellite (UARS) and the Extreme Ultraviolet Explorer (EUVE). The accuracy of spacecraft attitude estimation algorithms that use gyro data for propagating the spacecraft attitude is sensitive to gyro noise. EUVE gyro data were processed to validate a single-axis gyro noise model, which is used onboard various spacecraft. The paper addresses the potential impact of temperature effects on the gyro noise model and the overall impact on attitude determination accuracy. The power spectral density (PSD) of the gyro noise is estimated from UARS in-flight data by Fast Fourier Transform (FFT). The role of actuator dynamics on the PSD function is also discussed.

  15. Natural history of upper extremity musculoskeletal symptoms and resulting work limitations over 3 years in a newly hired working population

    PubMed Central

    Gardner, Bethany T.; Dale, Ann Marie; Descatha, Alexis; Evanoff, Bradley

    2014-01-01

    Objective To describe the proportions of workers with upper extremity (UE) symptoms and work limitations due to symptoms in a newly hired working population over a 3-year study period and to describe transitions between various outcome states. Methods 827 subjects completed repeat self-reported questionnaires including demographics, medical and work history, symptoms and work status. Outcomes of interest were UE symptoms and work limitations due to symptoms. Results 72% of workers reported symptoms at least once during the study, with 12% reporting persistent symptoms and 27% reporting fluctuating symptoms. 31% reported work limitations at least once, with 3% reporting consistent work limitations and 8% reporting fluctuating limitations. Conclusions UE symptoms and work limitations are common among workers and dynamic in their course. A better understanding of the natural course of symptoms is necessary for targeted interventions. PMID:24854251

  16. Motor impairments related to brain injury timing in early hemiparesis Part II: abnormal upper extremity joint torque synergies

    PubMed Central

    Sukal-Moulton, Theresa; Krosschell, Kristin J.; Gaebler-Spira, Deborah J.; Dewald, Julius P.A.

    2014-01-01

    Background Extensive neuromotor development occurs early in human life, and the timing of brain injury may affect the resulting motor impairment. In part I of this paper series it was demonstrated that the distribution of weakness in the upper extremity depended on the timing of brain injury in individuals with childhood-onset hemiparesis. Objective The goal of this study was to characterize how timing of brain injury impacts joint torque synergies, or losses of independent joint control. Method Twenty-four individuals with hemiparesis were divided into three groups based on the timing of their injury: before birth (PRE-natal, n=8), around the time of birth (PERI-natal, n=8) and after 6 months of age (POST-natal, n=8). Individuals with hemiparesis, as well as 8 typically developing peers participated in maximal isometric shoulder, elbow, wrist, and finger torque generation tasks while their efforts were recorded by a multiple degree-of-freedom load cell. Motor output in 4 joints of the upper extremity were concurrently measured during 8 primary torque generation tasks to quantify joint torque synergies. Results There were a number of significant coupling patterns identified in individuals with hemiparesis that differed from the typically developing group. POST-natal differences were most noted in the coupling of shoulder abductors with elbow, wrist, and finger flexors, while the PRE-natal group demonstrated significant distal joint coupling with elbow flexion. Conclusion The torque synergies measured provide indirect evidence for the use of bulbospinal pathways in the POST-natal group, while those with earlier injury may utilize relatively preserved ipsilateral corticospinal motor pathways. PMID:23911972

  17. Neuromusculoskeletal disorders in the neck and upper extremities among drivers of all-terrain vehicles a case series

    PubMed Central

    Rehn, Brje; Nilsson, Tohr; Jrvholm, Bengt

    2004-01-01

    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 upper extremities 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 upper extremities. 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. PMID:14718063

  18. The effect of enhanced trunk control on balance and falls through bilateral upper extremity exercises among chronic stroke patients in a standing position

    PubMed Central

    Shin, Ji Won; Don Kim, Kyoung

    2016-01-01

    [Purpose] This study examined the effects of bilateral upper extremity exercises on trunk control, balance, and risk of falls in stroke patients. [Subjects and Methods] A total of 30 study subjects were selected and randomly divided into experimental and control groups containing 15 subjects each, who received bilateral upper extremity activities and conventional rehabilitation treatment, respectively. [Results] There were statistically significant differences between groups in all sub-items and total trunk impairment and Berg Balance scale scores. Significant differences between groups were also observed in all sub-items of the trunk impairment scale, except for static sitting balance. [Conclusion] Bilateral upper extremity exercises are effective for trunk control and balance as well as for fall prevention. PMID:26957756

  19. Validation of a mechanism to balance exercise difficulty in robot-assisted upper-extremity rehabilitation after stroke

    PubMed Central

    2012-01-01

    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 upper extremity 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. PMID:22304989

  20. Potential compensation of hydrological extremes in headwaters: case study of upper Vltava River basin, umava Mts., Czechia

    NASA Astrophysics Data System (ADS)

    Kocum, Jan; Jansk, Bohumr.; ?esk, Julius

    2010-05-01

    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, umava 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.

  1. Computer game-based upper extremity training in the home environment in stroke persons: a single subject design

    PubMed Central

    2014-01-01

    Background The objective of the present study was to assess whether computer game-based training in the home setting in the late phase after stroke could improve upper extremity motor function. Methods Twelve subjects with prior stroke were recruited; 11 completed the study. Design The study had a single subject design; there was a baseline test (A1), a during intervention test (B) once a week, a post-test (A2) measured directly after the treatment phase, plus a follow-up (C) 16–18 weeks after the treatment phase. Information on motor function (Fugl-Meyer), grip force (GrippitR) and arm function in activity (ARAT, ABILHAND) was gathered at A1, A2 and C. During B, only Fugl-Meyer and ARAT were measured. The intervention comprised five weeks of game-based computer training in the home environment. All games were designed to be controlled by either the affected arm alone or by both arms. Conventional formulae were used to calculate the mean, median and standard deviations. Wilcoxon’s signed rank test was used for tests of dependent samples. Continuous data were analyzed by methods for repeated measures and ordinal data were analyzed by methods for ordered multinomial data using cumulative logistic models. A p-value of < 0.05 was considered statistically significant. Results Six females and five males, participated in the study with an average age of 58 years (range 26–66). FMA-UE A-D (motor function), ARAT, the maximal grip force and the mean grip force on the affected side show significant improvements at post-test and follow-up compared to baseline. No significant correlation was found between the amount of game time and changes in the outcomes investigated in this study. Conclusion The results indicate that computer game-based training could be a promising approach to improve upper extremity function in the late phase after stroke, since in this study, changes were achieved in motor function and activity capacity. PMID:24625289

  2. The Risk Factors for Failure of an Upper Extremity Replantation: Is the Use of Cigarettes/Tobacco a Significant Factor?

    PubMed Central

    He, Ji-Yin; Chen, Shih-Heng; Tsai, Tsu-Min

    2015-01-01

    Background The purpose of this study was to explore the potential risk factors associated with the failure of an upper extremity replantation with a focus on cigarette or tobacco use. Patients and Methods A cohort of 102 patients with 149 replants (6 extremities, 143 digits) and a mean age of 41 years (range 5 to 72 years) was enrolled in this study. The data collected included age, gender, tobacco/cigarettes use, trauma mechanism, underlying disease (e.g., hypertension (HTN), diabetes mellitus (DM), etc.), and vein graft use. An analysis with a multivariable regression was conducted to identify the risk factors of replant failure and their respective odds ratios (ORs). Results Multilevel generalized linear mixed models (GLMMs) with a binomial distribution and logit link showed that smoking did not increase the risk of replant failure (p = 0.234). In addition, the survival of replants was not affected by DM or HTN (p = 0.285 and 0.938, respectively). However, the replantation results were significantly affected by the age of the patients and the mechanism of injury. Patients older than 50 years and those with avulsion or crush injuries tended to have a higher risk of replant failure (OR = 2.29, 6.45, and 5.42, respectively; p = 0.047, 0.028, and 0.032, respectively). Conclusions This study showed that the use of cigarettes/tobacco did not affect the replantation outcome. The main risks for replant failure included being older than 50 years and the trauma mechanism (avulsion or crush injuries). PMID:26513147

  3. Neuromodulation of the cervical spinal cord in the treatment of chronic intractable neck and upper extremity pain: a case series and review of the literature.

    PubMed

    Vallejo, Ricardo; Kramer, Jeffery; Benyamin, Ramsin

    2007-03-01

    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 upper extremity 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 upper extremity 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 upper extremity 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 upper extremity pain. PMID:17387353

  4. Upper Extremity Radiography

    MedlinePLUS

    ... Society of Radiologic Technologists, 15000 Central Ave. SE, Albuquerque, NM 87123-3909, or visit us online at ... Americana de Tecnólogos Radiológicos, 15000 Central Ave. SE, Albuquerque, NM 87123-3909, o visítenos en la web ...

  5. Upper extremity wound management.

    PubMed

    Weeks, L E; Scheker, L R

    1990-07-01

    Many hand infections can produce permanent disability if not treated promptly and aggressively. Glass wounds and paint or grease gun injections can result in serious deep infections and often require immediate treatment in the operating room. The following common infections challenge the treating physician regarding their indications for surgical versus nonsurgical treatment. Caught early, infection of the nail fold (paronychia) responds to soaks in warm saline, oral antibiotics, and elevation of the affected part; in later stages, incision and drainage are necessary. Felons, subcutaneous abscess of a digit's distal pulp, must always be treated surgically, however. Herpetic whitlow, caused by herpes simplex, looks similar to other infections of the digit but pursues a self-limited course, resolving in 3 to 4 weeks; surgical treatment is strongly contraindicated. If erythema and drainage persist following proper treatment of hand infections, osteomyelitis should be ruled out with appropriate x-rays. PMID:2373947

  6. Effectiveness of workplace interventions in the prevention of upper extremity musculoskeletal disorders and symptoms: an update of the evidence.

    PubMed

    Van Eerd, D; Munhall, C; Irvin, E; Rempel, D; Brewer, S; van der Beek, A J; Dennerlein, J T; Tullar, J; Skivington, K; Pinion, C; Amick, B

    2016-01-01

    The burden of disabling musculoskeletal pain and injuries (musculoskeletal disorders, MSDs) arising from work-related causes in many workplaces remains substantial. There is little consensus on the most appropriate interventions for MSDs. Our objective was to update a systematic review of workplace-based interventions for preventing and managing upper extremity MSD (UEMSD). We followed a systematic review process developed by the Institute for Work & Health and an adapted best evidence synthesis. 6 electronic databases were searched (January 2008 until April 2013 inclusive) yielding 9909 non-duplicate references. 26 high-quality and medium-quality studies relevant to our research question were combined with 35 from the original review to synthesise the evidence on 30 different intervention categories. There was strong evidence for one intervention category, resistance training, leading to the recommendation: Implementing a workplace-based resistance training exercise programme can help prevent and manage UEMSD and symptoms. The synthesis also revealed moderate evidence for stretching programmes, mouse use feedback and forearm supports in preventing UEMSD or symptoms. There was also moderate evidence for no benefit for EMG biofeedback, job stress management training, and office workstation adjustment for UEMSD and symptoms. Messages are proposed for both these and other intervention categories. PMID:26552695

  7. Lateralization of cervical spinal cord activity during an isometric upper extremity motor task with functional magnetic resonance imaging.

    PubMed

    Weber, Kenneth A; Chen, Yufen; Wang, Xue; Kahnt, Thorsten; Parrish, Todd B

    2016-01-15

    The purpose of this study was to use an isometric upper extremity motor task to detect activity induced blood oxygen level dependent signal changes in the cervical spinal cord with functional magnetic resonance imaging. Eleven healthy volunteers performed six 5minute runs of an alternating left- and right-sided isometric wrist flexion task, during which images of the cervical spinal cord were acquired with a reduced field-of-view T2*-weighted gradient-echo echo-planar-imaging sequence. Spatial normalization to a standard spinal cord template was performed, and group average activation maps were generated in a mixed-effects analysis. The task activity significantly exceeded that of the control analyses. The activity was lateralized to the hemicord ipsilateral to the task and reliable across the runs at the group and subject level. Finally, a multi-voxel pattern analysis was able to successfully decode the left and right tasks at the C6 and C7 vertebral levels. PMID:26488256

  8. Rapid Responsiveness to Practice Predicts Longer-Term Retention of Upper Extremity Motor Skill in Non-Demented Older Adults

    PubMed Central

    Schaefer, Sydney Y.; Duff, Kevin

    2015-01-01

    Skill acquisition is a form of motor learning that may provide key insights into the aging brain. Although previous work suggests that older adults learn novel motor tasks slower and to a lesser extent than younger adults, we have recently demonstrated no significant effect of chronological age on the rates and amounts of skill acquisition, nor on its long-term retention, in adults over the age of 65. To better understand predictors of skill acquisition in non-demented older adults, we now explore the relationship between early improvements in motor performance due to practice (i.e., rapid responsiveness) and longer-term retention of an upper extremity motor skill, and whether the extent of rapid responsiveness was associated with global cognitive status. Results showed significant improvements in motor performance within the first five (of 150) trials, and that this “rapid responsiveness” was predictive of skill retention 1 month later. Notably, the extent of rapid responsiveness was not dependent on global cognitive status, as measured by the Montreal Cognitive Assessment (MoCA). Thus, rapid responsiveness appears to be an important variable in longer-term neurorehabilitative efforts with older adults, regardless of their cognitive status. PMID:26635601

  9. Investigation of the effects of mirror therapy on the upper extremity functions of stroke patients using the manual function test

    PubMed Central

    Kim, Hwanhee; Shim, Jemyung

    2015-01-01

    [Purpose] The purpose of this study was to investigate the effects of mirror therapy on the upper extremity functions of stroke patients. [Subjects] The subjects of this study were 14 hemiplegia patients (8 males, 6 females; 9 infarction, 5 hemorrhage; 8 right hemiplegia, 6 left hemiplegia) who voluntarily consented to participate in the study. [Methods] The Korean version of the manual function test (MFT) was used in this study. The test was performed in the following order: arm movement (4 items), grasp and pinch (2 items), and manipulation (2 items). The experiment was conducted with the subjects sitting in a chair. The mirror was vertically placed in the sagittal plane on the desk. The paretic hand was placed behind the mirror, and the non-paretic hand was placed in front of the mirror so that it was reflected in the mirror. In this position, the subjects completed activities repetitively according to the mirror therapy program over the course of four weeks. [Results] There were significant increases in the grasp-and-pinch score and manipulation score. [Conclusion] In conclusion, the grasp-and-pinch and manipulation functions were improved through mirror therapy. PMID:25642079

  10. Shoulder rotational strength, movement, pain and joint tenderness as indicators of upper-extremity activity limitation in moderate rheumatoid arthritis.

    PubMed

    Bostrm, C

    2000-09-01

    In this study 32 women were investigated in order to elucidate how shoulder rotational muscular strength and upper-extremity impairments are associated with activity limitation in moderate rheumatoid arthritis. A regression analysis was carried out to determine whether these variables could indicate the outcomes of a shoulder-arm disability questionnaire (SDQ) comprising three parts, plus parts of the Health Assessment Questionnaire, the Functional Status Questionnaire and the Sickness Impact Profile. Shoulder-arm and wrist movements were moderate-to-good (r = 0.53, p < 0.01 and r = 0.58, p < 0.01, respectively) in relation to isometric internal rotational strength. The relationship between isokinetic concentric and eccentric internal rotational strength was moderate-to-good (r = 0.59, p < 0.01). Isokinetic eccentric internal rotation strength, shoulder-arm movement, joint tenderness and pain variables together indicated 25-61% (adjusted R2) of the variation in SDQ. Eccentric strength had the highest adjusted R2 (41%) in relation to SDQ 1, covering mainly personal hygiene. Shoulder rotational strength did not indicate the more general instruments. Thus, hand and elbow impairments also are probably important in explaining activity limitations. PMID:11028798

  11. Evaluation of the JACO robotic arm: clinico-economic study for powered wheelchair users with upper-extremity disabilities.

    PubMed

    Maheu, Veronique; Frappier, Julie; Archambault, Philippe S; Routhier, Franois

    2011-01-01

    Many activities of daily living, such as picking up glasses, holding a fork or opening a door, which most people do without thinking, can become insurmountable for people who have upper extremity disabilities. The alternative to asking for human help is to use some assistive devices to compensate their loss of mobility; however, many of those devices are limited in terms of functionality. Robotics may provide a better approach for the development of assistive devices, by allowing greater functionality. In this paper, we present results of a study (n=31) which objectives were to evaluate the efficacy of a new joystick-controlled seven-degree of freedom robotic manipulator and assess its potential economic benefits. Results show that JACO is easy to use as the majority of the participants were able to accomplish the testing tasks on their first attempt. The economic model results inferred that the use of the JACO arm system could potentially reduce caregiving time by 41%. These study results are expected to provide valuable data for interested parties, such as individuals with disabilities, their family or caregivers. PMID:22275600

  12. Evaluating the effect of four different pointing device designs on upper extremity posture and muscle activity during mousing tasks.

    PubMed

    Lin, Michael Y C; Young, Justin G; Dennerlein, Jack T

    2015-03-01

    The goal of this study was to evaluate the effect of different types of computer pointing devices and placements on posture and muscle activity of the hand and arm. A repeated measures laboratory study with 12 adults (6 females, 6 males) was conducted. Participants completed two mouse-intensive tasks while using a conventional mouse, a trackball, a stand-alone touchpad, and a rollermouse. A motion analysis system and an electromyography system monitored right upper extremity postures and muscle activity, respectively. The rollermouse condition was associated with a more neutral hand posture (lower inter-fingertip spread and greater finger flexion) along with significantly lower forearm extensor muscle activity. The touchpad and rollermouse, which were centrally located, were associated with significantly more neutral shoulder postures, reduced ulnar deviation, and lower forearm extensor muscle activities than other types of pointing devices. Users reported the most difficulty using the trackball and touchpad. Rollermouse was not more difficult to use than any other devices. These results show that computer pointing device design and location elicit significantly different postures and forearm muscle activities during use, especially for the hand posture metrics. PMID:25479996

  13. Effect of spatial target reaching training based on visual biofeedback on the upper extremity function of hemiplegic stroke patients

    PubMed Central

    Kim, Chang-Yong; Lee, Jung-Sun; Lee, Jong-Hun; Kim, Yang-Gu; Shin, A-Reum; Shim, Young-Hun; Ha, Hyun Kun

    2015-01-01

    [Purpose] The aim of this study was to determine the effect of spatial target reaching training (TRT) based on visual biofeedback (VB) on the upper extremity (UE) function of hemiplegic subjects. [Subjects and Methods] Forty subjects between six and eighteen months post-stroke were enrolled in this study. They were randomly allocated to an experimental group (EG, n=20) and a control group (CG, n=20). All subjects received an hour of routine therapy for stroke three times a week for four weeks. Subjects in EG received additional spatial TRT based on VB using a 2-dimensional motion capture analysis system. Both groups were tested at pre and post-intervention. The motor function of each subject’s UE was assessed using the Fugl-Meyer (FM) test of UE and the Wolf Motor Function Test (WMFT). The reaching speed, angle and maximum reach distance were recorded using the motion capture analysis system. The experimental data were analyzed using the paired and independent t-tests. [Results] The mean change scores of the FM Test of UE and WMFT show there was significantly more improvement at post-intervention in EG than in CG. Also, the speed and angle reached showed significantly more increase in the EG compared with the CG. [Conclusions] The findings indicate that UE motor recovery of hemiplegic stroke patients can be enhanced through the use of TRT based on VB. PMID:25995564

  14. Evaluating the Impact of Player Experience in the Design of a Serious Game for Upper Extremity Stroke Rehabilitation.

    PubMed

    Cordeiro d'Ornellas, Marcos; Cargnin, Diego Joo; Cervi Prado, Ana Lcia

    2015-01-01

    Video games have become a major entertainment industry and one of the most popular leisure forms, ranging from laboratory experiments to a mainstream cultural medium. Indeed, current games are multimodal and multidimensional products, relying on sophisticated features including not only a narrative-driven story but also impressive graphics and detailed settings. All of these elements helped to create a seamless and appealing product that have resulted in a growing number of players and in the number of game genres. Although video games have been used in education, simulation, and training, another application that exploits serious gaming is the exploration of player experience in the context of game research. Recent advances in the natural user interfaces and player experience have brought new perspectives on the in-game assessment of serious games. This paper evaluates the impact of player experience in the design of a serious game for upper extremity stroke rehabilitation. The game combines biofeedback and mirror neurons both in single and multiplayer mode. Results have shown that the game is a feasible solution to integrate serious games into the physical therapy routine. PMID:26262072

  15. Kinesiology Taping reduces lymphedema of the upper extremity in women after breast cancer treatment: a pilot study

    PubMed Central

    Rosseger, Agnieszka; Hanuszkiewicz, Justyna; Woźniewski, Marek

    2014-01-01

    Introduction Secondary lymphedema affects approximately 40% of women treated for breast cancer and is recognized as a major problem associated with the therapy of malignant tumors. Consequently, new therapeutic methods are constantly being sought to effectively eliminate the condition. One of the new forms of edema management, especially in the initial stages of edematous development, is Kinesiology Taping (KT). Aim of the study The aim of the study was to assess the effects of KT applications on the extent of lymphedema of the upper extremity in women post cancer treatment. Material and methods The study group consisted of 28 women after axillary lymphadenectomy due to breast cancer. All the patients were diagnosed with grade I secondary lymphedema. Kinesiology Taping was applied to a total of 14 randomly selected women. The remaining 14 patients constituted a control group. The extent of lymphedema was measured using a centimeter tape and Limb Volumes Professional 5.0 software. Results A significant reduction in the extent of lymphedema (p = 0.0009) was achieved in the KT group between baseline and post-treatment assessments. No such reduction, however, was found in the control group (p = 0.36). Conclusions Kinesiology Taping applications are an effective method of early-stage edema management. Kinesiology Taping may be a safe new therapeutic option in patients who are contraindicated for the use of other methods. PMID:26327858

  16. Reliability of percutaneous intramuscular electrodes for upper extremity functional neuromuscular stimulation in adolescents with C5 tetraplegia.

    PubMed

    Smith, B T; Betz, R R; Mulcahey, M J; Triolo, R J

    1994-09-01

    Chronically indwelling percutaneous intramuscular electrodes were implanted in the upper extremity muscles of five adolescents with C5 or C5-6 tetraplegia in an effort to provide lateral and palmar prehension using the neuroprosthetic system designed by Case Western Reserve University. The responses from 177 electrodes were evaluated at 3-month intervals and included measurements of electrical impedance and an assessment of recruitment properties. Electrode failures were categorized as breakage, an altered stimulated response or adverse sensation during stimulation. Survival probabilities were generated for all electrodes, each muscle group, the volar and dorsal exit sites, intrinsic and extrinsic muscles, and according to the subjects' time postinjury. The overall probability of an electrode surviving to 6 months was 0.75 and the 1 year survival probability was 0.56. Among muscle groups, the finger extensor and thumb adductor electrodes had the highest proportion of failures and the poorest survival likelihoods within the first year after implant. According to the Breslow test, significantly smaller survival chances were predicted for electrodes exiting dorsally and for the newly-injured adolescents (< 1 year postinjury). The cumulative survival likelihoods of this study are smaller than those reported in adult applications using the same electrode design. Factors that may account for the disparate results are discussed. PMID:8085926

  17. Wireless wearable range-of-motion sensor system for upper and lower extremity joints: a validation study.

    PubMed

    Kumar, Yogaprakash; Yen, Shih-Cheng; Tay, Arthur; Lee, Wangwei; Gao, Fan; Zhao, Ziyi; Li, Jingze; Hon, Benjamin; Tian-Ma Xu, Tim; Cheong, Angela; Koh, Karen; Ng, Yee-Sien; Chew, Effie; Koh, Gerald

    2015-02-01

    Range-of-motion (ROM) assessment is a critical assessment tool during the rehabilitation process. The conventional approach uses the goniometer which remains the most reliable instrument but it is usually time-consuming and subject to both intra- and inter-therapist measurement errors. An automated wireless wearable sensor system for the measurement of ROM has previously been developed by the current authors. Presented is the correlation and accuracy of the automated wireless wearable sensor system against a goniometer in measuring ROM in the major joints of upper (UEs) and lower extremities (LEs) in 19 healthy subjects and 20 newly disabled inpatients through intra (same) subject comparison of ROM assessments between the sensor system against goniometer measurements by physical therapists. In healthy subjects, ROM measurements using the new sensor system were highly correlated with goniometry, with 95% of differences < 20 and 10 for most movements in major joints of UE and LE, respectively. Among inpatients undergoing rehabilitation, ROM measurements using the new sensor system were also highly correlated with goniometry, with 95% of the differences being < 20 and 25 for most movements in the major joints of UE and LE, respectively. PMID:26609398

  18. Changes in Resting State Effective Connectivity in the Motor Network Following Rehabilitation of Upper Extremity Poststroke Paresis

    PubMed Central

    James, G. Andrew; Lu, Zhong-Lin; VanMeter, John W.; Sathian, K.; Hu, Xiaoping P.; Butler, Andrew J.

    2013-01-01

    Background A promising paradigm in human neuroimaging is the study of slow (<0.1 Hz) spontaneous fluctuations in the hemodynamic response measured by functional magnetic resonance imaging (fMRI). Spontaneous activity (i.e., resting state) refers to activity that cannot be attributed to specific inputs or outputs, that is, activity intrinsically generated by the brain. Method This article presents pilot data examining neural connectivity in patients with poststroke hemiparesis before and after 3 weeks of upper extremity rehabilitation in the Accelerated Skill Acquisition Program (ASAP). Resting-state fMRI data acquired pre and post therapy were analyzed using an exploratory adaptation of structural equation modeling (SEM) to evaluate therapy-related changes in motor network effective connectivity. Results Each ASAP patient showed behavioral improvement. ASAP patients also showed increased influence of the affected hemisphere premotor cortex (a-PM) upon the unaffected hemisphere premotor cortex (u-PM) following therapy. The influence of a-PM on affected hemisphere primary motor cortex (a-M1) also increased with therapy for 3 of 5 patients, including those with greatest behavioral improvement. Conclusions Our findings suggest that network analyses of resting-state fMRI constitute promising tools for functional characterization of functional brain disorders, for intergroup comparisons, and potentially for assessing effective connectivity within single subjects; all of which have important implications for stroke rehabilitation. PMID:19740732

  19. Clinical evaluation of motion and position sense in the upper extremities of the elderly using motion analysis system

    PubMed Central

    Li, Kuan-yi; Wu, Yi-hui

    2014-01-01

    The purpose of this study was to measure kinesthetic accuracy in healthy older adults by using arm position and motion matching tests. We investigated the effect of task type, joint angle, and matching arm results on kinesthetic accuracy in the upper extremities of 17 healthy right-handed older adults. Blinded subjects were asked to match positions and motions at four reference joint angles: 1) shoulder flexion, 060; 2) elbow flexion, 90135; 3) wrist extension, 050 in the sagittal plane; and 4) shoulder abduction, 060 in the frontal plane. The absolute difference in angular displacement between the reference and matching arms was calculated to determine kinesthetic accuracy. Results showed that subjects were more accurate at matching motion than position tasks (P=0.03). Shoulder and elbow joints were more sensitive than wrist joints in perceiving passive positions and motions (P<0.05). The effect of the matching arm was found only when matching the joint angles of shoulder abduction and wrist extension (P<0.01). These results are comparable to findings of other studies that used machine-generated kinesthetic stimuli. The manual measurement of kinesthetic accuracy could be effective as a preliminary screening tool for therapists in clinical settings. PMID:25075181

  20. Effectiveness of workplace interventions in the prevention of upper extremity musculoskeletal disorders and symptoms: an update of the evidence

    PubMed Central

    Van Eerd, D; Munhall, C; Irvin, E; Rempel, D; Brewer, S; van der Beek, A J; Dennerlein, J T; Tullar, J; Skivington, K; Pinion, C; Amick, B

    2016-01-01

    The burden of disabling musculoskeletal pain and injuries (musculoskeletal disorders, MSDs) arising from work-related causes in many workplaces remains substantial. There is little consensus on the most appropriate interventions for MSDs. Our objective was to update a systematic review of workplace-based interventions for preventing and managing upper extremity MSD (UEMSD). We followed a systematic review process developed by the Institute for Work & Health and an adapted best evidence synthesis. 6 electronic databases were searched (January 2008 until April 2013 inclusive) yielding 9909 non-duplicate references. 26 high-quality and medium-quality studies relevant to our research question were combined with 35 from the original review to synthesise the evidence on 30 different intervention categories. There was strong evidence for one intervention category, resistance training, leading to the recommendation: Implementing a workplace-based resistance training exercise programme can help prevent and manage UEMSD and symptoms. The synthesis also revealed moderate evidence for stretching programmes, mouse use feedback and forearm supports in preventing UEMSD or symptoms. There was also moderate evidence for no benefit for EMG biofeedback, job stress management training, and office workstation adjustment for UEMSD and symptoms. Messages are proposed for both these and other intervention categories. PMID:26552695

  1. A study on the prevalence of upper extremity repetitive strain injuries among the handloom weavers of West Bengal.

    PubMed

    Banerjee, Prasun; Gangopadhyay, Somnath

    2003-06-01

    Handloom is one of the oldest cottage industries in India, particularly in West Bengal, where a considerable number of rural people are engaged in weaving. Purposes of the present investigation were to clarify the prevalence of repetitive strain injuries in upper extremities among the handloom weavers and to identify the risk factors leading to its development. Fifty male handloom weavers were randomly selected from the population. A questionnaire (Kourinka et al., 1987) method including Borg scale assessment of pain, checklist analyses of the work, and time-motion studies for analyzing the repetitiveness/non-repetitiveness of the job were implemented. The time-motion analyses demonstrated that weaving occupied over 50% of the work cycle time for majority of subjects, and thus could be regarded as a repetitive activity. Statistical analyses revealed a highly significant correlation between the intensity of pain feeling and the repetitiveness on one hand, and the year of experience as a weaver on the other. By contrast, no significant relationship was observed between chronological ages of weavers and the pain intensity. These results suggested that highly repetitive works engaged for a long time could increase the intensity of the pain felt and would lead to repetitive strain injuries. PMID:15176126

  2. [The esthetics of lower limb prosthesis].

    PubMed

    Gardrat, Franck

    2015-01-01

    The amputation, which is upper or lower limb, entails important consequences and often traumatic into subject amputee from a physical, psychological, interpersonal and social point of view. It acts on the body image unleashing different psychological disorders and alterations in the social and professional reality. The aesthetic prosthesis can be considered a good support to help the person regain a new body image of themselves, facilitating the process of physical rehabilitation and social integration. PMID:26731958

  3. High-Pressure Transvenous Perfusion of the Upper Extremity in Human Muscular Dystrophy: A Safety Study with 0.9% Saline.

    PubMed

    Fan, Zheng; Kocis, Keith; Valley, Robert; Howard, James F; Chopra, Manisha; Chen, Yasheng; An, Hongyu; Lin, Weili; Muenzer, Joseph; Powers, William

    2015-09-01

    We evaluated safety and feasibility of high-pressure transvenous limb perfusion in an upper extremity of adult patients with muscular dystrophy, after completing a similar study in a lower extremity. A dose escalation study of single-limb perfusion with 0.9% saline was carried out in nine adults with muscular dystrophies under intravenous analgesia. Our study demonstrates that it is feasible and definitely safe to perform high-pressure transvenous perfusion with 0.9% saline up to 35% of limb volume in the upper extremities of young adults with muscular dystrophy. Perfusion at 40% limb volume is associated with short-lived physiological changes in peripheral nerves without clinical correlates in one subject. This study provides the basis for a phase 1/2 clinical trial using pressurized transvenous delivery into upper limbs of nonambulatory patients with Duchenne muscular dystrophy. Furthermore, our results are applicable to other conditions such as limb girdle muscular dystrophy as a method for delivering regional macromolecular therapeutics in high dose to skeletal muscles of the upper extremity. PMID:25953425

  4. The effect of breast support and breast pain on upper-extremity kinematics during running: implications for females with large breasts.

    PubMed

    White, Jennifer; Mills, Chris; Ball, Nick; Scurr, Joanna

    2015-01-01

    The relationship between inappropriate breast support and upper-extremity kinematics for female runners is unclear. The purpose of this study was to investigate the effect of breast support and breast pain on upper-extremity kinematics during running. Eleven female recreational runners with larger breasts (UK D and E cup) completed a 7min 20s treadmill run (2.58m s(-1)) in a high and low breast support condition. Multi-planar breast and upper-extremity kinematic data were captured in each breast support condition by eight infrared cameras for 30s towards the end of the run. Breast pain was rated at the end of each treadmill run using a numeric analogue scale. The high support bra reduced breast kinematics and decreased breast pain (P<0.05). Upper-extremity kinematics did not differ between breast support conditions (P>0.05), although some moderate positive correlations were found between thorax range of motion and breast kinematics (r=0.54 to 0.73). Thorax and arm kinematics do not appear to be influenced by breast support level in female runners with large breasts. A high support bra that offers good multi-planar breast support is recommended for female runners with larger breasts to reduce breast pain. PMID:25793936

  5. Effects of a novel forced intensive strengthening technique on muscle size and upper extremity function in a patient with chronic stroke

    PubMed Central

    Jeong, Hee-won; Chon, Seung-chul

    2015-01-01

    [Purpose] This research demonstrated a forced intensive strength technique as a novel treatment for muscle power and function in the affected upper extremity muscle to determine the clinical feasibility with respect to upper extremity performance in a stroke hemiparesis. [Subject and Methods] The subject was a patient with chronic stroke who was dependent on others for performing the functional activities of his affected upper extremity. The technique incorporates a comprehensive approach of forced, intensive, and strength-inducing activities to enhance morphological changes associated with motor learning of the upper extremity. The forced intensive strength technique consisted of a 6-week course of sessions lasting 60 minutes per day, five times a week. [Results] After the 6-week intervention, the difference between relaxation and contraction of the affected extensor carpi radialis muscle increased from 0.28 to 0.63 cm2, and that of the affected triceps brachii muscle increased from 0.30 to 0.90 cm2. The results of clinical tests including the modified Ashworth scale (MAS; from 1+ to 1), muscle strength (from 15 to 32 kg), the manual function test (MFT; scores of 16/32 to 27/32 score), the Fugl-Meyer assessment (FMA; scores of 29/66 to 49/66 score), and the Jebsen-Taylor hand function test (JTHFT; from 38/60 to 19/60 sec) were improved. [Conclusion] Our results suggest that the forced intensive strength technique may have a beneficial effect on the muscle size of the upper extremity and motor function in patients with chronic stroke. PMID:26696748

  6. Prevalence of work-related musculoskeletal symptoms of the neck and upper extremity among dentists in China

    PubMed Central

    Feng, Beibei; Liang, Qi; Wang, Yuling; Andersen, Lars L; Szeto, Grace

    2014-01-01

    Objectives Studies from western countries show that dentists are vulnerable to work-related musculoskeletal disorders (WMSDs) of the neck and upper extremities, but little is known about their epidemiology among members of this rapidly growing profession in China. This study aims to investigate the prevalence of WMSDs and identify potential risk factors associated with their occurrence in the dental profession in China. Setting and participants A cross-sectional survey was carried out in 52 different hospitals in a large metropolitan city in China. A total of 304 questionnaires were distributed to respondents identified via stratified random sampling and 272 dentists (121 females and 151 males) completed the survey. The response rate was 89.5%. Outcomes Visual analogue score was used to record neck and upper limb musculoskeletal symptoms on a body chart. Work-related risk factors, including physical and psychosocial factors, were accounted for in the regression analysis. Results 88% of the dentists reported at least one musculoskeletal disorder and 83.8% suffered from neck pain. In the multivariate analyses, working hours per day were associated with neck pain (OR=1.43; 95% CI 1.03 to 1.98). Inability to select the appropriate size of dental instrument was associated with shoulder (OR=2.07; 95% CI 1.00 to 4.32) and wrist/hand (OR=2.47; 95% CI 1.15 to 5.32) pain. As for psychosocial factors, high job demand was associated with symptoms in the shoulder (OR=1.09; 95% CI 1.00 to 1.18), elbow (OR=1.11; 95% CI 1.03 to 1.19) and wrist/hand (OR=1.09; 95% CI 1.02 to 1.17). Regular physical exercise was associated with decreased neck pain (OR=0.37; 95% CI 0.14 to 1.00). Conclusions The prevalence of WMSDs among Chinese dentists is high. Specifically, long working hours, inability to select the appropriate size of dental instrument and high job demand are the most significant risk factors. PMID:25526795

  7. Simulation of Upper Limb Movements

    NASA Astrophysics Data System (ADS)

    Uher?k, Filip; Hu?ko, Branislav

    2011-12-01

    The paper deals with controlling an upper limb prosthesis based on the measurement of myoelectric signals (MES) while drinking. MES signals have been measured on healthy limbs to obtain the same response for the prosthesis. To simulate the drinking motion of a healthy upper limb, the program ADAMS was used, with all degrees of freedom and a hand after trans-radial amputation with an existing hand prosthesis. Modification of the simulation has the exact same logic of control, where the muscle does not have to be strenuous all the time, but it is the impulse of the muscle which drives the motor even though the impulse disappears and passed away.

  8. Language changes coincide with motor and fMRI changes following upper extremity motor therapy for hemiparesis: a brief report.

    PubMed

    Harnish, Stacy; Meinzer, Marcus; Trinastic, Jonathan; Fitzgerald, David; Page, Stephen

    2014-09-01

    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 upper extremity 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 3days/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

  9. Upper extremity acute compartment syndrome during tissue plasminogen activator therapy for pulmonary embolism in a morbidly obese patient

    PubMed Central

    Tuna, Serkan; Duymus, Tahir Mutlu; Mutlu, Serhat; Ketenci, Ismail Emre; Ulusoy, Ayhan

    2015-01-01

    Introduction Deep vein thrombosis (DVT) and pulmonary embolism (PE) are more frequently observed in morbidly obese patients. Tissue plasminogen activator (tPA) is a thrombolytic agent which dissolves the thrombus more rapidly than conventional heparin therapy and reduces the mortality and morbidity rates associated with PE. Compartment syndrome is a well-known and documented complication of thrombolytic treatment. In awake, oriented and cooperative patients, the diagnosis of compartment syndrome is made based on clinical findings including swelling, tautness, irrational and continuous pain, altered sensation, and severe pain due to passive stretching. These clinical findings may not be able to be adequately assessed in unconscious patients. Presentation of case In this case report, we present compartment syndrome observed, for which fasciotomy was performed on the upper right extremity of a 46-year old morbidly obese, conscious female patient who was receiving tPA due to a massive pulmonary embolism. Discussion Compartment syndrome had occurred due to the damage caused by the repeated unsuccessful catheterisation attempts to the brachial artery and the accompanying tPA treatment. Thus, the bleeding that occurred in the volar compartment of the forearm and the anterior compartment of the arm led to acute compartment syndrome (ACS). After relaxation was brought about in the volar compartment of the forearm and the anterior compartment of the arm, the circulation in the limb was restored. Conclusion As soon as the diagnosis of compartment syndrome is made, an emergency fasciotomy should be performed. Close follow-up is required to avoid wound healing problems after the fasciotomy. PMID:25618841

  10. Aesthetic finger prosthesis.

    PubMed

    Shanmuganathan, N; Maheswari, M Uma; Anandkumar, V; Padmanabhan, T V; Swarup, Shailee; Jibran, Ahmed Hasan

    2011-12-01

    Complete or partial fingers are the most commonly encountered forms of partial hand losses. Though finger amputations are commonly due to traumatic injuries, digit loss may also be attributed to congenital malformations and disease. Irrespective of the etiology, the loss of a finger has a considerable functional and psychological impact on an individual. In order to alleviate these problems, partial or complete finger prosthesis may be fabricated. This clinical report portrays a method to fabricate silicone rubber prosthesis for a patient who has a partial finger loss caused due to trauma. PMID:23204732

  11. What is the most effective posture to conduct vibration from the lower to the upper extremities during whole-body vibration exercise?

    PubMed Central

    Tsukahara, Yuka; Iwamoto, Jun; Iwashita, Kosui; Shinjo, Takuma; Azuma, Koichiro; Matsumoto, Hideo

    2016-01-01

    Background Whole-body vibration (WBV) exercise is widely used for training and rehabilitation. However, the optimal posture for training both the upper and lower extremities simultaneously remains to be established. Objectives The objective of this study was to search for an effective posture to conduct vibration from the lower to the upper extremities while performing WBV exercises without any adverse effects. Methods Twelve healthy volunteers (age: 22–34 years) were enrolled in the study. To measure the magnitude of vibration, four accelerometers were attached to the upper arm, back, thigh, and calf of each subject. Vibrations were produced using a WBV platform (Galileo 900) with an amplitude of 4 mm at two frequencies, 15 and 30 Hz. The following three postures were examined: posture A, standing posture with the knees flexed at 30°; posture B, crouching position with no direct contact between the knees and elbows; and posture C, crouching position with direct contact between the knees and elbows. The ratio of the magnitude of vibration at the thigh, back, and upper arm relative to that at the calf was used as an index of vibration conduction. Results Posture B was associated with a greater magnitude of vibration to the calf than posture A at 15 Hz, and postures B and C were associated with greater magnitudes of vibration than posture A at 30 Hz. Posture C was associated with a vibration conduction to the upper arm that was 4.62 times and 8.26 times greater than that for posture A at 15 and 30 Hz, respectively. Conclusion This study revealed that a crouching position on a WBV platform with direct contact between the knees and elbows was effective for conducting vibration from the lower to the upper extremities. PMID:26793008

  12. Musculoskeletal symptoms of the upper extremities and the neck: A cross-sectional study on prevalence and symptom-predicting factors at visual display terminal (VDT) workstations

    PubMed Central

    Klussmann, Andr; Gebhardt, Hansjuergen; Liebers, Falk; Rieger, Monika A

    2008-01-01

    Background The aim of this study was to determine the prevalence and the predictors of musculoskeletal symptoms in the upper extremities 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 upper extremities, preventive measures at VDT workstations should be focused on neck and shoulder symptoms (e.g. ergonomic measures, breaks to avoid sitting over long periods). PMID:18588677

  13. Endovascular thrombolysis to salvage central venous access in children with catheter-associated upper extremity deep vein thrombosis: technique and initial results.

    PubMed

    Lungren, Matthew P; Ward, Thomas J; Patel, Manish N; Racadio, John M; Kukreja, Kamlesh

    2015-10-01

    Nine patients (average age 8.3 years, range 20 days to 17 years; average weight 31 kg, range 2.7-79 kg) with catheter-associated UE-DVT underwent upper extremity venous thrombolysis with the goal of access salvage. Catheter directed therapy with alteplase (tPA), balloon angioplasty, and mechanical thrombectomy was used in all cases. The mean total dose of TPA was 15 mg (range 1-40 mg). Venous access was ultimately preserved in all patients. No stents or superior vena cava filters were used. There was one episode of symptomatic clinically suspected pulmonary embolism managed by systemic tPA and heparin without long term sequaele. Mean imaging and clinical follow-up was 351 208 and 613 498 days respectively. Endovenous thrombolysis for catheter-associated upper-extremity DVT in children may be safe and effective and could be considered particularly in patients in whom long-term venous access is needed. PMID:25894473

  14. Treatment of upper- and lower-extremity vitiligo with epidermal grafts after CO2 laser resurfacing with systemic and topical steroids.

    PubMed

    El Hoseny, Safwat M

    2010-04-01

    Vitiligo is an acquired condition that presents as sharply demarcated white macules. It affects 1-2% of people of all races, regardless of gender or age. Although the disease does not have any systemic complications, it is of great concern, particularly in darker-skinned individuals. We treated 14 patients with vitiligo involving the upper and lower extremities. Surgical therapies were used in conjunction with medical therapy to achieve repigmentation after the disease was stabilized. PMID:19533216

  15. Mirror therapy combined with biofeedback functional electrical stimulation for motor recovery of upper extremities after stroke: a pilot randomized controlled trial.

    PubMed

    Kim, Jung Hee; Lee, Byoung-Hee

    2015-06-01

    The objective of this study was to evaluate the effects of mirror therapy in combination with biofeedback functional electrical stimulation (BF-FES) on motor recovery of the upper extremities after stroke. Twenty-nine patients who suffered a stroke > 6 months prior participated in this study and were randomly allocated to three groups. The BF-FES + mirror therapy and FES + mirror therapy groups practiced training for 5 30 min sessions over a 4-week period. The control group received a conventional physical therapy program. The following clinical tools were used to assess motor recovery of the upper extremities: electrical muscle tester, electrogoniometer, dual-inclinometer, electrodynamometer, the Box and Block Test (BBT) and Jabsen Taylor Hand Function Test (JHFT), the Functional Independence Measure, the Modified Ashworth Scale, and the Stroke Specific Quality of Life (SSQOL) assessment. The BF-FES + mirror therapy group showed significant improvement in wrist extension as revealed by the Manual Muscle Test and Range of Motion (p < 0.05). The BF-FES + mirror therapy group showed significant improvement in the BBT, JTHT, and SSQOL compared with the FES + mirror therapy group and control group (p < 0.05). We found that BF-FES + mirror therapy induced motor recovery and improved quality of life. These results suggest that mirror therapy, in combination with BF-FES, is feasible and effective for motor recovery of the upper extremities after stroke. PMID:25367222

  16. GUEPAR hinge knee prosthesis.

    PubMed

    Aubriot, J-H; Deburge, A; Genet, J-P

    2014-02-01

    Early and late results of the GUEPAR hinge knee prosthesis were evaluated on a series of 184 operations performed before January 1st, 1974. There were 3 immediate deaths and 26 before 5 years. Nineteen prostheses were removed. One hundred and twenty-six knees had degenerative osteoarthritis, 52 rheumatoid arthritis. Twenty-two had been operated on before. Patellar displacement, present in 27% of the cases, was the most frequent cause of complaint: pain or instability, proportional to the severity of displacement, made re-operation necessary in 10% of the patients. Addition of a patellar prosthesis was the most successful treatment as far as pain is concerned: it is probably advisable as a primary procedure. Deep infections occurred in 8.3% of the cases, infrequently after 2 years. Healing was obtained in all cases either by revision or by removal and arthrodesis: but functional results were poor except when fusion was achieved, in half of the cases of arthrodesis. Loosening occurred in 16% of the cases, mainly as a consequence of inadequate technique. It was frequently tolerated: re-operation was necessary in 6% of the total. Late functional results were evaluated in 99 cases with a follow-up of 5 to 8 years. Apart from loosening, the results did not deteriorate. Sixty percent were evaluated as excellent or good, 29% fair, and 11% poor. In consideration of these results, the choice of this prosthesis should be limited to special cases. To prevent complications, the use of a patellar prosthesis, of reinforced models and of cementing under pressure is advisable. PMID:24456763

  17. A tactile control prosthesis

    NASA Astrophysics Data System (ADS)

    Perry, James Franklin

    This research involves development and testing of a tactile control prosthesis to aid human operators in control of dynamic vehicles. Specifically, this work includes development and demonstration of a torso mounted tactile drift display that allowed helicopter pilots to hover a Blackhawk helicopter with degraded vision (equivalent to 20/200 acuity), a NASA sponsored pilot-in-the-loop simulator study for a hover display and development and analysis of a tactile control prosthesis to help pilots correctly control an airplane experiencing an engine failure on takeoff. Results of a ten-subject experiment indicate that use of a tactile display in conjunction with a visual display reduces operator delay by 65 msec (SD of 28 msec), (P < 0.001) without a significant increase in error rate. In the pilot-in-the-loop simulation experiment pilots hovered a simulated helicopter better under increased workload conditions with the tactile control prosthesis than without it. The increased workload consisted of an addition drill in which the subject had to agree or disagree with a computer generated sum. Pilots were able to hover more precisely with the tactile display (mean of 5.19, SD of 2.57 feet) than without (mean of 6.39 and SD of 3.31 feet) especially when the secondary task was required (P < 0.001). Although learning effects were exhibited throughout the trials (P < 0.001), the tactile display was of greater benefit in higher workload conditions.

  18. Historical Channel Change on the Upper Gila River, Arizona and New Mexico in Response to Anthropogenic Modifications and Extreme Floods

    NASA Astrophysics Data System (ADS)

    Klawon, J. E.; Levish, D. R.

    2003-12-01

    Over the past century, the majority of alluvial reaches along the upper Gila River in Arizona and New Mexico have been leveed in an attempt to protect adjacent property from flood damage. In addition, the demand for irrigation has prompted the construction of diversion dams in these alluvial reaches to divert water for agriculture. Detailed geomorphic mapping and investigation of historical channel change along the upper Gila River reveals that many channel modifications are catalysts for major channel change and can result in catastrophic property loss rather than safeguarding valuable farmland. Channel widths were measured every kilometer for approximately 160 km from Safford Valley, Arizona through Cliff-Gila Valley, New Mexico for eight decades to develop a quantitative analysis of channel change. An overall pattern of channel narrowing and widening coincides with periods of few large floods and periods of multiple large floods, respectively. Furthermore, reaches along the upper Gila River with greater channel modifications have experienced more variation in channel width than reaches with fewer modifications. Although the average width of the upper Gila River is very similar to the width of the 1935 channel, the lateral position of the channel is very different in many reaches. Many channel changes in recent decades are unprecedented in previous historical aerial photography and reveal that the upper Gila River is currently eroding stream banks that are several hundred years to thousands of years old. These changes are consistently associated with artificial channel constrictions, such as levees, bank protection, and bridges, that have been built and rebuilt following large floods and that have accelerated natural channel narrowing during periods of few large floods. Examples of geomorphic responses due to channel modifications along the upper Gila River include lateral erosion upstream of levees and diversion dams, redirection of flow over diversion dams into opposite banks, breaching of levees during floods and resultant erosion behind levees, channel widening downstream of levees, aggradation in leveed reaches, and lateral migration associated with straightened tributary channels.

  19. Novel modification of voice prosthesis.

    PubMed

    Al Kadah, Basel; Papaspyrou, George; Schneider, Mathias; Schick, Bernhard

    2016-03-01

    The undesired dilatation of the tracheooesophageal shunt after surgical implantation of voice prosthesis is a typical complication of this procedure. Temporary removal of the prosthesis and reinsertion after a short period of time is a first-line therapeutical option aiming shrinkage of the shunt. Failure of this measure generally is an indication of revision surgery. We present first experiences treating leakage problems with novel modified voice prosthesis without surgical intervention in specified cases. 11 patients (1 female, 10 male) aging between 51 and 71 years were presented with shunt leakage between 11/2008 and 11/2012 in the ENT-Department of the University Hospital of Homburg/Saar after a custom built voice prosthesis had been used initially successfully. A "Provox 2"(®) voice prosthesis was modified with two discs made of silicone each on the tracheal and oesophageal side and additionally reinforcing the diameter of the prosthesis by a silicone tube. The modified prosthesis was inserted in a retrograde way under general anesthesia, analogical to the approach used with the "Provox 1"(®)-prosthesis. The period of observation ranged between 12 and 48 months. As a measure of control swallowing of methylene blue was used. In all cases leakage suspended. Durability of the modified prosthesis ranged between 2 and 6 months. Neither the patients' complained about, nor did the physicians notice subjectively an impairment of the voice quality. Modifications of "Provox 2"(®)-prosthesis should be regarded in individual cases and constitute a reasonable alternative to revision surgery. A surgical approach is more intricate and costly, more taxing for the patient and susceptible to failure. We regard the necessity of general anesthesia for the insertion of the modified prosthesis as a disadvantage. PMID:26463715

  20. A review of technological and clinical aspects of robot-aided rehabilitation of upper-extremity after stroke.

    PubMed

    Babaiasl, Mahdieh; Mahdioun, Seyyed Hamed; Jaryani, Poorya; Yazdani, Mojtaba

    2016-05-01

    Cerebrovascular accident (CVA) or stroke is one of the leading causes of disability and loss of motor function. Millions of people around the world are effected by it each year. Stroke results in disabled arm function. Restoration of arm function is essential to regaining activities of daily living (ADL). Along with traditional rehabilitation methods, robot-aided therapy has emerged in recent years. Robot-aided rehabilitation is more intensive, of longer duration and more repetitive. Using robots, repetitive dull exercises can turn into a more challenging and motivating tasks such as games. Besides, robots can provide a quantitative measure of the rehabilitation progress. This article overviews the terms used in robot-aided upper-limb rehabilitation. It continues by investigating the requirements for rehabilitation robots. Then the most outstanding works in robot-aided upper-limb rehabilitation and their control schemes have been investigated. The clinical outcomes of the built robots are also given that demonstrates the usability of these robots in real-life applications and their acceptance. This article summarizes a review done along with a research on the design, simulation and control of a robot for use in upper-limb rehabilitation after stroke. Implications for Rehabilitation Reviewing common terms in rehabilitation of upper limb using robots Reviewing rehabilitation robots built up to date Reviewing clinical outcomes of the mentioned rehabilitation robots. PMID:25600057

  1. A comparative ergonomic study of work-related upper extremity musculo skeletal disorder among the unskilled and skilled surgical blacksmiths in West Bengal, India

    PubMed Central

    Ghosh, Tirthankar; Das, Banibrata; Gangopadhyay, Somnath

    2011-01-01

    Objective: The main aim of the study was to determine the nature and extent of work-related upper extremity 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). PMID:22412291

  2. A Comparative Analysis of Speed Profile Models for Ankle Pointing Movements: Evidence that Lower and Upper Extremity Discrete Movements are Controlled by a Single Invariant Strategy

    PubMed Central

    Michmizos, Konstantinos P.; Vaisman, Lev; Krebs, Hermano Igo

    2014-01-01

    Little is known about whether our knowledge of how the central nervous system controls the upper extremities (UE), can generalize, and to what extent to the lower limbs. Our continuous efforts to design the ideal adaptive robotic therapy for the lower limbs of stroke patients and children with cerebral palsy highlighted the importance of analyzing and modeling the kinematics of the lower limbs, in general, and those of the ankle joints, in particular. We recruited 15 young healthy adults that performed in total 1,386 visually evoked, visually guided, and target-directed discrete pointing movements with their ankle in dorsal–plantar and inversion–eversion directions. Using a non-linear, least-squares error-minimization procedure, we estimated the parameters for 19 models, which were initially designed to capture the dynamics of upper limb movements of various complexity. We validated our models based on their ability to reconstruct the experimental data. Our results suggest a remarkable similarity between the top-performing models that described the speed profiles of ankle pointing movements and the ones previously found for the UE both during arm reaching and wrist pointing movements. Among the top performers were the support-bounded lognormal and the beta models that have a neurophysiological basis and have been successfully used in upper extremity studies with normal subjects and patients. Our findings suggest that the same model can be applied to different “human” hardware, perhaps revealing a key invariant in human motor control. These findings have a great potential to enhance our rehabilitation efforts in any population with lower extremity deficits by, for example, assessing the level of motor impairment and improvement as well as informing the design of control algorithms for therapeutic ankle robots. PMID:25505881

  3. A Comparative Analysis of Speed Profile Models for Ankle Pointing Movements: Evidence that Lower and Upper Extremity Discrete Movements are Controlled by a Single Invariant Strategy.

    PubMed

    Michmizos, Konstantinos P; Vaisman, Lev; Krebs, Hermano Igo

    2014-01-01

    Little is known about whether our knowledge of how the central nervous system controls the upper extremities (UE), can generalize, and to what extent to the lower limbs. Our continuous efforts to design the ideal adaptive robotic therapy for the lower limbs of stroke patients and children with cerebral palsy highlighted the importance of analyzing and modeling the kinematics of the lower limbs, in general, and those of the ankle joints, in particular. We recruited 15 young healthy adults that performed in total 1,386 visually evoked, visually guided, and target-directed discrete pointing movements with their ankle in dorsal-plantar and inversion-eversion directions. Using a non-linear, least-squares error-minimization procedure, we estimated the parameters for 19 models, which were initially designed to capture the dynamics of upper limb movements of various complexity. We validated our models based on their ability to reconstruct the experimental data. Our results suggest a remarkable similarity between the top-performing models that described the speed profiles of ankle pointing movements and the ones previously found for the UE both during arm reaching and wrist pointing movements. Among the top performers were the support-bounded lognormal and the beta models that have a neurophysiological basis and have been successfully used in upper extremity studies with normal subjects and patients. Our findings suggest that the same model can be applied to different "human" hardware, perhaps revealing a key invariant in human motor control. These findings have a great potential to enhance our rehabilitation efforts in any population with lower extremity deficits by, for example, assessing the level of motor impairment and improvement as well as informing the design of control algorithms for therapeutic ankle robots. PMID:25505881

  4. Outcome measures for hand function naturally reveal three latent domains in older adults: strength, coordinated upper extremity function, and sensorimotor processing

    PubMed Central

    Lawrence, Emily L.; Dayanidhi, Sudarshan; Fassola, Isabella; Requejo, Philip; Leclercq, Caroline; Winstein, Carolee J.; Valero-Cuevas, Francisco J.

    2015-01-01

    Understanding the mapping between individual outcome measures and the latent functional domains of interest is critical to a quantitative evaluation and rehabilitation of hand function. We examined whether and how the associations among six hand-specific outcome measures reveal latent functional domains in elderly individuals. We asked 66 healthy older adult participants (38F, 28M, 66.1 ± 11.6 years, range: 45–88 years) and 33 older adults (65.8 ± 9.7 years, 44–81 years, 51 hands) diagnosed with osteoarthritis (OA) of the carpometacarpal (CMC) joint, to complete six functional assessments: hand strength (Grip, Key and Precision Pinch), Box and Block, Nine Hole Pegboard, and Strength-Dexterity tests. The first three principal components suffice to explain 86% of variance among the six outcome measures in healthy older adults, and 84% of variance in older adults with CMC OA. The composition of these dominant associations revealed three distinct latent functional domains: strength, coordinated upper extremity function, and sensorimotor processing. Furthermore, in participants with thumb CMC OA we found a blurring of the associations between the latent functional domains of strength and coordinated upper extremity function. This motivates future work to understand how the physiological effects of thumb CMC OA lead upper extremity coordination to become strongly associated with strength, while dynamic sensorimotor ability remains an independent functional domain. Thus, when assessing the level of hand function in our growing older adult populations, it is particularly important to acknowledge its multidimensional nature—and explicitly consider how each outcome measure maps to these three latent and fundamental domains of function. Moreover, this ability to distinguish among latent functional domains may facilitate the design of treatment modalities to target the rehabilitation of each of them. PMID:26097455

  5. A Study on Extremely Dry and Wet Summer Monsoon in Pakistan by Focusing on the Anomalous States of the Upper Troposphere

    NASA Astrophysics Data System (ADS)

    Ahmad, S.; Koike, T.; Nishii, K.

    2012-04-01

    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

  6. Comparison between Steroid Injection and Stretching Exercise on the Scalene of Patients with Upper Extremity Paresthesia: Randomized Cross-Over Study

    PubMed Central

    Kim, Yong Wook; Yoon, Seo Yeon; Park, Yongbum; Chang, Won Hyuk

    2016-01-01

    Purpose To compare the therapeutic effects on upper extremity paresthesia of intra-muscular steroid injections into the scalene muscle with those of stretching exercise only. Materials and Methods Twenty patients with upper extremity paresthesia who met the criteria were recruited to participate in this single-blind, crossover study. Fourteen of 20 patients were female. The average age was 45.0±10.5 years and duration of symptom was 12.2±8.7 months. Each participant completed one injection and daily exercise program for 2 weeks. After randomization, half of all patients received ultrasound-guided injection of scalene muscles before exercise, while the other was invested for the other patients. Results After two weeks, there was a significant decrease of the visual analog scale score of treatment effect compared with baseline in both groups (6.90 to 2.85 after injection and 5.65 to 4.05 after stretching exercise, p<0.01). However, injection resulted in greater improvements than stretching exercise (p<0.01). The number of patients with successful treatment, defined as >50% reduction in post-treatment visual analog scale, was 18 of 20 (90.0%) after injection, compared to 5 of 20 (25.0%) after stretching exercise. There were no cases of unintended brachial plexus block after injection. Conclusion Ultrasound-guided steroid injection or stretching exercise of scalene muscles led to reduced upper extremity paresthesia in patients who present with localized tenderness in the scalene muscle without electrodiagnostic test abnormalities, although injection treatment resulted in more improvements. The results suggest that symptoms relief might result from injection into the muscle alone not related to blockade of the brachial plexus. PMID:26847305

  7. A 100-year extreme snow-avalanche record based on tree-ring research in upper Bdalen, inner Nordfjord, western Norway

    NASA Astrophysics Data System (ADS)

    Decaulne, Armelle; Eggertsson, lafur; Laute, Katja; Beylich, Achim A.

    2014-08-01

    This paper analyses with the help of tree-ring studies the recurrence of extreme snow avalanches in a path situated in the upper Bdalen valley and originating from an outlet glacier of the Jostedalsbreen ice cap. By analysing tree-ring patterns of 91 trees, four extreme snow-avalanche events, extending over the entire valley floor and up to a distance of 800 m from the foot of the slope, are clearly highlighted during the 20th century and at the beginning of the 21st century. Return periods of 15 to 20 years for the most extreme events are extracted from the analyses, and recurrence intervals of 10 to 15 years for avalanches presenting distinct deposition lobes uphill of the distal torrent. Results obtained by tree-ring analyses are successfully compared with available documents at different spatial and temporal scales. Rock-face snow-avalanche occurrences in the area, of small to medium size, are associated with heavy wintry precipitation combined with strong winds. However this normal situation is not valid for extreme snow avalanches crossing the path investigated in the paper, which result from the outlet glacier located in the starting zone; this glacier commands spatial and inter-annual variations of snow accumulation in the departure zone.

  8. Upper limb prosthetic use in Slovenia.

    PubMed

    Burger, H; Marincek, C

    1994-04-01

    The article deals with the use of different types of upper limb prostheses in Slovenia. Four hundred and fourteen upper limb amputees were sent a questionnaire on the type of their prosthesis, its use and reasons for non-use, respectively. The replies were subject to statistical analysis. Most of the questioned upper limb amputees (70%) wear a prosthesis only for cosmesis. The use of a prosthesis depends on the level of upper limb amputation, loss of the dominant hand, and time from amputation. Prosthetic success appears to be unrelated to age at the time of amputation and the rehabilitation programme. The most frequent reason for not wearing a prosthesis is heat and consequent sweating of the stump. More than a third of amputees are dissatisfied with their prostheses. PMID:8084746

  9. Effects of Age, Gender and Level of Co-contraction on Elbow and Shoulder Rotational Stiffness and Damping in the Impulsively End-Loaded Upper Extremity.

    PubMed

    Lee, Yunju; Ashton-Miller, James A

    2015-05-01

    Whether an arm will buckle under an impulsive end-load should partly depend on the elastic and viscous properties of the pretensed arm muscles. In measuring these properties we hypothesized that neither age, gender, nor muscle pre-contraction level would affect the bilinear elbow or shoulder lumped rotational stiffness or damping parameters in the impulsively end-loaded upper extremity of 38 healthy men and women. Subjects were instructed to preactivate triceps to either 25, 50 or 75% of maximum myoelectric activity levels. Then a standardized impulsive end-load was applied via a 6-axis load cell to the wrist of the slightly flexed arm in the prone posture. Arm kinematic responses were acquired at 280Hz and an inverse dynamics analysis was used to estimate the bilinear rotational stiffnesses and damping parameters at the elbow and shoulder. The results show that pre-contraction level affected normalized joint rotational stiffness and damping coefficients (p<0.02). Age affected the initial stiffness for the elbow (p<0.05), and gender affected that of the shoulder in the sagittal plane (p<0.006). Arm muscle strength was positively related to normalized stiffness at the elbow, but not the shoulder. We conclude that age, gender and pre-contraction level each affect the viscoelastic behavior of the end-loaded upper extremity in healthy adults. PMID:25395216

  10. Gains in upper extremity function after stroke via recovery or compensation: Potential differential effects on amount of real-world limb use.

    PubMed

    Lum, Peter S; Mulroy, Sara; Amdur, Richard L; Requejo, Philip; Prilutsky, Boris I; Dromerick, Alexander W

    2009-01-01

    In terms of integration of the paretic upper extremity in activities of daily living (ADLs), outcome is poor after stroke. Furthermore, amount of real-world arm use appears only weakly correlated with laboratory motor function scales. Therefore, amount of arm use may depend critically on the location, extent, and type of functional gains, which can be quantified with comprehensive kinematic and EMG analysis of ADL performance. Gains in upper extremity function can occur via compensation or recovery of premorbid movement and EMG patterns, and traditional treatment approaches encourage adoption of compensatory strategies early in the postacute period that can inhibit potential recovery. A new treatment approach called Accelerated Skill Acquisition Program (ASAP) focuses on impairment reduction coupled with repetitive, task-specific training of the paretic arm during ADLs. We present pilot data that show recovery in subjects who received the ASAP, while a usual care control subject showed increased use of compensation over the same period. Finally, we discuss the advantages of data reduction methods such as principal components analysis, confirmatory factor analysis, and structural equation modeling, which can potentially distill large kinematic and EMG data sets into the key latent variables that predict amount of real-world use. PMID:19740730

  11. Oxygen uptake, heart rate, perceived exertion, and integrated electromyogram of the lower and upper extremities during level and Nordic walking on a treadmill

    PubMed Central

    2013-01-01

    The purpose of this study was to characterize responses in oxygen uptake ( VO2), 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 VO2 , VE 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. VO2 was significantly higher during NW than during LW, with the exception of the speed of 70?m/min (P?upper extremities was significantly higher during NW than during LW at all speeds (P?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. PMID:23406834

  12. Prolonged mechanical and physiological changes in the upper extremity following short-term simulated power hand tool use.

    PubMed

    Chourasia, Amrish O; Sesto, Mary E; Block, Walter F; Radwin, Robert G

    2009-01-01

    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

  13. Underwater Near-Infrared Spectroscopy: Muscle Oxygen Changes in the Upper and Lower Extremities in Club Level Swimmers and Triathletes.

    PubMed

    Jones, B; Cooper, C E

    2016-01-01

    To date, measurements of oxygen status during swim exercise have focused upon systemic aerobic capacity. The development of a portable, waterproof NIRS device makes possible a local measurement of muscle hemodynamics and oxygenation that could provide a novel insight into the physiological changes that occur during swim exercise. The purpose of this study was to observe changes in muscle oxygenation in the vastus lateralis (VL) and latissimus dorsi (LD) of club level swimmers and triathletes. Ten subjects, five club level swimmers and five club level triathletes (three men and seven women) were used for assessment. Swim group; mean??SD?=?age 21.2??1.6years; height 170.6??7.5cm; weight 62.8??6.9kg; vastus lateralis skin fold 13.8??5.6mm; latissimus dorsi skin fold 12.6??3.7. Triathlete group; mean??SD?=?age 44.0??10.5years; height 171.6??7.0cm; weight 68.6??12.7kg; vastus lateralis skin fold 11.8??3.5mm; latissimus dorsi skin fold 11.2??3.1. All subjects completed a maximal 200m freestyle swim, with the PortaMon, a portable NIR device, attached to the subject's dominant side musculature. ?TSI % between the vastus lateralis and latissimus dorsi were analysed using either paired (2-tailed) t-tests or Wilcoxon signed rank test. The level of significance for analysis was set at p?upper and lower muscles to a similar extent during a maximal 200m swim. Club level triathletes predominately use the upper body for propulsion during the same exercise. The data produced by NIRS in this study are the first of their kind and provide insight into muscle oxygenation changes during swim exercise which can indicate the contribution of one muscle compared to another. This also enables a greater understanding of the differences in swimming techniques seen between different cohorts of swimmers and potentially within individual swimmers. PMID:26782192

  14. Photovoltaic retinal prosthesis

    NASA Astrophysics Data System (ADS)

    Loudin, James; Mathieson, Keith; Kamins, Ted; Wang, Lele; Galambos, Ludwig; Huie, Philip; Sher, Alexander; Harris, James; Palanker, Daniel

    2011-03-01

    Electronic retinal prostheses seek to restore sight to patients suffering from retinal degenerative disorders. Implanted electrode arrays apply patterned electrical stimulation to surviving retinal neurons, producing visual sensations. All current designs employ inductively coupled coils to transmit power and/or data to the implant. We present here the design and initial testing of a photovoltaic retinal prosthesis fabricated with a pixel density of up to 177 pixels/mm2. Photodiodes within each pixel of the subretinal array directly convert light to stimulation current, avoiding the use of bulky coil implants, decoding electronics, and wiring, and thereby reducing surgical complexity. A goggles-mounted camera captures the visual scene and transmits the data stream to a pocket processor. The resulting images are projected into the eyes by video goggles using pulsed, near infrared (~900 nm) light. Prostheses with three pixel densities (15, 55, and 177 pix/mm2) are being fabricated, and tests indicate a charge injection limit of 1.62 mC/cm2 at 25Hz. In vitro tests of the photovoltaic retinal stimulation using a 512-element microelectrode array have recorded stimulated spikes from the ganglion cells, with latencies in the 1-100ms range, and with peak irradiance stimulation thresholds varying from 0.1 to 1 mW/mm2. With 1ms pulses at 25Hz the average irradiance is more than 100 times below the IR retinal safety limit. Elicited retinal response disappeared upon the addition of synaptic blockers, indicating that the inner retina is stimulated rather than the ganglion cells directly, and raising hopes that the prosthesis will preserve some of the retina's natural signal processing.

  15. Upper Extremity Proprioception in Healthy Aging and Stroke Populations, and the Effects of Therapist- and Robot-Based Rehabilitation Therapies on Proprioceptive Function

    PubMed Central

    Hughes, Charmayne Mary Lee; Tommasino, Paolo; Budhota, Aamani; Campolo, Domenico

    2015-01-01

    The world’s population is aging, with the number of people ages 65 or older expected to surpass 1.5 billion people, or 16% of the global total. As people age, there are notable declines in proprioception due to changes in the central and peripheral nervous systems. Moreover, the risk of stroke increases with age, with approximately two-thirds of stroke-related hospitalizations occurring in people over the age of 65. In this literature review, we first summarize behavioral studies investigating proprioceptive deficits in normally aging older adults and stroke patients, and discuss the differences in proprioceptive function between these populations. We then provide a state of the art review the literature regarding therapist- and robot-based rehabilitation of the upper extremity proprioceptive dysfunction in stroke populations and discuss avenues of future research. PMID:25784872

  16. Mobile input device type, texting style and screen size influence upper extremity and trapezius muscle activity, and cervical posture while texting.

    PubMed

    Kietrys, David M; Gerg, Michael J; Dropkin, Jonathan; Gold, Judith E

    2015-09-01

    This study aimed to determine the effects of input device type, texting style, and screen size on upper extremity and trapezius muscle activity and cervical posture during a short texting task in college students. Users of a physical keypad produced greater thumb, finger flexor, and wrist extensor muscle activity than when texting with a touch screen device of similar dimensions. Texting on either device produced greater wrist extensor muscle activity when texting with 1 hand/thumb compared with both hands/thumbs. As touch screen size increased, more participants held the device on their lap, and chose to use both thumbs less. There was also a trend for greater finger flexor, wrist extensor, and trapezius muscle activity as touch screen size increased, and for greater cervical flexion, although mean differences for cervical flexion were small. Future research can help inform whether the ergonomic stressors observed during texting are associated with musculoskeletal disorder risk. PMID:25959323

  17. [Fracture of macroporous hydroxyapatite prosthesis].

    PubMed

    Adetchessi, A T; Pech-Gourg, G; Metellus, P; Fuentes, S

    2012-12-01

    Different prosthesis implants are offered to perform a cranioplasty after a decompressive craniectomy when autologous bone graft cannot be used. The authors report the case of a 25-year-old man who benefited a unilateral decompressive craniectomy after a severe head trauma. Seven months later, a cranioplasty using custom macroporous hydroxyapatite prosthesis was performed. The postoperative course was marked by a generalized seizure leading to a traumatic head injury. The CT-scan showed a comminutive fracture of the prosthesis and an extradural hematoma. The patient underwent a removal of the fractured prosthesis and an evacuation of the extradural clot. The postoperative course was uneventful with a Glasgow outcome scale score at 5. A second cranioplasty using a polyether ether ketone (PEEK) implant was performed. Among cranioplasty prosthesis solutions, hydroxyapatite implants seem to have similar property to the bone. However, its weak mechanic resistance is an actual problem in patients susceptible to present generalized seizures with consecutive head impact. Hence, in patients with decompressive craniectomy who are exposed to potential brain injury, we favor the use of more resistant implant as PEEK prosthesis. PMID:22898300

  18. High-Intensity, Unilateral Resistance Training of a Non-Paretic Muscle Group Increases Active Range of Motion in a Severely Paretic Upper Extremity Muscle Group after Stroke

    PubMed Central

    Urbin, M. A.; Harris-Love, Michelle L.; Carter, Alex R.; Lang, Catherine E.

    2015-01-01

    Limited rehabilitation strategies are available for movement restoration when paresis is too severe following stroke. Previous research has shown that high-intensity resistance training of one muscle group enhances strength of the homologous, contralateral muscle group in neurologically intact adults. How this “cross education” phenomenon might be exploited to moderate severe weakness in an upper extremity muscle group after stroke is not well understood. The primary aim of this study was to examine adaptations in force-generating capacity of severely paretic wrist extensors resulting from high intensity, dynamic contractions of the non-paretic wrist extensors. A secondary, exploratory aim was to probe neural adaptations in a subset of participants from each sample using a single-pulse, transcranial magnetic stimulation (TMS) protocol. Separate samples of neurologically intact controls (n = 7) and individuals ≥4 months post stroke (n = 6) underwent 16 sessions of training. Following training, one-repetition maximum of the untrained wrist extensors in the control group and active range of motion of the untrained, paretic wrist extensors in the stroke group were significantly increased. No changes in corticospinal excitability, intracortical inhibition, or interhemispheric inhibition were observed in control participants. Both stroke participants who underwent TMS testing, however, exhibited increased voluntary muscle activation following the intervention. In addition, motor-evoked potentials that were unobtainable prior to the intervention were readily elicited afterwards in a stroke participant. Results of this study demonstrate that high-intensity resistance training of a non-paretic upper extremity muscle group can enhance voluntary muscle activation and force-generating capacity of a severely paretic muscle group after stroke. There is also preliminary evidence that corticospinal adaptations may accompany these gains. PMID:26074871

  19. Determining the optimal system-specific cut-off frequencies for filtering in-vitro upper extremity impact force and acceleration data by residual analysis.

    PubMed

    Burkhart, Timothy A; Dunning, Cynthia E; Andrews, David M

    2011-10-13

    The fundamental nature of impact testing requires a cautious approach to signal processing, to minimize noise while preserving important signal information. However, few recommendations exist regarding the most suitable filter frequency cut-offs to achieve these goals. Therefore, the purpose of this investigation is twofold: to illustrate how residual analysis can be utilized to quantify optimal system-specific filter cut-off frequencies for force, moment, and acceleration data resulting from in-vitro upper extremity impacts, and to show how optimal cut-off frequencies can vary based on impact condition intensity. Eight human cadaver radii specimens were impacted with a pneumatic impact testing device at impact energies that increased from 20J, in 10J increments, until fracture occurred. The optimal filter cut-off frequency for pre-fracture and fracture trials was determined with a residual analysis performed on all force and acceleration waveforms. Force and acceleration data were filtered with a dual pass, 4th order Butterworth filter at each of 14 different cut-off values ranging from 60Hz to 1500Hz. Mean (SD) pre-fracture and fracture optimal cut-off frequencies for the force variables were 605.8 (82.7)Hz and 513.9 (79.5)Hz, respectively. Differences in the optimal cut-off frequency were also found between signals (e.g. Fx (medial-lateral), Fy (superior-inferior), Fz (anterior-posterior)) within the same test. These optimal cut-off frequencies do not universally agree with the recommendations of filtering all upper extremity impact data using a cut-off frequency of 600Hz. This highlights the importance of quantifying the filter frequency cut-offs specific to the instrumentation and experimental set-up. Improper digital filtering may lead to erroneous results and a lack of standardized approaches makes it difficult to compare findings of in-vitro dynamic testing between laboratories. PMID:21903214

  20. Lean Body Mass Associated with Upper Body Strength in Healthy Older Adults While Higher Body Fat Limits Lower Extremity Performance and Endurance

    PubMed Central

    Charlton, Karen; Batterham, Marijka; Langford, Kelly; Lateo, Jenna; Brock, Erin; Walton, Karen; Lyons-Wall, Philippa; Eisenhauer, Katie; Green, Nick; McLean, Cameron

    2015-01-01

    Impaired strength adversely influences an older person’s ability to perform activities of daily living. A cross-sectional study of 117 independently living men and women (age = 73.4 ± 9.4 year; body mass index (BMI) = 27.6 ± 4.8 kg/m2) aimed to assess the association between body composition and: (1) upper body strength (handgrip strength, HGS); (2) lower extremity performance (timed up and go (TUG) and sit to stand test (STS)); and (3) endurance (6-minute walk (SMWT). Body composition (% fat; lean body mass (LBM)) was assessed using bioelectrical impedance. Habitual physical activity was measured using the Minnesota Leisure Time Physical Activity Questionnaire (MLTPA) and dietary macronutrient intake, assessed using 24 h recalls and 3-day food records. Regression analyses included the covariates, protein intake (g/kg), MLTPA, age and sex. For natural logarithm (Ln) of right HGS, LBM (p < 0.001) and % body fat (p < 0.005) were significant (r2 = 46.5%; p < 0.000). For left LnHGS, LBM (p < 0.000), age (p = 0.036), protein intake (p = 0.015) and LnMLTPA (p = 0.015) were significant (r2 = 0.535; p < 0.000). For SMW, % body fat, age and LnMLTPA were significant (r2 = 0.346; p < 0.000). For STS, % body fat and age were significant (r2 = 0.251; p < 0.000). LBM is a strong predictor of upper body strength while higher % body fat and lower physical activity are associated with poorer outcomes on tests of lower extremity performance. PMID:26343709

  1. The Influence of the Extreme Ultraviolet Spectral Energy Distribution on the Structure and Composition of the Upper Atmosphere of Exoplanets

    NASA Astrophysics Data System (ADS)

    Guo, J. H.; Ben-Jaffel, Lotfi

    2016-02-01

    By varying the profiles of stellar extreme ultraviolet (EUV) spectral energy distributions (SEDs), we tested the influences of stellar EUV SEDs on the physical and chemical properties of an escaping atmosphere. We apply our model to study four exoplanets: HD 189733b, HD 209458b, GJ 436b, and Kepler-11b. We find that the total mass loss rates of an exoplanet, which are determined mainly by the integrated fluxes, are moderately affected by the profiles of the EUV SED, but the composition and species distributions in the atmosphere can be dramatically modified by the different profiles of the EUV SED. For exoplanets with a high hydrodynamic escape parameter (λ), the amount of atomic hydrogen produced by photoionization at different altitudes can vary by one to two orders of magnitude with the variation of stellar EUV SEDs. The effect of photoionization of H is prominent when the EUV SED is dominated by the low-energy spectral region (400–900 Å), which pushes the transition of H/H+ to low altitudes. In contrast, the transition of H/H+ moves to higher altitudes when most photons are concentrated in the high-energy spectral region (50–400 Å). For exoplanets with a low λ, the lower temperatures of the atmosphere make many chemical reactions so important that photoionization alone can no longer determine the composition of the escaping atmosphere. For HD 189733b, it is possible to explain the time variability of Lyα between 2010 and 2011 by a change in the EUV SED of the host K-type star, yet invoking only thermal H i in the atmosphere.

  2. Interfacing a haptic robotic system with complex virtual environments to treat impaired upper extremity motor function in children with cerebral palsy

    PubMed Central

    FLUET, GERARD G.; QIU, QINYIN; KELLY, DONNA; PARIKH, HETA D.; RAMIREZ, DIEGO; SALEH, SOHA; ADAMOVICH, SERGEI V.

    2011-01-01

    Objective To investigate the ability of the New Jersey Institute of Technology Robot Assisted Virtual Rehabilitation (NJIT-RAVR) system training to elicit changes in upper extremity (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. PMID:20828330

  3. Sediment transport and development of banner banks and sandwaves in an extreme tidal system: Upper Bay of Fundy, Canada

    NASA Astrophysics Data System (ADS)

    Li, Michael Z.; Shaw, John; Todd, Brian J.; Kostylev, Vladimir E.; Wu, Yongsheng

    2014-07-01

    Multibeam sonar mapping and geophysical and geological groundtruth surveys were coupled with tidal current and sediment transport model calculations to investigate the sediment transport and formation processes of the complex seabed features off the Cape Split headland in the upper Bay of Fundy. The Cape Split banner bank, composed of coarse to very coarse sand, is a southwest-northeast oriented, large tear-drop shaped sand body with superimposed sand waves that show wavelengths from 15 to 525 m and heights from 0.5 to 19 m. Isolated and chains of barchan dunes occur on top of a shadow bank to the southeast of the banner bank. The barchan dunes are composed of well-sorted medium sand and are oriented northwest-southeast. Their mean height and width are 1.5 and 55 m, respectively. A gravel bank, with an elongated elliptical shape and west-east orientation, lies in the Minas Passage erosional trough east of the headland to form the counterpart to the sandy Cape Split banner bank. The southern face is featureless but the northern face is covered by gravel megaripples. Tidal model predictions and sediment transport calculations show that the formation of the banner bank and the gravel bank are due to the development of the transient counter-clockwise and clockwise tidal eddies respectively to the west and east of the headland. The formation of barchan dunes is controlled by the nearly unidirectional flow regime in outer Scots Bay. Sand waves on the flanks of the Cape Split banner bank show opposite asymmetry and the barchan dunes are asymmetric to the northeast. The tidal current and sediment transport predictions corroborate bedform asymmetry to show that sand wave migration and net sediment transport is to southwest on the northern flank of the banner bank but to northeast on the southern bank. Long-term migration of the Scots Bay barchan dunes is to the northeast. Spring-condition tidal currents can cause frequent mobilization and high-stage transport over the banner bank and barchan dunes. Strong currents in Minas Passage can cause infrequent low-stage transport over the megarippled northern face but are not high enough to mobilize the coarser gravels on the southern face of the gravel bank.

  4. Isolated left upper extremity myositis and severe rhabdomyolysis in an adult with H1N1 Influenza, a case report with literature review

    PubMed Central

    Agrawal, Abhinav; Razjouyan, Hadie; Atluri, Paavani; Patel, Apoorva; Eng, Margaret

    2014-01-01

    Acute viral myositis is a fairly rare condition and usually seen in recovery phase of illness, especially in pediatric or geriatric population. Influenza type A, specifically H1N1 may present with generalized myositis and mild elevation of creatinine kinase in addition to usual manifestations. We would like to discuss an atypical presentation of Type A Influenza (H1N1) in a middle aged male who was never immunized for influenza, presenting with fever, vomiting, anuria and acute severe left upper extremity pain. The most interesting presentation in our patient was that, it was limited to a single extremity, unlike generalized presentation, which was previously reported, acute renal failure warranting renal replacement therapy. This case serves as a reminder for clinicians about atypical manifestations of H1N1 and its threatening metabolic complications. Hence the practitioners should be aware of this rare but possible presentation of certain strains of influenza virus. It also accentuates the importance of being immunized, reminding us of the Old but Golden Adage “Prevention is better than Cure.”

  5. 21 CFR 876.3750 - Testicular prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...) Identification. A testicular prosthesis is an implanted device that consists of a solid or gel-filled silicone rubber prosthesis that is implanted surgically to resemble a testicle. (b) Classification. Class...

  6. 21 CFR 876.3750 - Testicular prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...) Identification. A testicular prosthesis is an implanted device that consists of a solid or gel-filled silicone rubber prosthesis that is implanted surgically to resemble a testicle. (b) Classification. Class...

  7. 21 CFR 876.3750 - Testicular prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...) Identification. A testicular prosthesis is an implanted device that consists of a solid or gel-filled silicone rubber prosthesis that is implanted surgically to resemble a testicle. (b) Classification. Class...

  8. 21 CFR 876.3750 - Testicular prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...) Identification. A testicular prosthesis is an implanted device that consists of a solid or gel-filled silicone rubber prosthesis that is implanted surgically to resemble a testicle. (b) Classification. Class...

  9. Referral of sensation to an advanced humanoid robotic hand prosthesis.

    PubMed

    Rosn, Birgitta; Ehrsson, H Henrik; Antfolk, Christian; Cipriani, Christian; Sebelius, Fredrik; Lundborg, Gran

    2009-01-01

    Hand prostheses that are currently available on the market are used by amputees to only a limited extent, partly because of lack of sensory feedback from the artificial hand. We report a pilot study that showed how amputees can experience a robot-like advanced hand prosthesis as part of their own body. We induced a perceptual illusion by which touch applied to the stump of the arm was experienced from the artificial hand. This illusion was elicited by applying synchronous tactile stimulation to the hidden amputation stump and the robotic hand prosthesis in full view. In five people who had had upper limb amputations this stimulation caused referral touch sensation from the stump to the artificial hand, and the prosthesis was experienced more like a real hand. We also showed that this illusion can work when the amputee controls the movements of the artificial hand by recordings of the arm muscle activity with electromyograms. These observations indicate that the previously described "rubber hand illusion" is also valid for an advanced hand prosthesis, even when it has a robotic-like appearance. PMID:19863429

  10. Transtibial prosthesis suspension failure during skydiving freefall: a case report.

    PubMed

    Gordon, Assaf T; Land, Rebekah M

    2009-01-01

    This report describes the unusual case of an everyday-use prosthesis suspension system failure during the freefall phase of a skydiving jump. The case individual was a 53-year-old male with a left transtibial amputation secondary to trauma. He used his everyday prosthesis, a transtibial endoskeleton with push-button, plunger-releasing, pin-locking silicon liner suction suspension and a neoprene knee suspension sleeve, for a standard recreational tandem skydive. Within seconds of exiting the plane, the suspension systems failed, resulting in the complete prosthesis floating away. Several factors may have led to suspension system failure, including an inadequate seal and material design of the knee suspension sleeve and liner, lack of auxiliary suspension mechanisms, and lack of a safety cover overlying the push-button release mechanism. This is the first report, to our knowledge, to discuss prosthetic issues specifically related to skydiving. While amputees are to be encouraged to participate in this extreme sport, special modifications to everyday components may be necessary to reduce the possibility of prosthesis failure during freefall, parachute deployment, and landing. PMID:19719060

  11. 21 CFR 878.3590 - Ear prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Ear prosthesis. 878.3590 Section 878.3590 Food and... GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices § 878.3590 Ear prosthesis. (a) Identification. An ear prosthesis is a silicone rubber solid device intended to be implanted to reconstruct the...

  12. 21 CFR 878.3590 - Ear prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Ear prosthesis. 878.3590 Section 878.3590 Food and... GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices § 878.3590 Ear prosthesis. (a) Identification. An ear prosthesis is a silicone rubber solid device intended to be implanted to reconstruct the...

  13. 21 CFR 878.3590 - Ear prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Ear prosthesis. 878.3590 Section 878.3590 Food and... GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices § 878.3590 Ear prosthesis. (a) Identification. An ear prosthesis is a silicone rubber solid device intended to be implanted to reconstruct the...

  14. 21 CFR 878.3590 - Ear prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Ear prosthesis. 878.3590 Section 878.3590 Food and... GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices § 878.3590 Ear prosthesis. (a) Identification. An ear prosthesis is a silicone rubber solid device intended to be implanted to reconstruct the...

  15. 21 CFR 878.3590 - Ear prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Ear prosthesis. 878.3590 Section 878.3590 Food and... GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices § 878.3590 Ear prosthesis. (a) Identification. An ear prosthesis is a silicone rubber solid device intended to be implanted to reconstruct the...

  16. The implantable neurocybernetic prosthesis system.

    PubMed

    Terry, R S; Tarver, W B; Zabara, J

    1991-01-01

    The neurocybernetic prosthesis system (NCP) is an implantable, multiprogrammable pulse generator that delivers constant current electrical signals to the vagus nerve for the purpose of reducing the frequency and severity of epileptic seizures. The signals are delivered on a predetermined schedule, or may be initiated by the patient with an external magnet. The device is implanted in a subcutaneous pocket in the chest just below the clavicle, similar to pacemaker placement. The stimulation signal is transmitted from the prosthesis to the vagus nerve through a lead connected to an electrode which is a multi-turn silicone helix, with a platinum band on the inner turn of one helix. The prosthesis can be programmed with any IBM- compatible personal computer using NCP software and a programming wand. PMID:1705341

  17. Robotic Rehabilitator of the Rodent Upper Extremity: A System and Method for Assessing and Training Forelimb Force Production after Neurological Injury.

    PubMed

    Sharp, Kelli G; Duarte, Jaime E; Gebrekristos, Berkenesh; Perez, Sergi; Steward, Oswald; Reinkensmeyer, David J

    2016-03-01

    Rodent models of spinal cord injury are critical for the development of treatments for upper limb motor impairment in humans, but there are few methods for measuring forelimb strength of rodents, an important outcome measure. We developed a novel robotic device-the Robotic Rehabilitator of the Rodent Upper Extremity (RUE)-that requires rats to voluntarily reach for and pull a bar to retrieve a food reward; the resistance of the bar can be programmed. We used RUE to train forelimb strength of 16 rats three times per week for 23 weeks before and 38 weeks after a mild (100 kdyne) unilateral contusion at the cervical level 5 (C5). We measured maximum force produced when RUE movement was unexpectedly blocked. We compared this blocked pulling force (BPF) to weekly measures of forelimb strength obtained with a previous, well-established method: the grip strength meter (GSM). Before injury, BPF was 2.6 times higher (BPF, 444.6 ± 19.1 g; GSM, 168.4 ± 3.1 g) and 4.9 times more variable (p < 0.001) than pulling force measured with the GSM; the two measurement methods were uncorrelated (R(2) = 0.03; p = 0.84). After injury, there was a significant decrease in BPF of 134.35 g ± 14.71 g (p < 0.001). Together, our findings document BPF as a repeatable measure of forelimb force production, sensitive to a mild spinal cord injury, which comes closer to measuring maximum force than the GSM and thus may provide a useful measure for quantifying the effects of treatment in rodent models of SCI. PMID:26414700

  18. Relationship Between Skin Intrinsic Fluorescence—an Indicator of Advanced Glycation End Products—and Upper Extremity Impairments in Individuals With Diabetes Mellitus

    PubMed Central

    Shah, Kshamata M.; Clark, B. Ruth; McGill, Janet B.; Lang, Catherine E.; Maynard, John

    2015-01-01

    Background Accumulation of advanced glycation end products (AGEs) is thought to contribute to limited joint mobility in people with diabetes mellitus (DM), but the relationships among AGEs, shoulder structural changes, movement, and disability are not understood. Objective The purpose of this study was to determine the differences and relationships among skin intrinsic fluorescence (SIF), a proxy measure of AGEs, biceps and supraspinatus tendon thickness, upper extremity movement, and disability in groups with and without DM. Design This was a cross-sectional, case-control study. Methods Fifty-two individuals participated: 26 with type 2 DM and 26 controls matched for sex, age, and body mass index. The main outcome measures were: SIF; biceps and supraspinatus tendon thickness; 3-dimensional peak shoulder motion; and Disability of the Arm, Shoulder and Hand (DASH) questionnaire scores. Results Mean SIF measurements were 19% higher in the DM group compared with the control group (P<.05). Biceps tendons (mean and 95% confidence interval [CI]) (4.7 mm [4.4, 5.0] versus 3.2 mm [2.9, 3.5]) and supraspinatus tendons (6.4 mm [5.9, 6.8] versus 4.9 mm [4.4, 5.3]) were thicker and peak humerothoracic elevation (139° [135°, 146°] versus 150° [146°, 155°]) and glenohumeral external rotation (35° [26°, 46°] versus 51° [41°, 58°]) were reduced in the DM group compared with the control group (P<.05). In the DM group, SIF was correlated to biceps tendon thickness, DASH score, and shoulder motion (r=.44–.51, P<.05). The SIF score and shoulder strength explained 64% of the DASH scores (P<.01). Limitations Because this was a cross-sectional study design, a cause-effect relationship could not be established. Conclusions Accumulation of AGEs in the connective tissues of individuals with DM appears to be associated with increased tendon thickness and decreased shoulder joint mobility and upper extremity function. Physical therapists should be aware of these possible metabolic effects on structure, movement, and disability when treating people with diabetes. PMID:25858973

  19. Biomechanics of the Upper Extremity in Response to Dynamic Impact Loading Indicative of a Forward Fall: An Experimental and Numerical Investigation

    NASA Astrophysics Data System (ADS)

    Burkhart, Timothy A.

    The distal radius is one of the most common fracture sites in humans, often resulting from a forward fall with more than 60 % of all fractures to the wrist requiring some form of surgical intervention. Although there is a general consensus regarding the risk factors for distal radius fractures resulting from forward falling, prevention of these injuries requires a more thorough understanding of the injury mechanisms. Therefore the overall purpose of this dissertation was to assess the response of the upper extremity to impact loading to improve the understanding of distal radius fracture mechanisms and the effectiveness of joint kinematic strategies for reducing the impact effects. Three main studies were conducted that utilized in vivo, in vitro and numerical techniques. In vitro impact testing of the distal radius revealed that fracture will occur at a mean (SD) resultant impact force and velocity of 2142.1(1228.7) N and 3.4 (0.7) m/s, respectively. Based on the failure data, multi-variate injury criteria models were produced, highlighting the dynamic and multidirectional nature of distal radius fractures The in vitro investigation was also used to develop and validate a finite element model of the distal radius. Dynamic impacts were simulated in LS-DYNARTM and the resulting z-axis force validation metrics (0.23--0.54) suggest that this is a valid model. A comparison of the experimental fracture patterns to those predicted numerically (i.e. von-Mises stress criteria) shows the finite element model is capable of accurately predicting bone failure. Finally, an in vivo fall simulation apparatus was designed and built that was found to reliably (Intraclass Correlation Coefficients > 0.6) apply multi-directional motion and upper extremity impacts indicative of forward falls. This study revealed that, to some extent, individuals are capable of selected an impact strategy that minimizes the significant injury variables that were outlined in the in vitro investigation, with very little instruction. The body of work presented here has the potential to be used to develop distal radius fracture prevention methods in an attempt to improve the health and well being of those individuals currently at the highest risk of sustaining these injuries.

  20. Extreme erosion response after wildfire in the Upper Ovens, south-east Australia: Assessment of catchment scale connectivity by an intensive field survey

    NASA Astrophysics Data System (ADS)

    Box, Walter; Keestra, Saskia; Nyman, Petter; Langhans, Christoph; Sheridan, Gary

    2015-04-01

    South-eastern Australia is generally regarded as one of the world's most fire-prone environments because of its high temperatures, low rainfall and flammable native Eucalyptus forests. Modifications to the landscape by fire can lead to significant changes to erosion rates and hydrological processes. Debris flows in particular have been recognised as a process which increases in frequency as a result of fire. This study used a debris flow event in the east Upper Ovens occurred on the 28th of February 2013 as a case study for analysing sediment transport processes and connectivity of sediment sources and sinks. Source areas were identified using a 15 cm resolution areal imagery and a logistic regression model was made based on fire severity, aridity index and slope to predict locations of source areas. Deposits were measured by making cross-sections using a combination of a differential GPS and a total station. In total 77 cross-sections were made in a 14.1 km2 sub-catchment and distributed based on channel gradient and width. A more detailed estimation was obtained by making more cross-sections where the volume per area is higher. Particle size distribution between sources and sink areas were obtained by combination of field assessment, photography imagery analyses and sieve and laser diffraction. Sediment was locally eroded, transported and deposited depending on factors such as longitude gradient, stream power and the composition of bed and bank material. The role of headwaters as sediment sinks changed dramatically as a result of the extreme erosion event in the wildfire affected areas. Disconnected headwaters became connected to low order streams due to debris flow processes in the contributing catchment. However this redistribution of sediment from headwaters to the drainage network was confined to upper reaches of the Ovens. Below this upper part of the catchment the event resulted in redistribution of sediment already existing in the channel through a combination of debris flows and hyperconcentrated flows. These results indicate that there is a stepwise outflow of sediment influencing long-term erosion rates and landform development.

  1. Prosthetic rehabilitation of the upper limb amputee

    PubMed Central

    OKeeffe, Bernard

    2011-01-01

    The loss of all or part of the arm is a catastrophic event for a patient and a significant challenge to rehabilitation professionals and prosthetic engineers. The large, upper extremity amputee population in India has, historically, been poorly served, with most having no access to support or being provided with ineffective prostheses. In recent years, the arrival of organisations like Otto Bock has made high quality service standards and devices accessible to more amputees. This review attempts to provide surgeons and other medical professionals with an overview of the multidisciplinary, multistage rehabilitation process and the solution options available. With worldwide upper extremity prosthesis rejection rates at significant levels, the review also describes some of the factors which influence the outcome. This is particularly relevant in the Indian context where the service can involve high cost investments. It is the responsibility of all contributing professionals to guide vulnerable patients through the process and try to maximise the benefit that can be obtained within the resources available. PMID:22022035

  2. Radiography of the Upper Extremity

    MedlinePLUS

    ... superiores es otra forma de llamar a las imgenes de rayos X de los dedos, manos, muecas, ... pedir que gire en varias posiciones, para tomar imgenes adicionales desde diferentes ngulos. Tambin se le puede ...

  3. Muscles of the Upper Extremity

    MedlinePLUS

    ... Ureters Urinary Bladder Urethra Review Quiz Reproductive System Male Reproductive System Testes Duct System Accessory Glands Penis Male Sexual Response & Hormone Control Female Reproductive System Ovaries Genital Tract External Genitalia Female Sexual Response & ...

  4. Work organization is significantly associated with upper extremities musculoskeletal disorders among employees engaged in interactive computer-telephone tasks of an international bank subsidiary in So Paulo, Brazil.

    PubMed

    Ferreira Jnior, M; Conceio, G M; Saldiva, P H

    1997-04-01

    This study was designed to verify the risk factors for developing upper extremities musculoskeletal disorders (UEMD) among workers engaged in customer service tasks performed by telephone at a private banking corporation in So Paulo, Brazil. The monthly incidence of UEMD in hands and/or wrists in this group was studied retrospectively from January 1993 to June 1995. The statistical analysis was done by using multiple linear regression with the monthly incidence of UEMD considered as dependent variable in models controlled for age, seniority, mean daily regular worktime and overtime per operator, time pressure at work, rest/work schedule, management status, personnel training on postural and muscle stretching, and ergonomic hazards. The variables associated with UEMD were the following: time pressure at work (coefficient = 0.049; p = 0.008) and rest/work schedule (coefficient = -0.047; p = 0.02). The results indicate that working conditions are significantly associated with UEMD, and changes in the working schedule may decrease the incidence of this problem in workers assigned to tasks related to the interactive use of computer-accessible databases during telephone contacts. PMID:9093663

  5. Ascending curbs of progressively higher height increases forward trunk flexion along with upper extremity mechanical and muscular demands in manual wheelchair users with a spinal cord injury.

    PubMed

    Lalumiere, Mathieu; Gagnon, Dany H; Hassan, Jessica; Desroches, Guillaume; Zory, Raphael; Pradon, Didier

    2013-12-01

    High upper extremity (U/E) demands are required when manual wheelchair users (MWUs) with spinal cord injury (SCI) ascend curbs; this may contribute to the risk of developing U/E musculoskeletal impairments. The aim of this study was to compare movement strategies (kinematics), mechanical loads (kinetics) and muscular demand (EMG) at the non-dominant U/E among 15 MWUs with SCI when ascending curbs of 4 cm (3 trials), 8 cm (3 trials) and 12 cm high (3 trials) from a starting line set 3 m before the curb. Biomechanical data was collected during three trials for each height. The curb ascent task was divided into three adjustment phases: caster pop, rear-wheel ascent and post-ascent. The greatest effort was generated by the shoulder flexors and internal rotators as well as the elbow flexors. A significant difference (p < 0.0167) between the curb heights was found for most outcome measures studied: movement excursion, net joint moments and muscular utilization ratio (MUR) of the main muscles increased with the higher curb heights, mainly around the shoulder joint. These results provide insight that aside from adhering to a highly structured training method for wheelchair curb ascent, rehabilitation professionals need to propose task-specific strength training programs based on the demands documented in this study and continue to advocate for physically accessible environments. PMID:23866992

  6. The Long-term Risk of Upper-extremity Lymphedema is Two-fold Higher in Breast Cancer Patients than in Melanoma Patients

    PubMed Central

    Voss, Rachel K.; Cromwell, Kate D.; Chiang, Yi-Ju; Armer, Jane M.; Ross, Merrick I.; Lee, Jeffrey E.; Gershenwald, Jeffrey E.; Stewart, Bob R.; Shaitelman, Simona F.; Cormier, Janice N.

    2015-01-01

    Background and Objectives We assessed the cumulative incidence, symptoms, and risk factors for upper-extremity lymphedema in breast cancer and melanoma patients undergoing sentinel lymph node biopsy or axillary lymph node dissection. Methods Patients were recruited preoperatively (time 0) and assessed at 6, 12, and 18 months postoperatively. Limb volume change (LVC) was measured by perometry. Lymphedema was categorized as none, mild (LVC 59.9%), or moderate/severe (LVC?10%). Symptoms were assessed with a validated lymphedema instrument. Longitudinal logistic regression analyses were conducted to identify risk factors associated with moderate/severe lymphedema. Results Among 205 breast cancer and 144 melanoma patients, the cumulative incidence of moderate/severe lymphedema at 18 months was 36.5% and 35.0, respectively. However, in adjusted analyses, factors associated with moderate/severe lymphedema were breast cancer (OR 2.0, p=0.03), body mass index ?30 kg/m2 (OR 1.6, p=0.04), greater number of lymph nodes removed (OR 1.05, p<0.01), and longer interval since surgery (OR 2.33 at 18 months, p<0.01). Conclusions: Lymphedema incidence increased over time in both cohorts. However, the adjusted risk of moderate/severe lymphedema was two-fold higher in breast cancer patients. These results may be attributed to surgical treatment of the primary tumor in the breast and more frequent use of radiation. PMID:26477877

  7. Combined Cognitive-Strategy and Task-Specific Training Affects Cognition and Upper-Extremity Function in Subacute Stroke: An Exploratory Randomized Controlled Trial.

    PubMed

    Wolf, Timothy J; Polatajko, Helene; Baum, Carolyn; Rios, Jorge; Cirone, Dianne; Doherty, Meghan; McEwen, Sara

    2016-01-01

    The purpose of this study was to estimate the effect of Cognitive Orientation to Daily Occupational Performance (CO-OP) compared with usual occupational therapy on upper-extremity movement, cognitive flexibility, and stroke impact in people less than 3 mo after stroke. An exploratory, single-blind randomized controlled trial was conducted with people referred to outpatient occupational therapy services at two rehabilitation centers. Arm movement was measured with the Action Research Arm Test, cognitive flexibility with the Delis-Kaplan Executive Function System Trail Making subtest, and stroke impact with subscales of the Stroke Impact Scale. A total of 35 participants were randomized, and 26 completed the intervention. CO-OP demonstrated measurable effects over usual care on all measures. These data provide early support for the use of CO-OP to improve performance and remediate cognitive and arm movement impairments after stroke over usual care; however, future study is warranted to confirm the effects observed in this trial. PMID:26943113

  8. Experience from the in-flight calibration of the Extreme Ultraviolet Explorer (EUVE) and Upper Atmosphere Research Satellite (UARS) fixed head star trackers (FHSTs)

    NASA Technical Reports Server (NTRS)

    Lee, Michael

    1995-01-01

    Since the original post-launch calibration of the FHSTs (Fixed Head Star Trackers) on EUVE (Extreme Ultraviolet Explorer) and UARS (Upper Atmosphere Research Satellite), the Flight Dynamics task has continued to analyze the FHST performance. The algorithm used for inflight alignment of spacecraft sensors is described and the equations for the errors in the relative alignment for the simple 2 star tracker case are shown. Simulated data and real data are used to compute the covariance of the relative alignment errors. Several methods for correcting the alignment are compared and results analyzed. The specific problems seen on orbit with UARS and EUVE are then discussed. UARS has experienced anomalous tracker performance on an FHST resulting in continuous variation in apparent tracker alignment. On EUVE, the FHST residuals from the attitude determination algorithm showed a dependence on the direction of roll during survey mode. This dependence is traced back to time tagging errors and the original post launch alignment is found to be in error due to the impact of the time tagging errors on the alignment algorithm. The methods used by the FDF (Flight Dynamics Facility) to correct for these problems is described.

  9. Sex determination using discriminant analysis of upper and lower extremity bones: New approach using the volume and surface area of digital model.

    PubMed

    Lee, U-Young; Kim, In-Beom; Kwak, Dai-Soon

    2015-08-01

    This study used 110 CT images taken from donated Korean cadavers to create 3-D models of the following upper and lower limb bones: the clavicle, scapula, humerus, radius, ulna, hip bone (os coxa), femur, patella (knee cap), tibia, talus, and calcaneus. In addition, the bone volume and surface area were calculated to determine sex differences using discriminant analysis. Significant sex differences were found in all bones with respect to volume and surface area (p<0.01). The order of volume was the same in females and males (femur>hip bone>tibia>humerus>scapula), although the order of surface area was different. The largest surface area in men was the femur and in women was the hip bone (p<0.01). An interesting finding of this study was that the ulna is the bone with the highest accuracy for sex determination (94%). When using the surface area of multiple bones, the maximum accuracy (99.4%) was achieved. The equation was as follows: (discriminant equation of surface area; female<0extremity bones can be used for sex determination. PMID:26117502

  10. Assessing validity of the QuickDASH and SF-12 as surveillance tools among workers with neck or upper extremity musculoskeletal disorders.

    PubMed

    Fan, Z Joyce; Smith, Caroline K; Silverstein, Barbara A

    2008-01-01

    The purpose of this article was to assess validity of the regional Disabilities of Arm, Shoulder, and Hand (QuickDASH) and Short-Form 12 (SF-12) for surveillance purpose. We compared the predictive, discriminate, and concurrent validity of the QuickDASH and SF-12 among 231 workers with specific clinical diagnoses of neck or upper extremity musculoskeletal disorders (UEMSDs) and 175 workers with symptoms only. Compared to those with symptoms only, the odds of being any neck or UEMSD case were 1.45 (95% confidence interval [95% CI]: 1.24-1.70) and 0.66 (95% CI: 0.48-0.91) with every 10-point increase in QuickDASH disability and physical component scale (PCS-12) scores, respectively. The clinical cases had significantly higher QuickDASH disability (23.0 vs. 14.3, p<0.0001) and lower PCS-12 scores (44.8 vs. 47.3, p=0.0133) than those with symptom only. The QuickDASH disability scores were moderately correlated with the PCS-12 scores (rho=-0.40) among the clinical cases. Either QuickDASH or PCS-12 can be used as a simple surveillance tool in an active working population. PMID:19006762

  11. Specificity of the minimal clinically important difference of the quick Disabilities of the Arm Shoulder and Hand (QDASH) for distal upper extremity conditions.

    PubMed

    Smith-Forbes, Enrique V; Howell, Dana M; Willoughby, Jason; Pitts, Donald G; Uhl, Tim L

    2016-01-01

    Retrospective cohort design. The minimal clinically important difference (MCID) for the quick Disabilities of the Arm, Shoulder and Hand (QDASH) has been established using a pool of multiple conditions, and only exclusively for the shoulder. Understanding diagnoses-specific threshold change values can enhance the clinical decision-making process. Before and after QDASH scores for 406 participants with conditions of surgical distal radius fracture, non-surgical lateral epicondylitis, and surgical carpal tunnel release were obtained. The external anchor administered at each fourth visit was a 15-point global rating of change scale. The test-retest reliability of the QDASH was moderate for all diagnoses: intraclass correlation coefficient model 2, 1, for surgical distal radius=0.71; non-surgical lateral epicondylitis=0.69; and surgical carpal tunnel=0.69. The minimum detectable change at the 90% confidence level was 25.28; 22.49; and 27.63 points respectively; and the MCID values were 25.8; 15.8 and 18.7, respectively. For these three distal upper extremity conditions, a QDASH MCID of 16-26 points could represent the estimate of change in score that is important to the patient and guide clinicians through the decision-making process. PMID:26601561

  12. Effects of modified constraint-induced movement therapy and functional bimanual training on upper extremity function and daily activities in a patient with incomplete spinal cord injury: a case study

    PubMed Central

    Kim, Yeon-Ju; Kim, Jin-Kyung; Park, So-Yeon

    2015-01-01

    [Purpose] In this study, we examined effects of modified constraint-induced movement therapy (m-CIMT) and functional bimanual training, when applied to a patient with incomplete spinal cord injury, on upper extremity function and daily activities. [Subject and Methods] One patient, diagnosed with C4 incomplete spinal cord injury, underwent physical therapy with constraint-induced movement therapy for 3 hours and task-oriented bimanual training for 1 hour, per day. This combined 4-hour session was performed five times a week, for 3 weeks, totaling 15 sessions. Upper extremity function was measured using the Manual Function Test (MFT) and Box & Block Test (BBT). Additionally, Spinal Cord Independence Measure Version III (SCIM-III) and Short Form 36 Health Survey (SF-36) were used to assess functional outcomes. [Results] Mobility of the hand and overall function of upper extremities were enhanced following intervention. Moreover, the subjects quality of life and ability to carry out daily activities also improved. [Conclusion] Modified constraint-induced movement therapy and bimanual training was effective in enhancing upper extremity function and performance of daily routines in a patient with incomplete spinal cord injury. Further studies, recruiting multiple subjects, should focus on m-CIMT using diverse methods, performed during the course of daily activities. PMID:26834387

  13. Design, fabrication, and preliminary results of a novel below-knee prosthesis for snowboarding: A case report.

    PubMed

    Minnoye, Sander L M; Plettenburg, Dick H

    2009-09-01

    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

  14. Dynaflex prosthesis in total phalloplasty.

    PubMed

    Hage, J J

    1997-02-01

    Because of the high rate of complications and because voiding while standing is a priority for most female-to-male transsexuals, until recently, I have refrained from implantation of a rigidity prosthesis in total phalloplasty. However, promising results have been obtained with self-contained Dynaflex hydraulic penile implants. The results and complications observed in my first five cases are reported in order to help prevent failure in future cases. I advocate implantation as a secondary procedure after the neophallus has gained sensitivity. The penile prosthesis should be covered by a Dacron prosthesis to ensure optimal encapsulation and collagen ingrowth. Since the neophallus girth will not allow for two prostheses to be implanted, and because properly serviceable crus penis is lacking in female-to-male transsexuals, I further advocate fixation of the one cylinder to the pubic symphysis. For insertion, the neoscrotal approach is superior. I maintain that combination of a neourethra and a rigidity prosthesis in one neophallus remains a challenge, both to the patient and to the surgeon. PMID:9030158

  15. Knee joint replacement prosthesis (image)

    MedlinePLUS

    A prosthesis is a device designed to replace a missing part of the body, or to make a part of the body work better. The metal prosthetic device in knee joint replacement surgery replaces cartilage and bone which is damaged from disease or aging.

  16. Intraocular retinal prosthesis.

    PubMed Central

    Humayun, M S

    2001-01-01

    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. PMID:11797315

  17. Plasticity in the Visual System is Associated with Prosthesis Use in Phantom Limb Pain

    PubMed Central

    Preißler, Sandra; Dietrich, Caroline; Blume, Kathrin R.; Hofmann, Gunther O.; Miltner, Wolfgang H. R.; Weiss, Thomas

    2013-01-01

    The experience of strong phantom limb pain (PLP) in arm amputees was previously shown to be associated with structural neural plasticity in parts of the cortex that belong to dorsal and ventral visual streams. It has been speculated that this plasticity results from the extensive use of a functional prosthesis which is associated with increased visual feedback to control the artificial hand. To test this hypothesis, we reanalyzed data of cortical volumes of 21 upper limb amputees and tested the association between the amount of use of the hand prosthesis and cortical volume plasticity. On the behavioral level, we found no relation between PLP and the amount of prosthesis use for the whole patient group. However, by subdividing the patient group into patients with strong PLP and those with low to medium PLP, stronger pain was significantly associated with less prosthesis use whereas the group with low PLP did not show such an association. Most plasticity of cortical volume was identified within the dorsal stream. The more the patients that suffered from strong PLP used their prosthesis, the smaller was the volume of their posterior parietal cortex. Our data indicate a relationship between prosthesis use and cortical plasticity of the visual stream. This plasticity might present a brain adaptation process to new movement and coordination patterns needed to guide an artificial hand. PMID:23805096

  18. Upper extremity kinematics and kinetics during the performance of a stationary wheelie in manual wheelchair users with a spinal cord injury.

    PubMed

    Lalumiere, Mathieu; Gagnon, Dany H; Routhier, Franois; Bouyer, Laurent; Desroches, Guillaume

    2014-08-01

    No comprehensive biomechanical study has documented upper extremity (U/E) kinematics and kinetics during the performance of wheelchair wheelies among manual wheelchair users (MWUs). The aim of this study was to describe movement strategies (kinematics), mechanical loads (kinetics), and power at the nondominant U/E joints during a wheelie among MWUs with spinal cord injury (SCI). During a laboratory assessment, 16 MWUs with SCI completed four wheelie trials on a rigid surface. Each participant's wheelchair was equipped with instrumented wheels to record handrim kinetics, while U/E and wheelchair kinematics were recorded with a 3D motion analysis system. The greatest mean and peak total net joint moments were generated by the shoulder flexors (mean = 7.2 3.5 Nm; peak = 20.7 12.9 Nm) and internal rotators (mean = 3.8 2.2 Nm; peak = 11.4 10.9 Nm) as well as by the elbow flexors (mean = 5.5 2.5 Nm; peak = 14.1 7.6 Nm) during the performance of wheelies. Shoulder flexor and internal rotator efforts predominantly generate the effort needed to lift the front wheels of the wheelchair, whereas the elbow flexor muscles control these shoulder efforts to reach a state of balance. In combination with a task-specific training program that remains essential to properly learn how to control wheelies among MWUs with SCI, rehabilitation professionals should also propose a shoulder flexor, internal rotator, and elbow flexor strengthening program. PMID:24610281

  19. Risk Factors for Neck and Upper Extremity Disorders among Computers Users and the Effect of Interventions: An Overview of Systematic Reviews

    PubMed Central

    Andersen, Johan H.; Fallentin, Nils; Thomsen, Jane F.; Mikkelsen, Sigurd

    2011-01-01

    Background To summarize systematic reviews that 1) assessed the evidence for causal relationships between computer work and the occurrence of carpal tunnel syndrome (CTS) or upper extremity musculoskeletal disorders (UEMSDs), or 2) reported on intervention studies among computer users/or office workers. Methodology/Principal Findings PubMed, Embase, CINAHL and Web of Science were searched for reviews published between 1999 and 2010. Additional publications were provided by content area experts. The primary author extracted all data using a purpose-built form, while two of the authors evaluated the quality of the reviews using recommended standard criteria from AMSTAR; disagreements were resolved by discussion. The quality of evidence syntheses in the included reviews was assessed qualitatively for each outcome and for the interventions. Altogether, 1,349 review titles were identified, 47 reviews were retrieved for full text relevance assessment, and 17 reviews were finally included as being relevant and of sufficient quality. The degrees of focus and rigorousness of these 17 reviews were highly variable. Three reviews on risk factors for carpal tunnel syndrome were rated moderate to high quality, 8 reviews on risk factors for UEMSDs ranged from low to moderate/high quality, and 6 reviews on intervention studies were of moderate to high quality. The quality of the evidence for computer use as a risk factor for CTS was insufficient, while the evidence for computer use and UEMSDs was moderate regarding pain complaints and limited for specific musculoskeletal disorders. From the reviews on intervention studies no strong evidence based recommendations could be given. Conclusions/Significance Computer use is associated with pain complaints, but it is still not very clear if this association is causal. The evidence for specific disorders or diseases is limited. No effective interventions have yet been documented. PMID:21589875

  20. Constraint-Induced Movement Therapy for Severe Upper-Extremity Impairment after Stroke in an Outpatient Rehabilitation Setting: A Case Report

    PubMed Central

    Shears, Jennifer; Hutchings, Lisa; Osmond, Michelle

    2008-01-01

    Purpose: Laboratory studies confirm that constraint-induced movement therapy (CIMT) improves upper-extremity (UE) function after stroke. Due to strict patient criteria and the intensive resources required, CIMT has been slow to become part of rehabilitation practice. Our purpose was to determine the feasibility and effectiveness of an adapted experimental protocol within an outpatient clinical setting for a patient with moderate to severe UE impairment who did not meet traditional CIMT criteria. Patient Description: AJ, a 16-year-old male, experienced a left middle cerebral artery ischemic stroke due to carotid artery dissection one year before beginning CIMT. He demonstrated some proximal movement but no wrist or finger extension. He had received intensive rehabilitation for 12 months prior to beginning CIMT. Intervention: Two occupational therapists and two physiotherapists collaborated to provide CIMT task training for 6 hours daily for 2 weeks. A knitted mitten extending to the elbow restrained the less-involved UE during 90% of waking hours. Tasks were tailored to AJ's interests, with the goal of integrating his affected UE into his behavioural repertoire. Measures and Outcomes: After 2 weeks of CIMT, AJ improved in all measures (grip and lateral pinch strength, Action Research Arm Test [ARAT], and Box and Block Test) except the Chedoke McMaster Impairment Inventory. Greatest gains were seen at 6 months in the ARAT and Box and Block Test, which coincided with patient and family reports of AJ's using his arm in everyday functional tasks. Implications: Shared workload, emphasis on relevant functional tasks, and complete family participation likely influenced the success of CIMT. Our findings suggest that the strict CIMT criteria used in previous studies may exclude patients who might benefit from the treatment. Controlled trials should be undertaken to examine the effects of CIMT in patients with moderate to severe UE impairment. PMID:20145779

  1. The effect of driver age on the incidence and severity of upper extremity injuries due to second generation front air bag deployment.

    PubMed

    Marshall, Rafael; Hunting, Katherine; McKay, Mary Pat

    2010-01-01

    This study used NHTSA NASS/CDS data to examine whether advancing age was associated with a higher incidence and severity of front airbag-related upper extremity injury (UEI). Using a retrospective cohort design we analyzed weighted data from 1998-2007 for. The study population consisted of lap/shoulder belted people over 16 years of age who were driving passenger vehicles with model years 1998-2003 and were involved in a frontal crash where their front airbag deployed. Drivers who were ejected, involved in a vehicle rollover, or accompanied by a passenger sitting directly behind them were omitted. The exposure variable was age and the outcome variables were UEI incidence and severity. Associations were adjusted for gender, seat track position, vehicle type, vehicle weight, intrusion, and delta-v. Logistic regressions were performed using SAS survey procedures to account for the complex survey design. Overall, 42% of drivers sustained an UEI. Advancing age was associated with a higher incidence (p<0. 0001) and severity (p<0. 0001) of UEI. Nineteen percent of drivers sustained an UEI related to the airbag. No significant differences in the incidence or severity of airbag-related UEI were found between young drivers and older driver age groups. The degree of severity due to airbag-related UEI was generally minor. The majority of airbag-related UEI appeared to shift slightly from abrasions to contusions with aging. These results indicate that UEI due to depowered airbag deployment is common but not disproportionately high among older drivers, and injury severity is generally minor across all age groups. PMID:21050604

  2. Responsiveness of the QuickDASH and SF-12 in workers with neck or upper extremity musculoskeletal disorders: one-year follow-up.

    PubMed

    Fan, Z Joyce; Smith, Caroline K; Silverstein, Barbara A

    2011-06-01

    INTRODUCTION Questionnaires that measure functional status such as the Disability of the Arm, Shoulder and Hand (QuickDASH) and the Medical Outcomes Study 12-item Short-Form Health Survey (SF-12) can quantify the impact of health on performance. Little is known about whether these questionnaires can be used as a tool for measuring disabilities among workers. We compare the responsiveness of these two functional status questionnaires to changes in clinical outcomes of neck or upper extremity musculoskeletal disorders (UEMSD) among active workers in a longitudinal study. METHODS We evaluated the effect size (ES) and standardized response means (SRM) of the QuickDASH and the SF-12 for 148 workers who were divided into four subgroups based on the diagnosis status change between baseline and 1-year visit. RESULTS The ES and SRM for QuickDASH scores were 0.6/0.6 for the 50 subjects who became incident symptomatic neck or UEMSD cases, 1.3/1.0 for the 18 subjects who became incident clinical cases of neck or UEMSD, -1.0/-1.1 for the 46 subjects who recovered from having neck or UEMSD symptoms, and -1.1/-1.1 for the 34 subjects who recovered from being neck or UEMSD clinical cases. The correspondent ES/SRM for the QuickDASH work module were 0.4/0.3, 0.7/0.5, -0.6/-0.4, and -1.0/-0.8, respectively. The correspondent ES/SRM for the physical component scores of SF-12 (PCS12) for the four subgroups were 0.2/0.2, -0.9/-0.6, 0.3/0.2, and 0.3/0.3, respectively. CONCLUSIONS The QuickDASH scores were responsive to changes among active workers who were neck or UEMSD symptomatic or clinical case. PCS12 scores were sufficient only for use in clinical case status change. PMID:20890643

  3. [Somatosensoric prosthesis for the blind].

    PubMed

    Vysata, O; Prochzka, A; Kukal, J; Becvrovsk, P; Pazdera, L

    2008-09-01

    At present vision prosthesis proposes transmission of only a limited amount of visual information. Cutaneous receptor field may serve as a information channel. It has similar information-processing ability as retina. Lower information capacity of the skin may be compensated by wavelet transform image compression. Advances in microtechnology have facilitated the development of a haptic data visualization system with sufficient life-time for people with visual impairments. Proposed array with 2400 carbon electrodes stewed on elastic membrane in the present experiments demonstrate a good mechanical endurance, electrical stability and adhesivity to the trunk skin. Disadvantageous is short circuits production among near electrodes due to sweating and skin irritation after long term electrical stimulation. Vibrotactile piezo-electric stimulators are safer alternative with lower resolution. Comparing retinal and cortical vision prosthesis offers electrocutaneous communication system comparably higher amount of transmitted information. PMID:18988476

  4. Dosimetry of a silicone breast prosthesis

    SciTech Connect

    McGinley, P.H.; Powell, W.R.; Bostwick, J.

    1980-04-01

    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.

  5. Women's Satisfaction with Their Breast Prosthesis: What Determines a Quality Prosthesis?

    ERIC Educational Resources Information Center

    Livingston, Patricia M.; White, Victoria M.; Roberts, Susan B.; Pritchard, Emma; Hayman, Jane; Gibbs, Anne; Hill, David J.

    2005-01-01

    The aim of this study is to determine what factors constitute a quality prosthesis and ascertain which factors affect prosthesis satisfaction. Sixty-four women who received full funding for their prosthesis and 38 women who received their hospital's usual funding were recruited. Women rated the information provided about breast prostheses very…

  6. Tracheostomy cannulas and voice prosthesis

    PubMed Central

    Kramp, Burkhard; Dommerich, Steffen

    2011-01-01

    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. PMID:22073098

  7. High resolution optoelectronic retinal prosthesis

    NASA Astrophysics Data System (ADS)

    Loudin, Jim; Dinyari, Rostam; Huie, Phil; Butterwick, Alex; Peumans, Peter; Palanker, Daniel

    2009-02-01

    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.

  8. The Salto Talaris XT Revision Ankle Prosthesis.

    PubMed

    Roukis, Thomas S

    2015-10-01

    The Salto Talaris XT Revision Ankle Prosthesis is an anatomically designed fixed-bearing prosthesis available in the United States based on the design of previous Salto systems. The Salto Talaris XT Revision Ankle Prosthesis design optimizes surface area, cortical contact, and ultrahigh-molecular-weight polyethylene conformity. Two tibial component designs, both with the same base plate dimensions, are available, the standard conical fixation plug affixed to a short keel and a long-stemmed version. The author presents an overview of the Salto Talaris XT Revision Ankle Prosthesis surgical technique and pearls for successful application. PMID:26407741

  9. Three-dimensional printed calcaneal prosthesis following total calcanectomy?

    PubMed Central

    Imanishi, Jungo; Choong, Peter F.M.

    2015-01-01

    Introduction The majority of patients with extremity sarcoma can be surgically treated without amputation. However, limb-salvage surgery for foot sarcomas including the calcaneus remains challenging. Presentation of case A 71-year-old man presented with a 5-year history of right heel persistent pain. Imaging studies revealed an osteolytic, destructive and highly metabolic lesion in the right calcaneus. Computed tomography guided core needle biopsy confirmed the diagnosis of grade 2 chondrosarcoma. A total calcanectomy was performed, and the defect was reconstructed with a patient matched three-dimensional printed titanium calcaneal prosthesis. Intra-operatively, ligaments including the Achilles tendon, and plantar fascia were reattached. The post-operative course was uneventful, and at the 5-month clinical follow-up, the patient was fully weightbearing, with a mobile ankle without pain. Discussion This case is the first to use additive manufacturing to create a prosthetic calcaneus. The complex peri-calcaneal articular surfaces and reattachment of tendinous structures facilitate efforts to stabilize the prosthesis in situ. Conclusion Three-dimensional-printed prosthesis of the calcaneus is a viable alternative to amputation. PMID:25827294

  10. Effect of upper and lower extremity control strategies on predicted injury risk during simulated forward falls: a study in healthy young adults.

    PubMed

    Lo, Jiahsuan; Ashton-Miller, James A

    2008-08-01

    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 upper extremity 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

  11. Management of the upper-limb-deficient child with a powered prosthetic device.

    PubMed

    Glynn, M K; Galway, H R; Hunter, G; Sauter, W F

    1986-08-01

    A long-term survey of a large number of children fitted with an electrically powered upper-limb prosthesis seems not to have been reported in the literature. Children with upper-limb deficiencies (congenital or traumatic) were fitted with an electrically powered upper-limb prosthesis in Ontario during the 18-year period of 1965-1983. Seventy-eight patients responded to a questionnaire or were interviewed by telephone. The dropout rate in children with a below-elbow amputation was similar to that reported in below-elbow child amputees wearing a conventional body-powered prosthesis (10% vs. 13%). The acceptance rate in children with above-elbow amputations was higher in those wearing an electrically powered prosthesis than in those using the conventional prosthesis, testifying for improved prosthetic function in the former group. PMID:3731596

  12. 21 CFR 876.3750 - Testicular prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Testicular prosthesis. 876.3750 Section 876.3750 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Prosthetic Devices 876.3750 Testicular prosthesis....

  13. 21 CFR 878.3550 - Chin prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Chin prosthesis. 878.3550 Section 878.3550 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices § 878.3550 Chin prosthesis....

  14. 21 CFR 878.3680 - Nose prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Nose prosthesis. 878.3680 Section 878.3680 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices § 878.3680 Nose prosthesis....

  15. 21 CFR 878.3720 - Tracheal prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Tracheal prosthesis. 878.3720 Section 878.3720 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices § 878.3720 Tracheal prosthesis....

  16. 21 CFR 878.3680 - Nose prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Nose prosthesis. 878.3680 Section 878.3680 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices 878.3680 Nose prosthesis....

  17. 21 CFR 878.3550 - Chin prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Chin prosthesis. 878.3550 Section 878.3550 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices 878.3550 Chin prosthesis....

  18. 21 CFR 878.3720 - Tracheal prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Tracheal prosthesis. 878.3720 Section 878.3720 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices 878.3720 Tracheal prosthesis....

  19. 21 CFR 878.3720 - Tracheal prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Tracheal prosthesis. 878.3720 Section 878.3720 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices 878.3720 Tracheal prosthesis....

  20. 21 CFR 878.3550 - Chin prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Chin prosthesis. 878.3550 Section 878.3550 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices 878.3550 Chin prosthesis....

  1. 21 CFR 878.3720 - Tracheal prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Tracheal prosthesis. 878.3720 Section 878.3720 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices 878.3720 Tracheal prosthesis....

  2. 21 CFR 878.3550 - Chin prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Chin prosthesis. 878.3550 Section 878.3550 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices 878.3550 Chin prosthesis....

  3. 21 CFR 878.3680 - Nose prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Nose prosthesis. 878.3680 Section 878.3680 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices 878.3680 Nose prosthesis....

  4. 21 CFR 878.3680 - Nose prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Nose prosthesis. 878.3680 Section 878.3680 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices 878.3680 Nose prosthesis....

  5. 21 CFR 878.3720 - Tracheal prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Tracheal prosthesis. 878.3720 Section 878.3720 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices 878.3720 Tracheal prosthesis....

  6. 21 CFR 878.3550 - Chin prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Chin prosthesis. 878.3550 Section 878.3550 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices 878.3550 Chin prosthesis....

  7. 21 CFR 878.3680 - Nose prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Nose prosthesis. 878.3680 Section 878.3680 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices 878.3680 Nose prosthesis....

  8. BIORESORBABLE POLYMERIC MENISCAL PROSTHESIS: STUDY IN RABBITS

    PubMed Central

    Cardoso, Tulio Pereira; de Rezende Duek, Eliana Aparecida; Amatuzzi, Marco Martins; Caetano, Edie Benedito

    2015-01-01

    Objective: To induce growth of a neomeniscus into the pores of a prosthesis in order to protect the knee joint cartilage. Methods: 70 knees of 35 New Zealand rabbits were operated. The rabbits were five to seven months old, weighed 2 to 3.8 kilograms, and 22 were male and 13 were female. Each animal underwent medial meniscectomy in both knees during a single operation. A bioabsorbable polymeric meniscal prosthesis composed of 70% polydioxanone and 30% L-lactic acid polymer was implanted in one side. The animals were sacrificed after different postoperative time intervals. The femoral condyles and neomeniscus were subjected to histological analysis. Histograms were used to measure the degradation and absorption of the prosthesis, the growth of meniscal tissue in the prosthesis and the degree of degradation of the femoral condyle joint cartilage. Results: The data obtained showed that tissue growth histologically resembling a normal meniscus occurred, with gradual absorption of the prosthesis, and the percentages of chondrocytes on the control side and prosthesis side. Conclusion: Tissue growth into the prosthesis pores that histologically resembled the normal rabbit meniscus was observed. The joint cartilage of the femoral condyles on the prosthesis side presented greater numbers of chondrocytes in all its layers.

  9. Parametric modelling of a knee joint prosthesis.

    PubMed

    Khoo, L P; Goh, J C; Chow, S L

    1993-01-01

    This paper presents an approach for the establishment of a parametric model of knee joint prosthesis. Four different sizes of a commercial prosthesis are used as an example in the study. A reverse engineering technique was employed to reconstruct the prosthesis on CATIA, a CAD (computer aided design) system. Parametric models were established as a result of the analysis. Using the parametric model established and the knee data obtained from a clinical study on 21 pairs of cadaveric Asian knees, the development of a prototype prosthesis that suits a patient with a very small knee joint is presented. However, it was found that modification to certain parameters may be inevitable due to the uniqueness of the Asian knee. An avenue for rapid modelling and eventually economical production of a customized knee joint prosthesis for patients is proposed and discussed. PMID:8280312

  10. Endoscopic palliation of esophageal and cardial cancer: Nd:YAG laser and prosthesis

    NASA Astrophysics Data System (ADS)

    Norberto, Lorenzo; Ranzato, Riccardo; Marino, Saverio; Angriman, Imerio; Vella, Vincenzo; Donadi, Michele; D'Amico, D. F.

    1997-12-01

    From November 1, 1992 to January 31, 1997, 227 patients with inoperable esophageal and cardial carcinomas were treated with Nd:YAG laser therapy and prosthesis intubation. The retrograde technique was used in most cases. The tumor involved in 75 pts the Cardia, in 65 the middle thoracic esophagus, in 47 pts the lower thoracic esophagus, in 23 in the upper thoracic esophagus and in 17 in the cervical esophagus. The indications for palliative Nd:YAG laser and prosthesis intubation were a locally advanced or metastatic tumor in 146 pts (64.4%) and poor surgical risk in 81 pts (35.6%). The quality of palliation was evaluated according to the ability to swallow. The mean survival rate of the patients during the follow up was 22 weeks for the laser therapy and 16 weeks for the prosthesis intubation.

  11. Mesoatrial shunt: a prosthesis modification.

    PubMed

    Cameron, J L; Kadir, S; Pierce, W S

    1984-07-01

    The mesoatrial shunt is the indicated treatment in the Budd-Chiari syndrome when the inferior vena cava is occluded and not usable for the standard portasystemic shunts. As the mesoatrial shunt courses from the abdomen into the right side of the chest, it passes posterior to the xiphoid and sternum and frequently is compressed at this point. A prosthesis modification is reported whereby an exterior silicone rubber cuff is bonded to the Dacron or Gortex graft at the point at which it passes posterior to the sternum. This obviates the possibility of graft compression and should increase long-term patency. PMID:6234672

  12. Operative approach for secondary placement of penile prosthesis.

    PubMed

    O'Donnell, P D

    1986-08-01

    Secondary placement of penile prosthesis was done in 8 patients following removal of the primarily placed prosthesis for extrusion and infection. Exposure of the corpora cavernosum along its entire length facilitated placement of semirigid prosthesis in each of these patients. The postoperative result was functional in all cases with a normal size in girth and parallel alignment of the distal tip of the prosthesis. In each case the secondarily placed prosthesis was shorter than the primarily placed prosthesis, and the amount of decrease in length appeared to be dependent on the severity of the complication that led to the removal of the primarily placed prosthesis. PMID:3739111

  13. Instruments and techniques for the analysis of wheelchair propulsion and upper extremity involvement in patients with spinal cord injuries: current concept review

    PubMed Central

    Dellabiancia, Fabio; Porcellini, Giuseppe; Merolla, Giovanni

    2013-01-01

    Summary The correct functionality of the upper limbs is an essential condition for the autonomy of people with disabilities, especially for those in wheelchair. In this review we focused on the biomechanics of wheelchair propulsion and we described the instrumental analysis of techniques for the acquisition of wheelchair propulsion. PMID:24367774

  14. Prevalence and associations of symptoms of upper extremities, repetitive strain injuries (RSI) and 'RSI-like condition'. A cross sectional study of bank workers in Northeast Brazil

    PubMed Central

    Lacerda, Eliana M; Ncul, Luis C; da S Augusto, Lia G; Olinto, Maria Teresa A; Rocha, Dyhanne C; Wanderley, Danielle C

    2005-01-01

    Background The repetitive strain injury syndrome (RSI) is a worldwide occupational health problem affecting all types of economic activities. We investigated the prevalence and some risk factors for RSI and related conditions, namely 'symptoms of upper limbs' and 'RSI-like condition'. Methods We conducted a cross-sectional study with 395 bank workers in Recife, Northeast Brazil. Symptoms of upper limbs and 'RSI-like condition' were assessed by a simple questionnaire, which was used to screen probable cases of RSI. The diagnosis of RSI was confirmed by clinical examination. The associations of potential risk factors and the outcomes were assessed by multiple logistic regression analysis. Results We found prevalence rates of 56% for symptoms of the upper limbs and 30% for 'RSI-like condition'. The estimated prevalence of clinically confirmed cases of RSI was 22%. Female sex and occupation (as cashier or clerk) increased the risk of all conditions, but the associations were stronger for cases of RSI than for less specific diagnoses of 'RSI-like condition' and symptoms of upper limbs. Age was inversely related to the risk of symptoms of upper limbs but not to 'RSI-like' or RSI. Conclusion The variation in the magnitude of risk according to the outcome assessed suggests that previous studies using different definitions may not be immediately comparable. We propose the use of a simple instrument to screen cases of RSI in population based studies, which still needs to be validated in other populations. The high prevalence of RSI and related conditions in this population suggests the need for urgent interventions to tackle the problem, which could be directed to individuals at higher risk and to changes in the work organization and environment of the general population. PMID:16219095

  15. Intra-articular Fractures of the Sigmoid Notch of the Distal Radius: Analysis of Progression to Distal Radial Ulnar Joint Arthritis and Impact on Upper Extremity Function in Surgically Treated Fractures.

    PubMed

    Vitale, Mark A; Brogan, David M; Shin, Alexander Y; Berger, Richard A

    2016-03-01

    Background Studies have established an increased risk of radiocarpal joint posttraumatic arthritis in patients with displaced intra-articular fractures of the distal radius, although this phenomenon has yet to be evaluated in the distal radioulnar joint (DRUJ). Purpose We hypothesized that patients with displaced intra-articular fractures of the sigmoid notch would have a higher prevalence of DRUJ arthritis and greater upper extremity dysfunction after operative treatment of distal radius fractures compared with fractures without sigmoid notch involvement. We also hypothesized that the degree of sigmoid notch incongruity would be correlated with the grade of DRUJ arthritis and the severity of upper extremity dysfunction. Patients and Methods A retrospective review was conducted on surgically treated patients with distal radius fractures with pre- and/or postoperative computed tomography (CT) scans. Patients were divided into groups based on presence or absence of fracture extension into the sigmoid notch. Within the sigmoid notch group, postoperative CT scans were used to measure sigmoid notch fracture step-off and diastasis (mm), as well as volar or dorsal DRUJ subluxation (%). Patients were administered Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaires and radiographs were obtained to grade DRUJ arthritis using the Kellgren-Lawrence (KL) radiographic criteria. Results Thirty-three patients were included (19 with sigmoid notch involvement and 14 without) with an average radiographic follow-up of 6.3 years (range: 3.5-10.1 years). DASH scores were available for all patients, and radiographic follow-up was available in 24 patients (73%). A trend toward higher grade of DRUJ arthritis and poorer average DASH was found in those with sigmoid notch involvement, but was not statistically different. In the sigmoid notch group there were poorer DASH scores in patients with coronal step-off > 1.0-mm (p < 0.05). There were no significant correlations between sigmoid notch step-off, diastasis or DRUJ subluxation and either KL grade of arthritis or DASH scores. Conclusion Fractures involving the sigmoid notch did not appear to have a greater prevalence of DRUJ posttraumatic arthritis in operatively treated patients at greater than 6 years of follow-up. Postoperative sigmoid notch step-off, diastasis or DRUJ subluxation had a minimal effect on upper extremity function, but fractures with a coronal step-off of > 1.0-mm exhibited higher levels of upper extremity dysfunction. Level of Evidence Prognostic, Level III-Case control. PMID:26855837

  16. Inhibitory Response Capacities of Bilateral Lower and Upper Extremities in Children with Developmental Coordination Disorder in Endogenous and Exogenous Orienting Modes

    ERIC Educational Resources Information Center

    Tsai, Chia-Liang; Yu, Yi-Kai; Chen, Yung-Jung; Wu, Sheng-Kuang

    2009-01-01

    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

  17. Automated lower limb prosthesis design

    NASA Astrophysics Data System (ADS)

    Bhatia, Gulab H.; Commean, Paul K.; Smith, Kirk E.; Vannier, Michael W.

    1994-09-01

    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.

  18. Cementless isoelastic RM total hip prosthesis1

    PubMed Central

    Bombelli, Renato; Mathys, Robert

    1982-01-01

    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. PMID:7108878

  19. Experience with the Hydroflex penile prosthesis.

    PubMed

    Kabalin, J N; Kessler, R

    1989-01-01

    Between July 1985 and September 1987 we implanted 51 Hydroflex* penile prostheses for treatment of erectile impotence, with a minimum followup of 6 months in all patients and more than 1 year in 43. There have been no mechanical failures and no major complications. Of 47 evaluable patients 38 (81 per cent) are satisfied with the prosthesis. The 9 dissatisfied patients include 3 men who still are experiencing some difficulty operating the pump mechanism and 6 who desired a fuller or stiffer erection than provided by the Hydroflex prosthesis. All of the latter 6 individuals have successfully engaged in intercourse with the Hydroflex device. The patient who previously received a Scott inflatable penile prosthesis may not be as content with the erect state of the Hydroflex device. It also is important to assure adequate distal corporeal length before placement of the Hydroflex prosthesis. PMID:2908955

  20. 21 CFR 878.3610 - Esophageal prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices § 878.3610 Esophageal prosthesis... of a plastic, metal, or polymeric material that is intended to be implanted to restore the...

  1. 21 CFR 878.3610 - Esophageal prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices 878.3610 Esophageal prosthesis... of a plastic, metal, or polymeric material that is intended to be implanted to restore the...

  2. 21 CFR 878.3610 - Esophageal prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices 878.3610 Esophageal prosthesis... of a plastic, metal, or polymeric material that is intended to be implanted to restore the...

  3. 21 CFR 878.3610 - Esophageal prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices 878.3610 Esophageal prosthesis... of a plastic, metal, or polymeric material that is intended to be implanted to restore the...

  4. 21 CFR 878.3610 - Esophageal prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices 878.3610 Esophageal prosthesis... of a plastic, metal, or polymeric material that is intended to be implanted to restore the...

  5. Finger prosthesis: a boon to handicapped

    PubMed Central

    Gupta, Ridhima; Kumar, Lakshya; Rao, Jitendra; Singh, Kamleshwar

    2013-01-01

    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

  6. Custom Ocular Prosthesis: A Palliative Approach

    PubMed Central

    Thakkar, Prachi; Patel, JR; Sethuraman, Rajesh; Nirmal, Narendra

    2012-01-01

    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. PMID:22837616

  7. Aesthetic finger prosthesis with silicone biomaterial.

    PubMed

    Raghu, K M; Gururaju, C R; Sundaresh, K J; Mallikarjuna, Rachappa

    2013-01-01

    The fabrication of finger prosthesis is as much an art as it is science. The ideally constructed prosthesis must duplicate the missing structures so precisely that patients can appear in public without fear of attracting unwanted attraction. A 65-years-old patient reported with loss of his right index finger up to the second phalanx and wanted to get it replaced. An impression of the amputated finger and donor were made. A wax pattern of the prosthesis was fabricated using the donor impression; a trial was performed and flasked. Medical grade silicone was intrinsically stained to match the skin tone, following which it was packed, processed and finished. This clinical report describes a method of attaining retention by selective scoring of the master cast of partially amputated finger to enhance the vacuum effect at par with the proportional distribution of the positive forces on the tissues exerted by the prosthesis. PMID:23975917

  8. Visuomotor behaviours when using a myoelectric prosthesis

    PubMed Central

    2014-01-01

    Background A recent study showed that the gaze patterns of amputee users of myoelectric prostheses differ markedly from those seen in anatomically intact subjects. Gaze behaviour is a promising outcome measures for prosthesis designers, as it appears to reflect the strategies adopted by amputees to compensate for the absence of proprioceptive feedback and uncertainty/delays in the control system, factors believed to be central to the difficulty in using prostheses. The primary aim of our study was to characterise visuomotor behaviours over learning to use a trans-radial myoelectric prosthesis. Secondly, as there are logistical advantages to using anatomically intact subjects in prosthesis evaluation studies, we investigated similarities in visuomotor behaviours between anatomically intact users of a trans-radial prosthesis simulator and experienced trans-radial myoelectric prosthesis users. Methods In part 1 of the study, we investigated visuomotor behaviours during performance of a functional task (reaching, grasping and manipulating a carton) in a group of seven anatomically intact subjects over learning to use a trans-radial myoelectric prosthesis simulator (Dataset 1). Secondly, we compared their patterns of visuomotor behaviour with those of four experienced trans-radial myoelectric prosthesis users (Dataset 2). We recorded task movement time, performance on the SHAP test of hand function and gaze behaviour. Results Dataset 1 showed that while reaching and grasping the object, anatomically intact subjects using the prosthesis simulator devoted around 90% of their visual attention to either the hand or the area of the object to be grasped. This pattern of behaviour did not change with training, and similar patterns were seen in Dataset 2. Anatomically intact subjects exhibited significant increases in task duration at their first attempts to use the prosthesis simulator. At the end of training, the values had decreased and were similar to those seen in Dataset 2. Conclusions The study provides the first functional description of the gaze behaviours seen during use of a myoelectric prosthesis. Gaze behaviours were found to be relatively insensitive to practice. In addition, encouraging similarities were seen between the amputee group and the prosthesis simulator group. PMID:24758375

  9. Extremity x-ray

    MedlinePLUS

    An extremity x-ray is an image of the hands, wrist, feet, ankle, leg, thigh, forearm humerus or upper arm, hip, shoulder ... term "extremity" often refers to a human limb. X-rays are a form of radiation that passes through ...

  10. Computational reverse shoulder prosthesis model: Experimental data and verification.

    PubMed

    Martins, A; Quental, C; Folgado, J; Ambrsio, J; Monteiro, J; Sarmento, M

    2015-09-18

    The reverse shoulder prosthesis aims to restore the stability and function of pathological shoulders, but the biomechanical aspects of the geometrical changes induced by the implant are yet to be fully understood. Considering a large-scale musculoskeletal model of the upper limb, the aim of this study is to evaluate how the Delta reverse shoulder prosthesis influences the biomechanical behavior of the shoulder joint. In this study, the kinematic data of an unloaded abduction in the frontal plane and an unloaded forward flexion in the sagittal plane were experimentally acquired through video-imaging for a control group, composed of 10 healthy shoulders, and a reverse shoulder group, composed of 3 reverse shoulders. Synchronously, the EMG data of 7 superficial muscles were also collected. The muscle force sharing problem was solved through the minimization of the metabolic energy consumption. The evaluation of the shoulder kinematics shows an increase in the lateral rotation of the scapula in the reverse shoulder group, and an increase in the contribution of the scapulothoracic joint to the shoulder joint. Regarding the muscle force sharing problem, the musculoskeletal model estimates an increased activity of the deltoid, teres minor, clavicular fibers of the pectoralis major, and coracobrachialis muscles in the reverse shoulder group. The comparison between the muscle forces predicted and the EMG data acquired revealed a good correlation, which provides further confidence in the model. Overall, the shoulder joint reaction force was lower in the reverse shoulder group than in the control group. PMID:26206550

  11. The upper transition height over the Kharkiv incoherent scatter radar before, during and after the extreme minimum of the solar activity: Observational results and comparison with the IRI-2012 model

    NASA Astrophysics Data System (ADS)

    Kotov, Dmytro; Truhlik, Vladimir; Richards, Philipp; Huba, Joseph; Chernogor, Leonid; Bogomaz, Oleksandr; Domnin, Igor

    2014-05-01

    Variations in the diurnal minimum of upper transition height (height at which total light ions fraction is 50%) over Kharkiv, Ukraine are considered for vernal and autumnal equinoxes from 2006 to 2010. The data were obtained using the incoherent scatter radar of the Institute of ionosphere [1]. It was found that the decrease of daily F10.7 values approximately by 22 % (from 82 for spring 2006 to 67 for autumn 2007) was accompanied by a decrease in the upper transition height approximately by 19% too (from 518 km to 436 km). The linear correlation coefficient between the upper transition height and daily F10.7 was approximately 0.81. It should be noted that according to our knowledge such low values of upper transition height is the minimum ever recorded. In 2008-2009, the upper transition height over Kharkiv was up to 40 km lower than over the equator [2] and even up to 10-15 km lower than over Arecibo [3]. A comparison of the observational results with the IRI-2012 model [4] was made. It was found that the IRI-2012 model overestimates upper transition height up to 100 km in 2006, and 2010. The model also overestimates the upper transition height up to 150 km during the extreme solar minimum (2008-2009). It is clearly seen that for solar minimum under consideration latitudinal dependence of upper transition height according to observational data have decreasing character in contrast to the model dependence. Such behavior can be called latitudinal inversion of upper transition height. Strong dependence of upper transition height on Ap index was found for the conditions under consideration. It is suggested that model values for 2006 and 2010 are overestimated due to a higher geomagnetic activity during the satellite measurements (1974) underlying the model for the low level of solar activity compared with geomagnetic conditions for 2006 and 2010. Perhaps this led to the fact that the model does not show latitudinal inversion, which occurs only at very low geomagnetic activity. However, this hypothesis requires further careful checking. In 2008 and 2009, the decreasing of the upper transition height has been apparently caused by a prolonged general cooling of the thermosphere and ionosphere [5]. [1] I.F. Domnin et. al., Geomag. And Aeronomy, Intern. 53, 113 (2013). [2] R.A. Heelis et. al.,Geophys. Res. Lett. 36, L00C03, doi:10.1029/2009GL038652 (2009). [3] N. Aponte et. al., J. Geophys. Res. 118, 4465, doi:10.1002/jgra.50416 (2013). [4] V. Truhlik et al., Adv. Space. Res., Towards better description of solar activity variation in the IRI topside ion composition model, in review. [5] S.C. Solomon et. al., J. Geophys. Res. 116, doi:10.1029/2011JA016508.

  12. The clinical utility of testicular prosthesis placement in children with genital and testicular disorders

    PubMed Central

    2014-01-01

    Testicular prosthesis placement is a useful important adjunctive reconstructive therapy for managing children with testicular loss or absence. Though these prostheses are functionless, experience has shown that they are extremely helpful in creating a more normal male body image and in preventing/relieving psychological stress in males with a missing testicle. With attention to details of implant technique, excellent cosmetic results can be anticipated in simulating a normal appearing scrotum. PMID:26816795

  13. [Clinical studies in working populations: value and significance of anamnestic findings, clinical tests and instrumental tests for the diagnosis of musculoskeletal disorders of the upper extremities].

    PubMed

    De Marco, F; Menoni, O; Ricci, M G; Bonaiuti, D; Colombini, D; Occhipinti, E

    1996-01-01

    The authors discuss the value and significance of symptoms in WMSDs, considering that the anamnestic threshold proposed in epidemiological investigations cannot be used as clinical and diagnosing criteria. Some useful clinical procedures are suggested for cases where there is a suspicion of musculo-skeletal disorders of the cervical spine and upper limbs, bearing in mind that they are to be applied within the framework of health surveillance programmes undertaken by health care practitioners who are not specialists in orthopaedics, physiatrics or neurology. The recommendations for instrumental tests and specialist referrals are also discussed for the various disorders. The authors also provide flow charts for the diagnostic procedures pertaining to WMSDs. The Appendix shows a sample patient chart illustrating the proposed procedures; it also permits the findings to be encoded so that they can be stored in a dedicated database. The codes for diagnosing WMSDs are also reported for the same epidemiological purposes. PMID:9148113

  14. Large ice-wedge networks and tundra gley horizons in Northern France Upper Pleistocene loess: evidences of extreme cold events and cyclic millennial changes

    NASA Astrophysics Data System (ADS)

    Antoine, Pierre; Moine, Olivier; Guerin, Gilles

    2015-04-01

    Northern France loess-palaeosol sequences from the last interglacial-glacial cycle (Eemian-Weichselian) have been intensely studied during the last 20 years (about 100 individual sequences). Despite thickness variations of the different stratigraphic units, the sequences from the last interglacial-glacial cycle exhibit a particularly constant pedosedimentary pattern, including well-identified pedological and periglacial marker horizons that can be followed north- and eastward in Belgium and Germany. Within this system, new field investigations and luminescence (OSL) datings put in evidence at least four generations of large ice-wedge networks (10-14 m) preserved by loess deposits between ca. 50 and 20 ka. The best- and most systematically preserved network is presently dated at about 31-32 ka according to the OSL ages from its loess infilling. This main ice-wedge cast horizon systematically occurs at the boundary between Middle Pleniglacial brown soil complexes and the base of the Upper Pleniglacial typical loess cover. Consequently, it represents a major stratigraphic marker for correlations in Western Europe. According to recent OSL dating results, the first thick typical loess unit of the Upper Pleniglacial, covering the main ice-wedge cast horizon, has been deposited shortly after GIS-5 interstadial and could be contemporaneous of H3 event in deep-sea cores. In addition, it is shown that all the large ice wedge casts are developed from the surface of a tundra gley horizon (0.3 to 0.5 m in thickness). As it has been previously demonstrated that tundra gley layers were mainly formed during short interstadial events (malacology, sedimentology), a model linking tundra gley horizons, and ice wedges network regarding to DO stadial-interstadial cycles during the last glacial is proposed.

  15. A Physically Based Surface/ Subsurface Flow Model to Assess the Impacts of Climate Change Extremes on the Hydrology of an Upper Midwest U.S. Watershed

    NASA Astrophysics Data System (ADS)

    Acar, O.; Franz, K.; Simpkins, W. W.

    2014-12-01

    Climate change is already affecting the Midwest U.S. Occurrence and intensity of extreme events such as heat waves, droughts and floods are expected to increase in the next few decades. It is the climate extremes, not averages, that have the greater impact on crop and livestock productivity which are vital for the State's economy. Accordingly, potential changes in the hydrologic cycle under prospective climate conditions need to be addressed at the watershed scale for the Midwestern agricultural region to develop better management and adaptation solutions. For this purpose, the 3-D finite element model, HydroGeoSphere has been applied to and calibrated for a representative watershed in north-central Iowa, Tipton Creek watershed. The conceptual model for the watershed consists of all the elements of the hydrologic cycle from the ground surface through the Quaternary aquitard and into the underlying Mississippian limestone aquifer. Extreme wet and dry conditions derived from statistically downscaled climate model scenarios have been used as input to the basin model to simulate the impacts on streamflow and groundwater flow. The model accomplishes integrated hydrologic analysis by the coupled solution of the diffusion wave equation governing 2-D (areal) surface water flow and the Richards' equation governing 3-D unsaturated/ saturated subsurface flow. Thus, actual evapotranspiration is calculated internally as a function of the soil moisture at each node of the defined evaporative zone at each time step and interdependent processes like recharge that are critical for climate change can be handled more accurately. Preliminary results for HadCM3 scenario combined with two SRES projections, A2 and A1fi predict more remarkable increases in stream levels in response to wet periods than the decreases in flows for dry periods in comparison to control (contemporary) period simulations. The impacts on the water table levels seem to be more prominent, in the range of 4 m for dry and wet period simulations than for the potentiometric surface map changes that are 0-2.6 m of declines for the drought and up to 1.7 m of rise for the wet scenarios. The variations in the projected changes depend on the location throughout the model domain and the climate change scenario analyzed.

  16. Optogenetic approaches to retinal prosthesis.

    PubMed

    Barrett, John Martin; Berlinguer-Palmini, Rolando; Degenaar, Patrick

    2014-09-01

    The concept of visual restoration via retinal prosthesis arguably started in 1992 with the discovery that some of the retinal cells were still intact in those with the retinitis pigmentosa disease. Two decades later, the first commercially available devices have the capability to allow users to identify basic shapes. Such devices are still very far from returning vision beyond the legal blindness. Thus, there is considerable continued development of electrode materials, and structures and electronic control mechanisms to increase both resolution and contrast. In parallel, the field of optogenetics--the genetic photosensitization of neural tissue holds particular promise for new approaches. Given that the eye is transparent, photosensitizing remaining neural layers of the eye and illuminating from the outside could prove to be less invasive, cheaper, and more effective than present approaches. As we move toward human trials in the coming years, this review explores the core technological and biological challenges related to the gene therapy and the high radiance optical stimulation requirement. PMID:25100257

  17. 21 CFR 872.3970 - Interarticular disc prosthesis (interpositional implant).

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Interarticular disc prosthesis (interpositional... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices 872.3970 Interarticular disc prosthesis (interpositional implant). (a) Identification. An interarticular disc...

  18. 21 CFR 872.3960 - Mandibular condyle prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...) Identification. A mandibular condyle prosthesis is a device that is intended to be implanted in the human jaw to... requirement for premarket approval for any mandibular condyle prosthesis intended to be implanted in the...

  19. 21 CFR 872.3960 - Mandibular condyle prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...) Identification. A mandibular condyle prosthesis is a device that is intended to be implanted in the human jaw to... requirement for premarket approval for any mandibular condyle prosthesis intended to be implanted in the...

  20. 21 CFR 872.3960 - Mandibular condyle prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...) Identification. A mandibular condyle prosthesis is a device that is intended to be implanted in the human jaw to... requirement for premarket approval for any mandibular condyle prosthesis intended to be implanted in the...

  1. A telescopic retainer prosthesis in full mouth rehabilitation

    PubMed Central

    Kularashmi, B. S.; Anand, M. Vijay; Bettie, Nirmal F.; Ramachandiran, Hari

    2015-01-01

    The use of questionable abutments has been made possible by modifying the design of the prosthesis. Telescopic retainers help to retain a prosthesis on a tilted and malaligned abutments. PMID:26538975

  2. Virtual reality environment for simulating tasks with a myoelectric prosthesis: an assessment and training tool

    PubMed Central

    Lambrecht, Joris M.; Pulliam, Christopher L.; Kirsch, Robert F.

    2013-01-01

    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. PMID:23476108

  3. Archaeomagnetic study of five mounds from Upper Mesopotamia between 2500 and 700 BCE: Further evidence for an extremely strong geomagnetic field ca. 3000 years ago

    NASA Astrophysics Data System (ADS)

    Ertepinar, P.; Langereis, C. G.; Biggin, A. J.; Frangipane, M.; Matney, T.; kse, T.; Engin, A.

    2012-12-01

    The distribution of archaeomagnetic data in eastern Europe and the Near and Middle East shows a remarkable gap in Turkey. This study presents the first archaeomagnetic results from five different mounds in southeast Turkey, the northern part of Mesopotamia. The rock magnetic experiments indicate that in the majority of the samples the dominant magnetic carrier is magnetite, which is stable to heating to temperatures of 700 C. In general, the demagnetization diagrams are single component and all five sets display well-defined characteristic magnetizations and clustered directions. For the period between 2500 and 700 BCE, the declinations are between 350 and 20 while inclinations are in the range of 49-64. The directional results are compared with the global geomagnetic field models (CALS7k.2, ARCH3k_cst.1 and CALS3k.4) and the data from the archaeomagnetic database GEOMAGIA50v2. The results are coherent with both the data and the models except for two near-contemporaneous sets dating 2000 BCE, which are offset to the east by more than 20 with respect to CALS7k.2. Archaeointensity measurements were made using the microwave and conventional thermal Thellier methods applied to five sets of samples (four furnaces and a mud-brick wall). These yielded comparable and intriguing results. While those from the furnaces are slightly higher than the CALS7k.2 model and in agreement with the GEOMAGIA50v2 and the Middle East data, the results from the mud-brick wall suggest a high intensity of 100.8 ?T (17.71022 Am2) at 1000 BCE. This result is in excellent agreement with recent claims of extremely high intensity measured in other regions of the Middle East for this time period though less consistent with these being associated with extremely short-lived events. Finally, we discuss our new and other recently published archaeointensity results in terms of geomagnetic intensity versus climate.

  4. Life Estimation of Hip Joint Prosthesis

    NASA Astrophysics Data System (ADS)

    Desai, C.; Hirani, H.; Chawla, A.

    2014-11-01

    Hip joint is one of the largest weight-bearing structures in the human body. In the event of a failure of the natural hip joint, it is replaced with an artificial hip joint, known as hip joint prosthesis. The design of hip joint prosthesis must be such so as to resist fatigue failure of hip joint stem as well as bone cement, and minimize wear caused by sliding present between its head and socket. In the present paper an attempt is made to consider both fatigue and wear effects simultaneously in estimating functional-life of the hip joint prosthesis. The finite element modeling of hip joint prosthesis using HyperMesh (version 9) has been reported. The static analysis (load due to the dead weight of the body) and dynamic analysis (load due to walking cycle) have been described. Fatigue life is estimated by using the S-N curve of individual materials. To account for progressive wear of hip joint prosthesis, Archard's wear law, modifications in socket geometry and dynamic analysis have been used in a sequential manner. Using such sequential programming reduction in peak stress has been observed with increase in wear. Finally life is estimated on the basis of socket wear.

  5. In-situ evaluation of lower limb prosthesis fit by spiral-computed tomography

    NASA Astrophysics Data System (ADS)

    Vannier, Michael W.; Smith, Kirk E.; Commean, Paul K.; Bhatia, Gulab H.

    1995-05-01

    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.

  6. Robotic lower limb prosthesis design through simultaneous computer optimizations of human and prosthesis costs.

    PubMed

    Handford, Matthew L; Srinivasan, Manoj

    2016-01-01

    Robotic lower limb prostheses can improve the quality of life for amputees. Development of such devices, currently dominated by long prototyping periods, could be sped up by predictive simulations. In contrast to some amputee simulations which track experimentally determined non-amputee walking kinematics, here, we explicitly model the human-prosthesis interaction to produce a prediction of the user's walking kinematics. We obtain simulations of an amputee using an ankle-foot prosthesis by simultaneously optimizing human movements and prosthesis actuation, minimizing a weighted sum of human metabolic and prosthesis costs. The resulting Pareto optimal solutions predict that increasing prosthesis energy cost, decreasing prosthesis mass, and allowing asymmetric gaits all decrease human metabolic rate for a given speed and alter human kinematics. The metabolic rates increase monotonically with speed. Remarkably, by performing an analogous optimization for a non-amputee human, we predict that an amputee walking with an appropriately optimized robotic prosthesis can have a lower metabolic cost - even lower than assuming that the non-amputee's ankle torques are cost-free. PMID:26857747

  7. Robotic lower limb prosthesis design through simultaneous computer optimizations of human and prosthesis costs

    PubMed Central

    Handford, Matthew L.; Srinivasan, Manoj

    2016-01-01

    Robotic lower limb prostheses can improve the quality of life for amputees. Development of such devices, currently dominated by long prototyping periods, could be sped up by predictive simulations. In contrast to some amputee simulations which track experimentally determined non-amputee walking kinematics, here, we explicitly model the human-prosthesis interaction to produce a prediction of the user’s walking kinematics. We obtain simulations of an amputee using an ankle-foot prosthesis by simultaneously optimizing human movements and prosthesis actuation, minimizing a weighted sum of human metabolic and prosthesis costs. The resulting Pareto optimal solutions predict that increasing prosthesis energy cost, decreasing prosthesis mass, and allowing asymmetric gaits all decrease human metabolic rate for a given speed and alter human kinematics. The metabolic rates increase monotonically with speed. Remarkably, by performing an analogous optimization for a non-amputee human, we predict that an amputee walking with an appropriately optimized robotic prosthesis can have a lower metabolic cost – even lower than assuming that the non-amputee’s ankle torques are cost-free. PMID:26857747

  8. Electron microscopy study of a vascular prosthesis destructed in vivo reveals fractures in Dacron fibers.

    PubMed

    Woźniak, Witold; Olszewski, Wojciech; Górski, Grzegorz

    2016-02-01

    The genuine destruction of a synthetic prosthesis wall, as a late complication of vascular surgery, is extremely rare. We report a case of a 64-year-old male who had his 12-year-old femoropopliteal synthetic graft explanted due to two large pseudoaneurysms in the middle section of the graft. Microscopic evaluation demonstrated the areas of focal thinning along the entire prosthesis wall, with "foreign body" type reaction in the adjacent connective tissue. Transmission electron microscopy showed longitudinal fractures of Dacron fibers interposed with cellular structures, suggesting that destruction must have taken place significantly earlier. The problems of limited graft durability and graft surveillance are discussed. PMID:25957345

  9. [Tarflen-metal prosthesis in the surgical treatment of otosclerosis].

    PubMed

    Namys?owski, G; Gierek, T; Iwanowski, P

    1989-01-01

    The authors described the prosthesis for otosclerosis surgery. It is made by plastic material connected with the tantalum+ or platinum wire. The mode of prosthesis adaptation and taking into the place was described. The prosthesis was devised and produced by Instytut Przemys?u Tworzyw i Farb Gliwice (Poland). PMID:2622689

  10. 21 CFR 872.3940 - Total temporomandibular joint prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Total temporomandibular joint prosthesis. 872.3940 Section 872.3940 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... prosthesis. (a) Identification. A total temporomandibular joint prosthesis is a device that is intended to...

  11. 21 CFR 872.3960 - Mandibular condyle prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...) Identification. A mandibular condyle prosthesis is a device that is intended to be implanted in the human jaw to... requirement for premarket approval for any mandibular condyle prosthesis intended to be implanted in the human... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Mandibular condyle prosthesis. 872.3960...

  12. 21 CFR 888.3230 - Finger joint polymer constrained prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Finger joint polymer constrained prosthesis. 888... SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3230 Finger joint polymer constrained prosthesis. (a) Identification. A finger joint polymer constrained prosthesis is a device...

  13. 21 CFR 888.3230 - Finger joint polymer constrained prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Finger joint polymer constrained prosthesis. 888... SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3230 Finger joint polymer constrained prosthesis. (a) Identification. A finger joint polymer constrained prosthesis is a device...

  14. 21 CFR 888.3780 - Wrist joint polymer constrained prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Wrist joint polymer constrained prosthesis. 888... SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3780 Wrist joint polymer constrained prosthesis. (a) Identification. A wrist joint polymer constrained prosthesis is a device made...

  15. 21 CFR 888.3230 - Finger joint polymer constrained prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Finger joint polymer constrained prosthesis. 888... SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3230 Finger joint polymer constrained prosthesis. (a) Identification. A finger joint polymer constrained prosthesis is a device...

  16. 21 CFR 888.3720 - Toe joint polymer constrained prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Toe joint polymer constrained prosthesis. 888.3720... (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3720 Toe joint polymer constrained prosthesis. (a) Identification. A toe joint polymer constrained prosthesis is a device made of...

  17. 21 CFR 888.3780 - Wrist joint polymer constrained prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Wrist joint polymer constrained prosthesis. 888... SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3780 Wrist joint polymer constrained prosthesis. (a) Identification. A wrist joint polymer constrained prosthesis is a device made...

  18. 21 CFR 888.3230 - Finger joint polymer constrained prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Finger joint polymer constrained prosthesis. 888... SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3230 Finger joint polymer constrained prosthesis. (a) Identification. A finger joint polymer constrained prosthesis is a device...

  19. 21 CFR 888.3720 - Toe joint polymer constrained prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Toe joint polymer constrained prosthesis. 888.3720... (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3720 Toe joint polymer constrained prosthesis. (a) Identification. A toe joint polymer constrained prosthesis is a device made of...

  20. 21 CFR 888.3720 - Toe joint polymer constrained prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Toe joint polymer constrained prosthesis. 888.3720... (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3720 Toe joint polymer constrained prosthesis. (a) Identification. A toe joint polymer constrained prosthesis is a device made of...

  1. 21 CFR 888.3780 - Wrist joint polymer constrained prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Wrist joint polymer constrained prosthesis. 888... SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3780 Wrist joint polymer constrained prosthesis. (a) Identification. A wrist joint polymer constrained prosthesis is a device made...

  2. 21 CFR 888.3720 - Toe joint polymer constrained prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Toe joint polymer constrained prosthesis. 888.3720... (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3720 Toe joint polymer constrained prosthesis. (a) Identification. A toe joint polymer constrained prosthesis is a device made of...

  3. 21 CFR 888.3780 - Wrist joint polymer constrained prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Wrist joint polymer constrained prosthesis. 888... SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3780 Wrist joint polymer constrained prosthesis. (a) Identification. A wrist joint polymer constrained prosthesis is a device made...

  4. 21 CFR 888.3230 - Finger joint polymer constrained prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Finger joint polymer constrained prosthesis. 888... SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3230 Finger joint polymer constrained prosthesis. (a) Identification. A finger joint polymer constrained prosthesis is a device...

  5. 21 CFR 888.3720 - Toe joint polymer constrained prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Toe joint polymer constrained prosthesis. 888.3720... (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3720 Toe joint polymer constrained prosthesis. (a) Identification. A toe joint polymer constrained prosthesis is a device made of...

  6. 21 CFR 888.3780 - Wrist joint polymer constrained prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Wrist joint polymer constrained prosthesis. 888... SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3780 Wrist joint polymer constrained prosthesis. (a) Identification. A wrist joint polymer constrained prosthesis is a device made...

  7. 21 CFR 884.3650 - Fallopian tube prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Fallopian tube prosthesis. 884.3650 Section 884... 884.3650 Fallopian tube prosthesis. (a) Identification. A fallopian tube prosthesis is a device designed to maintain the patency (openness) of the fallopian tube and is used after reconstructive...

  8. 21 CFR 884.3650 - Fallopian tube prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Fallopian tube prosthesis. 884.3650 Section 884... 884.3650 Fallopian tube prosthesis. (a) Identification. A fallopian tube prosthesis is a device designed to maintain the patency (openness) of the fallopian tube and is used after reconstructive...

  9. 21 CFR 884.3650 - Fallopian tube prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Fallopian tube prosthesis. 884.3650 Section 884... 884.3650 Fallopian tube prosthesis. (a) Identification. A fallopian tube prosthesis is a device designed to maintain the patency (openness) of the fallopian tube and is used after reconstructive...

  10. 21 CFR 884.3650 - Fallopian tube prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Fallopian tube prosthesis. 884.3650 Section 884... 884.3650 Fallopian tube prosthesis. (a) Identification. A fallopian tube prosthesis is a device designed to maintain the patency (openness) of the fallopian tube and is used after reconstructive...

  11. 21 CFR 884.3650 - Fallopian tube prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Fallopian tube prosthesis. 884.3650 Section 884... 884.3650 Fallopian tube prosthesis. (a) Identification. A fallopian tube prosthesis is a device designed to maintain the patency (openness) of the fallopian tube and is used after reconstructive...

  12. 21 CFR 872.3950 - Glenoid fossa prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Glenoid fossa prosthesis. 872.3950 Section 872...) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices 872.3950 Glenoid fossa prosthesis. (a) Identification. A glenoid fossa prosthesis is a device that is intended to be implanted in the...

  13. 21 CFR 872.3950 - Glenoid fossa prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Glenoid fossa prosthesis. 872.3950 Section 872...) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices 872.3950 Glenoid fossa prosthesis. (a) Identification. A glenoid fossa prosthesis is a device that is intended to be implanted in the...

  14. 21 CFR 872.3950 - Glenoid fossa prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Glenoid fossa prosthesis. 872.3950 Section 872...) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices 872.3950 Glenoid fossa prosthesis. (a) Identification. A glenoid fossa prosthesis is a device that is intended to be implanted in the...

  15. 21 CFR 872.3950 - Glenoid fossa prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Glenoid fossa prosthesis. 872.3950 Section 872...) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices 872.3950 Glenoid fossa prosthesis. (a) Identification. A glenoid fossa prosthesis is a device that is intended to be implanted in the...

  16. 21 CFR 872.3950 - Glenoid fossa prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Glenoid fossa prosthesis. 872.3950 Section 872...) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices 872.3950 Glenoid fossa prosthesis. (a) Identification. A glenoid fossa prosthesis is a device that is intended to be implanted in the...

  17. 21 CFR 878.3530 - Silicone inflatable breast prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Silicone inflatable breast prosthesis. 878.3530... inflatable breast prosthesis. (a) Identification. A silicone inflatable breast prosthesis is a silicone... intended to be implanted to augment or reconstruct the female breast. (b) Classification. Class III....

  18. 21 CFR 872.3940 - Total temporomandibular joint prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Total temporomandibular joint prosthesis. 872.3940... (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices 872.3940 Total temporomandibular joint prosthesis. (a) Identification. A total temporomandibular joint prosthesis is a device that is intended to...

  19. 21 CFR 872.3940 - Total temporomandibular joint prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Total temporomandibular joint prosthesis. 872.3940... (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices 872.3940 Total temporomandibular joint prosthesis. (a) Identification. A total temporomandibular joint prosthesis is a device that is intended to...

  20. 21 CFR 872.3940 - Total temporomandibular joint prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Total temporomandibular joint prosthesis. 872.3940... (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices 872.3940 Total temporomandibular joint prosthesis. (a) Identification. A total temporomandibular joint prosthesis is a device that is intended to...

  1. 21 CFR 878.3530 - Silicone inflatable breast prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Silicone inflatable breast prosthesis. 878.3530... inflatable breast prosthesis. (a) Identification. A silicone inflatable breast prosthesis is a silicone... intended to be implanted to augment or reconstruct the female breast. (b) Classification. Class III....

  2. 21 CFR 878.3530 - Silicone inflatable breast prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Silicone inflatable breast prosthesis. 878.3530... inflatable breast prosthesis. (a) Identification. A silicone inflatable breast prosthesis is a silicone... intended to be implanted to augment or reconstruct the female breast. (b) Classification. Class III....

  3. An archaeomagnetic study of Upper Mesopotamia and Central Anatolia between 2500 and 700 BCE. Further evidence for an extremely strong geomagnetic field ca. 3000 years ago

    NASA Astrophysics Data System (ADS)

    Ertepinar, Pinar; Langereis, Cor; Biggin, Andrew; de Groot, Lennart

    2014-05-01

    The distribution of archaeomagnetic data in eastern Europe and the Near and Middle East shows a remarkable gap in Turkey. This study presents the first archaeomagnetic results from eight different archaeological sites in Central and Southeast Turkey. We sampled furnaces, burnt mud-brick walls, and granite and ignimbrite foundation stones. The rock magnetic experiments indicate that in the majority of the samples the dominant magnetic carrier is magnetite, which is stable to heating to temperatures of 700 C. In general, the demagnetization diagrams are single component and all sets display well-defined characteristic magnetizations and clustered directions. For the period between 2500 and 700 BCE, the declinations are between 350 and 20 while inclinations are in the range of 49-64 . The directional results are compared with the global geomagnetic field models (CALS7k.2, ARCH3k_cst.1 and CALS3k.4) and the data from the archaeomagnetic database GEOMAGIA50v2. The results are coherent with both the data and the models except for two near-contemporaneous sets dating ~2000 BCE, which are offset to the east by more than 20 with respect to CALS7k.2. Archaeointensity measurements were made using the microwave and conventional thermal Thellier methods, as well as the multi-specimen method. These different methods yielded comparable and intriguing results. While intensities from the furnaces are slightly higher than the CALS7k.2 model and in agreement with the GEOMAGIA50v2 and the Middle East data, the results from mud-brick walls suggest a high intensity of 100.8?T (17.7 x 1022 Am2 )at ~1000 BCE. This result is in excellent agreement with recent claims of extremely high intensity measured in other regions of the Middle East for this time period though less consistent with these being associated with extremely short-lived events. Finally, we discuss our new and other recently published archaeointensity results in terms of geomagnetic intensity versus climate.

  4. Invited commentary on comparison of robotics, functional electrical stimulation, and motor learning methods for treatment of persistent upper extremity dysfunction after stroke: a randomized controlled trial.

    PubMed

    Kwakkel, Gert; van Wegen, Erwin E; Meskers, Carel M

    2015-06-01

    In this issue of Archives of Physical Medicine and Rehabilitation, Jessica McCabe and colleagues report findings from their methodologically sound, dose-matched clinical trial in 39 patients beyond 6 months poststroke. In this phase II trial, the effects of 60 treatment sessions, each involving 3.5 hours of intensive practice plus either 1.5 hours of functional electrical stimulation (FES) or a shoulder-arm robotic therapy, were compared with 5 hours of intensive daily practice alone. Although no significant between-group differences were found on the primary outcome measure of Arm Motor Ability Test and the secondary outcome measure of Fugl-Meyer Arm motor score, 10% to 15% within-group therapeutic gains were on the Arm Motor Ability Test and Fugl-Meyer Arm. These gains are clinically meaningful for patients with stroke. However, the underlying mechanisms that drive these improvements remain poorly understood. The approximately $1000 cost reduction per patient calculated for the use of motor learning (ML) methods alone or combined with FES, compared with the combination of ML and shoulder-arm robotics, further emphasizes the need for cost considerations when making clinical decisions about selecting the most appropriate therapy for the upper paretic limb in patients with chronic stroke. PMID:25687763

  5. Contact dermatitis to a limb prosthesis.

    PubMed

    Sood, Apra; Taylor, James S; Billock, John N

    2003-09-01

    PROSTHESIS USERS commonly develop various skin problems on the residual limb, directly under the prosthetic device when the device is in direct contact with the skin. Prolonged occlusion and humidity increase the likelihood of developing contact sensitivity to moisturizing creams, medicaments, and materials in the prosthesis itself.1 Allergic contact dermatitis to various prosthetic design materials is uncommon, and the relevance of positive patch-test results to chemicals present in prostheses may be difficult to establish. Most reports of allergic contact dermatitis to prostheses have been concerned with surgical amputees and not congenital amputees. We report a 5-year-old boy with a transverse partial hemimelia who developed allergic contact dermatitis to an adhesive used in his myoelectric prosthesis. Unlike most prostheses, myoelectric prostheses are worn directly against the skin, for surface electromyography electrode contact. PMID:14744411

  6. The Effects of Topical Sesame (Sesamum indicum) Oil on Pain Severity and Amount of Received Non-Steroid Anti-Inflammatory Drugs in Patients With Upper or Lower Extremities Trauma

    PubMed Central

    Bigdeli Shamloo, Marzieh Beigom; Nasiri, Morteza; Dabirian, Aazam; Bakhtiyari, Ali; Mojab, Faraz; Alavi Majd, Hamid

    2015-01-01

    Background: Most patients with trauma experience different levels of pain. Due to side effects as well as economic burden of drugs used for pain relief after trauma commonly, it is important to use low-cost methods independently or combined with drugs to alleviate pain. Objectives: Therefore, this study aimed to investigate the effects of topical sesame oil on pain severity and frequency of received NSAIDs of patients with trauma. Patients and Methods: This randomized clinical trial study was conducted on 150 patients with upper or lower extremities trauma in Dezful Ganjavian Hospital, Ahvaz, Iran, in 2014. Data was collected by a researcher-made questionnaire and Visual Analogue Scale (VAS). Patients were divided into two groups of control (n = 75) and intervention (n = 75) randomly. In the intervention group, patients applied topical sesame oil beside the routine cares, while in the control group patients just received routine cares. Severity of pain and frequency of received NSAIDs was assessed in the first, third, seventh and tenth days after the intervention in the both groups. Data was analyzed by SPSS19 software using descriptive and analytic (Chi-square and independent sample t-test) statistical methods. Results: Based on student sample t-test, there was a significant difference between intervention and control groups regarding the pain severity in the first (P = 0.06), third (P = 0.001), seventh (P = 0.001) and tenth (P = 0.001) days after the intervention. Besides, the frequency of received NSAIDs in the intervention group and the control group showed significant difference in four days after the intervention (for four days P = 0.001). Conclusions: Topical application of sesame oil could reduce pain severity and frequency of received NSAIDs in patients with upper or lower extremities trauma. Therefore, it is recommended to use this oil in complementary medicine for pain relief due to low cost, easy usage and lack of adverse effects. PMID:26161326

  7. Acrylic Finger Prosthesis: A Case Report

    PubMed Central

    Bandela, Vinod; M, Bharathi; S V, Giridhar Reddy

    2014-01-01

    Hands basic function is to grasp, hold and manipulate items. Hand gesture is perhaps the most blatant example of non-verbal communication. Finger and partial finger amputations are most frequently encountered forms of partial hand loss. Common causes are traumatic injuries, congenital absence or malformations present great clinical challenges. In addition to immediate loss of grasp strength, finger absence may cause marked psychological trauma. Individuals who desire finger replacement usually have high expectation for the appearance of prosthesis. This clinical report portrays simple method to retain acrylic finger prosthesis. PMID:25302271

  8. Acrylic finger prosthesis: a case report.

    PubMed

    K, Rajeev Kumar Reddy; Bandela, Vinod; M, Bharathi; S V, Giridhar Reddy

    2014-08-01

    Hands basic function is to grasp, hold and manipulate items. Hand gesture is perhaps the most blatant example of non-verbal communication. Finger and partial finger amputations are most frequently encountered forms of partial hand loss. Common causes are traumatic injuries, congenital absence or malformations present great clinical challenges. In addition to immediate loss of grasp strength, finger absence may cause marked psychological trauma. Individuals who desire finger replacement usually have high expectation for the appearance of prosthesis. This clinical report portrays simple method to retain acrylic finger prosthesis. PMID:25302271

  9. Production of porous coating on a prosthesis

    DOEpatents

    Sump, Kenneth R. (Richland, WA)

    1987-01-01

    Preselected surface areas of a prosthesis are covered by a blend of matching primary metallic particles and expendable particles. The particles are compressed and heated to assure that deformation and metallurgical bonding occurs between them and between the primary particles and the surface boundaries of the prosthesis. Porosity is achieved by removal of the expendable material. The result is a coating including discrete bonded particles separated by a network of interconnected voids presenting a homogeneous porous coating about the substrate. It has strength suitable for bone implant usage without intermediate adhesives, and adequate porosity to promote subsequent bone ingrowth.

  10. Fabrication of a Custom Ocular Prosthesis

    PubMed Central

    Sethi, Tania; Kheur, Mohit; Haylock, Colin; Harianawala, Husain

    2014-01-01

    Defects of the eye may follow removal of a part of or the entire orbit. This results in the patient becoming visually, esthetically and psychologically handicapped. Restoring the defect with a silicone- or acrylic-based prosthesis not only restores esthetics but also gives back the lost confidence to the patient. This is a case report of a patient with a pthisical eye and details the steps in fabrication of an ocular prosthesis. Particular attention has been given to the laboratory process in this technique to minimize the residual monomer content in the artificial eye. PMID:25100916

  11. Effect of the Shoulder Flexion Angle in the Sagittal Plane on the Muscle Activities of the Upper Extremities when Performing Push-up plus Exercises on an Unstable Surface.

    PubMed

    Lee, Sangyong; Lee, Daehee; Park, Jungseo

    2014-10-01

    [Purpose] The purpose of this study was to investigate the effect of the shoulder flexion angle on the muscle activities of the upper extremities when performing the push-up plus exercise (PUPE) on an unstable surface with the forearm in the external rotation position. [Subjects] The subjects were conducted on 15 normal male adults. [Methods] A sling device was used for the unstable surface, and PUPE was performed with the forearm in the external rotation position. The shoulder flexion angles measured in the sagittal plane were 110°, 90°, and 70°. Electromyography was used for a comparitive analysis of the muscle activities of the serratus anterior (SA), the pectoralis major (PM), and the upper trapezius (UT). [Results] In the intra-group comparison, the muscle activity of SA was statistically the highest when the shoulder-flexion angle was 110°. [Conclusion] performing PUPE on an unstable surface, the muscle activity of the SA is activated the most when the shoulder flexion angle is 110° and the forearm is in the external rotation position. PMID:25364120

  12. Effect of the Shoulder Flexion Angle in the Sagittal Plane on the Muscle Activities of the Upper Extremities when Performing Push-up plus Exercises on an Unstable Surface

    PubMed Central

    Lee, Sangyong; Lee, Daehee; Park, Jungseo

    2014-01-01

    [Purpose] The purpose of this study was to investigate the effect of the shoulder flexion angle on the muscle activities of the upper extremities when performing the push-up plus exercise (PUPE) on an unstable surface with the forearm in the external rotation position. [Subjects] The subjects were conducted on 15 normal male adults. [Methods] A sling device was used for the unstable surface, and PUPE was performed with the forearm in the external rotation position. The shoulder flexion angles measured in the sagittal plane were 110°, 90°, and 70°. Electromyography was used for a comparitive analysis of the muscle activities of the serratus anterior (SA), the pectoralis major (PM), and the upper trapezius (UT). [Results] In the intra-group comparison, the muscle activity of SA was statistically the highest when the shoulder-flexion angle was 110°. [Conclusion] performing PUPE on an unstable surface, the muscle activity of the SA is activated the most when the shoulder flexion angle is 110° and the forearm is in the external rotation position. PMID:25364120

  13. Implant-Retained Auricular Prosthesis: A Case Report

    PubMed Central

    Ozturk, A. Nilgun; Usumez, Aslihan; Tosun, Zekeriya

    2010-01-01

    Extraoral implant retained prosthesis have been proven to be a predictable treatment option for maxillofacial rehabilitation. This case report describes the clinical and laboratory procedures for fabricating an auricular prosthesis. In this case report, an auricular prosthesis was fabricated for a patient who lost the left and right external ear in an electrical burn. Extraoral implants and bar-and-clip retention for the proper connection of the auricular prosthesis to implant were used. This prosthesis was acceptable to the patient because of excellent support, retentive abilities and the patients appearance. PMID:20046483

  14. Effects of a powered ankle-foot prosthesis on kinetic loading of the contralateral limb: a case series.

    PubMed

    Hill, David; Herr, Hugh

    2013-06-01

    Lower-extremity amputees encounter a series of stress-related challenges. Among them is an increased risk of chronic joint disorders. For unilateral, transtibial amputees, we hypothesize that increasing the power output of the trailing, ankle-foot prosthesis during powered plantar flexion could mitigate kinetic loading applied to the leading, contralateral leg during walking. Here, we present a case series that analyzes kinetic factors of unilateral, transtibial amputee gait and forms a comparison between two types of ankle prostheses with varying power outputs. The factors examined here are impact resultant force, peak foot pressure at heel-strike, step-to-step transition work, and knee external adduction moment. The two prostheses are the amputee participant's daily-use passive ankle-foot prosthesis and the BiOM powered ankle-foot prosthesis capable of biologically accurate powered plantar flexion during late stance. In a preliminary study on two transtibial amputees walking over level terrain at a controlled speed (1.25 m/s), we observed average reductions of 8% in peak impact resultant force, 18% in impact resultant force loading rate, 8% in peak heel-strike foot pressure, and 15% in the 1(st) peak knee external adduction moment when the powered ankle-foot prosthesis was compared to the conventional passive prosthesis. Overall, our preliminary results suggest that more biomimetic prosthetic ankle-foot push-off during late stance may limit leading-leg musculoskeletal stress in walking. PMID:24187194

  15. Prosthesis fabrication using electrical discharge machining.

    PubMed

    Van Roekel, N B

    1992-01-01

    Fixed-removable implant prostheses provide solutions for some of the problems associated with implant dentistry, especially in the maxilla. The technique for using electrical discharge machining to create a precise passive fit between the substructure bar and the removable suprastructure is presented. The advantages, disadvantages, and complications associated with this type of prosthesis are discussed. PMID:1398825

  16. Implant-Supported Auricular Prosthesis - An Overview.

    PubMed

    Sharma, Ashu; Rahul, G R; T Poduval, Soorya; Shetty, Karunakar

    2012-08-22

    Abstract Auricular defects can result from tumor resection, congenital malformations, and trauma. These defects lack hard or soft tissue undercuts, and prosthesis retention is obtained primarily by the use of skin adhesives. There are significant disadvantages to the use of skin adhesives.The margins of the facial prosthesis may be damaged by repeated application and removal of the adhesive, and occasionally a patient will have a toxic skin reaction. The retentive capacity of adhesives may be insufficient in mobile tissues or in moist environments. The presence of hair also complicates the use of skin adhesives. The use of craniofacial titanium implants for restoring auricular defects may provide many benefits. The quality of retention provided far exceeds that obtained with adhesives, and skin-penetrating osseointegrated implants have demonstrated an excellent level of predictability when placed in bone in the auricular area.The aim of this paper is to present concept and principles of maxillofacial implants, history, literature review , advantages and disadvantages, considerations in treatment planning, finally the treatment phases of an implant-supported auricular prosthesis in particular and prospective developments for ear prosthesis. PMID:22913280

  17. Online human training of a myoelectric prosthesis controller via actor-critic reinforcement learning.

    PubMed

    Pilarski, Patrick M; Dawson, Michael R; Degris, Thomas; Fahimi, Farbod; Carey, Jason P; Sutton, Richard S

    2011-01-01

    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 the task domain. This reinforcement-based machine learning framework is well suited for use by both patients and clinical staff, and may be easily adapted to different application domains and the needs of individual amputees. To our knowledge, this is the first my-oelectric control approach that facilitates the online learning of new amputee-specific motions based only on a one-dimensional (scalar) feedback signal provided by the user of the prosthesis. PMID:22275543

  18. Reading Visual Braille with a Retinal Prosthesis

    PubMed Central

    Lauritzen, Thomas Z.; Harris, Jordan; Mohand-Said, Saddek; Sahel, Jose A.; Dorn, Jessy D.; McClure, Kelly; Greenberg, Robert J.

    2012-01-01

    Retinal prostheses, which restore partial vision to patients blinded by outer retinal degeneration, are currently in clinical trial. The Argus II retinal prosthesis system was recently awarded CE approval for commercial use in Europe. While retinal prosthesis users have achieved remarkable visual improvement to the point of reading letters and short sentences, the reading process is still fairly cumbersome. This study investigates the possibility of using an epiretinal prosthesis to stimulate visual braille as a sensory substitution for reading written letters and words. The Argus II retinal prosthesis system, used in this study, includes a 10??6 electrode array implanted epiretinally, a tiny video camera mounted on a pair of glasses, and a wearable computer that processes the video and determines the stimulation current of each electrode in real time. In the braille reading system, individual letters are created by a subset of dots from a 3 by 2 array of six dots. For the visual braille experiment, a grid of six electrodes was chosen out of the 10??6 Argus II array. Groups of these electrodes were then directly stimulated (bypassing the camera) to create visual percepts of individual braille letters. Experiments were performed in a single subject. Single letters were stimulated in an alternative forced choice (AFC) paradigm, and short 24-letter words were stimulated (one letter at a time) in an open-choice reading paradigm. The subject correctly identified 89% of single letters, 80% of 2-letter, 60% of 3-letter, and 70% of 4-letter words. This work suggests that text can successfully be stimulated and read as visual braille in retinal prosthesis patients. PMID:23189036

  19. Development and clinical application of a new testicular prosthesis

    PubMed Central

    Ning, Ye; Cai, Zhikang; Chen, Huixing; Ping, Ping; Li, Peng; Wang, Zhong; Li, Zheng

    2011-01-01

    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 were recruited for this study. Follow-up after 6 months revealed no complications in the patients. All the patients answered that they were satisfied with their body image and the position of the implants, 19 patients were satisfied with the size and 16 patients were satisfied with the weight. These results show that the testicular prosthesis used in this study can meet patient's expectations. Patients undergoing orchiectomy should be offered the option to receive a testicular prosthesis implantation. The dimensions and weight of the available prosthetic implants should be further addressed to improve patient satisfaction. PMID:21927041

  20. Surgical Treatment of Upper Extremity Pain.

    PubMed

    Dellon, Arnold Lee

    2016-02-01

    If the patient with hand pain remains without significant relief and without recovery of function after appropriate pharmaceutical and physical modality treatments, it is appropriate to consider a surgical approach to the pain. Categories of pain amenable to a surgical approach are pain caused by nerve compression, pain caused by a neuroma, and joint pain of neural origin. Compressed nerve should be decompressed and depending on the intraoperative findings a neurolysis also should be performed. Painful neuroma must be resected to stop the pain generator. For a painful joint, the biomechanics of that joint must first be stable before denervation. PMID:26611391