Effect of horizontal pick and place locations on shoulder kinematics.

PubMed

Könemann, R; Bosch, T; Kingma, I; Van Dieën, J H; De Looze, M P

2015-01-01

In this study the effects of horizontal bin locations in an order picking workstation on upper arm elevation, trunk inclination and hand use were investigated. Eight subjects moved (self-paced) light or heavy products (0.2 and 3.0 kg) from a central product bin to an inner or outer order bin (at 60 or 150 cm) on the left or right side of the workstation, while movements were recorded. The outer compared to inner bin location resulted in more upper arm elevation and trunk inclination per work cycle, both in terms of number of peak values and in terms of time integrals of angles (which is a dose measure over time). Considering the peak values and time integrals per minute (instead of per work cycle), these effects are reduced, due to the higher cycle times for outer bins. Hand use (left, right or both) was not affected by order bin locations.

A slouched body posture decreases arm mobility and changes muscle recruitment in the neck and shoulder region.

PubMed

Malmström, Eva-Maj; Olsson, Joakim; Baldetorp, Johan; Fransson, Per-Anders

2015-12-01

Long-term use of unfavorable postures, congenital deformations and degenerative processes associated with aging or disease may generate an increased thoracic curvature resulting in pain and disability. We wanted to examine whether a slouched postural alignment with increased thoracic kyphosis changes the shoulder kinematics and muscle activity in upper trapezius (UT), lower trapezius (LT) and serratus anterior (SA) during arm elevation. The aim was to determine if a slouched posture influences range of motion, muscle activation patterns, maximal muscle activity and the total muscle work required when performing arm elevations. Twelve male subjects (23.3 ± 1.5 years) performed maximum arm elevations in upright and slouched postures. A combined 3D movement and EMG system recorded arm movements and spine curvature simultaneously with EMG activity in the UT, LT and SA. Slouched posture affected the biomechanical conditions by significantly decreasing maximum arm elevation by ~15° (p < 0.001) and decreasing arm movement velocity by ~8 % during movements upwards (p < 0.001) and downwards (p = 0.034). The peak muscle activity increased in all muscles: UT (p = 0.034, +32.3 %), LT (p = 0.001, +48.6 %) and SA (p = 0.007, +20.9 %). The total muscle work increased significantly in the slouched posture during movements upwards: UT (p = 0.003, +36.6 %), LT (p < 0.001, +89.0 %), SA (p = 0.002, +19.4 %) and downwards: UT (p = 0.012, +29.8 %) and LT (p < 0.001, +122.5 %). An increased thoracic kyphosis was found associated with marked increased physical costs when performing arm movements. Hence, patients suffering from neck-shoulder pain and disability should be investigated and treated for defective thoracic curvature issues.

Task based exposure assessment in ergonomic epidemiology: a study of upper arm elevation in the jobs of machinists, car mechanics, and house painters

PubMed Central

Svendsen, S; Mathiassen, S; Bonde, J

2005-01-01

Aims: To explore the precision of task based estimates of upper arm elevation in three occupational groups, compared to direct measurements of job exposure. Methods: Male machinists (n = 26), car mechanics (n = 23), and house painters (n = 23) were studied. Whole day recordings of upper arm elevation were obtained for four consecutive working days, and associated task information was collected in diaries. For each individual, task based estimates of job exposure were calculated by weighting task exposures from a collective database by task proportions according to the diaries. These estimates were validated against directly measured job exposures using linear regression. The performance of the task based approach was expressed through the gain in precision of occupational group mean exposures that could be obtained by adding subjects with task based estimates to a group of subjects with measured job exposures in a "validation" design. Results: In all three occupations, tasks differed in mean exposure, and task proportions varied between individuals. Task based estimation proved inefficient, with squared correlation coefficients only occasionally exceeding 0.2 for the relation between task based and measured job exposures. Consequently, it was not possible to substantially improve the precision of an estimated group mean by including subjects whose job exposures were based on task information. Conclusions: Task based estimates of mechanical job exposure can be very imprecise, and only marginally better than estimates based on occupation. It is recommended that investigators in ergonomic epidemiology consider the prospects of task based exposure assessment carefully before placing resources at obtaining task information. Strategies disregarding tasks may be preferable in many cases. PMID:15613604

Full-Shift Trunk and Upper Arm Postures and Movements Among Aircraft Baggage Handlers.

PubMed

Wahlström, Jens; Bergsten, Eva; Trask, Catherine; Mathiassen, Svend Erik; Jackson, Jennie; Forsman, Mikael

2016-10-01

The present study assessed full-shift trunk and upper arm postural exposure amplitudes, frequencies, and durations among Swedish airport baggage handlers and aimed to determine whether exposures differ between workers at the ramp (loading and unloading aircraft) and baggage sorting areas. Trunk and upper arm postures were measured using inclinometers during three full work shifts on each of 27 male baggage handlers working at a large Swedish airport. Sixteen of the baggage handlers worked on the ramp and 11 in the sorting area. Variables summarizing postures and movements were calculated, and mean values and variance components between subjects and within subject (between days) were estimated using restricted maximum likelihood algorithms in a one-way random effect model. In total, data from 79 full shifts (651h) were collected with a mean recording time of 495min per shift (range 319-632). On average, baggage handlers worked with the right and left arm elevated >60° for 6.4% and 6.3% of the total workday, respectively. The 90th percentile trunk forward projection (FP) was 34.1°, and the 50th percentile trunk movement velocity was 8° s(-1). For most trunk (FP) and upper arm exposure variables, between-subject variability was considerable, suggesting that the flight baggage handlers were not a homogeneously exposed group. A notable between-days variability pointed to the contents of the job differing on different days. Peak exposures (>90°) were higher for ramp workers than for sorting area workers (trunk 0.6% ramp versus 0.3% sorting; right arm 1.3% ramp versus 0.7% sorting). Trunk and upper arm postures and movements among flight baggage handlers measured by inclinometry were similar to those found in other jobs comprising manual material handling, known to be associated with increased risks for musculoskeletal disorders. The results showed that full-shift trunk (FP) and, to some extent, peak arm exposures were higher for ramp workers compared with sorting workers. © The Author 2016. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.

Assessing the influence of a passive, upper extremity exoskeletal vest for tasks requiring arm elevation: Part I - "Expected" effects on discomfort, shoulder muscle activity, and work task performance.

PubMed

Kim, Sunwook; Nussbaum, Maury A; Mokhlespour Esfahani, Mohammad Iman; Alemi, Mohammad Mehdi; Alabdulkarim, Saad; Rashedi, Ehsan

2018-03-07

Use of exoskeletal vests (designed to support overhead work) can be an effective intervention approach for tasks involving arm elevation, yet little is known on the potential beneficial impacts of their use on physical demands and task performance. This laboratory study (n = 12) evaluated the effects of a prototype exoskeletal vest during simulated repetitive overhead drilling and light assembly tasks. Anticipated or expected benefits were assessed, in terms of perceived discomfort, shoulder muscle activity, and task performance. Using the exoskeletal vest did not substantially influence perceived discomfort, but did decrease normalized shoulder muscle activity levels (e.g., ≤ 45% reduction in peak activity). Drilling task completion time decreased by nearly 20% with the vest, but the number of errors increased. Overall, exoskeletal vest use has the potential to be a new intervention for work requiring arm elevation; however, additional investigations are needed regarding potential unexpected or adverse influences (see Part II). Copyright © 2018 Elsevier Ltd. All rights reserved.

A Prospective Evaluation of Duplex Ultrasound for Thoracic Outlet Syndrome in High-Performance Musicians Playing Bowed String Instruments

PubMed Central

Adam, Garret; Wang, Kevin; Demaree, Christopher J.; Jiang, Jenny S.; Cheung, Mathew; Bechara, Carlos F.

2018-01-01

Thoracic outlet syndrome (TOS) is a neurovascular condition involving the upper extremity, which is known to occur in individuals who perform chronic repetitive upper extremity activities. We prospectively evaluate the incidence of TOS in high-performance musicians who played bowed string musicians. Sixty-four high-performance string instrument musicians from orchestras and professional musical bands were included in the study. Fifty-two healthy volunteers formed an age-matched control group. Bilateral upper extremity duplex scanning for subclavian vessel compression was performed in all subjects. Provocative maneuvers including Elevated Arm Stress Test (EAST) and Upper Limb Tension Test (ULTT) were performed. Abnormal ultrasound finding is defined by greater than 50% subclavian vessel compression with arm abduction, diminished venous waveforms, or arterial photoplethysmography (PPG) tracing with arm abduction. Bowed string instruments performed by musicians in our study included violin (41%), viola (33%), and cello (27%). Positive EAST or ULTT test in the musician group and control group were 44%, and 3%, respectively (p = 0.03). Abnormal ultrasound scan with vascular compression was detected in 69% of musicians, in contrast to 15% of control subjects (p = 0.03). TOS is a common phenomenon among high-performance bowed string instrumentalists. Musicians who perform bowed string instruments should be aware of this condition and its associated musculoskeletal symptoms. PMID:29370085

Total Mercury and Methylmercury Response in Water, Sediment, and Biota to Destratification of the Great Salt Lake, Utah, United States.

PubMed

Valdes, Carla; Black, Frank J; Stringham, Blair; Collins, Jeffrey N; Goodman, James R; Saxton, Heidi J; Mansfield, Christopher R; Schmidt, Joshua N; Yang, Shu; Johnson, William P

2017-05-02

Measurements of chemical and physical parameters made before and after sealing of culverts in the railroad causeway spanning the Great Salt Lake in late 2013 documented dramatic alterations in the system in response to the elimination of flow between the Great Salt Lake's north and south arms. The flow of denser, more-saline water through the culverts from the north arm (Gunnison Bay) to the south arm (Gilbert Bay) previously drove the perennial stratification of the south arm and the existence of oxic shallow brine and anoxic deep brine layers. Closure of the causeway culverts occurred concurrently with a multiyear drought that resulted in a decrease in the lake elevation and a concomitant increase in top-down erosion of the upper surface of the deep brine layer by wind-forced mixing. The combination of these events resulted in the replacement of the formerly stratified water column in the south arm with one that was vertically homogeneous and oxic. Total mercury concentrations in the deep waters of the south arm decreased by approximately 81% and methylmercury concentrations in deep waters decreased by roughly 86% due to destratification. Methylmercury concentrations decreased by 77% in underlying surficial sediment, whereas there was no change observed in total mercury. The dramatic mercury loss from deep waters and methylmercury loss from underlying sediment in response to causeway sealing provides new understanding of the potential role of the deep brine layer in the accumulation and persistence of methylmercury in the Great Salt Lake. Additional mercury measurements in biota appear to contradict the previously implied connection between elevated methylmercury concentrations in the deep brine layer and elevated mercury in avian species reported prior to causeway sealing.

Postanesthesia patients with large upper arm circumference: is use of an "extra-long" adult cuff or forearm cuff placement accurate?

PubMed

Watson, Sheri; Aguas, Marita; Bienapfl, Tracy; Colegrove, Pat; Foisy, Nancy; Jondahl, Bonnie; Yosses, Mary Beth; Yu, Larissa; Anastas, Zoe

2011-06-01

The purpose of this study was to determine if blood pressure (BP) measured in the forearm or with an extra-long BP cuff in the upper arm accurately reflects BP measured in the upper arm with an appropriately sized BP cuff in patients with large upper arm circumference. A method-comparison design was used with a convenience sample of 49 PACU patients. Noninvasive blood pressures were obtained in two different locations (forearm; upper arm) and in the upper arm with an extra-long adult and recommended large adult cuff sizes. Data were analyzed by calculating bias and precision for the BP cuff size and location and Student's t-tests, with P < .0125 considered significant. Significantly higher forearm systolic (P < .0001) and diastolic (P < .0002) BP measurements were found compared to BP obtained in the upper arm with the reference standard BP cuff. Significantly higher systolic (t(48df) = 5.38, P < .0001), but not diastolic (t(48df) = 4.11, P < .019), BP differences were found for BP measured with the extra-long cuff at the upper arm site compared to the upper arm, reference standard BP. Findings suggest that the clinical practice of using the forearm or an extra-long cuff in the upper arm for BP measurement in post anesthesia patients with large upper arm circumferences may result in inaccurate BP values. Copyright © 2011 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

Comparison of forearm and upper arm blood pressures.

PubMed

Singer, A J; Kahn, S R; Thode, H C; Hollander, J E

1999-01-01

In the prehospital setting it is not always feasible to obtain blood pressure (BP) readings from the upper arm. This study was performed to compare BPs obtained from subjects' forearms and upper arms in order to assess the utility of forearm BP as a surrogate for standard BP. The authors performed a prospective, cross-sectional, convenience study in a sample of ambulatory university ED patients, where each subject had sequential determinations of left upper arm and forearm BPs with an automated monitor at ED triage. The order of measurement was determined by the day of the week. Demographic and clinical data were also recorded. The main outcome measure was the correlation between upper arm and forearm systolic and diastolic BPs. Pearson's correlation coefficient and Student's t-test were used to analyze the data. 151 patients were enrolled. The mean age was 35.3+/-15.7 years; 40% were female and 78% were white. The mean forearm and upper arm systolic BPs were 129.8+/-20.7 mm Hg and 126.2+/-17.6 mm Hg (p = 0.002). The mean forearm and upper arm diastolic BPs were 80.7+/-14.5 mm Hg and 76.8+/-13.4 mm Hg (p<0.001). The correlations between forearm and upper arm systolic and diastolic BPs were 0.75 (p<0.001) and 0.72 (p<0.001). The differences between forearm and upper arm systolic and diastolic BPs were within 20 mm Hg in 86% and 94% of patients, respectively. Forearm BP is a fairly good predictor of standard upper arm BP in most patients. Forearm BP may be used when measurement of upper arm BP is not feasible.

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

PubMed Central

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

2008-01-01

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

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

PubMed

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

2008-01-01

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

Does "hidden undercuffing" occur among obese patients? Effect of arm sizes and other predictors of the difference between wrist and upper arm blood pressures.

PubMed

Doshi, Hardik; Weder, Alan B; Bard, Robert L; Brook, Robert D

2010-02-01

Arm size can affect the accuracy of blood pressure (BP) measurement, and "undercuffing" of large upper arms is likely to be a growing problem. Therefore, the authors investigated the relationship between upper arm and wrist readings. Upper arm and wrist circumferences and BP were measured in 261 consecutive patients. Upper arm auscultation and wrist BP was measured in triplicate, rotating measurements every 30 seconds between sites. Upper arm BP was 131.9+/-20.6/71.6+/-12.6 mm Hg in an obese population (body mass index, 30.6+/-6.6 kg/m(2)) with mean upper arm size of 30.7+/-5.1 cm. Wrist BP was higher (2.6+/-9.2 mm Hg and 4.9+/-6.6 mm Hg, respectively, P<.001); however, there was moderate concordance for the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) strata (kappa value=0.27-0.71), and the difference was >or=5 mm Hg in 72% of the patients. The authors conclude that there was poor concordance between arm and wrist BP measurement and found no evidence that "hidden undercuffing" was associated with obesity; therefore, they do not support routine use of wrist BP measurements.

Clinical comparison of automatic, noninvasive measurements of blood pressure in the forearm and upper arm.

PubMed

Schell, Kathleen; Bradley, Elisabeth; Bucher, Linda; Seckel, Maureen; Lyons, Denise; Wakai, Sandra; Bartell, Deborah; Carson, Elizabeth; Chichester, Melanie; Foraker, Teresa; Simpson, Kathleen

2005-05-01

When the upper arm (area from shoulder to elbow) is inaccessible and/or a standard-sized blood pressure cuff does not fit, some healthcare workers use the forearm to measure blood pressure. To compare automatic noninvasive measurements of blood pressure in the upper arm and forearm. A descriptive, correlational comparison study was conducted in the emergency department of a 1071-bed teaching hospital. Subjects were 204 English-speaking patients 6 to 91 years old in medically stable condition who had entered the department on foot or by wheelchair and who had no exclusions to using their left upper extremity. A Welch Allyn Vital Signs 420 series monitor was used to measure blood pressure in the left upper arm and forearm with the subject seated and the upper arm or forearm at heart level. Pearson r correlation coefficients between measurements in the upper arm and forearm were 0.88 for systolic blood pressure and 0.76 for diastolic blood pressure (P < .001 for both). Mean systolic pressures, but not mean diastolic pressures, in the upper arm and forearm differed significantly (t = 2.07, P = .04). A Bland-Altman analysis indicated that the distances between the mean values and the limits of agreement for the 2 sites ranged from 15 mm Hg (mean arterial pressure) to 18.4 mm Hg (systolic pressure). Despite strict attention to correct cuff size and placement of the upper arm or forearm at heart level, measurements of blood pressure obtained noninvasively in the arm and forearm of seated patients in stable condition are not interchangeable.

Residual Upper Arm Motor Function Primes Innervation of Paretic Forearm Muscles in Chronic Stroke after Brain-Machine Interface (BMI) Training

PubMed Central

Curado, Marco Rocha; Cossio, Eliana Garcia; Broetz, Doris; Agostini, Manuel; Cho, Woosang; Brasil, Fabricio Lima; Yilmaz, Oezge; Liberati, Giulia; Lepski, Guilherme

2015-01-01

Background Abnormal upper arm-forearm muscle synergies after stroke are poorly understood. We investigated whether upper arm function primes paralyzed forearm muscles in chronic stroke patients after Brain-Machine Interface (BMI)-based rehabilitation. Shaping upper arm-forearm muscle synergies may support individualized motor rehabilitation strategies. Methods Thirty-two chronic stroke patients with no active finger extensions were randomly assigned to experimental or sham groups and underwent daily BMI training followed by physiotherapy during four weeks. BMI sessions included desynchronization of ipsilesional brain activity and a robotic orthosis to move the paretic limb (experimental group, n = 16). In the sham group (n = 16) orthosis movements were random. Motor function was evaluated with electromyography (EMG) of forearm extensors, and upper arm and hand Fugl-Meyer assessment (FMA) scores. Patients performed distinct upper arm (e.g., shoulder flexion) and hand movements (finger extensions). Forearm EMG activity significantly higher during upper arm movements as compared to finger extensions was considered facilitation of forearm EMG activity. Intraclass correlation coefficient (ICC) was used to test inter-session reliability of facilitation of forearm EMG activity. Results Facilitation of forearm EMG activity ICC ranges from 0.52 to 0.83, indicating fair to high reliability before intervention in both limbs. Facilitation of forearm muscles is higher in the paretic as compared to the healthy limb (p<0.001). Upper arm FMA scores predict facilitation of forearm muscles after intervention in both groups (significant correlations ranged from R = 0.752, p = 0.002 to R = 0.779, p = 0.001), but only in the experimental group upper arm FMA scores predict changes in facilitation of forearm muscles after intervention (R = 0.709, p = 0.002; R = 0.827, p<0.001). Conclusions Residual upper arm motor function primes recruitment of paralyzed forearm muscles in chronic stroke patients and predicts changes in their recruitment after BMI training. This study suggests that changes in upper arm-forearm synergies contribute to stroke motor recovery, and provides candidacy guidelines for similar BMI-based clinical practice. PMID:26495971

Residual Upper Arm Motor Function Primes Innervation of Paretic Forearm Muscles in Chronic Stroke after Brain-Machine Interface (BMI) Training.

PubMed

Curado, Marco Rocha; Cossio, Eliana Garcia; Broetz, Doris; Agostini, Manuel; Cho, Woosang; Brasil, Fabricio Lima; Yilmaz, Oezge; Liberati, Giulia; Lepski, Guilherme; Birbaumer, Niels; Ramos-Murguialday, Ander

2015-01-01

Abnormal upper arm-forearm muscle synergies after stroke are poorly understood. We investigated whether upper arm function primes paralyzed forearm muscles in chronic stroke patients after Brain-Machine Interface (BMI)-based rehabilitation. Shaping upper arm-forearm muscle synergies may support individualized motor rehabilitation strategies. Thirty-two chronic stroke patients with no active finger extensions were randomly assigned to experimental or sham groups and underwent daily BMI training followed by physiotherapy during four weeks. BMI sessions included desynchronization of ipsilesional brain activity and a robotic orthosis to move the paretic limb (experimental group, n = 16). In the sham group (n = 16) orthosis movements were random. Motor function was evaluated with electromyography (EMG) of forearm extensors, and upper arm and hand Fugl-Meyer assessment (FMA) scores. Patients performed distinct upper arm (e.g., shoulder flexion) and hand movements (finger extensions). Forearm EMG activity significantly higher during upper arm movements as compared to finger extensions was considered facilitation of forearm EMG activity. Intraclass correlation coefficient (ICC) was used to test inter-session reliability of facilitation of forearm EMG activity. Facilitation of forearm EMG activity ICC ranges from 0.52 to 0.83, indicating fair to high reliability before intervention in both limbs. Facilitation of forearm muscles is higher in the paretic as compared to the healthy limb (p<0.001). Upper arm FMA scores predict facilitation of forearm muscles after intervention in both groups (significant correlations ranged from R = 0.752, p = 0.002 to R = 0.779, p = 0.001), but only in the experimental group upper arm FMA scores predict changes in facilitation of forearm muscles after intervention (R = 0.709, p = 0.002; R = 0.827, p<0.001). Residual upper arm motor function primes recruitment of paralyzed forearm muscles in chronic stroke patients and predicts changes in their recruitment after BMI training. This study suggests that changes in upper arm-forearm synergies contribute to stroke motor recovery, and provides candidacy guidelines for similar BMI-based clinical practice.

Investigation of Aircrew Protection During Emergency Escape at Dynamic Pressures up to 1600 Q.

DTIC Science & Technology

1982-05-01

Speed Ejections 14 4 Torso Airflow Stagnation Fence Arm Restraints 16 5 Upper Torso Support Restraint Garment 21 6 Multiaxial Pelvis Restraint 22 7...aircraft. Designs, such as the pelvis and leg elevating (PALE) seats, fixed reclined seats, or pressurized vests, are viable concepts for high sustained...final comment on direct energy transfer from the lower legs to the ai rmass involves aerodynamic asymmetry of the booted foot. Such asymmetry could lead

Similar metabolic response to lower- versus upper-body interval exercise or endurance exercise.

PubMed

Francois, Monique E; Graham, Matthew J; Parr, Evelyn B; Rehrer, Nancy J; Lucas, Samuel J E; Stavrianeas, Stasinos; Cotter, James D

2017-03-01

To compare energy use and substrate partitioning arising from repeated lower- versus upper-body sprints, or endurance exercise, across a 24-h period. Twelve untrained males (24±4 y) completed three trials in randomized order: (1) repeated sprints (five 30-s Wingate, 4.5-min recovery) on a cycle ergometer (SIT Legs ); (2) 50-min continuous cycling at 65% V̇O 2 max (END); (3) repeated sprints on an arm-crank ergometer (SIT Arms ). Respiratory gas exchange was assessed before and during exercise, and at eight points across 22h of recovery. Metabolic rate was elevated to greater extent in the first 8h after SIT Legs than SIT Arms (by 0.8±1.1kJ/min, p=0.03), and tended to be greater than END (by 0.7±1.3kJ/min, p=0.08). Total 24-h energy use (exercise+recovery) was equivalent between SIT Legs and END (p = 0.55), and SIT Legs and SIT Arms (p=0.13), but 24-h fat use was higher with SIT Legs than END (by 26±38g, p=0.04) and SIT Arms (by 27±43g, p=0.05), whereas carbohydrate use was higher with SIT Arms than SIT Legs (by 32±51g, p=0.05). Plasma volume-corrected post-exercise and fasting glucose and lipid concentrations were unchanged. Despite much lower energy use during five sprints than 50-min continuous exercise, 24-h energy use was not reliably different. However, (i) fat metabolism was greater after sprints, and (ii) carbohydrate metabolism was greater in the hours after sprints with arms than legs, while 24-h energy usage was comparable. Thus, sprints using arms or legs may be an important adjunct exercise mode for metabolic health. Copyright © 2016 Elsevier Inc. All rights reserved.

Benign symmetric lipomatosis (Launois-Bensaude syndrome).

PubMed

Fernández-Vozmediano, José; Armario-Hita, José

2005-03-01

A 37-year-old woman with a personal history of appendicectomy, cholecystectomy, left oophorectomy secondary to an ovarian cyst complication, nephritic colic with repeated episodes of pyelonephritis, alcoholic hepatopathy, Raynaud's phenomenon and bilateral exophthalmos showed an increase in volume in the root of the upper limbs and in the base of the neck over a period of 4 years, painful to the touch and of a soft consistency. She presented with a pseudo-athletic appearance (Fig. 1) produced by an increase in the volume at the root of the upper limbs, upper back and the back of the neck (Fig. 2). The lesions produced a pulling sensation and were associated with paresthesia, hyperesthesia, and a moderate loss of strength in both arms. A biopsy taken from the upper third of the right arm showed a diffuse proliferation of the subcutaneous adipose tissue, which appeared normal, and extended between the collagen fibers, reaching in some cases into the most superficial zones of the reticular dermis (Fig. 3). Laboratory evaluation revealed a chronic anemia, leukopenia with moderate lymphopenia, increased erythrocyte sedimentation rate, elevation of enzymes of hepatic function, decrease in total proteins, and increase in ferritin, all in the context of hepatopathy. Antinuclear antibodies and the hormonal profile were normal. Abdominal and gynecologic echography revealed a right ovarian cyst of no clinical relevance. Cranial nuclear magnetic resonance (NMR) revealed an increase in the periorbital fat responsible for bilateral exophthalmos.

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

PubMed

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

2013-11-01

The reverse shoulder replacement, recommended for the treatment of several shoulder pathologies such as cuff tear arthropathy and fractures in elderly people, changes the biomechanics of the shoulder when compared to the normal anatomy. Although several musculoskeletal models of the upper limb have been presented to study the shoulder joint, only a few of them focus on the biomechanics of the reverse shoulder. This work presents a biomechanical model of the upper limb, including a reverse shoulder prosthesis, to evaluate the impact of the variation of the joint geometry and position on the biomechanical function of the shoulder. The biomechanical model of the reverse shoulder is based on a musculoskeletal model of the upper limb, which is modified to account for the properties of the DELTA® reverse prosthesis. Considering two biomechanical models, which simulate the anatomical and reverse shoulder joints, the changes in muscle lengths, muscle moment arms, and muscle and joint reaction forces are evaluated. The muscle force sharing problem is solved for motions of unloaded abduction in the coronal plane and unloaded anterior flexion in the sagittal plane, acquired using video-imaging, through the minimization of an objective function related to muscle metabolic energy consumption. After the replacement of the shoulder joint, significant changes in the length of the pectoralis major, latissimus dorsi, deltoid, teres major, teres minor, coracobrachialis, and biceps brachii muscles are observed for a reference position considered for the upper limb. The shortening of the teres major and teres minor is the most critical since they become unable to produce active force in this position. Substantial changes of muscle moment arms are also observed, which are consistent with the literature. As expected, there is a significant increase of the deltoid moment arms and more fibers are able to elevate the arm. The solutions to the muscle force sharing problem support the biomechanical advantages attributed to the reverse shoulder design and show an increase in activity from the deltoid, teres minor, and coracobrachialis muscles. The glenohumeral joint reaction forces estimated for the reverse shoulder are up to 15% lower than those in the normal shoulder anatomy. The data presented here complements previous publications, which, all together, allow researchers to build a biomechanical model of the upper limb including a reverse shoulder prosthesis.

Superior Patency of Upper Arm Arteriovenous Fistulae in High Risk Patients

PubMed Central

Chiulli, Larissa C; Vasilas, Penny; Dardik, Alan

2011-01-01

Background Despite an increased propensity to primary failure in forearm arteriovenous fistulae compared to upper arm fistulae, forearm fistulae remain the preferred primary access type for chronic hemodialysis patients. In a high risk patient population with multiple medical comorbidities associated with requirement for intravenous access we compared the rates of access failure in forearm and upper arm fistulae. Materials and Methods The records of all patients having primary native arteriovenous fistulae placed between 2004 and 2009 at the VA Connecticut Healthcare system were reviewed (n=118). Primary and secondary patency of upper arm and forearm fistulae were evaluated using Kaplan-Meier survival analysis. The effects of medical comorbidities on access patency were analyzed with Cox regression. Results The median time to primary failure of the vascular access was 0.288 years in the forearm group compared to 0.940 years in the upper arm group (p=0.028). Secondary patency was 52% at 4.9 years in upper arm fistulae compared to 52% at 1.1 years in the forearm group (p=0.036). There was no significant effect of patient comorbidities on fistula failure; however, there was a trend toward upper arm surgical site as a protective factor for primary fistula patency (Hazard Ratio=0.573, p=0.076). Conclusions In veterans needing hemodialysis, a high risk population with extensive comorbid factors often requiring intravascular access, upper arm fistulae are not only a viable option for primary vascular access, but are likely to be a superior option to classic forearm fistulae. PMID:21571318

The Contribution of Upper Body Movements to Dynamic Balance Regulation during Challenged Locomotion

PubMed Central

Boström, Kim J.; Dirksen, Tim; Zentgraf, Karen; Wagner, Heiko

2018-01-01

Recent studies suggest that in addition to movements between ankle and hip joints, movements of the upper body, in particular of the arms, also significantly contribute to postural control. In line with these suggestions, we analyzed regulatory movements of upper and lower body joints supporting dynamic balance regulation during challenged locomotion. The participants walked over three beams of varying width and under three different verbally conveyed restrictions of arm posture, to control the potential influence of arm movements on the performance: The participants walked (1) with their arms stretched out perpendicularly in the frontal plane, (2) spontaneously, i.e., without restrictions to the arm movements, and (3) with their hands on their thighs. After applying an inverse-dynamics analysis to the measured joint kinematics, we investigated the contribution of upper and lower body joints to balance regulation in terms of torque amplitude and variation. On the condition with the hands on the thighs, the contribution of the upper body remains significantly lower than the contribution of the lower body irrespective of beam widths. For spontaneous arm movements and for outstretched arms we find that the upper body (including the arms) contributes to the balancing to a similar extent as the lower body. Moreover, when the task becomes more difficult, i.e., for narrower beam widths, the contribution of the upper body increases, while the contribution of the lower body remains nearly constant. These findings lend further support to the hypothetical existence of an “upper body strategy” complementing the ankle and hip strategies especially during challenging dynamic balance tasks. PMID:29434544

The effect of arm weight support on upper limb muscle synergies during reaching movements

PubMed Central

2014-01-01

Background Compensating for the effect of gravity by providing arm-weight support (WS) is a technique often utilized in the rehabilitation of patients with neurological conditions such as stroke to facilitate the performance of arm movements during therapy. Although it has been shown that, in healthy subjects as well as in stroke survivors, the use of arm WS during the performance of reaching movements leads to a general reduction, as expected, in the level of activation of upper limb muscles, the effects of different levels of WS on the characteristics of the kinematics of motion and of the activity of upper limb muscles have not been thoroughly investigated before. Methods In this study, we systematically assessed the characteristics of the kinematics of motion and of the activity of 14 upper limb muscles in a group of 9 healthy subjects who performed 3-D arm reaching movements while provided with different levels of arm WS. We studied the hand trajectory and the trunk, shoulder, and elbow joint angular displacement trajectories for different levels of arm WS. Besides, we analyzed the amplitude of the surface electromyographic (EMG) data collected from upper limb muscles and investigated patterns of coordination via the analysis of muscle synergies. Results The characteristics of the kinematics of motion varied across WS conditions but did not show distinct trends with the level of arm WS. The level of activation of upper limb muscles generally decreased, as expected, with the increase in arm WS. The same eight muscle synergies were identified in all WS conditions. Their level of activation depended on the provided level of arm WS. Conclusions The analysis of muscle synergies allowed us to identify a modular organization underlying the generation of arm reaching movements that appears to be invariant to the level of arm WS. The results of this study provide a normative dataset for the assessment of the effects of the level of arm WS on muscle synergies in stroke survivors and other patients who could benefit from upper limb rehabilitation with arm WS. PMID:24594139

Dislocated Shoulder: Symptoms and Causes

MedlinePlus

... arm bone pops out of the cup-shaped socket that's part of your shoulder blade. The shoulder ... your upper arm bone out of your shoulder socket. Partial dislocation — in which your upper arm bone ...

Pivots for pointing: visually-monitored pointing has higher arm elevations than pointing blindfolded.

PubMed

Wnuczko, Marta; Kennedy, John M

2011-10-01

Observers pointing to a target viewed directly may elevate their fingertip close to the line of sight. However, pointing blindfolded, after viewing the target, they may pivot lower, from the shoulder, aligning the arm with the target as if reaching to the target. Indeed, in Experiment 1 participants elevated their arms more in visually monitored than blindfolded pointing. In Experiment 2, pointing to a visible target they elevated a short pointer more than a long one, raising its tip to the line of sight. In Experiment 3, the Experimenter aligned the participant's arm with the target. Participants judged they were pointing below a visually monitored target. In Experiment 4, participants viewing another person pointing, eyes-open or eyes-closed, judged the target was aligned with the pointing arm. In Experiment 5, participants viewed their arm and the target via a mirror and posed their arm so that it was aligned with the target. Arm elevation was higher in pointing directly.

Accuracy and precision of flash glucose monitoring sensors inserted into the abdomen and upper thigh compared with the upper arm.

PubMed

Charleer, Sara; Mathieu, Chantal; Nobels, Frank; Gillard, Pieter

2018-06-01

Nowadays, most Belgian patients with type 1 diabetes use flash glucose monitoring (FreeStyle Libre [FSL]; Abbott Diabetes Care, Alameda, California) to check their glucose values, but some patients find the sensor on the upper arm too visible. The aim of the present study was to compare the accuracy and precision of FSL sensors when placed on different sites. A total of 23 adults with type 1 diabetes used three FSL sensors simultaneously for 14 days on the upper arm, abdomen and upper thigh. FSL measurements were compared with capillary blood glucose (BG) measurements obtained with a built-in FSL BG meter. The aggregated mean absolute relative difference was 11.8 ± 12.0%, 18.5 ± 18.4% and 12.3 ± 13.8% for the arm, abdomen (P = .002 vs arm) and thigh (P = .5 vs arm), respectively. Results of Clarke error grid analysis for the arm and thigh were similar (zone A: 84.9% vs 84.5%; P = .6), while less accuracy was seen for the abdomen (zone A: 69.4%; P = .01). Apart from the first day, the accuracy of FSL sensors on the arm and thigh was more stable across the 14-day wear duration than accuracy of sensors on the abdomen, which deteriorated mainly during week 2 (P < .0005). The aggregated precision absolute relative difference was markedly lower for the arm/thigh (10.9 ± 11.9%) compared with the arm/abdomen (20.9 ± 22.8%; P = .002). Our results indicate that the accuracy and precision of FSL sensors placed on the upper thigh are similar to the upper arm, whereas the abdomen performed unacceptably poorly. © 2018 John Wiley & Sons Ltd.

Upper Arm Central Venous Port Implantation: A 6-Year Single Institutional Retrospective Analysis and Pictorial Essay of Procedures for Insertion

PubMed Central

Shiono, Masatoshi; Takahashi, Shin; Kakudo, Yuichi; Takahashi, Masanobu; Shimodaira, Hideki; Kato, Shunsuke; Ishioka, Chikashi

2014-01-01

Background The requirement of central venous (CV) port implantation is increasing with the increase in the number of cancer patients and advancement in chemotherapy. In our division, medical oncologists have implanted all CV ports to save time and consultation costs to other departments. Recently, upper arm implantation has become the first choice as a safe and comfortable method in our unit. Here we report our experience and discuss the procedure and its potential advantages. Methods All CV port implantations (n = 599) performed in our unit from January 2006 to December 2011 were analyzed. Procedural success and complication rates between subclavian and upper arm groups were compared. Results Both groups had similar patient characteristics. Upper arm CV port and subclavian implantations were equivalently successful and safe. Although we only retrospectively analyzed data from a single center, the upper arm group had a significantly lower overall postprocedural complication rate than the subclavian group. No pneumothorax risk, less risk of arterial puncture by ultrasound, feasibility of stopping potential arterial bleeding, and prevention of accidental arterial cannulation by targeting the characteristic solitary basilic vein were the identified advantages of upper arm CV port implantation. In addition to the aforementioned advantages, there is no risk of “pinch-off syndrome,” possibly less patient fear of manipulation, no scars on the neck and chest, easier accessibility, and compatibility with the “peripherally inserted central catheter” technique. Conclusions Upper arm implantation may benefit clinicians and patients with respect to safety and comfort. We also introduce our methods for upper arm CV port implantation with the videos. PMID:24614412

Influence of gravity compensation training on synergistic movement patterns of the upper extremity after stroke, a pilot study

PubMed Central

2012-01-01

Background The majority of stroke patients have to cope with impaired arm function. Gravity compensation of the arm instantaneously affects abnormal synergistic movement patterns. The goal of the present study is to examine whether gravity compensated training improves unsupported arm function. Methods Seven chronic stroke patients received 18 half-hour sessions of gravity compensated reach training, in a period of six weeks. During training a motivating computer game was played. Before and after training arm function was assessed with the Fugl-Meyer assessment and a standardized, unsupported circle drawing task. Synergistic movement patterns were identified based on concurrent changes in shoulder elevation and elbow flexion/extension angles. Results Median increase of Fugl-Meyer scores was 3 points after training. The training led to significantly increased work area of the hemiparetic arm, as indicated by the normalized circle area. Roundness of the drawn circles and the occurrence of synergistic movement patterns remained similar after the training. Conclusions A decreased strength of involuntary coupling might contribute to the increased arm function after training. More research is needed to study working mechanisms involved in post stroke rehabilitation training. The used training setup is simple and affordable and is therefore suitable to use in clinical settings. PMID:22824488

Evaluating optimal superficial limb perfusion at different angles using non-invasive micro-lightguide spectrophotometry.

PubMed

Darmanin, Geraldine; Jaggard, Matthew; Hettiaratchy, Shehan; Nanchahal, Jagdeep; Jain, Abhilash

2013-06-01

It is common practice to elevate the limbs postoperatively to reduce oedema and hence optimise perfusion and facilitate rehabilitation. However, elevation may be counterproductive as it reduces the mean perfusion pressure. There are no clear data on the optimal position of the limbs even in normal subjects. The optimal position of limbs was investigated in 25 healthy subjects using a non-invasive micro-lightguide spectrophotometry system "O2C", which indirectly measures skin and superficial tissue perfusion through blood flow, oxygen saturation and relative haemoglobin concentration. We found a reduction in skin and superficial tissue blood flow of 17% (p=0.0001) on arm elevation (180° shoulder flexion) as compared to heart level and an increase in skin and superficial tissue blood flow of 25% (p=0.02) on forearm elevation of 45°. Lower limb skin and superficial tissue blood flow decreased by 15% (p=0.004) on elevation to 47 cm and by 70% on dependency (p=0.0001) compared to heart level. However, on elevation of the lower limb there was also a 28% reduction in superficial venous pooling (p=0.0001) compared to heart level. In the normal limb, the position for optimal superficial perfusion of the upper limb is with the arm placed at heart level and forearm at 45°. In the lower limb the optimal position for superficial perfusion would be at heart level. However, some degree of elevation may be useful if there is an element of venous congestion. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Level of Agreement Between Forearm and Upper Arm Blood Pressure Measurements in Patients With Large Arm Circumference.

PubMed

Watson, Sheri; Aguas, Marita; Colegrove, Pat; Foisy, Nancy; Jondahl, Bonnie; Anastas, Zoe

2017-02-01

The purpose of the study was to determine if forearm blood pressures (BPs) measured in three different locations agree with the recommended upper arm location for noninvasive BP measurement. A method-comparison design was used. In a convenience sample of postanesthesia care unit patients with large upper arm circumference, BP's were obtained in three different forearm locations (lower forearm, middle forearm, and upper forearm) and compared to upper arm BP using an automated BP measuring device. The level of agreement (bias ± precision) between each forearm location and the upper arm BP was calculated using standard formulas. Acceptable levels of agreement based on expert opinion were set a priori at bias and precision values of less than ±5 mm Hg (bias) and ±8 mm Hg (precision). Forty-eight postanesthesia patients participated in the study. Bias and precision values were found to exceed the acceptable level of agreement for all but one of the systolic and diastolic BP comparisons in the three forearm BP locations. Fifty-six percent of all patients studied had one or more BP difference of at least 10 mm Hg in each of the three forearm locations, with 10% having one or more differences of at least 20 mm Hg. The differences in forearm BP measurements observed in this study indicate that the clinical practice of using a forearm BP with a regular-sized BP cuff in place of a larger sized BP cuff placed on the upper arm in postanesthesia care unit patients with large arm circumferences is inappropriate. The BPs obtained at the forearm location are not equivalent to the BPs obtained at the upper arm location. Copyright © 2015 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

Prosthesis Prescription Protocol of the Arm (PPP-Arm): The implementation of a national prosthesis prescription protocol.

PubMed

Wijdenes, Paula; Brouwers, Michael; van der Sluis, Corry K

2018-02-01

In order to create more uniformity in the prescription of upper limb prostheses by Dutch rehabilitation teams, the development and implementation of a Prosthesis Prescription Protocol of the upper limb (PPP-Arm) was initiated. The aim was to create a national digital protocol to structure, underpin, and evaluate the prescription of upper limb prostheses for clients with acquired or congenital arm defects. Prosthesis Prescription Protocol of the Arm (PPP-Arm) was developed on the basis of the International Classification of Functioning and consisted of several layers. All stakeholders (rehabilitation teams, orthopedic workshops, patients, and insurance companies) were involved in development and implementation. A national project coordinator and knowledge brokers in each team were essential for the project. PPP-Arm was successfully developed and implemented in nine Dutch rehabilitation teams. The protocol improved team collaboration, structure, and completeness of prosthesis prescriptions and treatment uniformity and might be interesting for other countries as well. Clinical relevance A national protocol to prescribe upper limb prostheses can be helpful to create uniformity in treatment of patients with upper limb defects. Such a protocol improves quality of care for all patients in the country.

3-D scapular kinematics during arm elevation: effect of motion velocity.

PubMed

Fayad, F; Hoffmann, G; Hanneton, S; Yazbeck, C; Lefevre-Colau, M M; Poiraudeau, S; Revel, M; Roby-Brami, A

2006-11-01

No three-dimensional (3-D) data exist on the influence of motion velocity on scapular kinematics. The effect of arm elevation velocity has been studied only in a two-dimensional setting. Thirty healthy subjects performed dominant (right) arm elevation in two planes, sagittal and frontal, and at slow and fast self-selected arm speed. Scapular orientation and humeral elevation were measured at 30 Hz recording frequency with use of a 6-degree-of-freedom electromagnetic system (Polhemus Fastraka). Motion was computed according to the International Society of Biomechanics standards. Scapular orientation was also determined with the arm held in different static positions. We obtained a full 3-D kinematic description of scapula achieving a reliable, complex 3-D motion during humeral elevation and lowering. The maximal sagittal arm elevation showed a characteristic "M"-shape pattern of protraction/retraction curve. Scapular rotations did not differ significantly between slow and fast movements. Moreover, protraction/retraction and tilt angular values did not differ significantly between static and dynamic tasks. However, scapular lateral rotation values differed between static and dynamic measurements during sagittal and frontal arm elevation. Lateral scapular rotation appears to be less in static than in dynamic measurement, particularly in the sagittal plane. Interpolation of statically recorded positions of the bones cannot reflect the kinematics of the scapula.

Exposure-response relationships for work-related neck and shoulder musculoskeletal disorders--Analyses of pooled uniform data sets.

PubMed

Nordander, Catarina; Hansson, Gert-Åke; Ohlsson, Kerstina; Arvidsson, Inger; Balogh, Istvan; Strömberg, Ulf; Rittner, Ralf; Skerfving, Staffan

2016-07-01

There is a lack of quantitative data regarding exposure-response relationships between occupational risk factors and musculoskeletal disorders in the neck and shoulders. We explored such relationships in pooled data from a series of our cross-sectional studies. We recorded the prevalence of complaints/discomfort (Nordic Questionnaire) and diagnoses (physical examination) in 33 groups (24 female and 9 male) within which the workers had similar work tasks (3141 workers, of which 817 were males). In representative sub-groups, we recorded postures and velocities of the head (N = 299) and right upper arm (inclinometry; N = 306), right wrist postures and velocities (electrogoniometry; N = 499), and muscular activity (electromyography) in the right trapezius muscle (N = 431) and forearm extensors (N = 206). We also assessed the psychosocial work environment (Job Content Questionnaire). Uni- and multivariate linear meta-regression analysis revealed several statistically significant group-wise associations. Neck disorders were associated with head inclination, upper arm elevation, muscle activity of the trapezius and forearm extensors and wrist posture and angular velocity. Right-side shoulder disorders were associated with head and upper arm velocity, activity in the trapezius and forearm extensor muscles and wrist posture and angular velocity. The psychosocial work environment (low job control, job strain and isostrain) was also associated with disorders. Women exhibited a higher prevalence of neck and shoulder complaints and tension neck syndrome than men, when adjusting for postures, velocities, muscular activity or psychosocial exposure. In conclusion, the analyses established quantitative exposure-response relationships between neck and shoulder disorders and objective measures of the physical workload on the arm. Such information can be used for risk assessment in different occupations/work tasks, to establish quantitative exposure limits, and for the evaluation of preventive measures. Copyright © 2016 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Comparison of upper arm and forearm blood pressure.

PubMed

Domiano, Kathy L; Hinck, Susan M; Savinske, Debra L; Hope, Kathryn L

2008-11-01

The upper arm is the primary site used to obtain a blood pressure measurement (BPM); however, when it is not possible to use the upper arm, the forearm is a commonly used alternate site. This study determines if there is a significant difference between upper arm and forearm BPMs among adults and examines the relationship of participant characteristics to the BPM difference. A convenience sample was recruited from a low-income, independent-living, 104-apartment complex in the Midwest. Of the 106 participants, 64% were female and 89% were White. Ages ranged from 20 to 85 years (M = 50.7). The investigators calculated the BMIs (range = 18 to 42, M = 29.3, SD = 5.4) for the 89% (n = 94) of participants who reported their weight. The forearm tended to have higher BPMs than the upper arm (M difference = 4.0 mm Hg systolic, 2.3 mm Hg diastolic). However, site differences were greatest for men, obese adults, and middle aged (36 to 65) adults.

The Influence of Dopaminergic Striatal Innervation on Upper Limb Locomotor Synergies

PubMed Central

Isaias, Ioannis U.; Volkmann, Jens; Marzegan, Alberto; Marotta, Giorgio; Cavallari, Paolo; Pezzoli, Gianni

2012-01-01

To determine the role of striatal dopaminergic innervation on upper limb synergies during walking, we measured arm kinematics in 13 subjects with Parkinson disease. Patients were recruited according to several inclusion criteria to represent the best possible in vivo model of dopaminergic denervation. Of relevance, we included only subjects with normal spatio-temporal parameters of the stride and gait speed to avoid an impairment of upper limbs locomotor synergies as a consequence of gait impairment per se. Dopaminergic innervation of the striatum was measured by FP-CIT and SPECT. All patients showed a reduction of gait-associated arms movement. No linear correlation was found between arm ROM reduction and contralateral dopaminergic putaminal innervation loss. Still, a partition analysis revealed a 80% chance of reduced arm ROM when putaminal dopamine content loss was >47%. A significant correlation was described between the asymmetry indices of the swinging of the two arms and dopaminergic striatal innervation. When arm ROM was reduced, we found a positive correlation between upper-lower limb phase shift modulation (at different gait velocities) and striatal dopaminergic innervation. These findings are preliminary evidence that dopaminergic striatal tone plays a modulatory role in upper-limb locomotor synergies and upper-lower limb coupling while walking at different velocities. PMID:23236504

Prostate-Specific Membrane Antigen Expression in Distal Radius Fracture.

PubMed

Hoberück, Sebastian; Michler, Enrico; Kaiser, Daniel; Röhnert, Anne; Zöphel, Klaus; Kotzerke, Jörg

2018-06-12

A 79-year old man with prostate cancer under active surveillance for 5 years was referred for a PSMA-PET/MRI for re-evaluation because of a rising prostate-specific antigen value. PET/MRI revealed a ribbonlike tracer accumulation in a healing fracture of the distal radius. This case illustrates that PSMA expression may occur in healing bone fractures in the distal radius. It can be assumed that benign causes of tracer accumulations in the upper extremities are missed in PET/CT due to elevated position of the arms during image acquisition.

Vascular Accesses for Haemodialysis in the Upper Arm Cause Greater Reduction in the Carotid-Brachial Stiffness than Those in the Forearm: Study of Gender Differences

PubMed Central

Bia, Daniel; Cabrera-Fischer, Edmundo I.; Zócalo, Yanina; Galli, Cintia; Graf, Sebastián; Valtuille, Rodolfo; Pérez-Cámpos, Héctor; Saldías, María; Álvarez, Inés; Armentano, Ricardo L.

2012-01-01

Purpose. To evaluate in chronically haemodialysed patients (CHPs), if: (1) the vascular access (VA) position (upper arm or forearm) is associated with differential changes in upper limb arterial stiffness; (2) differences in arterial stiffness exist between genders associated with the VA; (3) the vascular substitute (VS) of choice, in biomechanical terms, depends on the previous VA location and CHP gender. Methods. 38 CHPs (18 males; VA in upper arm: 18) were studied. Left and right carotid-brachial pulse wave velocity (PWVc-b) was measured. In in vitro studies, PWV was obtained in ePTFE prostheses and in several arterial and venous homografts obtained from donors. The biomechanical mismatch (BM) between CHP native vessel (NV) and VS was calculated. Results/Conclusions. PWVc-b in upper limbs with VA was lower than in the intact contralateral limbs (P < 0.05), and differences were higher (P < 0.05) when the VA was performed in the upper arm. Differences between PWVc-b in upper limbs with VA (in the upper arm) with respect to intact upper limbs were higher (P < 0.05) in males. Independently of the region in which the VA was performed, the homograft that ensured the minimal BM was the brachial artery. The BM was highly dependent on gender and the location in the upper limb in which the VA was performed. PMID:22567282

[Comparison of invasive blood pressure measurement in the aorta with indirect oscillometric blood pressure measurement at the wrist and forearm].

PubMed

Saul, F; Aristidou, Y; Klaus, D; Wiemeyer, A; Lösse, B

1995-09-01

Indirectly measured blood pressure at the wrist or upper arm was compared with directly measured values in the aortic arch during routinely performed diagnostic cardiac catheterization in 100 patients (31-80 years, mean 59.3 years, 60% males). The noninvasive measurements were carried out by oscillometric devices, NAiS Blood Pressure Watch for measurements at the wrist, and Hestia OZ80 at the upper arm. Systolic blood pressure measured at the wrist was 4.3 +/- 14.1 mm Hg, and the diastolic value 6.0 +/- 8.9 mm Hg higher than when measured at the aortic arch; the difference was significant in both cases. Correlation coefficients were 0.85 for systolic and 0.71 for diastolic blood pressure. In 16% of the patients the systolic blood pressure at the wrist differed more than +/- 20 mm Hg. The diastolic blood pressure at the wrist measured more than +/- 20 mm Hg higher than in the aorta in 5% of the patients. At the upper arm mean systolic values were not different to the aorta. The diastolic pressure was 9.3 +/- 9.8 mm Hg higher in the aorta than at the upper arm. To verify the accuracy of values measured with the NAiS Blood Pressure Watch compared with the standard technique at the upper arm, sequential measurements were made at wrist and ipsilateral upper arm in the same group of 100 patients. The systolic blood pressure at the left wrist was 3.4 +/- 13.3 mm Hg higher and the diastolic pressure 3.8 +/- 9.5 mm Hg lower than at the upper arm. Only 53% of systolic values lay within a range of +/- 10 mm Hg. The correspondence between wrist and upper arm values was better for diastolic blood pressure, the values differing by less than +/- 10 mm Hg in two-thirds of patients. Self-measurement of arterial blood pressure with an oscillometric device at the wrist can be recommended only in individual cases with a difference of simultaneously measured values at the upper arm of less than +/- 10 mm Hg for systolic and diastolic blood pressures. The standard method for indirectly measuring arterial blood pressure remains the measurement at the upper arm site, which nevertheless showed a systolic pseudohypertension (deviation of more than 10 mm Hg) in comparison to the invasively measured values in 15% of our selected patients and a diastolic pseudohypertension (deviation of more than 15 mm Hg) in 23% of the patients.

Arm Volumetry Versus Upper Extremity Lymphedema Index: Validity of Upper Extremity Lymphedema Index for Body-Type Corrected Arm Volume Evaluation.

PubMed

Yamamoto, Nana; Yamamoto, Takumi; Hayashi, Nobuko; Hayashi, Akitatsu; Iida, Takuya; Koshima, Isao

2016-06-01

Volumetry, measurement of extremity volume, is a commonly used method for upper extremity lymphedema (UEL) evaluation. However, comparison between different patients with different physiques is difficult with volumetry, because body-type difference greatly affects arm volume. Seventy arms of 35 participants who had no history of arm edema or breast cancer were evaluated. Arm volume was calculated using a summed truncated cone model, and UEL index was calculated using circumferences and body mass index (BMI). Examinees' BMI was classified into 3 groups, namely, low BMI (BMI, <20 kg/m), middle BMI (BMI, 20-25 kg/m), and high BMI (BMI, >25 kg/m). Arm volume and UEL index were compared with corresponding BMI groups. Mean (SD) arm volume was 1090.9 (205.5) mL, and UEL index 96.9 (5.6). There were significant differences in arm volume between BMI groups [low BMI vs middle BMI vs high BMI, 945.2 (107.4) vs 1045.2 (87.5) vs 1443.1 (244.4) mL, P < 0.001]. There was no significant difference in UEL index between BMI groups [low BMI vs middle BMI vs high BMI, 97.2 (4.2) vs 96.6 (4.6) vs 96.7 (9.9), P > 0.5]. Arm volume significantly increased with increase of BMI, whereas UEL index stayed constant regardless of BMI. Upper extremity lymphedema index would allow better body-type corrected arm volume evaluation compared with arm volumetry.

KAPS (kinematic assessment of passive stretch): a tool to assess elbow flexor and extensor spasticity after stroke using a robotic exoskeleton.

PubMed

Centen, Andrew; Lowrey, Catherine R; Scott, Stephen H; Yeh, Ting-Ting; Mochizuki, George

2017-06-19

Spasticity is a common sequela of stroke. Traditional assessment methods include relatively coarse scales that may not capture all characteristics of elevated muscle tone. Thus, the aim of this study was to develop a tool to quantitatively assess post-stroke spasticity in the upper extremity. Ninety-six healthy individuals and 46 individuals with stroke participated in this study. The kinematic assessment of passive stretch (KAPS) protocol consisted of passive elbow stretch in flexion and extension across an 80° range in 5 movement durations. Seven parameters were identified and assessed to characterize spasticity (peak velocity, final angle, creep (or release), between-arm peak velocity difference, between-arm final angle, between-arm creep, and between-arm catch angle). The fastest movement duration (600 ms) was most effective at identifying impairment in each parameter associated with spasticity. A decrease in peak velocity during passive stretch between the affected and unaffected limb was most effective at identifying individuals as impaired. Spasticity was also associated with a decreased passive range (final angle) and a classic 'catch and release' as seen through between-arm catch and creep metrics. The KAPS protocol and robotic technology can provide a sensitive and quantitative assessment of post-stroke elbow spasticity not currently attainable through traditional measures.

Early manifestation of arm-leg coordination during stepping on a surface in human neonates.

PubMed

La Scaleia, Valentina; Ivanenko, Y; Fabiano, A; Sylos-Labini, F; Cappellini, G; Picone, S; Paolillo, P; Di Paolo, A; Lacquaniti, F

2018-04-01

The accomplishment of mature locomotor movements relies upon the integrated coordination of the lower and upper limbs and the trunk. Human adults normally swing their arms and a quadrupedal limb coordination persists during bipedal walking despite a strong corticospinal control of the upper extremities that allows to uncouple this connection during voluntary activities. Here we investigated arm-leg coordination during stepping responses on a surface in human neonates. In eight neonates, we found the overt presence of alternating arm-leg oscillations, the arms moving up and down in alternation with ipsilateral lower limb movements. These neonates moved the diagonal limbs together, and the peak of the arm-to-trunk angle (i.e., maximum vertical excursion of the arm) occurred around the end of the ipsilateral stance phase, as it occurs during typical adult walking. Although episodes of arm-leg coordination were sporadic in our sample of neonates, their presence provides significant evidence for a neural coupling between the upper and lower limbs during early ontogenesis of locomotion in humans.

Analysis of reaching movements of upper arm in robot assisted exercises. Kinematic assessment of robot assisted upper arm reaching single-joint movements.

PubMed

Iuppariello, Luigi; D'Addio, Giovanni; Romano, Maria; Bifulco, Paolo; Lanzillo, Bernardo; Pappone, Nicola; Cesarelli, Mario

2016-01-01

Robot-mediated therapy (RMT) has been a very dynamic area of research in recent years. Robotics devices are in fact capable to quantify the performances of a rehabilitation task in treatments of several disorders of the arm and the shoulder of various central and peripheral etiology. Different systems for robot-aided neuro-rehabilitation are available for upper limb rehabilitation but the biomechanical parameters proposed until today, to evaluate the quality of the movement, are related to the specific robot used and to the type of exercise performed. Besides, none study indicated a standardized quantitative evaluation of robot assisted upper arm reaching movements, so the RMT is still far to be considered a standardised tool. In this paper a quantitative kinematic assessment of robot assisted upper arm reaching movements, considering also the effect of gravity on the quality of the movements, is proposed. We studied a group of 10 healthy subjects and results indicate that our advised protocol can be useful for characterising normal pattern in reaching movements.

Arm posture-dependent changes in corticospinal excitability are largely spinal in origin.

PubMed

Nuzzo, James L; Trajano, Gabriel S; Barry, Benjamin K; Gandevia, Simon C; Taylor, Janet L

2016-04-01

Biceps brachii motor evoked potentials (MEPs) from cortical stimulation are influenced by arm posture. We used subcortical stimulation of corticospinal axons to determine whether this postural effect is spinal in origin. While seated at rest, 12 subjects assumed several static arm postures, which varied in upper-arm (shoulder flexed, shoulder abducted, arm hanging to side) and forearm orientation (pronated, neutral, supinated). Transcranial magnetic stimulation over the contralateral motor cortex elicited MEPs in resting biceps and triceps brachii, and electrical stimulation of corticospinal tract axons at the cervicomedullary junction elicited cervicomedullary motor evoked potentials (CMEPs). MEPs and CMEPs were normalized to the maximal compound muscle action potential (Mmax). Responses in biceps were influenced by upper-arm and forearm orientation. For upper-arm orientation, biceps CMEPs were 68% smaller (P= 0.001), and biceps MEPs 31% smaller (P= 0.012), with the arm hanging to the side compared with when the shoulder was flexed. For forearm orientation, both biceps CMEPs and MEPs were 34% smaller (both P< 0.046) in pronation compared with supination. Responses in triceps were influenced by upper-arm, but not forearm, orientation. Triceps CMEPs were 46% smaller (P= 0.007) with the arm hanging to the side compared with when the shoulder was flexed. Triceps MEPs and biceps and triceps MEP/CMEP ratios were unaffected by arm posture. The novel finding is that arm posture-dependent changes in corticospinal excitability in humans are largely spinal in origin. An interplay of multiple reflex inputs to motoneurons likely explains the results. Copyright © 2016 the American Physiological Society.

Arm posture-dependent changes in corticospinal excitability are largely spinal in origin

PubMed Central

Nuzzo, James L.; Trajano, Gabriel S.; Barry, Benjamin K.; Gandevia, Simon C.

2016-01-01

Biceps brachii motor evoked potentials (MEPs) from cortical stimulation are influenced by arm posture. We used subcortical stimulation of corticospinal axons to determine whether this postural effect is spinal in origin. While seated at rest, 12 subjects assumed several static arm postures, which varied in upper-arm (shoulder flexed, shoulder abducted, arm hanging to side) and forearm orientation (pronated, neutral, supinated). Transcranial magnetic stimulation over the contralateral motor cortex elicited MEPs in resting biceps and triceps brachii, and electrical stimulation of corticospinal tract axons at the cervicomedullary junction elicited cervicomedullary motor evoked potentials (CMEPs). MEPs and CMEPs were normalized to the maximal compound muscle action potential (Mmax). Responses in biceps were influenced by upper-arm and forearm orientation. For upper-arm orientation, biceps CMEPs were 68% smaller (P = 0.001), and biceps MEPs 31% smaller (P = 0.012), with the arm hanging to the side compared with when the shoulder was flexed. For forearm orientation, both biceps CMEPs and MEPs were 34% smaller (both P < 0.046) in pronation compared with supination. Responses in triceps were influenced by upper-arm, but not forearm, orientation. Triceps CMEPs were 46% smaller (P = 0.007) with the arm hanging to the side compared with when the shoulder was flexed. Triceps MEPs and biceps and triceps MEP/CMEP ratios were unaffected by arm posture. The novel finding is that arm posture-dependent changes in corticospinal excitability in humans are largely spinal in origin. An interplay of multiple reflex inputs to motoneurons likely explains the results. PMID:26864764

Validity of the Acti4 software using ActiGraph GT3X+accelerometer for recording of arm and upper body inclination in simulated work tasks.

PubMed

Korshøj, Mette; Skotte, Jørgen H; Christiansen, Caroline S; Mortensen, Pelle; Kristiansen, Jesper; Hanisch, Christiana; Ingebrigtsen, Jørgen; Holtermann, Andreas

2014-01-01

The validity of inclinometer measurements by ActiGraph GT3X+ (AG) accelerometer, when analysed with the Acti4 customised software, was examined by comparison of inclinometer measurements with a reference system (TrakStar) in a protocol with standardised arm movements and simulated working tasks. The sensors were placed at the upper arm (distal to the deltoid insertion) and at the spine (level of T1-T2) on eight participants. Root mean square errors (RMSEs) values of inclination between the two systems were low for the slow- and medium-speed standardised arm movements and in simulated working tasks. Fast arm movements caused the inclination estimated by the AG to deviate from the reference measurements (RMSE values up to ∼10°). Furthermore, it was found that AG positioned at the upper arm provided inclination data without bias compared to the reference system. These findings indicate that the AG provides valid estimates of arm and upper body inclination in working participants. Being inexpensive, small, water-resistant and without wires, ActiGraph GT3X+ seems to be a valid mean for direct long-term field measurements of arm and trunk inclinations when analysed by the Acti4 customised software.

Scapular kinematics during manual wheelchair propulsion in able-bodied participants.

PubMed

Bekker, Michel J; Vegter, Riemer J K; van der Scheer, Jan W; Hartog, Johanneke; de Groot, Sonja; de Vries, Wiebe; Arnet, Ursina; van der Woude, Lucas H V; Veeger, Dirkjan H E J

2018-05-01

Altered scapular kinematics have been associated with shoulder pain and functional limitations. To understand kinematics in persons with spinal cord injury during manual handrim wheelchair propulsion, a description of normal scapular behaviour in able-bodied persons during this specific task is a prerequisite for accurate interpretation. The primary aim of this study is to describe scapular kinematics in able-bodied persons during manual wheelchair propulsion. Sixteen able-bodied, novice wheelchair users without shoulder complaints participated in the study. Kinematic and kinetic data were collected during a standardized pose in the anatomic posture, frontal-plane arm elevation and low-intensity steady-state handrim wheelchair propulsion and upper-body Euler angles were calculated. Scapulothoracic joint orientations in a static position were 36.7° (SD 5.4°), 6.4° (SD 9.1°) and 9.1° (SD 5.7°) for respectively protraction, lateral rotation and anterior tilt. At 80° of arm elevation in the frontal plane, the respective values of 33.4° (SD 8.0°), 23.9° (SD 5.4°) and 4.1° (SD 11.3°) were found. During the push phase of manual wheelchair propulsion, the mean scapular rotations were respectively 32.7° (SD 7.1°), 7.1° (SD 9.2°) and 9.8° (SD 8.3°). The orientation of the scapula in a static pose, during arm elevation and in manual wheelchair propulsion in able-bodied participants showed similar patterns to a previous study in persons with para- and tetraplegia. These values provide a reference for the investigation of the scapular movement pattern in wheelchair-dependent persons and its relation to shoulder complex abnormalities. Copyright © 2018. Published by Elsevier Ltd.

Pivots for Pointing: Visually-Monitored Pointing Has Higher Arm Elevations than Pointing Blindfolded

ERIC Educational Resources Information Center

Wnuczko, Marta; Kennedy, John M.

2011-01-01

Observers pointing to a target viewed directly may elevate their fingertip close to the line of sight. However, pointing blindfolded, after viewing the target, they may pivot lower, from the shoulder, aligning the arm with the target as if reaching to the target. Indeed, in Experiment 1 participants elevated their arms more in visually monitored…

Physical symptoms and working performance in female breast cancer survivors: a systematic review.

PubMed

Zomkowski, Kamilla; Cruz de Souza, Bruna; Pinheiro da Silva, Fabiana; Moreira, Géssica Maria; de Souza Cunha, Natália; Sperandio, Fabiana Flores

2018-06-01

The aim of this systematic review was to summarize and systematize the information about physical symptoms and its relation with work activity on female Breast Cancer Survivors (BCS). A systematic search was performed on the databases MEDLINE/PubMed (via National Library of Medicine), SCOPUS (Elsevier), Web of Science (Thomson Reuters Scientific) and CINAHL with full text (EBSCO), including papers about physical impairments experienced by female workers who have had breast cancer. The search retrieved 238 studies, and another 5 were identified in the articles' references, totaling 243 papers. After removing duplicates and applying the inclusion criteria and a full text reading, 13 articles were included for qualitative analysis. Concerning physical limitations, most complaints were related to the elevation of upper limbs, carrying heavy objects, driving and holding manual movements. The most referred symptoms were breast/arm pain, fatigue, lymphedema, reduced range of motion and weakness in the upper limbs, scar tissue adherence in the breast/axilla and paresthesia in the arm/breast. These symptoms and physical limitations led to the difficulty or impossibility of performing work tasks, which also diminished work productivity, as well as the increase in time to return to work. The present results suggest higher unemployment rates and the need for modifying work conditions. Implication for Rehabilitation Health professionals should include risk assessment at daily routine to identify possible sources of physical impairments for upper limbs. Provide the support and orientations according to personal and job characteristics of the patient. Focus the aims of treatment over upper limbs impairments, reducing the prevalence and the gravity of symptoms.

The RAndomized Placebo Phase Study Of Rilonacept in the Treatment of Systemic Juvenile Idiopathic Arthritis (RAPPORT)

PubMed Central

Ilowite, Norman T.; Prather, Kristi; Lokhnygina, Yuliya; Schanberg, Laura E.; Elder, Melissa; Milojevic, Diana; Verbsky, James W.; Spalding, Steven J.; Kimura, Yukiko; Imundo, Lisa F.; Punaro, Marilynn G.; Sherry, David D.; Tarvin, Stacey E.; Zemel, Lawrence S.; Birmingham, James D.; Gottlieb, Beth S.; Miller, Michael L.; O'Neil, Kathleen; Ruth, Natasha M.; Wallace, Carol A.; Singer, Nora G.; Sandborg, Christy I.

2015-01-01

Background Interleukin-1 plays a pivotal role in in the pathogenesis of systemic juvenile idiopathic arthritis (sJIA). We assessed the efficacy and safety of rilonacept (IL-1 trap), an IL-1 inhibitor, in a randomized, double-blind, placebo-controlled trial. Methods An initial 4-week double-blind placebo phase was incorporated into a 24-week randomized multi-center design, followed by an open label phase. We randomized 71 children with at least 2 active joints 1:1 to 2 arms of the study. Patients in the rilonacept arm received rilonacept (4.4mg/kg loading dose followed by 2.2mg/kg weekly, subcutaneously) from day 0; patients in the placebo arm received placebo for 4 weeks followed by a loading dose of rilonacept at week 4 followed by weekly maintenance doses. The primary endpoint was time to response, using adapted JIA ACR30 response criteria coupled with absence of fever and taper of systemic corticosteroids using pre-specified criteria. Results Time to response was shorter in the rilonacept arm than in the placebo arm (Chi-square 7.235, P=.007). Secondary analysis showed 20/35 (57%) of patients in the rilonacept arm responded at week 4 compared to 9/33 (27%) in the placebo arm (P=.016) using the same response criteria. Exacerbation of sJIA (4) was the most common SAE. More patients in the rilonacept arm had elevated liver transaminases, including more than three times the upper limits of normal, as compared to those in the placebo arm. Adverse events were similar in the two arms of the study. Conclusions Rilonacept was generally well tolerated and demonstrated efficacy in active sJIA. PMID:24839206

Temporal arteritis

MedlinePlus

... the blood vessels that supply blood to the head, neck, upper body and arms. It is also called ... the blood vessels that supply blood to the head, neck, upper body, and arms. It most commonly occurs ...

49 CFR 572.15 - General description.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Assembly SA 103C 030 Torso Assembly SA 103C 041 Upper Arm Assembly Left SA 103C 042 Upper Arm Assembly Right SA 103C 051 Forearm Hand Assembly Left SA 103C 052 Forearm Hand Assembly Right SA 103C 061Upper Leg Assembly Left SA 103C 062 Upper Leg Assembly Right SA 103C 071 Lower Leg Assembly Left SA 103C 072...

49 CFR 572.15 - General description.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Assembly SA 103C 030 Torso Assembly SA 103C 041 Upper Arm Assembly Left SA 103C 042 Upper Arm Assembly Right SA 103C 051 Forearm Hand Assembly Left SA 103C 052 Forearm Hand Assembly Right SA 103C 061Upper Leg Assembly Left SA 103C 062 Upper Leg Assembly Right SA 103C 071 Lower Leg Assembly Left SA 103C 072...

49 CFR 572.15 - General description.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Assembly SA 103C 030 Torso Assembly SA 103C 041 Upper Arm Assembly Left SA 103C 042 Upper Arm Assembly Right SA 103C 051 Forearm Hand Assembly Left SA 103C 052 Forearm Hand Assembly Right SA 103C 061Upper Leg Assembly Left SA 103C 062 Upper Leg Assembly Right SA 103C 071 Lower Leg Assembly Left SA 103C 072...

49 CFR 572.15 - General description.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Assembly SA 103C 030 Torso Assembly SA 103C 041 Upper Arm Assembly Left SA 103C 042 Upper Arm Assembly Right SA 103C 051 Forearm Hand Assembly Left SA 103C 052 Forearm Hand Assembly Right SA 103C 061Upper Leg Assembly Left SA 103C 062 Upper Leg Assembly Right SA 103C 071 Lower Leg Assembly Left SA 103C 072...

Poor Reliability of Wrist Blood Pressure Self-Measurement at Home: A Population-Based Study.

PubMed

Casiglia, Edoardo; Tikhonoff, Valérie; Albertini, Federica; Palatini, Paolo

2016-10-01

The reliability of blood pressure measurement with wrist devices, which has not previously been assessed under real-life circumstances in general population, is dependent on correct positioning of the wrist device at heart level. We determined whether an error was present when blood pressure was self-measured at the wrist in 721 unselected subjects from the general population. After training, blood pressure was measured in the office and self-measured at home with an upper-arm device (the UA-767 Plus) and a wrist device (the UB-542, not provided with a position sensor). The upper-arm-wrist blood pressure difference detected in the office was used as the reference measurement. The discrepancy between office and home differences was the home measurement error. In the office, systolic blood pressure was 2.5% lower at wrist than at arm (P=0.002), whereas at home, systolic and diastolic blood pressures were higher at wrist than at arm (+5.6% and +5.4%, respectively; P<0.0001 for both); 621 subjects had home measurement error of at least ±5 mm Hg and 455 of at least ±10 mm Hg (bad measurers). In multivariable linear regression, a lower cognitive pattern independently determined both the systolic and the diastolic home measurement error and a longer forearm the systolic error only. This was confirmed by logistic regression having bad measurers as dependent variable. The use of wrist devices for home self-measurement, therefore, leads to frequent detection of falsely elevated blood pressure values likely because of a poor memory and rendition of the instructions, leading to the wrong position of the wrist. © 2016 American Heart Association, Inc.

[Clinical features of the hand-arm vibration syndrome in miners].

PubMed

Kákosy, Tibor; Németh, László; Kiss, Gábor; Lászlóffy, Marianna; Kardos, Kálmán

2006-05-07

It is well known that the vibrating tools used by the miners can cause hand-arm vibration syndrome. However no detailed reports on this field could be found in the Hungarian literature. The aim of this study was to clarify the clinical features of the hand-arm vibration syndrome of the miners. The circulation, the peripheral nerves and the osteoarticular system of the upper extremities of 152 miners were examined by means of cold provocation test, Allen-test, measurement of systolic blood pressure performed by Doppler flowmeter, clinical neurological and neurographic examination and X-ray investigation of the bones and joints. Hand-arm vibration syndrome was diagnosed in 87 patients (57.2%). The most common symptom was the lesion of the circulation which occurred in 78 patients (89.6%). The peripheral nerves were affected in 44 cases (50.5%). Radiological alteration of the bones and joints of the upper extremities was observed in 32 patients (36.8%). Out of 78 damaged cases the frequency of the vascular diseases was as follows: angiopathy (diminished systolic blood pressure in the fingers): 66 patient (84.6%), occlusion of the hand arteries (positive Allen-test) and arterial form of the thoracic outlet syndrome (positive elevation-test) respectively: 28 and 28 cases (35.9%), Raynaud phenomenon (positive cold-provocation test): 26 cases (33.3%). The peripheral nerves were examined in detail in 141 cases. Pathological alterations were observed in 78 patients (55.3%) in the following forms: carpal tunnel syndrome: 66 cases (84.6%), peripheral neuropathy of the upper limbs: 20 patients (25.6%), lesion of the ulnar nerve: 3 cases (3.8%), brachial plexus lesion: one patient (1.3%). Radiological alteration was most common in the carpal region (87 cases, 57.2%). The frequency of the lesion of cubital (40.4%) and shoulder region (40.7%) was practically the same. In the carpal region the most common alterations were the degenerative processes (23 cases, 15.1%) followed by the aseptic osteonecroses (22 patients, 14.5%). In the cubital region the periarticular changes (31 patients, 23.9%) were most common followed by degenerative changes (21 cases, 16.2%) and the osteochondrosis dissecans (13 cases, 10.1%). In the shoulder region the degenerative processes were the most common changes (41 patients, 34.7%), first of all in the acromioclavicular joint (21 cases, 17.8%). Aseptic necrosis was observed in two patients. The miners are professionally exposed not only to hand-arm vibration, but also to increased physical stress. The symptoms on the upper limbs can develop as the result of both exposures.

The efficacy of SMART Arm training early after stroke for stroke survivors with severe upper limb disability: a protocol for a randomised controlled trial.

PubMed

Brauer, Sandra G; Hayward, Kathryn S; Carson, Richard G; Cresswell, Andrew G; Barker, Ruth N

2013-07-02

Recovery of upper limb function after stroke is poor. The acute to subacute phase after stroke is the optimal time window to promote the recovery of upper limb function. The dose and content of training provided conventionally during this phase is however, unlikely to be adequate to drive functional recovery, especially in the presence of severe motor disability. The current study concerns an approach to address this shortcoming, through evaluation of the SMART Arm, a non-robotic device that enables intensive and repetitive practice of reaching by stroke survivors with severe upper limb disability, with the aim of improving upper limb function. The outcomes of SMART Arm training with or without outcome-triggered electrical stimulation (OT-stim) to augment movement and usual therapy will be compared to usual therapy alone. A prospective, assessor-blinded parallel, three-group randomised controlled trial is being conducted. Seventy-five participants with a first-ever unilateral stroke less than 4 months previously, who present with severe arm disability (three or fewer out of a possible six points on the Motor Assessment Scale [MAS] Item 6), will be recruited from inpatient rehabilitation facilities. Participants will be randomly allocated to one of three dose-matched groups: SMART Arm training with OT-stim and usual therapy; SMART Arm training without OT-stim and usual therapy; or usual therapy alone. All participants will receive 20 hours of upper limb training over four weeks. Blinded assessors will conduct four assessments: pre intervention (0-weeks), post intervention (4-weeks), 26 weeks and 52 weeks follow-up. The primary outcome measure is MAS item 6. All analyses will be based on an intention-to-treat principle. By enabling intensive and repetitive practice of a functional upper limb task during inpatient rehabilitation, SMART Arm training with or without OT-stim in combination with usual therapy, has the potential to improve recovery of upper limb function in those with severe motor disability. The immediate and long-term effects of SMART Arm training on upper limb impairment, activity and participation will be explored, in addition to the benefit of training with or without OT-stim to augment movement when compared to usual therapy alone. ACTRN12608000457347.

3D Measurement of Forearm and Upper Arm during Throwing Motion using Body Mounted Sensor

NASA Astrophysics Data System (ADS)

Koda, Hideharu; Sagawa, Koichi; Kuroshima, Kouta; Tsukamoto, Toshiaki; Urita, Kazutaka; Ishibashi, Yasuyuki

The aim of this study is to propose the measurement method of three-dimensional (3D) movement of forearm and upper arm during pitching motion of baseball using inertial sensors without serious consideration of sensor installation. Although high accuracy measurement of sports motion is achieved by using optical motion capture system at present, it has some disadvantages such as the calibration of cameras and limitation of measurement place. Whereas the proposed method for 3D measurement of pitching motion using body mounted sensors provides trajectory and orientation of upper arm by the integration of acceleration and angular velocity measured on upper limb. The trajectory of forearm is derived so that the elbow joint axis of forearm corresponds to that of upper arm. Spatial relation between upper limb and sensor system is obtained by performing predetermined movements of upper limb and utilizing angular velocity and gravitational acceleration. The integration error is modified so that the estimated final position, velocity and posture of upper limb agree with the actual ones. The experimental results of the measurement of pitching motion show that trajectories of shoulder, elbow and wrist estimated by the proposed method are highly correlated to those from the motion capture system within the estimation error of about 10 [%].

The relationships between height and arm span, mid-upper arm and waist circumferences and sum of four skinfolds in Ellisras rural children aged 8-18 years.

PubMed

Monyeki, Kotsedi Daniel; Sekhotha, Michael Matome

2016-05-01

Height is required for the assessment of growth and nutritional status, as well as for predictions and standardization of physiological parameters. To determine whether arm span, mid-upper arm and waist circumferences and sum of four skinfolds can be used to predict height, the relationships between these anthropometric variables were assessed among Ellisras rural children aged 8-18 years. The following parameters were measured according to the International Society for the Advancement of Kinathropometry: height, arm span, mid-upper arm circumference, waist circumference and four skinfolds (suprailiac, subscapular, triceps and biceps). Associations between the variables were assessed using Pearson correlation coefficients and linear regression models. Ellisras Longitudinal Study (ELS), Limpopo Province, South Africa. Boys (n 911) and girls (n 858) aged 8-18 years. Mean height was higher than arm span, with differences ranging from 4 cm to 11·5 cm between boys and girls. The correlation between height and arm span was high (ranging from 0·74 to 0·91) with P<0·001. The correlation between height and mid-upper arm circumference, waist circumference and sum of four skinfolds was low (ranging from 0·15 to 0·47) with P<0·00 among girls in the 15-18 years age group. Arm span was found to be a good predictor of height. The sum of four skinfolds was significantly associated with height in the older age groups for girls, while waist circumference showed a negative significant association in the same groups.

Work postures and neck-shoulder pain among orchestra musicians.

PubMed

Nyman, Teresia; Wiktorin, Christina; Mulder, Marie; Johansson, Yvonne Liljeholm

2007-05-01

The purpose of the present study was to identify associations between a work posture with elevated arm position, duration of active playing time, and neck-shoulder pain among orchestra musicians. In this study, with a cross-sectional study design, a total of 235 subjects from 12 Swedish orchestras were categorized into four exposure groups according to arm position and duration of active playing time. Logistic regression analysis was used to calculate odds ratios (OR) for neck-shoulder pain in the four exposure groups. A higher prevalence of neck-shoulder pain were found in the groups "elevated arm position, <2 hr per workday" [OR 4.15 (1.30-13.22)], and "elevated arm position, >3 hr per workday" [OR 5.35 (1.96-14.62)] compared to the group "neutral arm position, <2 hr per workday". Musicians working in an elevated arm position (e.g., violinists, violists, flutists, and trumpet players) had a higher prevalence of neck-shoulder pain than those working in a more neutral position.

Color Doppler Sonographic and Cadaveric Study of the Arterial Vascularity of the Lateral Upper Arm Flap.

PubMed

Sun, Ruimei; Ding, Yu; Sun, Chuanzheng; Li, Xiaojiang; Wang, Jinde; Li, Lei; Yang, Jie; Ren, Yanxin; Zhong, Zhaoming

2016-04-01

To determine the importance of adequate preoperative assessment with color Doppler sonography to assist in the successful transfer of lateral upper arm flaps by studying the lateral upper arm flap with color Doppler sonography and analyzing the anatomic features of the radial collateral artery. A clinical case-control study was performed. The radial collateral artery was studied with color Doppler sonography in 15 healthy volunteers. The origins, courses, variations, and locations of the perforators of the radial collateral artery were recorded. The results and data from the color Doppler sonographic investigation were compared with an anatomic study that was performed on 22 adult cadaveric upper limb specimens. The volunteer group (14 of 15 volunteers) and the cadaveric group (19 of 22 upper arm specimens) clearly showed that the branch pattern of the arterial supply was as follows: brachial artery → deep brachial artery → radial collateral artery → posterior radial collateral artery → myocutaneous perforator. Variations in the origin of the radial collateral artery were identified in 1 volunteer bilaterally and in 3 upper arm specimens. The diameters of the artery and vein measured at the distal insertion of the deltoid and the origin of the deep brachial artery were not significantly different between the volunteer and cadaver groups (P > .05). Due to the difference in measuring methods, the length of the vascular pedicles was significantly different between the groups (P < .05). Color Doppler sonography can facilitate the preoperative assessment of the origin, course, variations, and locations of the radial collateral artery and therefore may increase the success rate of lateral upper arm flap transfer. © 2016 by the American Institute of Ultrasound in Medicine.

19. DETAIL OF SOUTH CANTILEVER ANCHOR ARM UPPER CHORD AND ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

19. DETAIL OF SOUTH CANTILEVER ANCHOR ARM UPPER CHORD AND ENDPOST CONNECTION U-19, LOOKING SOUTHWEST - Jackson's Ferry Bridge, Route 52 over New River, 6.3 miles south of Route 94, Austinville, Wythe County, VA

Optimal Body Size and Limb Length Ratios Associated with 100-m Personal-Best Swim Speeds.

PubMed

Nevill, Alan M; Oxford, Samuel W; Duncan, Michael J

2015-08-01

This study aims to identify optimal body size and limb segment length ratios associated with 100-m personal-best (PB) swim speeds in children and adolescents. Fifty national-standard youth swimmers (21 males and 29 females age 11-16 yr; mean ± SD age, 13.5 ± 1.5 yr) participated in the study. Anthropometry comprised stature; body mass; skinfolds; maturity offset; upper arm, lower arm, and hand lengths; and upper leg, lower leg, and foot lengths. Swimming performance was taken as the PB time recorded in competition for the 100-m freestyle swim. To identify the optimal body size and body composition components associated with 100-m PB swim speeds (having controlled for age and maturity offset), we adopted a multiplicative allometric log-linear regression model, which was refined using backward elimination. Lean body mass was the singularly most important whole-body characteristic. Stature and body mass did not contribute to the model, suggesting that the advantage of longer levers was limb-specific rather than a general whole-body advantage. The allometric model also identified that having greater limb segment length ratios [i.e., arm ratio = (low arm)/(upper arm); foot-to-leg ratio = (foot)/(lower leg)] was key to PB swim speeds. It is only by adopting multiplicative allometric models that the above mentioned ratios could have been derived. The advantage of having a greater lower arm is clear; however, having a shorter upper arm (achieved by adopting a closer elbow angle technique or by possessing a naturally endowed shorter upper arm), at the same time, is a new insight into swimming performance. A greater foot-to-lower-leg ratio suggests that a combination of larger feet and shorter lower leg length may also benefit PB swim speeds.

20. DETAIL OF SOUTH CANTILEVER ANCHOR ARM UPPER CHORD, POST, ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

20. DETAIL OF SOUTH CANTILEVER ANCHOR ARM UPPER CHORD, POST, AND DIAGONAL CONNECTION U-17, LOOKING NORTHWEST - Jackson's Ferry Bridge, Route 52 over New River, 6.3 miles south of Route 94, Austinville, Wythe County, VA

Three-dimensional circumferential liposuction of the overweight or obese upper arm.

PubMed

Hong, Yoon Gi; Sim, Hyung Bo; Lee, Mu Young; Seo, Sang Won; Chang, Choong Hyun; Yeo, Kwan Koo; Kim, June-kyu

2012-06-01

Due to recent trends in liposuction, anatomic consideration of the body's fatty layers is essential. Based on this knowledge, a circumferential approach to achieving maximal aesthetic results is highlighted. In the upper arm, aspiration of fat from only the posterolateral region can result in skin flaccidity and disharmony of the overall balance of the upper arm contour. Different suction techniques were applied depending on the degree of fat accumulation. If necessary, the operation area was extended around the axillary and scapular regions to overcome the limitations of the traditional method and to achieve optimal effects. To maximize skin contracture and redraping, the authors developed three-dimensional circumferential liposuction (3D-CL) based on two concepts: circumferential aspiration of the upper arm, to which was applied different fluid infiltration and liposuction techniques in three anatomic compartments (anteromedial, anterolateral, and posterolateral), and extension of liposuction to the periaxillar and parascarpular areas. A total of 57 female patients underwent liposuction of their excess arm fat using this technique. The authors achieved their aesthetic goals of a straightened inferior brachial border and a more slender body contour. Complications occurred for five patients including irregularity, incision-site scar, and transient pigmentation. Through 3D-CL, the limitations of traditional upper arm liposuction were overcome, and a slender arm contour with a straightened inferior brachial border was produced. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at http://www.springer.com/00266.

VO2 Max in Variable Type Exercise Among Well-Trained Upper Body Athletes.

ERIC Educational Resources Information Center

Seals, Douglas R.; Mullin, John P.

1982-01-01

The maximal oxygen consumption (VO2 max) of well-trained upper body athletes was compared to that of untrained individuals in four types of exercise: arm cranking, legs only cycling, graded treadmill running, and combined arm cranking and leg cycling. Results of the study showed that well-trained upper body athletes attained a significantly higher…

Which cuff should I use? Indirect blood pressure measurement for the diagnosis of hypertension in patients with obesity: a diagnostic accuracy review.

PubMed

Irving, Greg; Holden, John; Stevens, Richard; McManus, Richard J

2016-11-03

To determine the diagnostic accuracy of different methods of blood pressure (BP) measurement compared with reference standards for the diagnosis of hypertension in patients with obesity with a large arm circumference. Systematic review with meta-analysis with hierarchical summary receiver operating characteristic models. Bland-Altman analyses where individual patient data were available. Methodological quality appraised using Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS2) criteria. MEDLINE, EMBASE, Cochrane, DARE, Medion and Trip databases were searched. Cross-sectional, randomised and cohort studies of diagnostic test accuracy that compared any non-invasive BP tests (upper arm, forearm, wrist, finger) with an appropriate reference standard (invasive BP, correctly fitting upper arm cuff, ambulatory BP monitoring) in primary care were included. 4037 potentially relevant papers were identified. 20 studies involving 26 different comparisons met the inclusion criteria. Individual patient data were available from 4 studies. No studies satisfied all QUADAS2 criteria. Compared with the reference test of invasive BP, a correctly fitting upper arm BP cuff had a sensitivity of 0.87 (0.79 to 0.93) and a specificity of 0.85 (0.64 to 0.95); insufficient evidence was available for other comparisons to invasive BP. Compared with the reference test of a correctly fitting upper arm cuff, BP measurement at the wrist had a sensitivity of 0.92 (0.64 to 0.99) and a specificity of 0.92 (0.85 to 0.87). Measurement with an incorrectly fitting standard cuff had a sensitivity of 0.73 (0.67 to 0.78) and a specificity of 0.76 (0.69 to 0.82). Measurement at the forearm had a sensitivity of 0.84 (0.71 to 0.92) and a specificity 0.75 of (0.66 to 0.83). Bland-Altman analysis of individual patient data from 3 studies comparing wrist and upper arm BP showed a mean difference of 0.46 mm Hg for systolic BP measurement and 2.2 mm Hg for diastolic BP measurement. BP measurement with a correctly fitting upper arm cuff is sufficiently sensitive and specific to diagnose hypertension in patients with obesity with a large upper arm circumference. If a correctly fitting upper arm cuff cannot be applied, an incorrectly fitting standard size cuff should not be used and BP measurement at the wrist should be considered. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Which cuff should I use? Indirect blood pressure measurement for the diagnosis of hypertension in patients with obesity: a diagnostic accuracy review

PubMed Central

Holden, John

2016-01-01

Objective To determine the diagnostic accuracy of different methods of blood pressure (BP) measurement compared with reference standards for the diagnosis of hypertension in patients with obesity with a large arm circumference. Design Systematic review with meta-analysis with hierarchical summary receiver operating characteristic models. Bland-Altman analyses where individual patient data were available. Methodological quality appraised using Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS2) criteria. Data sources MEDLINE, EMBASE, Cochrane, DARE, Medion and Trip databases were searched. Eligibility criteria Cross-sectional, randomised and cohort studies of diagnostic test accuracy that compared any non-invasive BP tests (upper arm, forearm, wrist, finger) with an appropriate reference standard (invasive BP, correctly fitting upper arm cuff, ambulatory BP monitoring) in primary care were included. Results 4037 potentially relevant papers were identified. 20 studies involving 26 different comparisons met the inclusion criteria. Individual patient data were available from 4 studies. No studies satisfied all QUADAS2 criteria. Compared with the reference test of invasive BP, a correctly fitting upper arm BP cuff had a sensitivity of 0.87 (0.79 to 0.93) and a specificity of 0.85 (0.64 to 0.95); insufficient evidence was available for other comparisons to invasive BP. Compared with the reference test of a correctly fitting upper arm cuff, BP measurement at the wrist had a sensitivity of 0.92 (0.64 to 0.99) and a specificity of 0.92 (0.85 to 0.87). Measurement with an incorrectly fitting standard cuff had a sensitivity of 0.73 (0.67 to 0.78) and a specificity of 0.76 (0.69 to 0.82). Measurement at the forearm had a sensitivity of 0.84 (0.71 to 0.92) and a specificity 0.75 of (0.66 to 0.83). Bland-Altman analysis of individual patient data from 3 studies comparing wrist and upper arm BP showed a mean difference of 0.46 mm Hg for systolic BP measurement and 2.2 mm Hg for diastolic BP measurement. Conclusions BP measurement with a correctly fitting upper arm cuff is sufficiently sensitive and specific to diagnose hypertension in patients with obesity with a large upper arm circumference. If a correctly fitting upper arm cuff cannot be applied, an incorrectly fitting standard size cuff should not be used and BP measurement at the wrist should be considered. PMID:27810973

Development of a prosthesis shoulder mechanism for upper limb amputees: application of an original design methodology to optimize functionality and wearability.

PubMed

Troncossi, Marco; Borghi, Corrado; Chiossi, Marco; Davalli, Angelo; Parenti-Castelli, Vincenzo

2009-05-01

The application of a design methodology for the determination of the optimal prosthesis architecture for a given upper limb amputee is presented in this paper along with the discussion of its results. In particular, a novel procedure was used to provide the main guidelines for the design of an actuated shoulder articulation for externally powered prostheses. The topology and the geometry of the new articulation were determined as the optimal compromise between wearability (for the ease of use and the patient's comfort) and functionality of the device (in terms of mobility, velocity, payload, etc.). This choice was based on kinematic and kinetostatic analyses of different upper limb prosthesis models and on purpose-built indices that were set up to evaluate the models from different viewpoints. Only 12 of the 31 simulated prostheses proved a sufficient level of functionality: among these, the optimal solution was an articulation having two actuated revolute joints with orthogonal axes for the elevation of the upper arm in any vertical plane and a frictional joint for the passive adjustment of the humeral intra-extra rotation. A prototype of the mechanism is at the clinical test stage.

Measuring upper limb function in children with hemiparesis with 3D inertial sensors.

PubMed

Newman, Christopher J; Bruchez, Roselyn; Roches, Sylvie; Jequier Gygax, Marine; Duc, Cyntia; Dadashi, Farzin; Massé, Fabien; Aminian, Kamiar

2017-12-01

Upper limb assessments in children with hemiparesis rely on clinical measurements, which despite standardization are prone to error. Recently, 3D movement analysis using optoelectronic setups has been used to measure upper limb movement, but generalization is hindered by time and cost. Body worn inertial sensors may provide a simple, cost-effective alternative. We instrumented a subset of 30 participants in a mirror therapy clinical trial at baseline, post-treatment, and follow-up clinical assessments, with wireless inertial sensors positioned on the arms and trunk to monitor motion during reaching tasks. Inertial sensor measurements distinguished paretic and non-paretic limbs with significant differences (P < 0.01) in movement duration, power, range of angular velocity, elevation, and smoothness (normalized jerk index and spectral arc length). Inertial sensor measurements correlated with functional clinical tests (Melbourne Assessment 2); movement duration and complexity (Higuchi fractal dimension) showed moderate to strong negative correlations with clinical measures of amplitude, accuracy, and fluency. Inertial sensor measurements reliably identify paresis and correlate with clinical measurements; they can therefore provide a complementary dimension of assessment in clinical practice and during clinical trials aimed at improving upper limb function.

Influence of basal ganglia on upper limb locomotor synergies. Evidence from deep brain stimulation and L-DOPA treatment in Parkinson's disease.

PubMed

Crenna, P; Carpinella, I; Lopiano, L; Marzegan, A; Rabuffetti, M; Rizzone, M; Lanotte, M; Ferrarin, M

2008-12-01

Clinical evidence of impaired arm swing while walking in patients with Parkinson's disease suggests that basal ganglia and related systems play an important part in the control of upper limb locomotor automatism. To gain more information on this supraspinal influence, we measured arm and thigh kinematics during walking in 10 Parkinson's disease patients, under four conditions: (i) baseline (no treatment), (ii) therapeutic stimulation of the subthalamic nucleus (STN), (iii)L-DOPA medication and (iv) combined STN stimulation and L-DOPA. Ten age-matched controls provided reference data. Under baseline conditions the range of patients' arm motion was severely restricted, with no correlation with the excursion of the thigh. In addition, the arm swing was abnormally coupled in time with oscillation of the ipsilateral thigh. STN stimulation significantly increased the gait speed and improved the spatio-temporal parameters of arm and thigh motion. The kinematic changes as a function of gait speed changes, however, were significantly smaller for the upper than the lower limb, in contrast to healthy controls. Arm motion was also less responsive after L-DOPA. Simultaneous deep brain stimulation and L-DOPA had additive effects on thigh motion, but not on arm motion and arm-thigh coupling. The evidence that locomotor automatisms of the upper and lower limbs display uncorrelated impairment upon dysfunction of the basal ganglia, as well as different susceptibility to electrophysiological and pharmacological interventions, points to the presence of heterogeneously distributed, possibly partially independent, supraspinal control channels, whereby STN and dopaminergic systems have relatively weaker influence on the executive structures involved in the arm swing and preferential action on those for lower limb movements. These findings might be considered in the light of phylogenetic changes in supraspinal control of limb motion related to primate bipedalism.

Activity of upper limb muscles during human walking.

PubMed

Kuhtz-Buschbeck, Johann P; Jing, Bo

2012-04-01

The EMG activity of upper limb muscles during human gait has rarely been studied previously. It was examined in 20 normal volunteers in four conditions: walking on a treadmill (1) with unrestrained natural arm swing (Normal), (2) while volitionally holding the arms still (Held), (3) with the arms immobilized (Bound), and (4) with the arms swinging in phase with the ipsilateral legs, i.e. opposite-to-normal phasing (Anti-Normal). Normal arm swing involved weak rhythmical lengthening and shortening contractions of arm and shoulder muscles. Phasic muscle activity was needed to keep the unrestricted arms still during walking (Held), indicating a passive component of arm swing. An active component, possibly programmed centrally, existed as well, because some EMG signals persisted when the arms were immobilized during walking (Bound). Anti-Normal gait involved stronger EMG activity than Normal walking and was uneconomical. The present results indicate that normal arm swing has both passive and active components. Copyright © 2011 Elsevier Ltd. All rights reserved.

A Prospective Observational Comparison Between Arm and Wrist Blood Pressure During Scheduled Cesarean Delivery.

PubMed

Sebbag, Ilana; Massey, Simon R; Albert, Arianne Y K; Dube, Alison; Gunka, Vit; Douglas, M Joanne

2015-09-01

Shivering is common during cesarean delivery (CD) under neuraxial anesthesia and may disrupt the measurement of noninvasive blood pressure (BP). BP measured at the wrist may be less affected by shivering. There have been no studies comparing trends in BP measured on the upper arm and wrist. We hypothesized that wrist systolic blood pressure (sBP) would accurately trend with upper arm sBP measurements (agree within a limit of ±10%) in parturients undergoing elective CD under spinal anesthesia or combined spinal-epidural anesthesia. After initiation of spinal anesthesia, BP measurements were obtained simultaneously from the upper arm and wrist on opposite arms. The interval between measurements was 1 to 2 minutes, and data were collected for 20 minutes or until delivery. The primary outcome was agreement in dynamic changes in sBP measurements between the upper arm and the wrist. Bland-Altman plots indicating the levels of agreement between the methods were drawn for baseline measurements, over multiple measurements, and over multiple measurements on percentage change from baseline. Forty-nine patients were recruited and completed the study. The wrist sBP tended to overestimate the upper sBP for both baseline data (sBP bias = 13.4 mm Hg; 95% confidence interval = +10.4 to +16.4 mm Hg) and data obtained over multiple measurements (sBP bias = 12.8 mm Hg; 95% confidence interval = +9.3 to +16.3 mm Hg). For change in sBP from baseline over multiple measurements, the mean difference between the wrist and the arm sBP was -0.2 percentage points (99% limits of agreement -25 to +25 percentage points). The wrist measurement overestimated the reading relative to the upper arm measurement for multiple measurements over time. However, when the time series for each subject was examined for percentage change from baseline, the 2 methods mirrored each other in most cases. Nevertheless, our hypothesis was rejected as the limits of agreement were higher than ±10%. This finding suggests that wrist BP may not be an accurate method of detecting hypotension or hypertension during spinal or combined spinal-epidural anesthesia for CD.

Comparison study of upper arm and forearm non-invasive blood pressures in adult Emergency Department patients.

PubMed

Schimanski, Karen; Jull, Andrew; Mitchell, Nancy; McLay, Jessica

2014-12-01

Forearm blood pressures have been suggested as an alternative site to measure blood pressures when the upper arm is unavailable. However there is little evidence utilising clinical populations to support this substitution. To determine agreement between blood pressures measured in the left upper arm and forearm using a singular oscillometric non-invasive device in adult Emergency Department patients. The secondary objective was to explore the relationship of blood pressure differences with age, sex, ethnicity, smoking history and obesity. Single centre comparison study. Adult Emergency Department, Tertiary Trauma Centre. Forty-four participants who met inclusion/exclusion criteria selected sequentially from the Emergency Department arrival board. A random assignment of order of measurement for left upper arm and forearm blood pressures was utilised. Participants were eligible if they were aged 18 years or older, had been assigned an Australasian Triage Scale code of 2, 3, 4, or 5, were able to consent, and able to have blood pressures measured on their left arm whilst lying at a 45° angle. The Bland-Altman method of statistical analysis was used, with the level of agreement for clinical acceptability for the systolic, diastolic and mean arterial pressure defined as ±10 mmHg. The forearm measure overestimated systolic (mean difference 2.2 mmHg, 95% limits of agreement ±19 mmHg), diastolic (mean difference 3.4 mmHg, 95% limits of agreement ±14.4 mmHg), and mean arterial pressures (mean difference 4.1 mmHg, 95% limits of agreement ±13.7 mmHg). The systolic measure was not significantly different from zero. Evidence of better agreement was found with upper arm/forearm systolic measures below 140 mmHg compared to systolic measures above 140 mmHg using the Levene's test (p=0.002, F-statistic=11.09). Blood pressure disparity was not associated with participant characteristics. Forearm measures cannot routinely replace upper arm measures for blood pressure measurement. If the clinical picture requires use of forearm blood pressure, the potential variance from an upper arm measure is ±19 mmHg for systolic pressure, although the variability may be close to ±10 mmHg if the systolic blood pressure is below 140 mmHg. Copyright © 2014 Elsevier Ltd. All rights reserved.

Effects of Crossed Brassiere Straps on Pain, Range of Motion, and Electromyographic Activity of Scapular Upward Rotators in Women With Scapular Downward Rotation Syndrome.

PubMed

Kang, Min-Hyeok; Choi, Ji-Young; Oh, Jae-seop

2015-12-01

Scapular downward rotation syndrome manifests as an abnormally downward-rotated scapula at rest or with arm motion and typically results in neck and shoulder pain. The brassiere strap has been suggested as a possible contributing factor to scapula downward rotation and pain in the upper trapezius because of increased downward rotational force on the lateral aspect of the scapula. No study, however, has examined the influences of a modified brassiere strap on pain in and the function of the scapular muscles. To examine the effects of crossed brassiere straps on the pressure pain threshold (PPT) of the upper trapezius, neck rotation range of motion (ROM), and electromyographic activity of the scapular upward rotators in females with scapular downward rotation syndrome. Cross-over design. Laboratory. In total, 15 female subjects with scapular downward rotation syndrome were recruited at hospitals and a local university. All participants performed neck rotation and humeral elevation under 2 different conditions: parallel and crossed brassiere straps. The PPT of the upper trapezius was measured using an analog algometer, whereas neck rotation ROM was quantified with a 3-dimensional ultrasonic motion analysis system. The electromyographic activities of the upper trapezius, serratus anterior, and lower trapezius during humeral elevation were assessed with a surface electromyography system. Outcome measures were assessed under parallel and crossed brassiere strap conditions, and differences in outcomes between the conditions were analyzed using a paired t-test. The PPT and neck rotation ROM were increased when the subject was wearing the brassiere with crossed versus parallel straps (P < .001). Greater electromyographic activities of the serratus anterior, lower trapezius, and lesser upper trapezius muscles during humeral elevation were found under the crossed strap condition than the parallel strap condition (P < .05). These findings provide useful information for clinicians when designing management programs to decrease pain and improve biomechanical function for females with scapular downward rotation syndrome. Copyright © 2015 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Persistent arm pain is distinct from persistent breast pain following breast cancer surgery.

PubMed

Langford, Dale J; Paul, Steven M; West, Claudia; Abrams, Gary; Elboim, Charles; Levine, Jon D; Hamolsky, Deborah; Luce, Judith A; Kober, Kord M; Neuhaus, John M; Cooper, Bruce A; Aouizerat, Bradley E; Miaskowski, Christine

2014-12-01

Persistent pain following breast cancer surgery is well documented. However, it is not well characterized in terms of the anatomic site affected (ie, breast, arm). In 2 separate growth mixture modeling analyses, we identified subgroups of women (N = 398) with distinct breast pain and arm pain trajectories. The fact that these latent classes differed by anatomic site, types of tissue affected, and neural innervation patterns suggests the need for separate evaluations of these distinct persistent pain conditions. The purposes of this companion study were to identify demographic and clinical characteristics that differed between the 2 arm pain classes and determine if differences existed over time in sensitivity in the upper inner arm and axillary lymph node dissection sites, pain qualities, pain interference, and hand and arm function, as well as to compare findings with persistent breast pain. Higher occurrence rates for depression and lymphedema were found in the moderate arm pain class. Regardless of pain group membership, sensory loss was observed in the upper inner arm and axillary lymph node dissection site. Arm pain was described similarly to neuropathic pain and interfered with daily functioning. Persistent arm pain was associated with sustained impairments in shoulder mobility. For persistent breast and arm pain, changes in sensation following breast cancer surgery were notable. Persistent arm pain was associated with sustained interference with daily functioning and upper body mobility impairments. Long-term management of persistent pain following breast cancer surgery is warranted to improve the quality of survivorship for these women. Copyright © 2014 American Pain Society. Published by Elsevier Inc. All rights reserved.

PERSISTENT ARM PAIN IS DISTINCT FROM PERSISTENT BREAST PAIN FOLLOWING BREAST CANCER SURGERY

PubMed Central

Langford, Dale J.; Paul, Steven M.; West, Claudia; Abrams, Gary; Elboim, Charles; Levine, Jon D.; Hamolsky, Deborah; Luce, Judith A.; Kober, Kord M.; Neuhaus, John M.; Cooper, Bruce A.; Aouizerat, Bradley E.; Miaskowski, Christine

2014-01-01

Persistent pain following breast cancer surgery is well-documented. However, it is not well characterized in terms of the anatomic site effected (i.e., breast, arm). In two separate growth mixture modeling analyses, we identified subgroups of women (n=398) with distinct breast pain and arm pain trajectories. Based on the fact that these latent classes differed by anatomic site, types if tissue affected, and neural innervation patterns suggests the need for separate evaluations of these distinct persistent pain conditions. Purposes of this companion study were to identify demographic and clinical characteristics that differed between the two arm pain classes and determine if differences existed over time in sensitivity in the upper inner arm and axillary lymph node dissection (ALND) sites, pain qualities, pain interference, and hand and arm function; as well as to compare findings with persistent breast pain. Higher occurrence rates for depression and lymphedema were found in the Moderate Arm pain class. Regardless of pain group membership, sensory loss was observed in the upper inner arm and ALND site. Arm pain was described similarly to neuropathic pain and interfered with daily functioning. Persistent arm pain was associated with sustained impairments in shoulder mobility. Perspective: For persistent breast and arm pain, changes in sensation following breast cancer surgery were notable. Persistent arm pain was associated with sustained interference with daily functioning and upper body mobility impairments. Long-term management of persistent pain following breast cancer surgery is warranted to improve the quality of survivorship for these women. PMID:25439319

78 FR 23112 - Airworthiness Directives; Grob-Werke Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-18

... aviation product. The MCAI describes the unsafe condition as cracks in the elevator trim tab arms on... MCAI states: On several Grob G 115 aeroplanes, elevator trim tab arms Part Number (P/N) 115E-3758 have been found cracked, from a rear mounting hole (either L/H or R/H) to the rear edge of the trim tab arm...

Pain, functional disability, and psychologic status in tennis elbow.

PubMed

Alizadehkhaiyat, Omid; Fisher, Anthony C; Kemp, Graham J; Frostick, Simon P

2007-01-01

First to compare pain and functional disability in tennis elbow (TE) patients with healthy controls. Second, to evaluate the relationship between the 2 major psychologic factors (anxiety and depression) and TE. Sixteen TE patients were recruited from 46 consecutive attendees at an upper limb clinic: inclusion criteria were lateral epicondyle tenderness, pain with resisted wrist and middle finger extension and at least 3 months localized lateral elbow pain. Sixteen healthy controls with no upper limb problem were recruited from students and staff. Participants were given 4 questionnaires, together with instructions for completion: Disabilities of the Arm, Shoulder, and Hand, Patient-Rated Forearm Evaluation Questionnaire, Patient-Rated Wrist Evaluation Questionnaire, and Hospital Anxiety and Depression Scale. The independent t test was used to compare the total and subscale scores between the groups. Significantly higher scores were found in TE for pain and function subscales and also total score for Disabilities of the Arm, Shoulder, and Hand, Patient-Rated Forearm Evaluation Questionnaire, and Patient-Rated Wrist Evaluation Questionnaire. For Hospital Anxiety and Depression Scale, both anxiety and depression subscales (P<0.001) and the total score (P<0.01) were significantly higher in TE. According to the anxiety and depression subscales, 55% and 36% of patients, respectively, were classified as probable cases (score >11). TE patients showed markedly increased pain and functional disability. Significantly elevated levels of depression and anxiety pointed out the importance of psychologic assessment in TE patients. In the development of supportive and treatment strategies, we suggest the combination of "upper limb" and "psychologic" assessment tools.

3D scapular orientation on healthy and pathologic subjects using stereoradiographs during arm elevation.

PubMed

Ohl, Xavier; Hagemeister, Nicola; Zhang, Cheng; Billuart, Fabien; Gagey, Olivier; Bureau, Nathalie J; Skalli, Wafa

2015-11-01

Alterations of the scapular kinematics in different pathologic conditions have been widely studied. However, results have shown considerable discrepancies concerning the direction and the amplitude of scapular movement. The lack of consistency in the literature probably has several explanations. The purpose of this study was to analyze scapular orientation with the arm at rest and with 90° lateral elevation in healthy and pathologic subjects by use of stereoradiographs. All participants (n = 65) underwent a clinical examination and magnetic resonance imaging of the shoulder to assess rotator cuff status. Participants were separated into 3 groups: healthy, rotator cuff tear (RCT), and RCT and subacromial impingement syndrome (RCT+ SIS). A 3-dimensional model of the scapula was fitted to each low-dose stereoradiograph acquired with the arm at rest and 90° arm elevation. Orientation of the scapula with the arm at rest was not significantly different between groups. During lateral elevation, scapular orientation was not significantly different between the healthy group and the RCT group. However, upward rotation was significantly reduced in the RCT + SIS group. Alterations of scapular kinematics in symptomatic subjects are multifactorial. We observed a link between clinically assessed subacromial impingement and scapular orientation during lateral elevation of the arm. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Compensatory Versus Noncompensatory Shoulder Movements Used for Reaching in Stroke.

PubMed

Levin, Mindy F; Liebermann, Dario G; Parmet, Yisrael; Berman, Sigal

2016-08-01

Background The extent to which the upper-limb flexor synergy constrains or compensates for arm motor impairment during reaching is controversial. This synergy can be quantified with a minimal marker set describing movements of the arm-plane. Objectives To determine whether and how (a) upper-limb flexor synergy in patients with chronic stroke contributes to reaching movements to different arm workspace locations and (b) reaching deficits can be characterized by arm-plane motion. Methods Sixteen post-stroke and 8 healthy control subjects made unrestrained reaching movements to targets located in ipsilateral, central, and contralateral arm workspaces. Arm-plane, arm, and trunk motion, and their temporal and spatial linkages were analyzed. Results Individuals with moderate/severe stroke used greater arm-plane movement and compensatory trunk movement compared to those with mild stroke and control subjects. Arm-plane and trunk movements were more temporally coupled in stroke compared with controls. Reaching accuracy was related to different segment and joint combinations for each target and group: arm-plane movement in controls and mild stroke subjects, and trunk and elbow movements in moderate/severe stroke subjects. Arm-plane movement increased with time since stroke and when combined with trunk rotation, discriminated between different subject groups for reaching the central and contralateral targets. Trunk movement and arm-plane angle during target reaches predicted the subject group. Conclusions The upper-limb flexor synergy was used adaptively for reaching accuracy by patients with mild, but not moderate/severe stroke. The flexor synergy, as parameterized by the amount of arm-plane motion, can be used by clinicians to identify levels of motor recovery in patients with stroke. © The Author(s) 2015.

Effects of a Home-Based Upper Limb Training Program in Patients With Multiple Sclerosis: A Randomized Controlled Trial.

PubMed

Ortiz-Rubio, Araceli; Cabrera-Martos, Irene; Rodríguez-Torres, Janet; Fajardo-Contreras, Waldo; Díaz-Pelegrina, Ana; Valenza, Marie Carmen

2016-12-01

To evaluate the effects of a home-based upper limb training program on arm function in patients with multiple sclerosis (MS). Additionally, the effects of this program on manual dexterity, handgrip strength, and finger prehension force were analyzed. Randomized, single-blind controlled trial. Home based. Patients with a clinical diagnosis of MS acknowledging impaired manual ability (N=37) were randomized into 2 groups. Patients in the experimental group were included in a supervised home-based upper limb training program for 8 weeks twice a week. Patients in the control group received information in the form of a leaflet with a schedule of upper limb exercise training. The primary outcome measure was arm function (motor functioning assessed using the finger tapping test and a functional measure, the Action Research Arm Test). The secondary outcome measures were manual dexterity assessed with the Purdue Pegboard Test and handgrip strength and finger prehension force evaluated with a handgrip and a pinch dynamometer, respectively. After 8 weeks, a significant between-group improvement (P<.05) was found on the Action Research Arm Test bilaterally and the finger tapping test in the most affected upper limb. The secondary outcomes also improved in the most affected limb in the experimental group. An 8-week home-based intervention program focused on upper limbs twice a week improved arm function and physiologic variables with a primary focus on the more affected extremity in patients with MS compared with the control group. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Association between intramuscular fat in the arm following arm training and INSIG2.

PubMed

Popadic Gacesa, J Z; Secher, N H; Momcilovic, M; Grujic, N G

2014-12-01

Insulin-induced gene 2 (INSIG2) single-nucleotide polymorphism (SNP rs7566605) is linked to lipid metabolism, and this study assessed its potential influence on fat in the upper arm following arm training. Twenty healthy sedentary volunteers (22.0 ± 1.1 years, body mass index 25.4 ± 4.0 kg/m(2) ; mean ± standard deviation) carried out a 12-week two-arm elbow extensor training (10 maximal extensions with 1 min recovery between bouts) five times per day, five times per week. For 17 volunteers, upper arm muscle and adipose tissue [subcutaneous (SCAT) and intramuscular (IMAT)] volumes were evaluated by magnetic resonance imaging before, immediately after, and 12 months after training and variables were related to the subjects' INSIG2 SNP rs7566605 genotype. Muscle volume and SCAT for the upper arm, as the decrease in IMAT during training were not related to INSIG2 SNP rs7566605: GG: %IMAT 1.0 ± 0.9%; GC/CC: %IMAT 0.6 ± 0.5% (P > 0.05). However, in the year following the training, accumulation of upper arm IMAT was twice as large in participants homozygous for the G allele (GG: Δ%IMAT +2.5 ± 0.8%; GC/CC: Δ%IMAT +1.1 ± 0.7%; P < 0.01). This study suggests that the G allele in the INSIG2 SNP rs7566605 is more relevant for changes in IMAT following training than for the amount of subcutaneous fat. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Arm position influences the activation patterns of trunk muscles during trunk range-of-motion movements.

PubMed

Siu, Aaron; Schinkel-Ivy, Alison; Drake, Janessa Dm

2016-10-01

To understand the activation patterns of the trunk musculature, it is also important to consider the implications of adjacent structures such as the upper limbs, and the muscles that act to move the arms. This study investigated the effects of arm positions on the activation patterns and co-activation of the trunk musculature and muscles that move the arm during trunk range-of-motion movements (maximum trunk axial twist, flexion, and lateral bend). Fifteen males and fifteen females, asymptomatic for low back pain, performed maximum trunk range-of-motion movements, with three arm positions for axial twist (loose, crossed, abducted) and two positions for flexion and lateral bend (loose, crossed). Electromyographical data were collected for eight muscles bilaterally, and activation signals were cross-correlated between trunk muscles and the muscles that move the arms (upper trapezius, latissimus dorsi). Results revealed consistently greater muscle co-activation (higher cross-correlation coefficients) between the trunk muscles and upper trapezius for the abducted arm position during maximum trunk axial twist, while results for the latissimus dorsi-trunk pairings were more dependent on the specific trunk muscles (either abdominal or back) and latissimus dorsi muscle (either right or left side), as well as the range-of-motion movement. The findings of this study contribute to the understanding of interactions between the upper limbs and trunk, and highlight the influence of arm positions on the trunk musculature. In addition, the comparison of the present results to those of individuals with back or shoulder conditions may ultimately aid in elucidating underlying mechanisms or contributing factors to those conditions. Copyright © 2016 Elsevier B.V. All rights reserved.

Robot-Assisted Training of Arm and Hand Movement Shows Functional Improvements for Incomplete Cervical Spinal Cord Injury.

PubMed

Francisco, Gerard E; Yozbatiran, Nuray; Berliner, Jeffrey; OʼMalley, Marcia K; Pehlivan, Ali Utku; Kadivar, Zahra; Fitle, Kyle; Boake, Corwin

2017-10-01

The aim of the study was to demonstrate the feasibility, tolerability, and effectiveness of robotic-assisted arm training in incomplete chronic tetraplegia. Pretest/posttest/follow-up was conducted. Ten individuals with chronic cervical spinal cord injury were enrolled. Participants performed single degree-of-freedom exercise of upper limbs at an intensity of 3-hr per session for 3 times a week for 4 wks with MAHI Exo-II. Arm and hand function tests (Jebsen-Taylor Hand Function Test, Action Research Arm Test), strength of upper limb (upper limb motor score, grip, and pinch strength), and independence in daily living activities (Spinal Cord Independence Measure II) were performed at baseline, end of training, and 6 mos later. After 12 sessions of training, improvements in arm and hand functions were observed. Jebsen-Taylor Hand Function Test (0.14[0.04]-0.21[0.07] items/sec, P = 0.04), Action Research Arm Test (30.7[3.8]-34.3[4], P = 0.02), American Spinal Injury Association upper limb motor score (31.5[2.3]-34[2.3], P = 0.04) grip (9.7[3.8]-12[4.3] lb, P = 0.02), and pinch strength (4.5[1.1]-5.7[1.2] lb, P = 0.01) resulted in significant increases. Some gains were maintained at 6 mos. No change in Spinal Cord Independence Measure II scores and no adverse events were observed. Results from this pilot study suggest that repetitive training of arm movements with MAHI Exo-II exoskeleton is safe and has potential to be an adjunct treatment modality in rehabilitation of persons with spinal cord injury with mild to moderate impaired arm functions.

The Perioperative Educational Program for Improving Upper Arm Dysfunction in Patients with Breast Cancer at 1-Year Follow-Up: A Prospective, Controlled Trial.

PubMed

Sato, Fumiko; Arinaga, Yoko; Sato, Naoko; Ishida, Takanori; Ohuchi, Noriaki

2016-03-01

The many women with breast cancer who underwent axillary lymph node dissection (ALND) suffer from the upper arm dysfunction. In this study, we investigated the effectiveness of a perioperative educational program for improving upper arm dysfunction in breast cancer patients following ALND. This study was a sub-analysis of a previous controlled trial with an educational program. The subjects of this analysis included 64 patients following ALND who completed measurements at 12 months. The perioperative educational program consisted of monitoring of arm dysfunction, exercises, massage, and lifestyle adjustments. The intervention group (37 patients) received this perioperative educational program over 12 months, while 27 patients in the control group received written information about shoulder exercise from on-site staff only before surgery. Primary outcomes were shoulder range of motion (ROM), arm girth, and grip strength. Secondary outcomes were evaluated with the Subjective Perception of Post-Operative Functional Impairment of the Arm (SPOFIA) scores, the Disabilities of the Arm, Shoulder and Hand (DASH) scores, and the Medical Outcome Study 36-Item Short-Form Health Survey v2 (SF-36v2). The SF-36v2 measures health-related quality of life (QOL). Primary and secondary outcomes were compared between groups at 1 week (after drainage tube removal) and 12 months after surgery, using the Mann-Whitney U test. The horizontal extension was significantly improved only in the intervention group. Moreover, the SPOFIA score was significantly improved in the intervention group, and other scores of the secondary outcomes were similar between the two groups. The perioperative educational program may improve postoperative upper arm dysfunction and symptoms.

Liver toxicity associated with tuberculosis chemotherapy in the REMoxTB study.

PubMed

Tweed, Conor Duncan; Wills, Genevieve Helen; Crook, Angela M; Dawson, Rodney; Diacon, Andreas H; Louw, Cheryl E; McHugh, Timothy D; Mendel, Carl; Meredith, Sarah; Mohapi, Lerato; Murphy, Michael E; Murray, Stephen; Murthy, Sara; Nunn, Andrew J; Phillips, Patrick P J; Singh, Kasha; Spigelman, M; Gillespie, S H

2018-03-28

Drug-induced liver injury (DILI) is a common complication of tuberculosis treatment. We utilised data from the REMoxTB clinical trial to describe the incidence of predisposing factors and the natural history in patients with liver enzyme levels elevated in response to tuberculosis treatment. Patients received either standard tuberculosis treatment (2EHRZ/4HR), or a 4-month regimen in which moxifloxacin replaced either ethambutol (isoniazid arm, 2MHRZ/2MHR) or isoniazid (ethambutol arm, 2EMRZ/2MR). Hepatic enzymes were measured at 0, 2, 4, 8, 12 and 17 weeks and as clinically indicated during reported adverse events. Patients included were those receiving at least one dose of drug and with two or more hepatic enzyme measurements. A total of 1928 patients were included (639 2EHRZ/4HR, 654 2MHRZ/2MHR and 635 2EMRZ/2MR). DILI was defined as peak alanine aminotransferase (ALT) ≥ 5 times the upper limit of normal (5 × ULN) or ALT ≥ 3 × ULN with total bilirubin > 2 × ULN. DILI was identified in 58 of the 1928 (3.0%) patients at a median time of 28 days (interquartile range IQR 14-56). Of 639 (6.4%) patients taking standard tuberculosis therapy, 41 experienced clinically significant enzyme elevations (peak ALT ≥ 3 × ULN). On standard therapy, 21.1% of patients aged >55 years developed a peak ALT/aspartate aminotransferase (AST) ≥ 3 × ULN (p = 0.01) and 15% of HIV-positive patients experienced a peak ALT/AST ≥ 3 × ULN compared to 9% of HIV-negative patients (p = 0.160). The median peak ALT/AST was higher in isoniazid-containing regimens vs no-isoniazid regimens (p < 0.05), and lower in moxifloxacin-containing arms vs no-moxifloxacin arms (p < 0.05). Patients receiving isoniazid reached a peak ALT ≥ 3 × ULN 9.5 days earlier than those on the ethambutol arm (median time of 28 days vs 18.5 days). Of the 67 Asian patients with a peak ALT/AST ≥ 3 × ULN, 57 (85.1%) were on an isoniazid-containing regimen (p = 0.008). Our results provide evidence of the risk of DILI in tuberculosis patients on standard treatment. Older patients on standard therapy, HIV-positive patients, Asian patients and those receiving isoniazid were at higher risk of elevated enzyme levels. Monitoring hepatic enzymes during the first 2 months of standard therapy detected approximately 75% of patients with a peak enzyme elevation ≥3 × ULN, suggesting this should be a standard of care. These results provide evidence for the potential of moxifloxacin in hepatic sparing.

Backwaters in the upper reaches of reservoirs produce high densities of age-0 crappies

USGS Publications Warehouse

Dagel, Jonah D.; Miranda, Leandro E.

2012-01-01

Reservoir backwaters are aquatic habitats in floodplains of reservoir tributaries that are permanently or periodically flooded by the reservoir. Like many reservoir arms, backwaters are commonly shallow, littoral habitats, but they differ from arms in various respects, including their support of primarily wetland plant assemblages that are tolerant to flooding. Elsewhere, the reservoir floods mainly upland plants that are less tolerant to flooding, producing a band of barren shoreline along the fluctuation zone. We investigated differences in relative abundance of age-0 crappies Pomoxis spp. in backwaters and arms of widely fluctuating flood control reservoirs, examined the effect of water level, and estimated the likelihood and timing with which these habitats are flooded annually. Higher catch rates of age-0 crappies were obtained in backwater habitats than in arm habitats. When inundated during the crappie spawning season, backwaters provided vegetated habitat at lower water levels than arms. Backwaters flooded earlier than arms and remained flooded longer to provide prolonged nursery habitat. Whereas vegetated habitat was inundated almost yearly in backwaters and arms, inundation that was timed to the onset of spawning occurred less regularly. Because of differences in water elevation, vegetated habitats were flooded in time for crappie spawning about every other year in backwaters but only every third year in arms. Recruitment of age-0 crappies was inversely correlated with high water levels during the months preceding the spawning period, perhaps because early flooding degraded the vegetation. Our results suggest that water levels may be managed during late winter and spring to regularly flood wetland vegetation communities in backwaters; however, water levels should be maintained at or below normal pool and should only irregularly flood upland vegetation in reservoir arms to promote the preservation of such vegetation. Furthermore, management efforts to enhance crappie recruitment should consider the enhancement and preservation of backwaters.

Influence of pectoralis minor and upper trapezius lengths on observable scapular dyskinesis.

PubMed

Yeşilyaprak, Sevgi Sevi; Yüksel, Ertuğrul; Kalkan, Serpil

2016-05-01

Although a relationship between short pectoralis minor and upper trapezius and scapular dyskinesis has been postulated, no studies have investigated this theory. Understanding the effect of these muscle lengths on observable scapular dyskinesis may aid in determining risks and therefore making treatment decisions. Being aware of the magnitude of this effect would help gauge the significance of risks involved. Our aim was to evaluate the influence of pectoralis minor and upper trapezius lengths on scapular dyskinesis. Cross-sectional study. University research laboratory. Asymptomatic participants (n = 148; 296 arms) were evaluated. Scapular Dyskinesis Test (SDT) was used to identify scapular dyskinesis, Pectoralis Minor Index (PMI) and Upper Trapezius Length Testing were used to determine muscle length. SDT+ arms had shorter pectoralis minor resting length (PMI: 7.49 ± 0.38) (p < 0.001) and greater incidence of short upper trapezius (ISUT) (66.7%) (p < 0.001) compared to SDT- arms (PMI:8.58 ± 0.75, ISUT:22.5%). With each decrease in PMI, the likelihood of having scapular dyskinesis increased 96% (p < 0.001). Arms with short upper trapezius were 2.049 times more likely to exhibit scapular dyskinesis than those with normal length (p = 0.042). Having a shorter pectoralis minor and upper trapezius length substantially increased the likelihood of having visually observable scapular dyskinesis. Copyright © 2015 Elsevier Ltd. All rights reserved.

Correlations of Handgrip Strength with Selected Hand-Arm-Anthropometric Variables in Indian Inter-university Female Volleyball Players

PubMed Central

Koley, Shyamal; Pal Kaur, Satinder

2011-01-01

Purpose The purpose of this study was to estimate the dominant handgrip strength and its correlations with some hand and arm anthropometric variables in 101 randomly selected Indian inter-university female volleyball players aged 18-25 years (mean age 20.52±1.40) from six Indian universities. Methods Three anthropometric variables, i.e. height, weight, BMI, two hand anthropometric variables, viz. right and left hand width and length, four arm anthropometric variables, i.e. upper arm length, lower arm length, upper extremity length, upper arm circumference and dominant right and non-dominant handgrip strength were measured among Indian inter-university female volleyball players by standard anthropometric techniques. Results The findings of the present study indicated that Indian female volleyball players had higher mean values in eleven variables and lesser mean values in two variables than their control counterparts, showing significant differences (P<0.032-0.001) in height (t=2.63), weight (t=8.66), left hand width (t=2.10), left and right hand length (t=9.99 and 10.40 respectively), right upper arm length (t=8.48), right forearm length (t=5.41), dominant (right) and non-dominant (left) handgrip strength (t=9.37 and 6.76 respectively). In female volleyball players, dominant handgrip strength had significantly positive correlations (P=0.01) with all the variables studied. Conclusion It may be concluded that dominant handgrip strength had strong positive correlations with all the variables studied in Indian inter-university female volleyball players. PMID:22375242

Isometric Arm Strength and Subjective Rating of Upper Limb Fatigue in Two-Handed Carrying Tasks

PubMed Central

Li, Kai Way; Chiu, Wen-Sheng

2015-01-01

Sustained carrying could result in muscular fatigue of the upper limb. Ten male and ten female subjects were recruited for measurements of isometric arm strength before and during carrying a load for a period of 4 minutes. Two levels of load of carrying were tested for each of the male and female subjects. Exponential function based predictive equations for the isometric arm strength were established. The mean absolute deviations of these models in predicting the isometric arm strength were in the range of 3.24 to 17.34 N. Regression analyses between the subjective ratings of upper limb fatigue and force change index (FCI) for the carrying were also performed. The results indicated that the subjective rating of muscular fatigue may be estimated by multiplying the FCI with a constant. The FCI may, therefore, be adopted as an index to assess muscular fatigue for two-handed carrying tasks. PMID:25794159

Isometric arm strength and subjective rating of upper limb fatigue in two-handed carrying tasks.

PubMed

Li, Kai Way; Chiu, Wen-Sheng

2015-01-01

Sustained carrying could result in muscular fatigue of the upper limb. Ten male and ten female subjects were recruited for measurements of isometric arm strength before and during carrying a load for a period of 4 minutes. Two levels of load of carrying were tested for each of the male and female subjects. Exponential function based predictive equations for the isometric arm strength were established. The mean absolute deviations of these models in predicting the isometric arm strength were in the range of 3.24 to 17.34 N. Regression analyses between the subjective ratings of upper limb fatigue and force change index (FCI) for the carrying were also performed. The results indicated that the subjective rating of muscular fatigue may be estimated by multiplying the FCI with a constant. The FCI may, therefore, be adopted as an index to assess muscular fatigue for two-handed carrying tasks.

Short-Term Upper Limb Immobilization Affects Action-Word Understanding

ERIC Educational Resources Information Center

Bidet-Ildei, Christel; Meugnot, Aurore; Beauprez, Sophie-Anne; Gimenes, Manuel; Toussaint, Lucette

2017-01-01

The present study aimed to investigate whether well-established associations between action and language can be altered by short-term upper limb immobilization. The dominant arm of right-handed participants was immobilized for 24 hours with a rigid splint fixed on the hand and an immobilization vest restraining the shoulder, arm, and forearm. The…

Non-contact versus contact-based sensing methodologies for in-home upper arm robotic rehabilitation.

PubMed

Howard, Ayanna; Brooks, Douglas; Brown, Edward; Gebregiorgis, Adey; Chen, Yu-Ping

2013-06-01

In recent years, robot-assisted rehabilitation has gained momentum as a viable means for improving outcomes for therapeutic interventions. Such therapy experiences allow controlled and repeatable trials and quantitative evaluation of mobility metrics. Typically though these robotic devices have been focused on rehabilitation within a clinical setting. In these traditional robot-assisted rehabilitation studies, participants are required to perform goal-directed movements with the robot during a therapy session. This requires physical contact between the participant and the robot to enable precise control of the task, as well as a means to collect relevant performance data. On the other hand, non-contact means of robot interaction can provide a safe methodology for extracting the control data needed for in-home rehabilitation. As such, in this paper we discuss a contact and non-contact based method for upper-arm rehabilitation exercises that enables quantification of upper-arm movements. We evaluate our methodology on upper-arm abduction/adduction movements and discuss the advantages and limitations of each approach as applied to an in-home rehabilitation scenario.

Wii™-habilitation of upper extremity function in children with cerebral palsy. An explorative study.

PubMed

Winkels, Diny G M; Kottink, Anke I R; Temmink, Rutger A J; Nijlant, Juliëtte M M; Buurke, Jaap H

2013-01-01

Commercially available virtual reality systems can possibly support rehabilitation objectives in training upper arm function in children with Cerebral Palsy (CP). The present study explored the effect of the Nintendo Wii™ training on upper extremity function in children with CP. During six weeks, all children received twice a week training with the Wii™, with their most affected arm. The Melbourne Assessment of Upper Limb Function and ABILHAND-Kids were assessed pre- and post- training. In addition, user satisfaction of both children and health professionals was assessed after training. Enjoyment in gaming was scored on a visual analogue scale scale after each session by the children. Fifteen children with CP participated in the study. The quality of upper extremity movements did not change (-2.1, p > 0.05), while a significant increase of convenience in using hands/arms during performance of daily activities was found (0.6, p < 0.05). Daily activities seem to be easier performed after Wii™ training for most of the included children with CP.

Gravity-supported exercise with computer gaming improves arm function in chronic stroke.

PubMed

Jordan, Kimberlee; Sampson, Michael; King, Marcus

2014-08-01

To investigate the effect of 4 to 6 weeks of exergaming with a computer mouse embedded within an arm skate on upper limb function in survivors of chronic stroke. Intervention study with a 4-week postintervention follow-up. In home. Survivors (N=13) of chronic (≥6 mo) stroke with hemiparesis of the upper limb with stable baseline Fugl-Meyer assessment scores received the intervention. One participant withdrew, and 2 participants were not reassessed at the 4-week follow-up. No participants withdrew as a result of adverse effects. Four to 6 weeks of exergaming using the arm skate where participants received either 9 (n=5) or 16 (n=7) hours of game play. Upper limb component of the Fugl-Meyer assessment. There was an average increase in the Fugl-Meyer upper limb assessment score from the beginning to end of the intervention of 4.9 points. At the end of the 4-week period after the intervention, the increase was 4.4 points. A 4- to 6-week intervention using the arm skate significantly improved arm function in survivors of chronic stroke by an average of 4.9 Fugl-Meyer upper limb assessment points. This research shows that a larger-scale randomized trial of this device is warranted and highlights the potential value of using virtual reality technology (eg, computer games) in a rehabilitation setting. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Effects of arm elevation on radial artery pressure: a new method to distinguish hypovolemic shock and septic shock from hypotension.

PubMed

Xie, Zhiyi; Zhang, Zhenyu; Xu, Yuan; Zhou, Hua; Wu, Sheng; Wang, Zhong

2018-06-01

In this prospective observational study, we investigated the variability in radial artery invasive blood pressure associated with arm elevation in patients with different hemodynamic types. We carried out a prospective observational study using data from 73 general anesthesia hepatobiliary postoperative adult patients admitted to an ICU over a 1-year period. A standard procedure was used for the arm elevation test. The value of invasive radial arterial pressure was recorded at baseline, and 30 and 60 s after the arm had been raised from 0° to 90°. We compared the blood pressure before versus after arm elevation, and between hemodynamically stable, hypovolemic shock, and septic shock patient groups. In all 73 patients, systolic arterial pressure (SAP) decreased, diastolic arterial pressure (DAP) increased, and pulse pressure (PP) decreased at 30 and 60 s after arm elevation (P<0.01), but the mean arterial pressure (MAP) was unchanged (P>0.05). On comparing 30 and 60 s, there was no significant difference in SAP, DAP, PP, or MAP (P>0.05). In 40 hemodynamically stable patients, SAP and PP decreased, and DAP and MAP increased significantly at 30 and 60 s after arm elevation compared with baseline (P<0.01). In 16 hypovolemic patients, SAP, DAP, and MAP increased significantly compared with baseline at 30 and 60 s (P<0.01), but PP was unchanged (P>0.05). In 17 patients with septic shock, SAP, PP, and MAP decreased significantly versus baseline at 30 and 60 s (P<0.01), but DAP was unchanged (P>0.05). Comparison of the absolute value of pressure change of septic shock patients at 30 s after raising the arm showed that SAP, DAP, and MAP changes were significantly lower compared with those in hypovolemic shock and hemodynamically stable patients (P<0.01). The areas under the receiver operator characteristic curve for predicting septic shock was 0.930 [95% confidence interval (CI): 0.867-0.992, P< 0.001] for change value at 30 s after arm elevation of SAP. The best cut-off point for the SAP change value was -5 mmHg or less, with a sensitivity of 94.12%, a specificity of 80.36%, a positive likelihood ratio of 4.79 (95% CI: 2.8-8.2), and a negative likelihood ratio of 0.073 (95% CI: 0.01-0.5). Our study shows that hypovolemic shock and septic shock patients have significantly different radial artery invasive blood pressure changes in an arm elevation test, which could be applied as a new method to distinguish hypovolemic shock and septic shock from hypotension.

Rotary Series Elastic Actuator

NASA Technical Reports Server (NTRS)

Ihrke, Chris A. (Inventor); Mehling, Joshua S. (Inventor); Parsons, Adam H. (Inventor); Griffith, Bryan Kristian (Inventor); Radford, Nicolaus A. (Inventor); Permenter, Frank Noble (Inventor); Davis, Donald R. (Inventor); Ambrose, Robert O. (Inventor); Junkin, Lucien Q. (Inventor)

2013-01-01

A rotary actuator assembly is provided for actuation of an upper arm assembly for a dexterous humanoid robot. The upper arm assembly for the humanoid robot includes a plurality of arm support frames each defining an axis. A plurality of rotary actuator assemblies are each mounted to one of the plurality of arm support frames about the respective axes. Each rotary actuator assembly includes a motor mounted about the respective axis, a gear drive rotatably connected to the motor, and a torsion spring. The torsion spring has a spring input that is rotatably connected to an output of the gear drive and a spring output that is connected to an output for the joint.

Rotary series elastic actuator

NASA Technical Reports Server (NTRS)

Ihrke, Chris A. (Inventor); Mehling, Joshua S. (Inventor); Parsons, Adam H. (Inventor); Griffith, Bryan Kristian (Inventor); Radford, Nicolaus A. (Inventor); Permenter, Frank Noble (Inventor); Davis, Donald R. (Inventor); Ambrose, Robert O. (Inventor); Junkin, Lucien Q. (Inventor)

2012-01-01

A rotary actuator assembly is provided for actuation of an upper arm assembly for a dexterous humanoid robot. The upper arm assembly for the humanoid robot includes a plurality of arm support frames each defining an axis. A plurality of rotary actuator assemblies are each mounted to one of the plurality of arm support frames about the respective axes. Each rotary actuator assembly includes a motor mounted about the respective axis, a gear drive rotatably connected to the motor, and a torsion spring. The torsion spring has a spring input that is rotatably connected to an output of the gear drive and a spring output that is connected to an output for the joint.

A prospective randomised double-blind placebo-controlled trial to assess the effect of diuretics on shockwave lithotripsy of calculi.

PubMed

Sabharwal, Sagar; Jeyaseelan, L; Panda, Arabind; Gnanaraj, Lionel; Kekre, Nitin S; Devasia, Antony

2017-12-01

To assess the effect of diuretics with shockwave lithotripsy (SWL) on the treatment of renal and upper ureteric calculi. Adult patients with a solitary non-obstructive radio-opaque renal or upper ureteric calculus with normal renal function were included. They were prospectively randomised to receive either SWL with placebo or SWL with diuretics (40 mg parenteral furosemide) in a double-blind manner with a sample size of 48 patients in each arm. The primary outcomes were the SWL success and failure rates. The secondary outcomes were the number of shocks and sessions. Complete fragmentation was achieved in 89.6% of the patients in the furosemide arm as compared to 81.3% in the placebo arm. Clearance was achieved in 77.1% of the patients in the furosemide arm as compared to 70.8% in the placebo arm. The number of shocks and the number of sessions were higher in the placebo arm. These differences were not statistically significant. The use of diuretics along with SWL treatment of renal and upper ureteric calculi does not show a statistically significant improvement in fragmentation or clearance.

Sensory-Feedback Exoskeletal Arm Controller

NASA Technical Reports Server (NTRS)

An, Bin; Massie, Thomas H.; Vayner, Vladimir

2004-01-01

An electromechanical exoskeletal arm apparatus has been designed for use in controlling a remote robotic manipulator arm. The apparatus, called a force-feedback exoskeleton arm master (F-EAM) is comfortable to wear and easy to don and doff. It provides control signals from the wearer s arm to a robot arm or a computer simulator (e.g., a virtual-reality system); it also provides force and torque feedback from sensors on the robot arm or from the computer simulator to the wearer s arm. The F-EAM enables the wearer to make the robot arm gently touch objects and finely manipulate them without exerting excessive forces. The F-EAM features a lightweight design in which the motors and gear heads that generate force and torque feedback are made smaller than they ordinarily would be: this is achieved by driving the motors to power levels greater than would ordinarily be used in order to obtain higher torques, and by providing active liquid cooling of the motors to prevent overheating at the high drive levels. The F-EAM (see figure) includes an assembly that resembles a backpack and is worn like a backpack, plus an exoskeletal arm mechanism. The FEAM has five degrees of freedom (DOFs) that correspond to those of the human arm: 1. The first DOF is that of the side-to-side rotation of the upper arm about the shoulder (rotation about axis 1). The reflected torque for this DOF is provided by motor 1 via drum 1 and a planar four-bar linkage. 2. The second DOF is that of the up-and-down rotation of the arm about the shoulder. The reflected torque for this DOF is provided by motor 2 via drum 2. 3. The third DOF is that of twisting of the upper arm about its longitudinal axis. This DOF is implemented in a cable remote-center mechanism (CRCM). The reflected torque for this DOF is provided by motor 3, which drives the upper-arm cuff and the mechanism below it. A bladder inflatable by gas or liquid is placed between the cuff and the wearer s upper arm to compensate for misalignment between the exoskeletal mechanism and the shoulder. 4. The fourth DOF is that of flexion and extension of the elbow. The reflected torque for this DOF is provided by motor 4 and drum 4, which are mounted on a bracket that can slide longitudinally by a pin-and-slot engagement with the upper-arm cuff to compensate for slight variations in the position of the kinematic center of the elbow. Attached to drum 4 is an adapter plate to which is attached a CRCM for the lower arm. 5. The lower-arm CRCM implements the fifth DOF, which is the twist of the forearm about its longitudinal axis. Motor 5 provides the reflected torque for this DOF by driving the lower-arm cuff. A rod transmits twist and torsion between the lower-arm cuff and the hand cuff. With this system, the motion of the wearer s joints and the reflected torques applied to these joints can be measured and controlled in a relatively simple manner. This is because the anthropomorphic design of the mechanism imitates the kinematics of the human arm, eliminating the need for kinematic conversion of joint-torque and joint-angle data.

The appropriateness of the length of insulin needles based on determination of skin and subcutaneous fat thickness in the abdomen and upper arm in patients with type 2 diabetes.

PubMed

Sim, Kang Hee; Hwang, Moon Sook; Kim, Sun Young; Lee, Hye Mi; Chang, Ji Yeun; Lee, Moon Kyu

2014-04-01

Longer needle and complicated insulin injection technique such as injecting at a 45-degree angle and making skinfolds may decrease patient compliance to insulin injection therapy. In this light, shorter insulin needles have been recently developed. However, it is necessary to ascertain that such shorter needles are appropriate for Korean patients with diabetes as well. First, the diverse demographic and diabetic features of 156 Korean adults with diabetes were collected by a questionnaire and a device unit of body fat measurement. The skin and subcutaneous fat thicknesses of each subject were measured by Ultrasound device with a 7- to 12-MHz probe. Data were analyzed using analysis of variance and multiple linear regression. The mean skin thickness was 2.29±0.37 mm in the abdomen and 2.00±0.34 mm in the upper arms, and the mean subcutaneous fat thickness was to 10.15±6.54 mm in the abdomen and 5.50±2.68 mm in the upper arms. Our analysis showed that the factors affecting the skin thickness of the abdomen and upper arms were gender and body mass index (BMI), whereas the factors influencing the subcutaneous fat thickness in the abdomen were gender and BMI, and the factors influencing the subcutaneous fat thickness in the upper arms were gender, BMI, and age. Insulin fluids may not appear to be intradermally injected into the abdomen and upper arms at any needle lengths. The risk of intramuscular injection is likely to increase with longer insulin needles and lower BMI. It is recommended to fully inform the patients about the lengths of needles for insulin injections. As for the recommended needle length, the findings of this study indicate that needles as short as 4 mm are sufficient to deliver insulin for Korean patients with diabetes.

Application and comparison of different implanted ports in malignant tumor patients.

PubMed

Li, Yanhong; Cai, Yonghua; Gan, Xiaoqin; Ye, Xinmei; Ling, Jiayu; Kang, Liang; Ye, Junwen; Zhang, Xingwei; Zhang, Jianwei; Cai, Yue; Hu, Huabin; Huang, Meijin; Deng, Yanhong

2016-09-23

The current study aims to compare the application and convenience of the upper arm port with the other two methods of implanted ports in the jugular vein and the subclavian vein in patients with gastrointestinal cancers. Currently, the standard of practice is placement of central venous access via an internal jugular vein approach. Perioperative time, postoperative complications, and postoperative comfort level in patients receiving an implanted venous port in the upper arm were retrospectively compared to those in the jugular vein and the subclavian vein from April 2013 to November 2014. Three hundred thirty-four patients are recruited for this analysis, consisting of 107 in the upper arm vein group, 70 in the jugular vein group, and 167 in the subclavian vein group. The occurrence of catheter misplacement in the upper arm vein is higher than that in the other two groups (13.1 vs. 2.9 vs. 5.4 %, respectively, P = 0.02), while the other complications in the perioperative period were not significantly different. The occurrence of transfusion obstacle of the upper arm vein group is significantly lower than that of the jugular and subclavian groups (0.9 vs. 7.1 vs. 7.2 %, P = 0.01). The occurrence of thrombus is also lower than that of other two groups (0.9 vs. 4.3 vs. 3.6 %, P = 0.03). Regarding the postoperative comfort, the influences of appearance (0 vs. 7.1 vs. 2.9 %, P = 0.006) and sleep (0.9 vs. 4.2 vs. 10.7 %, P = 0.003) are significantly better than those of the jugular and subclavian vein groups. Compared to the jugular and the subclavian vein groups, the implanted venous port in the upper arm vein has fewer complications and more convenience and comfort, and might be a superior novel choice for patients requiring long-term chemotherapy or parenteral nutrition.

The Appropriateness of the Length of Insulin Needles Based on Determination of Skin and Subcutaneous Fat Thickness in the Abdomen and Upper Arm in Patients with Type 2 Diabetes

PubMed Central

Sim, Kang Hee; Kim, Sun Young; Lee, Hye Mi; Chang, Ji Yeun; Lee, Moon Kyu

2014-01-01

Background Longer needle and complicated insulin injection technique such as injecting at a 45-degree angle and making skinfolds may decrease patient compliance to insulin injection therapy. In this light, shorter insulin needles have been recently developed. However, it is necessary to ascertain that such shorter needles are appropriate for Korean patients with diabetes as well. Methods First, the diverse demographic and diabetic features of 156 Korean adults with diabetes were collected by a questionnaire and a device unit of body fat measurement. The skin and subcutaneous fat thicknesses of each subject were measured by Ultrasound device with a 7- to 12-MHz probe. Data were analyzed using analysis of variance and multiple linear regression. Results The mean skin thickness was 2.29±0.37 mm in the abdomen and 2.00±0.34 mm in the upper arms, and the mean subcutaneous fat thickness was to 10.15±6.54 mm in the abdomen and 5.50±2.68 mm in the upper arms. Our analysis showed that the factors affecting the skin thickness of the abdomen and upper arms were gender and body mass index (BMI), whereas the factors influencing the subcutaneous fat thickness in the abdomen were gender and BMI, and the factors influencing the subcutaneous fat thickness in the upper arms were gender, BMI, and age. Insulin fluids may not appear to be intradermally injected into the abdomen and upper arms at any needle lengths. The risk of intramuscular injection is likely to increase with longer insulin needles and lower BMI. Conclusion It is recommended to fully inform the patients about the lengths of needles for insulin injections. As for the recommended needle length, the findings of this study indicate that needles as short as 4 mm are sufficient to deliver insulin for Korean patients with diabetes. PMID:24851206

Pharmacokinetic Interaction between Pyronaridine-Artesunate and Metoprolol

PubMed Central

Morris, Carrie A.; Pokorny, Rolf; Lopez-Lazaro, Luis; Miller, Robert M.; Arbe-Barnes, Sarah; Duparc, Stephan; Borghini-Fuhrer, Isabelle; Shin, Jang-Sik

2014-01-01

The objectives of this study were to characterize any drug-drug interaction between the antimalarial Pyramax (pyronaridine-artesunate [PA]) and the CYP2D6 probe substrate metoprolol and to assess the safety of 60-day or 90-day PA redosing, particularly with regard to liver biochemistry parameters. Healthy adult subjects were randomized to arm A (n = 26) or arm B (n = 30), with the arm A subjects administered 100 mg metoprolol tartrate in the first period, 100 mg metoprolol tartrate with the third of three daily doses of PA in the second period, and three daily doses of PA alone in the 90-day redosing period. The arm B subjects received the three-day PA regimen in the first period, with redosing of the regimen after 60 days in the second period. The noncompartmental pharmacokinetic parameters were computed for metoprolol, its metabolite alpha-hydroxymetoprolol, and pyronaridine. The coadministration of metoprolol and PA was associated with an average 47.93% (90% confidence interval [CI], 30.52, 67.66) increase in the maximum concentration of metoprolol and a 25.60% (90% CI, 15.78, 36.25) increase in the metoprolol area under the concentration-time curve from time zero to the last quantifiable concentration obtained (AUC0-t); these increases most likely resulted from pyronaridine-mediated CYP2D6 inhibition. No interaction effect of metoprolol with pyronaridine was apparent. Following dosing with PA, some subjects experienced rises in liver function tests above the upper limit of normal during the first few days following PA administration. All such elevations resolved typically within 10 days, and up to 30 days at most. In subjects who were redosed, the incidences of alanine aminotransferase (ALT) or aspartate transaminase (AST) level elevations were similar on the first and second administrations, with no marked difference between the 60-day and 90-day redosing. PMID:25070091

An ergonomic study of the optimum operating table height for laparoscopic surgery.

PubMed

Berquer, R; Smith, W D; Davis, S

2002-03-01

Laparoscopic surgery requires the use of longer instruments than open surgery, thus changing the relation between the height of the surgeon's hands and the desirable height of the operating room table. The optimum height of the operating room table for laparoscopic surgery is investigated in this study. Twenty-one surgeons performed a two-handed, one-fourth circle cutting task using a laparoscopic video system and laparoscopic instruments positioned at five instrument handle heights relative to subjects' elbow height (-20, -10, 0, +10, and +20 cm) by adjusting the height of the trainer box. Subjects rated the difficulty and discomfort experienced during each task on a visual analog scale. Skin conductance (SC) was measured in Micromhos via paired surface electrodes placed near the ulnar edge of the palm of the right (cutting) hand. The mean electromyographic (EMG) signal from the right deltoid and trapezius muscles was measured. Arm orientation was measured in three dimensions using a magnetometer/accelerometer. Signals were acquired using analog circuitry and digitally sampled using a National Instruments DAQCard 700 connected to a Macintosh PowerBook 5300c running LabVIEW software. Statistical analysis was carried out by analysis of variance and post hoc testing. Statistically significant changes were found in the subjective rating of discomfort (p <0.002), deltoid EMG (p <0.0006), trapezius EMG (p <0.0001), and arm elevation (p <0.0001) between instrument handle heights. SC values and task times did not change significantly. Discomfort and difficulty ratings were lowest when instrument handles were positioned at elbow height. EMG values and arm elevation all decreased with lower instrument height. This study suggests that the optimum table height for laparoscopic surgery should position the laparoscopic instrument handles close to surgeons' elbow level to minimize discomfort and upper arm and shoulder muscle work. This corresponds to an approximate table height of 64 to 77 cm above floor level. A redesign of current operating room tables may be required to meet these ergonomic guidelines.

Disease and Non-Battle Injuries among Navy and Marine Corps Personnel during Operation Desert Shield/Desert Storm

DTIC Science & Technology

1991-10-01

KNEE I SHOULDER V SHIN /CALF 357 OTITIS EXTERNA 17 HEAT EXHAUSTION J, UPPER ARM W ANKLE T358 OITIS MEDIA K ELBOW X FOOT 0 337 CONJUNCTIVITIS - 18...OTHER, SPECIFY:__ 17 HEAT EXHAUSTION a CHEST T UPPER LEG S18 HEAT STROKE H RIBS U KNEE EYEAR: _ 19 LACERATION I SHOULDER V SHIN ,-LF 0 38010...GROINoGENITAL 03 ALERT 0 VERBAL RESPONSE I SHOULDER V UPPER LEG C3 PAIN RESPONSE 0’ UNRESPONSIVE J UPPER ARM W KNEE K ELBOW X SHIN /CALF MEDICATION L

Relationship Between the Elevated Muscle FDG Uptake in the Distal Upper Extremities on PET/CT Scan and Prescan Utilization of Mobile Devices in Young Patients.

PubMed

Bai, Xia; Wang, Xuemei; Zhuang, Hongming

2018-03-01

It is common to notice increased FDG activity in the muscles of the forearms or hands on PET/CT images. The purpose of this study was to determine relationship between the prevalence of increased FDG activity in the forearms or hands and using mobile devices prior to the FDG PET/CT study. A total of 443 young patients with ages between 5 and 19 years who underwent FDG PET/CT scan were included in this retrospective analysis. All patients had FDG PET/CT with their arms within the field of views. The images were reviewed for elevated activity in the muscles of the distal upper extremities (DUEs), which include forearms and hands. The preimaging questionnaire/interview records regarding using mobile devices prior to FDG PET/CT were also reviewed and compared with the imaging findings. Most patients (72.0% [319/443]) used mobile devices more than 60 minutes in the period of 24 hours prior to the FDG PET/CT study. Elevated uptake in the muscles in the DUEs was observed in 38.6% (123/319) of these patients. In contrast, among 124 patients who did not use the mobile devices or used the mobile device minimally prior to the study, only 6.5% (8/124) of them had elevated FDG activity in the DUEs. The difference persisted following stratification analysis for sex, age, and serum glucose level in our patient population. Increased FDG uptake in the muscles of the DUEs in young patients is commonly seen in those who used mobile devices prior to PET/CT study. Recommendation should be considered to reduce using mobile devices prior to FDG PET/CT study in young patient population.

The correlation between body mass index, limb circumferences and blood pressure cuff fit in bariatric surgical patients.

PubMed

Schumann, R; Alyamani, O; Viswanath, A; Bonney, I

2016-01-01

The purpose of this study was to determine the correlation between body mass index (BMI) and upper and lower arm as well as lower leg circumferences and the frequency of correct blood pressure (BP) cuff fit. We explored recommendations for the most likely BP cuff size and location for the three BMI categories. Following IRB approval we retrospectively analyzed a research database of bariatric surgical patients with a BMI of ≥40 kg/m(2). Data included patients' characteristics, upper and lower arm as well as lower leg circumferences. Patients were divided into three groups based on BMI (kg/m(2), Group I: <45, Group II: 45-55, and Group III: >55). Appropriate cuff fit using a standard or large adult BP cuff (CRITIKON(®), GE Healthcare, Waukesha, Wisconsin, USA) on the upper and lower arm, and lower leg was determined. We analyzed the percent proportion of proper cuff fit for cuff sizes and locations between groups using appropriate nonparametric testing. Limb circumference correlated significantly with BMI (P = 0.01), and the upper arm correlated most closely (r = 0.76). A standard adult BP cuff on the lower arm fit properly in >90% and >80% and in Groups I and II, respectively. A large cuff on the lower arm was appropriate in 87% of Group III. In two participants, a large cuff fit properly on the lower leg. Limb circumference significantly correlated with BMI. Recommendations for proper cuff fit in different BMI categories can be made.

Isometric and isokinetic muscle strength in the upper extremity can be reliably measured in persons with chronic stroke.

PubMed

Ekstrand, Elisabeth; Lexell, Jan; Brogårdh, Christina

2015-09-01

To evaluate the test-retest reliability of isometric and isokinetic muscle strength measurements in the upper extremity after stroke. A test-retest design. Forty-five persons with mild to moderate paresis in the upper extremity > 6 months post-stroke. Isometric arm strength (shoulder abduction, elbow flexion), isokinetic arm strength (elbow extension/flexion) and isometric grip strength were measured with electronic dynamometers. Reliability was evaluated with intra-class correlation coefficients (ICC), changes in the mean, standard error of measurements (SEM) and smallest real differences (SRD). Reliability was high (ICCs: 0.92-0.97). The absolute and relative (%) SEM ranged from 2.7 Nm (5.6%) to 3.0 Nm (9.4%) for isometric arm strength, 2.6 Nm (7.4%) to 2.9 Nm (12.6%) for isokinetic arm strength, and 22.3 N (7.6%) to 26.4 N (9.2%) for grip strength. The absolute and relative (%) SRD ranged from 7.5 Nm (15.5%) to 8.4 Nm (26.1%) for isometric arm strength, 7.1 Nm (20.6%) to 8.0 Nm (34.8%) for isokinetic arm strength, and 61.8 N (21.0%) to 73.3 N (25.6%) for grip strength. Muscle strength in the upper extremity can be reliably measured in persons with chronic stroke. Isometric measurements yield smaller measurement errors than isokinetic measurements and might be preferred, but the choice depends on the research question.

22. View showing main anchor arm, as viewed from main ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

22. View showing main anchor arm, as viewed from main cantilever arm looking south. Note upper chord eyebar arrangement. - Williamstown-Marietta Bridge, Spanning Ohio River between Williamstown & Marietta, Williamstown, Wood County, WV

Profiles of muscularity in junior Olympic weight lifters.

PubMed

Kanehisa, H; Funato, K; Abe, T; Fukunaga, T

2005-03-01

This study aimed to investigate the muscularity of strength-trained junior athletes. Muscle thickness (Mt) values at 10 sites (anterior forearm, anterior upper arm, posterior upper arm, chest, abdomen, back, anterior thigh, posterior thigh, anterior lower leg, and posterior lower leg) were determined in junior Olympic weight lifters (OWL, n=7, 15.1+/-0.3 y, mean+/-SD) and non-athletes (CON, n=13, 15.1+/-0.3 y) using a brightness mode ultrasonography. Skeletal age assessed with the Tanner-Whitehouse II method (20 hand-wrist bones) was similar in OWL (16.4+/-0.7 y) and CON (16.3+/-0.6 y). At the 6 sites (anterior forearm, anterior upper arm, posterior upper arm, chest, back and anterior thigh), OWL showed significantly greater Mt values than CON even in terms of Mt relative to body mass(1/3) Mt x BM(-1/3). On the other hand, there were no significant differences between the 2 groups in the Mt ratios of the anterior to posterior site in the upper arm, thigh and lower leg and those of the back to either the chest or abdomen in the trunk. For OWL only, skeletal age was significantly correlated to Mt x BM(-1/3) at the abdomen (r=0.869, p<0.05) and anterior thigh (r=0.883, p<0.05). The findings here indicate that 1) as compared to adolescent non-athletes, junior Olympic weight lifters show a greater muscularity in the upper body and anterior thigh without predominant development in either of anterior and posterior sites within the same body segment, 2) for junior Olympic weight lifters, the muscularity of abdominal and knee extensor muscles is influenced by the biological maturation.

Controlling a multi-degree of freedom upper limb prosthesis using foot controls: user experience.

PubMed

Resnik, Linda; Klinger, Shana Lieberman; Etter, Katherine; Fantini, Christopher

2014-07-01

The DEKA Arm, a pre-commercial upper limb prosthesis, funded by the DARPA Revolutionizing Prosthetics Program, offers increased degrees of freedom while requiring a large number of user control inputs to operate. To address this challenge, DEKA developed prototype foot controls. Although the concept of utilizing foot controls to operate an upper limb prosthesis has been discussed for decades, only small-sized studies have been performed and no commercial product exists. The purpose of this paper is to report amputee user perspectives on using three different iterations of foot controls to operate the DEKA Arm. Qualitative data was collected from 36 subjects as part of the Department of Veterans Affairs (VA) Study to Optimize the DEKA Arm through surveys, interviews, audio memos, and videotaped sessions. Three major, interrelated themes were identified using the constant comparative method: attitudes towards foot controls, psychomotor learning and physical experience of using foot controls. Feedback about foot controls was generally positive for all iterations. The final version of foot controls was viewed most favorably. Our findings indicate that foot controls are a viable control option that can enable control of a multifunction upper limb prosthesis (the DEKA Arm). Multifunction upper limb prostheses require many user control inputs to operate. Foot controls offer additional control input options for such advanced devices, yet have had minimal study. This study found that foot controls were a viable option for controlling multifunction upper limb prostheses. Most of the 36 subjects in this study were willing to adopt foot controls to control the multiple degrees of freedom of the DEKA Arm. With training and practice, all users were able to develop the psychomotor skills needed to successfully operate food controls. Some had initial difficulty, but acclimated over time.

Appropriateness of advanced upper limb prosthesis prescription for a patient with cognitive impairment: a case report.

PubMed

Barredo, Jennifer; Acluche, Frantzy; Disla, Roxanne; Fantini, Christopher; Fishelis, Leah; Sasson, Nicole; Resnik, Linda

2017-08-01

To describe a participant with scapulo-thoracic amputation and cognitive impairment trained to use the DEKA Arm and discuss factors relevant to the determination that he was not an appropriate candidate for independent home use of the device. The participant underwent 40 h of in-laboratory training with the DEKA Arm Advanced Upper Limb Prosthesis. Pre-training neuropsychological measures of cognition were collected. Qualitative and quantitative data related to functional performance, quality of life and pain were collected after 10 h of training, and at the conclusion of training. Using a constant comparative approach, data were binned into major themes; elements within each theme were identified. Six themes were relevant to the determination that the participant was inappropriate for home use of the DEKA Arm: physical and mental health; learning, memory and cognition; adult role function; functional performance; user safety and judgement and capacity for independent device use. Issues contraindicating unsupervised device use included: uncontrolled health symptoms, poor knowledge application, safety concerns, absenteeism and performance degradation under stress. The findings have implications for training with and prescription of the DEKA Arm and other complex upper limb prostheses. Further research is needed to develop a model to guide prescription of technologically complex upper limb prostheses. Implications for Rehabilitation Advanced upper limb prostheses, like the DEKA Arm, promise greater functionality, but also may be cognitively demanding, raising questions of when, and if, prescription is appropriate for patients with cognitive impairment. At this time, no formal criteria exist to guide prescription of advanced upper limb prostheses. Each clinical team applies their own informal standards in decision-making. In this case report, we described six factors that were considered in determining whether or not a research participant, with scapulo-thoracic amputation and cognitive impairment was appropriate for home use of a complex upper limb prosthesis. The findings have implications for training with and prescription of the DEKA Arm, and highlights the need for further research to develop prescription guidelines for advanced assistive devices.

Predicting Directly Measured Trunk and Upper Arm Postures in Paper Mill Work From Administrative Data, Workers' Ratings and Posture Observations.

PubMed

Heiden, Marina; Garza, Jennifer; Trask, Catherine; Mathiassen, Svend Erik

2017-03-01

A cost-efficient approach for assessing working postures could be to build statistical models for predicting results of direct measurements from cheaper data, and apply these models to samples in which only the latter data are available. The present study aimed to build and assess the performance of statistical models predicting inclinometer-assessed trunk and arm posture among paper mill workers. Separate models were built using administrative data, workers' ratings of their exposure, and observations of the work from video recordings as predictors. Trunk and upper arm postures were measured using inclinometry on 28 paper mill workers during three work shifts each. Simultaneously, the workers were video filmed, and their postures were assessed by observation of the videos afterwards. Workers' ratings of exposure, and administrative data on staff and production during the shifts were also collected. Linear mixed models were fitted for predicting inclinometer-assessed exposure variables (median trunk and upper arm angle, proportion of time with neutral trunk and upper arm posture, and frequency of periods in neutral trunk and upper arm inclination) from administrative data, workers' ratings, and observations, respectively. Performance was evaluated in terms of Akaike information criterion, proportion of variance explained (R2), and standard error (SE) of the model estimate. For models performing well, validity was assessed by bootstrap resampling. Models based on administrative data performed poorly (R2 ≤ 15%) and would not be useful for assessing posture in this population. Models using workers' ratings of exposure performed slightly better (8% ≤ R2 ≤ 27% for trunk posture; 14% ≤ R2 ≤ 36% for arm posture). The best model was obtained when using observational data for predicting frequency of periods with neutral arm inclination. It explained 56% of the variance in the postural exposure, and its SE was 5.6. Bootstrap validation of this model showed similar expected performance in other samples (5th-95th percentile: R2 = 45-63%; SE = 5.1-6.2). Observational data had a better ability to predict inclinometer-assessed upper arm exposures than workers' ratings or administrative data. However, observational measurements are typically more expensive to obtain. The results encourage analyses of the cost-efficiency of modeling based on administrative data, workers' ratings, and observation, compared to the performance and cost of measuring exposure directly. © The Author 2017. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.

Monitoring the adequacy of catch-up growth among moderately malnourished children receiving home-based therapy using mid-upper arm circumference in Southern Malawi

USDA-ARS?s Scientific Manuscript database

Each year more children die from moderate than severe malnutrition. Home-based therapy (HBT) using Ready-to-Use Therapeutic Foods (RUTF) has proven to successfully treat uncomplicated childhood malnutrition on an outpatient basis. This study attempts to discern if Mid-upper Arm Circumference (MUAC) ...

[A man with a painful upper arm after bench press exercise].

PubMed

Sijtsma, Ben C T; van der Veen, Hugo C; van Raay, Jos J A M

2015-01-01

A 22-year-old male bodybuilder presented with pain and a haematoma of his right upper arm after bench press exercises. Suspicion of a pectoralis muscle tear was confirmed by MRI and surgical repair was performed. Ruptures of the pectoralis major muscle are rare, but may occur in young male bodybuilders, typically after bench press exercises.

49 CFR 572.86 - Test conditions and dummy adjustment.

Code of Federal Regulations, 2012 CFR

2012-10-01

... lying on a horizontal surface and the neck assembly mounted and shoulders on the edge of the surface... surface with the shoulders on the edge of the surface, mount the head and tighten the head bolt and nut... upper arm and tighten firmly the adjustment bolts for the shoulder joint with the upper arm placed in a...

49 CFR 572.86 - Test conditions and dummy adjustment.

Code of Federal Regulations, 2014 CFR

2014-10-01

... lying on a horizontal surface and the neck assembly mounted and shoulders on the edge of the surface... surface with the shoulders on the edge of the surface, mount the head and tighten the head bolt and nut... upper arm and tighten firmly the adjustment bolts for the shoulder joint with the upper arm placed in a...

49 CFR 572.86 - Test conditions and dummy adjustment.

Code of Federal Regulations, 2011 CFR

2011-10-01

... lying on a horizontal surface and the neck assembly mounted and shoulders on the edge of the surface... surface with the shoulders on the edge of the surface, mount the head and tighten the head bolt and nut... upper arm and tighten firmly the adjustment bolts for the shoulder joint with the upper arm placed in a...

49 CFR 572.86 - Test conditions and dummy adjustment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... lying on a horizontal surface and the neck assembly mounted and shoulders on the edge of the surface... surface with the shoulders on the edge of the surface, mount the head and tighten the head bolt and nut... upper arm and tighten firmly the adjustment bolts for the shoulder joint with the upper arm placed in a...

49 CFR 572.86 - Test conditions and dummy adjustment.

Code of Federal Regulations, 2013 CFR

2013-10-01

... lying on a horizontal surface and the neck assembly mounted and shoulders on the edge of the surface... surface with the shoulders on the edge of the surface, mount the head and tighten the head bolt and nut... upper arm and tighten firmly the adjustment bolts for the shoulder joint with the upper arm placed in a...

Skin tightening with a combined unipolar and bipolar radiofrequency device.

PubMed

Mayoral, Flor A

2007-02-01

Monopolar radiofrequency (RF) devices are well established treatment modalities for tightening facial skin. A 60-year-old woman presented with a desire to tighten the lax skin and improve the appearance of both upper arms. A combination unipolar and bipolar RF device may provide volume reduction as well as skin tightening in the upper arm.

Effects of Action Observational Training Plus Brain-Computer Interface-Based Functional Electrical Stimulation on Paretic Arm Motor Recovery in Patient with Stroke: A Randomized Controlled Trial.

PubMed

Kim, TaeHoon; Kim, SeongSik; Lee, ByoungHee

2016-03-01

The purpose of this study was to investigate whether action observational training (AOT) plus brain-computer interface-based functional electrical stimulation (BCI-FES) has a positive influence on motor recovery of paretic upper extremity in patients with stroke. This was a hospital-based, randomized controlled trial with a blinded assessor. Thirty patients with a first-time stroke were randomly allocated to one of two groups: the BCI-FES group (n = 15) and the control group (n = 15). The BCI-FES group administered to AOT plus BCI-FES on the paretic upper extremity five times per week during 4 weeks while both groups received conventional therapy. The primary outcomes were the Fugl-Meyer Assessment of the Upper Extremity, Motor Activity Log (MAL), Modified Barthel Index and range of motion of paretic arm. A blinded assessor evaluated the outcomes at baseline and 4 weeks. All baseline outcomes did not differ significantly between the two groups. After 4 weeks, the Fugl-Meyer Assessment of the Upper Extremity sub-items (total, shoulder and wrist), MAL (MAL-Activity of Use and Quality of Movement), Modified Barthel Index and wrist flexion range of motion were significantly higher in the BCI-FES group (p < 0.05). AOT plus BCI-based FES is effective in paretic arm rehabilitation by improving the upper extremity performance. The motor improvements suggest that AOT plus BCI-based FES can be used as a therapeutic tool for stroke rehabilitation. The limitations of the study are that subjects had a certain limited level of upper arm function, and the sample size was comparatively small; hence, it is recommended that future large-scale trials should consider stratified and lager populations according to upper arm function. Copyright © 2015 John Wiley & Sons, Ltd.

The development of an arm activity survey for breast cancer survivors using the Protection Motivation Theory.

PubMed

Lee, Teresa S; Kilbreath, Sharon L; Sullivan, Gerard; Refshauge, Kathryn M; Beith, Jane M

2007-05-08

Current research evidence indicates that women should return to normal use of their arm after breast cancer surgery. However, it appears some women continue to hold the view that they are supposed to protect their arm from strenuous activities because of the risk of lymphoedema. Many factors contribute to women's perceptions about lymphoedema and their ability to use their affected arm, and it is the aim of this study to explore and understand these perceptions. A survey, based on the Protection Motivation Theory, has been developed and tested. The survey assesses whether subjective norms, fear and/or coping attributes predict women's intention to use their affected arm. In addition, the survey includes questions regarding cancer treatment and demographic characteristics, arm and chest symptoms, and arm function. Recruitment of 170 breast cancer survivors has begun at 3 cancer treatment sites in Sydney, Australia. This study will identify perceptions that help predict the extent women use their affected arm. The results will also determine whether upper limb impairments arise secondary to over-protection of the affected arm. Identification of factors that limit arm use will enable appropriate prevention and better provision of treatment to improve upper limb outcomes.

Current situation regarding central venous port implantation procedures and complications: a questionnaire-based survey of 11,693 implantations in Japan.

PubMed

Shiono, Masatoshi; Takahashi, Shin; Takahashi, Masanobu; Yamaguchi, Takuhiro; Ishioka, Chikashi

2016-12-01

We conducted a nationwide questionnaire-based survey to understand the current situation regarding central venous port implantation in order to identify the ideal procedure. Questionnaire sheets concerning the number of implantation procedures and the incidence of complications for all procedures completed in 2012 were sent to 397 nationwide designated cancer care hospitals in Japan in June 2013. Venipuncture sites were categorized as chest, neck, upper arm, forearm, and others. Methods were categorized as landmark, cut-down, ultrasound-mark, real-time ultrasound guided, venography, and other groups. We received 374 responses (11,693 procedures) from 153 centers (38.5 %). The overall complication rates were 7.4 % for the chest (598/8,097 cases); 6.8 % for the neck (157/2325); 5.2 % for the upper arm (54/1,033); 7.3 % for the forearm (9/124); and 6.1 % for the other groups (7/114). Compared to the chest group, only the upper arm group showed a significantly lower incidence of complications (P = 0.010), and multivariate logistic regression (odds ratio 0.69; 95 % confidence interval 0.51-0.91; P = 0.008) also showed similar findings. Real-time ultrasound-guided puncture was most commonly used in the upper arm group (83.8 %), followed by the neck (69.8 %), forearm (53.2 %), chest (41.8 %), and other groups (34.2 %). Upper arm venipuncture with ultrasound guidance seems the most promising technique to prevent complications of central venous port implantation.

Brachioplasty outcomes: a review of a multipractice cohort.

PubMed

Zomerlei, Terri A; Neaman, Keith C; Armstrong, Shannon D; Aitken, Marguerite E; Cullen, William T; Ford, Ronald D; Renucci, John D; VanderWoude, Douglas L

2013-04-01

Upper arm deformities secondary to massive weight loss or senile elastosis have led to an increased demand for aesthetic contouring procedures such as brachioplasty. The records of all patients who underwent a brachioplasty procedure from a multipractice medical center were reviewed. Outcomes measured included patient demographics, operative interventions, and postoperative course. Ninety-six patients were analyzed. Fifty-three patients (55.2 percent) underwent a concomitant procedure, with 53.1 percent undergoing arm liposuction at the time of brachioplasty. Major and minor complications rates were 17.7 percent and 44.8 percent, respectively. Common complications included hypertrophic scarring (24.0 percent) and infection (14.6 percent). The total revision rate was 22.9 percent, with residual contour deformity (40.9 percent of revisions) and hypertrophic scarring (36.4 percent of revisions) representing the most common causes for revision. Patients who underwent a previous bariatric procedure were at an increased risk of developing a major complication (p = 0.02). Concomitant upper arm liposuction and concomitant procedures were not associated with a significantly increased complication rate. Brachioplasty, despite being an effective treatment for contour irregularities of the upper arm, is associated with significant revision and complication rates. Post-bariatric surgery patients should be informed of the potential for increased complications. Additional procedures performed at the time of brachioplasty do not significantly increase complications. Liposuction of the upper arm can be performed safely in conjunction with brachioplasty.

Identification and classification of upper limb motions using PCA.

PubMed

Veer, Karan; Vig, Renu

2018-03-28

This paper describes the utility of principal component analysis (PCA) in classifying upper limb signals. PCA is a powerful tool for analyzing data of high dimension. Here, two different input strategies were explored. The first method uses upper arm dual-position-based myoelectric signal acquisition and the other solely uses PCA for classifying surface electromyogram (SEMG) signals. SEMG data from the biceps and the triceps brachii muscles and four independent muscle activities of the upper arm were measured in seven subjects (total dataset=56). The datasets used for the analysis are rotated by class-specific principal component matrices to decorrelate the measured data prior to feature extraction.

Ergonomic design and training for preventing work-related musculoskeletal disorders of the upper limb and neck in adults.

PubMed

Hoe, Victor C W; Urquhart, Donna M; Kelsall, Helen L; Sim, Malcolm R

2012-08-15

Work-related upper limb and neck musculoskeletal disorders (MSDs) are one of the most common occupational disorders around the world. Although ergonomic design and training are likely to reduce the risk of workers developing work-related upper limb and neck MSDs, the evidence is unclear. To assess the effects of workplace ergonomic design or training interventions, or both, for the prevention of work-related upper limb and neck MSDs in adults. We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, AMED, Web of Science (Science Citation Index), SPORTDiscus, Cochrane Occupational Safety and Health Review Group Database and Cochrane Bone, Joint and Muscle Trauma Group Specialised Register to July 2010, and Physiotherapy Evidence Database, US Centers for Disease Control and Prevention, the National Institute for Occupational Safety and Health database, and International Occupational Safety and Health Information Centre database to November 2010. We included randomised controlled trials (RCTs) of ergonomic workplace interventions for preventing work-related upper limb and neck MSDs. We included only studies with a baseline prevalence of MSDs of the upper limb or neck, or both, of less than 25%. Two review authors independently extracted data and assessed risk of bias. We included studies with relevant data that we judged to be sufficiently homogeneous regarding the intervention and outcome in the meta-analysis. We assessed the overall quality of the evidence for each comparison using the GRADE approach. We included 13 RCTs (2397 workers). Eleven studies were conducted in an office environment and two in a healthcare setting. We judged one study to have a low risk of bias. The 13 studies evaluated effectiveness of ergonomic equipment, supplementary breaks or reduced work hours, ergonomic training, a combination of ergonomic training and equipment, and patient lifting interventions for preventing work-related MSDs of the upper limb and neck in adults.Overall, there was moderate-quality evidence that arm support with alternative mouse reduced the incidence of neck/shoulder disorders (risk ratio (RR) 0.52; 95% confidence interval (CI) 0.27 to 0.99) but not the incidence of right upper limb MSDs (RR 0.73; 95% CI 0.32 to 1.66); and low-quality evidence that this intervention reduced neck/shoulder discomfort (standardised mean difference (SMD) -0.41; 95% CI -0.69 to -0.12) and right upper limb discomfort (SMD -0.34; 95% CI -0.63 to -0.06).There was also moderate-quality evidence that the incidence of neck/shoulder and right upper limb disorders were not reduced when comparing alternative mouse and conventional mouse (neck/shoulder RR 0.62; 95% CI 0.19 to 2.00; right upper limb RR 0.91; 95% CI 0.48 to 1.72), arm support and no arm support with conventional mouse (neck/shoulder RR 0.67; 95% CI 0.36 to 1.24; right upper limb RR 1.09; 95% CI 0.51 to 2.29), and alternative mouse with arm support and conventional mouse with arm support (neck/shoulder RR 0.58; 95% CI 0.30 to 1.12; right upper limb RR 0.92; 95% CI 0.36 to 2.36).There was low-quality evidence that using an alternative mouse with arm support compared to conventional mouse with arm support reduced neck/shoulder discomfort (SMD -0.39; 95% CI -0.67 to -0.10). There was low- to very low-quality evidence that other interventions were not effective in reducing work-related upper limb and neck MSDs in adults. We found moderate-quality evidence to suggest that the use of arm support with alternative mouse may reduce the incidence of neck/shoulder MSDs, but not right upper limb MSDs. Moreover, we found moderate-quality evidence to suggest that the incidence of neck/shoulder and right upper limb MSDs is not reduced when comparing alternative and conventional mouse with and without arm support. However, given there were multiple comparisons made involving a number of interventions and outcomes, high-quality evidence is needed to determine the effectiveness of these interventions clearly. While we found very-low- to low-quality evidence to suggest that other ergonomic interventions do not prevent work-related MSDs of the upper limb and neck, this was limited by the paucity and heterogeneity of available studies. This review highlights the need for high-quality RCTs examining the prevention of MSDs of the upper limb and neck.

A strategy for computer-assisted mental practice in stroke rehabilitation.

PubMed

Gaggioli, Andrea; Meneghini, Andrea; Morganti, Francesca; Alcaniz, Mariano; Riva, Giuseppe

2006-12-01

To investigate the technical and clinical viability of using computer-facilitated mental practice in the rehabilitation of upper-limb hemiparesis following stroke. A single-case study. Academic-affiliated rehabilitation center. A 46-year-old man with stable motor deficit of the upper right limb following subcortical ischemic stroke. Three computer-enhanced mental practice sessions per week at the rehabilitation center, in addition to usual physical therapy. A custom-made virtual reality system equipped with arm-tracking sensors was used to guide mental practice. The system was designed to superimpose over the (unseen) paretic arm a virtual reconstruction of the movement registered from the nonparetic arm. The laboratory intervention was followed by a 1-month home-rehabilitation program, making use of a portable display device. Pretreatment and posttreatment clinical assessment measures were the upper-extremity scale of the Fugl-Meyer Assessment of Sensorimotor Impairment and the Action Research Arm Test. Performance of the affected arm was evaluated using the healthy arm as the control condition. The patient's paretic limb improved after the first phase of intervention, with modest increases after home rehabilitation, as indicated by functional assessment scores and sensors data. Results suggest that technology-supported mental training is a feasible and potentially effective approach for improving motor skills after stroke.

Effects of wrist tendon vibration on targeted upper-arm movements in poststroke hemiparesis.

PubMed

Conrad, Megan O; Scheidt, Robert A; Schmit, Brian D

2011-01-01

Impaired motor control of the upper extremity after stroke may be related to lost sensory, motor, and integrative functions of the brain. Artificial activation of sensory afferents might improve control of movement by adding excitatory drive to sensorimotor control structures. The authors evaluated the effect of wrist tendon vibration (TV) on paretic upper-arm stability during point-to-point planar movements. TV (70 Hz) was applied to the forearm wrist musculature of 10 hemiparetic stroke patients as they made center-out planar arm movements. End-point stability, muscle activity, and grip pressure were compared as patients stabilized at the target position for trials completed before, during, and after the application of the vibratory stimulus. Prior to vibration, hand position fluctuated as participants attempted to maintain the hand at the target after movement termination. TV improved arm stability, as evidenced by decreased magnitude of hand tangential velocity at the target. Improved stability was accompanied by a decrease in muscle activity throughout the arm as well as a mean decrease in grip pressure. These results suggest that vibratory stimulation of the distal wrist musculature enhances stability of the proximal arm and can be studied further as a mode for improving end-point stability during reaching in hemiparetic patients.

49 CFR 572.196 - Thorax without arm.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 7 2012-10-01 2012-10-01 false Thorax without arm. 572.196 Section 572.196... Dummy, Small Adult Female § 572.196 Thorax without arm. (a) The thorax is part of the upper torso... (drawing 180-0000) with the arm (180-6000) on the impacted side removed. The dummy's thorax is equipped...

49 CFR 572.196 - Thorax without arm.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 7 2014-10-01 2014-10-01 false Thorax without arm. 572.196 Section 572.196... Test Dummy, Small Adult Female § 572.196 Thorax without arm. (a) The thorax is part of the upper torso... (drawing 180-0000) with the arm (180-6000) on the impacted side removed. The dummy's thorax is equipped...

49 CFR 572.196 - Thorax without arm.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 7 2011-10-01 2011-10-01 false Thorax without arm. 572.196 Section 572.196... Dummy, Small Adult Female § 572.196 Thorax without arm. (a) The thorax is part of the upper torso... (drawing 180-0000) with the arm (180-6000) on the impacted side removed. The dummy's thorax is equipped...

49 CFR 572.196 - Thorax without arm.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 7 2013-10-01 2013-10-01 false Thorax without arm. 572.196 Section 572.196... Test Dummy, Small Adult Female § 572.196 Thorax without arm. (a) The thorax is part of the upper torso... (drawing 180-0000) with the arm (180-6000) on the impacted side removed. The dummy's thorax is equipped...

Self-Administered, Home-Based SMART (Sensorimotor Active Rehabilitation Training) Arm Training: A Single-Case Report.

PubMed

Hayward, Kathryn S; Neibling, Bridee A; Barker, Ruth N

2015-01-01

This single-case, mixed-method study explored the feasibility of self-administered, home-based SMART (sensorimotor active rehabilitation training) Arm training for a 57-yr-old man with severe upper-limb disability after a right frontoparietal hemorrhagic stroke 9 mo earlier. Over 4 wk of self-administered, home-based SMART Arm training, the participant completed 2,100 repetitions unassisted. His wife provided support for equipment set-up and training progressions. Clinically meaningful improvements in arm impairment (strength), activity (arm and hand tasks), and participation (use of arm in everyday tasks) occurred after training (at 4 wk) and at follow-up (at 16 wk). Areas for refinement of SMART Arm training derived from thematic analysis of the participant's and researchers' journals focused on enabling independence, ensuring home and user friendliness, maintaining the motivation to persevere, progressing toward everyday tasks, and integrating practice into daily routine. These findings suggest that further investigation of self-administered, home-based SMART Arm training is warranted for people with stroke who have severe upper-limb disability. Copyright © 2015 by the American Occupational Therapy Association, Inc.

[A case of chronic multifocal myositis].

PubMed

Maruyama, T; Kondo, K; Tabata, K; Yanagisawa, N

1992-11-01

A 61-year-old civil engineer began to have slowly progressive muscle atrophy in the right shoulder and the left arm at 56 years of age. Muscle wasting became manifest in the left thigh at 59 years and in the right thigh at 60 years. He had mild difficulty in climbing and descending stairs. On examination, although he had notable muscle atrophy in the right trapezius and proximal muscles in the upper and lower extremities, his muscle strength was relatively well preserved. The muscle atrophy was asymmetrical; the right periscapular region and the left upper and lower extremities were more markedly atrophic. In addition, multiple foci of the striking muscle atrophy were noted in the upper trunk and the proximal limb muscles. Fasciculation was not present. Deep tendon reflexes were normal with no pathologic reflexes. Except for a moderately elevated serum creatine kinase level of 709 Ul/l (normal 40-170) and mildly elevated serum myoglobin level of 100 ng/ml (normal < 60), no laboratory tests showed abnormal values suggesting an inflammatory process. Motor and sensory nerve conduction velocities were within normal limits. Electromyography disclosed myopathic and neuropathic changes. Computed tomography (CT) of skeletal muscles showed asymmetrical muscle atrophy and patchy low-density foci. In biopsied left quadriceps and right gastrocnemius muscles which showed partially low density on CT, there was marked variation in muscle fiber size, with necrotic and regenerating fibers, an increased number of centrally placed nuclei, and interstitial fibrosis. There were numerous foci of mononuclear inflammatory cellular infiltration, especially around the blood vessels.(ABSTRACT TRUNCATED AT 250 WORDS)

Upper arm anthropometrics versus DXA scan in survivors of acute respiratory distress syndrome.

PubMed

Chan, Kitty S; Mourtzakis, Marina; Aronson Friedman, Lisa; Dinglas, Victor D; Hough, Catherine L; Ely, E Wesley; Morris, Peter E; Hopkins, Ramona O; Needham, Dale M

2018-04-01

Survivors of acute respiratory distress syndrome (ARDS) experience severe muscle wasting. Upper arm anthropometrics can provide a quick, non-invasive estimate of muscle status, but its accuracy is unknown. This study examines the accuracy of upper arm percent muscle area (UAMA) with reference measures of lean mass from dual energy X-ray absorptiometry (DXA). Data are from 120 ARDS survivors participating in a multicenter national study. Receiver operating characteristic (ROC) curves, by patient sex, demonstrated that UAMA did no better than chance in discriminating low appendicular skeletal muscle mass identified using DXA findings (c-statistics, 6 months: 0.50-0.59, 12 months: 0.54-0.57). Modest correlations of UAMA with DXA measures (whole-body: r = 0.46-0.49, arm-specific: r = 0.50-0.51, p < 0.001) and Bland-Altman plots indicate poor precision. UAMA is not an appropriate screening measure for estimating muscle mass when compared to a DXA reference standard. Alternate screening measures should be evaluated in ARDS survivors.

World and Olympic mountain bike champions' anthropometry, body composition and somatotype.

PubMed

Sánchez-Muñoz, Cristóbal; Muros, José J; Zabala, Mikel

2018-06-01

The aim of the study was to describe the anthropometric profile of male Olympic cross country (XCO) mountain bikers. Fifty one XCO bikers participated in this study, divided into an elite group who competed in top level international competitions, and a non-elite group who competed at a national level. The elite group was further classified according to whether they had been world or Olympic champion mountain bikers (WOC) or not (NWOC). The anthropometric profiles included the measurements of height, weight, arm span, skinfolds, girths, and breadths. Body Mass Index (BMI), body composition and somatotype were also calculated. Variables was described as mean, standard deviation and range. The standardizing of the variables was carried out using the Shapiro-Wilk with Lillieforts correction and homoscedasticity was analyzed using the Levene Test. After verifying that the variables were normal, the data were analyzed using non-paired t-tests (elite vs. non-elite and WOC vs. NWOC). Elite riders had significantly lower BMI, lower percentage of fat, total thigh area and larger thigh muscle area than the sub-elite riders, and presented significantly lower values for the endomorphic component and higher values for the ectomorphic component. The mean somatotype of the elite riders could be defined as ecto-mesomorphic (1.7-4.6-3.1). Comparisons between of WOC riders and NWOC, showed that the WOC bikers had a significantly higher value for weight, arm span, upper arm girth relaxed and upper arm girth flexed and tensed, calf girth, total upper arm area, and upper arm muscle area than the NWOC riders group.

Estimation of distal arm joint angles from EMG and shoulder orientation for transhumeral prostheses.

PubMed

Akhtar, Aadeel; Aghasadeghi, Navid; Hargrove, Levi; Bretl, Timothy

2017-08-01

In this paper, we quantify the extent to which shoulder orientation, upper-arm electromyography (EMG), and forearm EMG are predictors of distal arm joint angles during reaching in eight subjects without disability as well as three subjects with a unilateral transhumeral amputation and targeted reinnervation. Prior studies have shown that shoulder orientation and upper-arm EMG, taken separately, are predictors of both elbow flexion/extension and forearm pronation/supination. We show that, for eight subjects without disability, shoulder orientation and upper-arm EMG together are a significantly better predictor of both elbow flexion/extension during unilateral (R 2 =0.72) and mirrored bilateral (R 2 =0.72) reaches and of forearm pronation/supination during unilateral (R 2 =0.77) and mirrored bilateral (R 2 =0.70) reaches. We also show that adding forearm EMG further improves the prediction of forearm pronation/supination during unilateral (R 2 =0.82) and mirrored bilateral (R 2 =0.75) reaches. In principle, these results provide the basis for choosing inputs for control of transhumeral prostheses, both by subjects with targeted motor reinnervation (when forearm EMG is available) and by subjects without target motor reinnervation (when forearm EMG is not available). In particular, we confirm that shoulder orientation and upper-arm EMG together best predict elbow flexion/extension (R 2 =0.72) for three subjects with unilateral transhumeral amputations and targeted motor reinnervation. However, shoulder orientation alone best predicts forearm pronation/supination (R 2 =0.88) for these subjects, a contradictory result that merits further study. Copyright © 2017 Elsevier Ltd. All rights reserved.

Training of reaching in stroke survivors with severe and chronic upper limb paresis using a novel nonrobotic device: a randomized clinical trial.

PubMed

Barker, Ruth N; Brauer, Sandra G; Carson, Richard G

2008-06-01

Severe upper limb paresis is a major contributor to disability after stroke. This study investigated the efficacy of a new nonrobotic training device, the Sensorimotor Active Rehabilitation Training (SMART) Arm, that was used with or without electromyography-triggered electrical stimulation of triceps brachii to augment elbow extension, permitting stroke survivors with severe paresis to practice a constrained reaching task. A single-blind, randomized clinical trial was conducted with 42 stroke survivors with severe and chronic paresis. Thirty-three participants completed the study, of whom 10 received training using the SMART Arm with electromyography-triggered electrical stimulation, 13 received training using the SMART Arm alone, and 10 received no intervention (control). Training consisted of 12 1-hour sessions over 4 weeks. The primary outcome measure was "upper arm function," item 6 of the Motor Assessment Scale. Secondary outcome measures included impairment measures; triceps muscle strength, reaching force, modified Ashworth scale; and activity measures: reaching distance and Motor Assessment Scale. Assessments were administered before (0 weeks) and after training (4 weeks) and at 2 months follow-up (12 weeks). Both SMART Arm groups demonstrated significant improvements in all impairment and activity measures after training and at follow-up. There was no significant difference between these 2 groups. There was no change in the control group. Our findings indicate that training of reaching using the SMART Arm can reduce impairment and improve activity in stroke survivors with severe and chronic upper limb paresis, highlighting the benefits of intensive task-oriented practice, even in the context of severe paresis.

Piezoelectric film load cell robot collision detector

DOEpatents

Lembke, J.R.

1988-03-15

A piezoelectric load cell which can be utilized for detecting collisions and obstruction of a robot arm end effector includes a force sensing element of metallized polyvinylidene fluoride (PVDF) film. The piezoelectric film sensing element and a resilient support pad are clamped in compression between upper and lower plates. The lower plate has a central recess in its upper face for supporting the support pad and sensing element, while the upper plate has a corresponding central projection formed on its lower face for bearing on the sensing element and support pad. The upper and lower plates are dowelled together for concentric alignment and screwed together. The upper and lower plates are also adapted for mounting between the robot arm wrist and end effector. 3 figs.

Piezoelectric film load cell robot collision detector

DOEpatents

Lembke, John R.

1989-04-18

A piezoelectric load cell which can be utilized for detecting collisions and obstruction of a robot arm end effector includes a force sensing element of metallized polyvinylidene fluoride (PVDF) film. The piezoelectric film sensing element and a resilient support pad are clamped in compression between upper and lower plates. The lower plate has a central recess in its upper face for supporting the support pad and sensing element, while the upper plate has a corresponding central projection formed on its lower face for bearing on the sensing element and support pad. The upper and lower plates are dowelled together for concentric alignment and screwed together. The upper and lower plates are also adapted for mounting between the robot arm wrist and end effector.

Piezoelectric film load cell robot collision detector

DOEpatents

Lembke, J.R.

1989-04-18

A piezoelectric load cell which can be utilized for detecting collisions and obstruction of a robot arm end effector includes a force sensing element of metallized polyvinylidene fluoride (PVDF) film. The piezoelectric film sensing element and a resilient support pad are clamped in compression between upper and lower plates. The lower plate has a central recess in its upper face for supporting the support pad and sensing element, while the upper plate has a corresponding central projection formed on its lower face for bearing on the sensing element and support pad. The upper and lower plates are doweled together for concentric alignment and screwed together. The upper and lower plates are also adapted for mounting between the robot arm wrist and end effector. 3 figs.

The Physiological Mechanisms of Performance Enhancement with Sprint Interval Training Differ between the Upper and Lower Extremities in Humans.

PubMed

Zinner, Christoph; Morales-Alamo, David; Ørtenblad, Niels; Larsen, Filip J; Schiffer, Tomas A; Willis, Sarah J; Gelabert-Rebato, Miriam; Perez-Valera, Mario; Boushel, Robert; Calbet, Jose A L; Holmberg, Hans-Christer

2016-01-01

To elucidate the mechanisms underlying the differences in adaptation of arm and leg muscles to sprint training, over a period of 11 days 16 untrained men performed six sessions of 4-6 × 30-s all-out sprints (SIT) with the legs and arms, separately, with a 1-h interval of recovery. Limb-specific VO 2 peak, sprint performance (two 30-s Wingate tests with 4-min recovery), muscle efficiency and time-trial performance (TT, 5-min all-out) were assessed and biopsies from the m. vastus lateralis and m. triceps brachii taken before and after training. VO 2 peak and Wmax increased 3-11% after training, with a more pronounced change in the arms ( P < 0.05). Gross efficiency improved for the arms (+8.8%, P < 0.05), but not the legs (-0.6%). Wingate peak and mean power outputs improved similarly for the arms and legs, as did TT performance. After training, VO 2 during the two Wingate tests was increased by 52 and 6% for the arms and legs, respectively ( P < 0.001). In the case of the arms, VO 2 was higher during the first than second Wingate test (64 vs. 44%, P < 0.05). During the TT, relative exercise intensity, HR, VO 2 , VCO 2 , V E , and V t were all lower during arm-cranking than leg-pedaling, and oxidation of fat was minimal, remaining so after training. Despite the higher relative intensity, fat oxidation was 70% greater during leg-pedaling ( P = 0.017). The aerobic energy contribution in the legs was larger than for the arms during the Wingate tests, although VO 2 for the arms was enhanced more by training, reducing the O 2 deficit after SIT. The levels of muscle glycogen, as well as the myosin heavy chain composition were unchanged in both cases, while the activities of 3-hydroxyacyl-CoA-dehydrogenase and citrate synthase were elevated only in the legs and capillarization enhanced in both limbs. Multiple regression analysis demonstrated that the variables that predict TT performance differ for the arms and legs. The primary mechanism of adaptation to SIT by both the arms and legs is enhancement of aerobic energy production. However, with their higher proportion of fast muscle fibers, the arms exhibit greater plasticity.

The Physiological Mechanisms of Performance Enhancement with Sprint Interval Training Differ between the Upper and Lower Extremities in Humans

PubMed Central

Zinner, Christoph; Morales-Alamo, David; Ørtenblad, Niels; Larsen, Filip J.; Schiffer, Tomas A.; Willis, Sarah J.; Gelabert-Rebato, Miriam; Perez-Valera, Mario; Boushel, Robert; Calbet, Jose A. L.; Holmberg, Hans-Christer

2016-01-01

To elucidate the mechanisms underlying the differences in adaptation of arm and leg muscles to sprint training, over a period of 11 days 16 untrained men performed six sessions of 4–6 × 30-s all-out sprints (SIT) with the legs and arms, separately, with a 1-h interval of recovery. Limb-specific VO2peak, sprint performance (two 30-s Wingate tests with 4-min recovery), muscle efficiency and time-trial performance (TT, 5-min all-out) were assessed and biopsies from the m. vastus lateralis and m. triceps brachii taken before and after training. VO2peak and Wmax increased 3–11% after training, with a more pronounced change in the arms (P < 0.05). Gross efficiency improved for the arms (+8.8%, P < 0.05), but not the legs (−0.6%). Wingate peak and mean power outputs improved similarly for the arms and legs, as did TT performance. After training, VO2 during the two Wingate tests was increased by 52 and 6% for the arms and legs, respectively (P < 0.001). In the case of the arms, VO2 was higher during the first than second Wingate test (64 vs. 44%, P < 0.05). During the TT, relative exercise intensity, HR, VO2, VCO2, VE, and Vt were all lower during arm-cranking than leg-pedaling, and oxidation of fat was minimal, remaining so after training. Despite the higher relative intensity, fat oxidation was 70% greater during leg-pedaling (P = 0.017). The aerobic energy contribution in the legs was larger than for the arms during the Wingate tests, although VO2 for the arms was enhanced more by training, reducing the O2 deficit after SIT. The levels of muscle glycogen, as well as the myosin heavy chain composition were unchanged in both cases, while the activities of 3-hydroxyacyl-CoA-dehydrogenase and citrate synthase were elevated only in the legs and capillarization enhanced in both limbs. Multiple regression analysis demonstrated that the variables that predict TT performance differ for the arms and legs. The primary mechanism of adaptation to SIT by both the arms and legs is enhancement of aerobic energy production. However, with their higher proportion of fast muscle fibers, the arms exhibit greater plasticity. PMID:27746738

Upper extremity sensorimotor control among collegiate football players.

PubMed

Laudner, Kevin G

2012-03-01

Injuries stemming from shoulder instability are very common among athletes participating in contact sports, such as football. Previous research has shown that increased laxity negatively affects the function of the sensorimotor system potentially leading to a pathological cycle of shoulder dysfunction. Currently, there are no data detailing such effects among football players. Therefore, the purpose of this study was to examine the differences in upper extremity sensorimotor control among football players compared with that of a control group. Forty-five collegiate football players and 70 male control subjects with no previous experience in contact sports participated. All the subjects had no recent history of upper extremity injury. Each subject performed three 30-second upper extremity balance trials on each arm. The balance trials were conducted in a single-arm push-up position with the test arm in the center of a force platform and the subjects' feet on a labile device. The trials were averaged, and the differences in radial area deviation between groups were analyzed using separate 1-way analyses of variance (p < 0.05). The football players showed significantly more radial area deviation of the dominant (0.41 ± 1.23 cm2, p = 0.02) and nondominant arms (0.47 ± 1.63 cm2, p = 0.03) when compared with the control group. These results suggest that football players may have decreased sensorimotor control of the upper extremity compared with individuals with no contact sport experience. The decreased upper extremity sensorimotor control among the football players may be because of the frequent impacts accumulated during football participation. Football players may benefit from exercises that target the sensorimotor system. These findings may also be beneficial in the evaluation and treatment of various upper extremity injuries among football players.

Reliability of the Inverse Water Volumetry Method to Measure the Volume of the Upper Limb.

PubMed

Beek, Martinus A; te Slaa, Alexander; van der Laan, Lijckle; Mulder, Paul G H; Rutten, Harm J T; Voogd, Adri C; Luiten, Ernest J T; Gobardhan, Paul D

2015-06-01

Lymphedema of the upper extremity is a common side effect of lymph node dissection or irradiation of the axilla. Several techniques are being applied in order to examine the presence and severity of lymphedema. Measurement of circumference of the upper extremity is most frequently performed. An alternative is the water-displacement method. The aim of this study was to determine the reliability and the reproducibility of the "Inverse Water Volumetry apparatus" (IWV-apparatus) for the measurement of arm volumes. The IWV-apparatus is based on the water-displacement method. Measurements were performed by three breast cancer nurse practitioners on ten healthy volunteers in three weekly sessions. The intra-class correlation coefficient, defined as the ratio of the subject component to the total variance, equaled 0.99. The reliability index is calculated as 0.14 kg. This indicates that only changes in a patient's arm volume measurement of more than 0.14 kg would represent a true change in arm volume, which is about 6% of the mean arm volume of 2.3 kg. The IWV-apparatus proved to be a reliable and reproducible method to measure arm volume.

Forearm versus upper arm grafts for vascular access.

PubMed

Gage, Shawn M; Lawson, Jeffrey H

2017-03-06

Forearm and upper arm arteriovenous grafts perform similarly in terms of patency and complications. Primary patency at 1 year for forearm arteriovenous grafts versus upper arm grafts ranges from 22%-50% versus 22%-42%, and secondary patency at 1 year ranges from 78%-89% versus 52%-67%), respectively. Secondary patency at 2 years, ranges from 30%-64% versus 35%-60% for forearm and upper arteriovenous graft, respectively. Ample pre-operative planning is essential to improved clinical success and the decision to place a graft at one location versus the other should be based solely on previous access history, physical exam, appropriate venous imaging, and other factors that make up the clinical picture. Operative implant strategies and risk of complications are very similar between the two configurations. Postoperative ischemia due to steal syndrome is a potential complication that requires immediate attention. Utilization of the proximal radial or ulnar artery for inflow for the graft can minimize risk of clinically relevant steal syndrome.

Three-Dimensional Scapular Kinematics in Patients with Reverse Total Shoulder Arthroplasty during Arm Motion.

PubMed

Lee, Kwang Won; Kim, Yong In; Kim, Ha Yong; Yang, Dae Suk; Lee, Gyu Sang; Choy, Won Sik

2016-09-01

There have been few reports on altered kinematics of the shoulder after reverse total shoulder arthroplasty (RTSA). We investigated differences in 3-dimensional (3D) scapular motions assessed using an optical tracking system between RTSA treated shoulders and asymptomatic contralateral shoulders during arm motion. Thirteen patients who underwent RTSA were assessed for active arm elevation in 2 distinct elevation planes (sagittal plane flexion and scapular plane abduction). Their mean age was 72 years (range, 69 to 79 years) and the mean follow-up was 24.4 months (range, 13 to 48 months). The dominant side was the right side in all the 13 patients, and it was also the side treated with RTSA. Scapular kinematics was recorded with an optical tracking system. The scapular kinematics and the scapulohumeral rhythm (SHR) of the RTSA shoulders and asymptomatic contralateral shoulders were recorded and analyzed during arm elevation. There were no significant differences in internal/external rotation and anterior/posterior tilting of the scapula between shoulders during arm motion (p > 0.05). However, upward rotation of the scapula differed significantly during arm motion (p = 0.035 for sagittal plane flexion; p = 0.046 for scapular plane abduction). There were significant differences in the SHR between the two shoulders (p = 0.016 for sagittal plane flexion; p = 0.021 for scapular plane abduction). The shoulder kinematics after RTSA showed significant differences from the contralateral asymptomatic shoulders. Increased upward rotation and decreased SHR after RTSA indicate that RTSA shoulders use more scapulothoracic motion and less glenohumeral motion to elevate the arm.

Three-Dimensional Scapular Kinematics in Patients with Reverse Total Shoulder Arthroplasty during Arm Motion

PubMed Central

Lee, Kwang Won; Kim, Ha Yong; Yang, Dae Suk; Lee, Gyu Sang; Choy, Won Sik

2016-01-01

Background There have been few reports on altered kinematics of the shoulder after reverse total shoulder arthroplasty (RTSA). We investigated differences in 3-dimensional (3D) scapular motions assessed using an optical tracking system between RTSA treated shoulders and asymptomatic contralateral shoulders during arm motion. Methods Thirteen patients who underwent RTSA were assessed for active arm elevation in 2 distinct elevation planes (sagittal plane flexion and scapular plane abduction). Their mean age was 72 years (range, 69 to 79 years) and the mean follow-up was 24.4 months (range, 13 to 48 months). The dominant side was the right side in all the 13 patients, and it was also the side treated with RTSA. Scapular kinematics was recorded with an optical tracking system. The scapular kinematics and the scapulohumeral rhythm (SHR) of the RTSA shoulders and asymptomatic contralateral shoulders were recorded and analyzed during arm elevation. Results There were no significant differences in internal/external rotation and anterior/posterior tilting of the scapula between shoulders during arm motion (p > 0.05). However, upward rotation of the scapula differed significantly during arm motion (p = 0.035 for sagittal plane flexion; p = 0.046 for scapular plane abduction). There were significant differences in the SHR between the two shoulders (p = 0.016 for sagittal plane flexion; p = 0.021 for scapular plane abduction). Conclusions The shoulder kinematics after RTSA showed significant differences from the contralateral asymptomatic shoulders. Increased upward rotation and decreased SHR after RTSA indicate that RTSA shoulders use more scapulothoracic motion and less glenohumeral motion to elevate the arm. PMID:27583116

The Effect of Restricted Arm Swing on Energy Expenditure in Healthy Men

ERIC Educational Resources Information Center

Yizhar, Ziva; Boulos, Spiro; Inbar, Omri; Carmeli, Eli

2009-01-01

Arm swing in human walking is an active natural motion involving the upper extremities. Earlier studies have described the interrelationship between arms and legs during walking, but the effect of arm swing on energy expenditure and dynamic parameters during normal gait, is inconclusive. The aim of this study was to investigate the effect of…

CT dose modulation using automatic exposure control in whole-body PET/CT: effects of scout imaging direction and arm positioning.

PubMed

Inoue, Yusuke; Nagahara, Kazunori; Kudo, Hiroko; Itoh, Hiroyasu

2018-01-01

Automatic exposure control (AEC) modulates tube current and consequently X-ray exposure in CT. We investigated the behavior of AEC systems in whole-body PET/CT. CT images of a whole-body phantom were acquired using AEC on two scanners from different manufactures. The effects of scout imaging direction and arm positioning on dose modulation were evaluated. Image noise was assessed in the chest and upper abdomen. On one scanner, AEC using two scout images in the posteroanterior (PA) and lateral (Lat) directions provided relatively constant image noise along the z-axis with the arms at the sides. Raising the arms increased tube current in the head and neck and decreased it in the body trunk. Image noise increased in the upper abdomen, suggesting excessive reduction in radiation exposure. AEC using the PA scout alone strikingly increased tube current and reduced image noise in the shoulder. Raising the arms did not substantially influence dose modulation and decreased noise in the abdomen. On the other scanner, AEC using the PA scout alone or Lat scout alone resulted in similar dose modulation. Raising the arms increased tube current in the head and neck and decreased it in the trunk. Image noise was higher in the upper abdomen than in the middle and lower chest, and was not influenced by arm positioning. CT dose modulation using AEC may vary greatly depending on scout direction. Raising the arms tended to decrease radiation exposure; however, the effect depends on scout direction and the AEC system.

Human arm joints reconstruction algorithm in rehabilitation therapies assisted by end-effector robotic devices.

PubMed

Bertomeu-Motos, Arturo; Blanco, Andrea; Badesa, Francisco J; Barios, Juan A; Zollo, Loredana; Garcia-Aracil, Nicolas

2018-02-20

End-effector robots are commonly used in robot-assisted neuro-rehabilitation therapies for upper limbs where the patient's hand can be easily attached to a splint. Nevertheless, they are not able to estimate and control the kinematic configuration of the upper limb during the therapy. However, the Range of Motion (ROM) together with the clinical assessment scales offers a comprehensive assessment to the therapist. Our aim is to present a robust and stable kinematic reconstruction algorithm to accurately measure the upper limb joints using only an accelerometer placed onto the upper arm. The proposed algorithm is based on the inverse of the augmented Jaciobian as the algorithm (Papaleo, et al., Med Biol Eng Comput 53(9):815-28, 2015). However, the estimation of the elbow joint location is performed through the computation of the rotation measured by the accelerometer during the arm movement, making the algorithm more robust against shoulder movements. Furthermore, we present a method to compute the initial configuration of the upper limb necessary to start the integration method, a protocol to manually measure the upper arm and forearm lengths, and a shoulder position estimation. An optoelectronic system was used to test the accuracy of the proposed algorithm whilst healthy subjects were performing upper limb movements holding the end effector of the seven Degrees of Freedom (DoF) robot. In addition, the previous and the proposed algorithms were studied during a neuro-rehabilitation therapy assisted by the 'PUPArm' planar robot with three post-stroke patients. The proposed algorithm reports a Root Mean Square Error (RMSE) of 2.13cm in the elbow joint location and 1.89cm in the wrist joint location with high correlation. These errors lead to a RMSE about 3.5 degrees (mean of the seven joints) with high correlation in all the joints with respect to the real upper limb acquired through the optoelectronic system. Then, the estimation of the upper limb joints through both algorithms reveal an instability on the previous when shoulder movement appear due to the inevitable trunk compensation in post-stroke patients. The proposed algorithm is able to accurately estimate the human upper limb joints during a neuro-rehabilitation therapy assisted by end-effector robots. In addition, the implemented protocol can be followed in a clinical environment without optoelectronic systems using only one accelerometer attached in the upper arm. Thus, the ROM can be perfectly determined and could become an objective assessment parameter for a comprehensive assessment.

The effects of virtual reality-based bilateral arm training on hemiplegic children's upper limb motor skills.

PubMed

Do, Ji-Hye; Yoo, Eun-Young; Jung, Min-Ye; Park, Hae Yean

2016-01-01

Hemiplegic cerebral palsy is a neurological symptom appearing on the unilateral arm and leg of the body that causes affected upper/lower limb muscle weakening and dysesthesia and accompanies tetany and difficulties in postural control due to abnormal muscle tone, and difficulties in body coordination. The purpose of this study was to examine the impact of virtual reality-based bilateral arm training on the motor skills of children with hemiplegic cerebral palsy, in terms of their upper limb motor skills on the affected side, as well as their bilateral coordination ability. The research subjects were three children who were diagnosed with hemiplegic cerebral palsy. The research followed an ABA design, which was a single-subject experimental design. The procedure consisted of a total of 20 sessions, including four during the baseline period (A1), 12 during the intervention period (B), and four during the baseline regression period (A2), For the independent variable bilateral arm training based on virtual reality, Nintendo Wii game was played for 30 minutes in each of the 12 sessions. For the dependent variables of upper limb motor skills on the affected side and bilateral coordination ability, a Wolf Motor Function Test (WMFT) was carried out for each session and the Pediatric Motor Activity Log (PMAL) was measured before and after the intervention, as well as after the baseline regression period. To test bilateral coordination ability, shooting baskets in basketball with both hands and moving large light boxes were carried out under operational definitions, with the number of shots and time needed to move boxes measured. The results were presented using visual graphs and bar graphs. The study's results indicated that after virtual reality-based bilateral arm training, improvement occurred in upper limb motor skills on the affected sides, and in bilateral coordination ability, for all of the research subjects. Measurements of the effects of sustained therapy after completion of the intervention, during the baseline regression period, revealed that upper limb motor skills on the affected side and bilateral coordination ability were better than in the baseline period for all subjects. This study confirmed that for children with hemiplegic with cerebral palsy, bilateral arm training based on virtual reality can be an effective intervention method for enhancing the upper limb motor skills on the affected side, as well as bilateral coordination ability.

Development of a parent‐reported questionnaire evaluating upper limb activity limitation in children with cerebral palsy

PubMed Central

Preston, N.; Levesley, M.; Mon‐Williams, M.; O'Connor, R.J.

2017-01-01

Abstract Background and purpose Upper limb activity measures for children with cerebral palsy have a number of limitations, for example, lack of validity and poor responsiveness. To overcome these limitations, we developed the Children's Arm Rehabilitation Measure (ChARM), a parent‐reported questionnaire validated for children with cerebral palsy aged 5–16 years. This paper describes both the development of the ChARM items and response categories and its psychometric testing and further refinement using the Rasch measurement model. Methods To generate valid items for the ChARM, we collected goals of therapy specifically developed by therapists, children with cerebral palsy, and their parents for improving activity limitation of the upper limb. The activities, which were the focus of these goals, formed the basis for the items. Therapists typically break an activity into natural stages for the purpose of improving activity performance, and these natural orders of achievement formed each item's response options. Items underwent face validity testing with health care professionals, parents of children with cerebral palsy, academics, and lay persons. A Rasch analysis was performed on ChARM questionnaires completed by the parents of 170 children with cerebral palsy from 12 hospital paediatric services. The ChARM was amended, and the procedure repeated on 148 ChARMs (from children's mean age: 10 years and 1 month; range: 4 years and 8 months to 16 years and 11 months; 85 males; Manual Ability Classification System Levels I = 9, II = 26, III = 48, IV = 45, and V = 18). Results The final 19‐item unidimensional questionnaire displayed fit to the Rasch model (chi‐square p = .18), excellent reliability (person separation index = 0.95, α = 0.95), and no floor or ceiling effects. Items showed no response bias for gender, distribution of impairment, age, or learning disability. Discussion The ChARM is a psychometrically sound measure of upper limb activity validated for children with cerebral palsy aged 5–16 years. The ChARM is freely available for use to clinicians and nonprofit organisations. PMID:28112465

78 FR 2910 - Airworthiness Directives; GROB-WERKE Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-15

... condition on an aviation product. The MCAI describes the unsafe condition as cracks in the elevator trim tab... for the specified products. The MCAI states: On several Grob G 115 aeroplanes, elevator trim tab arms... the rear edge of the trim tab arm. This condition, if not detected and corrected, could lead to...

Sex-Related Differences in Scapular Kinematics During Elevation of the Arm in Asymptomatic Children and Adults.

PubMed

Habechian, Fernanda Assis Paes; Rosa, Dayana Patricia; Haik, Melina Nevoeiro; Camargo, Paula Rezende

2016-10-01

Recently, it has been suggested that sex may influence scapular kinematics. A more comprehensive analysis of the scapular kinematics in children and adults, including sex as a factor, will help to understand if differences between sexes are present since childhood. The purpose of this study was to compare scapular kinematics between sex in children and adults during elevation of the arm. One-hundred and sixteen asymptomatic adults (58 men and 58 women) and 53 children (28 boys and 25 girls) participated in the study. Three-dimensional scapular kinematics during elevation of the arm were obtained using an electromagnetic tracking device. Women had a more upwardly rotated scapula in the nondominant side (P < .05), with large effects and a more anteriorly tilted position at 60°, 90°, and 120° of arm elevation in the dominant side, and at 90° and 120° in the nondominant side (P < .05) with moderate effects when compared with men. Differences between sexes were not found in the children (P > .05). In conclusion, sex seems to influence scapular kinematics in adulthood, but not in childhood.

Upper limb discomfort profile due to intermittent isometric pronation torque at different postural combinations of the shoulder-arm system.

PubMed

Mukhopadhyay, Prabir; O'Sullivan, Leonard W; Gallwey, Timothy J

2009-05-01

Twenty-seven right-handed male university students participated in this study, which comprised a full factorial model consisting of three forearm rotation angles (60% prone and supine and neutral range of motion), three elbow angles (45 degrees , 90 degrees and 135 degrees ), three upper arm angles (45 degrees flexion/extension and neutral), one exertion frequency (15 per min) and one level of pronation torque (20% maximum voluntary contraction (MVC) relative to MVC at each articulation). Discomfort rating after the end of each 5 min treatment was recorded on a visual analogue scale. Results of a repeated measures analysis of covariance on discomfort score, with torque endurance time as covariate, indicated that none of the factors was significant including torque endurance time (p = 0.153). An initial data collection phase preceded the main experiment in order to ensure that participants exerted exactly 20% MVC of the particular articulation. In this phase MVC pronation torque was measured at each articulation. The data revealed a significant forearm rotation angle effect (p = 0.001) and participant effect (p = 0.001). Of the two-way interactions, elbow*participant (p = 0.004), forearm*participant (p = 0.001) and upper arm*participant (p = 0.005) were the significant factors. Electromyographic activity of the pronator teres and biceps brachii muscles revealed no significant change in muscle activity in most of the articulations. Industrial jobs involving deviated upper arm postures are typical in industry but have a strong association with injury. Data from this study will enable better understanding of the effects of deviated upper arm postures on musculoskeletal disorders and can also be used to identify and control high-risk tasks in industry.

The development of an arm activity survey for breast cancer survivors using the Protection Motivation Theory

PubMed Central

Lee, Teresa S; Kilbreath, Sharon L; Sullivan, Gerard; Refshauge, Kathryn M; Beith, Jane M

2007-01-01

Background Current research evidence indicates that women should return to normal use of their arm after breast cancer surgery. However, it appears some women continue to hold the view that they are supposed to protect their arm from strenuous activities because of the risk of lymphoedema. Many factors contribute to women's perceptions about lymphoedema and their ability to use their affected arm, and it is the aim of this study to explore and understand these perceptions. Methods/design A survey, based on the Protection Motivation Theory, has been developed and tested. The survey assesses whether subjective norms, fear and/or coping attributes predict women's intention to use their affected arm. In addition, the survey includes questions regarding cancer treatment and demographic characteristics, arm and chest symptoms, and arm function. Recruitment of 170 breast cancer survivors has begun at 3 cancer treatment sites in Sydney, Australia. Discussion This study will identify perceptions that help predict the extent women use their affected arm. The results will also determine whether upper limb impairments arise secondary to over-protection of the affected arm. Identification of factors that limit arm use will enable appropriate prevention and better provision of treatment to improve upper limb outcomes. PMID:17488497

Everyday movement and use of the arms: Relationship in children with hemiparesis differs from adults.

PubMed

Sokal, Brad; Uswatte, Gitendra; Vogtle, Laura; Byrom, Ezekiel; Barman, Joydip

2015-01-01

In adults with hemiparesis amount of movement of the more-affected arm is related to its amount of use in daily life. In children, little is known about everyday arm use. This report examines the relationships between everyday movement of the more-affected arm and its (a) everyday use and (b) motor capacity in children with hemiparesis. Participants were 28 children with a wide range of upper-extremity hemiparesis subsequent to cerebral palsy due to pre- or peri-natal stroke. Everyday movement of the more-affected arm was assessed by putting accelerometers on the children's forearms for three days. Everyday use of that arm and its motor capacity were assessed with the Pediatric Motor Activity Log-Revised and Pediatric Arm Function Test, respectively. Intensity of everyday movement of the more-affected arm was correlated with its motor capacity (rs ≥ 0.52, ps ≤ 0.003). However, everyday movement of that arm was not correlated with its everyday use (rs ≤ 0.30, ps ≥ $ 0.126). In children with upper-extremity hemiparesis who meet the study intake criteria amount of movement of the more-affected arm in daily life is not related to its amount to use, suggesting that children differ from adults in this respect.

Virtual reality environments for post-stroke arm rehabilitation.

PubMed

Subramanian, Sandeep; Knaut, Luiz A; Beaudoin, Christian; McFadyen, Bradford J; Feldman, Anatol G; Levin, Mindy F

2007-06-22

Optimal practice and feedback elements are essential requirements for maximal motor recovery in patients with motor deficits due to central nervous system lesions. A virtual environment (VE) was created that incorporates practice and feedback elements necessary for maximal motor recovery. It permits varied and challenging practice in a motivating environment that provides salient feedback. The VE gives the user knowledge of results feedback about motor behavior and knowledge of performance feedback about the quality of pointing movements made in a virtual elevator. Movement distances are related to length of body segments. We describe an immersive and interactive experimental protocol developed in a virtual reality environment using the CAREN system. The VE can be used as a training environment for the upper limb in patients with motor impairments.

Measurement of carotid blood pressure and local pulse wave velocity changes during cuff induced hyperemia.

PubMed

Nabeel, P M; Karthik, Srinivasa; Joseph, Jayaraj; Sivaprakasam, Mohanasankar

2017-07-01

We present a prototype design of dual element photoplethysmograph (PPG) probe along with associated measurement system for carotid local pulse wave velocity (PWV) evaluation in a non-invasive and continuous manner. The PPG probe consists of two identical sensing modules placed 23 mm apart. Simultaneously measured blood pulse waveforms from these arterial sites were processed and the pulse transit time delay was resolved using the developed application-specific software. The ability of developed PPG probe and associated measurement system to detect acute changes in carotid local PWV due to blood pressure (BP) variations was experimentally validated by an in-vivo study. Intra-subject carotid BP elevation was achieved by an upper arm cuff based occlusion, which offered a controlled way of local PWV escalation. The elevated carotid BP values were also recorded by a calibrated pressure tonometer prior to the study, and was used as a reference. A significant increment (1.0 - 2.6 m/s) in local PWV was observed and was proportional to the BP increment induced by the occlusive reactive hyperemia. Study results demonstrated the feasibility of real-time signal acquisition and reliable local PWV evaluation under normal and elevated BP conditions using the developed measurement system.

Effects of Robot-Assisted Therapy for the Upper Limb After Stroke.

PubMed

Veerbeek, Janne M; Langbroek-Amersfoort, Anneli C; van Wegen, Erwin E H; Meskers, Carel G M; Kwakkel, Gert

2017-02-01

Robot technology for poststroke rehabilitation is developing rapidly. A number of new randomized controlled trials (RCTs) have investigated the effects of robot-assisted therapy for the paretic upper limb (RT-UL). To systematically review the effects of poststroke RT-UL on measures of motor control of the paretic arm, muscle strength and tone, upper limb capacity, and basic activities of daily living (ADL) in comparison with nonrobotic treatment. Relevant RCTs were identified in electronic searches. Meta-analyses were performed for measures of motor control (eg, Fugl-Meyer Assessment of the arm; FMA arm), muscle strength and tone, upper limb capacity, and basic ADL. Subgroup analyses were applied for the number of joints involved, robot type, timing poststroke, and treatment contrast. Forty-four RCTs (N = 1362) were included. No serious adverse events were reported. Meta-analyses of 38 trials (N = 1206) showed significant but small improvements in motor control (~2 points FMA arm) and muscle strength of the paretic arm and a negative effect on muscle tone. No effects were found for upper limb capacity and basic ADL. Shoulder/elbow robotics showed small but significant effects on motor control and muscle strength, while elbow/wrist robotics had small but significant effects on motor control. RT-UL allows patients to increase the number of repetitions and hence intensity of practice poststroke, and appears to be a safe therapy. Effects on motor control are small and specific to the joints targeted by RT-UL, whereas no generalization is found to improvements in upper limb capacity. The impact of RT-UL started in the first weeks poststroke remains unclear. These limited findings could mainly be related to poor understanding of robot-induced motor learning as well as inadequate designing of RT-UL trials, by not applying an appropriate selection of stroke patients with a potential to recovery at baseline as well as the lack of fixed timing of baseline assessments and using an insufficient treatment contrast early poststroke.

Numerical analysis of stress distribution in the upper arm tissues under an inflatable cuff: Implications for noninvasive blood pressure measurement

NASA Astrophysics Data System (ADS)

Deng, Zhipeng; Liang, Fuyou

2016-10-01

An inflatable cuff wrapped around the upper arm is widely used in noninvasive blood pressure measurement. However, the mechanical interaction between cuff and arm tissues, a factor that potentially affects the accuracy of noninvasive blood pressure measurement, remains rarely addressed. In the present study, finite element (FE) models were constructed to quantify intra-arm stresses generated by cuff compression, aiming to provide some theoretical evidence for identifying factors of importance for blood pressure measurement or explaining clinical observations. Obtained results showed that the simulated tissue stresses were highly sensitive to the distribution of cuff pressure on the arm surface and the contact condition between muscle and bone. In contrast, the magnitude of cuff pressure and small variations in elastic properties of arm soft tissues had little influence on the efficiency of pressure transmission in arm tissues. In particular, it was found that a thickened subcutaneous fat layer in obese subjects significantly reduced the effective pressure transmitted to the brachial artery, which may explain why blood pressure overestimation occurs more frequently in obese subjects in noninvasive blood pressure measurement.

Vibrations transmitted from human hands to upper arm, shoulder, back, neck, and head.

PubMed

Xu, Xueyan S; Dong, Ren G; Welcome, Daniel E; Warren, Christopher; McDowell, Thomas W; Wu, John Z

2017-12-01

Some powered hand tools can generate significant vibration at frequencies below 25 Hz. It is not clear whether such vibration can be effectively transmitted to the upper arm, shoulder, neck, and head and cause adverse effects in these substructures. The objective of this study is to investigate the vibration transmission from the human hands to these substructures. Eight human subjects participated in the experiment, which was conducted on a 1-D vibration test system. Unlike many vibration transmission studies, both the right and left hand-arm systems were simultaneously exposed to the vibration to simulate a working posture in the experiment. A laser vibrometer and three accelerometers were used to measure the vibration transmitted to the substructures. The apparent mass at the palm of each hand was also measured to help in understanding the transmitted vibration and biodynamic response. This study found that the upper arm resonance frequency was 7-12 Hz, the shoulder resonance was 7-9 Hz, and the back and neck resonances were 6-7 Hz. The responses were affected by the hand-arm posture, applied hand force, and vibration magnitude. The transmissibility measured on the upper arm had a trend similar to that of the apparent mass measured at the palm in their major resonant frequency ranges. The implications of the results are discussed. Musculoskeletal disorders (MSDs) of the shoulder and neck are important issues among many workers. Many of these workers use heavy-duty powered hand tools. The combined mechanical loads and vibration exposures are among the major factors contributing to the development of MSDs. The vibration characteristics of the body segments examined in this study can be used to help understand MSDs and to help develop more effective intervention methods.

Vibrations transmitted from human hands to upper arm, shoulder, back, neck, and head

PubMed Central

Xu, Xueyan S.; Dong, Ren G.; Welcome, Daniel E.; Warren, Christopher; McDowell, Thomas W.; Wu, John Z.

2016-01-01

Some powered hand tools can generate significant vibration at frequencies below 25 Hz. It is not clear whether such vibration can be effectively transmitted to the upper arm, shoulder, neck, and head and cause adverse effects in these substructures. The objective of this study is to investigate the vibration transmission from the human hands to these substructures. Eight human subjects participated in the experiment, which was conducted on a 1-D vibration test system. Unlike many vibration transmission studies, both the right and left hand-arm systems were simultaneously exposed to the vibration to simulate a working posture in the experiment. A laser vibrometer and three accelerometers were used to measure the vibration transmitted to the substructures. The apparent mass at the palm of each hand was also measured to help in understanding the transmitted vibration and biodynamic response. This study found that the upper arm resonance frequency was 7–12 Hz, the shoulder resonance was 7–9 Hz, and the back and neck resonances were 6–7 Hz. The responses were affected by the hand-arm posture, applied hand force, and vibration magnitude. The transmissibility measured on the upper arm had a trend similar to that of the apparent mass measured at the palm in their major resonant frequency ranges. The implications of the results are discussed. Relevance to industry Musculoskeletal disorders (MSDs) of the shoulder and neck are important issues among many workers. Many of these workers use heavy-duty powered hand tools. The combined mechanical loads and vibration exposures are among the major factors contributing to the development of MSDs. The vibration characteristics of the body segments examined in this study can be used to help understand MSDs and to help develop more effective intervention methods. PMID:29123326

Quantification of Upper Limb Motor Recovery and EEG Power Changes after Robot-Assisted Bilateral Arm Training in Chronic Stroke Patients: A Prospective Pilot Study

PubMed Central

Geroin, Christian; Bortolami, Marta; Saltuari, Leopold; Manganotti, Paolo

2018-01-01

Background Bilateral arm training (BAT) has shown promise in expediting progress toward upper limb recovery in chronic stroke patients, but its neural correlates are poorly understood. Objective To evaluate changes in upper limb function and EEG power after a robot-assisted BAT in chronic stroke patients. Methods In a within-subject design, seven right-handed chronic stroke patients with upper limb paresis received 21 sessions (3 days/week) of the robot-assisted BAT. The outcomes were changes in score on the upper limb section of the Fugl-Meyer assessment (FM), Motricity Index (MI), and Modified Ashworth Scale (MAS) evaluated at the baseline (T0), posttraining (T1), and 1-month follow-up (T2). Event-related desynchronization/synchronization were calculated in the upper alpha and the beta frequency ranges. Results Significant improvement in all outcomes was measured over the course of the study. Changes in FM were significant at T2, and in MAS at T1 and T2. After training, desynchronization on the ipsilesional sensorimotor areas increased during passive and active movement, as compared with T0. Conclusions A repetitive robotic-assisted BAT program may improve upper limb motor function and reduce spasticity in the chronically impaired paretic arm. Effects on spasticity were associated with EEG changes over the ipsilesional sensorimotor network. PMID:29780410

Effectiveness of Functional Electrical Stimulation in Improving Clinical Outcomes in the Upper Arm following Stroke: A Systematic Review and Meta-Analysis

PubMed Central

Vafadar, Amir K.; Côté, Julie N.; Archambault, Philippe S.

2015-01-01

Background. Different therapeutic methods are being used to prevent or decrease long-term impairments of the upper arm in stroke patients. Functional electrical stimulation (FES) is one of these methods, which aims to stimulate the nerves of the weakened muscles so that the resulting muscle contractions resemble those of a functional task. Objectives. The objective of this study was to review the evidence for the effect of FES on (1) shoulder subluxation, (2) pain, and (3) upper arm motor function in stroke patients, when added to conventional therapy. Methods. From the 727 retrieved articles, 10 (9 RCTs, 1 quasi-RCT) were selected for final analysis and were rated based on the PEDro (Physiotherapy Evidence Database) scores and the Sackett's levels of evidence. A meta-analysis was performed for all three considered outcomes. Results. The results of the meta-analyses showed a significant difference in shoulder subluxation in experimental groups compared to control groups, only if FES was applied early after stroke. No effects were found on pain or motor function outcomes. Conclusion. FES can be used to prevent or reduce shoulder subluxation early after stroke. However, it should not be used to reduce pain or improve upper arm motor function after stroke. PMID:25685805

Quantifying anti-gravity torques for the design of a powered exoskeleton.

PubMed

Ragonesi, Daniel; Agrawal, Sunil K; Sample, Whitney; Rahman, Tariq

2013-03-01

Designing an upper extremity exoskeleton for people with arm weakness requires knowledge of the joint torques due to gravity and joint stiffness, as well as, active residual force capabilities of users. The objective of this research paper is to describe the characteristics of the upper limb of children with upper limb impairment. This paper describes the experimental measurements of the torque on the upper limb due to gravity and joint stiffness of three groups of subjects: able-bodied adults, able-bodied children, and children with neuromuscular disabilities. The experiment involves moving the arm to various positions in the sagittal plane and measuring the resultant force at the forearm. This force is then converted to torques at the elbow and shoulder. These data are compared to a two-link lumped mass model based on anthropomorphic data. Results show that the torques based on anthropometry deviate from experimentally measured torques as the arm goes through the range. Subjects with disabilities also maximally pushed and pulled against the force sensor to measure maximum strength as a function of arm orientation. For all subjects, the maximum voluntary applied torque at the shoulder and elbow in the sagittal plane was found to be lower than gravity torques throughout the disabled subjects' range of motion. This experiment informs designers of upper limb orthoses on the contribution of passive human joint torques due to gravity and joint stiffness and the strength capability of targeted users.

Differences in the activation and co-activation ratios of the four subdivisions of trapezius between genders following a computer typing task.

PubMed

Szucs, Kimberly A; Molnar, Megan

2017-04-01

The aim of this study was to provide a description of gender differences of the activation patterns of the four subdivisions of the trapezius (clavicular, upper, middle, lower) following a 60min computer work task. Surface EMG was collected from these subdivisions from 21 healthy subjects during bilateral arm elevation pre-/post- task. Subjects completed a standardized 60min computer work task at a standard, ergonomic workstation. Normalized activation and activation ratios of each trapezius subdivision were compared between genders and condition with repeated measures ANOVAs. The interaction effect of Gender×Condition for upper trapezius% activation approached significance at p=0.051with males demonstrating greater activation post-task. The main effect of Condition was statistically significant for% activation of middle and lower trapezius (p<0.05), with both muscles demonstrating increase activation post-task. There was a statistically significant interaction effect of Gender×Condition for the Middle Trapezius/Upper Trapezius ratio and main effect of Condition for the Clavicular Trapezius/Upper Trapezius ratio, with a decreased ratio post-typing. Gender differences exist following 60min of a low force computer typing task. Imbalances in muscle activation and activation ratios following computer work may affect total shoulder kinematics and should be further explored. Copyright © 2017 Elsevier B.V. All rights reserved.

The effect of arm support combined with rehabilitation games on upper-extremity function in subacute stroke: a randomized controlled trial.

PubMed

Prange, Gerdienke B; Kottink, Anke I R; Buurke, Jaap H; Eckhardt, Martine M E M; van Keulen-Rouweler, Bianca J; Ribbers, Gerard M; Rietman, Johan S

2015-02-01

Use of rehabilitation technology, such as (electro)mechanical devices or robotics, could partly relieve the increasing strain on stroke rehabilitation caused by an increasing prevalence of stroke. Arm support (AS) training showed improvement of unsupported arm function in chronic stroke. To examine the effect of weight-supported arm training combined with computerized exercises on arm function and capacity, compared with dose-matched conventional reach training in subacute stroke patients. In a single-blind, multicenter, randomized controlled trial, 70 subacute stroke patients received 6 weeks of training with either an AS device combined with computerized exercises or dose-matched conventional training (CON). Arm function was evaluated pretraining and posttraining by Fugl-Meyer assessment (FM), maximal reach distance, Stroke Upper Limb Capacity Scale (SULCS), and arm pain via Visual Analogue Scale, in addition to perceived motivation by Intrinsic Motivation Inventory posttraining. FM and SULCS scores and reach distance improved significantly within both groups. These improvements and experienced pain did not differ between groups. The AS group reported higher interest/enjoyment during training than the CON group. AS training with computerized exercises is as effective as conventional therapy dedicated to the arm to improve arm function and activity in subacute stroke rehabilitation, when applied at the same dose. © The Author(s) 2014.

Reference ranges for midupper arm circumference, upper arm muscle area, and upper arm fat area in US children and adolescents aged 1-20 y.

PubMed

Addo, O Yaw; Himes, John H; Zemel, Babette S

2017-01-01

Midupper arm circumference (MUAC) has long been used in anthropometric assessments of nutritional status in field settings, especially in emergency situations, but percentile ranges for healthy, well-nourished children are currently unavailable. We developed reference curves for MUAC and derived measures of arm muscle area (AMA) and arm fat area (AFA) on the basis of the population used in the current CDC body mass index growth charts. We analyzed cross-sectional MUAC and triceps (triceps skinfold thickness) data from 32,952 US children aged 1-20 y. Generalized additive models for location, scale, and shape were used to calculate semiparametric smoothed percentiles and L, M, and S coefficients needed for z-score estimation by age and sex. Equations were developed with the use of the height-for-age z score (HAZ) to adjust for the associations of stature with upper arm measures. MUAC increased with age steadily throughout the growing period. For children <5 y old, lower percentile ranges varied markedly across age and sex such that the single cutoff (<11.5 or 12.5 cm) for field screening of acute malnutrition did not track along the same percentile. AFA and AMA growth patterns exhibited sex-specific trends including multiple distinct age-related inflections that were more pronounced in males for AFA-for-age than in females. HAZ and age were substantially and independently related with all arm measures. The new reference percentile ranges for midupper arm measures for healthy children provide a useful nutritional assessment tool in a wide variety of settings. Height status (HAZ) has complex independent associations with arm measures irrespective of the distributional ranking by age and sex. Prediction equations that account for these effects further extend the practical use of the new curves. © 2017 American Society for Nutrition.

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

PubMed

Resnik, Linda; Etter, Katherine; Klinger, Shana Lieberman; Kambe, Charles

2011-01-01

Technological advances in upper-limb prosthetic design offer dramatically increased possibilities for powered movement. The DEKA Arm system allows users 10 powered degrees of movement. Learning to control these movements by utilizing a set of motions that, in most instances, differ from those used to obtain the desired action prior to amputation is a challenge for users. In the Department of Veterans Affairs "Study to Optimize the DEKA Arm," we attempted to facilitate motor learning by using a virtual reality environment (VRE) program. This VRE program allows users to practice controlling an avatar using the controls designed to operate the DEKA Arm in the real world. In this article, we provide highlights from our experiences implementing VRE in training amputees to use the full DEKA Arm. This article discusses the use of VRE in amputee rehabilitation, describes the VRE system used with the DEKA Arm, describes VRE training, provides qualitative data from a case study of a subject, and provides recommendations for future research and implementation of VRE in amputee rehabilitation. Our experience has led us to believe that training with VRE is particularly valuable for upper-limb amputees who must master a large number of controls and for those amputees who need a structured learning environment because of cognitive deficits.

A review of bilateral training for upper extremity hemiparesis.

PubMed

Stoykov, Mary Ellen; Corcos, Daniel M

2009-01-01

Upper extremity hemiparesis is the most common post-stroke disability. Longitudinal studies have indicated that 30-66% of stroke survivors do not have full arm function 6 months post-stroke. The current gold standard for treatment of mild post-stroke upper limb impairment is constraint-induced therapy but, because of the inclusion criteria, alternative treatments are needed which target more impaired subjects. Bilateral arm training has been investigated as a potential rehabilitation intervention. Bilateral arm training encompasses a number of methods including: (1) bilateral isokinematic training; (2) mirror therapy using bilateral training; (3) device-driven bilateral training; and (4) bilateral motor priming. Neural mechanisms mediating bilateral training are first reviewed. The key bilateral training studies that have demonstrated evidence of efficacy will then be discussed. Finally, conclusions are drawn concerning clinical implications based on the reviewed literature. (c) 2009 John Wiley & Sons, Ltd.

CRUX: a Compliant Robotic Upper-Extremity eXosuit for Lightweight, Portable, Multi-DoF Muscular Augmentation

NASA Technical Reports Server (NTRS)

Lessard, Steven; Pansodtee, Pattawong; Robbins, Ash; Baltaxe-Admony, Leya Breanna; Teodorescu, Mircea; Kurniawan,Sri; Agogino, Adrian; Kurniawan, Sri

2017-01-01

Wearable robots can potentially offer their users enhanced stability and strength. These augmentations are ideally designed to actuate harmoniously with the users movements and provide extra force as needed. The creation of such robots, however, is particularly challenging due to the complexity of the underlying human body. In this paper, we present a compliant, robotic exosuit for upper-extremities called CRUX. This exosuit, inspired by tensegrity models of the human arm, features a lightweight (1.3 kg), flexible design for portability. We also show how CRUX maintains full flexibility of the upper-extremities for its users while providing multi- DoF augmentative strength to the major muscles of the arm, as evident by tracking the heart rate of an individual exercising said arm. Exosuits such as CRUX may be useful in physical therapy and in extreme environments where users are expected to exert their bodies to the fullest extent.

Beyond Body Mass Index: Using Anthropometric Measures and Body Composition Indicators to Assess Odds of an Endometriosis Diagnosis.

PubMed

Backonja, Uba; Hediger, Mary L; Chen, Zhen; Lauver, Diane R; Sun, Liping; Peterson, C Matthew; Buck Louis, Germaine M

2017-09-01

Body mass index (BMI) and endometriosis have been inversely associated. To address gaps in this research, we examined associations among body composition, endometriosis, and physical activity. Women from 14 clinical sites in the Salt Lake City, Utah and San Francisco, California areas and scheduled for laparoscopy/laparotomy were recruited during 2007-2009. Participants (N = 473) underwent standardized anthropometric assessments to estimate body composition before surgery. Using a cross-sectional design, odds of an endometriosis diagnosis (adjusted odds ratio [aOR]; 95% confidence interval [CI]) were calculated for anthropometric and body composition measures (weight in kg; height in cm; mid upper arm, waist, hip, and chest circumferences in cm; subscapular, suprailiac, and triceps skinfold thicknesses in mm; arm muscle and fat areas in cm 2 ; centripetal fat, chest-to-waist, chest-to-hip, waist-to-hip, and waist-to-height ratios; arm fat index; and BMI in kg/m 2 ). Physical activity (metabolic equivalent of task-minutes/week) and sedentariness (average minutes sitting on a weekday) were assessed using the International Physical Activity Questionnaire-Short Form. Measures were modeled continuously and in quartiles based on sample estimates. Adjusted models were controlled for age (years, continuous), site (Utah/California), smoking history (never, former, or current smoker), and income (below, within 180%, and above of the poverty line). Findings were standardized by dividing variables by their respective standard deviations. We used adjusted models to examine whether odds of an endometriosis diagnosis were moderated by physical activity or sedentariness. Inverse relationships were observed between endometriosis and standardized: weight (aOR = 0.71, 95% CI 0.57-0.88); subscapular skinfold thickness (aOR = 0.79, 95% CI 0.65-0.98); waist and hip circumferences (aOR = 0.79, 95% CI 0.64-0.98 and aOR = 0.76, 95% CI 0.61-0.94, respectively); total upper arm and upper arm muscle areas (aOR = 0.76, 95% CI 0.61-0.94 and aOR = 0.74, 95% CI 0.59-0.93, respectively); and BMI (aOR = 0.75, 95% CI 0.60-0.93), despite similar heights. Women in the highest versus lowest quartile had lower adjusted odds of an endometriosis diagnosis for: weight; mid-upper arm, hip, and waist circumferences; total upper arm and upper arm muscle areas; BMI; and centripetal fat ratio. There was no evidence of a main effect or moderation of physical activity or sedentariness. In a surgical cohort, endometriosis was inversely associated with anthropometric measures and body composition indicators.

Altered ventral neck muscle deformation for individuals with whiplash associated disorder compared to healthy controls - a case-control ultrasound study.

PubMed

Peterson, Gunnel; Dedering, Åsa; Andersson, Erika; Nilsson, David; Trygg, Johan; Peolsson, Michael; Wallman, Thorne; Peolsson, Anneli

2015-04-01

Previous studies have shown altered neck muscle function in individuals with chronic whiplash associated disorder (WAD). However, we lack real-time investigations with non-invasive methods that can distinguish between the different ventral neck muscle layers. This study investigated deformations and deformation rates in the sternocleidomastoid (SCM), longus capitis (Lcap), and longus colli (Lco) muscles with real-time ultrasonography. Twenty-six individuals with WAD were compared with 26 controls, matched for age and sex. Ultrasound imaging of the SCM, Lcap, and Lco were recorded during 10 repetitive arm elevations. The first and tenth arm elevations were post-process analyzed with speckle tracking. There were few significant differences in the deformations or deformation rates in the SCM, Lcap, and Lco between the WAD and control group. In controls, deformations and deformation rates showed linear positive relationships between SCM/Lcap, SCM/Lco, and Lcap/Lco which increased from the first arm elevation (R(2) = 0.14-0.70); to the tenth arm elevation (R(2) = 0.51-0.71). The WAD group showed similar or weaker linear relationship (R(2) < 0.19) during the tenth compared to the first (R(2) < 0.44) arm elevation except for deformations in Lcap/Lco (R(2) = 0.13-0.57). This result indicated that deformations and deformation rates in one muscle were correlated by similar deformations and deformation rates in other neck muscles in the control group, but this interplay between muscles was not found in the WAD group. Copyright © 2014 Elsevier Ltd. All rights reserved.

No impaired hemoglobin oxygenation in forearm muscles of patients with chronic CRPS-1.

PubMed

Brunnekreef, Jaap J J; Oosterhof, Jan; Wolff, André P; Crul, Ben J P; Wilder-Smith, Oliver H G; Oostendorp, Rob A B

2009-01-01

Physiotherapy is considered an important treatment option in patients with upper limb complex regional pain syndrome type-1 (CRPS-1). In case of chronic CRPS-1, exercise therapy of the affected limb forms an important part of the physiotherapeutic program. We investigated whether muscle loading in chronic CRPS-1 patients is associated with impairments in muscle circulation of the forearm of the affected limb. Thirty patients with chronic CRPS-1 unilaterally affecting their upper limbs, and 30 age-matched and sex-matched control participants were included in this study. Local muscle blood flow and hemoglobin oxygenation were measured by near infrared spectroscopy within the muscles of the forearm at rest, after 1-minute isometric handgrip exercises, and after arterial occlusion. Main outcome parameters were: local muscle blood flow, O2 consumption (mVO2), and postischemic reoxygenation (ReOx). We found no differences in baseline muscle blood flow, mVO2, and ReOx between the affected CRPS-1, unaffected CRPS-1, and control arms. After exercise, mVO2 of the affected CRPS-1 arms was not different from the clinically unaffected CRPS-1 arms. Furthermore, in comparison with the control arms, unaffected CRPS-1 arms showed no difference in mVO2 or ReOx. Muscle loading does not seems to be related to impairments in muscle oxygen uptake in forearm muscles of upper limbs affected by chronic CRPS-1. Our results suggest that exercise therapy can be safely used in physiotherapeutic training programs for chronic CRPS-1 of the upper limb.

A method to determine the orientation of the upper arm about its longitudinal axis during dynamic motions.

PubMed

Gordon, Brian J; Dapena, Jesús

2013-01-04

Inaccuracy in determining the orientation of the upper arm about its longitudinal axis (twist orientation) has been a pervasive problem in sport biomechanics research. The purpose of this study was to develop a method to improve the calculation of the upper arm twist orientation in dynamic sports activities. The twist orientation of the upper arm is defined by the orientation of its mediolateral axis. The basis for the new method is that at any angle in the flexion/extension range of an individual's elbow, it is possible to define a true mediolateral axis and also a surrogate mediolateral axis perpendicular to the plane containing the shoulder, elbow and wrist joints. The difference between the twist orientations indicated by these two versions of the mediolateral axis will vary from one elbow angle to another, but if the elbow joint deforms equally in different activities, for any given subject the difference should be constant at any given value of the elbow angle. Application of the new method required individuals to execute sedate elbow extension trials prior to the dynamic trials. Three-dimensional motion analysis of the sedate extension trials allowed quantification of the difference between the true and surrogate mediolateral axes for all angles in the entire flexion/extension range of an individual's elbow. This made it possible to calculate in any dynamic trial the twist orientation defined by the true mediolateral axis from the twist orientation defined by the surrogate mediolateral axis. The method was tested on a wooden model of the arm. Copyright © 2012 Elsevier Ltd. All rights reserved.

Elevated preoperative blood pressures in adult surgical patients are highly predictive of elevated home blood pressures.

PubMed

Schonberger, Robert B; Nwozuzu, Adambeke; Zafar, Jill; Chen, Eric; Kigwana, Simon; Monteiro, Miriam M; Charchaflieh, Jean; Sophanphattana, Sophisa; Dai, Feng; Burg, Matthew M

2018-04-01

Blood pressure (BP) measurement during the presurgical assessment has been suggested as a way to improve longitudinal detection and treatment of hypertension. The relationship between BP measured during this assessment and home blood pressure (HBP), a better indicator of hypertension, is unknown. The purpose of the present study was to determine the positive predictive value of presurgical BP for predicting elevated HBP. We prospectively enrolled 200 patients at a presurgical evaluation clinic with clinic blood pressures (CBPs) ≥130/85 mm Hg, as measured using a previously validated automated upper-arm device (Welch Allyn Vital Sign Monitor 6000 Series), to undergo daily HBP monitoring (Omron Model BP742N) between the index clinic visit and their day of surgery. Elevated HBP was defined, per American Heart Association guidelines, as mean systolic HBP ≥135 mm Hg or mean diastolic HBP ≥85 mm Hg. Of the 200 participants, 188 (94%) returned their home blood pressure monitors with valid data. The median number of HBP recordings was 10 (interquartile range, 7-14). Presurgical CBP thresholds of 140/90, 150/95, and 160/100 mm Hg yielded positive predictive values (95% confidence interval) for elevated HBP of 84.1% (0.78-0.89), 87.5% (0.81-0.92), and 94.6% (0.87-0.99), respectively. In contrast, self-reported BP control, antihypertensive treatment, availability of primary care, and preoperative pain scores demonstrated poor agreement with elevated HBP. Elevated preoperative CBP is highly predictive of longitudinally elevated HBP. BP measurement during presurgical assessment may provide a way to improve longitudinal detection and treatment of hypertension. Copyright © 2018 American Heart Association. Published by Elsevier Inc. All rights reserved.

76 FR 40905 - Turnagain Arm Tidal Electric Energy Project; Notice of Intent To File License Application, Filing...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-12

... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Project No. 13509-001] Turnagain Arm Tidal Electric Energy Project; Notice of Intent To File License Application, Filing of Pre-Application.... Name of Project: Turnagain Arm Tidal Electric Energy Project. f. Location: Of the Upper Cook Inlet off...

Localized Arm Volume Index: A New Method for Body Type-Corrected Evaluation of Localized Arm Lymphedematous Volume Change.

PubMed

Yamamoto, Takumi; Yamamoto, Nana; Yoshimatsu, Hidehiko

2017-10-01

Volume measurement is a common evaluation for upper extremity lymphedema. However, volume comparison between different patients with different body types may be inappropriate, and it is difficult to evaluate localized limb volume change using arm volume. Localized arm volumes (Vk, k = 1-5) and localized arm volume indices (LAVIk) at 5 points (1, upper arm; 2, elbow; 3, forearm; 4, wrist; 5, hand) of 106 arms of 53 examinees with no arm edema were calculated based on physical measurements (arm circumferences and lengths and body mass index [BMI]). Interrater and intrarater reliabilities of LAVIk were assessed, and Vk and LAVIk were compared between lower BMI (BMI, <22 kg/m) group and higher BMI (BMI, ≥22 kg/m) group. Interrater and intrarater reliabilities of LAVIk were all high (all, r > 0.98). Between lower and higher BMI groups, significant differences were observed in all Vk (V1 [P = 6.8 × 10], V2 [P = 3.1 × 10], V3 [P = 1.1 × 10], V4 [P = 8.3 × 10], and V5 [P = 3.0 × 10]). Regarding localized arm volume index (LAVI) between groups, significant differences were seen in LAVI1 (P = 9.7 × 10) and LAVI5 (P = 1.2 × 10); there was no significant difference in LAVI2 (P = 0.60), LAVI3 (P = 0.61), or LAVI4 (P = 0.22). Localized arm volume index is a convenient and highly reproducible method for evaluation of localized arm volume change, which is less affected by body physique compared with arm volumetry.

Characterization of Upper-Troposphere Water Vapor Measurements during AFWEX Using LASE

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ferrare, Richard; Browell, E. V.; Ismail, S.

Water vapor profiles from NASA's Lidar Atmospheric Sensing Experiment (LASE) system acquired during the ARM/FIRE Water Vapor Experiment (AFWEX) are used to characterize upper troposphere water vapor (UTWV) measured by ground-based Raman lidars, radiosondes, and in situ aircraft sensors over the Department of Energy Atmospheric Radiation Measurement (ARM) Southern Great Plains (SGP) site in northern Oklahoma. LASE was deployed from the NASA DC-8 aircraft and measured water vapor over the ARM SGP Central Facility (CF) site during seven flights between November 27 and December 10, 2000. Initially, the DOE ARM SGP Cloud and Radiation Testbed (CART) Raman lidar (CARL) UTWVmore » profiles were about 5-7% wetter than LASE in the upper troposphere, and the Vaisala RS80-H radiosonde profiles were about 10% drier than LASE between 8-12 km. Scaling the Vaisala water vapor profiles to match the precipitable water vapor (PWV) measured by the ARM SGP microwave radiometer (MWR) did not change these results significantly. By accounting for an overlap correction of the CARL water vapor profiles and by employing schemes designed to correct the Vaisala RS80-H calibration method and account for the time response of the Vaisala RS80H water vapor sensor, the average differences between the CARL and Vaisala radiosonde upper troposphere water vapor profiles are reduced to about 5%, which is within the ARM goal of mean differences of less than 10%. The LASE and DC-8 in situ Diode Laser Hygrometer (DLH) UTWV measurements generally agreed to within about 3 to 4%. The DC-8 in situ frost point cryogenic hygrometer and Snow White chilled mirror measurements were drier than the LASE, Raman lidars, and corrected Vaisala RS80H measurements by about 10-25% and 10-15%, respectively. Sippican (formerly VIZ manufacturing) carbon hygristor radiosondes exhibited large variabilities and poor agreement with the other measurements. PWV derived from the LASE profiles agreed to within about 3% on average with PWV derived from the ARM SGP microwave radiometer. The agreement between the LASE and MWR PWV and the LASE and CARL UTWV measurements supports the hypotheses that MWR measurements of the 22 GHz water vapor line can accurately constrain the total water vapor amount and that the CART Raman lidar, when calibrated using the MWR PWV, can provide an accurate, stable reference for characterizing upper troposphere water vapor.« less

Mechanical energy and power flow of the upper extremity in manual wheelchair propulsion.

PubMed

Guo, Lan-Yuen; Su, Fong-Chin; Wu, Hong-Wen; An, Kai-Nan

2003-02-01

To investigate the characteristics of mechanical energy and power flow of the upper limb during wheelchair propulsion. Mechanical energy and power flow of segments were calculated. Very few studies have taken into account the mechanical energy and power flow of the musculoskeletal system during wheelchair propulsion. Mechanical energy and power flow have proven to be useful tools for investigating locomotion disorders during human gait. Twelve healthy male adults (mean age, 23.5 years) were recruited for this study. Three-dimensional kinematic and kinetic data of the upper extremity were collected during wheelchair propulsion using a Hi-Res Expert Vision system and an instrumented wheel, respectively. During the initiation of the propulsion phase, joint power is generated in the upper arm or is transferred from the trunk downward to the forearm and hand to propel the wheel forward. During terminal propulsion, joint power is transferred upward to the trunk from the forearm and upper arm. The rate of change of mechanical energy and power flow for the forearm and hand have similar patterns, but the upper arm values differ. Joint power plays an important role in energy transfer as well as the energy generated and absorbed by muscles spanning the joints during wheelchair propulsion. Energy and power flow information during wheelchair propulsion allows us to gain a better understanding of the coordination of the movement by the musculoskeletal system.

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

PubMed

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

2016-01-01

The purpose of this study was to examine the relationship between the upper limb anthropometric dimensions and a history of dominant upper limb injury in tennis players. Dominant and non-dominant wrist, forearm, elbow and arm circumferences, along with a history of dominant upper limb injuries, were assessed in 147 male and female players, assigned to four groups based on location of injury: wrist (n = 9), elbow (n = 25), shoulder (n = 14) and healthy players (n = 99). From anthropometric dimensions, bilateral differences in circumferences and in proportions were calculated. The wrist group presented a significant bilateral difference in arm circumference, and asymmetrical bilateral proportions between wrist and forearm, as well as between elbow and arm, compared to the healthy group (6.6 ± 3.1% vs. 4.9 ± 4.0%, P < 0.01; -3.6 ± 3.0% vs. -0.9 ± 2.9%, P < 0.05; and -2.2 ± 2.2% vs. 0.1 ± 3.4%, P < 0.05, respectively). The elbow group displayed asymmetrical bilateral proportions between forearm and arm compared to the healthy group (-0.4 ± 4.3% vs. 1.5 ± 4.0%, P < 0.01). The shoulder group showed significant bilateral difference in elbow circumference, and asymmetrical bilateral proportions between forearm and elbow when compared to the healthy group (5.8 ± 4.7% vs. 3.1 ± 4.8%, P < 0.05 and -1.7 ± 4.5% vs. 1.4 ± 4.3%, P < 0.01, respectively). These findings suggest that players with a history of injury at the upper limb joint present altered dominant upper limb proportions in comparison with the non-dominant side, and such asymmetrical proportions would appear to be specific to the location of injury. Further studies are needed to confirm the link between location of tennis injury and asymmetry in upper limb proportions using high-tech measurements in symptomatic tennis players.

Integrative rehabilitation of elderly stroke survivors: the design and evaluation of the BrightArm™.

PubMed

Rabin, Bryan A; Burdea, Grigore C; Roll, Doru T; Hundal, Jasdeep S; Damiani, Frank; Pollack, Simcha

2012-07-01

To describe the development of the BrightArm upper extremity rehabilitation system, and to determine its clinical feasibility with older hemiplegic patients. The BrightArm adjusted arm gravity loading through table tilting. Patients wore an arm support that sensed grasp strength and communicated wirelessly with a personal computer. Games were written to improve cognitive, psychosocial and the upper extremity motor function and adapted automatically to each patient. The system underwent feasibility trials spanning 6 weeks. Participants were evaluated pre-therapy, post-therapy, and at 6 weeks follow-up using standardized clinical measures. Computerized measures of supported arm reach and game performance were stored on a remote server. Five participants had clinically significant improvements in their active range of shoulder movement, shoulder strength, grasp strength, and their ability to focus. Several participants demonstrated substantially higher arm function (measured with the Fugl-Meyer test) and two were less-depressed (measured with the Becks Depression Inventory, Second Edition). The BrightArm technology was well-accepted by the participants, who gave it an overall subjective rating of 4.1 on a 5 point Likert scale. Given these preliminary findings, it will be beneficial to evaluate the BrightArm through controlled clinical trials and to investigate its application to other clinical populations.

Integrative rehabilitation of elderly stroke survivors: The design and evaluation of the BrightArm™

PubMed Central

Rabin, Bryan A.; Burdea, Grigore C.; Roll, Doru T.; Hundal, Jasdeep S.; Damiani, Frank; Pollack, Simcha

2011-01-01

Purpose To describe the development of the BrightArm upper extremity rehabilitation system, and to determine its clinical feasibility with older hemiplegic patients. Method The BrightArm adjusted arm gravity loading through table tilting. Patients wore an arm support that sensed grasp strength and communicated wirelessly with a personal computer. Games were written to improve cognitive, psychosocial and the upper extremity motor function and adapted automatically to each patient. The system underwent feasibility trials spanning 6 weeks. Participants were evaluated pre-therapy, post-therapy, and at 6 weeks follow-up using standardized clinical measures. Computerized measures of supported arm reach and game performance were stored on a remote server. Results Five participants had clinically significant improvements in their active range of shoulder movement, shoulder strength, grasp strength, and their ability to focus. Several participants demonstrated substantially higher arm function (measured with the Fugl-Meyer test) and two were less-depressed (measured with the Becks Depression Inventory, Second Edition). The BrightArm technology was well-accepted by the participants, who gave it an overall subjective rating of 4.1 on a 5 point Likert scale. Conclusions Given these preliminary findings, it will be beneficial to evaluate the BrightArm through controlled clinical trials and to investigate its application to other clinical populations. PMID:22107353

Increasing heat storage by wearing extra clothing during upper body exercise up-regulates heat shock protein 70 but does not modify the cytokine response.

PubMed

Leicht, Christof A; Papanagopoulos, Aris; Haghighat, Sam; Faulkner, Steve H

2017-09-01

Plasma heat shock protein 70 (HSP70) concentrations rise during heat stress, which can independently induce cytokine production. Upper body exercise normally results in modest body temperature elevations. The aim of this study was to investigate the impacts of additional clothing on the body temperature, cytokine and HSP70 responses during this exercise modality. Thirteen males performed 45-min constant-load arm cranking at 63% maximum aerobic power (62 ± 7%V̇O 2peak ) in either a non-permeable whole-body suit (intervention, INT) or shorts and T-shirt (control, CON). Exercise resulted in a significant increase of IL-6 and IL-1ra plasma concentrations (P < 0.001), with no difference between conditions (P > 0.19). The increase in HSP70 from pre to post was only significant for INT (0.12 ± 0.11ng∙mL -1 , P < 0.01 vs. 0.04 ± 0.18 ng∙mL -1 , P = 0.77). Immediately following exercise, T core was elevated by 0.46 ± 0.29 (INT) and 0.37 ± 0.23ºC (CON), respectively (P < 0.01), with no difference between conditions (P = 0.16). The rise in mean T skin (2.88 ± 0.50 and 0.30 ± 0.89ºC, respectively) and maximum heat storage (3.24 ± 1.08 and 1.20 ± 1.04 J∙g -1 , respectively) was higher during INT (P < 0.01). Despite large differences in heat storage between conditions, the HSP70 elevations during INT, even though significant, were very modest. Possibly, the T core elevations were too low to induce a more pronounced HSP70 response to ultimately affect cytokine production.

A novel upper limb rehabilitation system with self-driven virtual arm illusion.

PubMed

Aung, Yee Mon; Al-Jumaily, Adel; Anam, Khairul

2014-01-01

This paper proposes a novel upper extremity rehabilitation system with virtual arm illusion. It aims for fast recovery from lost functions of the upper limb as a result of stroke to provide a novel rehabilitation system for paralyzed patients. The system is integrated with a number of technologies that include Augmented Reality (AR) technology to develop game like exercise, computer vision technology to create the illusion scene, 3D modeling and model simulation, and signal processing to detect user intention via EMG signal. The effectiveness of the developed system has evaluated via usability study and questionnaires which is represented by graphical and analytical methods. The evaluation provides with positive results and this indicates the developed system has potential as an effective rehabilitation system for upper limb impairment.

Radial nerve dysfunction (image)

MedlinePlus

The radial nerve travels down the arm and supplies movement to the triceps muscle at the back of the upper arm. ... the wrist and hand. The usual causes of nerve dysfunction are direct trauma, prolonged pressure on the ...

Contribution of inter-muscular synchronization in the modulation of tremor intensity in Parkinson's disease.

PubMed

He, Xin; Hao, Man-Zhao; Wei, Ming; Xiao, Qin; Lan, Ning

2015-12-01

Involuntary central oscillations at single and double tremor frequencies drive the peripheral neuromechanical system of muscles and joints to cause tremor in Parkinson's disease (PD). The central signal of double tremor frequency was found to correlate more directly to individual muscle EMGs (Timmermann et al. 2003). This study is aimed at investigating what central components of oscillation contribute to inter-muscular synchronization in a group of upper extremity muscles during tremor in PD patients. 11 idiopathic, tremor dominant PD subjects participated in this study. Joint kinematics during tremor in the upper extremity was recorded along with EMGs of six upper arm muscles using a novel experimental apparatus. The apparatus provided support for the upper extremity on a horizontal surface with reduced friction, so that resting tremor in the arm can be recorded with a MotionMonitor II system. In each subject, the frequencies of rhythmic firings in upper arm muscles were determined using spectral analysis. Paired and pool-averaged coherence analyses of EMGs for the group of muscles were performed to correlate the level of inter-muscular synchronization to tremor amplitudes at shoulder and elbow. The phase shift between synchronized antagonistic muscle pairs was calculated to aid coherence analysis in the muscle pool. Recorded EMG revealed that rhythmic firings were present in most recorded muscles, which were either synchronized to form phase-locked bursting cycles at a subject specific frequency, or unsynchronized with a random phase distribution. Paired coherence showed a stronger synchronization among a subset of recorded arm muscles at tremor frequency than that at double tremor frequency. Furthermore, the number of synchronized muscles in the arm was positively correlated to tremor amplitudes at elbow and shoulder. Pool-averaged coherence at tremor frequency also showed a better correlation with the amplitude of resting tremor than that of double tremor frequency, indicating that the neuromechanical coupling in peripheral neuromuscular system was stronger at tremor frequency. Both paired and pool-averaged coherences are more consistent indexes to correlate to tremor intensity in a group of upper extremity muscles of PD patients. The central drive at tremor frequency contributes mainly to synchronize peripheral muscles in the modulation of tremor intensity.

Efficacy of mid-upper arm circumference in identification, follow-up and discharge of malnourished children during nutrition rehabilitation.

PubMed

Mogendi, Joseph Birundu; De Steur, Hans; Gellynck, Xavier; Saeed, Hibbah Araba; Makokha, Anselimo

2015-06-01

Although it is crucial to identify those children likely to be treated in an appropriate nutrition rehabilitation programme and discharge them at the appropriate time, there is no golden standard for such identification. The current study examined the appropriateness of using Mid-Upper Arm Circumference for the identification, follow-up and discharge of malnourished children. We also assessed its discrepancy with the Weight-for-Height based diagnosis, the rate of recovery, and the discharge criteria of the children during nutrition rehabilitation. The study present findings from 156 children (aged 6-59 months) attending a supplementary feeding programme at Makadara and Jericho Health Centres, Eastern District of Nairobi, Kenya. Records of age, weight, height and mid-upper arm circumference were selected at three stages of nutrition rehabilitation: admission, follow-up and discharge. The values obtained were then used to calculate z-scores as defined by WHO Anthro while estimating different diagnostic indices. Mid-upper arm circumference single cut-off (< 12.5 cm) was found to exhibit high values of sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio at both admission and discharge. Besides, children recorded higher rate of recovery at 86 days, an average increment of 0.98 cm at the rate of 0.14mm/day, and a weight gain of 13.49gm/day, albeit higher in female than their male counterparts. Nevertheless, children admitted on basis of low MUAC had a significantly higher MUAC gain than WH at 0.19mm/day and 0.13mm/day respectively. Mid-upper arm circumference can be an appropriate tool for identifying malnourished children for admission to nutrition rehabilitation programs. Our results confirm the appropriateness of this tool for monitoring recovery trends and discharging the children thereafter. In principle the tool has potential to minimize nutrition rehabilitation costs, particularly in community therapeutic centres in developing countries.

Deodorants: a clinical provocation study in fragrance-sensitive individuals.

PubMed

Johansen, J D; Rastogi, S C; Bruze, M; Andersen, K E; Frosch, P; Dreier, B; Lepoittevin, J P; White, I; Menné, T

1998-10-01

Deodorants are one of the most marketed types of cosmetics and are frequently reported as a cause of dermatitis, particularly among fragrance-sensitive persons. The aim of this study was to investigate the ability of deodorants, which had previously caused axillary dermatitis in fragrance-mix-sensitive eczema patients, to provoke reactions on repeated open application tests on the upper arm and in the axillae, and to relate the findings to the content of fragrance-mix constituents in those deodorants. 14 eczema patients performed a 7-day use test with 1 or 2 deodorants that had caused a rash within the last 12 months. 2 applications per day were made in the axilla and simultaneously on a 25 cm2 area on the upper arm. A total of 20 deodorants were tested among the 14 patients. Afterwards, the deodorants were subjected to quantitative chemical analysis identifying constituents of the fragrance mix. 12/20 (60%) deodorants elicited eczema on use testing in the axilla. 8/12 deodorants were positive in the axilla on day (D) 7 and 4 both in the axilla and on the upper arm. 2 of the 4 developed a reaction in the axilla before it developed on the upper arm. Chemical analysis revealed that 18/19 deodorants contained between 1 and 6 of the fragrance-mix constituents, on average 3 being found. The mean concentration of fragrance-mix constituents was generally higher in the deodorants causing a positive use test, as compared with those giving a negative reaction, indicating that the differences between the deodorants in terms of elicitation potential were more related to quantitative aspects of allergen content than of a qualitative nature. It is recommended that deodorants are tested in the axilla in the case of a negative use test on the upper arm and a strong clinical suspicion.

Reliability, Validity, and Responsiveness of the QuickDASH in Patients With Upper Limb Amputation.

PubMed

Resnik, Linda; Borgia, Matthew

2015-09-01

To examine the internal consistency, test-retest reliability, validity, and responsiveness of the shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire in persons with upper limb amputation. Cross-sectional and longitudinal. Three sites participating in the U.S. Department of Veterans Affairs Home Study of the DEKA Arm. A convenience sample of upper limb amputees (N=44). Training with a multifunction upper limb prosthesis. Multiple outcome measures including the QuickDASH were administered twice within 1 week, and for a subset of 20 persons, after completion of in-laboratory training with the DEKA Arm. Scale alphas and intraclass correlation coefficient type 3,1 (ICC3,1) were used to examine reliability. Minimum detectable change (MDC) scores were calculated. Analyses of variance, comparing QuickDASH scores by the amount of prosthetic use and amputation level, were used for known-group validity analyses with alpha set at .05. Pairwise correlations between QuickDASH and other measures were used to examine concurrent validity. Responsiveness was measured by effect size (ES) and standardized response mean (SRM). QuickDASH alpha was .83, and ICC was .87 (95% confidence interval, .77-.93). MDC at the 95% confidence level (MDC95%) was 17.4. Full- or part-time prosthesis users had better QuickDASH scores compared with nonprosthesis users (P=.021), as did those with more distal amputations at both baseline (P=.042) and with the DEKA Arm (P=.024). The QuickDASH was correlated with concurrent measures of activity limitation as expected. The ES and SRM after training with the DEKA Arm were 0.6. This study provides evidence of reliability and validity of the QuickDASH in persons with upper limb amputation. Results provide preliminary evidence of responsiveness to prosthetic device type/training. Further research with a larger sample is needed to confirm results. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Movement analysis of upper limb during resistance training using general purpose robot arm "PA10"

NASA Astrophysics Data System (ADS)

Morita, Yoshifumi; Yamamoto, Takashi; Suzuki, Takahiro; Hirose, Akinori; Ukai, Hiroyuki; Matsui, Nobuyuki

2005-12-01

In this paper we perform movement analysis of an upper limb during resistance training. We selected sanding training, which is one type of resistance training for upper limbs widely performed in occupational therapy. Our final aims in the future are to quantitatively evaluate the therapeutic effect of upper limb motor function during training and to develop a new rehabilitation training support system. For these purposes, first of all we perform movement analysis using a conventional training tool. By measuring upper limb motion during the sanding training we perform feature abstraction. Next we perform movement analysis using the simulated sanding training system. This system is constructed using the general purpose robot arm "PA10". This system enables us to measure the force/torque exerted by subjects and to easily change the load of resistance. The control algorithm is based on impedance control. We found these features of the upper limb motion during the sanding training.

The relationship between consistency of propulsive cycles and maximum angular velocity during wheelchair racing.

PubMed

Wang, Yong Tai; Vrongistinos, Konstantinos Dino; Xu, Dali

2008-08-01

The purposes of this study were to examine the consistency of wheelchair athletes' upper-limb kinematics in consecutive propulsive cycles and to investigate the relationship between the maximum angular velocities of the upper arm and forearm and the consistency of the upper-limb kinematical pattern. Eleven elite international wheelchair racers propelled their own chairs on a roller while performing maximum speeds during wheelchair propulsion. A Qualisys motion analysis system was used to film the wheelchair propulsive cycles. Six reflective markers placed on the right shoulder, elbow, wrist joints, metacarpal, wheel axis, and wheel were automatically digitized. The deviations in cycle time, upper-arm and forearm angles, and angular velocities among these propulsive cycles were analyzed. The results demonstrated that in the consecutive cycles of wheelchair propulsion the increased maximum angular velocity may lead to increased variability in the upper-limb angular kinematics. It is speculated that this increased variability may be important for the distribution of load on different upper-extremity muscles to avoid the fatigue during wheelchair racing.

Laser-assisted lipolysis for arm contouring in Teimourian grades I and II: a prospective study of 45 patients.

PubMed

Leclère, Franck Marie; Alcolea, Justo M; Vogt, Peter; Moreno-Moraga, Javier; Mordon, Serge; Casoli, Vincent; Trelles, Mario A

2015-04-01

Upper arm deformities secondary to weight loss or senile elastosis have led to an increased demand for aesthetic contouring procedures. We conducted this study to objectively assess if, in Teimourian low-grade upper arm remodelling, one session of laser-assisted lypolisis (LAL) could result in full patient satisfaction. Between 2011 and 2013, 45 patients were treated for unsightly fat arm Teimourian grade I (15 patients), grade IIa (15 patients) and grade IIb (15 patients) with one session of LAL. The laser used in this study was a 1470-nm diode laser (Alma Lasers, Cesarea, Israel) with the following parameters: continuous mode, 15 W power and transmission through a 600-μm optical fibre. Previous mathematical modelling suggested that 0.1 kJ was required in order to destroy 1 ml of fat. Treatment parameters and adverse effects were recorded.The arm circumference and skin pinch measurements were assessed pre and postoperatively. Patients were asked to file a satisfaction questionnaire. Pain during the anaesthesia and discomfort after the procedure were minimal. Complications included prolonged oedema in 11 patients. The average arm circumference decreased by 4.9 ± 0.4 cm in the right arm (p < 0.01) and 4.7 ± 0.5 cm in the left arm (p < 0.01) in grade I patients, 5.5 ± 0.6 cm in the right arm (p < 0.01) and 5.2 ± 0.5 cm in the left arm (p < 0.01) in grade IIa patients and 5.4 ± 0.5 cm in the right arm (p < 0.01) and 5.3 ± 0.5 cm in the left arm (p < 0.01) in grade IIB patients. The skin tightening effect was confirmed by the reduction of the skin calliper measurements in all three groups. Overall mean opinion of treatment was high for both patients and investigators. Of the 45 patients, all but one would recommend this treatment. A single session of LAL in upper arm remodelling for Teimourian grades I to IIb is a safe and reproducible technique. The procedure allows reduction in the amount of adipose deposits while providing full skin tightening.

Gravity compensation of an upper extremity exoskeleton.

PubMed

Moubarak, S; Pham, M T; Moreau, R; Redarce, T

2010-01-01

This paper presents a new gravity compensation method for an upper extremity exoskeleton mounted on a wheel chair. This new device is dedicated to regular and efficient rehabilitation training for post-stroke and injured people without the continuous presence of a therapist. The exoskeleton is a wearable robotic device attached to the human arm. The user provides information signals to the controller by means of the force sensors around the wrist and the arm, and the robot controller generates the appropriate control signals for different training strategies and paradigms. This upper extremity exoskeleton covers four basic degrees of freedom of the shoulder and the elbow joints with three additional adaptability degrees of freedom in order to match the arm anatomy of different users. For comfortable and efficient rehabilitation, a new heuristic method have been studied and applied on our prototype in order to calculate the gravity compensation model without the need to identify the mass parameters. It is based on the geometric model of the robot and accurate torque measurements of the prototype's actuators in a set of specifically chosen joint positions. The weight effect has been successfully compensated so that the user can move his arm freely while wearing the exoskeleton without feeling its mass.

Regeneration of upper-elevation red oak in the White Mountains of New Hampshire

Treesearch

William B. Leak; Mariko. Yamasaki

2013-01-01

Northern red oak occurs in limited amounts with a mixture of softwoods on the shallow soils at upper elevations in northern New England. These stands are important for wildlife habitat and forest diversity as well as a modest amount of timber harvesting. Little experience or research is available on how to regenerate upper-elevation oak. However, an examination of a 35...

Military Personnel: Army Needs to Focus on Cost-Effective Use of Financial Incentives and Quality Standards in Managing Force Growth

DTIC Science & Technology

2009-05-01

diplomas and who score in the upper half on the Armed Forces Qualification Test. The Army implemented some new programs to increase the market of...quality of its enlisted personnel, we analyzed data from OSD on educational credentials and aptitude test scores for these personnel, and we collected...recruits to have high-school diplomas and at least 60 percent to have scores in the upper half on the Armed Forces Qualification Test (AFQT). In fiscal

User Evaluation of a Dynamic Arm Orthosis for People With Neuromuscular Disorders.

PubMed

Gunn, Margaret; Shank, Tracy M; Eppes, Marissa; Hossain, Jobayer; Rahman, Tariq

2016-12-01

This paper presents the results of an online survey conducted with users of a functional upper extremity orthosis called the Wilmington Robotic EXoskeleton (WREX). The WREX is a passive anti-gravity arm orthosis that allows people with neuromuscular disabilities to move their arms in three dimensions. The paper also describes the design of a novel lightweight 3-D printed WREX used for ambulatory children. Three different versions of the WREX are now offered to patients. Two can be mounted on a wheelchair and one to a body jacket for ambulatory patients. An online user survey with 55 patients was conducted to determine the benefits of the various WREXs. The survey asked ten questions related to upper extremity function with and without the WREX as well as subjective impressions of the device. Results show a statistically significant improvement in arm function for everyday tasks with the WREX.

Mechanical Impedance Modeling of Human Arm: A survey

NASA Astrophysics Data System (ADS)

Puzi, A. Ahmad; Sidek, S. N.; Sado, F.

2017-03-01

Human arm mechanical impedance plays a vital role in describing motion ability of the upper limb. One of the impedance parameters is stiffness which is defined as the ratio of an applied force to the measured deformation of the muscle. The arm mechanical impedance modeling is useful in order to develop a better controller for system that interacts with human as such an automated robot-assisted platform for automated rehabilitation training. The aim of the survey is to summarize the existing mechanical impedance models of human upper limb so to justify the need to have an improved version of the arm model in order to facilitate the development of better controller of such systems with ever increase in complexity. In particular, the paper will address the following issue: Human motor control and motor learning, constant and variable impedance models, methods for measuring mechanical impedance and mechanical impedance modeling techniques.

Visualisation of upper limb activity using spirals: A new approach to the assessment of daily prosthesis usage.

PubMed

Chadwell, Alix; Kenney, Laurence; Granat, Malcolm; Thies, Sibylle; Head, John S; Galpin, Adam

2018-02-01

Current outcome measures used in upper limb myoelectric prosthesis studies include clinical tests of function and self-report questionnaires on real-world prosthesis use. Research in other cohorts has questioned both the validity of self-report as an activity assessment tool and the relationship between clinical functionality and real-world upper limb activity. Previously, 1 we reported the first results of monitoring upper limb prosthesis use. However, the data visualisation technique used was limited in scope. Methodology development. To introduce two new methods for the analysis and display of upper limb activity monitoring data and to demonstrate the potential value of the approach with example real-world data. Upper limb activity monitors, worn on each wrist, recorded data on two anatomically intact participants and two prosthesis users over 1 week. Participants also filled in a diary to record upper limb activity. Data visualisation was carried out using histograms, and Archimedean spirals to illustrate temporal patterns of upper limb activity. Anatomically intact participants' activity was largely bilateral in nature, interspersed with frequent bursts of unilateral activity of each arm. At times when the prosthesis was worn prosthesis users showed very little unilateral use of the prosthesis (≈20-40 min/week compared to ≈350 min/week unilateral activity on each arm for anatomically intact participants), with consistent bias towards the intact arm throughout. The Archimedean spiral plots illustrated participant-specific patterns of non-use in prosthesis users. The data visualisation techniques allow detailed and objective assessment of temporal patterns in the upper limb activity of prosthesis users. Clinical relevance Activity monitoring offers an objective method for the assessment of upper limb prosthesis users' (PUs) activity outside of the clinic. By plotting data using Archimedean spirals, it is possible to visualise, in detail, the temporal patterns of upper limb activity. Further work is needed to explore the relationship between traditional functional outcome measures and real-world prosthesis activity.

Soy protein supplement intake for 12 months has no effect on sexual maturation and may improve nutritional status in pre-pubertal children.

PubMed

Duitama, Sandra M; Zurita, Javier; Cordoba, Diana; Duran, Paola; Ilag, Leopold; Mejia, Wilson

2018-05-20

To evaluate the intake of a soy protein-based supplement (SPS) and its effects on the sexual maturation and nutritional status of prepubertal children who consumed it for a year. Healthy children (n = 51) were recruited and randomly assigned to consume the lunch fruit juice with (n = 29) or without (n = 22) addition of 45 g of a commercial soy protein-based supplement (SPS) over 12 months. Nutritional assessment including anthropometry (bodyweight, height, triceps skinfold thickness, mid-upper arm circumference), body mass index (BMI), upper arm muscle area, arm muscle circumference, upper arm area, upper arm fat area data were derived from measures using usual procedures; age and gender-specific percentiles were used as reference. Sexual maturation was measured by Tanner stage. Isoflavones were quantified using liquid chromatography and tandem mass spectrometry. Height, BMI/age, weight/age and height/age were significantly different (P < 0.05) at 12 months between girls in the control and intervention groups. Statistically significant differences between groups by gender (P < 0.05) were found in boys in the control group for the triceps skinfold thickness and fat area. Nutritional status was adequate according to the World Health Organization parameters. On average, 0.130 mg/kg body weight/day of isoflavones were consumed by children, which did not show significant differences in their sexual maturation. Consumption of SPS for 12 months did not affect sexual maturation or the onset of puberty in prepubertal boys and girls; however, it may have induced an increase in height, BMI/age, height/age and weight/age of the girls, associated with variations in fat-free mass. © 2018 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

Perception and action in swimming: Effects of aquatic environment on upper limb inter-segmental coordination.

PubMed

Guignard, Brice; Rouard, Annie; Chollet, Didier; Ayad, Omar; Bonifazi, Marco; Dalla Vedova, Dario; Seifert, Ludovic

2017-10-01

This study assessed perception-action coupling in expert swimmers by focusing on their upper limb inter-segmental coordination in front crawl. To characterize this coupling, we manipulated the fluid flow and compared trials performed in a swimming pool and a swimming flume, both at a speed of 1.35ms -1 . The temporal structure of the stroke cycle and the spatial coordination and its variability for both hand/lower arm and lower arm/upper arm couplings of the right body side were analyzed as a function of fluid flow using inertial sensors positioned on the corresponding segments. Swimmers' perceptions in both environments were assessed using the Borg rating of perceived exertion scale. Results showed that manipulating the swimming environment impacts low-order (e.g., temporal, position, velocity or acceleration parameters) and high-order (i.e., spatial-temporal coordination) variables. The average stroke cycle duration and the relative duration of the catch and glide phases were reduced in the flume trial, which was perceived as very intense, whereas the pull and push phases were longer. Of the four coordination patterns (in-phase, anti-phase, proximal and distal: when the appropriate segment is leading the coordination of the other), flume swimming demonstrated more in-phase coordination for the catch and glide (between hand and lower arm) and recovery (hand/lower arm and lower arm/upper arm couplings). Conversely, the variability of the spatial coordination was not significantly different between the two environments, implying that expert swimmers maintain consistent and stable coordination despite constraints and whatever the swimming resistances. Investigations over a wider range of velocities are needed to better understand coordination dynamics when the aquatic environment is modified by a swimming flume. Since the design of flumes impacts significantly the hydrodynamics and turbulences of the fluid flow, previous results are mainly related to the characteristics of the flume used in the present study (or a similar one), and generalization is subject to additional investigations. Copyright © 2017 Elsevier B.V. All rights reserved.

Effect of Exposure to Lithium-Paired or Amphetamine-Paired Saccharin Solution on Open Arm Avoidance in an Elevated Plus Maze

ERIC Educational Resources Information Center

Rana, Shadna A.; Parker, Linda A.

2006-01-01

Recent evidence suggests that drug-induced conditioned taste avoidance may be mediated by conditioned fear (e.g., Parker, 2003). The experiments reported here evaluated the effect of exposure to a drug-paired flavor on open arm exploration in an elevated plus maze (EPM), a measure of fear. When rats were tested on a familiar (trial 2) EPM, but not…

Control of the seven-degree-of-freedom upper limb exoskeleton for an improved human-robot interface

NASA Astrophysics Data System (ADS)

Kim, Hyunchul; Kim, Jungsuk

2017-04-01

This study analyzes a practical scheme for controlling an exoskeleton robot with seven degrees of freedom (DOFs) that supports natural movements of the human arm. A redundant upper limb exoskeleton robot with seven DOFs is mechanically coupled to the human body such that it becomes a natural extension of the body. If the exoskeleton robot follows the movement of the human body synchronously, the energy exchange between the human and the robot will be reduced significantly. In order to achieve this, the redundancy of the human arm, which is represented by the swivel angle, should be resolved using appropriate constraints and applied to the robot. In a redundant 7-DOF upper limb exoskeleton, the pseudoinverse of the Jacobian with secondary objective functions is widely used to resolve the redundancy that defines the desired joint angles. A secondary objective function requires the desired joint angles for the movement of the human arm, and the angles are estimated by maximizing the projection of the longest principle axis of the manipulability ellipsoid for the human arm onto the virtual destination toward the head region. Then, they are fed into the muscle model with a relative damping to achieve more realistic robot-arm movements. Various natural arm movements are recorded using a motion capture system, and the actual swivel-angle is compared to that estimated using the proposed swivel angle estimation algorithm. The results indicate that the proposed algorithm provides a precise reference for estimating the desired joint angle with an error less than 5°.

CRUX: A compliant robotic upper-extremity exosuit for lightweight, portable, multi-joint muscular augmentation.

PubMed

Lessard, Steven; Pansodtee, Pattawong; Robbins, Ash; Baltaxe-Admony, Leya Breanna; Trombadore, James M; Teodorescu, Mircea; Agogino, Adrian; Kurniawan, Sri

2017-07-01

Wearable robots can potentially offer their users enhanced stability and strength. These augmentations are ideally designed to actuate harmoniously with the user's movements and provide extra force as needed. The creation of such robots, however, is particularly challenging due to the underlying complexity of the human body. In this paper, we present a compliant, robotic exosuit for upper extremities called CRUX. This exosuit, inspired by tensegrity models of the human arm, features a lightweight (1.3 kg), flexible multi-joint design for portable augmentation. We also illustrate how CRUX maintains the full range of motion of the upper-extremities for its users while providing multi-DoF strength amplification to the major muscles of the arm, as evident by tracking the heart rate of an individual exercising said arm. Exosuits such as CRUX may be useful in physical therapy and in extreme environments where users are expected to exert their bodies to the fullest extent.

Intra-Cyclic Phases of Arm-Leg Movement and Index of Coordination in Relation to Sprint Breaststroke Swimming in Young Swimmers

PubMed Central

Strzala, Marek; Krezalek, Piotr; Glab, Grzegorz; Kaca, Marcin; Ostrowski, Andrzej; Stanula, Arkadiusz; Tyka, Anna K.

2013-01-01

Despite the limitations set by FINA regulations, execution technique in breaststroke swimming is being improved thanks to more and more advanced analyses of the efficiency of the swimmer’s movements. The aim of this study was to detect the parameters of the time structure of the cycle correlated with the maximal swimming speed at the of 50 meters distance, in order to focus to specific technical aspects in the breaststroke training. In the group of 23 participants, between the age of 15.0 ± 1.17, the breaststroke cycle movement of the arms and legs was divided into two phases: propulsive or non-propulsive. In addition, indices characterizing the temporal coordination of movements of the upper limbs in relation to the lower limbs were distinguished: 1) Arm-Leg Lag - determines the interval between the phases of propulsion generated by upper and lower limbs; 2) Glide or Overlap - the inter-cyclic glide or overlap of the propulsive movement of the upper on lower limbs. Significant dependence was noted between the swim speed (V50surface breast) and the percentage of time of the arm propulsive in-sweep phase 0.64, p < 0.01. A significant correlation was observed between the V50surface breast with the percentage of partially surfaced hand phase of arm recovery 0.54, p < 0.01. Correlation between total leg propulsion and non-propulsion phases with V50surface breast was 0.49 and -0.49 respectively, both p < 0.01. The Glide or Overlap index was significantly related to the swimming speed V50surface breast 0.48, p < 0.05. This type of analysis suggests how to refine the swimming technique, with the goal to improve the current speed capabilities; furthermore the results also indicate the direction of its development in the future swimmers of the group studied. Key Points This study investigated the influence of the inter- and intra-cyclic time structure of the movements in sprint breaststroke swimming. The distinction of the operations phases of the upper limbs in the propulsive movement shows significant correlation 0.64, p <0.01 between the swimming speed V50surface breast and the execution time of the in-sweep phase in the movement cycle. Significant relationship was noted between minimizing the first non-propulsive phase of arm recovery with higher contribution of the next, partially immersed sliding phase of arm recovery. The specification of the inter-cyclic coordination index of the upper and lower limbs during the movement cycle shows influence of the overlap of the propulsive movement of the upper limbs on the propulsive movement of the lower limbs on V50surface breast with correlation 0.48, p <0.05 for young swimmers. PMID:24421728

A feasibility study to determine the benefits of upper extremity virtual rehabilitation therapy for coping with chronic pain post-cancer surgery

PubMed Central

House, Gregory; Burdea, Grigore; Grampurohit, Namrata; Polistico, Kevin; Roll, Doru; Damiani, Frank; Hundal, Jasdeep; Demesmin, Didier

2016-01-01

Background: Persistent pain in shoulder and arm following post-surgical breast cancer treatment can lead to cognitive and physical deficits. Depression is also common in breast cancer survivors. Virtual reality therapy with integrative cognitive and physical rehabilitation has not been clinically trialed for this population. The novel BrightArm Duo technology improved cognition and upper extremity (UE) function for other diagnoses and has great potential to benefit individuals coping with post-surgical breast cancer pain. Objectives: The aim of this study was to explore the feasibility of BrightArm Duo therapy for coping with post-surgical chronic pain and associated disability in breast cancer survivors with depression. Methods: BrightArm Duo is a robotic rehabilitation table modulating gravity loading on supported forearms. It tracks arm position and grasping strength while patients play three-dimensional (3D) custom integrative rehabilitation games. Community-dwelling women (N = 6) with post-surgical breast cancer pain in the upper arm trained on the system twice a week for 8 weeks. Training difficulty increased progressively in game complexity, table tilt and session length (20–50 minutes). Standardized assessments were performed before and after therapy for pain, cognition, emotion, UE function and activities of daily living. Results: Subjects averaged upwards of 1300 arm repetitions and 850 hand grasps per session. Pain intensity showed a 20% downward trend (p = 0.1) that was corroborated by therapist observations and participant feedback. A total of 10 out of 11 cognitive metrics improved post-training (p = 0.01) with a significant 8.3-point reduction in depression severity (p = 0.04). A total of 17 of 18 range of motion metrics increased (p < 0.01), with five affected-side shoulder improvements above the Minimal Clinically Important Difference (8°). In all, 13 out of 15 strength and function metrics improved (p = 0.02) with lateral deltoid strength increasing 7.4 N on the affected side (p = 0.05). Conclusion: This pilot study demonstrated feasibility of using the BrightArm Duo Rehabilitation System to treat cancer survivors coping with upper body chronic pain. Outcomes indicate improvement in cognition, shoulder range, strength, function and depression. PMID:27867508

A feasibility study to determine the benefits of upper extremity virtual rehabilitation therapy for coping with chronic pain post-cancer surgery.

PubMed

House, Gregory; Burdea, Grigore; Grampurohit, Namrata; Polistico, Kevin; Roll, Doru; Damiani, Frank; Hundal, Jasdeep; Demesmin, Didier

2016-11-01

Persistent pain in shoulder and arm following post-surgical breast cancer treatment can lead to cognitive and physical deficits. Depression is also common in breast cancer survivors. Virtual reality therapy with integrative cognitive and physical rehabilitation has not been clinically trialed for this population. The novel BrightArm Duo technology improved cognition and upper extremity (UE) function for other diagnoses and has great potential to benefit individuals coping with post-surgical breast cancer pain. The aim of this study was to explore the feasibility of BrightArm Duo therapy for coping with post-surgical chronic pain and associated disability in breast cancer survivors with depression. BrightArm Duo is a robotic rehabilitation table modulating gravity loading on supported forearms. It tracks arm position and grasping strength while patients play three-dimensional (3D) custom integrative rehabilitation games. Community-dwelling women (N = 6) with post-surgical breast cancer pain in the upper arm trained on the system twice a week for 8 weeks. Training difficulty increased progressively in game complexity, table tilt and session length (20-50 minutes). Standardized assessments were performed before and after therapy for pain, cognition, emotion, UE function and activities of daily living. Subjects averaged upwards of 1300 arm repetitions and 850 hand grasps per session. Pain intensity showed a 20% downward trend (p = 0.1) that was corroborated by therapist observations and participant feedback. A total of 10 out of 11 cognitive metrics improved post-training (p = 0.01) with a significant 8.3-point reduction in depression severity (p = 0.04). A total of 17 of 18 range of motion metrics increased (p < 0.01), with five affected-side shoulder improvements above the Minimal Clinically Important Difference (8°). In all, 13 out of 15 strength and function metrics improved (p = 0.02) with lateral deltoid strength increasing 7.4 N on the affected side (p = 0.05). This pilot study demonstrated feasibility of using the BrightArm Duo Rehabilitation System to treat cancer survivors coping with upper body chronic pain. Outcomes indicate improvement in cognition, shoulder range, strength, function and depression.

Physiologically Relevant Prosthetic Limb Movement Feedback for Upper and Lower Extremity Amputees

DTIC Science & Technology

2016-10-01

upper arm (elbow movement), Upper leg (knee movement) and lower leg ( ankle movement) to provide a physiologically relevant sense of limb movement...Additionally a BOA cable tensioning system is passed through these plates and anchored to the external surface of the socket. When tension is applied the

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

Age differences in energy absorption in the upper extremity during a descent movement: implications for arresting a fall.

PubMed

Sran, Meena M; Stotz, Paula J; Normandin, Sarah C; Robinovitch, Stephen N

2010-03-01

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. 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 degrees to 90 degrees . Measures were acquired of peak upper extremity energy absorption, arm deflection, and hand contact force. 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 x 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. 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.

Intermanual transfer in training with an upper-limb myoelectric prosthesis simulator: a mechanistic, randomized, pretest-posttest study.

PubMed

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

2013-01-01

Intermanual transfer may improve prosthetic handling and acceptance if used in training soon after an amputation. The purpose of this study was to determine whether intermanual transfer effects can be detected after training with a myoelectric upper-limb prosthesis simulator. A mechanistic, randomized, pretest-posttest design was used. A total of 48 right-handed participants (25 women, 23 men) who were able-bodied were randomly assigned to an experimental group or a control group. The experimental group performed a training program of 5 days' duration using the prosthesis simulator. To determine the improvement in skill, a test was administered before, immediately after, and 6 days after training. The control group only performed the tests. Training was performed with the unaffected arm, and tests were performed with the affected arm (the affected arm simulating an amputated limb). Half of the participants were tested with the dominant arm and half with the nondominant arm. Initiation time was defined as the time from starting signal until start of the movement, movement time was defined as the time from the beginning of the movement until completion of the task, and force control was defined as the maximal applied force on a deformable object. The movement time decreased significantly more in the experimental group (F₂,₉₂=7.42, P=.001, η²(G)=.028) when compared with the control group. This finding is indicative of faster handling of the prosthesis. No statistically significant differences were found between groups with regard to initiation time and force control. We did not find a difference in intermanual transfer between the dominant and nondominant arms. The training utilized participants who were able-bodied in a laboratory setting and focused only on transradial amputations. Intermanual transfer was present in the affected arm after training the unaffected arm with a myoelectric prosthesis simulator, and this effect did not depend on laterality. This effect may improve rehabilitation of patients with an upper-limb amputation.

Deficits in Upper Limb Position Sense of Children with Spastic Hemiparetic Cerebral Palsy Are Distance-Dependent

ERIC Educational Resources Information Center

Smorenburg, Ana R. P.; Ledebt, Annick; Deconinck, Frederik J. A.; Savelsbergh, Geert J. P.

2012-01-01

This study examined the arm position sense in children with Spastic Hemiparetic Cerebral Palsy (SHCP) and typically developing children (TD) by means of a contralateral matching task. This task required participants to match the position of one arm with the position of the other arm for different target distances and from different starting…

The clinical aspects of the upper extremity exoskeleton "EXAR" use

NASA Astrophysics Data System (ADS)

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

2015-11-01

The article considers some of indications and contraindications for the use of the exoskeleton "EXAR". Our experience with the present construction use shows that the exoskeleton "EXAR" is able to make up the following lost or disturbed muscle functions:- an arm raise; a drawing of the arm aside from the trunk;- a bending of the arm in shoulder or elbow joints.

Blood pressure measurement in obese patients: comparison between upper arm and forearm measurements.

PubMed

Pierin, Angela M G; Alavarce, Débora C; Gusmão, Josiane L; Halpern, Alfredo; Mion, Décio

2004-06-01

It is well known that blood pressure measurement with a standard 12-13 cm wide cuff is erroneous for large arms. To compare arm blood pressure measurements with an appropriate cuff and forearm blood pressure measurements (BPM) with a standard cuff, and both measurements by the Photopletismography (Finapres) method. One hundred and twenty-nine obese patients were studied (body mass index=40+/-7 kg/m2). The patients had three arm BPM taken by an automatic oscillometric device using an appropriate cuff and three forearm BPM with a standard cuff in the sitting position after a five-minute rest. Data were analysed by the analysis of variance. The correction values were obtained by the linear regression test. Systolic and diastolic arm BPM with an appropriate cuff were significantly lower (p<0.05) than forearm BPM with a standard cuff. The measurements obtained by Finapres were significantly lower (p<0.05) than those found for forearm systolic and diastolic blood pressures and upper arm diastolic blood pressure. The equation to correct BPM in forearm in obese patients with arm circumference between 32-44 cm was: systolic BPM=33.2+/-0.68 x systolic forearm BPM, and diastolic BPM=25.2+0.59 x forearm diastolic BPM. This study showed that forearm blood pressure measurement overestimates the values of arm blood pressure measurement. In addition, it is possible to correct forearm BPM with an equation.

Characterization of the rat exploratory behavior in the elevated plus-maze with Markov chains.

PubMed

Tejada, Julián; Bosco, Geraldine G; Morato, Silvio; Roque, Antonio C

2010-11-30

The elevated plus-maze is an animal model of anxiety used to study the effect of different drugs on the behavior of the animal. It consists of a plus-shaped maze with two open and two closed arms elevated 50cm from the floor. The standard measures used to characterize exploratory behavior in the elevated plus-maze are the time spent and the number of entries in the open arms. In this work, we use Markov chains to characterize the exploratory behavior of the rat in the elevated plus-maze under three different conditions: normal and under the effects of anxiogenic and anxiolytic drugs. The spatial structure of the elevated plus-maze is divided into squares, which are associated with states of a Markov chain. By counting the frequencies of transitions between states during 5-min sessions in the elevated plus-maze, we constructed stochastic matrices for the three conditions studied. The stochastic matrices show specific patterns, which correspond to the observed behaviors of the rat under the three different conditions. For the control group, the stochastic matrix shows a clear preference for places in the closed arms. This preference is enhanced for the anxiogenic group. For the anxiolytic group, the stochastic matrix shows a pattern similar to a random walk. Our results suggest that Markov chains can be used together with the standard measures to characterize the rat behavior in the elevated plus-maze. Copyright © 2010 Elsevier B.V. All rights reserved.

Treatment of gummy smile: Gingival recontouring with the containment of the elevator muscle of the upper lip and wing of nose. A surgery innovation technique.

PubMed

Storrer, Carmen Lucia Mueller; Valverde, Fabiane Kristine Bochenek; Santos, Felipe Rychuv; Deliberador, Tatiana Miranda

2014-09-01

The containment of the elevator muscle of the upper lip and wing of nose was used for the treatment of patients with gummy smile. This technique had corrected esthetic alterations of smile, reducing the upper lip elevation, which results in a smaller gingival display. An upper lip lengthening as well as a reduction in the upper lip shortening when the patient smiled could be observed. The high smile line was corrected without compromising the labial harmony. This study presents an innovative and effective therapeutic option to obtain a natural and harmonious smile. The patient expressed a high degree of satisfaction.

The effects of plane and arc of elevation on electromyography of shoulder musculature in patients with rotator cuff tears.

PubMed

Alenabi, Talia; Dal Maso, Fabien; Tétreault, Patrice; Begon, Mickaël

2016-02-01

Arm elevations in different planes are commonly assessed in clinics and are included in rehabilitation protocols for patients with rotator cuff pathology. The aim of this study was to quantify the effect of plane and angle of elevation on shoulder muscles activity in patients with symptomatic rotator cuff tear to be used for rehabilitation purposes. Eight symptomatic patients with rotator cuff tears were assessed by using EMG (11 surface and 2 fine wire electrodes) synchronized with a motion analysis. The subjects completed five elevations in full can position (arm externally rotated and thumb up) in frontal, scapular and sagittal planes. Muscle activity in three elevation arcs of 20° (from 0° to 60°) was presented as the percentage of mean activity. Data were analyzed by mixed linear models (α=0.003), and Tuckey Post-hoc comparisons for significant effects (α=0.05). The effect of plane was significant for supraspinatus, middle trapezius, anterior, middle, and posterior deltoid, triceps, and pectoralis major (P<0.001). Supraspinatus was more active during abduction than scaption and flexion (P<0.05), and its activity did not increase significantly after 40° of elevation (P>0.05). Infraspinatus had similar activity pattern in the three planes of elevation (P>0.003) with increasing trend in accordance with the elevation angle. In any rehabilitation protocol, if less activity of supraspinatus is desired, active arm elevation should be directed toward flexion and scaption and postponed abduction to prevent high level of activity in this muscle. Copyright © 2015 Elsevier Ltd. All rights reserved.

The Upper Mississippi River System—Topobathy

USGS Publications Warehouse

Stone, Jayme M.; Hanson, Jenny L.; Sattler, Stephanie R.

2017-03-23

The Upper Mississippi River System (UMRS), the navigable part of the Upper Mississippi and Illinois Rivers, is a diverse ecosystem that contains river channels, tributaries, shallow-water wetlands, backwater lakes, and flood-plain forests. Approximately 10,000 years of geologic and hydrographic history exist within the UMRS. Because it maintains crucial wildlife and fish habitats, the dynamic ecosystems of the Upper Mississippi River Basin and its tributaries are contingent on the adjacent flood plains and water-level fluctuations of the Mississippi River. Separate data for flood-plain elevation (lidar) and riverbed elevation (bathymetry) were collected on the UMRS by the U.S. Army Corps of Engineers’ (USACE) Upper Mississippi River Restoration (UMRR) Program. Using the two elevation datasets, the U.S. Geological Survey (USGS) Upper Midwest Environmental Sciences Center (UMESC) developed a systemic topobathy dataset.

Spinal loads as influenced by external loads: a combined in vivo and in silico investigation.

PubMed

Zander, Thomas; Dreischarf, Marcel; Schmidt, Hendrik; Bergmann, Georg; Rohlmann, Antonius

2015-02-26

Knowledge of in vivo spinal loads and muscle forces remains limited but is necessary for spinal biomechanical research. To assess the in vivo spinal loads, measurements with telemeterised vertebral body replacements were performed in four patients. The following postures were investigated: (a) standing with arms hanging down on sides, (b) holding dumbbells to subject the patient to a vertical load, and (c) the forward elevation of arms for creating an additional flexion moment. The same postures were simulated by an inverse static model for validation purposes, to predict muscle forces, and to assess the spinal loads in subjects without implants. Holding dumbbells on sides increased implant forces by the magnitude of the weight of the dumbbells. In contrast, elevating the arms yielded considerable implant forces with a high correlation between the external flexion moment and the implant force. Predictions agreed well with experimental findings, especially for forward elevation of arms. Flexion moments were mainly compensated by erector spinae muscles. The implant altered the kinematics and, thus, the spinal loads. Elevation of both arms in vivo increased spinal axial forces by approximately 100N; each additional kg of dumbbell weight held in the hands increased the spinal axial forces by 60N. Model predictions suggest that in the intact situation, the force increase is one-third greater for these loads. In vivo measurements are essential for the validation of analytical models, and the combination of both methods can reveal unquantifiable data such as the spinal loads in the intact non-instrumented situation. Copyright © 2015 Elsevier Ltd. All rights reserved.

Winter water relations at the upper elevational limits of hemlock on Mt. Ascutney, Vermont

Treesearch

Chandra B. Vostral; Richard L. Boyce

2000-01-01

Winter water relations have been monitored in hemlock (Tsuga canadensis (L.) Carr.) at their upper elevational limits for three winters, 1997, 1998, and 1999, on Mt. Ascutney, Vermont. Hemlock and white pine trees (Pinus strobus L.) reach their elevational limit on Mt. Ascutney at 640 m (2100?), while the summit has an elevation of...

Vector movement underlies avian malaria at upper elevation in Hawaii: implications for transmission of human malaria.

PubMed

Freed, Leonard A; Cann, Rebecca L

2013-11-01

With climate warming, malaria in humans and birds at upper elevations is an emerging infectious disease because development of the parasite in the mosquito vector and vector life history are both temperature dependent. An enhanced-mosquito-movement model from climate warming predicts increased transmission of malaria at upper elevation sites that are too cool for parasite development in the mosquito vector. We evaluate this model with avian malaria (Plasmodium relictum) at 1,900-m elevation on the Island of Hawaii, with air temperatures too low for sporogony in the vector (Culex quinquefasciatus). On a well-defined site over a 14-year period, 10 of 14 species of native and introduced birds became infected, several epizootics occurred, and the increase in prevalence was driven more by resident species than by mobile species that could have acquired their infections at lower elevations. Greater movement of infectious mosquitoes from lower elevations now permits avian malaria to spread at 1,900 m in Hawaii, in advance of climate warming at that elevation. The increase in malaria at upper elevations due to dispersal of infectious mosquitoes is a real alternative to temperature for the increased incidence of human malaria in tropical highlands.

Dual-cycle ergometry as an exercise modality during prebreathe with 100 percent oxygen

NASA Technical Reports Server (NTRS)

Heaps, Cristine L.; Fischer, Michele D.; Webb, James T.

1994-01-01

In an effort to reduce prebreathe time requirements prior to extravehicular activities and high-altitude flights, a combined arm and leg exercise task proposes to enhance denitrogenation by incorporation of both upper and lower body musculature at a moderately high work intensity during prebreathe with 100% oxygen. Preliminary findings indicated peak oxygen consumption (VO2peak) levels attained on the dual-cycle ergometer do not differ significantly from those levels attained on the treadmill. Eight male subjects were exercised to VO2peak using leg-only cycle ergometry and dual-cycle ergometry on separate days. Preliminary data during dual-cycle ergometry showed arm work equaling 30% of the leg workrate at each stage of the incremental test resulted in arm fatigue in several subjects and a reduced VO2peak compared to dual-cycle ergometry with arm work at 20%. Thus, the 20% workrate was used during the dual-cycle VO2peak trial. On a third experimental day, subjects performed a 10 minute exercise test at a workrate required to elicit 75% of VO2peak for each subject on the dual-cycle ergometer. Blood lactate response to the exercise was monitored as an objective measure of fatigue. Peak VO2 levels attained on the leg-only and the dual-cycle ergometry tasks were not significantly different. Blood lactate levels were significantly elevated following the dual-cycle ergometry at 75% VO2peak. However, lactate levels show the expected rate of decline during recovery and, as demonstrated in the literature, should return to baseline levels within 30 minutes following exercise cessation. Thus, dual-cycle ergometry at 75% VO2peak appears to be a valid exercise for use during prebreathe and should not contribute to fatigue during subsequent EVA's.

Upper limb joint kinetics of three sitting pivot wheelchair transfer techniques in individuals with spinal cord injury.

PubMed

Kankipati, Padmaja; Boninger, Michael L; Gagnon, Dany; Cooper, Rory A; Koontz, Alicia M

2015-07-01

Repeated measures design. This study compared the upper extremity (UE) joint kinetics between three transfer techniques. Research laboratory. Twenty individuals with spinal cord injury performed three transfer techniques from their wheelchair to a level tub bench. Two of the techniques involved a head-hips method with leading hand position close (HH-I) and far (HH-A) from the body, and the third technique with the trunk upright (TU) and hand far from body. Motion analysis equipment recorded upper body movements and force sensors recorded their hand and feet reaction forces during the transfers. Several significant differences were found between HH-A and HH-I and TU and HH-I transfers indicating that hand placement was a key factor influencing the UE joint kinetics. Peak resultant hand, elbow, and shoulder joint forces were significantly higher for the HH-A and TU techniques at the trailing arm (P < 0.036) and lower at the leading arm (P < 0.021), compared to the HH-I technique. Always trailing with the same arm if using HH-A or TU could predispose that arm to overuse related pain and injuries. Technique training should focus on initial hand placement close to the body followed by the amount of trunk flexion needed to facilitate movement.

An elevated plus-maze in mixed reality for studying human anxiety-related behavior.

PubMed

Biedermann, Sarah V; Biedermann, Daniel G; Wenzlaff, Frederike; Kurjak, Tim; Nouri, Sawis; Auer, Matthias K; Wiedemann, Klaus; Briken, Peer; Haaker, Jan; Lonsdorf, Tina B; Fuss, Johannes

2017-12-21

A dearth of laboratory tests to study actual human approach-avoidance behavior has complicated translational research on anxiety. The elevated plus-maze (EPM) is the gold standard to assess approach-avoidance behavior in rodents. Here, we translated the EPM to humans using mixed reality through a combination of virtual and real-world elements. In two validation studies, we observed participants' anxiety on a behavioral, physiological, and subjective level. Participants reported higher anxiety on open arms, avoided open arms, and showed an activation of endogenous stress systems. Participants' with high anxiety exhibited higher avoidance. Moreover, open arm avoidance was moderately predicted by participants' acrophobia and sensation seeking, with opposing influences. In a randomized, double blind, placebo controlled experiment, GABAergic stimulation decreased avoidance of open arms while alpha-2-adrenergic antagonism increased avoidance. These findings demonstrate cross-species validity of open arm avoidance as a translational measure of anxiety. We thus introduce the first ecologically valid assay to track actual human approach-avoidance behavior under laboratory conditions.

The Arm is Not the Leg: Pathophysiology, Diagnosis, and Management of Upper Extremity Deep Vein Thrombosis.

PubMed

Noyes, Adam M; Dickey, John

2017-05-01

Upper extremity deep venous thrombosis (UEDVT) involves thrombosis of the deep veins of the arm as they enter the thorax. They are increasing in frequency, largely due to the rising use of central venous catheters and implantable cardiac devices, and represent more than 10% of all DVT cases, Upper extremity deep venous thrombosis has been historically misunderstood when compared to lower extremity deep vein thrombosis (LEDVT). Their associated disease states may carry devastating complications, with mortality rates often higher than that of LEDVT. Thus, education on recognition, classification and management is critical to avoid long-term sequelae and mortality from UEDVT. [Full article available at http://rimed.org/rimedicaljournal-2017-05.asp].

Acute effects of spinal bracing on scapular kinematics in adolescent idiopathic scoliosis.

PubMed

Gur, Gozde; Turgut, Elif; Ayhan, Cigdem; Baltaci, Gul; Yakut, Yavuz

2017-08-01

Bracing is the most common nonsurgical treatment for adolescent idiopathic scoliosis. Spinal braces affect glenohumeral and scapulothoracic motion because they restrict trunk movements. However, the potential spinal-bracing effects on scapular kinematics are unknown. The present study aimed to investigate the acute effects of spinal bracing on scapular kinematics in adolescent idiopathic scoliosis. Scapular kinematics, including scapular internal/external rotation, posterior/anterior tilting, and downward/upward rotation during scapular plane elevation, were evaluated in 27 in-brace and out-of-brace adolescent idiopathic scoliosis patients with a three-dimensional electromagnetic tracking system. Data on the position and orientation of the scapula at 30°, 60°, 90°, and 120° humerothoracic elevation were used for statistical comparisons. The paired t-test was used to assess the differences between the mean values of in-brace and out-of-brace conditions. The in-brace condition showed significantly increased (P<0.05) scapular anterior tilting and decreased internal rotation in the resting position on the convex and concave sides; increased scapular downward rotation at 120° humerothoracic elevation on the convex side and at 30°, 60°, 90°, and 120° humerothoracic elevation on the concave side; increased scapular anterior tilt at 30°, 60°, 90°, and 120° humerothoracic elevation on the convex and concave sides; and decreased (P<0.05) maximal humerothoracic elevation of the arm. Spinal bracing affects scapular kinematics. Observed changes in scapular kinematics with brace may also affect upper extremity function for adolescents with idiopathic scoliosis. Therefore, clinicians should include assessments of the glenohumeral and scapulothoracic joints when designing rehabilitation protocols for patients with adolescent idiopathic scoliosis. Copyright © 2017 Elsevier Ltd. All rights reserved.

Accessory superficial ulnar artery: a case report.

PubMed

Solan, Shweta

2013-12-01

Variations in the arterial system of the upper limb have been well documented. A thorough knowledge on variations of arteries of upper extremity is necessary during performance of vascular and reconstructive surgeries and also, during evaluation of angiographic images. A case of accessory superficial ulnar artery was reported. The ulnar artery had a high origin from the brachial artery, in the upper third of the arm and it proceeded superficially and lateral to ulnar nerve in forearm, but it had a normal termination in the hand. The brachial artery had a usual course in the arm, but in the cubital fossa, it divided into the radial and deep ulnar arteries. This deep ulnar artery ended by dividing into ulnar recurrent and common interosseous arteries. Knowledge on this variation is important for the radiologists, orthopaedic and plastic surgeons, for appropriate planning of operative procedures involving the arteries of the upper limb.

Accessory Superficial Ulnar Artery: A Case Report

PubMed Central

Solan, Shweta

2013-01-01

Variations in the arterial system of the upper limb have been well documented. A thorough knowledge on variations of arteries of upper extremity is necessary during performance of vascular and reconstructive surgeries and also, during evaluation of angiographic images. A case of accessory superficial ulnar artery was reported. The ulnar artery had a high origin from the brachial artery, in the upper third of the arm and it proceeded superficially and lateral to ulnar nerve in forearm, but it had a normal termination in the hand. The brachial artery had a usual course in the arm, but in the cubital fossa, it divided into the radial and deep ulnar arteries. This deep ulnar artery ended by dividing into ulnar recurrent and common interosseous arteries. Knowledge on this variation is important for the radiologists, orthopaedic and plastic surgeons, for appropriate planning of operative procedures involving the arteries of the upper limb. PMID:24551682

Quantifying anti-gravity torques in the design of a powered exoskeleton.

PubMed

Ragonesi, Daniel; Agrawal, Sunil; Sample, Whitney; Rahman, Tariq

2011-01-01

Designing an upper extremity exoskeleton for people with arm weakness requires knowledge of the passive and active residual force capabilities of users. This paper experimentally measures the passive gravitational torques of 3 groups of subjects: able-bodied adults, able bodied children, and children with neurological disabilities. The experiment involves moving the arm to various positions in the sagittal plane and measuring the gravitational force at the wrist. This force is then converted to static gravitational torques at the elbow and shoulder. Data are compared between look-up table data based on anthropometry and empirical data. Results show that the look-up torques deviate from experimentally measured torques as the arm reaches up and down. This experiment informs designers of Upper Limb orthoses on the contribution of passive human joint torques.

New Exoskeleton Arm Concept Design And Actuation For Haptic Interaction With Virtual Objects

NASA Astrophysics Data System (ADS)

Chakarov, D.; Veneva, I.; Tsveov, M.; Tiankov, T.

2014-12-01

In the work presented in this paper the conceptual design and actuation of one new exoskeleton of the upper limb is presented. The device is designed for application where both motion tracking and force feedback are required, such as human interaction with virtual environment or rehabilitation tasks. The choice is presented of mechanical structure kinematical equivalent to the structure of the human arm. An actuation system is selected based on braided pneumatic muscle actuators. Antagonistic drive system for each joint is shown, using pulley and cable transmissions. Force/displacement diagrams are presented of two antagonistic acting muscles. Kinematics and dynamic estimations are performed of the system exoskeleton and upper limb. Selected parameters ensure in the antagonistic scheme joint torque regulation and human arm range of motion.

Design and pilot validation of A-gear: a novel wearable dynamic arm support.

PubMed

Kooren, Peter N; Dunning, Alje G; Janssen, Mariska M H P; Lobo-Prat, Joan; Koopman, Bart F J M; Paalman, Micha I; de Groot, Imelda J M; Herder, Just L

2015-09-18

Persons suffering from progressive muscular weakness, like those with Duchenne muscular dystrophy (DMD), gradually lose the ability to stand, walk and to use their arms. This hinders them from performing daily activities, social participation and being independent. Wheelchairs are used to overcome the loss of walking. However, there are currently few efficient functional substitutes to support the arms. Arm supports or robotic arms can be mounted to wheelchairs to aid in arm motion, but they are quite visible (stigmatizing), and limited in their possibilities due to their fixation to the wheelchair. The users prefer inconspicuous arm supports that are comfortable to wear and easy to control. In this paper the design, characterization, and pilot validation of a passive arm support prototype, which is worn on the body, is presented. The A-gear runs along the body from the contact surface between seat and upper legs via torso and upper arm to the forearm. Freedom of motion is accomplished by mechanical joints, which are nearly aligned with the human joints. The system compensates for the arm weight, using elastic bands for static balance, in every position of the arm. As opposed to existing devices, the proposed kinematic structure allows trunk motion and requires fewer links and less joint space without compromising balancing precision. The functional prototype has been validated in three DMD patients, using 3D motion analysis. Measurements have shown increased arm performance when the subjects were wearing the prototype. Upward and forward movements were easier to perform. The arm support is easy to put on and remove. Moreover, the device felt comfortable for the subjects. However, downward movements were more difficult, and the patients would prefer the device to be even more inconspicuous. The A-gear prototype is a step towards inconspicuousness and therefore well-received dynamic arm supports for people with muscular weakness.

A comparison of upper limb amputees and patients with upper limb injuries using the Disability of the Arm, Shoulder and Hand (DASH).

PubMed

Davidson, Judith

To use the Disability of the Arm Shoulder and Hand (DASH) scale to measure the disability of patients with upper limb amputation(s) and to compare these to other upper limb injuries. All 274 patients over the age of 18 years presenting to Prince Henry Hospital in Sydney over a 4-year time frame were given the DASH assessment tool and asked to complete it under supervision of the Occupational Therapist. Patients with brachial plexus injuries, Complex Regional Pain Syndrome and bilateral upper limb amputations demonstrated significantly higher levels of disability to patients with unilateral upper limb amputations. Partial hand amputees reported a higher level of disability than major unilateral upper limb amputees. For the 48 patients who completed pre- and post-treatment assessments, there was a significant improvement in their health status. Further research is required to understand the factors that affect a patient's perceptions of their disability. Perhaps the definitive nature of an amputation and the immediate involvement of highly skilled health professionals serve to assist patients to accept their injury and therefore minimizes the level of disability.

Short-Term Effects of Thoracic Spine Manipulation on Shoulder Impingement Syndrome: A Randomized Controlled Trial.

PubMed

Haik, Melina N; Alburquerque-Sendín, Francisco; Camargo, Paula R

2017-08-01

To investigate the short-term effects of thoracic spine manipulation (TSM) on pain, function, scapular kinematics, and scapular muscle activity in individuals with shoulder impingement syndrome. Randomized controlled trial with blinded assessor and patient. Laboratory. Patients with shoulder impingement syndrome (N=61). Participants were randomly allocated to TSM group (n=30) or sham-TSM group (n=31) and attended 2 intervention sessions over a 1-week period. Scapular kinematics and muscle activity were measured at day 1 (baseline, before the first intervention), day 2 preintervention (before second intervention), day 2 postintervention (after the second intervention), and day 3 (follow-up). Shoulder pain and function were assessed by the Disability of the Arm, Shoulder and Hand questionnaire and Western Ontario Rotator Cuff Index at baseline, day 2 preintervention, and follow-up. An assessor blinded to group assignment measured all outcomes. Pain decreased by 0.7 points (95% confidence interval, 1.3-0.1 points) at day 2 preintervention and 0.9 points (95% confidence interval, 1.5-0.3 points) at day 2 postintervention in the TSM group. The Disability of the Arm, Shoulder and Hand questionnaire (P=.01) and Western Ontario Rotator Cuff Index (P=.02) scores improved in both groups. Scapular upward rotation increased during arm lowering (P<.01) at day 2 postintervention (5.3°) and follow-up (3.5°) in the TSM group. Upper trapezius activity increased (P<.05) in the sham-TSM group. Middle trapezius, lower trapezius, and serratus anterior decreased activities in both groups during elevation and lowering of the arm. TSM may increase scapular upward rotation during arm lowering. TSM does not seem to influence activity of the scapular muscles. The results concerning shoulder pain, function, scapular tilt, and internal rotation are not conclusive. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Augmentation of blood circulation to the fingers by warming distant body areas

NASA Technical Reports Server (NTRS)

Koscheyev, V. S.; Leon, G. R.; Paul, S.; Tranchida, D.; Linder, I. V.

2000-01-01

Future activities in space will require greater periods of time in extreme environments in which the body periphery will be vulnerable to chilling. Maintaining the hands and fingers in comfortable conditions enhances finger flexibility and dexterity, and thus effects better work performance. We have evaluated the efficacy of promoting heat transfer and release by the extremities by increasing the blood flow to the periphery from more distant parts of the body. The experimental garment paradigm developed by the investigators was used to manipulate the temperature of different body areas. Six subjects, two females and four males, were evaluated in a stage-1 baseline condition, with the inlet temperature of the circulating water in the liquid cooling/warming garment (LCWG) at 33 degrees C. At stage 2 the total LCWG water inlet temperature was cooled to 8 degrees C, and at stage 3 the inlet water temperature in specific segments of the LCWG was warmed (according to protocol) to 45 degrees C, while the inlet temperature in the rest of the LCWG was maintained at 8 degrees C. The following four body-area-warming conditions were studied in separate sessions: (1) head, (2) upper torso/arm, (3) upper torso/arm/head, and (4) legs/feet. Skin temperature, heat flux and blood perfusion of the fingers, and subjective perception of thermal sensations and overall physical comfort were assessed. Finger temperature (T(fing)) analyses showed a statistically significant condition x stage interaction. Post-hoc comparisons (T(fing)) indicated that at stage 3, the upper torso/arm/head warming condition was significantly different from the head, upper torso/arm and legs/feet conditions, showing an increase in T(fing). There was a significant increase in blood perfusion in the fingers at stage 3 in all conditions. Subjective perception of hand warmth, and overall physical comfort level significantly increased in the stage 3 upper torso/arm/head condition. The findings indicate that physiological methods to enhance heat transfer by the blood to the periphery within protective clothing provide an additional tool for increasing total and local human comfort in extreme environments.

Analysis of factors related to arm weakness in patients with breast cancer-related lymphedema.

PubMed

Lee, Daegu; Hwang, Ji Hye; Chu, Inho; Chang, Hyun Ju; Shim, Young Hun; Kim, Jung Hyun

2015-08-01

The aim of this study was to evaluate the ratio of significant weakness in the affected arm of breast cancer-related lymphedema patients to their unaffected side. Another purpose was to identify factors related to arm weakness and physical function in patients with breast cancer-related lymphedema. Consecutive patients (n = 80) attended a single evaluation session following their outpatient lymphedema clinic visit. Possible independent factors (i.e., lymphedema, pain, psychological, educational, and behavioral) were evaluated. Handgrip strength was used to assess upper extremity muscle strength and the disabilities of arm, shoulder, and hand (DASH) questionnaire was used to assess upper extremity physical function. Multivariate logistic regression was performed using factors that had significant differences between the handgrip weakness and non-weakness groups. Out of the 80 patients with breast cancer-related lymphedema, 29 patients (36.3 %) had significant weakness in the affected arm. Weakness of the arm with lymphedema was not related to lymphedema itself, but was related to the fear of using the affected limb (odds ratio = 1.76, 95 % confidence interval = 1.30-2.37). Fears of using the affected limb and depression significantly contributed to the variance in DASH scores. Appropriate physical and psychological interventions, including providing accurate information and reassurance of physical activity safety, are necessary to prevent arm weakness and physical dysfunction in patients with breast cancer-related lymphedema.

Relationship between self-reported upper limb disability and quantitative tests in hand-arm vibration syndrome.

PubMed

Poole, Kerry; Mason, Howard

2007-03-15

To establish the relationship between quantitative tests of hand function and upper limb disability, as measured by the Disability of the Arm, Shoulder and Hand (DASH) questionnaire, in hand-arm vibration syndrome (HAVS). A total of 228 individuals with HAVS were included in this study. Each had undergone a full HAVS assessment by an experienced physician, including quantitative tests of vibrotactile and thermal perception thresholds, maximal hand-grip strength (HG) and the Purdue pegboard (PP) test. Individuals were also asked to complete a DASH questionnaire. PP and HG of the quantitative tests gave the best and statistically significant individual correlations with the DASH disability score (r2 = 0.168 and 0.096). Stepwise linear regression analysis revealed that only PP and HG measurements were statistically significant predictors of upper limb disability (r2 = 0.178). Overall a combination of the PP and HG measurements, rather than each alone, gave slightly better discrimination, although not statistically significant, between normal and abnormal DASH scores with a sensitivity of 73.1% and specificity of 64.3%. Measurements of manual dexterity and hand-grip strength using PP and HG may be useful in helping to confirm lack of upper limb function and 'perceived' disability in HAVS.

Upper limb stroke rehabilitation: the effectiveness of Stimulation Assistance through Iterative Learning (SAIL).

PubMed

Meadmore, Katie L; Cai, Zhonglun; Tong, Daisy; Hughes, Ann-Marie; Freeman, Chris T; Rogers, Eric; Burridge, Jane H

2011-01-01

A novel system has been developed which combines robotic therapy with electrical stimulation (ES) for upper limb stroke rehabilitation. This technology, termed SAIL: Stimulation Assistance through Iterative Learning, employs advanced model-based iterative learning control (ILC) algorithms to precisely assist participant's completion of 3D tracking tasks with their impaired arm. Data is reported from a preliminary study with unimpaired participants, and also from a single hemiparetic stroke participant with reduced upper limb function who has used the system in a clinical trial. All participants completed tasks which involved moving their (impaired) arm to follow an image of a slowing moving sphere along a trajectory. The participants' arm was supported by a robot and ES was applied to the triceps brachii and anterior deltoid muscles. During each task, the same tracking trajectory was repeated 6 times and ILC was used to compute the stimulation signals to be applied on the next iteration. Unimpaired participants took part in a single, one hour training session and the stroke participant undertook 18, 1 hour treatment sessions composed of tracking tasks varying in length, orientation and speed. The results reported describe changes in tracking ability and demonstrate feasibility of the SAIL system for upper limb rehabilitation. © 2011 IEEE

Network of movement and proximity sensors for monitoring upper-extremity motor activity after stroke: proof of principle.

PubMed

Sokal, Brad; Uswatte, Gitendra; Barman, Joydip; Brewer, Michael; Byrom, Ezekiel; Latten, Jessica; Joseph, Jeethu; Serafim, Camila; Ghaffari, Touraj; Sarkar, Nilanjan

2014-03-01

To test the convergent validity of an objective method, Sensor-Enabled Radio-frequency Identification System for Monitoring Arm Activity (SERSMAA), that distinguishes between functional and nonfunctional activity. Cross-sectional study. Laboratory. Participants (N=25) were ≥0.2 years poststroke (median, 9) with a wide range of severity of upper-extremity hemiparesis. Not applicable. After stroke, laboratory tests of the motor capacity of the more-affected arm poorly predict spontaneous use of that arm in daily life. However, available subjective methods for measuring everyday arm use are vulnerable to self-report biases, whereas available objective methods only provide information on the amount of activity without regard to its relation with function. The SERSMAA consists of a proximity-sensor receiver on the more-affected arm and multiple units placed on objects. Functional activity is signaled when the more-affected arm is close to an object that is moved. Participants were videotaped during a laboratory simulation of an everyday activity, that is, setting a table with cups, bowls, and plates instrumented with transmitters. Observers independently coded the videos in 2-second blocks with a validated system for classifying more-affected arm activity. There was a strong correlation (r=.87, P<.001) between time that the more-affected arm was used for handling objects according to the SERSMAA and functional activity according to the observers. The convergent validity of SERSMAA for measuring more-affected arm functional activity after stroke was supported in a simulation of everyday activity. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

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

PubMed

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

2015-04-01

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

Constrained handgrip force decreases upper extremity muscle activation and arm strength.

PubMed

Smets, Martin P H; Potvin, James R; Keir, Peter J

2009-09-01

Many industrial tasks require repetitive shoulder exertions to be performed with concurrent physical and mental demands. The highly mobile nature of the shoulder predisposes it to injury. The purpose of this study was to determine the effects of simultaneous gripping, at a specified magnitude, on muscle activity and maximal arm force in various directions. Ten female subjects performed maximal arm exertions at two different heights and five directions using both specified (30% maximum voluntary grip) and preferred (self-selected) grip forces. Electromyography was recorded from eight muscles of the right upper extremity. The preferred grip condition produced grip forces that were dependent on the combination of arm height and force direction and were significantly greater (arm force down), lower (to left, up and push forward), or similar to the specified grip condition. Regardless of the magnitude of the preferred grip force, specifying the grip resulted in decreased maximal arm strength (by 18-25%) and muscle activity (by 15-30%) in all conditions, indicating an interfering effect when the grip force was specified by visual target force-matching. Task constraints, such as specific gripping demands, may decrease peak force levels attainable and alter muscle activity. Depending on the nature of task, the amount of relative demand may differ, which should be considered when determining safety thresholds.

Movement quality of conventional prostheses and the DEKA Arm during everyday tasks

PubMed Central

Cowley, Jeffrey; Resnik, Linda; Wilken, Jason; Walters, Lisa Smurr; Gates, Deanna

2017-01-01

Background Conventional prosthetic devices fail to restore the function and characteristic movement quality of the upper limb. The DEKA Arm is a new, advanced prosthesis featuring a compound, powered wrist and multiple grip configurations. Objectives The purpose of this study was to determine if the DEKA Arm improved the movement quality of upper limb prosthesis users compared to conventional prostheses. Study design Case series. Methods Three people with transradial amputation completed tasks of daily life with their conventional prosthesis and with the DEKA Arm. A total of 10 healthy controls completed the same tasks. The trajectory of the wrist joint center was analyzed to determine how different prostheses affected movement duration, speed, smoothness, and curvature compared to patients’ own intact limbs and controls. Results Movement quality decreased with the DEKA Arm for two participants, and increased for the third. Prosthesis users made slower, less smooth, more curved movements with the prosthetic limb compared to the intact limb and controls, particularly when grasping and manipulating objects. Conclusion The effects of one month of training with the DEKA Arm on movement quality varied with participants’ skill and experience with conventional prostheses. Future studies should examine changes in movement quality after long-term use of advanced prostheses. PMID:26932980

A Mirror Therapy-Based Action Observation Protocol to Improve Motor Learning After Stroke.

PubMed

Harmsen, Wouter J; Bussmann, Johannes B J; Selles, Ruud W; Hurkmans, Henri L P; Ribbers, Gerard M

2015-07-01

Mirror therapy is a priming technique to improve motor function of the affected arm after stroke. To investigate whether a mirror therapy-based action observation (AO) protocol contributes to motor learning of the affected arm after stroke. A total of 37 participants in the chronic stage after stroke were randomly allocated to the AO or control observation (CO) group. Participants were instructed to perform an upper-arm reaching task as fast and as fluently as possible. All participants trained the upper-arm reaching task with their affected arm alternated with either AO or CO. Participants in the AO group observed mirrored video tapes of reaching movements performed by their unaffected arm, whereas participants in the CO group observed static photographs of landscapes. The experimental condition effect was investigated by evaluating the primary outcome measure: movement time (in seconds) of the reaching movement, measured by accelerometry. Movement time decreased significantly in both groups: 18.3% in the AO and 9.1% in the CO group. Decrease in movement time was significantly more in the AO compared with the CO group (mean difference = 0.14 s; 95% confidence interval = 0.02, 0.26; P = .026). The present study showed that a mirror therapy-based AO protocol contributes to motor learning after stroke. © The Author(s) 2014.

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

PubMed

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

2010-01-01

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

An EMG-based robot control scheme robust to time-varying EMG signal features.

PubMed

Artemiadis, Panagiotis K; Kyriakopoulos, Kostas J

2010-05-01

Human-robot control interfaces have received increased attention during the past decades. With the introduction of robots in everyday life, especially in providing services to people with special needs (i.e., elderly, people with impairments, or people with disabilities), there is a strong necessity for simple and natural control interfaces. In this paper, electromyographic (EMG) signals from muscles of the human upper limb are used as the control interface between the user and a robot arm. EMG signals are recorded using surface EMG electrodes placed on the user's skin, making the user's upper limb free of bulky interface sensors or machinery usually found in conventional human-controlled systems. The proposed interface allows the user to control in real time an anthropomorphic robot arm in 3-D space, using upper limb motion estimates based only on EMG recordings. Moreover, the proposed interface is robust to EMG changes with respect to time, mainly caused by muscle fatigue or adjustments of contraction level. The efficiency of the method is assessed through real-time experiments, including random arm motions in the 3-D space with variable hand speed profiles.

Professional tennis players' serve: correlation between segmental angular momentums and ball velocity.

PubMed

Martin, Caroline; Kulpa, Richard; Delamarche, Paul; Bideau, Benoit

2013-03-01

The purpose of the study was to identify the relationships between segmental angular momentum and ball velocity between the following events: ball toss, maximal elbow flexion (MEF), racket lowest point (RLP), maximal shoulder external rotation (MER), and ball impact (BI). Ten tennis players performed serves recorded with a real-time motion capture. Mean angular momentums of the trunk, upper arm, forearm, and the hand-racket were calculated. The anteroposterior axis angular momentum of the trunk was significantly related with ball velocity during the MEF-RLP, RLP-MER, and MER-BI phases. The strongest relationships between the transverse-axis angular momentums and ball velocity followed a proximal-to-distal timing sequence that allows the transfer of angular momentum from the trunk (MEF-RLP and RLP-MER phases) to the upper arm (RLP-MER phase), forearm (RLP-MER and MER-BI phases), and the hand-racket (MER-BI phase). Since sequence is crucial for ball velocity, players should increase angular momentums of the trunk during MEF-MER, upper arm during RLP-MER, forearm during RLP-BI, and the hand-racket during MER-BI.

Arm mechanical efficiency and arm exercise capacity are relatively preserved in chronic obstructive pulmonary disease.

PubMed

Franssen, Frits M E; Wouters, Emiel F M; Baarends, Erica M; Akkermans, Marco A; Schols, Annemie M W J

2002-10-01

Previous studies indicate that energy expenditure related to physical activity is enhanced and that mechanical efficiency of leg exercise is reduced in patients with chronic obstructive pulmonary disease (COPD). However, it is yet unclear whether an inefficient energy expenditure is also present during other activities in COPD. This study was carried out to examine arm efficiency and peak arm exercise performance relative to leg exercise in 33 (23 male) patients with COPD ((mean +/- SEM) age: 61 +/- 2 yr; FEV : 40 +/- 2% of predicted) and 20 sex- and age-matched healthy controls. Body composition, pulmonary function, resting energy expenditure (REE), and peak leg and arm exercise performance were determined. To calculate mechanical efficiency, subjects performed submaximal leg and arm ergometry at 50% of achieved peak loads. During exercise testing, metabolic and ventilatory parameters were measured. In contrast to a reduced leg mechanical efficiency in patients compared with controls (15.6 +/- 0.6% and 22.5 +/- 0.6%, respectively; < 0.001), arm mechanical efficiency was comparable in both groups (COPD: 18.3 +/- 0.9%, controls: 21.0 +/- 1.2%; NS). Arm efficiency was not related to leg efficiency, pulmonary function, work of breathing, or REE. Also, arm exercise capacity was relatively preserved in patients with COPD (ratio arm peak work rate/leg peak work rate in patients: 89% vs 53% in controls; < 0.001). Mechanical efficiency and exercise capacity of the upper and lower limbs are not homogeneously affected in COPD, with a relative preservation of the upper limbs. This may have implications for screening of exercise tolerance and prescription of training interventions in patients with COPD. Future studies need to elucidate the mechanism behind this observation.

Upper quadrant port placement for robot-assisted renal surgery: implementation of the Floating Arm and the XL Protype.

PubMed

Totonchi, Samer; Elgin, Robert; Monahan, Michael; Johnston, William K

2014-08-01

Abstract Background and Purpose: Placement of the fourth arm (4th arm) in the lower quadrant (LQ) is commonly described for robot-assisted renal surgical procedures but has anatomic restrictions and limited ergonomics. An alternative, upper quadrant (UQ) location is desirable, but patient habitus and spacing may restrict robotic attachment. We investigate current trends in 4th arm port placement and propose an alternative method at attaching the robot-the "Floating Arm" (FLA). Robotic surgeons from the Endourological Society were surveyed. A 20-cm extra-long (XL Protype) da Vinci instrument was developed for the FLA technique. A dry lab allowed quantitative comparison of spacing and ranges of motion for standard da Vinci ports (dVP), bariatric dVP, telescoping dVP, and FLA. There were 108 respondents who participated. Half of the respondents avoid using the 4th arm (30% lack of need and 20% because of interference). The majority (90%) typically positions the 4th arm in the LQ, but many reported limitations in this location. Few (5%) place 4th arm in the UQ, while most (73%) have never heard of UQ placement. Existing techniques may increase shoulder height clearance but inversely shorten the working length of the instrument intracorporeally. Alternatively, the XL Protype significantly increased the shoulder length and maintained available working distances intracorporeally. Adjacent arm interference angle was essentially identical (27 degrees) for all ports except a greater range of movement for the XL Protype (35 degrees). Few surgeons are using an UQ positioning or use techniques to improve attachment of the 4th arm. The greatest freedom may be obtained by implementing the FLA, but this necessitates production of a longer instrument.

Changes in shoulder muscle size and activity following treatment for breast cancer.

PubMed

Shamley, Delva R; Srinanaganathan, Ragavan; Weatherall, Rosamund; Oskrochi, Reza; Watson, Marion; Ostlere, Simon; Sugden, Elaine

2007-11-01

Morbidity of the shoulder after breast cancer is a well-known phenomenon. MRI studies have shown muscle morbidity in cervical cancer and prostate cancer. In breast cancer clinical observations and patient reports include muscle morbidity in a number of muscles acting at the shoulder. Several of these muscles lie in the field of surgery and radiotherapy. Timed interaction between muscles that stabilise the shoulder and those acting as prime movers is essential to achieve a smooth scapulohumeral rthythm during functional elevation of the arm. CROSS-SECTIONAL STUDY: Seventy-four women treated for unilateral carcinoma of the breast were included in the study. All patients filled out the Shoulder Pain and Disability Index (SPADI). EMG activity of four muscles was recorded during scaption on the affected and unaffected side. Muscle cross sectional area and signal intensity was determined from MRI scans. The association between EMG and covariates was determined using multiple linear regression techniques. Three of the 4 muscles on the affected side demonstrated significantly less EMG activity, particularly when lowering the arm. Upper trapezius demonstrated the greatest loss in activity. Decreased activity in both upper trapezius and rhomboid were significantly associated with an increase in SPADI score and increased time since surgery. Pectoralis major and minor were significantly smaller on the affected side. Muscles affected in the long term are the muscles associated with pain and disability yet are not in the direct field of surgery or radiotherapy. Primary muscle shortening and secondary loss of muscle activity may be producing a movement disorder similar to the 'Dropped Shoulder Syndrome'. Exercise programmes should aim not only for range of movement but also for posture correction and education of potential long-term effects.

Implementation of a smartphone as a wireless gyroscope platform for quantifying reduced arm swing in hemiplegie gait with machine learning classification by multilayer perceptron neural network.

PubMed

LeMoyne, Robert; Mastroianni, Timothy

2016-08-01

Natural gait consists of synchronous and rhythmic patterns for both the lower and upper limb. People with hemiplegia can experience reduced arm swing, which can negatively impact the quality of gait. Wearable and wireless sensors, such as through a smartphone, have demonstrated the ability to quantify various features of gait. With a software application the smartphone (iPhone) can function as a wireless gyroscope platform capable of conveying a gyroscope signal recording as an email attachment by wireless connectivity to the Internet. The gyroscope signal recordings of the affected hemiplegic arm with reduced arm swing arm and the unaffected arm are post-processed into a feature set for machine learning. Using a multilayer perceptron neural network a considerable degree of classification accuracy is attained to distinguish between the affected hemiplegic arm with reduced arm swing arm and the unaffected arm.

Effects of the humeral tray component positioning for onlay reverse shoulder arthroplasty design: a biomechanical analysis.

PubMed

Berhouet, Julien; Kontaxis, Andreas; Gulotta, Lawrence V; Craig, Edward; Warren, Russel; Dines, Joshua; Dines, David

2015-04-01

Recent shoulder prostheses have introduced a concept of a universal humeral stem component platform that has an onlay humeral tray for the reverse total shoulder arthroplasty (RTSA). No studies have reported how humeral tray positioning can affect the biomechanics of RTSA. The Newcastle Shoulder Model was used to investigate the biomechanical effect of humeral tray positioning in the Biomet Comprehensive Total Shoulder System (Biomet, Warsaw, IN, USA) RTSA. Five humeral tray configuration positions were tested: no offset, and 5 mm offset in the anterior, posterior, medial, and lateral positions. Superior and inferior impingement were evaluated for abduction, scapular plane elevation, forward flexion, and external/internal rotation with the elbow at the side (adduction) and at 90° of shoulder abduction. Muscle lengths and moment arms (elevating and rotational) were calculated for the deltoid, the infraspinatus, the teres minor, and the subscapularis. Inferior impingement was not affected by the humeral tray position. There was less superior impingement during abduction, scapular plane elevation, and rotation with the shoulder when the tray was placed laterally or posteriorly. The subscapularis rotational moment arm was increased with a posterior offset, whereas infraspinatus and teres minor rotational moment arms were increased with an anterior offset. Very little change was observed for the deltoid elevating moment arm or for its muscle length. Positioning the humeral tray with posterior offset offers a biomechanical advantage for patients needing RTSA by decreasing superior impingement and increasing the internal rotational moment arm of the subscapularis, without creating inferior impingement. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Disorders of Upper Limb Movements in Ataxia-Telangiectasia

PubMed Central

Shaikh, Aasef G.; Zee, David S.; Mandir, Allen S.; Lederman, Howard M.; Crawford, Thomas O.

2013-01-01

Ataxia-telangiectasia is known for cerebellar degeneration, but clinical descriptions of abnormal tone, posture, and movements suggest involvement of the network between cerebellum and basal ganglia. We quantitatively assessed the nature of upper-limb movement disorders in ataxia-telangiectasia. We used a three-axis accelerometer to assess the natural history and severity of abnormal upper-limb movements in 80 ataxia-telangiectasia and 19 healthy subjects. Recordings were made during goal-directed movements of upper limb (kinetic task), while arms were outstretched (postural task), and at rest. Almost all ataxia-telangiectasia subjects (79/80) had abnormal involuntary movements, such as rhythmic oscillations (tremor), slow drifts (dystonia or athetosis), and isolated rapid movements (dystonic jerks or myoclonus). All patients with involuntary movements had both kinetic and postural tremor, while 48 (61%) also had resting tremor. The tremor was present in transient episodes lasting several seconds during two-minute recording sessions of all three conditions. Percent time during which episodic tremor was present was greater for postural and kinetic tasks compared to rest. Resting tremor had higher frequency but smaller amplitude than postural and kinetic tremor. Rapid non-rhythmic movements were minimal during rest, but were triggered during sustained arm postures and goal directed arm movements suggesting they are best considered a form of dystonic jerks or action myoclonus. Advancing age did not correlate with the severity of involuntary limb movements. Abnormal upper-limb movements in ataxia-telangiectasia feature classic cerebellar impairment, but also suggest involvement of the network between the cerebellum and basal ganglia. PMID:23826191

Disorders of Upper Limb Movements in Ataxia-Telangiectasia.

PubMed

Shaikh, Aasef G; Zee, David S; Mandir, Allen S; Lederman, Howard M; Crawford, Thomas O

2013-01-01

Ataxia-telangiectasia is known for cerebellar degeneration, but clinical descriptions of abnormal tone, posture, and movements suggest involvement of the network between cerebellum and basal ganglia. We quantitatively assessed the nature of upper-limb movement disorders in ataxia-telangiectasia. We used a three-axis accelerometer to assess the natural history and severity of abnormal upper-limb movements in 80 ataxia-telangiectasia and 19 healthy subjects. Recordings were made during goal-directed movements of upper limb (kinetic task), while arms were outstretched (postural task), and at rest. Almost all ataxia-telangiectasia subjects (79/80) had abnormal involuntary movements, such as rhythmic oscillations (tremor), slow drifts (dystonia or athetosis), and isolated rapid movements (dystonic jerks or myoclonus). All patients with involuntary movements had both kinetic and postural tremor, while 48 (61%) also had resting tremor. The tremor was present in transient episodes lasting several seconds during two-minute recording sessions of all three conditions. Percent time during which episodic tremor was present was greater for postural and kinetic tasks compared to rest. Resting tremor had higher frequency but smaller amplitude than postural and kinetic tremor. Rapid non-rhythmic movements were minimal during rest, but were triggered during sustained arm postures and goal directed arm movements suggesting they are best considered a form of dystonic jerks or action myoclonus. Advancing age did not correlate with the severity of involuntary limb movements. Abnormal upper-limb movements in ataxia-telangiectasia feature classic cerebellar impairment, but also suggest involvement of the network between the cerebellum and basal ganglia.

Stump sensibility in children with upper limb reduction deficiency.

PubMed

Reinkingh, Marianne; Reinders-Messelink, Heleen A; Dijkstra, Pieter U; Maathuis, Karel G B; van der Sluis, Corry K

2014-01-01

To compare stump sensibility in children with upper limb reduction deficiency with sensibility of the unaffected arm and hand. In addition, to evaluate the associations between stump sensibility, stump length and activity level. Cross-sectional study. Children and young adults aged 6-25 years with upper limb reduction deficiency. Threshold of touch was measured with Semmes-Weinstein monofilaments, stereognosis was measured with the Shape-Texture Identification test and kinaesthesia and activity level was measured with the Child Amputee Prosthetics Project - Functional Status Inventory and the Prosthetic Upper Extremity Functional Index. A total of 31 children with upper limb reduction deficiency (mean age 15 years, 3 prosthesis wearers) were investigated. The threshold of touch of the stump circumference was lower (indicating higher sensibility) than of the unaffected arm (p = 0.006), hand (p = 0.004) and stump end-point (p = < 0.001). Long stumps had higher threshold of touch (indicating lower sensibility) than short stumps (p = 0.046). Twenty-nine children recognized 1 or more shapes or textures with the stump. Kinaesthesia in the affected and unaffected sides was comparable. Sensibility was not correlated with activity level. Threshold of touch, stereognosis and kinaesthesia of the affected sides were excellent. Threshold of touch of the stump circumference was lower (indicating higher sensibility) than of the unaffected arm and hand. High stump sensibility may clarify good functioning in the children without prostheses and contribute to prosthesis rejection.

Noninvasive lifting of arm, thigh, and knee skin with transcutaneous intense focused ultrasound.

PubMed

Alster, Tina S; Tanzi, Elizabeth L

2012-05-01

Transcutaneous intense focused ultrasound is a novel Food and Drug Administration-approved technology for noninvasive skin tightening of the face and neck. No studies have reported on its safety and effectiveness on nonfacial areas. Eighteen paired areas (6 each) on the upper arms, medial thighs, and extensor knees were randomly treated with two different transducers (4.0 MHz, 4.5-mm focal depth and 7.0 MHz, 3.0-mm focal depth). One side was randomly assigned to receive a single pass (single plane) of microthermal coagulation zones over the involved area with the 4.0 MHz, 4.5-mm-depth transducer, and the contralateral side was assigned to receive consecutive single passes (dual plane) using both transducers (4.0 MHz, 4.5-mm depth followed by 7.0 MHz, 3.0-mm depth). Two independent masked assessors determined clinical improvement scores using comparative standardized photographs obtained at baseline and 3 and 6 months after treatment. Subjective assessments of clinical improvement and side effects of treatment were obtained. Global assessment scores revealed significant improvement in all treated areas, with the upper arms and knees demonstrating more skin lifting and tightening than the thighs. Areas receiving dual-plane treatment had slightly better clinical scores than those receiving single-plane treatment in all three sites. Clinical scores from single-plane and dual-plane treated areas continued to improve between 3 and 6 months after treatment. Side effects were mild and transient and included erythema, warmth, and skin tenderness. Rare focal bruising was noted in two patients on the upper arms that resolved within 7 days. No other side effects were reported or observed. Transcutaneous intense focused ultrasound can be safely and effectively used to improve the clinical appearance (texture and contour) of the upper arms, extensor knees, and medial thighs. © 2012 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.

Individual differences in the elevated plus-maze and the forced swim test.

PubMed

Estanislau, Celio; Ramos, Anna Carolina; Ferraresi, Paula Daniele; Costa, Naiara Fernanda; de Carvalho, Heloisa Maria Cotta Pires; Batistela, Silmara

2011-01-01

The elevated plus-maze is an apparatus composed of enclosed and open (elevated) arms and time spent in the open arms by a rat can be increased/decreased by anxiolytic/anxiogenic agents. In the forced swim test, floating behavior is used as an index of behavioral despair and can be decreased by antidepressant agents. As the comorbidity between anxiety and depression is a remarkable issue in human behavioral disorders, a possible relationship between the behaviors seen in the cited tests is of great relevance. In the present study, fifty-four male rats (Rattus norvegicus) were submitted to a plus-maze session and to a 2-day forced swim protocol. According to their time in the open arms, they were divided into three groups: Low Open, Medium Open and High Open. Some plus-maze measures were found to be coherent with time in the open arms and are suggested to also be reliable anxiety indexes. In the forced swim test, the Low Open group showed decreases in floating duration from forced swim Session 1 to Session 2, an alteration opposite to that observed in the other groups (particularly, the Medium Open group). The Low Open group also showed increases in floating latency, again in sharp contrast with the alteration found in the other groups. Accordingly, positive and negative correlation were found between time in the open arms and floating duration and latency, respectively. Results are compared to previous studies and mediation of the effect by reactivity to aversive stimulation or alterations induced by open arm exposure is discussed. Copyright © 2010 Elsevier B.V. All rights reserved.

Interpretation of ICESat-Derived Elevation Change on the Malaspina-Seward Glacier

NASA Astrophysics Data System (ADS)

Sauber, J.; Ramage, J.; Kopczynski, S.; Muskett, R.

2005-12-01

In this study, we report and interpret ICESat-derived short-term variability in surface elevation in the snow accumulation region of the Seward-Malaspina Glacier, one of the largest glacier systems in southern Alaska. The Seward-Malaspina complex consists of an extensive icefield, the upper Seward Glacier, and a narrower lower outlet glacier (lower Seward) through which ice drains to the enormous piedmont of the Malaspina Glacier. Although the upper Seward is just 80 km north of the Gulf of Alaska it has an environment more continental than maritime because of shielding afforded by high mountains to the south [Sharp, 1951]. The Malaspina Glacier by contrast lies completely within the moist maritime environment of the southern Alaska coast. In an earlier study of the Malaspina Glacier, we reported elevation differences between ICESat Laser 1-3 observations (February 2003 - November 2004) and a Shuttle Radar Topography Mission (SRTM)-derived DEM from February 2000 [Sauber et al., 2005]. Elevation decreases of up to 20-25 m over a 3-4 year time period were observed across the folded loop moraine on the southern portion of the piedmont lobe of the Malaspina Glacier. For the western portion of the Upper Seward we will estimate elevation change over a comparable time period by using an X-band InSAR-derived DEM from Intermap Tech. (Sept. 2000) and ICESat-derived elevations. Early field measurements (1945-1949) from the Upper Seward Glacier indicated an average annual net surplus of 75 cm water equivalent in the Upper Seward basin [Sharp, 1951]. However, even over this short time period, Sharp [1951] found large interannual variability in net accumulation of 41-168 cm. To further constrain and understand surface changes, we examined ICESat-derived elevations from a variable set of repeated ICESat upper Seward profiles made between Feb. 2003 and May 2005. Additionally we compared the elevation change profiles to snowmelt timing and ablation season length derived from the Special Sensor Microwave Imager (SSM/I) 37 GHz brightness temperatures for 2000-2004 using the approach of Ramage and Isacks (2003). We found the largest elevation increase between Oct 2003 and late Feb./March 2004 (3-4 m over a flat region of the upper Seward at 1740 m), little discernible elevation change occurred between March and May 2004, and about 2 m of elevation decrease occurred at 1750 m between May and Oct. 2004. The elevation increase of 3-4 m at 1740 m in the upper Seward occurred after refreezing started in August 2003 and before the snowmelt onset in mid to late April 2004. Ramage and Isacks, J. Glaciol., 2003. Sauber et al., Geophys. Res. Lett., in press, 2005. Sharp, Geol. Soc. Am.,1951.

Design & control of a 3D stroke rehabilitation platform.

PubMed

Cai, Z; Tong, D; Meadmore, K L; Freeman, C T; Hughes, A M; Rogers, E; Burridge, J H

2011-01-01

An upper limb stroke rehabilitation system is developed which combines electrical stimulation with mechanical arm support, to assist patients performing 3D reaching tasks in a virtual reality environment. The Stimulation Assistance through Iterative Learning (SAIL) platform applies electrical stimulation to two muscles in the arm using model-based control schemes which learn from previous trials of the task. This results in accurate movement which maximises the therapeutic effect of treatment. The principal components of the system are described and experimental results confirm its efficacy for clinical use in upper limb stroke rehabilitation. © 2011 IEEE

114. SMALL ARMS (BUILDINGS 9798) AND INERT STOREHOUSE (BLDGS. 1031040) ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

114. SMALL ARMS (BUILDINGS 97-98) AND INERT STOREHOUSE (BLDGS. 103-1040) PLAN AND ELEVATIONS, FULLER/SCOTT, MARCH 15, 1941. QP ACC 1791. - Quonset Point Naval Air Station, Roger Williams Way, North Kingstown, Washington County, RI

Effect of Elevated CO2 Concentration, Elevated Temperature and No Nitrogen Fertilization on Methanogenic Archaeal and Methane-Oxidizing Bacterial Community Structures in Paddy Soil

PubMed Central

Liu, Dongyan; Tago, Kanako; Hayatsu, Masahito; Tokida, Takeshi; Sakai, Hidemitsu; Nakamura, Hirofumi; Usui, Yasuhiro; Hasegawa, Toshihiro; Asakawa, Susumu

2016-01-01

Elevated concentrations of atmospheric CO2 ([CO2]) enhance the production and emission of methane in paddy fields. In the present study, the effects of elevated [CO2], elevated temperature (ET), and no nitrogen fertilization (LN) on methanogenic archaeal and methane-oxidizing bacterial community structures in a free-air CO2 enrichment (FACE) experimental paddy field were investigated by PCR-DGGE and real-time quantitative PCR. Soil samples were collected from the upper and lower soil layers at the rice panicle initiation (PI) and mid-ripening (MR) stages. The composition of the methanogenic archaeal community in the upper and lower soil layers was not markedly affected by the elevated [CO2], ET, or LN condition. The abundance of the methanogenic archaeal community in the upper and lower soil layers was also not affected by elevated [CO2] or ET, but was significantly increased at the rice PI stage and significantly decreased by LN in the lower soil layer. In contrast, the composition of the methane-oxidizing bacterial community was affected by rice-growing stages in the upper soil layer. The abundance of methane-oxidizing bacteria was significantly decreased by elevated [CO2] and LN in both soil layers at the rice MR stage and by ET in the upper soil layer. The ratio of mcrA/pmoA genes correlated with methane emission from ambient and FACE paddy plots at the PI stage. These results indicate that the decrease observed in the abundance of methane-oxidizing bacteria was related to increased methane emission from the paddy field under the elevated [CO2], ET, and LN conditions. PMID:27600710

Effect of Elevated CO2 Concentration, Elevated Temperature and No Nitrogen Fertilization on Methanogenic Archaeal and Methane-Oxidizing Bacterial Community Structures in Paddy Soil.

PubMed

Liu, Dongyan; Tago, Kanako; Hayatsu, Masahito; Tokida, Takeshi; Sakai, Hidemitsu; Nakamura, Hirofumi; Usui, Yasuhiro; Hasegawa, Toshihiro; Asakawa, Susumu

2016-09-29

Elevated concentrations of atmospheric CO2 ([CO2]) enhance the production and emission of methane in paddy fields. In the present study, the effects of elevated [CO2], elevated temperature (ET), and no nitrogen fertilization (LN) on methanogenic archaeal and methane-oxidizing bacterial community structures in a free-air CO2 enrichment (FACE) experimental paddy field were investigated by PCR-DGGE and real-time quantitative PCR. Soil samples were collected from the upper and lower soil layers at the rice panicle initiation (PI) and mid-ripening (MR) stages. The composition of the methanogenic archaeal community in the upper and lower soil layers was not markedly affected by the elevated [CO2], ET, or LN condition. The abundance of the methanogenic archaeal community in the upper and lower soil layers was also not affected by elevated [CO2] or ET, but was significantly increased at the rice PI stage and significantly decreased by LN in the lower soil layer. In contrast, the composition of the methane-oxidizing bacterial community was affected by rice-growing stages in the upper soil layer. The abundance of methane-oxidizing bacteria was significantly decreased by elevated [CO2] and LN in both soil layers at the rice MR stage and by ET in the upper soil layer. The ratio of mcrA/pmoA genes correlated with methane emission from ambient and FACE paddy plots at the PI stage. These results indicate that the decrease observed in the abundance of methane-oxidizing bacteria was related to increased methane emission from the paddy field under the elevated [CO2], ET, and LN conditions.

The Use of B-Mode Ultrasound for Measuring Subcutaneous Fat Thickness on the Upper Arms.

ERIC Educational Resources Information Center

Weiss, Lawrence W.; Clark, Frank C.

1985-01-01

A study was carried out to investigate the potential use of B-mode ultrasound for measuring subcutaneous fat thickness at two arm sites. B-mode sonograms and skinfold measurements were found to be highly correlated for both men and women. (Author/MT)

Systemic inflammatory responses to maximal versus submaximal lengthening contractions of the elbow flexors.

PubMed

Peake, Jonathan M; Nosaka, Kazunori; Muthalib, Makii; Suzuki, Katsuhiko

2006-01-01

We compared changes in markers of muscle damage and systemic inflammation after submaximal and maximal lengthening muscle contractions of the elbow flexors. Using a cross-over design, 10 healthy young men not involved in resistance training completed a submaximal trial (10 sets of 60 lengthening contractions at 10% maximum isometric strength, 1 min rest between sets), followed by a maximal trial (10 sets of three lengthening contractions at 100% maximum isometric strength, 3 min rest between sets). Lengthening contractions were performed on an isokinetic dynamometer. Opposite arms were used for the submaximal and maximal trials, and the trials were separated by a minimum of two weeks. Blood was sampled before, immediately after, 1 h, 3 h, and 1-4 d after each trial. Total leukocyte and neutrophil numbers, and the serum concentration of soluble tumor necrosis factor-alpha receptor 1 were elevated after both trials (P < 0.01), but there were no differences between the trials. Serum IL-6 concentration was elevated 3 h after the submaximal contractions (P < 0.01). The concentrations of serum tumor necrosis factor-alpha, IL-1 receptor antagonist, IL-10, granulocyte-colony stimulating factor and plasma C-reactive protein remained unchanged following both trials. Maximum isometric strength and range of motion decreased significantly (P < 0.001) after both trials, and were lower from 1-4 days after the maximal contractions compared to the submaximal contractions. Plasma myoglobin concentration and creatine kinase activity, muscle soreness and upper arm circumference all increased after both trials (P < 0.01), but were not significantly different between the trials. Therefore, there were no differences in markers of systemic inflammation, despite evidence of greater muscle damage following maximal versus submaximal lengthening contractions of the elbow flexors.

Packaging Of Control Circuits In A Robot Arm

NASA Technical Reports Server (NTRS)

Kast, William

1994-01-01

Packaging system houses and connects control circuitry mounted on circuit boards within shoulder, upper section, and lower section of seven-degree-of-freedom robot arm. Has modular design that incorporates surface-mount technology, multilayer circuit boards, large-scale integrated circuits, and multi-layer flat cables between sections for compactness. Three sections of robot arm contain circuit modules in form of stardardized circuit boards. Each module contains two printed-circuit cards, one of each face.

Upper limb joint kinetics of three sitting pivot wheelchair transfer techniques in individuals with spinal cord injury

PubMed Central

Kankipati, Padmaja; Boninger, Michael L.; Gagnon, Dany; Cooper, Rory A.; Koontz, Alicia M.

2015-01-01

Study design Repeated measures design. Objective This study compared the upper extremity (UE) joint kinetics between three transfer techniques. Setting Research laboratory. Methods Twenty individuals with spinal cord injury performed three transfer techniques from their wheelchair to a level tub bench. Two of the techniques involved a head–hips method with leading hand position close (HH-I) and far (HH-A) from the body, and the third technique with the trunk upright (TU) and hand far from body. Motion analysis equipment recorded upper body movements and force sensors recorded their hand and feet reaction forces during the transfers. Results Several significant differences were found between HH-A and HH-I and TU and HH-I transfers indicating that hand placement was a key factor influencing the UE joint kinetics. Peak resultant hand, elbow, and shoulder joint forces were significantly higher for the HH-A and TU techniques at the trailing arm (P < 0.036) and lower at the leading arm (P < 0.021), compared to the HH-I technique. Conclusion Always trailing with the same arm if using HH-A or TU could predispose that arm to overuse related pain and injuries. Technique training should focus on initial hand placement close to the body followed by the amount of trunk flexion needed to facilitate movement. PMID:25130053

Validation of the Andon KD-5917 automatic upper arm blood pressure monitor, for clinic use and self-measurement, according to the European Society of Hypertension International Protocol revision 2010.

PubMed

Guo, Wan-Gang; Li, Bing-Ling; He, Yong; Xue, Yu-Sheng; Wang, Hai-Yan; Zheng, Qiang-Sun; Xiang, Ding-Cheng

2014-08-01

To validate the Andon KD-5917 automatic upper arm blood pressure monitor according to the European Society of Hypertension International Protocol revision 2010. Sequential same-left-arm measurements of systolic blood pressure (SBP) and diastolic blood pressure (DBP) were obtained in 33 participants using the mercury sphygmomanometer and the test device. According to the validation protocol, 99 pairs of test device and reference blood pressure measurements (three pairs for each of the 33 participants) were obtained in the study. The device produced 73, 98, and 99 measurements within 5, 10, and 15 mmHg for SBP and 86, 98, and 99 for DBP, respectively. The mean ± SD device-observer difference was 3.07 ± 3.68 mmHg for SBP and -0.89 ± 3.72 mmHg for DBP. The number of patients with two or three of the device-observer difference within 5 mmHg was 26 for SBP and 29 for DBP, and no patient had a device-observer difference within 5 mmHg. The Andon KD-5917 automatic upper arm blood pressure monitor can be recommended for clinical use and self-measurement in an adult population on the basis of the European Society of Hypertension International Protocol revision 2010.

RMS upper boom framed by aft flight deck viewing window W10

NASA Technical Reports Server (NTRS)

1983-01-01

Remote Manipulator System (RMS) upper arm boom (tear in multilayer beta cloth) deployed during dynamic interaction test using Payload Flight Test Article (PFTA) is visible outside aft viewing window W10. RMS 'Canada' insignia or logo appears on boom.

Skin Barrier Function and Staphylococcus aureus Colonization in Vestibulum Nasi and Fauces in Healthy Infants and Infants with Eczema: A Population-Based Cohort Study.

PubMed

Berents, Teresa Løvold; Carlsen, Karin Cecilie Lødrup; Mowinckel, Petter; Skjerven, Håvard Ove; Kvenshagen, Bente; Rolfsjord, Leif Bjarte; Bradley, Maria; Lieden, Agne; Carlsen, Kai-Håkon; Gaustad, Peter; Gjersvik, Petter

2015-01-01

Atopic eczema (AE) is associated with Staphylococcus aureus (S. aureus) colonization and skin barrier dysfunction, often measured by increased transepidermal water loss (TEWL). In the present study, the primary aim was to see whether S. aureus colonization in the vestibulum nasi and/or fauces was associated with increased TEWL in infants with healthy skin and infants with eczema. Secondarily, we aimed to investigate whether TEWL measurements on non-lesional skin on the lateral upper arm is equivalent to volar forearm in infants. In 167 of 240 infants, recruited from the general population, TEWL measurements on the lateral upper arm and volar forearm, using a DermaLab USB, fulfilled our environmental requirements. The mean of three TEWL measurements from each site was used for analysis. The infants were diagnosed with no eczema (n = 110), possible AE (n = 28) or AE (n = 29). DNA samples were analysed for mutations in the filaggrin gene (FLG). Bacterial cultures were reported positive with the identification of at least one culture with S. aureus from vestibulum nasi and/or fauces. S. aureus colonization, found in 89 infants (53%), was not associated with increased TEWL (i.e. TEWL in the upper quartile), neither on the lateral upper arm or volar forearm (p = 0.08 and p = 0.98, respectively), nor with AE (p = 0.10) or FLG mutation (p = 0.17). TEWL was significantly higher on both measuring sites in infants with AE compared to infants with possible AE and no eczema. FLG mutation was significantly associated with increased TEWL, with a 47% difference in TEWL. We conclude that S. aureus in vestibulum nasi and/or fauces was not associated with TEWL, whereas TEWL measurements on the lateral upper arm and volar forearm appear equally appropriate in infants.

Non-elite gymnastics participation is associated with greater bone strength, muscle size, and function in pre- and early pubertal girls.

PubMed

Burt, L A; Naughton, G A; Greene, D A; Courteix, D; Ducher, G

2012-04-01

Recent reports indicate an increase in forearm fractures in children. Bone geometric properties are an important determinant of bone strength and therefore fracture risk. Participation in non-elite gymnastics appears to contribute to improving young girls' musculoskeletal health, more specifically in the upper body. The primary aim of this study was to determine the association between non-elite gymnastics participation and upper limb bone mass, geometry, and strength in addition to muscle size and function in young girls. Eighty-eight pre- and early pubertal girls (30 high-training gymnasts [HGYM, 6-16 hr/ wk], 29 low-training gymnasts [LGYM, 1-5 h r/wk] and 29 non-gymnasts [NONGYM]), aged 6-11 years were recruited. Upper limb lean mass, BMD and BMC were derived from a whole body DXA scan. Forearm volumetric BMD, bone geometry, estimated strength, and muscle CSA were determined using peripheral QCT. Upper body muscle function was investigated with muscle strength, explosive power, and muscle endurance tasks. HGYM showed greater forearm bone strength compared with NGYM, as well as greater arm lean mass, BMC, and muscle function (+5% to +103%, p < 0.05). LGYM displayed greater arm lean mass, BMC, muscle power, and endurance than NGYM (+4% to +46%, p < 0.05); however, the difference in bone strength did not reach significance. Estimated fracture risk at the distal radius, which accounted for body weight, was lower in both groups of gymnasts. Compared with NONGYM, HGYM tended to show larger skeletal differences than LGYM; yet, the two groups of gymnasts only differed for arm lean mass and muscle CSA. Non-elite gymnastics participation was associated with musculoskeletal benefits in upper limb bone geometry, strength and muscle function. Differences between the two gymnastic groups emerged for arm lean mass and muscle CSA, but not for bone strength.

Combined treatment of botulinumtoxin and robot-assisted rehabilitation therapy on poststroke, upper limb spasticity

PubMed Central

Lee, So Young; Jeon, Young Tae; Kim, Bo Ryun; Han, Eun Young

2017-01-01

Abstract Rationale: Spasticity is a major complication after stroke, and botulinumtoxin A (BoNT-A) injection is commonly used to manage focal spasticity. However, it is uncertain whether BoNT-A can improve voluntary motor control or activities of daily living function of paretic upper limbs. This study investigated whether BoNT-A injection combined with robot-assisted upper limb therapy improves voluntary motor control or functions of upper limbs after stroke. Patient concerns: Two subacute stroke patients were transferred to the Department of Rehabilitation. Diagnoses: Patients demonstrated spasticity in the upper extremity on the affected side. Interventions: BoNT-A was injected into the paretic muscles of the shoulder, arm, and forearm of the 2 patients at the subacute stage. Conventional rehabilitation therapy and robot-assisted upper limb training were performed during the rehabilitation period. Outcomes: Manual dexterity, grip strength, muscle tone, and activities of daily living function were improved after multidisciplinary rehabilitation treatment. Lessons: BoNT-A injection in combination with multidisciplinary rehabilitation treatment, including robot-assisted arm training, should be recommended for subacute spastic stroke patients to enhance appropriate motor recovery. PMID:29390585

Anthropometrics Identify Wasting in Patients Undergoing Surgery for Encapsulating Peritoneal Sclerosis

PubMed Central

Campbell, Rosalind; Augustine, Titus; Hurst, Helen; Pararajasingam, Ravi; van Dellen, David; Armstrong, Sheilagh; Bartley, Carol; Birtles, Linda; Summers, Angela

2015-01-01

♦ Introduction: Encapsulating peritoneal sclerosis (EPS) is a serious complication of peritoneal dialysis in which gastrointestinal (GI) symptoms reduce appetite and dietary intake. Adequate nutrition is important, especially if surgery is required. Although the incidence of EPS is low, the present report is able to detail preoperative nutrition status and treatment in a large cohort of patients from a national EPS referral center. ♦ Methods: Of 51 patients admitted to this EPS specialist center hospital for their first peritonectomy in the study period, 50 had a preoperative dietetic assessment, and 49 underwent upper-arm anthropometry. ♦ Results: Mean body mass index (BMI) was 20.6 kg/m2. Mean weight loss was 14% of body weight in the preceding 6 months, with 35 of 50 patients losing more than 10%. On anthropometry, 25 of 49 patients were below the 5th percentile for mid-arm circumference (MAC), 17 of 49 were below for triceps skinfold thickness (TSF), and 21 of 49 were below for mid-arm muscle circumference (MAMC). Mean handgrip strength (HGS) was 60% of normal, with 43 of 49 patients being below 85% of normal. Appetite was poor in 21 of 50 patients, and 37 of 50 had upper and 40 of 50 had lower GI symptoms. By subjective global assessment, 27 of 51 patients were graded as severely malnourished, and 5 of 51, as well-nourished. Mean serum albumin was 28 g/L and did not correlate with BMI, MAC, TSF, MAMC, or HGS. In most patients, C-reactive protein was elevated (mean: 111 mg/L). Preoperative parenteral nutrition was given to 46 of 51 patients for a mean of 21 days. ♦ Discussion: Our findings demonstrate the poor nutrition status of patients admitted for EPS surgical intervention. Anthropometrics reveal depleted fat and lean body mass in EPS patients, which might be a result of anorexia and inflammation, and the reason that albumin was not an accurate marker of nutrition. Poor nutrition status is likely to negatively affect outcome in this patient group. ♦ Conclusions: Early recognition of GI symptoms may herald a diagnosis of EPS. Optimization of preoperative nutrition status with intensive nutrition support is needed. PMID:24584612

Anthropometrics Identify Wasting in Patients Undergoing Surgery for Encapsulating Peritoneal Sclerosis.

PubMed

Campbell, Rosalind; Augustine, Titus; Hurst, Helen; Pararajasingam, Ravi; van Dellen, David; Armstrong, Sheilagh; Bartley, Carol; Birtles, Linda; Summers, Angela

2015-01-01

♦ Encapsulating peritoneal sclerosis (EPS) is a serious complication of peritoneal dialysis in which gastrointestinal (GI) symptoms reduce appetite and dietary intake. Adequate nutrition is important, especially if surgery is required. Although the incidence of EPS is low, the present report is able to detail preoperative nutrition status and treatment in a large cohort of patients from a national EPS referral center. ♦ Of 51 patients admitted to this EPS specialist center hospital for their first peritonectomy in the study period, 50 had a preoperative dietetic assessment, and 49 underwent upper-arm anthropometry. ♦ Mean body mass index (BMI) was 20.6 kg/m(2). Mean weight loss was 14% of body weight in the preceding 6 months, with 35 of 50 patients losing more than 10%. On anthropometry, 25 of 49 patients were below the 5th percentile for mid-arm circumference (MAC), 17 of 49 were below for triceps skinfold thickness (TSF), and 21 of 49 were below for mid-arm muscle circumference (MAMC). Mean handgrip strength (HGS) was 60% of normal, with 43 of 49 patients being below 85% of normal. Appetite was poor in 21 of 50 patients, and 37 of 50 had upper and 40 of 50 had lower GI symptoms. By subjective global assessment, 27 of 51 patients were graded as severely malnourished, and 5 of 51, as well-nourished. Mean serum albumin was 28 g/L and did not correlate with BMI, MAC, TSF, MAMC, or HGS. In most patients, C-reactive protein was elevated (mean: 111 mg/L). Preoperative parenteral nutrition was given to 46 of 51 patients for a mean of 21 days. ♦ Our findings demonstrate the poor nutrition status of patients admitted for EPS surgical intervention. Anthropometrics reveal depleted fat and lean body mass in EPS patients, which might be a result of anorexia and inflammation, and the reason that albumin was not an accurate marker of nutrition. Poor nutrition status is likely to negatively affect outcome in this patient group. ♦ Early recognition of GI symptoms may herald a diagnosis of EPS. Optimization of preoperative nutrition status with intensive nutrition support is needed. Copyright © 2015 International Society for Peritoneal Dialysis.

Hand dominance in intravenous drug using patients does not affect peripheral venous access sites identified by ultrasound.

PubMed

Kaban, Nicole L; Avitabile, Nicholas C; Siadecki, Sebastian D; Saul, Turandot

2016-06-01

The peripheral veins in the arms and forearms of patients with a history of intravenous (IV) drug use may be sclerosed, calcified, or collapsed due to damage from previous injections. These patients may consequently require alternative, more invasive types of vascular access including central venous or intraosseous catheters. We investigated the relationship between hand dominance and the presence of patent upper extremity (UE) veins specifically in patients with a history of IV drug-use. We predicted that injection into the non-dominant UE would occur with a higher frequency than the dominant UE, leading to fewer damaged veins in the dominant UE. If hand dominance affects which upper extremity has more patent veins, providers could focus their first vascular access attempt on the dominant upper extremity. Adult patients were approached for enrollment if they provided a history of IV drug use into one of their upper extremities. Each upper extremity was examined with a high frequency linear transducer in 3 areas: the antecubital crease, forearm and the proximal arm. The number of fully compressible veins ≥1.8 mm in diameter was recorded for each location. The mean vein difference between the numbers of veins in the dominant versus the non-dominant UE was -1.5789. At a .05 significance level, there was insufficient evidence to suggest the number of compressible veins between patients' dominant and non-dominant arms was significantly different (P = .0872.) The number of compressible veins visualized with ultrasound was not greater in the dominant upper extremity as expected. Practitioners may gain more information about potential peripheral venous access sites by asking patients their previous injection practice patterns. Copyright © 2016 Elsevier Inc. All rights reserved.

Responsiveness of outcome measures for upper limb prosthetic rehabilitation.

PubMed

Resnik, Linda; Borgia, Matthew

2016-02-01

There is limited research on responsiveness of prosthetic rehabilitation outcome measures. To examine responsiveness of the Box and Block test, Jebsen-Taylor Hand Function tests, Upper Extremity Functional Scale, University of New Brunswick skill and spontaneity tests, Activity Measure for Upper Limb Amputation, and the Patient-Specific Functional Scale. This was a quasi-experimental study with repeated measurements in a convenience sample of upper limb amputees. Measures were collected before, during, and after training with the DEKA Arm. Largest effect sizes were observed for Patient-Specific Functional Scale (effect size: 1.59, confidence interval: 1.00, 2.14), Activity Measure for Upper Limb Amputation (effect size: 1.33, confidence interval: 0.73, 1.90), and University of New Brunswick skill test (effect size: 1.18, confidence interval: 0.61, 1.73). Other measures that were responsive to change were Box and Block test, Jebsen-Taylor Hand Function light and heavy can tests, and University of New Brunswick spontaneity test. Responsiveness and pattern of responsiveness varied by prosthetic level. The Box and Block test, Jebsen-Taylor Hand Function light and heavy can tests, University of New Brunswick skill and spontaneity tests, Activities Measure for Upper Limb Amputation, and the Patient-Specific Functional Scale were responsive to change during prosthetic training. These findings have implications for choice of measures for research and practice and inform clinicians about the amount of training necessary to maximize outcomes with the DEKA Arm. Findings on responsiveness of outcome measures have implications for the choice of measures for clinical trials and practice. Findings regarding the responsiveness to change over the course of training can inform clinicians about the amount of training that may be necessary to maximize specific outcomes with the DEKA Arm. © The International Society for Prosthetics and Orthotics 2014.

Transcutaneous Auricular Vagus Nerve Stimulation with Concurrent Upper Limb Repetitive Task Practice for Poststroke Motor Recovery: A Pilot Study.

PubMed

Redgrave, Jessica N; Moore, Lucy; Oyekunle, Tosin; Ebrahim, Maryam; Falidas, Konstantinos; Snowdon, Nicola; Ali, Ali; Majid, Arshad

2018-03-23

Invasive vagus nerve stimulation (VNS) has the potential to enhance the effects of physiotherapy for upper limb motor recovery after stroke. Noninvasive, transcutaneous auricular branch VNS (taVNS) may have similar benefits, but this has not been evaluated in stroke recovery. We sought to determine the feasibility of taVNS delivered alongside upper limb repetitive task-specific practice after stroke and its effects on a range of outcome measures evaluating limb function. Thirteen participants at more than 3 months postischemic stroke with residual upper limb dysfunction were recruited from the community of Sheffield, United Kingdom (October-December 2016). Participants underwent 18 × 1-hour sessions over 6 weeks in which they made 30-50 repetitions of 8-10 arm movements concurrently with taVNS (NEMOS; Cerbomed, Erlangen, Germany, 25 Hz, .1-millisecond pulse width) at maximum tolerated intensity (mA). An electrocardiogram and rehabilitation outcome scores were obtained at each visit. Qualitative interviews determined the acceptability of taVNS to participants. Median time after stroke was 1.16 years, and baseline median/interquartile range upper limb Fugl-Meyer (UFM) score was 63 (54.5-99.5). Participants attended 92% of the planned treatment sessions. Three participants reported side effects, mainly fatigue, but all performed mean of more than 300 arm repetitions per session with no serious adverse events. There was a significant change in the UFM score with a mean increase per participant of 17.1 points (standard deviation 7.8). taVNS is feasible and well-tolerated alongside upper limb repetitive movements in poststroke rehabilitation. The motor improvements observed justify a phase 2 trial in patients with residual arm weakness. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Locomotor-Like Leg Movements Evoked by Rhythmic Arm Movements in Humans

PubMed Central

Sylos-Labini, Francesca; Ivanenko, Yuri P.; MacLellan, Michael J.; Cappellini, Germana; Poppele, Richard E.; Lacquaniti, Francesco

2014-01-01

Motion of the upper limbs is often coupled to that of the lower limbs in human bipedal locomotion. It is unclear, however, whether the functional coupling between upper and lower limbs is bi-directional, i.e. whether arm movements can affect the lumbosacral locomotor circuitry. Here we tested the effects of voluntary rhythmic arm movements on the lower limbs. Participants lay horizontally on their side with each leg suspended in an unloading exoskeleton. They moved their arms on an overhead treadmill as if they walked on their hands. Hand-walking in the antero-posterior direction resulted in significant locomotor-like movements of the legs in 58% of the participants. We further investigated quantitatively the responses in a subset of the responsive subjects. We found that the electromyographic (EMG) activity of proximal leg muscles was modulated over each cycle with a timing similar to that of normal locomotion. The frequency of kinematic and EMG oscillations in the legs typically differed from that of arm oscillations. The effect of hand-walking was direction specific since medio-lateral arm movements did not evoke appreciably leg air-stepping. Using externally imposed trunk movements and biomechanical modelling, we ruled out that the leg movements associated with hand-walking were mainly due to the mechanical transmission of trunk oscillations. EMG activity in hamstring muscles associated with hand-walking often continued when the leg movements were transiently blocked by the experimenter or following the termination of arm movements. The present results reinforce the idea that there exists a functional neural coupling between arm and legs. PMID:24608249

[Women boxing athletes' EMG of upper limbs and lumbar muscles in the training of air striking of straight punch].

PubMed

Zhang, Ri-Hui; Kang, Zhi-Xin

2011-05-01

To study training effect of upper limbs and lumbar muscles in the proceed of air striking of straight punch by analyzing boxing athletes' changes of electromyogram (EMG). We measured EMG of ten women boxing athletes' upper arm biceps (contractor muscle), upper arm triceps (antagonistic muscle), forearm flexor muscle (contractor muscle), forearm extensor muscle (antagonistic muscle), and lumbar muscles by ME6000 (Mega Electronics Ltd.). The stipulated exercise was to do air striking of straight punch with loads of 2.5 kg of dumbbell in the hand until exhausted. In the proceed of exercise-induce exhausted, the descend magnitude and speed of median frequency (MF) in upper limb antagonistic muscle exceeded to contracting muscle, moreover, the work percentage showed that contractor have done a larger percentage of work than antagonistic muscle. Compared with world champion's EMG, the majority of ordinary athletes' lumbar muscles MF revealed non-drop tendency, and the work percentage showed that lumbar muscles had a very little percentage of work. After comparing the EMG test index in upper limb and lumbar muscle of average boxing athletes with that of the world champion, we find the testees lack of the training of upper limb antagonistic muscle and lumbar muscle, and more trainings aimed at these muscles need to be taken.

Effects of scapular taping on the activity onset of scapular muscles and the scapular kinematics in volleyball players with rotator cuff tendinopathy.

PubMed

Leong, Hio Teng; Ng, Gabriel Yin-Fat; Fu, Siu Ngor

2017-06-01

To examine the effect of scapular taping on the activity onset of scapular muscles and the scapular kinematics during arm elevation in volleyball players with rotator cuff (RC) tendinopathy. Randomized placebo-controlled repeated measures METHODS: Twenty-six male volleyball players with RC tendinopathy (mean age=23.6±3.3years) participated in the study. Electromyography (EMG) activity onset of upper trapezius (UT), middle trapezius (MT), lower trapezius (LT) and serratus anterior (SA) and the three-dimensional scapular kinematics quantified by using an acromial marker cluster method were compared with three scapular taping protocols, namely, no taping, therapeutic taping, and placebo taping. The MT, LT and SA activated significantly earlier in both therapeutic taping (all p<0.005) and placebo taping conditions than no taping conditions (all p<0.002). There was a small increase in the scapular upward rotation when therapeutic taping and no taping conditions were compared (p=0.007). Scapular taping may enhance the neuromotor control of the scapular muscles. Whether it provides adequate support for normal scapular kinematics during arm movement in athletes with RC tendinopathy await for further studies. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

HARBO, a simple computer-aided observation method for recording work postures.

PubMed

Wiktorin, C; Mortimer, M; Ekenvall, L; Kilbom, A; Hjelm, E W

1995-12-01

The aim of the study was to present an observation method focusing on the positions of the hands relative to the body and to evaluate whether this simple observation technique gives a reliable estimate of the total time spent in each of five work postures during one workday. In the first part of the study the interobserver reliability of the observation method was tested with eight blue-collar workers. In the second part the observed time spent with work above the shoulder level was tested in relation to an upper-arm position analyzer, and observed time spent in work below knuckle level was tested in relation to a trunk flexion analyzer, both with 72 blue-collar workers. The interobserver reliability for full-day registrations was high. The intraclass correlation coefficients ranged from 0.99 to 1.00. The observed duration of work with hands above shoulder level correlated well with the measured duration of pronounced arm elevation (> 75 degrees). The product moment correlation coefficient was 0.97. The observed duration of work with hands below knuckle level correlated well with the measured duration of pronounced trunk flexion angles (> 40 degrees). The product moment correlation coefficient was 0.98. The present observation method, designed to make postural observations continuously for several hours, is easy to learn and seems reliable.

Tapping but not massage enhances vasodilation and improves venous palpation of cutaneous veins.

PubMed

Ichimura, Mika; Sasaki, Shinsuke; Mori, Masaharu; Ogino, Tetsuya

2015-01-01

This paper investigated whether tapping on the median cubital vein or massaging the forearm was more effective in obtaining better venous palpation for venipuncture. Forty healthy volunteers in their twenties were subjected to tapping (10 times in 5 sec) or massage (10 strokes in 20 sec from the wrist to the cubital fossa) under tourniquet inflation on the upper arm. Venous palpation was assessed using the venous palpation score (0-6, with 0 being impalpable). Three venous factors-venous depth, cross-sectional area, and elevation-were also measured using ultrasonography. The venous palpation score increased significantly by tapping but not by massage. Moreover, all 3 venous measurements changed significantly by tapping, while only the depth decreased significantly by massage. The three venous measurements correlated significantly with the venous palpation score, indicating that they are useful objective indicators for evaluating vasodilation. We suggest that tapping is an effective vasodilation technique.

Longwall Guidance and Control Development

NASA Technical Reports Server (NTRS)

1982-01-01

The longwall guidance and control (G&C) system was evaluated to determine which systems and subsystems lent themselves to automatic control in the mining of coal. The upper coal/shale interface was identified as the reference for a vertical G&C system, with two sensors (the natural backgound and the sensitized pick) being used to locate and track this boundary. In order to insure a relatively smooth recession surface (roof and floor of the excavated seam), a last and present cut measuring instrument (acoustic sensor) was used. Potentiometers were used to measure elevations of the shearer arms. The intergration of these components comprised the vertical control system (pitch control). Yaw and roll control were incorporated into a face alignment system which was designed to keep the coal face normal to its external boundaries. Numerous tests, in the laboratory and in the field, have confirmed the feasibility of automatic horizon control, as well as determining the face alignment.

Role of contralesional hemisphere in paretic arm reaching in patients with severe arm paresis due to stroke: A preliminary report.

PubMed

Mohapatra, Sambit; Harrington, Rachael; Chan, Evan; Dromerick, Alexander W; Breceda, Erika Y; Harris-Love, Michelle

2016-03-23

Stroke is highly prevalent and a leading cause of serious, long-term disability among American adults. Impaired movement (i.e. paresis) of the stroke-affected arm is a major contributor to post-stroke disability, yet the mechanisms of upper extremity motor recovery are poorly understood, particularly in severely impaired patients who lack hand function. To address this problem, we examined the functional relevance of the contralesional hemisphere in paretic arm motor performance in individuals with severe arm paresis. Twelve individuals with severe stroke-induced arm paresis (Upper Extremity Fugl-Meyer Assessment=17.1 ± 8.5; maximum score=66) participated in the study. Participants performed a reaching response time task with their paretic arm. At varying time intervals following a 'Go' cue, a pair of transcranial magnetic stimulation (TMS) pulses were delivered to contralesional hemisphere primary motor (M1) or dorsal pre-motor cortex (PMd) to momentarily disrupt the pattern of neural firing. Response time components and hand-path characteristics were compared across the 2 sites for trials with and without TMS disruption. There was no significant effect of TMS disruption on overall Response time or Reaction time, but Movement time was significantly longer (i.e. slower) with disruption of the contralesional hemisphere (p=0.015), regardless of which area was stimulated. Peak hand-path velocity and hand-path smoothness were also significantly lower (p=0.005 and p<0.0001, respectively) with TMS disruption of the contralesional hemisphere. The data from this study provide evidence supporting a functionally relevant role of contralesional hemisphere motor areas in paretic arm reaching movements in individuals with severe post-stroke arm impairment. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Cognitive predictors of skilled performance with an advanced upper limb multifunction prosthesis: a preliminary analysis.

PubMed

Hancock, Laura; Correia, Stephen; Ahern, David; Barredo, Jennifer; Resnik, Linda

2017-07-01

Purpose The objectives were to 1) identify major cognitive domains involved in learning to use the DEKA Arm; 2) specify cognitive domain-specific skills associated with basic versus advanced users; and 3) examine whether baseline memory and executive function predicted learning. Method Sample included 35 persons with upper limb amputation. Subjects were administered a brief neuropsychological test battery prior to start of DEKA Arm training, as well as physical performance measures at the onset of, and following training. Multiple regression models controlling for age and including neuropsychological tests were developed to predict physical performance scores. Prosthetic performance scores were divided into quartiles and independent samples t-tests compared neuropsychological test scores of advanced scorers and basic scorers. Baseline neuropsychological test scores were used to predict change in scores on physical performance measures across time. Results Cognitive domains of attention and processing speed were statistically significantly related to proficiency of DEKA Arm use and predicted level of proficiency. Conclusions Results support use of neuropsychological tests to predict learning and use of a multifunctional prosthesis. Assessment of cognitive status at the outset of training may help set expectations for the duration and outcomes of treatment. Implications for Rehabilitation Cognitive domains of attention and processing speed were significantly related to level of proficiencyof an advanced multifunctional prosthesis (the DEKA Arm) after training. Results provide initial support for the use of neuropsychological tests to predict advanced learningand use of a multifunctional prosthesis in upper-limb amputees. Results suggest that assessment of patients' cognitive status at the outset of upper limb prosthetictraining may, in the future, help patients, their families and therapists set expectations for theduration and intensity of training and may help set reasonable proficiency goals.

UAE population reference standard charts for body mass index and skinfold thickness, at ages 0-18 years.

PubMed

Abdulrazzaq, Yousef M; Nagelkerke, Nico; Moussa, Mohamed A

2011-11-01

To determine a range of anthropometric measurements including skinfold thickness measurements in four different areas of the body, to construct population growth charts for body mass index (BMI), skinfolds, and to compare these with growth charts from other countries. One aim was also to validate body fat charts derived from skinfold thickness. A national cross-sectional growth survey of children, 0-18 years old, was conducted using multistage stratified random sampling. The sample size included at least 200 children in each age-sex group. Height, weight, biceps skinfold, triceps skinfold, subscapular skinfold, suprailiac skinfold, and mid-upper-arm circumference were measured in each child. We describe correlation, standard deviation scores relative to the other standards, and calculation of body density in the United Arab Emirates population. We determined whether any of the above is a good indicator of fatness in children. BMI, upper-arm circumference, sum of four skinfolds, and percentage body fat charts were constructed using the LMS method of smoothing. BMI was very significantly correlated with sum of skinfold thicknesses, and mid-upper-arm circumference. Prevalence of obesity and overweight in ages 13-17 years was respectively 9.94% and 15.16% in females and 6.08% and 14.16% in males. Derived body fat charts were found not to be accurate. A national BMI, upper-arm circumference, and sum of four skinfolds chart has been constructed that can be used as a reference standard for the United Arab Emirates. Sum of four skinfold thickness charts can be used as crude determinants of adiposity in children, but derived body fat charts were shown to be inaccurate.

Predictors of the risk of malnutrition among children under the age of 5 years in Somalia.

PubMed

Kinyoki, Damaris K; Berkley, James A; Moloney, Grainne M; Kandala, Ngianga-Bakwin; Noor, Abdisalan M

2015-12-01

To investigate the predictors of wasting, stunting and low mid-upper arm circumference among children aged 6-59 months in Somalia using data from household cross-sectional surveys from 2007 to 2010 in order to help inform better targeting of nutritional interventions. Cross-sectional nutritional assessment surveys using structured interviews were conducted among communities in Somalia each year from 2007 to 2010. A two-stage cluster sampling methodology was used to select children aged 6-59 months from households across three livelihood zones (pastoral, agro-pastoral and riverine). Predictors of three anthropometric measures, weight-for-height (wasting), height-for-age (stunting) and mid-upper arm circumference, were analysed using Bayesian binomial regression, controlling for both spatial and temporal dependence in the data. The study was conducted in randomly sampled villages, representative of three livelihood zones in Somalia. Children between the ages of 6 and 59 months in Somalia. The estimated national prevalence of wasting, stunting and low mid-upper arm circumference in children aged 6-59 months was 21 %, 31 % and 36 %, respectively. Although fever, diarrhoea, sex and age of the child, household size and access to foods were significant predictors of malnutrition, the strongest association was observed between all three indicators of malnutrition and the enhanced vegetation index. A 1-unit increase in enhanced vegetation index was associated with a 38 %, 49 % and 59 % reduction in wasting, stunting and low mid-upper arm circumference, respectively. Infection and climatic variations are likely to be key drivers of malnutrition in Somalia. Better health data and close monitoring and forecasting of droughts may provide valuable information for nutritional intervention planning in Somalia.

Impact of a cash-for-work programme on food consumption and nutrition among women and children facing food insecurity in rural Bangladesh.

PubMed

Mascie-Taylor, C G N; Marks, M K; Goto, R; Islam, R

2010-11-01

To determine whether a cash-for-work programme during the annual food insecurity period in Bangladesh improved nutritional status in poor rural women and children. The panel study involved a random sample of 895 households from over 50,000 enrolled in a cash-for-work programme between September and December 2007 and 921 similar control households. The height, weight and mid-upper arm circumference of one woman and child aged less than 5 years from each household were measured at baseline and at the end of the study (mean time: 10 weeks). Women reported 7-day household food expenditure and consumption on both occasions. Changes in parameters were compared between the two groups. At baseline, no significant difference existed between the groups. By the study end, the difference in mean mid-upper arm circumference between women in the intervention and control groups had widened by 2.29 mm and the difference in mean weight, by 0.88 kg. Among children, the difference in means between the two groups had also widened in favour of the intervention group for: height (0.08 cm; P<0.05), weight (0.22 kg; P<0.001), mid-upper arm circumference (1.41 mm; P<0.001) and z-scores for height-for-age (0.02; P<0.001), weight-for-age (0.17; P<0.001), weight-for-height (0.23; P<0.001) and mid-upper arm circumference (0.12; P<0.001). Intervention households spent more on food and consumed more protein-rich food at the end of the study. The cash-for-work programme led to greater household food expenditure and consumption and women's and children's nutritional status improved.

Validation of the Omron M6 (HEM-7001-E) upper arm blood pressure measuring device according to the International Protocol in elderly patients.

PubMed

Altunkan, Sekip; Iliman, Nevzat; Altunkan, Erkan

2008-04-01

Despite the widespread use of automated self-measurement monitors, there is limited published evidence on their accuracy and reliability on different patient groups. The objective of this study was to evaluate the accuracy and reliability of the Omron M6 (HEM-7001-E) upper-arm blood pressure (BP) device against mercury sphygmomanometer on elderly patients according to the criteria of the International Protocol. Thirty-three patients above 65 years of age, who were classified based on the BP categories of the International Protocol, were recruited for the study. BP measurements at the upper arm with the Omron M6 were compared with the results obtained by two trained observers using a mercury sphygmomanometer. Nine sequential BP measurements were taken. During the validation study, 99 measurements were obtained from 33 patients for comparison. The first phase was carried out on 15 patients and if the device passed this phase, 18 more patients were selected. Mean discrepancies and standard deviations of the device sphygmomanometer were 1.4+/-5.3 mmHg for systolic BP (SBP) and -1.4+/-4.5 mmHg for diastolic BP (DBP) in the study group. The device passed phase 1 in 15 patients. In phase 2.1, from the total 99 comparisons, 76, 92, and 97 for SBP and 77, 94, and 99 for DBP were less than 5, 10, and 15 mmHg, respectively. The Omron M6 passed phases 2.1 and 2.2 in the elderly group of patients. The Omron M6 (HEM-7001-E) upper-arm BP monitor passed according to the International Protocol criteria and can be recommended for use in elderly patients.

Mirror therapy enhances motor performance in the paretic upper limb after stroke: a pilot randomized controlled trial.

PubMed

Samuelkamaleshkumar, Selvaraj; Reethajanetsureka, Stephen; Pauljebaraj, Paul; Benshamir, Bright; Padankatti, Sanjeev Manasseh; David, Judy Ann

2014-11-01

To investigate the effectiveness of mirror therapy (MT) combined with bilateral arm training and graded activities to improve motor performance in the paretic upper limb after stroke. Randomized, controlled, assessor-blinded study. Inpatient stroke rehabilitation center of a tertiary care teaching hospital. Patients with first-time ischemic or hemorrhagic stroke (N=20), confined to the territory of the middle cerebral artery, occurring <6 months before the commencement of the study. The MT and control group participants underwent a patient-specific multidisciplinary rehabilitation program including conventional occupational therapy, physical therapy, and speech therapy for 5 d/wk, 6 h/d, over 3 weeks. The participants in the MT group received 1 hour of MT in addition to the conventional stroke rehabilitation. The Upper Extremity Fugl-Meyer Assessment for motor recovery, Brunnstrom stages of motor recovery for the arm and hand, Box and Block Test for gross manual hand dexterity, and modified Ashworth scale to assess the spasticity. After 3 weeks of MT, mean change scores were significantly greater in the MT group than in the control group for the Fugl-Meyer Assessment (P=.008), Brunnstrom stages of motor recovery for the arm (P=.003) and hand (P=.003), and the Box and Block Test (P=.022). No significant difference was found between the groups for modified Ashworth scale (P=.647). MT when combined with bilateral arm training and graded activities was effective in improving motor performance of the paretic upper limb after stroke compared with conventional therapy without MT. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Comparison of shoulder strength in males with and without myofascial trigger points in the upper trapezius.

PubMed

Kim, H A; Hwang, U J; Jung, S H; Ahn, S H; Kim, J H; Kwon, O Y

2017-11-01

This study was conducted in order to compare the strength of scapular elevator and shoulder abductor with and without restricted scapular elevation between male subjects with and without myofascial trigger points in the upper trapezius. In total, 15 male subjects with myofascial trigger points, and 15age- and weight-matched male subjects without myofascial trigger points in the upper trapezius. Each subject was measured in the strength of maximum isometric scapular elevation and shoulder abduction with and without restricted scapular elevation. Maximum isometric contractions were measured using the Smart KEMA strength measurement system. Independent t-tests were used to compare shoulder strength values between the myofascial trigger points and non- myofascial trigger points groups. The results showed that shoulder abductor strength in the group with myofascial trigger points (5.64kgf) was significantly lower than in the group without myofascial trigger points (11.96kgf) when scapular elevation was restricted (p<0.05). However, there was no significant difference in the strength of the scapular elevator or shoulder abductor between groups (p>0.05). These findings suggest that decreased strength in the shoulder abductor with restricted scapular elevation should be considered in evaluating and treating individuals with myofascial trigger points of the upper trapezius. Copyright © 2017 Elsevier Ltd. All rights reserved.

Validity for the simplified water displacement instrument to measure arm lymphedema as a result of breast cancer surgery.

PubMed

Sagen, Ase; Kåresen, Rolf; Skaane, Per; Risberg, May Arna

2009-05-01

To evaluate concurrent and construct validity for the Simplified Water Displacement Instrument (SWDI), an instrument for measuring arm volumes and arm lymphedema as a result of breast cancer surgery. Validity design. Hospital setting. Women (N=23; mean age, 64+/-11y) were examined 6 years after breast cancer surgery with axillary node dissection. Not applicable. The SWDI was included for measuring arm volumes to estimate arm lymphedema as a result of breast cancer surgery. A computed tomography (CT) scan was included to examine the cross-sectional areas (CSAs) in square millimeters for the subcutaneous tissue, for the muscle tissue, and for measuring tissue density in Hounsfield units. Magnetic resonance imaging (MRI) with T2-weighted sequences was included to show increased signal intensity in subcutaneous and muscle tissue areas. The affected arm volume measured by the SWDI was significantly correlated to the total CSA of the affected upper limb (R=.904) and also to the CSA of the subcutaneous tissue and muscles tissue (R=.867 and R=.725), respectively (P<.001). The CSA of the subcutaneous tissue for the upper limb was significantly larger compared with the control limb (11%). Tissue density measured in Hounsfield units did not correlate significantly with arm volume (P>.05). The affected arm volume was significantly larger (5%) than the control arm volume (P<.05). Five (22%) women had arm lymphedema defined as a 10% increase in the affected arm volume compared with the control arm volume, and an increased signal intensity was identified in all 5 women on MRI (T2-weighted, kappa=.777, P<.001). The SWDI showed high concurrent and construct validity as shown with significant correlations between the CSA (CT) of the subcutaneous and muscle areas of the affected limb and the affected arm volume (P>.001). There was a high agreement between those subjects who were diagnosed with arm lymphedema by using the SWDI and the increased signal intensity on MRI, with a kappa value of .777 (P<.001). High construct validity for the SWDI was confirmed for arm lymphedema as a volume increase, but it was not confirmed for lymphedema without an increase in arm volume (swelling). The SWDI is a simple and valid tool for estimating arm volume and arm lymphedema after breast cancer surgery.

Changes in neuromuscular activity during motor training with a body-machine interface after spinal cord injury.

PubMed

Pierella, C; De Luca, A; Tasso, E; Cervetto, F; Gamba, S; Losio, L; Quinland, E; Venegoni, A; Mandraccia, S; Muller, I; Massone, A; Mussa-Ivaldi, F A; Casadio, M

2017-07-01

Body machine interfaces (BMIs) are used by people with severe motor disabilities to control external devices, but they also offer the opportunity to focus on rehabilitative goals. In this study we introduced in a clinical setting a BMI that was integrated by the therapists in the rehabilitative treatments of 2 spinal cord injured (SCI) subjects for 5 weeks. The BMI mapped the user's residual upper body mobility onto the two coordinates of a cursor on a screen. By controlling the cursor, the user engaged in playing computer games. The BMI allowed the mapping between body and cursor spaces to be modified, gradually challenging the user to exercise more impaired movements. With this approach, we were able to change our subjects' behavior, who initially used almost exclusively their proximal upper body-shoulders and arms - for using the BMI. By the end of training, cursor control was shifted toward more distal body regions - forearms instead of upper arms - with an increase of mobility and strength of all the degrees of freedom involved in the control. The clinical tests and the electromyographic signals from the main muscles of the upper body confirmed the positive effect of the training. Encouraging the subjects to explore different and sometimes unusual movement combinations was beneficial for recovering distal arm functions and for increasing their overall mobility.

The role of upper torso and pelvis rotation in driving performance during the golf swing.

PubMed

Myers, Joseph; Lephart, Scott; Tsai, Yung-Shen; Sell, Timothy; Smoliga, James; Jolly, John

2008-01-15

While the role of the upper torso and pelvis in driving performance is anecdotally appreciated by golf instructors, their actual biomechanical role is unclear. The aims of this study were to describe upper torso and pelvis rotation and velocity during the golf swing and determine their role in ball velocity. One hundred recreational golfers underwent a biomechanical golf swing analysis using their own driver. Upper torso and pelvic rotation and velocity, and torso-pelvic separation and velocity, were measured for each swing. Ball velocity was assessed with a golf launch monitor. Group differences (groups based on ball velocity) and moderate relationships (r > or = 0.50; P < 0.001) were observed between an increase in ball velocity and the following variables: increased torso-pelvic separation at the top of the swing, maximum torso-pelvic separation, maximum upper torso rotation velocity, upper torso rotational velocity at lead arm parallel and last 40 ms before impact, maximum torso-pelvic separation velocity and torso-pelvic separation velocity at both lead arm parallel and at the last 40 ms before impact. Torso-pelvic separation contributes to greater upper torso rotation velocity and torso-pelvic separation velocity during the downswing, ultimately contributing to greater ball velocity. Golf instructors can consider increasing ball velocity by maximizing separation between the upper torso and pelvis at the top of and initiation of the downswing.

Sex differences in kinematic adaptations to muscle fatigue induced by repetitive upper limb movements.

PubMed

Bouffard, Jason; Yang, Chen; Begon, Mickael; Côté, Julie

2018-04-19

Muscle fatigue induced by repetitive movements contributes to the development of musculoskeletal disorders. Men and women respond differently to muscle fatigue during isometric single-joint efforts, but sex differences during dynamic multi-joint tasks have not been clearly identified. Moreover, most studies comparing men and women during fatigue development assessed endurance time. However, none evaluated sex differences in kinematic adaptations to fatigue during multi-joint dynamic tasks. The objective of the study was to compare how men and women adapt their upper body kinematics during a fatiguing repetitive pointing task. Forty men and 41 women performed repetitive pointing movements (one per second) between two targets while maintaining their elbow elevated at shoulder height. The task ended when participants rated a perceived level of fatigue of 8/10. Trunk, humerothoracic, and elbow angles were compared between the first and last 30 s of the experiment and between men and women. Linear positions of the index finger (distance from the target) and the elbow (arm elevation) as well as movement timing were documented as task performance measures. Men (7.4 ± 3.2 min) and women (8.3 ± 4.5 min) performed the repetitive pointing task for a similar duration. For both sex groups, trunk range of motion increased with fatigue while shoulder's and elbow's decreased. Moreover, participants modified their trunk posture to compensate for the decreased humerothoracic elevation. Movements at all joints also became more variable with fatigue. However, of the 24 joint angle variables assessed, only two Sex × Fatigue interactions were observed. Although average humerothoracic elevation angle decreased in both subgroups, this decrease was greater in men (standardized response mean [SRM] - 1.63) than in women (SRM - 1.44). Moreover, the movement-to-movement variability of humerothoracic elevation angle increased only in women (SRM 0.42). Despite many similarities between men's and women's response to fatigue induced by repetitive pointing movements, some sex differences were observed. Those subtle differences may indicate that men's shoulder muscles were more fatigued than women's despite a similar level of perceived exertion. They may also indicate that men and women do not adapt the exact same way to a similar fatigue.

Glove box on vehicular instrument panel

DOEpatents

Atarashi, Kazuya

1985-01-01

A glove box for the upper surface of an automobile dashboard whereby it may be positioned close to the driver. The glove box lid is pivotally supported by arms extending down either side to swing forwardly for opening. A hook is pivotally support adjacent an arm and weighted to swing into engagement with the arm to prevent opening of the lid during abrupt deceleration. A toggle spring assists in maintaining the lid in either the open or closed position.

Physical Fitness as It Pertains to Sustained Military Operations

DTIC Science & Technology

1986-05-01

Vogel and his colleagues (Vogel et al., 1983, Murphy et al., 1985) measured initial V02 max, and 2-mile run time, anaerobic power of the arms and...trial, and troop performance was evaluated by observers. Vogel and his co-workers found arm strength and arm anaerobic p,4er to decrease following...defense from infantry ground attack. Measurements of isometric, handgrip strength and upper and lower body anaerobic power (using the Wingate test) were

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. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

[The Activation of Interlimb Interactions Increase the Motor Output in Legs in Healthy Subjects under the Conditions of Arm and Leg Unloading].

PubMed

Selionov, V A; Solopova, I A; Zhvansky, D S

2016-01-01

We studied the effect of arm movements and movements of separate arm joints on the electrophysiological and kinematic characteristics of voluntary and vibration-triggered stepping-like leg movements under the conditions of horizontal support of upper and lower limbs. The horizontal support of arms provided a significantly increase in the rate of activation of locomotor automatism by non-invasive impact on tonic sensory inputs. The addition of active arm movements during involuntary rhytmic stepping-like leg movements led to an increase in EMG activity of hip muscles and was accompanied by an increase in the amplitude of hip and shin movements. Passive arm movements had the same effect on induced leg movements. The movement of the shoulder joints led to an increase in the activity of hip muscles and an increase in the amplitude of movements of the knee and hip joints. At the same time, the movement of forearms. and wrists had similar facilitating effect on electrophysiological and kinematic characteristics of rhytmic stepping-like movements, but influenced the distal segments of legs to a greater extent. Under the conditions of sub-threshold vibration of leg muscles, voluntary arm movements led to the activation of involuntary rhytmic stepping movements. During voluntary leg movements, the addition of arm movements had a significantly smaller impact on the parameters of rhytmic stepping than during involuntary leg movements. Thus, the simultaneous movements of upper and lower limbs are an effective method of activation of neural networks connecting the rhythm generators of arms and legs. Under the conditions of arm and leg unloading, the interactions between the cervical and lumbosacral segments of the spinal cord seem to play the major role in the impact of arm movements on the patterns of leg movements. The described methods of activation of interlimb interactions can be used in the rehabilitation of post-stroke patients and patients with spinal cord injuries, Parkinson's disease and other neurological diseases.

The Effect of Three Methods of Supporting the Double Bass on Muscle Tension.

ERIC Educational Resources Information Center

Dennis, Allan

1984-01-01

Using different methods of holding the double bass, college students performed Beethoven's Symphony No. 9. Audio recordings of performance were rated. Muscle tension readings from the left arm, right arm, upper back, and lower back were taken, using electromyography. Results suggest nonsignificant differences in both performance quality and muscle…

Upper Limb Asymmetries in the Perception of Proprioceptively Determined Dynamic Position Sense

ERIC Educational Resources Information Center

Goble, Daniel J.; Brown, Susan H.

2010-01-01

Recent studies of position-related proprioceptive sense have provided evidence of a nonpreferred left arm advantage in right-handed individuals. The present study sought to determine whether similar asymmetries might exist in "dynamic position" sense. Thirteen healthy, right-handed adults were blindfolded and seated with arms placed on…

Characterization of Upper Troposphere Water Vapor Measurements during AFWEX using LASE

NASA Technical Reports Server (NTRS)

Ferrare, R. A.; Browell, E. V.; Ismail, S.; Kooi, S.; Brasseur, L. H.; Brackett, V. G.; Clayton, M.; Barrick, J.; Linne, H.; Lammert, A.

2002-01-01

Water vapor profiles from NASA's Lidar Atmospheric Sensing Experiment (LASE) system acquired during the ARM/FIRE Water Vapor Experiment (AFWEX) are used to characterize upper troposphere water vapor (UTWV) measured by ground-based Raman lidars, radiosondes, and in situ aircraft sensors. Initial comparisons showed the average Vaisala radiosonde measurements to be 5-15% drier than the average LASE, Raman lidar, and DC-8 in situ diode laser hygrometer measurements. We show that corrections to the Raman lidar and Vaisala measurements significantly reduce these differences. Precipitable water vapor (PWV) derived from the LASE water vapor profiles agrees within 3% on average with PWV derived from the ARM ground-based microwave radiometer (MWR). The agreement among the LASE, Raman lidar, and MWR measurements demonstrates how the LASE measurements can be used to characterize both profile and column water vapor measurements and that ARM Raman lidar, when calibrated using the MWR PWV, can provide accurate UTWV measurements.

Robotically facilitated virtual rehabilitation of arm transport integrated with finger movement in persons with hemiparesis.

PubMed

Merians, Alma S; Fluet, Gerard G; Qiu, Qinyin; Saleh, Soha; Lafond, Ian; Davidow, Amy; Adamovich, Sergei V

2011-05-16

Recovery of upper extremity function is particularly recalcitrant to successful rehabilitation. Robotic-assisted arm training devices integrated with virtual targets or complex virtual reality gaming simulations are being developed to deal with this problem. Neural control mechanisms indicate that reaching and hand-object manipulation are interdependent, suggesting that training on tasks requiring coordinated effort of both the upper arm and hand may be a more effective method for improving recovery of real world function. However, most robotic therapies have focused on training the proximal, rather than distal effectors of the upper extremity. This paper describes the effects of robotically-assisted, integrated upper extremity training. Twelve subjects post-stroke were trained for eight days on four upper extremity gaming simulations using adaptive robots during 2-3 hour sessions. The subjects demonstrated improved proximal stability, smoothness and efficiency of the movement path. This was in concert with improvement in the distal kinematic measures of finger individuation and improved speed. Importantly, these changes were accompanied by a robust 16-second decrease in overall time in the Wolf Motor Function Test and a 24-second decrease in the Jebsen Test of Hand Function. Complex gaming simulations interfaced with adaptive robots requiring integrated control of shoulder, elbow, forearm, wrist and finger movements appear to have a substantial effect on improving hemiparetic hand function. We believe that the magnitude of the changes and the stability of the patient's function prior to training, along with maintenance of several aspects of the gains demonstrated at retention make a compelling argument for this approach to training.

Robotically facilitated virtual rehabilitation of arm transport integrated with finger movement in persons with hemiparesis

PubMed Central

2011-01-01

Background Recovery of upper extremity function is particularly recalcitrant to successful rehabilitation. Robotic-assisted arm training devices integrated with virtual targets or complex virtual reality gaming simulations are being developed to deal with this problem. Neural control mechanisms indicate that reaching and hand-object manipulation are interdependent, suggesting that training on tasks requiring coordinated effort of both the upper arm and hand may be a more effective method for improving recovery of real world function. However, most robotic therapies have focused on training the proximal, rather than distal effectors of the upper extremity. This paper describes the effects of robotically-assisted, integrated upper extremity training. Methods Twelve subjects post-stroke were trained for eight days on four upper extremity gaming simulations using adaptive robots during 2-3 hour sessions. Results The subjects demonstrated improved proximal stability, smoothness and efficiency of the movement path. This was in concert with improvement in the distal kinematic measures of finger individuation and improved speed. Importantly, these changes were accompanied by a robust 16-second decrease in overall time in the Wolf Motor Function Test and a 24-second decrease in the Jebsen Test of Hand Function. Conclusions Complex gaming simulations interfaced with adaptive robots requiring integrated control of shoulder, elbow, forearm, wrist and finger movements appear to have a substantial effect on improving hemiparetic hand function. We believe that the magnitude of the changes and the stability of the patient's function prior to training, along with maintenance of several aspects of the gains demonstrated at retention make a compelling argument for this approach to training. PMID:21575185

How do deltoid muscle moment arms change after reverse total shoulder arthroplasty?

PubMed

Walker, David R; Struk, Aimee M; Matsuki, Keisuke; Wright, Thomas W; Banks, Scott A

2016-04-01

Although many advantages of reverse total shoulder arthroplasty (RTSA) have been demonstrated, a variety of complications indicate there is much to learn about how RTSA modifies normal shoulder function. This study used a subject-specific computational model driven by in vivo kinematic data to assess how RTSA affects deltoid muscle moment arms after surgery. A subject-specific 12 degree-of-freedom musculoskeletal model was used to analyze the shoulders of 26 individuals (14 RTSA and 12 normal). The model was modified from the work of Holzbaur to directly input 6 degree-of-freedom humeral and scapular kinematics obtained using fluoroscopy. The moment arms of the anterior, lateral, and posterior aspects of the deltoid were significantly different when RTSA and normal cohorts were compared at different abduction angles. Anterior and lateral deltoid moment arms were significantly larger in the RTSA group at the initial elevation of the arm. The posterior deltoid was significantly larger at maximum elevation. There was large intersubject variability within the RTSA group. Placement of implant components during RTSA can directly affect the geometric relationship between the humerus and scapula and the muscle moment arms in the RTSA shoulder. RTSA shoulders maintain the same anterior and posterior deltoid muscle moment-arm patterns as healthy shoulders but show much greater intersubject variation and larger moment-arm magnitudes. These observations provide a basis for determining optimal implant configuration and surgical placement to maximize RTSA function in a patient-specific manner. Published by Elsevier Inc.

A robotic workstation for stroke rehabilitation of the upper extremity using FES.

PubMed

Freeman, C T; Hughes, A-M; Burridge, J H; Chappell, P H; Lewin, P L; Rogers, E

2009-04-01

An experimental test facility is developed for use by stroke patients in order to improve sensory-motor function of their upper limb. Subjects are seated at the workstation and their task is to repeatedly follow reaching trajectories that are projected onto a target above their arm. To do this they use voluntary control with the addition of electrical stimulation mediated by advanced control schemes applied to muscles in their impaired shoulder and arm. Full details of the design of the workstation and its periphery systems are given, together with a description of its use during the treatment of stroke patients.

The Floating Upper Limb: Multiple Injuries Involving Ipsilateral, Proximal, Humeral, Supracondylar, and Distal Radial Limb

PubMed Central

Manaan, Qazi; Bashir, Adil; Zahoor, Adnan; Mokhdomi, Taseem A.

2016-01-01

Floating arm injury represents a common yet complicated injury of the childhood severely associated with limb deformation and even morbidity, if not precisely addressed and credibly operated. Here, we report a rare floating upper limb case of a 9-year-old boy with multiple injuries of ipsilateral proximal humeral, supracondylar and distal radial limb. This is the first report to document such a combined floating elbow and floating arm injury in the same limb. In this report, we discuss the surgical procedures used and recovery of the patient monitored to ascertain the effectiveness of the method in limb reorganisation. PMID:27583121

The Floating Upper Limb: Multiple Injuries Involving Ipsilateral, Proximal, Humeral, Supracondylar, and Distal Radial Limb.

PubMed

Manaan, Qazi; Bashir, Adil; Zahoor, Adnan; Mokhdomi, Taseem A; Danish, Qazi

2016-09-01

Floating arm injury represents a common yet complicated injury of the childhood severely associated with limb deformation and even morbidity, if not precisely addressed and credibly operated. Here, we report a rare floating upper limb case of a 9-year-old boy with multiple injuries of ipsilateral proximal humeral, supracondylar and distal radial limb. This is the first report to document such a combined floating elbow and floating arm injury in the same limb. In this report, we discuss the surgical procedures used and recovery of the patient monitored to ascertain the effectiveness of the method in limb reorganisation.

Validation of the Andon KD-5851 upper arm blood pressure monitor, for self-measurement according to the European Society of Hypertension International Protocol revision 2010.

PubMed

Wu, Lili; Jiao, Yinghui; Wang, Chengdong; Chen, Lei; Di, Dalin; Zhang, Haiyan

2015-08-01

This study aimed to validate the Andon KD-5851 upper arm blood pressure (BP) monitor according to the European Society of Hypertension International Protocol (ESH-IP) revision 2010. A total of 33 eligible participants were included in the study. Sequential measurements of BPs were performed using a mercury sphygmomanometer and the device, and the data analysis was carried out following precisely the ESH-IP revision 2010. The device had 82, 98, and 99 measurements within 5, 10, and 15 mmHg for systolic blood pressure and 85, 95, and 99 measurements for diastolic blood pressure, respectively. The average device-observer difference was -0.53±4.00 mmHg for systolic blood pressure and -1.15±4.06 mmHg for diastolic blood pressure. The device passed all the criteria according to the ESH-IP revision 2010. According to the validation results on the basis of the ESH-IP revision 2010, the Andon KD-5851 upper arm BP monitor can be recommended for self/home measurement in adults. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

Validation of the Medisana MTP Plus upper arm blood pressure monitor, for self-measurement, according to the European Society of Hypertension International Protocol revision 2010.

PubMed

Erdem, Emre; Aydogdu, Türkan; Akpolat, Tekin

2011-02-01

Standard validation protocols are objective guides for healthcare providers, physicians, and patients. The purpose of this study was to test validation of the Medisana MTP Plus upper arm blood pressure (BP) measuring monitor for self-measurement according to the European Society of Hypertension International Protocol (ESH-IP2) in adults. The Medisana MTP Plus monitor is an automated and oscillometric upper arm device for home BP monitoring. Nine consecutive measurements were made according to the ESH-IP2. Overseen by an independent supervisor, measurements were recorded by two observers blinded from both each other's readings and from the device readings. The Medisana MTP Plus device fulfills the validation criteria of the ESH-IP2 for the general population. The mean (standard deviation) of the difference between the observers and the device measurements was 0.6 mmHg (5.1 mmHg) for systolic and 2.7 mmHg (3.4 mmHg) for diastolic pressures, respectively. As the Medisana MTP Plus device has achieved the required standards, it is recommended for home BP monitoring in an adult population.

Validation of the SEJOY BP-1307 upper-arm blood pressure monitor for home blood pressure monitoring according to the European Society of Hypertension International Protocol revision 2010.

PubMed

Lei, Lei; Chen, Yi; Chen, Qi; Li, Yan; Wang, Ji-Guang

2017-12-01

The present study aimed to evaluate the accuracy of the automated oscillometric upper-arm blood pressure monitor SEJOY BP-1307 (also called JOYTECH DBP-1307) for home blood pressure monitoring according to the International Protocol of the European Society of Hypertension revision 2010. Systolic and diastolic blood pressures were sequentially measured in 33 adult Chinese individuals (13 women, 45.1 years of mean age) using a mercury sphygmomanometer (two observers) and the SEJOY BP-1307 device (one supervisor). Ninety-nine pairs of comparisons were obtained from 33 participants for judgments in two parts with three grading phases. The average±SD of the device-observer differences was 0.2±4.1 and -1.7±4.7 mmHg for systolic and diastolic blood pressure, respectively. The SEJOY BP-1307 device achieved the criteria in both part 1 and part 2 of the validation study. The SEJOY upper-arm blood pressure monitor BP-1307 has passed the requirements of the International Protocol revision 2010, and hence can be recommended for home use in adults.

The influence of breast support on torso, pelvis and arm kinematics during a five kilometer treadmill run.

PubMed

Milligan, Alexandra; Mills, Chris; Corbett, Jo; Scurr, Joanna

2015-08-01

Many women wear sports bras due to positive benefits associated with these garments (i.e. reduction in breast movement and breast pain), however the effects these garments have on upper body running kinematics has not been investigated. Ten female participants (32 DD or 34 D) completed two five kilometer treadmill runs (9 km h(-1)), once in a low and once in a high breast support. The range of motion (ROM) and peak torso, pelvis, and upper arm Cardan joint angles were calculated over five gait cycles during a five kilometer run. Peak torso yaw, peak rotation of the pelvis, peak pelvis obliquity, ROM in rotation of the pelvis, and ROM in upper arm extension were significant, but marginally reduced when participants ran in the high breast support. The running kinematics reported in the high breast support condition more closely align with economical running kinematics previously defined in the literature, therefore, running in a high breast support may be more beneficial to female runners, with a high breast support advocated for middle distance runners. Copyright © 2015 Elsevier B.V. All rights reserved.

Monitoring elbow isometric contraction by novel wearable fabric sensing device

NASA Astrophysics Data System (ADS)

Wang, Xi; Tao, Xiaoming; So, Raymond C. H.; Shu, Lin; Yang, Bao; Li, Ying

2016-12-01

Fabric-based wearable technology is highly desirable in sports, as it is light, flexible, soft, and comfortable with little interference to normal sport activities. It can provide accurate information on the in situ deformation of muscles in a continuous and wireless manner. During elbow flexion in isometric contraction, upper arm circumference increases with the contraction of elbow flexors, and it is possible to monitor the muscles’ contraction by limb circumferential strains. This paper presents a new wireless wearable anthropometric monitoring device made from fabric strain sensors for the human upper arm. The materials, structural design and calibration of the device are presented. Using an isokinetic testing system (Biodex3®) and the fabric monitoring device simultaneously, in situ measurements were carried out on elbow flexors in isometric contraction mode with ten subjects for a set of positions. Correlations between the measured values of limb circumferential strain and normalized torque were examined, and a linear relationship was found during isometric contraction. The average correlation coefficient between them is 0.938 ± 0.050. This wearable anthropometric device thus provides a useful index, the limb circumferential strain, for upper arm muscle contraction in isometric mode.

Assessing physical function in adult acquired major upper-limb amputees by combining the Disabilities of the Arm, Shoulder and Hand (DASH) Outcome Questionnaire and clinical examination.

PubMed

Ostlie, Kristin; Franklin, Rosemary J; Skjeldal, Ola H; Skrondal, Anders; Magnus, Per

2011-10-01

To describe physical function in adult acquired major upper-limb amputees (ULAs) by combining self-assessed arm function and physical measures obtained by clinical examinations; to estimate associations between background factors and self-assessed arm function in ULAs; and to assess whether clinical examination findings may be used to detect reduced arm function in unilateral ULAs. postal questionnaires and clinical examinations. Norwegian ULA population. Clinical examinations performed at 3 clinics. Questionnaires: population-based sample (n=224; 57.4% response rate). Clinical examinations: combined referred sample and convenience sample of questionnaire responders (n=70; 83.3% of those invited). SURVEY inclusion criteria: adult acquired major upper-limb amputation, resident in Norway, mastering of spoken and written Norwegian. Not applicable. The Disabilities of the Arm, Shoulder and Hand (DASH) Outcome Questionnaire, and clinical examination of joint motion and muscle strength with and without prostheses. Mean DASH score was 22.7 (95% confidence interval [CI], 20.3-25.0); in bilateral amputees, 35.7 (95% CI, 23.0-48.4); and in unilateral amputees, 22.1 (95% CI, 19.8-24.5). A lower unilateral DASH score (better function) was associated with paid employment (vs not in paid employment: adjusted regression coefficient [aB]=-5.40, P=.033; vs students: aB=-13.88, P=.022), increasing postamputation time (aB=-.27, P=.001), and Norwegian ethnicity (aB=-14.45, P<.001). At clinical examination, we found a high frequency of impaired neck mobility and varying frequencies of impaired joint motion and strength at the shoulder, elbow, and forearm level. Prosthesis wear was associated with impaired joint motion in all upper-limb joints (P<.006) and with reduced shoulder abduction strength (P=.002). Impaired without-prosthesis joint motion in shoulder flexion (ipsilateral: aB=12.19, P=.001) and shoulder abduction (ipsilateral: aB=12.01, P=.005; contralateral: aB=28.82, P=.004) was associated with increased DASH scores. Upper-limb loss clearly affects physical function. DASH score limitation profiles may be useful in individual clinical assessments. Targeted clinical examination may indicate patients with extra rehabilitational needs. Such examinations may be of special importance in relation to prosthesis function. Copyright © 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

THE RESPONSE OF X-IRRADIATED LIMBS OF ADULT URODELES TO NORMAL TISSUE GRAFTS. I. EFFECTS OF AUTOGRAFTS OF SIXTY-DAY FOREARM REGENERATES

DOE Office of Scientific and Technical Information (OSTI.GOV)

Stinson, B.D.

1963-06-01

Results are reported of autoplastic transplantation of parts of nonirradiated, regenerated forelimb to the contralateral x-irradiated forelimb in adult Triturus viridescens. The right forelimbs were exposed to various doses of localized irradiation (1000 to 5000 r) followed by amputation of both left and right forelimbs through the mid forearm. Left limbs regenerated normally, but irradiated right limbs failed to exhibit any significant degree of regenerative activity over a 3-month period. Both forelimbs were reamputated through the distal humerus and observed for an additional two months. Left limbs produced normal regenerates, but irradiated right limbs gave no gross evidence of regenerationmore » at any of the radiation dose levels. Normal left regenerates were reamputated immediately distal to the elbow on the 60th day after the second amputation; the severed forearm was trimmed with scissors along anterior and posterior borders and denuded of skin over its proximal half, leaving an essentially complete forearm region as a normal autograft. This was implanted into the irradiated right upper arm stump, after ablation of the distal half of its humerus, with normal proximodistal polarity in all cases. The irradiated stump was reamputated through the distal portion of the implanted normal autograft two weeks after implantation, and was observed for four months. Periodic gross observations showed that over 90% of irradiated upper arms formed regenerates at a rate which paralleled that of nonirradiated controls. However, regenerates formed on irradiated upper arms exhibited a restriction of morphogenetic capacity, only 60% attaining 3- and 4-digit stages. Most of the morphologically more complex regenerates which developed on the irradiated upper arm stumps manifested left limb asymmetry despite their formation on right irradiated stumps, suggesting a relation between the asymmetry of the normal graft and that of the resulting regenerate. All regenerates which developed on irradiated upper arms showed marked deficiencies in the restoration of a complete proximodistal structural pattern appropriate to the level of amputation through the irradiated stump. However, the actual pattern produced was appropriate to the level of amputation through the implanted normal autograft. These findings support the hypothesis that normal grafts promote the formation of regenerates on irradiated limbs through the autonomous developmental activity of the transected graft. (BBB)« less

Relations between open-field, elevated plus-maze, and emergence tests as displayed by C57/BL6J and BALB/c mice.

PubMed

Lalonde, R; Strazielle, C

2008-06-15

The relations between open-field, elevated plus-maze, and emergence tests were examined in two strains of mice. In the open-field, C57BL/6J mice had more ambulatory movements and rears but not stereotyped movements relative to BALB/c. In addition, C57BL/6J mice entered more often than BALB/c into enclosed and open arms of the elevated plus-maze. When placed inside a large enclosure, C57BL/6J mice emerged more quickly than BALB/c from a small toy object. In the entire series of mice, ambulation and rears in the open-field were linearly correlated with open and enclosed arm visits in the elevated plus-maze. Ambulatory movements and rears were also correlated with emergence latencies. In contrast, stereotyped movements were correlated with emergence latencies, but not with any elevated plus-maze value. These results specify the extent and limits of association between the three tests.

Risk factors for generally reduced productivity--a prospective cohort study of young adults with neck or upper-extremity musculoskeletal symptoms.

PubMed

Boström, Maria; Dellve, Lotta; Thomée, Sara; Hagberg, Mats

2008-04-01

This study prospectively assessed the importance of individual conditions and computer use during school or work and leisure time as risk factors for self-reported generally reduced productivity due to musculoskeletal complaints among young adults with musculoskeletal symptoms in the neck or upper extremities. A cohort of 2914 young adults (18-25 years, vocational school and college or university students) responded to an internet-based questionnaire concerning musculoskeletal symptoms related to individual conditions and computer use during school or work and leisure time that possibly affected general productivity. Prevalence ratios (PR) were used to assess prospective risk factors for generally reduced productivity. The selected study sample (N=1051) had reported neck or upper-extremity symptoms. At baseline, 280 of them reported reduced productivity. A follow-up of the 771 who reported no reduced productivity was carried out after 1 year. Risk factors for self-reported generally reduced productivity for those followed-up were symptoms in two or three locations or dimensions for the upper back or neck and the shoulders, arms, wrists, or hands [PR 2.30, 95% confidence interval (95% CI) 1.40-3.78], symptoms persisting longer than 90 days in the shoulders, arms, wrists, or hands (PR 2.50, 95% CI 1.12-5.58), current symptoms in the shoulders, arms, wrists, or hands (PR 1.78, 95% CI 1.10-2.90) and computer use 8-14 hours/week during leisure time (PR 2.32, 95% CI 1.20-4.47). A stronger relationship was found if three or four risk factors were present. For women, a relationship was found between generally reduced productivity and widespread and current symptoms in the upper extremities. The main risk factors for generally reduced productivity due to musculoskeletal symptoms among young adults in this study were chronic symptoms in the upper extremities and widespread symptoms in the neck and upper extremities.

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

"Ballistic Six" Upper-Extremity Plyometric Training for the Pediatric Volleyball Players.

PubMed

Turgut, Elif; Cinar-Medeni, Ozge; Colakoglu, Filiz F; Baltaci, Gul

2017-09-19

The Ballistic Six exercise program includes commonly used upper-body exercises, and the program is recommended for overhead throwing athletes. The purpose of the current study was to investigate the effects of a 12-week the Ballistic Six upper-extremity plyometric training program on upper-body explosive power, endurance, and reaction time in pediatric overhead athletes. Twenty-eight female pediatric volleyball players participated in the study. The participants were randomly divided into 2 study groups: an intervention group (upper-extremity plyometric training in addition to the volleyball training; n = 14) and a control group (the volleyball training only; n = 14). All the participants were assessed before and after a 12-week training program for upper-body power, strength and endurance, and reaction time. Statistical comparison was performed using an analysis of variance test. Comparisons showed that after a 12-week training program, the Ballistic Six upper-body plyometric training program resulted in more improvements in an overhead medicine ball throwing distance and a push-up performance, as well as greater improvements in the reaction time in the nonthrowing arm when compared with control training. In addition, a 12-week training program was found to be effective in achieving improvements in the reaction time in the throwing arm for both groups similarly. Compared with regular training, upper-body plyometric training resulted in additional improvements in upper-body power and strength and endurance among pediatric volleyball players. The findings of the study provide a basis for developing training protocols for pediatric volleyball players.

OUTCOME AND NUTRITIONAL ASSESSMENT OF CHRONIC LIVER DISEASE PATIENTS USING ANTHROPOMETRY AND SUBJECTIVE GLOBAL ASSESSMENT.

PubMed

Nunes, Gonçalo; Santos, Carla Adriana; Barosa, Rita; Fonseca, Cristina; Barata, Ana Teresa; Fonseca, Jorge

2017-01-01

Protein-calorie malnutrition is common in chronic liver disease (CLD) but adequate clinical tools for nutritional assessment are not defined. In CLD patients, it was aimed: 1. Characterize protein-calorie malnutrition; 2. Compare several clinical, anthropometric and functional tools; 3. Study the association malnutrition/CLD severity and malnutrition/outcome. Observational, prospective study. Consecutive CLD ambulatory/hospitalised patients were recruited from 01-03-2012 to 31-08-2012, studied according with age, gender, etiology, alcohol consumption and CLD severity defined by Child-Turcotte-Pugh. Nutritional assessment used subjective global assessment, anthropometry, namely body-mass index (BMI), triceps skinfold, mid upper arm circumference, mid arm muscular circumference and handgrip strength. Patients were followed during two years and survival data was recorded. A total of 130 CLD patients (80 men), aged 22-89 years (mean 60 years) were included. Most suffered from alcoholic cirrhosis (45%). Hospitalised patients presented more severe disease ( P <0.001) and worst nutritional status defined by BMI ( P =0.002), mid upper arm circumference ( P <0.001), mid arm muscular circumference ( P <0.001), triceps skinfold ( P =0.07) and subjective global assessment ( P <0.001). A third presented deficient/low handgrip strength. Alcohol consumption ( P =0.03) and malnutrition detected by BMI ( P =0.03), mid upper arm circumference ( P =0.001), triceps skinfold ( P =0.06), mid arm muscular circumference ( P =0.02) and subjective global assessment ( P <0.001) were associated with CLD severity. From 25 patients deceased during follow-up, 17 patients were severely malnourished according with triceps skinfold. Malnutrition defined by triceps skinfold predicted mortality ( P <0.001). Protein-calorie malnutrition is common in CLD patients and alcohol plays an important role. Triceps skinfold is the most efficient anthropometric parameter and is associated with mortality. Nutritional assessment should be considered mandatory in the routine care of CLD patients.

Effect of cadence on locomotor-respiratory coupling during upper-body exercise.

PubMed

Tiller, Nicholas B; Price, Mike J; Campbell, Ian G; Romer, Lee M

2017-02-01

Asynchronous arm-cranking performed at high cadences elicits greater cardiorespiratory responses compared to low cadences. This has been attributed to increased postural demand and locomotor-respiratory coupling (LRC), and yet, this has not been empirically tested. This study aimed to assess the effects of cadence on cardiorespiratory responses and LRC during upper-body exercise. Eight recreationally-active men performed arm-cranking exercise at moderate and severe intensities that were separated by 10 min of rest. At each intensity, participants exercised for 4 min at each of three cadences (50, 70, and 90 rev min -1 ) in a random order, with 4 min rest-periods applied in-between cadences. Exercise measures included LRC via whole- and half-integer ratios, cardiorespiratory function, perceptions of effort (RPE and dyspnoea), and diaphragm EMG using an oesophageal catheter. The prevalence of LRC during moderate exercise was highest at 70 vs. 50 rev min -1 (27 ± 10 vs. 13 ± 9%, p = 0.000) and during severe exercise at 90 vs. 50 rev min -1 (24 ± 7 vs. 18 ± 5%, p = 0.034), with a shorter inspiratory time and higher mean inspiratory flow (p < 0.05) at higher cadences. During moderate exercise, [Formula: see text] and f C were higher at 90 rev min -1 (p < 0.05) relative to 70 and 50 rev min -1 ([Formula: see text] 1.19 ± 0.25 vs. 1.05 ± 0.21 vs. 0.97 ± 0.24 L min -1 ; f C 116 ± 11 vs. 101 ± 13 vs. 101 ± 12 b min -1 ), with concomitantly elevated dyspnoea. There were no discernible cadence-mediated effects on diaphragm EMG. Participants engage in LRC to a greater extent at moderate-high cadences which, in turn, increase respiratory airflow. Cadence rate should be carefully considered when designing aerobic training programmes involving the upper-limbs.

DEET Insect Repellent: Effects on Thermoregulatory Sweating and Physiological Strain

DTIC Science & Technology

2011-01-01

local measures of mean sweat rate of upper arm and forearm during 70 min of cycling exercise in *44C. They reported a significant increase in rectal...right arm of four volunteers and the left arm of the remaining five. The mid-point of the ventral forearm , between the antecubital space and the wrist...acclimation (45_C, 20% rh; 545 watts; 100 min/day) and performed three trials: control (CON); DEET applied to forearm (DEETLOC, 12 cm2 ); and DEET

49 CFR 572.181 - General description.

Code of Federal Regulations, 2011 CFR

2011-10-01

... assembly Drawing number Head Assembly 175-1000 Neck Assembly Test/Cert 175-2000 Neck Bracket Including..., dated February 2008. (c) Weights of body segments (head, neck, upper and lower torso, arms and upper and... the convenience of the user, the added and revised text is set forth as follows: § 572.181 General...

Allometric associations between body size, shape, and 100-m butterfly speed performance.

PubMed

Sammoud, Senda; Nevill, Alan M; Negra, Yassine; Bouguezzi, Raja; Chaabene, Helmi; Hachana, Younés

2018-05-01

This study aimed to estimate the optimal body size, limb-segment length, and girth or breadth ratios associated with 100-m butterfly speed performance in swimmers. One-hundred-sixty-seven swimmers as subjects (male: N.=103; female: N.=64). Anthropometric measurements comprised height, body-mass, skinfolds, arm-span, upper-limb-length, upper-arm, forearm, hand-lengths, lower-limb-length, thigh-length, leg-length, foot-length, arm-relaxed-girth, forearm-girth, wrist-girth, thigh-girth, calf-girth, ankle-girth, biacromial and biiliocristal-breadths. To estimate the optimal body size and body composition components associated with 100-m butterfly speed performance, we adopted a multiplicative allometric log-linear regression model, which was refined using backward elimination. Fat-mass was the singularly most important whole-body characteristic. Height and body-mass did not contribute to the model. The allometric model identified that having greater limb segment length-ratio (arm-ratio = [arm-span]/[forearm]) and limb girth-ratio (girth-ratio = [calf-girth]/[ankle-girth]) were key to butterfly speed performance. A greater arm-span to forearm-length ratio and a greater calf to ankle-girth-ratio suggest that a combination of larger arm-span and shorter forearm-length and the combination of larger calves and smaller ankles-girth may benefit butterfly swim speed performance. In addition having greater biacromial and biliocristal breadths is also a major advantage in butterfly swimming speed performance. Finally, the estimation of these ratios was made possible by adopting a multiplicative allometric model that was able to confirm, theoretically, that swim speeds are nearly independent of total body size. The 100-m butterfly speed performance was strongly negatively associated with fat mass and positively associated with the segment length ratio (arm-span/forearm-length) and girth ratio (calf-girth)/(ankle-girth), having controlled for the developmental changes in age.

Gender differences between muscle activation and onset timing of the four subdivisions of trapezius during humerothoracic elevation.

PubMed

Szucs, Kimberly A; Borstad, John D

2013-12-01

The aim of this study was to provide a description of gender differences of the normal muscle activation patterns of the four subdivisions of the trapezius (clavicular, descending, transverse, ascending) during arm elevation. Surface EMG was collected from these four subdivisions from twenty-two healthy subjects (12 females, 10 males) during arm elevation in the scapular plane. Percent activation (RMS) of each subdivision was compared between genders across arm angles and elevation phase and onset time of each subdivision was compared between genders. Females demonstrated significantly higher % activation levels for each subdivision (p<.05), except transverse trapezius (p=.36). A statistically significant difference for onset time was observed between gender for the descending trapezius, with a slower onset time for females (p<.05). Findings from this study support the theory that subdivisions within descending trapezius are preferentially activated and demonstrate that gender differences are present within the fourth subdivision of trapezius. As subjects were without shoulder pathology, the observed gender differences may be explained by normal motor control variations. However, as coordinated activation of trapezius is required for normal shoulder motion, it is recommended to include all four subdivisions of trapezius and address gender differences in future studies. Copyright © 2013 Elsevier B.V. All rights reserved.

Overtaking method based on sand-sifter mechanism: Why do optimistic value functions find optimal solutions in multi-armed bandit problems?

PubMed

Ochi, Kento; Kamiura, Moto

2015-09-01

A multi-armed bandit problem is a search problem on which a learning agent must select the optimal arm among multiple slot machines generating random rewards. UCB algorithm is one of the most popular methods to solve multi-armed bandit problems. It achieves logarithmic regret performance by coordinating balance between exploration and exploitation. Since UCB algorithms, researchers have empirically known that optimistic value functions exhibit good performance in multi-armed bandit problems. The terms optimistic or optimism might suggest that the value function is sufficiently larger than the sample mean of rewards. The first definition of UCB algorithm is focused on the optimization of regret, and it is not directly based on the optimism of a value function. We need to think the reason why the optimism derives good performance in multi-armed bandit problems. In the present article, we propose a new method, which is called Overtaking method, to solve multi-armed bandit problems. The value function of the proposed method is defined as an upper bound of a confidence interval with respect to an estimator of expected value of reward: the value function asymptotically approaches to the expected value of reward from the upper bound. If the value function is larger than the expected value under the asymptote, then the learning agent is almost sure to be able to obtain the optimal arm. This structure is called sand-sifter mechanism, which has no regrowth of value function of suboptimal arms. It means that the learning agent can play only the current best arm in each time step. Consequently the proposed method achieves high accuracy rate and low regret and some value functions of it can outperform UCB algorithms. This study suggests the advantage of optimism of agents in uncertain environment by one of the simplest frameworks. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

The effects of below-elbow immobilization on driving performance.

PubMed

Jones, Evan M; Barrow, Aaron E; Skordas, Nic J; Green, David P; Cho, Mickey S

2017-02-01

There is limited research to guide physicians and patients in deciding whether it is safe to drive while wearing various forms of upper extremity immobilization. The purpose of this study is to evaluate the effect of below-elbow removable splints and fiberglass casts on automobile driving performance. 20 healthy subjects completed 10 runs through a closed, cone-marked driving course while wearing a randomized sequence of four different types of immobilization on each extremity (short arm thumb spica fiberglass cast, short arm fiberglass cast, short arm thumb spica splint, and short arm wrist splint). The first and last driving runs were without immobilization and served as controls. Performance was measured based on evaluation by a certified driving instructor (pass/fail scoring), cones hit, run time, and subject-perceived driving difficulty (1-10 analogue scoring). The greatest number of instructor-scored failures occurred while immobilized in right arm spica casts (n=6; p=0.02) and left arm spica casts (n=5; p=0.049). The right arm spica cast had the highest subject-perceived difficulty (5.2±1.9; p<0.001). All forms of immobilization had significantly increased perceived difficulty compared to control, except for the left short arm splint (2.5±1.6; p>0.05). There was no significant difference in number of cones hit or driving time between control runs and runs with any type of immobilization. Drivers should use caution when wearing any of the forms of upper extremity immobilization tested in this study. All forms of immobilization, with exception of the left short arm splint significantly increased perceived driving difficulty. However, only the fiberglass spica casts (both left and right arm), significantly increased drive run failures due to loss of vehicle control. We recommend against driving when wearing a below-elbow fiberglass spica cast on either extremity. Copyright © 2016. Published by Elsevier Ltd.

41. VIEW NORTH OF UPPER LEVEL OF CRUSHER ADDITION. DINGS ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

41. VIEW NORTH OF UPPER LEVEL OF CRUSHER ADDITION. DINGS MAGNETIC PULLEY AT CENTER. ALSO SHOWS 100-TON CRUSHED UNOXIDIZED ORE BIN (RIGHT), PULLEY FORM 18 INCH BELT CONVEYOR CRUSHED OXIDIZED ORE BIN FEED AND STEPHENSADAMSON 25 TON/HR BUCKET ELEVATOR (UPPER CENTER). THE UPPER PORTION OF THE SAMPLING ELEVATOR IS ABOVE THE MAGNETIC PULLEY (CENTER LEFT) WITH THE ROUTE OF THE 16 INCH BELT CONVEYOR FINES FEED TO CRUSHED OXIDIZED ORE BIN TO ITS LEFT. - Bald Mountain Gold Mill, Nevada Gulch at head of False Bottom Creek, Lead, Lawrence County, SD

Influence of a variation in the position of the arms on the sagittal connection of the gravity line with the spinal structures.

PubMed

Legaye, Jean; Duval-Beaupere, Ginette

2017-11-01

To evaluate the influence of the position of the arms on the location of the body's gravity line. The sagittal balance of the pelvi-spinal unit is organized so that the gravity line is localized in a way that limits the mechanical loads and the muscle efforts. This position of the gravity line was analyzed in vivo, in standing position, the arms dangling, by the barycentremeter, a gamma rays scanner. Then, several teams had the same purpose but using a force platform combined with radiographies. Their results differed significantly among themselves and with the data of the barycentremetry. However, in these studies, the positions of the arms varied noticeably, either slightly bent forwards on a support, or the fingers on the clavicles or on the cheeks. We estimated, for each varied posture of the arms, the sagittal coordinates of the masses of the upper limbs and their influence on the anatomical position of the gravity line of the whole body. Using a simple equation and the data of the barycentremeter, we observed that the variations in the location of the gravity line were proportionally connected to the changes of the sagittal position of the mass of the upper limbs induced by the various positions of the arms. We conclude in a validation of the data of the barycentremeter, as well as of the data obtained by the force platforms as long as the artifact of the position of the arms is taken into account.

A randomized controlled trial comparing two types of pneumatic compression for breast cancer-related lymphedema treatment in the home.

PubMed

Fife, Caroline E; Davey, Suzanne; Maus, Erik A; Guilliod, Renie; Mayrovitz, Harvey N

2012-12-01

Pneumatic compression devices (PCDs) are used in the home setting as adjunctive treatment for lymphedema after acute treatment in a clinical setting. PCDs range in complexity from simple to technologically advanced. The objective of this prospective, randomized study was to determine whether an advanced PCD (APCD) provides better outcomes as measured by arm edema and tissue water reductions compared to a standard PCD (SPCD) in patients with arm lymphedema after breast cancer treatment. Subjects were randomized to an APCD (Flexitouch system, HCPCS E0652) or SPCD (Bio Compression 2004, HCPCS E0651) used for home treatment 1 h/day for 12 weeks. Pressure settings were 30 mmHg for the SPCD and upper extremity treatment program (UE01) with standard pressure for the APCD. Thirty-six subjects (18 per group) with unilateral upper extremity lymphedema with at least 5% arm edema volume at the time of enrollment, completed treatments over the 12-week period. Arm volumes were determined from arm girth measurements and suitable model calculations, and tissue water was determined based on measurements of the arm tissue dielectric constant (TDC). The APCD-treated group experienced an average of 29% reduction in edema compared to a 16% increase in the SPCD group. Mean changes in TDC values were a 5.8% reduction for the APCD group and a 1.9% increase for the SPCD group. This study suggests that for the home maintenance phase of treatment of arm lymphedema secondary to breast cancer therapy, the adjuvant treatment with an APCD provides better outcomes than with a SPCD.

Cholinergic autonomic dysfunction in veterans with Gulf War illness: confirmation in a population-based sample.

PubMed

Haley, Robert W; Charuvastra, Elizabeth; Shell, William E; Buhner, David M; Marshall, W Wesley; Biggs, Melanie M; Hopkins, Steve C; Wolfe, Gil I; Vernino, Steven

2013-02-01

The authors of prior small studies raised the hypothesis that symptoms in veterans of the 1991 Gulf War, such as chronic diarrhea, dizziness, fatigue, and sexual dysfunction, are due to cholinergic autonomic dysfunction. To perform a confirmatory test of this prestated hypothesis in a larger, representative sample of Gulf War veterans. Nested case-control study. Clinical and Translational Research Center, University of Texas Southwestern Medical Center, Dallas. Representative samples of Gulf War veterans meeting a validated case definition of Gulf War illness with 3 variants (called syndromes 1-3) and a control group, all selected randomly from the US Military Health Survey. Validated domain scales from the Autonomic Symptom Profile questionnaire, the Composite Autonomic Severity Score, and high-frequency heart rate variability from a 24-hour electrocardiogram. The Autonomic Symptom Profile scales were significantly elevated in all 3 syndrome groups (P< .001), primarily due to elevation of the orthostatic intolerance, secretomotor, upper gastrointestinal dysmotility, sleep dysfunction, urinary, and autonomic diarrhea symptom domains. The Composite Autonomic Severity Score was also higher in the 3 syndrome groups (P= .045), especially in syndrome 2, primarily due to a significant reduction in sudomotor function as measured by the Quantitative Sudomotor Axon Reflex Test, most significantly in the foot; the score was intermediate in the ankle and upper leg and was nonsignificant in the arm, indicating a peripheral nerve length-related deficit. The normal increase in high-frequency heart rate variability at night was absent or blunted in all 3 syndrome groups (P< .001). Autonomic symptoms are associated with objective, predominantly cholinergic autonomic deficits in the population of Gulf War veterans.

Keeping up with video game technology: objective analysis of Xbox Kinect™ and PlayStation 3 Move™ for use in burn rehabilitation.

PubMed

Parry, Ingrid; Carbullido, Clarissa; Kawada, Jason; Bagley, Anita; Sen, Soman; Greenhalgh, David; Palmieri, Tina

2014-08-01

Commercially available interactive video games are commonly used in rehabilitation to aide in physical recovery from a variety of conditions and injuries, including burns. Most video games were not originally designed for rehabilitation purposes and although some games have shown therapeutic potential in burn rehabilitation, the physical demands of more recently released video games, such as Microsoft Xbox Kinect™ (Kinect) and Sony PlayStation 3 Move™ (PS Move), have not been objectively evaluated. Video game technology is constantly evolving and demonstrating different immersive qualities and interactive demands that may or may not have therapeutic potential for patients recovering from burns. This study analyzed the upper extremity motion demands of Kinect and PS Move using three-dimensional motion analysis to determine their applicability in burn rehabilitation. Thirty normal children played each video game while real-time movement of their upper extremities was measured to determine maximal excursion and amount of elevation time. Maximal shoulder flexion, shoulder abduction and elbow flexion range of motion were significantly greater while playing Kinect than the PS Move (p≤0.01). Elevation time of the arms above 120° was also significantly longer with Kinect (p<0.05). The physical demands for shoulder and elbow range of motion while playing the Kinect, and to a lesser extent PS Move, are comparable to functional motion needed for daily tasks such as eating with a utensil and hair combing. Therefore, these more recently released commercially available video games show therapeutic potential in burn rehabilitation. Objectively quantifying the physical demands of video games commonly used in rehabilitation aides clinicians in the integration of them into practice and lays the framework for further research on their efficacy. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

Intensive virtual reality-based training for upper limb motor function in chronic stroke: a feasibility study using a single case experimental design and fMRI.

PubMed

Schuster-Amft, Corina; Henneke, Andrea; Hartog-Keisker, Birgit; Holper, Lisa; Siekierka, Ewa; Chevrier, Edith; Pyk, Pawel; Kollias, Spyros; Kiper, Daniel; Eng, Kynan

2015-01-01

To evaluate feasibility and neurophysiological changes after virtual reality (VR)-based training of upper limb (UL) movements. Single-case A-B-A-design with two male stroke patients (P1:67 y and 50 y, 3.5 and 3 y after onset) with UL motor impairments, 45-min therapy sessions 5×/week over 4 weeks. Patients facing screen, used bimanual data gloves to control virtual arms. Three applications trained bimanual reaching, grasping, hand opening. Assessments during 2-week baseline, weekly during intervention, at 3-month follow-up (FU): Goal Attainment Scale (GAS), Chedoke Arm and Hand Activity Inventory (CAHAI), Chedoke-McMaster Stroke Assessment (CMSA), Extended Barthel Index (EBI), Motor Activity Log (MAL). Functional magnetic resonance imaging scans (FMRI) before, immediately after treatment and at FU. P1 executed 5478 grasps (paretic arm). Improvements in CAHAI (+4) were maintained at FU. GAS changed to +1 post-test and +2 at FU. P2 executed 9835 grasps (paretic arm). CAHAI improvements (+13) were maintained at FU. GAS scores changed to -1 post-test and +1 at FU. MAL scores changed from 3.7 at pre-test to 5.5 post-test and 3.3 at FU. The VR-based intervention was feasible, safe, and intense. Adjustable application settings maintained training challenge and patient motivation. ADL-relevant UL functional improvements persisted at FU and were related to changed cortical activation patterns. Implications for Rehabilitation YouGrabber trains uni- and bimanual upper motor function. Its application is feasible, safe, and intense. The control of the virtual arms can be done in three main ways: (a) normal (b) virtual mirror therapy, or (c) virtual following. The mirroring feature provides an illusion of affected limb movements during the period when the affected upper limb (UL) is resting. The YouGrabber training led to ADL-relevant UL functional improvements that were still assessable 12 weeks after intervention finalization and were related to changed cortical activation patterns.

15. NORTH ELEVATION OF UPPER ORE BIN, CHUTE, AND JAW ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

15. NORTH ELEVATION OF UPPER ORE BIN, CHUTE, AND JAW CRUSHER, LOOKING SOUTH FROM END OF CONVEYOR PLATFORM. NOTICE THE THREE ORE BIN CONTROL DOORS, CORRESPONDING TO SEPARATE COMPARTMENTS OF THE BIN. - Skidoo Mine, Park Route 38 (Skidoo Road), Death Valley Junction, Inyo County, CA

[Slipped superior rectus in Grave's orbitopathy. A case report].

PubMed

Spielmann, A C

2007-02-01

Superior rectus slippage after its surgical recession is characterized by short-term progressive overcorrection. Similarities with inferior rectus slippage are pronounced, especially a history of Grave's orbitopathy and the use of an adjustable suture. In the present clinical case, upper eyelid retraction and a history of upper eyelid elevator muscle surgery might be specific risk factors, due to the close anatomical links between the superior rectus and the upper eyelid elevator.

8. EAST ELEVATION OF SKIDOO MILL AND UPPER ORE BIN, ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

8. EAST ELEVATION OF SKIDOO MILL AND UPPER ORE BIN, LOOKING WEST FROM ACCESS ROAD. THE ROADWAY ON THIS LEVEL (CENTER) WAS USED FOR UNLOADING ORE BROUGHT ON BURROWS INTO THE ORE BIN AT THE TOP LEVEL OF THE MILL. THE ORE BIN IN THE UPPER LEFT WAS ADDED LATER WHEN ORE WAS BROUGHT TO THE MILL BY TRUCKS. - Skidoo Mine, Park Route 38 (Skidoo Road), Death Valley Junction, Inyo County, CA

Performing Complex Tasks by Users With Upper-Extremity Disabilities Using a 6-DOF Robotic Arm: A Study.

PubMed

Al-Halimi, Reem K; Moussa, Medhat

2017-06-01

In this paper, we report on the results of a study that was conducted to examine how users suffering from severe upper-extremity disabilities can control a 6 degrees-of-freedom (DOF) robotics arm to complete complex activities of daily living. The focus of the study is not on assessing the robot arm but on examining the human-robot interaction patterns. Three participants were recruited. Each participant was asked to perform three tasks: eating three pieces of pre-cut bread from a plate, drinking three sips of soup from a bowl, and opening a right-handed door with lever handle. Each of these tasks was repeated three times. The arm was mounted on the participant's wheelchair, and the participants were free to move the arm as they wish to complete these tasks. Each task consisted of a sequence of modes where a mode is defined as arm movement in one DOF. Results show that participants used a total of 938 mode movements with an average of 75.5 (std 10.2) modes for the eating task, 70 (std 8.8) modes for the soup task, and 18.7 (std 4.5) modes for the door opening task. Tasks were then segmented into smaller subtasks. It was found that there are patterns of usage per participant and per subtask. These patterns can potentially allow a robot to learn from user's demonstration what is the task being executed and by whom and respond accordingly to reduce user effort.

Mathematical methods to model rodent behavior in the elevated plus-maze.

PubMed

Arantes, Rafael; Tejada, Julián; Bosco, Geraldine G; Morato, Silvio; Roque, Antonio C

2013-11-15

The elevated plus maze is a widely used experimental test to study anxiety-like rodent behavior. It is made of four arms, two open and two closed, connected at a central area forming a plus shaped maze. The whole apparatus is elevated 50 cm from the floor. The anxiety of the animal is usually assessed by the number of entries and duration of stay in each arm type during a 5-min period. Different mathematical methods have been proposed to model the mechanisms that control the animal behavior in the maze, such as factor analysis, statistical inference on Markov chains and computational modeling. In this review we discuss these methods and propose possible extensions of them as a direction for future research. Copyright © 2013 Elsevier B.V. All rights reserved.

Workplace management of upper limb disorders: a systematic review.

PubMed

Dick, F D; Graveling, R A; Munro, W; Walker-Bone, K

2011-01-01

Upper limb pain is common among working-aged adults and a frequent cause of absenteeism. To systematically review the evidence for workplace interventions in four common upper limb disorders. Systematic review of English articles using Medline, Embase, Cinahl, AMED, Physiotherapy Evidence Database PEDro (carpal tunnel syndrome and non-specific arm pain only) and Cochrane Library. Study inclusion criteria were randomized controlled trials, cohort studies or systematic reviews employing any workplace intervention for workers with carpal tunnel syndrome, non-specific arm pain, extensor tenosynovitis or lateral epicondylitis. Papers were selected by a single reviewer and appraised by two reviewers independently using methods based on Scottish Intercollegiate Guidelines Network (SIGN) methodology. 1532 abstracts were identified, 28 papers critically appraised and four papers met the minimum quality standard (SIGN grading + or ++) for inclusion. There was limited evidence that computer keyboards with altered force displacement characteristics or altered geometry were effective in reducing carpal tunnel syndrome symptoms. There was limited, but high quality, evidence that multi-disciplinary rehabilitation for non-specific musculoskeletal arm pain was beneficial for those workers absent from work for at least four weeks. In adults with tenosynovitis there was limited evidence that modified computer keyboards were effective in reducing symptoms. There was a lack of high quality evidence to inform workplace management of lateral epicondylitis. Further research is needed focusing on occupational management of upper limb disorders. Where evidence exists, workplace outcomes (e.g. successful return to pre-morbid employment; lost working days) are rarely addressed.

Corticosterone response to the plus-maze: high correlation with risk assessment in rats and mice.

PubMed

Rodgers, R J; Haller, J; Holmes, A; Halasz, J; Walton, T J; Brain, P F

Exposure to the elevated plus-maze induces behavioural and physiological effects in rodents consistent with fear/anxiety. Maze-naive animals display high levels of risk assessment towards the open arms, and explore these areas less extensively than other parts of the maze while, immediately following the test, pain latencies, skin conductance levels, and plasma corticosterone titres (CORT) are significantly elevated. Although previous research has suggested a link between the plasma CORT response and open-arm exploration, significant elevations in CORT have also been found with restricted exposure to the closed arms. The present study employed ethological measures in an attempt to further characterise the relationship between behavioural and CORT responses to this widely used animal model of anxiety. Our results confirm that, relative to home-cage controls, 5-min exposure to the plus-maze significantly increases plasma CORT levels in test-naive male Wistar rats and male Swiss-Webster mice. Furthermore, in both species, the CORT response was found to be highly correlated with measures of risk assessment (mice: rs = +0.87; rats: rs = +0.58), but not with measures of open-arm activity (entries, time), general locomotor activity, rearing, or head dipping. Findings are discussed in relation to the functional significance of risk assessment in potentially dangerous situations and the potential involvement of glucocorticoids in this process. All rights reserved.

[Upper extremities, neck and back symptoms in office employees working at computer stations].

PubMed

Zejda, Jan E; Bugajska, Joanna; Kowalska, Małgorzata; Krzych, Lukasz; Mieszkowska, Marzena; Brozek, Grzegorz; Braczkowska, Bogumiła

2009-01-01

To obtain current data on the occurrence ofwork-related symptoms of office computer users in Poland we implemented a questionnaire survey. Its goal was to assess the prevalence and intensity of symptoms of upper extremities, neck and back in office workers who use computers on a regular basis, and to find out if the occurrence of symptoms depends on the duration of computer use and other work-related factors. Office workers in two towns (Warszawa and Katowice), employed in large social services companies, were invited to fill in the Polish version of Nordic Questionnaire. The questions included work history and history of last-week symptoms of pain of hand/wrist, elbow, arm, neck and upper and lower back (occurrence and intensity measured by visual scale). Altogether 477 men and women returned the completed questionnaires. Between-group symptom differences (chi-square test) were verified by multivariate analysis (GLM). The prevalence of symptoms in individual body parts was as follows: neck, 55.6%; arm, 26.9%; elbow, 13.3%; wrist/hand, 29.9%; upper back, 49.6%; and lower back, 50.1%. Multivariate analysis confirmed the effect of gender, age and years of computer use on the occurrence of symptoms. Among other determinants, forearm support explained pain of wrist/hand, wrist support of elbow pain, and chair adjustment of arm pain. Association was also found between low back pain and chair adjustment and keyboard position. The findings revealed frequent occurrence of symptoms of pain in upper extremities and neck in office workers who use computers on a regular basis. Seating position could also contribute to the frequent occurrence of back pain in the examined population.

Advances in upper extremity prosthetics.

PubMed

Zlotolow, Dan A; Kozin, Scott H

2012-11-01

Until recently, upper extremity prostheses had changed little since World War II. In 2006, the Defense Advanced Research Projects Agency responded to an increasing number of military amputees with the Revolutionizing Prosthetics program. The program has yielded several breakthroughs both in the engineering of new prosthetic arms and in the control of those arms. Direct brain-wave control of a limb with 22° of freedom may be within reach. In the meantime, advances such as individually powered digits have opened the door to multifunctional full and partial hand prostheses. Restoring sensation to the prosthetic limb remains a major challenge to full integration of the limb into a patient's self-image. Copyright © 2012 Elsevier Inc. All rights reserved.

Home-based Computer Assisted Arm Rehabilitation (hCAAR) robotic device for upper limb exercise after stroke: results of a feasibility study in home setting.

PubMed

Sivan, Manoj; Gallagher, Justin; Makower, Sophie; Keeling, David; Bhakta, Bipin; O'Connor, Rory J; Levesley, Martin

2014-12-12

Home-based robotic technologies may offer the possibility of self-directed upper limb exercise after stroke as a means of increasing the intensity of rehabilitation treatment. The current literature has a paucity of robotic devices that have been tested in a home environment. The aim of this research project was to evaluate a robotic device Home-based Computer Assisted Arm Rehabilitation (hCAAR) that can be used independently at home by stroke survivors with upper limb weakness. hCAAR device comprises of a joystick handle moved by the weak upper limb to perform tasks on the computer screen. The device provides assistance to the movements depending on users ability. Nineteen participants (stroke survivors with upper limb weakness) were recruited. Outcome measures performed at baseline (A0), at end of 8-weeks of hCAAR use (A1) and 1 month after end of hCAAR use (A2) were: Optotrak kinematic variables, Fugl Meyer Upper Extremity motor subscale (FM-UE), Action Research Arm Test (ARAT), Medical Research Council (MRC) and Modified Ashworth Scale (MAS), Chedoke Arm and Hand Activity Inventory (CAHAI) and ABILHAND. Two participants were unable to use hCAAR: one due to severe paresis and the other due to personal problems. The remaining 17 participants were able to use the device independently in their home setting. No serious adverse events were reported. The median usage time was 433 minutes (IQR 250 - 791 min). A statistically significant improvement was observed in the kinematic and clinical outcomes at A1. The median gain in the scores at A1 were by: movement time 19%, path length 15% and jerk 19%, FM-UE 1 point, total MAS 1.5 point, total MRC 2 points, ARAT 3 points, CAHAI 5.5 points and ABILHAND 3 points. Three participants showed clinically significant improvement in all the clinical outcomes. The hCAAR feasibility study is the first clinical study of its kind reported in the current literature; in this study, 17 participants used the robotic device independently for eight weeks in their own homes with minimal supervision from healthcare professionals. Statistically significant improvements were observed in the kinematic and clinical outcomes in the study.

12. Interior, boiler house, at elev. 55' looking west at ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

12. Interior, boiler house, at elev. 55' looking west at retired 300 lb. boilers #11, 10, and 9 with pulverized coal storage hoppers on upper left and rock coal storage bunkers on upper right. - Manchester Street Generating Station, Manchester Street Station, 460 Eddy Street, Providence, Providence County, RI

SALGOT - Stroke Arm Longitudinal study at the University of Gothenburg, prospective cohort study protocol

PubMed Central

2011-01-01

Background Recovery patterns of upper extremity motor function have been described in several longitudinal studies, but most of these studies have had selected samples, short follow up times or insufficient outcomes on motor function. The general understanding is that improvements in upper extremity occur mainly during the first month after the stroke incident and little if any, significant recovery can be gained after 3-6 months. The purpose of this study is to describe the recovery of upper extremity function longitudinally in a non-selected sample initially admitted to a stroke unit with first ever stroke, living in Gothenburg urban area. Methods/Design A sample of 120 participants with a first-ever stroke and impaired upper extremity function will be consecutively included from an acute stroke unit and followed longitudinally for one year. Assessments are performed at eight occasions: at day 3 and 10, week 3, 4 and 6, month 3, 6 and 12 after onset of stroke. The primary clinical outcome measures are Action Research Arm Test and Fugl-Meyer Assessment for Upper Extremity. As additional measures, two new computer based objective methods with kinematic analysis of arm movements are used. The ABILHAND questionnaire of manual ability, Stroke Impact Scale, grip strength, spasticity, pain, passive range of motion and cognitive function will be assessed as well. At one year follow up, two patient reported outcomes, Impact on Participation and Autonomy and EuroQol Quality of Life Scale, will be added to cover the status of participation and aspects of health related quality of life. Discussion This study comprises a non-selected population with first ever stroke and impaired arm function. Measurements are performed both using traditional clinical assessments as well as computer based measurement systems providing objective kinematic data. The ICF classification of functioning, disability and health is used as framework for the selection of assessment measures. The study design with several repeated measurements on motor function will give us more confident information about the recovery patterns after stroke. This knowledge is essential both for optimizing rehabilitation planning as well as providing important information to the patient about the recovery perspectives. Trial registration ClinicalTrials.gov: NCT01115348 PMID:21612620

49 CFR 572.196 - Thorax without arm.

Code of Federal Regulations, 2010 CFR

2010-10-01

... orientation. (4) Push the dummy at the knees and at mid-sternum of the upper torso with just sufficient horizontally oriented force towards the seat back until the back of the upper torso is in contact with the seat back. (5) While maintaining the dummy's position as specified in paragraphs (b)(3) and (4) of this...

49 CFR 572.195 - Thorax with arm.

Code of Federal Regulations, 2010 CFR

2010-10-01

... dummy is in vertical orientation. (4) Push the dummy at the knees and at mid-sternum of the upper torso with just sufficient horizontally oriented force towards the seat back until the back of the upper torso is in contact with the seat back. (5) While maintaining the dummy's position as specified in...

Quantification of human upper extremity nerves and fascicular anatomy.

PubMed

Brill, Natalie A; Tyler, Dustin J

2017-09-01

In this study we provide detailed quantification of upper extremity nerve and fascicular anatomy. The purpose is to provide values and trends in neural features useful for clinical applications and neural interface device design. Nerve cross-sections were taken from 4 ulnar, 4 median, and 3 radial nerves from 5 arms of 3 human cadavers. Quantified nerve features included cross-sectional area, minor diameter, and major diameter. Fascicular features analyzed included count, perimeter, area, and position. Mean fascicular diameters were 0.57 ± 0.39, 0.6 ± 0.3, 0.5 ± 0.26 mm in the upper arm and 0.38 ± 0.18, 0.47 ± 0.18, 0.4 ± 0.27 mm in the forearm of ulnar, median, and radial nerves, respectively. Mean fascicular diameters were inversely proportional to fascicle count. Detailed quantitative anatomy of upper extremity nerves is a resource for design of neural electrodes, guidance in extraneural procedures, and improved neurosurgical planning. Muscle Nerve 56: 463-471, 2017. © 2016 Wiley Periodicals, Inc.

Preliminary research of a novel center-driven robot for upper extremity rehabilitation.

PubMed

Cao, Wujing; Zhang, Fei; Yu, Hongliu; Hu, Bingshan; Meng, Qiaoling

2018-01-19

Loss of upper limb function often appears after stroke. Robot-assisted systems are becoming increasingly common in upper extremity rehabilitation. Rehabilitation robot provides intensive motor therapy, which can be performed in a repetitive, accurate and controllable manner. This study aims to propose a novel center-driven robot for upper extremity rehabilitation. A new power transmission mechanism is designed to transfer the power to elbow and shoulder joints from three motors located on the base. The forward and inverse kinematics equations of the center-driven robot (CENTROBOT) are deduced separately. The theoretical values of the scope of joint movements are obtained with the Denavit-Hartenberg parameters method. A prototype of the CENTROBOT is developed and tested. The elbow flexion/extension, shoulder flexion/extension and shoulder adduction/abduction can be realized of the center-driven robot. The angles value of joints are in conformity with the theoretical value. The CENTROBOT reduces the overall size of the robot arm, the influence of motor noise, radiation and other adverse factors by setting all motors on the base. It can satisfy the requirements of power and movement transmission of the robot arm.

Work-related lesions of the supraspinatus tendon: a case-control study.

PubMed

Seidler, Andreas; Bolm-Audorff, Ulrich; Petereit-Haack, Gabriela; Ball, Elke; Klupp, Magdalena; Krauss, Noëlle; Elsner, Gine

2011-04-01

To examine the dose-response relationship between cumulative duration of work with highly elevated arms (work above shoulder level) as well as of manual material handling and ruptures of the supraspinatus tendon in a population-based case-control study. In 14 radiologic practices, we recruited 483 male patients aged 25-65 with radiographically confirmed partial (n = 385) or total (n = 98) supraspinatus tears associated with shoulder pain. A total of 300 male control subjects were recruited. Data were gathered in a structured personal interview. To calculate cumulative exposure, the self-reported duration of lifting/carrying of heavy loads (>20 kg) as well as the duration of work with highly elevated arms was added up over the entire working life. The results of our study support a dose-response relationship between cumulative duration of work with highly elevated arms and symptomatic supraspinatus tendon tears. For a cumulative duration of >3,195 h work above shoulder level, the risk of a supraspinatus tendon rupture is elevated to 2.0 (95% CI 1.1-3.5), adjusted for age, region, lifting/carrying of heavy loads, handheld vibration, apparatus gymnastics/shot put/javelin/hammer throwing/wrestling, and tennis. The cumulative duration of carrying/lifting of heavy loads also yields a positive dose-response relation with disease (independent from work above shoulder level and from handheld vibration), with an adjusted odds ratio of 1.8 (95% CI 1.0-3.2) in the highest exposure category (>77 h). We find an increased risk for subjects exposed to handheld vibration with an adjusted OR of 3.2 (95% CI 1.7-5.9) in the highest exposure category (16 years or more in the job with exposure), but a clear dose-response relationship is lacking. This study points to a potential etiologic role of long-term cumulative effects of work with highly elevated arms and heavy lifting/carrying on shoulder tendon disorders.

Measuring up: A Simple Lesson That Engages Students in Scientific Practices and Mathematics

ERIC Educational Resources Information Center

Capps, Daniel

2012-01-01

A well-known lesson taught by many upper-elementary and early-middle-school teachers at the beginning of the school year asks students to compare how arm span relates to height. Students measure their height and arm span and compare their measurements to those of their classmates. This lesson gets students measuring, graphing, and practicing…

Developing a multi-joint upper limb exoskeleton robot for diagnosis, therapy, and outcome evaluation in neurorehabilitation.

PubMed

Ren, Yupeng; Kang, Sang Hoon; Park, Hyung-Soon; Wu, Yi-Ning; Zhang, Li-Qun

2013-05-01

Arm impairments in patients post stroke involve the shoulder, elbow and wrist simultaneously. It is not very clear how patients develop spasticity and reduced range of motion (ROM) at the multiple joints and the abnormal couplings among the multiple joints and the multiple degrees-of-freedom (DOF) during passive movement. It is also not clear how they lose independent control of individual joints/DOFs and coordination among the joints/DOFs during voluntary movement. An upper limb exoskeleton robot, the IntelliArm, which can control the shoulder, elbow, and wrist, was developed, aiming to support clinicians and patients with the following integrated capabilities: 1) quantitative, objective, and comprehensive multi-joint neuromechanical pre-evaluation capabilities aiding multi-joint/DOF diagnosis for individual patients; 2) strenuous and safe passive stretching of hypertonic/deformed arm for loosening up muscles/joints based on the robot-aided diagnosis; 3) (assistive/resistive) active reaching training after passive stretching for regaining/improving motor control ability; and 4) quantitative, objective, and comprehensive neuromechanical outcome evaluation at the level of individual joints/DOFs, multiple joints, and whole arm. Feasibility of the integrated capabilities was demonstrated through experiments with stroke survivors and healthy subjects.

Mechanical arm trainer for the treatment of the severely affected arm after a stroke: a single-blinded randomized trial in two centers.

PubMed

Hesse, S; Werner, C; Pohl, M; Mehrholz, J; Puzich, U; Krebs, H I

2008-10-01

To test whether training with a new mechanical arm trainer leads to better outcomes than electrical stimulation of the paretic wrist extensors in subacute stroke patients with severe upper limb paresis. Electrical stimulation is a standard and reimbursable form of therapy in Germany. Randomized controlled trial of 54 inpatients enrolled 4-8 wks from stroke onset, mean upper-extremity subsection of Fugl-Meyer assessment (0-66) at admission less than 18. In addition to standard care, all patients practiced 20-30 mins arm trainer or electrical stimulation every workday for 6 wks, totaling 30 sessions. Primary outcome was the Fugl-Meyer assessment, secondary outcomes were the Box and Block test, the Medical Research Council and the modified Ashworth scale, blindly assessed at enrollment, after 6 wks, and at 3-mo follow-up. Both groups were homogeneous at study onset. Shoulder pain occurred in two arm trainer patients. The primary Fugl-Meyer assessment outcome improved for both groups over time (P < 0.001), but this improvement did not differ between groups. The initial (terminal) mean Fugl-Meyer assessment scores were 8.8 +/- 4.8 (19.2 +/- 14.5) for the arm trainer and 8.6 +/- 3.5 (13.6 +/- 7.9) for the electrical stimulation group. No patient could transport a block initially, but at completion significantly more arm trainer patients were able to transport at least three blocks (five vs. zero, P = 0.023). No significant differences were observed between the groups on the secondary Box and Block outcome at follow-up (eight vs. four patients). All Box and Block responders had an initial Fugl-Meyer assessment > or =10. Arm trainer training did not lead to a superior primary outcome over electrical stimulation training. However, "good performers" on the secondary outcome seemed to benefit more from the arm trainer training.

Angular position, range of motion and velocity of arm elevation: a study of consistency of performance.

PubMed

García-Alsina, Joan; García Almazan, Concepción; Moranta Mesquida, José; Pleguezuelos Cobo, Eulogio

2005-11-01

To define the normal range, velocity and consistency of the movement of active arm elevation with humerus in neutral or in external rotation using a simplified kinematic model. Nine normal volunteers and the non-involved side of twenty five patients with unilateral shoulder lesion participated. A 3D optoelectronic tracking system was used to register the movement of raising the arm from the normal upright position to maximal elevation in a repetitive way. Peak humeral position, range of movement, velocity of motion and consistency of cycles were analyzed. Descriptive statistics, correlation between variables and with sex, age and side are presented, including differences between performances of movement done in neutral or external rotation. Data of the six variables were: maximal abduction 142 degrees [137.4-147.0], range of motion 118.1 degrees [112-124], maximal velocity 238 degrees/s [209-265]; mean velocity 113 degrees/s [96-130]; coefficient of variation of maximal angular abduction was 2.2% [1.7-2.7]; coefficient of variation of maximal velocity 8.6% [7.3-9.9]. No significant differences were observed either on side, sex or between the shoulder of normal volunteers or that of the patients with opposite shoulder lesions. Participants older than 45 years old showed only a significant slightly lower average velocity. The study confirms the weak association between dependent (biomechanical) and independent variables. As it is described here, analysis of arm elevation has not been previously studied and shows that has a good consistency in angular position, velocity and repeatability of motion in normal conditions which permits a picture of the overall performance of the shoulder.

Ethnic differences in stratum corneum functions between Chinese and Thai infants residing in Bangkok, Thailand.

PubMed

Fujimura, Tsutomu; Miyauchi, Yuki; Shima, Kyoko; Hotta, Mitsuyuki; Tsujimura, Hisashi; Kitahara, Takashi; Takema, Yoshinori; Palungwachira, Pakhawadee; Laohathai, Diane; Chanthothai, Jetchawa; Nararatwanchai, Thamthiwat

2018-01-01

Ethnic and racial differences in infant skin have not been well characterized. The purpose of this study was to establish whether there are ethnic differences and similarities in the stratum corneum (SC) functions of Thai and Chinese infants. Healthy infants 6 to 24 months of age (N = 60; 30 Thai, 30 Chinese) who resided in Bangkok, Thailand, were enrolled. Transepidermal water loss (TEWL) and SC hydration (capacitance) on the thigh, buttock, and upper arm were measured. Ceramide content was determined in the SC on the upper arm. SC hydration was not remarkably different between the two ethnicities at any site measured, but TEWL was significantly higher in Chinese infants than in Thai infants at all sites. Hydration of the SC was not significantly correlated with age in either ethnicity. TEWL had significant but weak correlations with age on the thigh and upper arm in Thai infants. Ceramide content was significantly higher in Chinese SC than in Thai SC. No relationship between ceramide content and TEWL or hydration was observed in either ethnicity. The significant differences in TEWL and ceramide contents between Chinese and Thai infant skin could prove useful in designing skin care and diapering products that are best suited for each ethnicity. © 2017 Wiley Periodicals, Inc.

Disability in the upper extremity and quality of life in hand-arm vibration syndrome.

PubMed

Poole, Kerry; Mason, Howard

2005-11-30

To investigate whether hand-arm vibration syndrome (HAVS) leads to disability in the upper extremity or deficit in quality of life (QoL) using validated questionnaire tools, and to establish whether these effects are related to the Stockholm Workshop Staging (SWS). This was a postal cross-sectional questionnaire study with a 50% response rate. Four hundred and forty-four males, who had been diagnosed and staged according to the SWS were sent the Disability in the Arm, Shoulder and Hand (DASH) and the SF-36v2 QoL questionnaires. HAVS cases had significantly greater DASH disability scores and reduced QoL physical and mental component scores compared to published normal values. Those HAVS cases with a presumptive diagnosis of Carpal Tunnel Syndrome(CTS) had even higher disability scores. There was a clear, linear relationship between both the DASH disability score and the physical component of the QoL and sensorineural SWS, but not with the vascular SWS. HAVS has a significant effect on an individual's perceived ability to perform everyday tasks involving the upper extremity, and their quality of life. Physical capability may be further compromised in those individuals who have a presumptive diagnosis of CTS. These findings may have important implications regarding management of the affected worker.

Technology-assisted training of arm-hand skills in stroke: concepts on reacquisition of motor control and therapist guidelines for rehabilitation technology design

PubMed Central

Timmermans, Annick AA; Seelen, Henk AM; Willmann, Richard D; Kingma, Herman

2009-01-01

Background It is the purpose of this article to identify and review criteria that rehabilitation technology should meet in order to offer arm-hand training to stroke patients, based on recent principles of motor learning. Methods A literature search was conducted in PubMed, MEDLINE, CINAHL, and EMBASE (1997–2007). Results One hundred and eighty seven scientific papers/book references were identified as being relevant. Rehabilitation approaches for upper limb training after stroke show to have shifted in the last decade from being analytical towards being focussed on environmentally contextual skill training (task-oriented training). Training programmes for enhancing motor skills use patient and goal-tailored exercise schedules and individual feedback on exercise performance. Therapist criteria for upper limb rehabilitation technology are suggested which are used to evaluate the strengths and weaknesses of a number of current technological systems. Conclusion This review shows that technology for supporting upper limb training after stroke needs to align with the evolution in rehabilitation training approaches of the last decade. A major challenge for related technological developments is to provide engaging patient-tailored task oriented arm-hand training in natural environments with patient-tailored feedback to support (re) learning of motor skills. PMID:19154570

Recent unprecedented tree-ring growth in bristlecone pine at the highest elevations and possible causes

PubMed Central

Salzer, Matthew W.; Hughes, Malcolm K.; Bunn, Andrew G.; Kipfmueller, Kurt F.

2009-01-01

Great Basin bristlecone pine (Pinus longaeva) at 3 sites in western North America near the upper elevation limit of tree growth showed ring growth in the second half of the 20th century that was greater than during any other 50-year period in the last 3,700 years. The accelerated growth is suggestive of an environmental change unprecedented in millennia. The high growth is not overestimated because of standardization techniques, and it is unlikely that it is a result of a change in tree growth form or that it is predominantly caused by CO2 fertilization. The growth surge has occurred only in a limited elevational band within ≈150 m of upper treeline, regardless of treeline elevation. Both an independent proxy record of temperature and high-elevation meteorological temperature data are positively and significantly correlated with upper-treeline ring width both before and during the high-growth interval. Increasing temperature at high elevations is likely a prominent factor in the modern unprecedented level of growth for Pinus longaeva at these sites. PMID:19918054

Reference values of anthropometric measurements in Dutch children. The Oosterwolde Study.

PubMed

Gerver, W J; Drayer, N M; Schaafsma, W

1989-03-01

In the period 1979-1980 the following anthropometric measurements were recorded in 2351 healthy Dutch children from 0-17 years of age: height, weight, sitting height, arm span, lengths of upper-arm, lower-arm and hand, tibial length, foot length, biacromial diameter, biiliacal diameter, and head circumference. Corresponding percentile values were constructed on the basis of normality assumptions, the mean and standard deviation at age t being determined by a cubic spline approximation. The results are compared with other studies and given in the form of growth charts.

Acoustic Source Elevation Angle Estimates Using Two Microphones

DTIC Science & Technology

2014-06-01

elevated. Elevation angles are successfully estimated, under certain conditions, for a loudspeaker broadcasting band limited white noise. 15. SUBJECT...INTENTIONALLY LEFT BLANK. 1 1. Introduction The U.S. Army uses acoustic arrays to track and locate various sources including...ground and airborne vehicles, small arms, mortars, and rockets. The tracking and locating algorithms often used with these acoustic arrays perform

Kinematic analysis of dynamic shoulder motion in patients with reverse total shoulder arthroplasty.

PubMed

Kwon, Young W; Pinto, Vivek J; Yoon, Jangwhon; Frankle, Mark A; Dunning, Page E; Sheikhzadeh, Ali

2012-09-01

Reverse total shoulder arthroplasty (rTSA) has been used to treat patients with irreparable rotator cuff dysfunction. Despite the proven clinical efficacy, there is minimal information regarding the underlying changes to the shoulder kinematics associated with this construct. Therefore, we sought to examine the kinematics of dynamic shoulder motion in patients with well-functioning rTSA. We tested 12 healthy subjects and 17 patients with rTSA. All rTSA patients were able to elevate their arms to at least 90° and received the implant as the primary arthroplasty at least 6 months before testing. On average, the rTSA patients elevated their arms to 112° ± 12° (mean ± SD) and reported an American Shoulder and Elbow Surgeons outcome score of 90.6 ± 6.3. A 3-dimensional electromagnetic motion capture device was used to detect the dynamic motion of the trunk, scapula, and humerus during bilateral active shoulder elevation along the sagittal, scapular, and coronal planes. In both healthy and rTSA shoulders, the majority of the humeral-thoracic motion was provided by the glenohumeral motion. Therefore, the ratio of glenohumeral to scapulothoracic (ST) motion was always greater than 1.62 during elevation along the scapular plane. In comparison to healthy subjects, however, the contribution of ST motion to overall shoulder motion was significantly increased in the rTSA shoulders. This increased contribution was noted in all planes of shoulder elevation and was maintained when weights were attached to the arm. Kinematics of the rTSA shoulders are significantly altered, and more ST motion is used to achieve shoulder elevation. Copyright © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Survey of upper extremity injuries among martial arts participants.

PubMed

Diesselhorst, Matthew M; Rayan, Ghazi M; Pasque, Charles B; Peyton Holder, R

2013-01-01

To survey participants at various experience levels of different martial arts (MA) about upper extremity injuries sustained during training and fighting. A 21-s question survey was designed and utilised. The survey was divided into four groups (Demographics, Injury Description, Injury Mechanism, and Miscellaneous information) to gain knowledge about upper extremity injuries sustained during martial arts participation. Chi-square testing was utilised to assess for significant associations. Males comprised 81% of respondents. Involvement in multiple forms of MA was the most prevalent (38%). The hand/wrist was the most common area injured (53%), followed by the shoulder/upper arm (27%) and the forearm/elbow (19%). Joint sprains/muscle strains were the most frequent injuries reported overall (47%), followed by abrasions/bruises (26%). Dislocations of the upper extremity were reported by 47% of participants while fractures occurred in 39%. Surgeries were required for 30% of participants. Females were less likely to require surgery and more likely to have shoulder and elbow injuries. Males were more likely to have hand injuries. Participants of Karate and Tae Kwon Do were more likely to have injuries to their hands, while participants of multiple forms were more likely to sustain injuries to their shoulders/upper arms and more likely to develop chronic upper extremity symptoms. With advanced level of training the likelihood of developing chronic upper extremity symptoms increases, and multiple surgeries were required. Hand protection was associated with a lower risk of hand injuries. Martial arts can be associated with substantial upper extremity injuries that may require surgery and extended time away from participation. Injuries may result in chronic upper extremity symptoms. Hand protection is important for reducing injuries to the hand and wrist.

Combined Cognitive-Strategy and Task-Specific Training Affects Cognition and Upper-Extremity Function in Subacute Stroke: An Exploratory Randomized Controlled Trial

PubMed Central

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

Exercise effect with the wheelchair aerobic fitness trainer on conditioning and metabolic function in disabled persons: a pilot study.

PubMed

Midha, M; Schmitt, J K; Sclater, M

1999-03-01

To determine the effect of exercise with the wheelchair aerobic fitness trainer (WAFT) on anthropometric indices, conditioning, and endocrine and metabolic parameters in persons with lower extremity disability. Exercise sessions with the WAFT lasted 20 to 30 minutes for two to three sessions. Tertiary-care Veterans Administration medical center. Twelve subjects (3 with quadriplegia, 7 with paraplegia, 1 with cerebrovascular accident, 1 with bilateral above-knee amputation). Anthropometric indices (heart rate, blood pressure, weight, oxygen utilization, body mass index, upper arm and abdominal circumference, arm power) and endocrine and metabolic parameters (fasting serum glucose, lipids, and thyroid function) were determined before and after 10 weeks of exercise with the WAFT. All patients noted improved feelings of well-being after training. Mean resting heart rate, upper arm fat area, and fasting serum cholesterol level decreased significantly. Peak oxygen consumption, midarm circumference, and free thyroxine index increased significantly with training. WAFT improves quality of life, conditioning, and endocrine-metabolic parameters in disabled persons.

Characterization of upper troposphere water vapor measurements during AFWEX using LASE.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ferrare, R. A.; Browell, E. V.; Ismail, I.

2002-07-15

Water vapor profiles from NASA's Lidar Atmospheric Sensing Experiment (LASE) system acquired during the ARM/FIRE Water Vapor Experiment (AFWEX) are used to characterize upper troposphere (UT) water vapor measured by ground-based Raman lidars, radiosondes, and in situ aircraft sensors. Initial comparisons showed the average Vaisala radiosonde measurements to be 5-15% drier than the average LASE, Raman lidar, and DC-8 in situ diode laser hygrometer measurements. They show that corrections to the Raman lidar and Vaisala measurements significantly reduce these differences. Precipitable water vapor (PWV) derived from the LASE water vapor profiles agrees within 3% on average with PWV derived frommore » the ARM ground-based microwave radiometer (MWR). The agreement among the LASE, Raman lidar, and MWR measurements demonstrates how the LASE measurements can be used to characterize both profile and column water vapor measurements and that ARM Raman lidar, when calibrated using the MWR PWV, can provide accurate UT water vapor measurements.« less

Arm and neck pain in ultrasonographers.

PubMed

Claes, Frank; Berger, Jan; Stassijns, Gaëtane

2015-03-01

The aim of this study was to evaluate the prevalence of upper-body-quadrant pain among ultrasonographers and to evaluate the association between individual ergonomics, musculoskeletal disorders, and occurrence of neck pain. A hundred and ten (N = 110) Belgian and Dutch male and female hospital ultrasonographers were consecutively enrolled in the study. Data on work-related ergonomic and musculoskeletal disorders were collected with an electronic inquiry, including questions regarding ergonomics (position of the screen, high-low table, and ergonomic chair), symptoms (neck pain, upper-limb pain), and work-related factors (consecutive working hours a day, average working hours a week). Subjects with the screen on their left had significantly more neck pain (odds ratio [OR] = 3.6, p = .0286). Depending on the workspace, high-low tables increased the chance of developing neck pain (OR = 12.9, p = .0246). A screen at eye level caused less neck pain (OR = .22, p = .0610). Employees with a fixed working space were less susceptible to arm pain (OR = 0.13, p = .0058). The prevalence of arm pain was significantly higher for the vascular department compared to radiology, urology, and gynecology departments (OR = 9.2, p = .0278). Regarding prevention of upper-limb pain in ultrasonograph, more attention should be paid to the work environment and more specialty to the ultrasound workstation layout. Primary ergonomic prevention could provide a painless work situation for the ultrasonographer. Further research on the ergonomic conditions of ultrasonography is necessary to develop ergonomic solutions in the work environment that will help to alleviate neck and arm pain. © 2014, Human Factors and Ergonomics Society.

Beneficial Effect of the Nutritional Support in Children Who Underwent Hematopoietic Stem Cell Transplant.

PubMed

Koç, Nevra; Gündüz, Mehmet; Tavil, Betül; Azik, M Fatih; Coşkun, Zeynep; Yardımcı, Hülya; Uçkan, Duygu; Tunç, Bahattin

2017-08-01

The aim of this study was to evaluate nutritional status in children who underwent hematopoietic stem cell transplant compared with a healthy control group. A secondary aim was to utilize mid-upper arm circumference as a measure of nutritional status in these groups of children. Our study group included 40 children (18 girls, 22 boys) with mean age of 9.2 ± 4.6 years (range, 2-17 y) who underwent hematopoietic stem cell transplant. Our control group consisted of 20 healthy children (9 girls, 11 boys). The children were evaluated at admission to the hospital and followed regularly 3, 6, 9, and 12 months after discharge from the hospital. In the study group, 27 of 40 patients (67.5%) received nutritional support during hematopoietic stem cell transplant, with 15 patients (56%) receiving enteral nutrition, 6 (22%) receiving total parenteral nutrition, and 6 (22%) receiving enteral and total parenteral nutrition. Chronic malnutrition rate in the study group was 47.5% on admission to the hospital, with the control group having a rate of 20%. One year after transplant, the rate decreased to 20% in the study group and 5% in the control group. The mid-upper arm circumference was lower in children in the study group versus the control group at the beginning of the study (P < .05). However, there were no significant differences in mid-upper arm circumference measurements between groups at follow-up examinations (P > .05). During follow-up, all anthropometric measurements increased significantly in both groups. Monitoring nutritional status and initiating appropriate nutritional support improved the success of hematopoietic stem cell transplant and provided a more comfortable process during the transplant period. Furthermore, mid-upper arm circumference is a more sensitive, useful, and safer parameter that can be used to measure nutritional status of children who undergo hematopoietic stem cell transplant.

Patient-Specific Computational Modeling of Upper Extremity Arteriovenous Fistula Creation: Its Feasibility to Support Clinical Decision-Making

PubMed Central

Bosboom, E. Marielle H.; Kroon, Wilco; van der Linden, Wim P. M.; Planken, R. Nils; van de Vosse, Frans N.; Tordoir, Jan H. M.

2012-01-01

Introduction Inadequate flow enhancement on the one hand, and excessive flow enhancement on the other hand, remain frequent complications of arteriovenous fistula (AVF) creation, and hamper hemodialysis therapy in patients with end-stage renal disease. In an effort to reduce these, a patient-specific computational model, capable of predicting postoperative flow, has been developed. The purpose of this study was to determine the accuracy of the patient-specific model and to investigate its feasibility to support decision-making in AVF surgery. Methods Patient-specific pulse wave propagation models were created for 25 patients awaiting AVF creation. Model input parameters were obtained from clinical measurements and literature. For every patient, a radiocephalic AVF, a brachiocephalic AVF, and a brachiobasilic AVF configuration were simulated and analyzed for their postoperative flow. The most distal configuration with a predicted flow between 400 and 1500 ml/min was considered the preferred location for AVF surgery. The suggestion of the model was compared to the choice of an experienced vascular surgeon. Furthermore, predicted flows were compared to measured postoperative flows. Results Taken into account the confidence interval (25th and 75th percentile interval), overlap between predicted and measured postoperative flows was observed in 70% of the patients. Differentiation between upper and lower arm configuration was similar in 76% of the patients, whereas discrimination between two upper arm AVF configurations was more difficult. In 3 patients the surgeon created an upper arm AVF, while model based predictions allowed for lower arm AVF creation, thereby preserving proximal vessels. In one patient early thrombosis in a radiocephalic AVF was observed which might have been indicated by the low predicted postoperative flow. Conclusions Postoperative flow can be predicted relatively accurately for multiple AVF configurations by using computational modeling. This model may therefore be considered a valuable additional tool in the preoperative work-up of patients awaiting AVF creation. PMID:22496816

Chronic Pseudomonas aeruginosa infection and respiratory muscle impairment in cystic fibrosis.

PubMed

Dassios, Theodore G; Katelari, Anna; Doudounakis, Stavros; Dimitriou, Gabriel

2014-03-01

Chronic infection with Pseudomonas aeruginosa in patients with cystic fibrosis (CF) is associated with increased morbidity. Chronic infection can cause limb and respiratory muscle compromise. Respiratory muscle function can be assessed via maximal inspiratory pressure (PImax), maximal expiratory pressure (PEmax), and the pressure-time index of the respiratory muscles (PTImus). We studied the effect of chronic P. aeruginosa infection on respiratory muscle function in patients with CF. This cross-sectional study assessed PImax, PEmax, PTImus, FEV1, FVC, maximum expiratory flow during the middle half of the FVC maneuver, body mass index, and upper arm muscle area in 122 subjects with CF, in 4 subgroups matched for age and sex at different stages of P. aeruginosa infection, according to the Leeds criteria. We compared respiratory muscle function in the subgroups according to P. aeruginosa infection state. Median PImax was significantly lower in CF subjects with chronic P. aeruginosa infection (PImax = 62 cm H2O), compared to subjects who were never infected (PImax = 86 cm H2O, P = .02), free of infection (PImax = 74 cm H2O, P = .01), or intermittently infected (PImax = 72 cm H2O, P = .02). Median PTImus was significantly increased in CF subjects with chronic P. aeruginosa infection (PTImus = .142), compared to subjects who were free of infection (PTImus = .102, P = .006). Median upper-arm muscle area was significantly lower in CF subjects with chronic P. aeruginosa infection (upper-arm muscle area = 2,219 mm(2)), compared to subjects who were never infected (2,754 mm(2), P = .03), free of infection (2,678 mm(2), P = .01), or intermittently infected (2,603 mm(2), P = .04). Multivariate logistic regression revealed P. aeruginosa state of infection as a significant determinant of PTImus (P = .03) independently of sex, upper-arm muscle area, and FEV1. CF subjects with chronic P. aeruginosa infection exhibited impaired respiratory muscle function and decreased inspiratory muscle strength, and chronic P. aeruginosa infection independently impacts respiratory muscle function in subjects with CF.

Post-Little Landscape and Glacier Change in Glacier Bay National Park: Documenting More than a Century of Variability with Repeat Photography

NASA Astrophysics Data System (ADS)

Molnia, B. F.; Karpilo, R. D.; Pranger, H. S.

2004-12-01

Historical photographs, many dating from the late-19th century are being used to document landscape and glacier change in the Glacier Bay area. More than 350 pre-1980 photographs that show the Glacier Bay landscape and glacier termini positions have been acquired by the authors. Beginning in 2003, approximately 150 of the sites from which historical photographs had been made were revisited. At each site, elevation and latitude and longitude were recorded using WAAS-enabled GPS. Compass bearings to photographic targets were also determined. Finally, using the historical photographs as a composition guide, new photographs were exposed using digital imaging and film cameras. In the laboratory, 21st century images and photographs were compared with corresponding historical photographs to determine, and to better understand rates, timing, and mechanics of Glacier Bay landscape evolution, as well as to clarify the response of specific glaciers to changing climate and environment. The comparisons clearly document rapid vegetative succession throughout the bay; continued retreat of larger glaciers in the East Arm of the bay; a complex pattern of readvance and retreat of the larger glaciers in the West Arm of the bay, coupled with short-term fluctuations of its smaller glaciers; transitions from tidewater termini to stagnant, debris-covered termini; fiord sedimentation and erosion; development of outwash and talus features; and many other dramatic changes. As might be expected, 100-year-plus photo comparisons show significant changes throughout the Glacier Bay landscape, especially at the southern ends of East and West Arms. Surprisingly, recent changes, occurring since the late-1970s were equally dramatic, especially documenting the rapid thinning and retreat of glaciers in upper Muir Inlet.

Finger muscle attachments for an OpenSim upper-extremity model.

PubMed

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

2015-01-01

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

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

Sex and genetic effects on upper and lower body fat and associations with diabetes in multigenerational families of African heritage.

PubMed

Miljkovic-Gacic, Iva; Wang, Xiaojing; Kammerer, Candace M; Bunker, Clareann H; Patrick, Alan L; Wheeler, Victor W; Kuller, Lewis H; Evans, Rhobert W; Zmuda, Joseph M

2008-06-01

Very few studies have comprehensively defined the genetic and environmental influences on body fat storage in the arms and legs and their association with diabetes, especially in families of African heritage. We analyzed body fat distribution by dual-energy x-ray absorptiometry (percentage total fat, percentage trunk fat, percentage arm fat, and percentage leg fat) and fasting serum glucose in 471 individuals (mean age, 43 years) from 8 multigenerational Afro-Caribbean families (mean family size = 51; 3535 relative pairs). Diabetes was inversely associated with percentage leg fat (P = .009) and, to some extent, positively associated with percentage arm fat independent of age, sex, and body size (P = .08), but not with anthropometric or dual-energy x-ray absorptiometric measures of total and central adiposity. Furthermore, percentage leg fat was inversely, whereas percentage arm fat was positively, associated with body mass index, waist circumference, and serum glucose (P < .01). Residual heritability (h2r) for arm and leg fat was significant (P < .01) and high: 62% (for percentage arm fat) and 40% (for percentage leg fat). Moreover, sex-specific h2r for leg fat was considerably higher (P = .02) in women than in men (h2r values, 58% vs 17%, respectively). Genetic correlation (rho(G)) between arm and leg fat was -0.61 (P < .01), suggesting that only 37% of the covariation between these 2 adipose tissue depots may be due to shared genetic influences. This study provides new evidence for a strong genetic and sex contribution to upper and lower body fat, with relatively little covariation between these traits due to shared genes. Our findings also suggest that, in this population, leg fat is associated with diabetes independent of overall adiposity.

Validation of the Omron M6 (HEM-7001-E) upper-arm blood pressure measuring device according to the International Protocol in adults and obese adults.

PubMed

Altunkan, Sekip; Ilman, Nevzat; Kayatürk, Nur; Altunkan, Erkan

2007-08-01

Electronic blood pressure (BP) measurement devices are the preferred choice of patients owing to their user-friendly nature; however, there is a requirement to investigate the accuracy and reliability of these devices. The objective of this study is to evaluate the accuracy of the Omron M6 upper-arm BP device against the mercury sphygmomanometer in adults and obese adults according to the International Protocol criteria. One hundred and twenty-one patients, older than 30 years of age, were studied and classified on the basis of the range of the International Protocol. BP measurements at the upper arm with the Omron M6 were compared with the results obtained by two trained observers using a mercury sphygmomanometer. Nine sequential BP measurements were taken. A total of 33 participants were selected for each validation study. During the validation study, 99 measurements were performed on 33 participants for comparison. The first phase was performed on 15 participants, and if the device passed this phase, 18 more participants were selected. Having a two-fold purpose, this study was conducted on both adult and obese adult patients. Mean discrepancies and standard deviations of the monitor-mercury sphygmomanometer were 1.1+/-4.0 mmHg for systolic BP (SBP) and -0.5+/-3.5 mmHg for diastolic BP (DBP) in the adult group. The device passed phase 1 in 15 participants. In phase 2.1, out of a total of 99 comparisons, 88, 96, and 97 for SBP, and 88, 98, and 99 for DBP were <5, <10, and <15 mmHg, respectively. Mean discrepancies and standard deviations of the monitor-mercury sphygmomanometer were 1.7+/-4.8 mmHg for SBP and -0.8+/-4.3 mmHg for DBP in the obese adult group. The device passed phase 1 in 15 participants. In phase 2.1, out of a total of 99 comparisons, 82, 90, and 97 for SBP, and 80, 97, and 99 for DBP were <5, <10, and <15 mmHg, respectively. It was found that the Omron M6 automatic monitor, which measures BP at the upper arm, produced results in accordance with the criteria of phases 2.1 and 2.2 in both SBP and DBP, when applied to adults and to obese adults. It was concluded that the Omron M6 device, which measures BP at the upper arm, was deemed to be in accordance with the International Protocol criteria and can be recommended for use by adults and obese adults.

The relationship between latissimus dorsi stiffness and altered scapular kinematics among asymptomatic collegiate swimmers.

PubMed

Laudner, Kevin G; Williams, Jeffrey G

2013-02-01

To determine the strength of the relationship between latissimus dorsi stiffness and altered scapular kinematics among swimmers. Cross sectional. Laboratory. Nineteen NCAA Division III swimmers (7 male, 12 female) (age = 18.8 ± 0.9 years, height = 174.7 ± 8.9 cm, mass = 71.6 ± 11.9 kg) volunteered to participate. Subjects had no recent history of upper extremity pathology or any previous surgery. We measured latissimus dorsi stiffness of the dominant arm while in a lengthened position with a myotonometer. We used an electromagnetic tracking device with specialized software to measure scapular kinematics at humeral elevation angles of 30°, 60°, 90°, and 110° within the scapular plane. Latissimus dorsi stiffness and scapular upward/downward rotation, internal/external rotation, and anterior/posterior tilt. Latissimus dorsi stiffness showed moderate-to-good relationships with increased scapular upward rotation (r > -0.63, P < 0.002) and posterior tilt (r > -0.62, P < 0.004) at all four angles of humeral elevation. Increased latissimus dorsi stiffness also showed moderate-to-good relationships with decreased scapular internal rotation at humeral elevation angles of 60° (r = 0.47, P = 0.03) and 90° (r = 0.54, P = 0.01). Our results suggest there are several moderate-to-good relationships between increased latissimus dorsi stiffness in swimmers and altered scapular upward rotation, internal rotation, and posterior tilt at various angles of humeral elevation. If latissimus dorsi stiffness is not addressed subsequent scapular alterations, which have been associated with shoulder dysfunction, may occur. Published by Elsevier Ltd.

Torsionally rigid support apparatus for marine seismic transducer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Myers, W.J.; Cole, J.H.

1989-11-14

This patent describes apparatus for supporting a marine seismic transducer from a vessel. It comprises: an elongated substantially rigid towing arm; a connector means for connecting the transducer to a lower end of the towing arm; a swivel member which is secured to the vessel and is pivotable about a generally horizontal first axis transverse to a length of the vessel; and a support means for pivotally connecting an upper end of the towing arm to the swivel member. The support means being pivotal relative to the swivel member about a second axis transverse to a longitudinal axis of themore » towing arm. The support means being substantially rigid so as to prevent any substantial rotation of the towing arm about its the longitudinal axis.« less

74. East elevation of elevated Mainline structure (Section F6) looking ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

74. East elevation of elevated Mainline structure (Section F-6) looking West - along the Arborway toward the masonry bridge carrying the former New Haven R.R. tracks over the Arborway. Arborway overpass is at upper right. - Boston Elevated Railway, Elevated Mainline, Washington Street, Boston, Suffolk County, MA

The effect of arm sling on balance in patients with hemiplegia.

PubMed

Acar, Merve; Karatas, Gulcin Kaymak

2010-10-01

The aim of this study was to investigate the effect of an arm sling on balance in patients with, hemiplegia following a stroke. Twenty-six patients with hemiplegia (11 men, 15 women) who had, shoulder subluxation were enrolled in the study. Balance was evaluated by the Berg Balance Scale, the, Functional Reach test, and a static balance index which was measured by the Kinesthetic Ability, Trainer 3000. Balance tests were performed twice, with arm sling and without arm sling use. Results of, this study show that the Berg Balance Scores and static balance index ameliorated with arm sling use (p=0.005 and p=0.004, respectively). Likewise, the Functional Reach test was better when performed with an arm sling (p=0.039). In conclusion, arm slings have a beneficial effect on balance in patients, with hemiplegia. An arm sling may be applied for its possible beneficial effect on balance especially in, the early phases of stroke rehabilitation while the upper extremity is still flaccid and arm swing is, reduced. Copyright © 2010 Elsevier B.V. All rights reserved.

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

ERIC Educational Resources Information Center

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

2011-01-01

The aim of this study was to correlate clinical and functional evaluations with kinematic variables of upper limp reach-to-grasp movement in patients with tetraplegia. Twenty chronic patients were selected to perform reach-to-grasp kinematic assessment using a target placed at a distance equal to the arm's length. Kinematic variables (hand peak…

Overhead work and shoulder-neck pain in orchard farmers harvesting pears and apples.

PubMed

Sakakibara, H; Miyao, M; Kondo, T; Yamada, S

1995-04-01

The effects of overhead work were studied by comparing orchard farmers' musculoskeletal symptoms while bagging pears with those same symptoms while bagging apples. The subjects were 52 Japanese female farmers, who were examined twice an evening in late June for bagging pears, and during another evening of late July for bagging apples, when each task had been almost finished. They were questioned about musculoskeletal complaints of stiffness and pain during each job, and examined for muscle tenderness and pain from joint movement. Arm elevation angles during the work were measured for each type of bagging. The prevalence of stiffness and pain in the neck and shoulder, muscle tenderness in the shoulder regions, and pain in neck motion were found to be significantly higher when bagging pears than apples. Musculoskeletal symptoms of parts other than the neck and shoulder did not differ between the two types of bagging. The working posture of elevating the arm more than 90 degrees was assumed to account for 75% of the time bagging pears, against 40% for bagging apples. Overhead work requiring arm elevation and head extension was considered to be closely related with shoulder-neck disorders among farmers.

Ergonomic stressors and upper extremity disorders in vehicle manufacturing: cross sectional exposure-response trends

PubMed Central

Punnett, L.

1998-01-01

OBJECTIVE: To evaluate the association between upper extremity soft tissue disorders and exposure to preventable ergonomic stressors in vehicle manufacturing operations. METHODS: A cross sectional study was conducted in one vehicle stamping plant and one engine assembly plant. A standardised physical examination of the upper extremities was performed on all subjects. An interviewer administered questionnaire obtained data on demographics, work history, musculoskeletal symptoms, non-occupational covariates, and psycho-physical (relative intensity) ratings of ergonomic stressors. The primary exposure score was computed by summing the responses to the psychophysical exposure items. Multivariate regression analysis was used to model the prevalence of disorders of the shoulders or upper arms, wrists or hands, and all upper extremity regions (each defined both by symptoms and by physical examination plus symptoms) as a function of exposure quartile. RESULTS: A total of 1315 workers (85% of the target population) was examined. The prevalence of symptom disorders was 22% for the wrists or hands and 15% for the shoulders or upper arms; cases defined on the basis of a physical examination were about 80% as frequent. Disorders of the upper extremities, shoulders, and wrists or hands all increased markedly with exposure score, after adjustment for plant, acute injury, sex, body mass index, systemic disease, and seniority. CONCLUSIONS: Musculoskeletal disorders of the upper extremities were strongly associated with exposure to combined ergonomic stressors. The exposure- response trend was very similar for symptom cases and for physical examination cases. It is important to evaluate all dimensions of ergonomic exposure in epidemiological studies, as exposures often occur in combination in actual workplaces.   PMID:9764102

Characterisation and Outcomes of Upper Extremity Amputations

DTIC Science & Technology

2014-06-01

military service members from 1 October 2001 to 30 July 2011 was conducted. Data from the Department of Defense Trauma Registry, the Armed Forces... Trauma Registry, the Armed Forces Health Longitudinal Technology Application, and the Physical Evaluation Board Liaison Offices were queried in order to...without associated lower extremity amputation. This cohort was cross-referenced with the Department of Defense Trauma Registry (DoDTR, Joint Base

A hybrid BMI-based exoskeleton for paresis: EMG control for assisting arm movements

NASA Astrophysics Data System (ADS)

Kawase, Toshihiro; Sakurada, Takeshi; Koike, Yasuharu; Kansaku, Kenji

2017-02-01

Objective. Brain-machine interface (BMI) technologies have succeeded in controlling robotic exoskeletons, enabling some paralyzed people to control their own arms and hands. We have developed an exoskeleton asynchronously controlled by EEG signals. In this study, to enable real-time control of the exoskeleton for paresis, we developed a hybrid system with EEG and EMG signals, and the EMG signals were used to estimate its joint angles. Approach. Eleven able-bodied subjects and two patients with upper cervical spinal cord injuries (SCIs) performed hand and arm movements, and the angles of the metacarpophalangeal (MP) joint of the index finger, wrist, and elbow were estimated from EMG signals using a formula that we derived to calculate joint angles from EMG signals, based on a musculoskeletal model. The formula was exploited to control the elbow of the exoskeleton after automatic adjustments. Four able-bodied subjects and a patient with upper cervical SCI wore an exoskeleton controlled using EMG signals and were required to perform hand and arm movements to carry and release a ball. Main results. Estimated angles of the MP joints of index fingers, wrists, and elbows were correlated well with the measured angles in 11 able-bodied subjects (correlation coefficients were 0.81  ±  0.09, 0.85  ±  0.09, and 0.76  ±  0.13, respectively) and the patients (e.g. 0.91  ±  0.01 in the elbow of a patient). Four able-bodied subjects successfully positioned their arms to adequate angles by extending their elbows and a joint of the exoskeleton, with root-mean-square errors  <6°. An upper cervical SCI patient, empowered by the exoskeleton, successfully carried a ball to a goal in all 10 trials. Significance. A BMI-based exoskeleton for paralyzed arms and hands using real-time control was realized by designing a new method to estimate joint angles based on EMG signals, and these may be useful for practical rehabilitation and the support of daily actions.

A hybrid BMI-based exoskeleton for paresis: EMG control for assisting arm movements.

PubMed

Kawase, Toshihiro; Sakurada, Takeshi; Koike, Yasuharu; Kansaku, Kenji

2017-02-01

Brain-machine interface (BMI) technologies have succeeded in controlling robotic exoskeletons, enabling some paralyzed people to control their own arms and hands. We have developed an exoskeleton asynchronously controlled by EEG signals. In this study, to enable real-time control of the exoskeleton for paresis, we developed a hybrid system with EEG and EMG signals, and the EMG signals were used to estimate its joint angles. Eleven able-bodied subjects and two patients with upper cervical spinal cord injuries (SCIs) performed hand and arm movements, and the angles of the metacarpophalangeal (MP) joint of the index finger, wrist, and elbow were estimated from EMG signals using a formula that we derived to calculate joint angles from EMG signals, based on a musculoskeletal model. The formula was exploited to control the elbow of the exoskeleton after automatic adjustments. Four able-bodied subjects and a patient with upper cervical SCI wore an exoskeleton controlled using EMG signals and were required to perform hand and arm movements to carry and release a ball. Estimated angles of the MP joints of index fingers, wrists, and elbows were correlated well with the measured angles in 11 able-bodied subjects (correlation coefficients were 0.81  ±  0.09, 0.85  ±  0.09, and 0.76  ±  0.13, respectively) and the patients (e.g. 0.91  ±  0.01 in the elbow of a patient). Four able-bodied subjects successfully positioned their arms to adequate angles by extending their elbows and a joint of the exoskeleton, with root-mean-square errors  <6°. An upper cervical SCI patient, empowered by the exoskeleton, successfully carried a ball to a goal in all 10 trials. A BMI-based exoskeleton for paralyzed arms and hands using real-time control was realized by designing a new method to estimate joint angles based on EMG signals, and these may be useful for practical rehabilitation and the support of daily actions.

Lack of association between venous hemodynamics, venous morphology and the postthrombotic syndrome after upper extremity deep venous thrombosis.

PubMed

Czihal, M; Paul, S; Rademacher, A; Bernau, C; Hoffmann, U

2015-03-01

To explore the association of the postthrombotic syndrome with venous hemodynamics and morphological abnormalities after upper extremity deep venous thrombosis. Thirty-seven patients with a history of upper extremity deep venous thrombosis treated with anticoagulation alone underwent a single study visit (mean time after diagnosis: 44.4 ± 28.1 months). Presence and severity postthrombotic syndrome were classified according to the modified Villalta score. Venous volume and venous emptying were determined by strain-gauge plethysmography. The arm veins were assessed for postthrombotic abnormalities by ultrasonography. The relationship between postthrombotic syndrome and hemodynamic and morphological sequelae was evaluated using univariate significance tests and Spearman's correlation analysis. Fifteen of 37 patients (40.5%) developed postthrombotic syndrome. Venous volume and venous emptying of the arm affected by upper extremity deep venous thrombosis did not correlate with the Villalta score (rho = 0.17 and 0.19; p = 0.31 and 0.25, respectively). Residual morphological abnormalities, as assessed by ultrasonography, did not differ significantly between patients with and without postthrombotic syndrome (77.3% vs. 86.7%, p = 0.68). Postthrombotic syndrome after upper extremity deep venous thrombosis is not associated with venous hemodynamics or residual morphological abnormalities. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Innovative approaches to the rehabilitation of upper extremity hemiparesis using virtual environments

PubMed Central

MERIANS, A. S.; TUNIK, E.; FLUET, G. G.; QIU, Q.; ADAMOVICH, S. V.

2017-01-01

Aim Upper-extremity interventions for hemiparesis are a challenging aspect of stroke rehabilitation. Purpose of this paper is to report the feasibility of using virtual environments (VEs) in combination with robotics to assist recovery of hand-arm function and to present preliminary data demonstrating the potential of using sensory manipulations in VE to drive activation in targeted neural regions. Methods We trained 8 subjects for 8 three hour sessions using a library of complex VE’s integrated with robots, comparing training arm and hand separately to training arm and hand together. Instrumented gloves and hand exoskeleton were used for hand tracking and haptic effects. Haptic Master robotic arm was used for arm tracking and generating three-dimensional haptic VEs. To investigate the use of manipulations in VE to drive neural activations, we created a “virtual mirror” that subjects used while performing a unimanual task. Cortical activation was measured with functional MRI (fMRI) and transcranial magnetic stimulation. Results Both groups showed improvement in kinematics and measures of real-world function. The group trained using their arm and hand together showed greater improvement. In a stroke subject, fMRI data suggested virtual mirror feedback could activate the sensorimotor cortex contralateral to the reflected hand (ipsilateral to the moving hand) thus recruiting the lesioned hemisphere. Conclusion Gaming simulations interfaced with robotic devices provide a training medium that can modify movement patterns. In addition to showing that our VE therapies can optimize behavioral performance, we show preliminary evidence to support the potential of using specific sensory manipulations to selectively recruit targeted neural circuits. PMID:19158659

[Effects of massage on delayed-onset muscle soreness].

PubMed

Bakowski, Paweł; Musielak, Bartosz; Sip, Paweł; Biegański, Grzegorz

2008-01-01

Delayed onset muscle soreness (DOMS) is the pain or discomfort often felt 12 to 24 hours after exercising and subsides generally within 4 to 6 days. Once thought to be caused by lactic acid buildup, a more recent theory is that it is caused by inflammatory process or tiny tears in the muscle fibers caused by eccentric contraction, or unaccustomed training levels. Exercises that involve many eccentric contractions will result in the most severe DOMS. Fourteen healthy men with no history of upper arm injury and no experience in resistance training were recruited. The mean age, height, and mass of the subjects were 22.8 +/- 1.2 years, 178.3 +/- 10.3 cm, and 75.0 +/- 14.2 kg, respectively. Subjects performed 8 sets of concentric and eccentric actions of the elbow flexors with each arm according to Stay protocol. One arm received 10 minutes of massage 30 minutes after exercise, the contralateral arm received no treatment. Measurements were taken at 9 assessment times: pre-exercise and postexercise at 10 min, 6, 12, 24, 36, 48, 72 and 96 hours. Dependent variables were range of motion, perceived soreness and upper arm circumference. There was noticed difference in perceived soreness across time between groups. The analysis indicated that massage resulted in a 10% to 20% decrease in the severity of soreness, but the differences were not significant. Difference in range of motion and arm circumference was not observed. Massage administered 30 minutes after exercises could have a beneficial influence on DOMS but without influence on muscle swelling and range of motion.

Kinematics of preferred and non-preferred handballing in Australian football.

PubMed

Parrington, Lucy; Ball, Kevin; MacMahon, Clare

2015-01-01

In Australian football (AF), handballing proficiently with both the preferred and non-preferred arm is important at elite levels; yet, little information is available for handballing on the non-preferred arm. This study compared preferred and non-preferred arm handballing techniques. Optotrak Certus (100 Hz) collected three-dimensional data for 19 elite AF players performing handballs with the preferred and non-preferred arms. Position data, range of motion (ROM), and linear and angular velocities were collected and compared between preferred and non-preferred arms using dependent t-tests. The preferred arm exhibited significantly greater forearm and humerus ROM and angular velocity and significantly greater shoulder angular velocity at ball contact compared to the non-preferred arm. In addition, the preferred arm produced a significantly greater range of lateral bend and maximum lower-trunk speed, maximum strike-side hip speed and hand speed at ball contact than the non-preferred arm. The non-preferred arm exhibited a significantly greater shoulder angle and lower- and upper-trunk orientation angle, but significantly lower support-elbow angle, trunk ROM, and trunk rotation velocity compared to the preferred arm. Reduced ROM and angular velocities found in non-preferred arm handballs indicates a reduction in the degrees of freedom and a less developed skill. Findings have implication for development of handballing on the non-preferred arm.

Maintained physical activity and physiotherapy in the management of distal upper limb pain – a protocol for a randomised controlled trial (the arm pain trial)

PubMed Central

2014-01-01

Background Distal upper limb pain (pain affecting the elbow, forearm, wrist, or hand) can be non-specific, or can arise from specific musculoskeletal disorders. It is clinically important and costly, the best approach to clinical management is unclear. Physiotherapy is the standard treatment and, while awaiting treatment, advice is often given to rest and avoid strenuous activities, but there is no evidence base to support these strategies. This paper describes the protocol of a randomised controlled trial to determine, among patients awaiting physiotherapy for distal arm pain, (a) whether advice to remain active and maintain usual activities results in a long-term reduction in arm pain and disability, compared with advice to rest; and (b) whether immediate physiotherapy results in a long-term reduction in arm pain and disability, compared with physiotherapy delivered after a seven week waiting list period. Methods/Design Between January 2012 and January 2014, new referrals to 14 out-patient physiotherapy departments were screened for potential eligibility. Eligible and consenting patients were randomly allocated to one of the following three groups in equal numbers: 1) advice to remain active, 2) advice to rest, 3) immediate physiotherapy. Patients were and followed up at 6, 13, and 26 weeks post-randomisation by self-complete postal questionnaire and, at six weeks, patients who had not received physiotherapy were offered it at this time. The primary outcome is the proportion of patients free of disability at 26 weeks, as determined by the modified DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire. We hypothesise (a) that advice to maintain usual activities while awaiting physiotherapy will be superior than advice to rest the arm; and (b) that fast-track physiotherapy will be superior to normal (waiting list) physiotherapy. These hypotheses will be examined using an intention-to-treat analysis. Discussion Results from this trial will contribute to the evidence base underpinning the clinical management of patients with distal upper limb pain, and in particular, will provide guidance on whether they should be advised to rest the arm or remain active within the limits imposed by their symptoms. Trial registration Registered on http://www.controlled-trials.com (reference number: ISRCTN79085082). PMID:24612447

Maintained physical activity and physiotherapy in the management of distal upper limb pain - a protocol for a randomised controlled trial (the arm pain trial).

PubMed

Jones, Gareth T; Mertens, Kathrin; Macfarlane, Gary J; Palmer, Keith T; Coggon, David; Walker-Bone, Karen; Burton, Kim; Heine, Peter J; McCabe, Candy; McNamee, Paul; McConnachie, Alex

2014-03-10

Distal upper limb pain (pain affecting the elbow, forearm, wrist, or hand) can be non-specific, or can arise from specific musculoskeletal disorders. It is clinically important and costly, the best approach to clinical management is unclear. Physiotherapy is the standard treatment and, while awaiting treatment, advice is often given to rest and avoid strenuous activities, but there is no evidence base to support these strategies. This paper describes the protocol of a randomised controlled trial to determine, among patients awaiting physiotherapy for distal arm pain, (a) whether advice to remain active and maintain usual activities results in a long-term reduction in arm pain and disability, compared with advice to rest; and (b) whether immediate physiotherapy results in a long-term reduction in arm pain and disability, compared with physiotherapy delivered after a seven week waiting list period. Between January 2012 and January 2014, new referrals to 14 out-patient physiotherapy departments were screened for potential eligibility. Eligible and consenting patients were randomly allocated to one of the following three groups in equal numbers: 1) advice to remain active, 2) advice to rest, 3) immediate physiotherapy. Patients were and followed up at 6, 13, and 26 weeks post-randomisation by self-complete postal questionnaire and, at six weeks, patients who had not received physiotherapy were offered it at this time. The primary outcome is the proportion of patients free of disability at 26 weeks, as determined by the modified DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire.We hypothesise (a) that advice to maintain usual activities while awaiting physiotherapy will be superior than advice to rest the arm; and (b) that fast-track physiotherapy will be superior to normal (waiting list) physiotherapy. These hypotheses will be examined using an intention-to-treat analysis. Results from this trial will contribute to the evidence base underpinning the clinical management of patients with distal upper limb pain, and in particular, will provide guidance on whether they should be advised to rest the arm or remain active within the limits imposed by their symptoms. Registered on http://www.controlled-trials.com (reference number: ISRCTN79085082).

The Impact of Model Configuration and Large-Scale, Upper-Level Forcing on CRM-Simulated Convective Systems

NASA Technical Reports Server (NTRS)

Tao, W.-K.; Zeng, X.; Shie, C.-L.; Starr, D.; Simpson, J.

2004-01-01

Real clouds and cloud systems are inherently three-dimensional (3D). Because of the limitations in computer resources, however, most cloud-resolving models (CRMs) today are still two-dimensional (2D, see a brief review by Tao 2003). Only recently have 3D experiments been performed for multi-day periods for tropical cloud systems with large horizontal domains at the National Center for Atmospheric Research, at NOAA GFDL, at the U. K. Met. Office, at Colorado State University and at NASA Goddard Space Flight Center (Tao 2003). At Goddard, a 3D Goddard Cumulus Ensemble (GCE) model was used to simulate periods during TOGA COARE (December 19-27, 1992), GATE (September 1-7, 1974), SCSMEX (June 2-11, 1998), ARM (June 26-30, 1997) and KWAJEX (August 7-13, August 18-21, and August 29-September 12, 1999) using a 512 km domain (with 2-kilometer resolution). The results indicate that surface precipitation and latent heating profiles are similar between the 2D and 3D GCE model simulations. However, there are difference in radiation, surface fluxes and precipitation characteristics. The 2D GCE model was used to perform a long-term integration on ARM/GCSS case 4 (22 days at the ARM southern Great Plains site in March 2000). Preliminary results showed a large temperature bias in the upper troposphere that had not been seen in previous tropical cases. The major objectives of this paper are: (1) to determine the sensitivities to model configuration (ie., 2D in west-east, south-north or 3D), (2) to identify the differences and similarities in the organization and entrainment rates of convection between 2D- and 3D-simulated ARM cloud systems, and (3) assess the impact of upper tropospheric forcing on tropical and ARM case 4 cases.

The Impact of Model Configuration and Large-Scale, Upper-Level Forcing on CRM- Simulated Convective Systems

NASA Technical Reports Server (NTRS)

Tao, W.-K.; Zeng, X.; Shie, C.-L.; Starr, D.; Simpson, J.

2004-01-01

Real clouds and cloud systems are inherently three-dimensional (3D). Because of the limitations in computer resources, however, most cloud-resolving models (CRMs) today are still two-dimensional (2D, see a brief review by Tao 2003). Only recently have 3D experiments been performed for multi-day periods for tropical cloud systems with large horizontal domains at the National Center for Atmospheric Research, at NOAA GFDL, at the U. K. Met. Office, at Colorado State University and at NASA Goddard Space Flight Center (Tao 2003). At Goddard, a 3D Goddard Cumulus Ensemble (GCE) model was used to simulate periods during TOGA COARE (December 19-27, 1992), GATE (September 1-7, 1974), SCSMEX (June 2-11, 1998), ARM (June 26-30, 1997) and KWAJEX (August 7-13, August 18-21, and August 29-September 12, 1999) using a 512 by 512 km domain (with 2-km resolution). The results indicate that surface precipitation and latent heating profiles are similar between the 2D and 3D GCE model simulations. However, there are difference in radiation, surface fluxes and precipitation characteristics. The 2D GCE model was used to perform a long-term integration on ARM/GCSS case 4 (22 days at the ARM Southern Great Plains site in March 2000). Preliminary results showed a large temperature bias in the upper troposphere that had not been seen in previous tropical cases. The major objectives of this paper are: (1) to determine the sensitivities to model configuration (i.e., 2D in west-east, south-north or 3D), (2) to identify the differences and similarities in the organization and entrainment rates of convection between 2D- and 3D-simulated ARM cloud systems, and (3) assess the impact of upper tropospheric forcing on tropical and ARM case 4 cases.

Restaurant inspection frequency: The RestoFreq Study.

PubMed

Medu, Olanrewaju; Turner, Hollie; Cushon, Jennifer A; Melis, Deborah; Rea, Leslie; Abdellatif, Treena; Neudorf, Cory O; Schwandt, Michael

2017-03-01

Foodborne illness is an important contributor to morbidity and health system costs in Canada. Using number of critical hazards as a proxy for food safety, we sought to better understand how to improve food safety in restaurants. We compared the current standard of annual inspections to twice-yearly inspections among restaurants "at risk" for food safety infractions. These were restaurants that had three or more elevated-risk inspection ratings in the preceding 36 months. We conducted a two-arm randomized controlled trial between November 2012 and October 2014. The intervention was twice-yearly routine restaurant inspection compared to standard once-yearly routine inspection. Included were all restaurants within Saskatoon Health Region that were assessed as "at risk", with 73 restaurants in the intervention arm and 78 in the control arm. Independent sample t-tests were conducted between groups to compare: i) average number of critical hazards per inspection; and ii) proportion of inspections resulting in a rating indicating an elevated hazard. Over time we noted statistically significant improvements across both study arms, in number of both critical food safety hazards (decreased by 61%) and elevated-risk inspection ratings (decreased by 45%) (p < 0.0001). We observed no significant differences between the two groups pre- or post-intervention. Results suggest increasing the number of annual routine inspections in high-risk restaurants was not associated with a significant difference in measures of compliance with food safety regulations. Findings of this study do not provide evidence supporting increased frequency of restaurant inspection from annually to twice annually.

Thermal Nondestructive Evaluation Report: Inspection of the Refurbished Manipulator Arm System in the Manipulator Development Facility at Johnson Space Center 10-12 January 2001

NASA Technical Reports Server (NTRS)

Cramer, K. Elliott

2002-01-01

On 4 December 2002, a failure of the Refurbished Manipulator Arm System (RMAS) occurred in the Manipulator Development Facility (MDF) at Johnson Space Center. When the Test Director commanded a should pitch maneuver to lift the arm from its payload bay pedestal, the yaw controls failed. This, coupled with a gravitational forces (due to the angle of the shoulder joint with respect to vertical), resulted in uncontrolled arm motion. The shoulder yaw joint moved approximately 20 degrees, causing the extended arm to strike and severely damage the port side MDF catwalk handrails. The arm motion stopped after impact with the handrails. On 10-12 January 2001, inspections were performed on the port face of the lower and upper arms of the RMAS using a infrared thermography developed at Langley Research Center. This paper presents the results of those nondestructive inspections and provides a complete description of the anomalies found and their locations.

78 FR 7768 - Public Service Company of Colorado; Notice of Application Accepted for Filing, Soliciting Motions...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-04

... project. The normal daily operation cycle involves pumping water from the lower reservoir to the upper... acre upper reservoir with 1,087 acre-feet of usable storage between the maximum operating elevation of... lower reservoir with 1,221 acre-feet of usable storage between the maximum operating elevation of 10,002...

Kinect-based virtual rehabilitation and evaluation system for upper limb disorders: A case study.

PubMed

Ding, W L; Zheng, Y Z; Su, Y P; Li, X L

2018-04-19

To help patients with disabilities of the arm and shoulder recover the accuracy and stability of movements, a novel and simple virtual rehabilitation and evaluation system called the Kine-VRES system was developed using Microsoft Kinect. First, several movements and virtual tasks were designed to increase the coordination, control and speed of the arm movements. The movements of the patients were then captured using the Kinect sensor, and kinematics-based interaction and real-time feedback were integrated into the system to enhance the motivation and self-confidence of the patient. Finally, a quantitative evaluation method of upper limb movements was provided using the recorded kinematics during hand-to-hand movement. A preliminary study of this rehabilitation system indicates that the shoulder movements of two participants with ataxia became smoother after three weeks of training (one hour per day). This case study demonstrated the effectiveness of the designed system, which could be promising for the rehabilitation of patients with upper limb disorders.

A structural comparison of female-male and female-female mounting in Japanese macaques (Macaca fuscata).

PubMed

Ottenheimer Carrier, Lydia; Leca, Jean-Baptiste; Pellis, Sergio; Vasey, Paul L

2015-10-01

In certain populations, female Japanese macaques (Macaca fuscata) mount both males and females. Vasey (2007) proposed that female-female sexual mounting in Japanese macaques may be a neutral evolutionary by-product of a purported adaptation, namely, female-male mounting. In this study, we aim to further examine the proposed link between female-male and female-female mounting in Japanese macaques by comparing the structural characteristics that define both forms of mounting. We do so using Eshkol-Wachman Movement Notation (EWMN), a globographic reference system that can be used to describe the position of body segments. No significant differences were observed in the female mounters' positioning of eight different body segments (i.e., lower torso, mid-torso, upper torso, upper arm, lower arm, upper leg, lower leg, and foot) during female-male and female-female mounting. This finding lends support to the conclusion that female-female and female-male mounting are structurally, and thus, evolutionarily, related. Copyright © 2015 Elsevier B.V. All rights reserved.

How maternal malnutrition affects linear growth and development in the offspring.

PubMed

Papathakis, Peggy C; Singh, Lauren N; Manary, Mark J

2016-11-05

Maternal malnutrition is common in the developing world and has detrimental effects on both the mother and infant. Pre-pregnancy nutritional status and weight gain during pregnancy are positively related to fetal growth and development. Internationally, there is no agreement on the method of diagnosis or treatment of moderate or severe malnutrition during pregnancy. Establishing clear guidelines for diagnosis and treatment will be essential in elevating the problem. Possible anthropometric measurements used to detect and monitor maternal malnutrition include pre-pregnancy BMI, weight gain, and mid upper arm circumference. Food supplements have the potential to increase gestational weight gain and energy intake which are positively associated with fetal growth and development. Overall more studies are needed to conclude the impact of food/nutrient supplements on infant growth in undernourished pregnant women in developing countries. Currently, a study underway may provide much needed documentation of the benefits of treating malnutrition in pregnancy. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Attrition and retention in upper limb prosthetics research: experience of the VA home study of the DEKA arm.

PubMed

Resnik, Linda; Klinger, Shana

2017-11-01

(1) Describe study attrition; (2) identify reasons for attrition, and (3) discuss implications for prosthetic prescription and design of future device studies. Design and methodological procedures used: Completion phase (during in-laboratory training, after training, or home use) was identified for 42 participants. Qualitative data were analyzed to identify attrition reasons. Reasons were classified as related to the DEKA arm, or not. Study attrition was 57%, with 43% completing the full study. Attrition during the in-laboratory portion was 21%. Reasons for attrition were related to the DEKA arm entirely or in-part for 42%, 25%, respectively. Most common reasons were scheduling/personal (54%); device weight (29%); and dissatisfaction with device (25%). About 21% withdrew because of concerns about compliance with study protocol. This study had a high attrition rate with evidence of selective attrition due to device characteristics. Strategies to minimize attrition and the importance of tracking reasons for withdrawal are discussed. Given that retention could be an indicator of willingness to adopt the DEKA arm, findings suggest that it would be prudent to provide patients with the opportunity to train with the DEKA arm before a decision is made regarding the appropriateness of the device for the patient. Implications for Rehabilitation This study of a new upper limb prosthesis, the DEKA arm, had a 57% attrition rate with evidence of selective attrition due to characteristics of the DEKA arm. Findings point to the need for strategies to minimize attrition in future studies. Findings also illustrate the importance of tracking reasons for subject withdrawal in longitudinal prosthesis device studies. Because participant retention in longitudinal device studies may be an indicator of future willingness to adopt a device, our findings suggest that it would be prudent to provide patients with the opportunity to train with the DEKA arm before a final decision is made regarding the appropriateness of the device for the patient.

Robot Assisted Training for the Upper Limb after Stroke (RATULS): study protocol for a randomised controlled trial.

PubMed

Rodgers, Helen; Shaw, Lisa; Bosomworth, Helen; Aird, Lydia; Alvarado, Natasha; Andole, Sreeman; Cohen, David L; Dawson, Jesse; Eyre, Janet; Finch, Tracy; Ford, Gary A; Hislop, Jennifer; Hogg, Steven; Howel, Denise; Hughes, Niall; Krebs, Hermano Igo; Price, Christopher; Rochester, Lynn; Stamp, Elaine; Ternent, Laura; Turner, Duncan; Vale, Luke; Warburton, Elizabeth; van Wijck, Frederike; Wilkes, Scott

2017-07-20

Loss of arm function is a common and distressing consequence of stroke. We describe the protocol for a pragmatic, multicentre randomised controlled trial to determine whether robot-assisted training improves upper limb function following stroke. Study design: a pragmatic, three-arm, multicentre randomised controlled trial, economic analysis and process evaluation. NHS stroke services. adults with acute or chronic first-ever stroke (1 week to 5 years post stroke) causing moderate to severe upper limb functional limitation. Randomisation groups: 1. Robot-assisted training using the InMotion robotic gym system for 45 min, three times/week for 12 weeks 2. Enhanced upper limb therapy for 45 min, three times/week for 12 weeks 3. Usual NHS care in accordance with local clinical practice Randomisation: individual participant randomisation stratified by centre, time since stroke, and severity of upper limb impairment. upper limb function measured by the Action Research Arm Test (ARAT) at 3 months post randomisation. upper limb impairment (Fugl-Meyer Test), activities of daily living (Barthel ADL Index), quality of life (Stroke Impact Scale, EQ-5D-5L), resource use, cost per quality-adjusted life year and adverse events, at 3 and 6 months. Blinding: outcomes are undertaken by blinded assessors. Economic analysis: micro-costing and economic evaluation of interventions compared to usual NHS care. A within-trial analysis, with an economic model will be used to extrapolate longer-term costs and outcomes. Process evaluation: semi-structured interviews with participants and professionals to seek their views and experiences of the rehabilitation that they have received or provided, and factors affecting the implementation of the trial. allowing for 10% attrition, 720 participants provide 80% power to detect a 15% difference in successful outcome between each of the treatment pairs. Successful outcome definition: baseline ARAT 0-7 must improve by 3 or more points; baseline ARAT 8-13 improve by 4 or more points; baseline ARAT 14-19 improve by 5 or more points; baseline ARAT 20-39 improve by 6 or more points. The results from this trial will determine whether robot-assisted training improves upper limb function post stroke. ISRCTN, identifier: ISRCTN69371850 . Registered 4 October 2013.

Mechanisms of Injury and Countermeasures for EVA Associated Upper Extremity Medical Issues: Extended Vent Tube Study

NASA Technical Reports Server (NTRS)

Jones, Jeff; Hoffman, Ron; Harvey, Craig; Bowen, C. K.; Hudy, C. E.; Tuxhorn, Jennifer; Gernhardt, Mike; Scheuring, Richard A.

2007-01-01

The goal of this study is to determine the role that moisture plays in the injury to the fingers and fingernails during EVA training operations in the Neutral Buoyancy Laboratory. Current Extravehicular Mobility Unit (EMU, with a PLSS) as configured in the NBL was used for all testing and a vent tube was extended down a single arm of the crewmember during the test; vent tube was moved between left and right arm to serve as experimental condition being investigated and the other arm served as control condition.

The quest for the bionic arm.

PubMed

Hutchinson, Douglas T

2014-06-01

The current state of research of upper extremity prosthetic devices is focused on creating a complete prosthesis with full motor and sensory function that will provide amputees with a near-normal human arm. Although advances are being made rapidly, many hurdles remain to be overcome before a functional, so-called bionic arm is a reality. Acquiring signals via nerve or muscle inputs will require either a reliable wireless device or direct wiring through an osseous-integrated implant. The best way to tap into the "knowledge" present in the peripheral nerve is yet to be determined. Copyright 2014 by the American Academy of Orthopaedic Surgeons.

Equivalence Reliability among the FITNESSGRAM[R] Upper-Body Tests of Muscular Strength and Endurance

ERIC Educational Resources Information Center

Sherman, Todd; Barfield, J. P.

2006-01-01

This study was designed to investigate the equivalence reliability between the suggested FITNESSGRAM[R] muscular strength and endurance test, the 90[degrees] push-up (PSU), and alternate FITNESSGRAM[R] tests of upper-body strength and endurance (i.e., modified pull-up [MPU], flexed-arm hang [FAH], and pull-up [PU]). Children (N = 383) in Grades 3…

Robot training of upper limb in multiple sclerosis: comparing protocols with or without manipulative task components.

PubMed

Carpinella, Ilaria; Cattaneo, Davide; Bertoni, Rita; Ferrarin, Maurizio

2012-05-01

In this pilot study, we compared two protocols for robot-based rehabilitation of upper limb in multiple sclerosis (MS): a protocol involving reaching tasks (RT) requiring arm transport only and a protocol requiring both objects' reaching and manipulation (RMT). Twenty-two MS subjects were assigned to RT or RMT group. Both protocols consisted of eight sessions. During RT training, subjects moved the handle of a planar robotic manipulandum toward circular targets displayed on a screen. RMT protocol required patients to reach and manipulate real objects, by moving the robotic arm equipped with a handle which left the hand free for distal tasks. In both trainings, the robot generated resistive and perturbing forces. Subjects were evaluated with clinical and instrumental tests. The results confirmed that MS patients maintained the ability to adapt to the robot-generated forces and that the rate of motor learning increased across sessions. Robot-therapy significantly reduced arm tremor and improved arm kinematics and functional ability. Compared to RT, RMT protocol induced a significantly larger improvement in movements involving grasp (improvement in Grasp ARAT sub-score: RMT 77.4%, RT 29.5%, p=0.035) but not precision grip. Future studies are needed to evaluate if longer trainings and the use of robotic handles would significantly improve also fine manipulation.

A standard set of upper extremity tasks for evaluating rehabilitation interventions for individuals with complete arm paralysis

PubMed Central

Cornwell, Andrew S.; Liao, James Y.; Bryden, Anne M.; Kirsch, Robert F.

2013-01-01

We have developed a set of upper extremity functional tasks to guide the design and test the performance of rehabilitation technologies that restore arm motion in people with high tetraplegia. Our goal was to develop a short set of tasks that would be representative of a much larger set of activities of daily living while also being feasible for a unilateral user of an implanted Functional Electrical Stimulation (FES) system. To compile this list of tasks, we reviewed existing clinical outcome measures related to arm and hand function, and were further informed by surveys of patient desires. We ultimately selected a set of five tasks that captured the most common components of movement seen in these tasks, making them highly relevant for assessing FES-restored unilateral arm function in individuals with high cervical spinal cord injury (SCI). The tasks are intended to be used when setting design specifications and for evaluation and standardization of rehabilitation technologies under development. While not unique, this set of tasks will provide a common basis for comparing different interventions (e.g., FES, powered orthoses, robotic assistants) and testing different user command interfaces (e.g., sip-and-puff, head joysticks, brain-computer interfaces). PMID:22773199

Incorporating haptic effects into three-dimensional virtual environments to train the hemiparetic upper extremity

PubMed Central

Adamovich, Sergei; Fluet, Gerard G.; Merians, Alma S.; Mathai, Abraham; Qiu, Qinyin

2010-01-01

Current neuroscience has identified several constructs to increase the effectiveness of upper extremity rehabilitation. One is the use of progressive, skill acquisition-oriented training. Another approach emphasizes the use of bilateral activities. Building on these principles, this paper describes the design and feasibility testing of a robotic / virtual environment system designed to train the arm of persons who have had strokes. The system provides a variety of assistance modes, scalable workspaces and hand-robot interfaces allowing persons with strokes to train multiple joints in three dimensions. The simulations utilize assistance algorithms that adjust task difficulty both online and offline in relation to subject performance. Several distinctive haptic effects have been incorporated into the simulations. An adaptive master-slave relationship between the unimpaired and impaired arm encourages active movement of the subject's hemiparetic arm during a bimanual task. Adaptive anti-gravity support and damping stabilize the arm during virtual reaching and placement tasks. An adaptive virtual spring provides assistance to complete the movement if the subject is unable to complete the task in time. Finally, haptically rendered virtual objects help to shape the movement trajectory during a virtual placement task. A proof of concept study demonstrated this system to be safe, feasible and worthy of further study. PMID:19666345

Upper-arm anthropometry: an alternative indicator of nutritional health to body mass index in unilateral lower-extremity amputees?

PubMed

Miller, Michelle; Wong, Wing Ki; Wu, Jing; Cavenett, Sally; Daniels, Lynne; Crotty, Maria

2008-10-01

To evaluate the utility of body mass index (BMI) and corrected-arm-muscle area (CAMA) as measures of nutritional health for lower-limb amputees attending prosthetics clinics. Cross-sectional study. Prosthetics clinic in Australia. Unilateral lower-extremity amputees (N=58; age range, 21-91y; 37 transtibial, 21 transfemoral) attending a regional prosthetics clinic between May and November 2003. Not applicable. Weight (without prosthesis), corrected and uncorrected for the amputated limb was used with height estimated from knee height to calculate corrected BMI (cBMI) and uncorrected BMI (uBMI). CAMA was calculated using the mean of triplicate mid-upper-arm circumference (MUAC) and triceps skinfold thickness (TST) measurements. The Mini Nutritional Assessment (MNA) and Assessment of Quality of Life were administered according to recommended protocols. The Pearson correlation was used to determine the strength and significance of associations between variables, and bivariate regression analyses were performed to determine whether an association existed between the nutritional variables (BMI, CAMA, MNA) and quality of life (QOL). There were no statistically significant differences in the measures of nutritional health according to site (transtibial, transfemoral) of amputation. MUAC, TST, and CAMA all showed moderate to high positive correlations (r range, .541-.782) with both cBMI and uBMI. The strength of the relationship between the MNA and cBMI/uBMI was weaker (r=.383, r=.380, respectively) but remained positive and statistically significant (P=.003). QOL was not associated with cBMI or uBMI but was related to CAMA (beta=-.132; P=.030) and MNA (beta=-.561; P=.017). For persons with unilateral lower-extremity amputation, measurement of upper-arm anthropometry may be a more useful indicator of nutritional health and its consequences than BMI.

Reproducibility and validity of the Nintendo Wii Balance Board for measuring shoulder sensorimotor control in prone lying.

PubMed

Eshoj, H; Juul-Kristensen, Birgit; Jørgensen, Rene Gam Bender; Søgaard, Karen

2017-02-01

For the lower limbs, the Nintendo Wii Balance Board (NWBB) has been widely used to measure postural control. However, this has not been performed for upper limb measurements. Further, the NWBB has shown to produce more background noise with decreasing loads, which may be of concern when used for upper limb testing. The aim was to investigate reproducibility and validity of the NWBB. A test-retest design was performed with 68 subjects completing three different prone lying, upper limb weight-bearing balance tasks on a NWBB: two-arms, eyes closed (1) one-arm, non-dominant/non-injured (2) and one-arm, dominant/injured (3). Each task was repeated three times over the course of two test sessions with a 30-min break in between. Further, the level of background noise from a NWBB was compared with a force platform through systematic loading of both boards with increasing deadweights ranging from 5 to 90kg. Test-retest reproducibility was high with ICCs ranging from 0.95 to 0.97 (95% CI 0.92 to 0.98). However, systematic bias and tendencies for funnel effects in the Bland Altman plots for both one-armed tests were present. The concurrent validity of the NWBB was low (CCC 0.17 (95% CI 0.12-0.22)) due to large differences between the NWBB and force platform in noise sensitivity at low deadweights (especially below 50kg). The NWBB prone lying, shoulder sensorimotor control test was highly reproducible. Though, concurrent validity of the NWBB was poor compared to a force platform. Further investigation of the impact of the background noise, especially at low loads, is needed. Copyright © 2016 Elsevier B.V. All rights reserved.

Improvement of upper trunk posture during walking in hemiplegic patients after injections of botulinum toxin into the arm.

PubMed

Hefter, Harald; Rosenthal, Dietmar

2017-03-01

It has been hypothesized that altered trunk movements during gait in post-stroke patients or children with cerebral palsy are compensatory to lower limb impairment. Improvement of trunk movements and posture after injections of botulinum toxin into the affected arm would be at variance with this hypothesis and hint towards a multifactorial trunk control deficit. Clinical gait analysis was performed in 11 consecutively recruited hemiplegic patients immediately before and 4weeks after a botulinum toxin type A-injection into the affected arm. Kinematic data were collected using an 8 camera optical motion-capturing system and reflective skin-markers were attached according to a standard plug-in-gait model. Deviation of the trunk in lateral and forward direction and the trajectory of the C7-marker in a sacrum-fixed horizontal plane were analyzed in addition to classical gait parameters. The Wilson-signed-rank test was used for pre/post-botulinum toxin comparisons. After botulinum toxin injections a significant improvement of forearm flexion scores from 2.57 to 2.0 (p<0.014), and a reduced lateral deviation of the upper trunk from 3.5degrees to 2.5degrees (p<0.014) were observed. Free-walkers tended to walk faster (p<0.046, 1-sided), with reduced pre-swing duration of both legs and an increased step length of the non-affected leg. The C7-marker trajectory was shifted towards the midline. Injections of botulinum toxin into the affected arm of hemiplegic patients improve abnormal trunk lateral flexion. This shift of the center of mass of the upper body towards the midline improves various gait parameters including gait speed. Copyright © 2017. Published by Elsevier Ltd.

Efficacy of Slimming Cream Containing 3.5% Water-Soluble Caffeine and Xanthenes for the Treatment of Cellulite: Clinical Study and Literature Review

PubMed Central

Byun, Sang-Young; Kwon, Soon-Hyo; Heo, Su-Hak; Shim, Jae-Seong; Du, Mi-Hee

2015-01-01

Background Cellulite is a 'cottage cheese-like' cutaneous change caused by subcutaneous fat bulging into the dermis that usually leads to cosmetic problems. Slimming cream containing 3.5% water-soluble caffeine and xanthenes exhibits a lipolytic effect with penetration into the dermis. Objective To evaluate the efficacy and safety of slimming cream for the treatment of cellulite. Methods Fifteen subjects with cellulite applied slimming cream to the thighs and inner side of the upper arms twice daily for 6 weeks. Efficacy was assessed using a standard visual scale, changes in the circumferences of the thighs and upper arms, and patient satisfaction by a questionnaire at baseline, week 3, and week 6. Safety was assessed by inquiring about adverse events through questionnaires. Results The standard visual scale score improved significantly by 0.49 points (19.8%) at week 6. Thigh and upper-arm circumferences decreased by 0.7 cm (1.7%) and 0.8 cm (2.3%), respectively, at week 6. Slight itching and transient flushing were commonly reported, but no serious adverse event occurred. Conclusion The slimming cream tested appears to be effective for the treatment of cellulitis without serious adverse effects. However, additional large clinical trials are required to confirm the efficacy and safety of slimming cream for the treatment of cellulitis. PMID:26082579

Validation of the Omron M3 Intellisense (HEM-7051-E) upper arm blood pressure monitor, for self-measurement, according to the European Society of Hypertension International Protocol revision 2010 in a stage 3-5 chronic kidney disease population.

PubMed

Akpolat, Tekin; Erdem, Emre; Aydogdu, Türkan

2012-01-01

Encouragement of home blood pressure (BP) monitoring has a great potential to improve hypertension control rates. The purpose of this study was to test validation of the Omron M3 Intellisense (HEM-7051-E) upper arm BP measuring monitor for self-measurement according to the European Society of Hypertension International Protocol revision 2010 (ESH-IP2) in stage 3-5 chronic kidney disease (CKD) patients. 66 patients having CKD stage 3-5 were included in the study. Nine consecutive measurements were made according to the ESH-IP2 protocol. The Omron M3 Intellisense device fulfills the validation criteria of the ESH-IP2 for stage 3-5 CKD patients. Although arterial stiffness can affect accurate BP measurement, there are limited data regarding the use of automated oscillometric devices in CKD. To our knowledge, this is the first study investigating validation of an oscillometric device in stage 3-5 predialysis CKD patients. This study validates the Omron M3 Intellisense upper arm device for stage 3-5 CKD patients. New validation studies investigating other oscillometric sphygmomanometers for CKD patients and involvement of nephrologists in these studies have great potential to increase patient care in CKD. Copyright © 2011 S. Karger AG, Basel.

Validation of the iHealth BP5 wireless upper arm blood pressure monitor for self-measurement according to the European Society of Hypertension International Protocol revision 2010.

PubMed

Shang, Fujun; Zhu, Yizheng; Zhu, Zhenlai; Liu, Lei; Wan, Yi

2013-10-01

The aim of this study was to validate the iHealth BP5 wireless upper arm blood pressure (BP) monitor according to the European Society of Hypertension International Protocol (ESH-IP) revision 2010. The ESH-IP revision 2010 for validation of BP measuring devices in adults was followed precisely. A total of 99 pairs of test device and reference BP measurements (three pairs for each of the 33 participants) were obtained in the study. The device produced 71, 89, and 97 measurements within 5, 10, and 15 mmHg for systolic blood pressure (SBP) and 73, 90, and 99 mmHg for diastolic blood pressure (DBP), respectively. The mean ± SD device-observer difference was -1.21 ± 5.87 mmHg for SBP and -1.04 ± 5.28 mmHg for DBP. The number of participants with two or three device-observer differences within 5 mmHg was 25 for SBP and 28 for DBP. In addition, three participants had no device-observer difference within 5 mmHg for SBP and none of the participants had the same for DBP. According to the validation results on the basis of the ESH-IP revision 2010, the iHealth BP5 wireless upper arm BP monitor can be recommended for self/home measurement in an adult population.

Validation of A&D TM-2430 upper-arm blood pressure monitor for ambulatory blood pressure monitoring in children and adolescents, according to the British Hypertension Society protocol.

PubMed

Yip, Gabriel Wai-Kwok; So, Hung-Kwan; Li, Albert Martin; Tomlinson, Brian; Wong, Sik-Nin; Sung, Rita Yn-Tz

2012-04-01

The A&D TM-2430 ambulatory blood pressure (BP) monitor has been validated in adults but not in a young population. We sought to validate the device monitoring in children and adolescents, according to the British Hypertension Society (BHS) protocol. The A&D TM-2430 is an automated oscillometric upper-arm device for ambulatory BP monitoring. Nine consecutive measurements were taken in 61 children (mean age, 9.8 years; range, 5-15 years) according to the BHS criteria. Overseen by an independent supervisor, measurements were recorded by two observers blinded from each other's readings and from the device readings. The mean difference ± SD between the observers and device measurements was 0.73 ± 1.64 mmHg for systolic blood pressure (SBP) and -1.23 ± 1.65 mmHg for diastolic blood pressure (DBP), respectively, with an interobserver difference of 4 mmHg. The cumulative percentages of differences within 5, 10, and 15 mmHg were 89, 95, and 98% for SBP and 67, 88, and 98% for DBP. The device achieved a grade A rating for SBP and a B grade for DBP. The A&D TM-2430 upper-arm BP monitor has fulfilled the required BHS standards and can be recommended for measuring ambulatory BP in children and adolescent populations.

High resolution three-dimensional robotic synthetic tracked aperture ultrasound imaging: feasibility study

NASA Astrophysics Data System (ADS)

Zhang, Haichong K.; Fang, Ting Yun; Finocchi, Rodolfo; Boctor, Emad M.

2017-03-01

Three dimensional (3D) ultrasound imaging is becoming a standard mode for medical ultrasound diagnoses. Conventional 3D ultrasound imaging is mostly scanned either by using a two dimensional matrix array or by motorizing a one dimensional array in the elevation direction. However, the former system is not widely assessable due to its cost, and the latter one has limited resolution and field-of-view in the elevation axis. Here, we propose a 3D ultrasound imaging system based on the synthetic tracked aperture approach, in which a robotic arm is used to provide accurate tracking and motion. While the ultrasound probe is moved by a robotic arm, each probe position is tracked and can be used to reconstruct a wider field-of-view as there are no physical barriers that restrict the elevational scanning. At the same time, synthetic aperture beamforming provides a better resolution in the elevation axis. To synthesize the elevational information, the single focal point is regarded as the virtual element, and forward and backward delay-andsum are applied to the radio-frequency (RF) data collected through the volume. The concept is experimentally validated using a general ultrasound phantom, and the elevational resolution improvement of 2.54 and 2.13 times was measured at the target depths of 20 mm and 110 mm, respectively.

Relations between open-field, elevated plus-maze, and emergence tests in C57BL/6J and BALB/c mice injected with GABA- and 5HT-anxiolytic agents.

PubMed

Lalonde, Robert; Strazielle, Catherine

2010-06-01

Two 5HT(1A) receptor agonists and chlordiazepoxide were examined in open-field, elevated plus maze, and emergence tests. At doses with no effect in the open-field, chlordiazepoxide increased open and open/total arm visits as well as open arm duration in the elevated plus maze, whereas 5HT(1A) receptor agonists showed an anxiolytic response on a single measure. The anxiolytic action of chlordiazepoxide was limited to the less active BALB/c strain. Unlike the 5HT(1A) receptor agonists, chlordiazepoxide was also anxiolytic in the emergence test, once again only in BALB/c and not C57BL/6J mice. Significant correlations were found between emergence latencies and specific indicators of anxiety in the elevated plus-maze in chlordiazepoxide-treated but not in mice treated with buspirone and 8-OH-DPAT. These results indicate that elevated plus-maze and emergence tests depend on benzodiazepine receptors. In contrast, 5HT(1A) receptor agonists were ineffective in the emergence test and no correlation was found between emergence latencies and specific indicators of anxiety in the elevated plus-maze. Though superficially similar, the emergence test seems to tap into a partially separate facet of anxiety.

The Motor Activity Log-28: assessing daily use of the hemiparetic arm after stroke.

PubMed

Uswatte, G; Taub, E; Morris, D; Light, K; Thompson, P A

2006-10-10

Data from monkeys with deafferented forelimbs and humans after stroke indicate that tests of the motor capacity of impaired extremities can overestimate their spontaneous use. Before the Motor Activity Log (MAL) was developed, no instruments assessed spontaneous use of a hemiparetic arm outside the treatment setting. To study the MAL's reliability and validity for assessing real-world quality of movement (QOM scale) and amount of use (AOU scale) of the hemiparetic arm in stroke survivors. Participants in a multisite clinical trial completed a 30-item MAL before and after treatment (n = 106) or an equivalent no-treatment period (n = 116). Participants also completed the Stroke Impact Scale (SIS) and wore accelerometers that monitored arm movement for three consecutive days outside the laboratory. All were 3 to 12 months post-stroke and had mild to moderate paresis of an upper extremity. After an item analysis, two MAL tasks were eliminated. Revised participant MAL QOM scores were reliable (r =0.82). Validity was also supported. During the first observation period, the correlation between QOM and SIS Hand Function scale scores was 0.72. The corresponding correlation for QOM and accelerometry values was 0.52. Participant QOM and AOU scores were highly correlated (r = 0.92). The participant Motor Activity Log is reliable and valid in individuals with subacute stroke. It might be employed to assess the real-world effects of upper extremity neurorehabilitation and detect deficits in spontaneous use of the hemiparetic arm in daily life.

Movement Kinematics of the Ipsilesional Upper Extremity in Persons With Moderate or Mild Stroke.

PubMed

Bustrén, Eva-Lena; Sunnerhagen, Katharina Stibrant; Alt Murphy, Margit

2017-04-01

An increasing number of studies have indicated that the ipsilesional arm may be impaired after stroke. There is, however, a lack of knowledge whether ipsilesional deficits influence movement performance during purposeful daily tasks. The aim of this study was to investigate whether, and to what extent, movement impairments are present while performing an ipsilesional upper extremity task during the first 3 months after stroke. Movement kinematics describing movement time, smoothness, velocity, strategy, and pattern were captured during a standardized drinking task in 40 persons with first-ever stroke and 20 controls. Kinematics were measured early and at 3 months poststroke, and sensorimotor impairment was assessed with Fugl-Meyer Assessment in stroke. Half of the ipsilesional kinematics showed significant deficits early after stroke compared to controls, and the stroke severity had a significant impact on the kinematics. Movements of the ipsilesional arm were slower, less smooth, demonstrated prolonged relative time in deceleration, and increased arm abduction during drinking. Kinematics improved over time and reached a level comparable with controls at 3 months, except for angular velocity of the elbow and deceleration time in reaching for those with more severe motor impairment. This study demonstrates that movements of the ipsilesional arm, during a purposeful daily task, are impaired after stroke. These deficits are more prominent early after stroke and when the motor impairment is more severe. In clinical studies and praxis, the use of less-affected arm as a reference may underestimate the level of impairment and extent of recovery.

[Hand fine motor skills and use of both hand and arm in subjects after a stroke: a systematic review].

PubMed

Ostolaza, M; Abudarham, J; Dilascio, S; Drault-Boedo, E; Gallo, S; Garcete, A; Kramer, M; Maiaru, M; Mendelevich, A; Modica, M; Peralta, F; Sanchez-Correa, C

2017-04-01

In clinical practice it is important to be able to assess the function of the upper limb of the patient who has suffered a stroke. There is currently no systemic review that could identify assessment tools for the 'fine use of the hand' and 'use of both hand and arm'. Primary, to identify observational tools which can assess the fine use of the hand and the use of both hand and arm in patients with stroke sequels. Secondary, to analyze the bias risk in the included articles, describing and categorizing the clinical utility, validity and reliability. A search was carried in Medline, LILACS, SciELO and Open Grey, which included articles published until October 2015. Studies that validate assessing tools of the upper limb in subjects with a stroke sequel which evaluate the fine use of the hand and the use of both hand and arm were included. Eleven tools in evaluate observational haven been selected, which assess the fine use of the hand and the use of hand and arm. In every case both validity and reliability have been reported, but clinical utility has been less considered for assessment. The studies that researched these tools showed a high risk of bias in their development. ARAT-19 showed a lower bias risk, but when it has to do with applicability and the reference trial is taken into account, the level of concern is high.

Mining legacy across a wetland landscape: high mercury in Upper Peninsula (Michigan) rivers, lakes, and fish.

PubMed

Kerfoot, W Charles; Urban, Noel R; McDonald, Cory P; Zhang, Huanxin; Rossmann, Ronald; Perlinger, Judith A; Khan, Tanvir; Hendricks, Ashley; Priyadarshini, Mugdha; Bolstad, Morgan

2018-04-25

A geographic enigma is that present-day atmospheric deposition of mercury in the Upper Peninsula of Michigan is low (48%) and that regional industrial emissions have declined substantially (ca. 81% reduction) relative to downstate. Mercury levels should be declining. However, state (MDEQ) surveys of rivers and lakes revealed elevated total mercury (THg) in Upper Peninsula waters and sediment relative to downstate. Moreover, Western Upper Peninsula (WUP) fish possess higher methyl mercury (MeHg) levels than Northern Lower Peninsula (NLP) fish. A contributing explanation for elevated THg loading is that a century ago the Upper Peninsula was a major industrial region, centered on mining. Many regional ores (silver, copper, zinc, massive sulfides) contain mercury in part per million concentrations. Copper smelters and iron furnace-taconite operations broadcast mercury almost continuously for 140 years, whereas mills discharged tailings and old mine shafts leaked contaminated water. We show that mercury emissions from copper and iron operations were substantial (60-650 kg per year) and dispersed over relatively large areas. Moreover, lake sediments in the vicinity of mining operations have higher THg concentrations. Sediment profiles from the Keweenaw Waterway show that THg accumulation increased 50- to 400-fold above modern-day atmospheric deposition levels during active mining and smelting operations, with lingering MeHg effects. High MeHg concentrations are geographically correlated with low pH and dissolved organic carbon (DOC), a consequence of biogeochemical cycling in wetlands, characteristic of the Upper Peninsula. DOC can mobilize metals and elevate MeHg concentrations. We argue that mercury loading from mining is historically superimposed upon strong regional wetland effects, producing a combined elevation of both THg and MeHg in the Western Upper Peninsula.

The ARAMIS project: a concept robot and technical design.

PubMed

Colizzi, Lucio; Lidonnici, Antonio; Pignolo, Loris

2009-11-01

To describe the ARAMIS (Automatic Recovery Arm Motility Integrated System) project, a concept robot applicable in the neuro-rehabilitation of the paretic upper limb after stroke. Methods, results and conclusion: The rationale and engineering of a state-of-the-art, hardware/software integrated robot system, its mechanics, ergonomics, electric/electronics features providing control, safety and suitability of use are described. An ARAMIS prototype has been built and is now available for clinical tests. It allows the therapist to design neuro-rehabilitative (synchronous or asynchronous) training protocols in which sample exercises are generated by a single exoskeleton (operated by the patient's unaffected arm or by the therapist's arm) and mirrored in real-time or offline by the exoskeleton supporting the paretic arm.

Elevations of Endogenous Kynurenic Acid Produce Spatial Working Memory Deficits

PubMed Central

Chess, Amy C.; Simoni, Michael K.; Alling, Torey E.; Bucci, David J.

2007-01-01

Kynurenic acid (KYNA) is a tryptophan metabolite that is synthesized and released by astrocytes and acts as a competitive antagonist of the glycine site of N-methyl-D-aspartate receptors at high concentrations and as a noncompetitive antagonist of the α7-nicotinic acetylcholine receptor at low concentrations. The discovery of increased cortical KYNA levels in schizophrenia prompted the hypothesis that elevated KYNA concentration may underlie the working memory dysfunction observed in this population that has been attributed to altered glutamatergic and/or cholinergic transmission. The present study investigated the effect of elevated endogenous KYNA on spatial working memory function in rats. Increased KYNA levels were achieved with intraperitoneal administration of kynurenine (100 mg/kg), the precursor of KYNA synthesis. Rats were treated with either kynurenine or a vehicle solution prior to testing in a radial arm maze task at various delays. Elevations of endogenous KYNA resulted in increased errors in the radial arm maze. In separate experiments, assessment of locomotor activity in an open field and latency to retrieve food reward from one of the maze arms ruled out the possibility that deficits in the maze were attributable to altered locomotor activity or motivation to consume food. These results provide evidence that increased KYNA levels produce spatial working memory deficits and are among the first to demonstrate the influence of glia-derived molecules on cognitive function. The implications for psychopathological conditions such as schizophrenia are discussed. PMID:16920787

The Differential Effect of Arm Movements during Gait on the Forward Acceleration of the Centre of Mass in Children with Cerebral Palsy and Typically Developing Children.

PubMed

Meyns, Pieter; Molenaers, Guy; Duysens, Jacques; Jonkers, Ilse

2017-01-01

Background: We aimed to study the contribution of upper limb movements to propulsion during walking in typically developing (TD) children ( n = 5) and children with hemiplegic and diplegic cerebral palsy (CP; n = 5 and n = 4, respectively). Methods: Using integrated three-dimensional motion capture data and a scaled generic musculoskeletal model that included upper limbs, we generated torque driven simulations of gait in OpenSim. Induced acceleration analyses were then used to determine the contributions of the individual actuators located at the relevant degrees of freedoms of the upper and lower limb joints to the forward acceleration of the COM at each time point of the gait simulation. The mean values of the contribution of the actuators of upper limbs, lower limbs, and gravity in different phases of the gait cycle were compared between the three groups. Findings: The results indicated a limited contribution of the upper limb actuators to COM forward acceleration compared to the contribution of lower limbs and gravity, in the three groups. In diplegic CP, the contribution of the upper limbs seemed larger compared to TD during the preswing and swing phases of gait. In hemiplegic CP, the unaffected arm seemed to contribute more to COM deceleration during (pre)swing, while the affected side contributed to COM acceleration. Interpretation: These findings suggest that in the presence of lower limb dysfunction, the contribution of the upper limbs to forward propulsion is altered, although they remain negligible compared to the lower limbs and gravity.

Characterization of Peripheral Activity States and Cortical Local Field Potentials of Mice in an Elevated Plus Maze Test.

PubMed

Okonogi, Toya; Nakayama, Ryota; Sasaki, Takuya; Ikegaya, Yuji

2018-01-01

Elevated plus maze (EPM) tests have been used to assess animal anxiety levels. Little information is known regarding how physiological activity patterns of the brain-body system are altered during EPM tests. Herein, we monitored cortical local field potentials (LFPs), electrocardiograms (ECGs), electromyograms (EMGs), and respiratory signals in individual mice that were repeatedly exposed to EPM tests. On average, mouse heart rates were higher in open arms. In closed arms, the mice occasionally showed decreased heart and respiratory rates lasting for several seconds or minutes, characterized as low-peripheral activity states of peripheral signals. The low-activity states were observed only when the animals were in closed arms, and the frequencies of the states increased as the testing days proceeded. During the low-activity states, the delta and theta powers of cortical LFPs were significantly increased and decreased, respectively. These results demonstrate that cortical oscillations crucially depend on whether an animal exhibits low-activity states in peripheral organs rather than the EPM arm in which the animal is located. These results suggest that combining behavioral tests with physiological makers enables a more accurate evaluation of rodent mental states.

Polymyalgia Rheumatica

MedlinePlus

... symptom) Aches or pain in your neck, upper arms, buttocks, hips or thighs Stiffness in affected areas, ... two times more likely to develop the disorder. Race and geographic region. Polymyalgia rheumatica is most common ...

Dislocated Shoulder

MedlinePlus

... up of three bones: your collarbone, your shoulder blade, and your upper arm bone. The top of ... fits into a cuplike socket in your shoulder blade. A shoulder dislocation is an injury that happens ...

Lithium ameliorates open-field and elevated plus maze behaviors, and brain phospho-glycogen synthase kinase 3-beta expression in fragile X syndrome model mice.

PubMed

Chen, Xi; Sun, Weiwen; Pan, Ying; Yang, Quan; Cao, Kaiyi; Zhang, Jin; Zhang, Yizhi; Chen, Mincong; Chen, Feidi; Huang, Yueling; Dai, Lijun; Chen, Shengqiang

2013-10-01

To investigate whether lithium modifies open-field and elevated plus maze behavior, and brain phospho-glycogen synthase kinase 3 (P-GSK3beta) expression in Fmr1 knockout mice. One hundred and eighty FVB mice, including knockout and wild type, with an age of 30 days were used. An open-field and elevated plus maze was utilized to test behavior, while western blot was used to measure the P-GSK3beta expression. Six groups were formed: control (saline), lithium chloride 30, 60, 90, 120, and 200 mg/kg. The experiments were carried out in the Institute of Neuroscience, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China between January and June 2012. Lithium significantly decreased total distance, crossing, central area time, and center entry in the open-field test (p<0.05), and significantly reduced open-arm tracking, open-arm entry, and open-arm time in the elevated plus maze (p<0.05) in knockout mice. In wild type mice, significant changes were observed in both behavior tests in some treatment groups. Lithium ameliorated P-GSK3beta expression in the hippocampus of all the treatment groups in knockout mice (p<0.05). However, lithium did not modify either GSK3beta expression in tissues of knockout mice, or P-GSK3beta or GSK3beta expression in tissues of wild type mice. Lithium ameliorated open-field and elevated plus maze behaviors of Fmr1 knockout mice. This effect may be related to its enhancement of P-GSK3beta expression. Our findings suggest that lithium might have a therapeutic effect in fragile X syndrome.

Supplemental Carbon Dioxide Stabilizes the Upper Airway in Volunteers Anesthetized with Propofol.

PubMed

Ruscic, Katarina Jennifer; Bøgh Stokholm, Janne; Patlak, Johann; Deng, Hao; Simons, Jeroen Cedric Peter; Houle, Timothy; Peters, Jürgen; Eikermann, Matthias

2018-05-10

Propofol impairs upper airway dilator muscle tone and increases upper airway collapsibility. Preclinical studies show that carbon dioxide decreases propofol-mediated respiratory depression. We studied whether elevation of end-tidal carbon dioxide (PETCO2) via carbon dioxide insufflation reverses the airway collapsibility (primary hypothesis) and impaired genioglossus muscle electromyogram that accompany propofol anesthesia. We present a prespecified, secondary analysis of previously published experiments in 12 volunteers breathing via a high-flow respiratory circuit used to control upper airway pressure under propofol anesthesia at two levels, with the deep level titrated to suppression of motor response. Ventilation, mask pressure, negative pharyngeal pressure, upper airway closing pressure, genioglossus electromyogram, bispectral index, and change in end-expiratory lung volume were measured as a function of elevation of PETCO2 above baseline and depth of propofol anesthesia. PETCO2 augmentation dose-dependently lowered upper airway closing pressure with a decrease of 3.1 cm H2O (95% CI, 2.2 to 3.9; P < 0.001) under deep anesthesia, indicating improved upper airway stability. In parallel, the phasic genioglossus electromyogram increased by 28% (23 to 34; P < 0.001). We found that genioglossus electromyogram activity was a significant modifier of the effect of PETCO2 elevation on closing pressure (P = 0.005 for interaction term). Upper airway collapsibility induced by propofol anesthesia can be reversed in a dose-dependent manner by insufflation of supplemental carbon dioxide. This effect is at least partly mediated by increased genioglossus muscle activity.

Arm and Intensity-Matched Leg Exercise Induce Similar Inflammatory Responses.

PubMed

Leicht, Christof A; Paulson, Thomas A W; Goosey-Tolfrey, Victoria L; Bishop, Nicolette C

2016-06-01

The amount of active muscle mass can influence the acute inflammatory response to exercise, associated with reduced risk for chronic disease. This may affect those restricted to upper body exercise, for example, due to injury or disability. The purpose of this study was to compare the inflammatory responses for arm exercise and intensity-matched leg exercise. Twelve male individuals performed three 45-min constant load exercise trials after determination of peak oxygen uptake for arm exercise (V˙O2peak A) and cycling (V˙O2peak C): 1) arm cranking exercise at 60% V˙O2peak A, 2) moderate cycling at 60% V˙O2peak C, and 3) easy cycling at 60% V˙O2peak A. Cytokine, adrenaline, and flow cytometric analysis of monocyte subsets were performed before and up to 4 h postexercise. Plasma IL-6 increased from resting concentrations in all trials; however, postexercise concentrations were higher for arm exercise (1.73 ± 1.04 pg·mL) and moderate cycling (1.73 ± 0.95 pg·mL) compared with easy cycling (0.87 ± 0.41 pg·mL; P < 0.04). Similarly, the plasma IL-1ra concentration in the recovery period was higher for arm exercise (325 ± 139 pg·mL) and moderate cycling (316 ± 128 pg·mL) when compared with easy cycling (245 ± 77 pg·mL, P < 0.04). Arm exercise and moderate cycling induced larger increases in monocyte numbers and larger increases of the classical monocyte subset in the recovery period than easy cycling (P < 0.05). The postexercise adrenaline concentration was lowest for easy cycling (P = 0.04). Arm exercise and cycling at the same relative exercise intensity induces a comparable acute inflammatory response; however, cycling at the same absolute oxygen uptake as arm exercise results in a blunted cytokine, monocyte, and adrenaline response. Relative exercise intensity appears to be more important to the acute inflammatory response than modality, which is of major relevance for populations restricted to upper body exercise.

Quantitative measures with WREX usage.

PubMed

Shank, Tracy M; Wee, Jinyong; Ty, Jennifer; Rahman, Tariq

2017-07-01

This paper presents the results of two surveys conducted with users of a functional upper extremity orthosis called the Wilmington Robotic EXoskeleton (WREX). The WREX is a passive anti-gravity arm orthosis that allows people with neuromuscular disabilities to move their arms in three dimensions. An online user survey with 55 patients was conducted to determine the benefits of the WREX. The survey asked 10 questions related to upper extremity function with and without the WREX as well as subjective impressions of the device. A second survey used a phone interview based on the Canadian Occupational Performance Measure (COPM). Parents rated their child's performance and satisfaction while partaking in important activities both with and without the exoskeleton device. Scores were assessed for change between the two conditions. Twenty-five families responded to this survey. Twenty-four out of 25 subjects reported greater levels of performance and satisfaction when they were wearing the WREX. The mean change in performance score was 3.61 points, and the mean change in satisfaction score was 4.44 points. Results show a statistically significant improvement in arm function for everyday tasks with the WREX.

Obesity, hypertension and home sphygmomanometer cuffs.

PubMed

Akpolat, Tekin

2010-08-01

Since the increasing prevalence of obesity leads to a larger mean arm circumferences in the hypertensive population and appropriate cuff size is essential for accurate measurement of blood pressure, overweight and obese patients often require automated home sphygmomanometers with large- or extra large-sized cuffs. The aims of this study were to evaluate the information about cuff size on automated upper arm home sphygmomanometer packing boxes and compare the findings with wrist device boxes. One hundred twelve different device boxes (49 automated upper arm, 5 semi-automatic, and 58 wrist) produced by 40 manufacturers were investigated. Three different types of information were observed (written, graphical, or a combination of both). There was not any information about cuff size on 49 (44%) device boxes. Most of the information expressed on the boxes was not attractive or informative for the patients. This study showed that the information regarding cuff size on most of the device boxes was obtuse and the patients are not warned sufficiently about appropriate cuff size. Physicians and health care providers should inform and train their patients about appropriate cuff size.

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

NASA Astrophysics Data System (ADS)

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

2007-11-01

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

Bilateral differences in the upper quarter function of high school aged baseball and softball players.

PubMed

Butler, Robert J; Myers, Heather S; Black, Douglass; Kiesel, Kyle B; Plisky, Phillip J; Moorman, Claude T; Queen, Robin M

2014-08-01

The Upper Quarter Y Balance Test (YBT-UQ) was developed as a way to identify upper extremity and trunk mobility in the open kinetic chain in the reaching limb as well as midrange limitations and asymmetries of upper extremity and core stability in the closed kinetic chain on the stabilizing limb. Performance on the YBT-UQ is similar between genders and between limbs; however, this has not been examined in athletes who participate in sports that result in upper extremity asymmetries. The primary purpose of this study is to determine if differences exist between the throwing vs. non-throwing sides in high-school baseball and softball athletes on the YBT-UQ. In order to complete this forty-eight male high school baseball players and seventeen female high school softball players were tested on the YBT-UQ. Reach distances were normalized to arm length (% AL). Comparisons were made between the throwing (T) and non-throwing (NT) arm for each direction as well as the composite score. No significant differences were observed between the T and NT arm for the medial (NT: 98.4 ± 8.6 %AL, T: 99.1 ± 8.6 %AL, p=0.42), inferolateral (NT: 90.8 ± 11.8 %AL, T: 90.3 ± 11.5 %AL, p =0.61), superolateral (NT: 70.6 ± 10.9 %AL, T: 70.4 ± 11.1 % AL, p=0.91) reaches, or the composite score (NT: 87.2 ± 8.9 % AL, T: 86.6 ± 8.1 %AL, p=0.72). Similarly, no differences were observed between the male baseball and female softball players (p=0.30-0.90). Based on these findings, it was concluded that there was no difference in performance on the YBT-UQ between throwing and non-throwing limbs in high school baseball and softball players. 3.

Differences in physical workload, psychosocial factors and musculoskeletal disorders between two groups of female hospital cleaners with two diverse organizational models.

PubMed

Unge, Jeannette; Ohlsson, Kerstina; Nordander, Catarina; Hansson, Gert-Ake; Skerfving, Staffan; Balogh, Istvan

2007-11-01

To clarify if differences in the physical workload, the psychosocial factors and in musculoskeletal disorders can be attributed to work organizational factors. The physical workload (muscular activity of m. trapezius, positions and movements of the head, upper arms and wrists and heart rate) was assessed in 24 female hospital cleaners working in a traditional work organization (TO) and in 22 working in an extended one (i.e. with an enlarged work content and more responsibilities; EO). The psychosocial work environment was assessed as job demand, decision latitude and social support in 135 (TO) and 111 (EO) cleaners, and disorders of the neck and upper extremity by a physical examination. The EO group was associated with lower physical workload, in terms of heart rate ratio (23 vs 32; P<0.001), head and upper arm positions and movements (right upper arm, 50th percentile, 35 degrees/s vs 71 degrees/s; P<0.001) and wrist movements (20 degrees/s vs 27 degrees/s; P=0.001), than the TO group. The EO group reported higher decision latitude and lower work demand than the TO one, while we found no difference in social support. The prevalence of complaints and diagnoses in neck/shoulders were lower in the EO group (diagnoses 35% vs 48%; P=0.04). Moreover, the prevalence of subjects with at least ten physical finding in elbows/hands was lower in the EO group (10 vs 29; P<0.001). Hospital cleaners have a high prevalence of neck and upper limb disorders and a high physical workload. Comparing two groups of cleaners, with differences in the way of organizing the work, lower physical workload, more beneficial psychosocial factors and a better musculoskeletal health was found in the group with an extended organization. Hence, the differences found can be attributed to the organizational factors.

Inertial Sensor Measurements of Upper-Limb Kinematics in Stroke Patients in Clinic and Home Environment.

PubMed

Held, Jeremia P O; Klaassen, Bart; Eenhoorn, Albert; van Beijnum, Bert-Jan F; Buurke, Jaap H; Veltink, Peter H; Luft, Andreas R

2018-01-01

Upper-limb impairments in stroke patients are usually measured in clinical setting using standard clinical assessment. In addition, kinematic analysis using opto-electronic systems has been used in the laboratory setting to map arm recovery. Such kinematic measurements cannot capture the actual function of the upper extremity in daily life. The aim of this study is to longitudinally explore the complementarity of post-stroke upper-limb recovery measured by standard clinical assessments and daily-life recorded kinematics. The study was designed as an observational, single-group study to evaluate rehabilitation progress in a clinical and home environment, with a full-body sensor system in stroke patients. Kinematic data were recorded with a full-body motion capture suit during clinical assessment and self-directed activities of daily living. The measurements were performed at three time points for 3 h: (1) 2 weeks before discharge of the rehabilitation clinic, (2) right after discharge, and (3) 4 weeks after discharge. The kinematic analysis of reaching movements uses the position and orientation of each body segment to derive the joint angles. Newly developed metrics for classifying activity and quality of upper extremity movement were applied. The data of four stroke patients (three mildly impaired, one sever impaired) were included in this study. The arm motor function assessment improved during the inpatient rehabilitation, but declined in the first 4 weeks after discharge. A change in the data (kinematics and new metrics) from the daily-life recording was seen in in all patients. Despite this worsening patients increased the number of reaches they performed during daily life in their home environment. It is feasible to measure arm kinematics using Inertial Measurement Unit sensors during daily life in stroke patients at the different stages of rehabilitation. Our results from the daily-life recordings complemented the data from the clinical assessments and illustrate the potential to identify stroke patient characteristics, based on kinematics, reaching counts, and work area. https://clinicaltrials.gov, identifier NCT02118363.

The nature of arm movement in children with cerebral palsy when using computer-generated exercise games.

PubMed

Weightman, Andrew; Preston, Nick; Levesley, Martin; Bhakta, Bipin; Holt, Raymond; Mon-Williams, Mark

2014-05-01

To compare upper limb kinematics of children with spastic cerebral palsy (CP) using a passive rehabilitation joystick with those of adults and able-bodied children, to better understand the design requirements of computer-based rehabilitation devices. A blocked comparative study involving seven children with spastic CP, nine able-bodied adults and nine able-bodied children, using a joystick system to play a computer game whilst the kinematics of their upper limb were recorded. The translational kinematics of the joystick's end point and the participant's shoulder movement (protraction/retraction) and elbow rotational kinematics (flexion/extension) were analysed for each group. Children with spastic CP matched their able-bodied peers in the time taken to complete the computer task, but this was due to a failure to adhere to the task instructions of travelling along a prescribed straight line when moving between targets. The spastic CP group took longer to initiate the first movement, which showed jerkier trajectories and demonstrated qualitatively different movement patterns when using the joystick, with shoulder movements that were significantly of greater magnitude than the able-bodied participants. Children with spastic CP generate large shoulder and hence trunk movements when using a joystick to undertake computer-generated arm exercises. This finding has implications for the development and use of assistive technologies to encourage exercise and the instructions given to users of such systems. A kinematic analysis of upper limb function of children with CP when using joystick devices is presented. Children with CP may use upper body movements to compensate for limitations in voluntary shoulder and elbow movements when undertaking computer games designed to encourage the practice of arm movement. The design of rehabilitative computer exercise systems should consider movement of the torso/shoulder as it may have implications for the quality of therapy in the rehabilitation of the upper limb in children with CP.

The effects of arm movement on reaction time in patients with latent and active upper trapezius myofascial trigger point.

PubMed

Yassin, Marzieh; Talebian, Saeed; Ebrahimi Takamjani, Ismail; Maroufi, Nader; Ahmadi, Amir; Sarrafzadeh, Javad; Emrani, Anita

2015-01-01

Myofascial pain syndrome is a significant source of mechanical pain. The aim of this study was to investigate the effects of arm movement on reaction time in females with latent and active upper trapezius myofascial trigger point. In this interventional study, a convenience sample of fifteen women with one active MTP, fifteen women with one latent MTP in the upper trapezius, and fifteen normal healthy women were participated. Participants were asked to stand for 10 seconds in an erect standing position. Muscle reaction times were recorded including anterior deltoid (AD), cervical paraspinal (CP) lumbar paraspinal (LP), both of upper trapezius (UT), sternocleidomastoid (SCM) and medial head of gastrocnemius (GcM). Participants were asked to flex their arms in response to a sound stimulus preceded by a warning sound stimulus. Data were analyzed using one-way ANOVA Test. There was significant differences in motor time and reaction time between active and control groups (p< 0.05) except for GcM. There was no significant difference in motor time between active and passive groups except for UT without MTP and SCM (p< 0.05). Also, there were no significant differences in motor times between latent MTP and control groups. Furthermore, there was no significant difference in premotor times between the three groups. The present study shows that patients with active MTP need more time to react to stimulus, but patients with latent MTP are similar to healthy subjects in the reaction time. Patients with active MTP had less compatibility with environmental stimulations, and they responded to a specific stimulation with variability in Surface Electromyography (SEMG).

Time course of upper limb function and return-to-work post-radiotherapy in young adults with breast cancer: a pilot randomized control trial on effects of targeted exercise program.

PubMed

Ibrahim, Marize; Muanza, Thierry; Smirnow, Nadia; Sateren, Warren; Fournier, Beatrice; Kavan, Petr; Palumbo, Michael; Dalfen, Richard; Dalzell, Mary-Ann

2017-12-01

Breast cancer (BC) diagnosis in young adults (YA) is rising, and both disease and treatments are aggressive in this population. Evidence supports the use of physical activity in reducing shoulder dysfunction, which is common among BC survivors. A pilot randomized clinical trial was performed to determine the effectiveness of a 12-week post-radiation exercise program in minimizing upper extremity dysfunction in YA with BC. Participants were randomized to either an exercise arm or a control arm receiving standard care. Data was collected over six time points using: the Disability of Arm, Shoulder, and Hand (DASH); the Metabolic Equivalent of Task-hours per week (MET-hours/week), and a post hoc questionnaire on return to work. In total, 59 young women participated in the study (n = 29 exercise; n = 30 control). No statistically significant differences were found in overall DASH results between groups; however, those who underwent total mastectomy had residual upper limb dysfunction (p < 0.05). Both groups returned to pre-diagnosis activity levels by 18 months. Final evaluation showed that 86% of the women returned to work, and 89% resumed prior work activities with a decrease of 8.5 h/week. Although the short-term targeted exercise program had no effect on long-term upper limb function post-radiation, timing and program specificity may require consideration of tissue healing post-radiation and surgery type. The majority of participants returned to work, however not returning to pre-diagnosis work hours. Exercise interventions alone may not reverse the long-term sequelae of breast cancer treatment and allow young adult patients to return to work.

A Neuromuscular Electrical Stimulation (NMES) and robot hybrid system for multi-joint coordinated upper limb rehabilitation after stroke.

PubMed

Rong, Wei; Li, Waiming; Pang, Mankit; Hu, Junyan; Wei, Xijun; Yang, Bibo; Wai, Honwah; Zheng, Xiaoxiang; Hu, Xiaoling

2017-04-26

It is a challenge to reduce the muscular discoordination in the paretic upper limb after stroke in the traditional rehabilitation programs. In this study, a neuromuscular electrical stimulation (NMES) and robot hybrid system was developed for multi-joint coordinated upper limb physical training. The system could assist the elbow, wrist and fingers to conduct arm reaching out, hand opening/grasping and arm withdrawing by tracking an indicative moving cursor on the screen of a computer, with the support from the joint motors and electrical stimulations on target muscles, under the voluntary intention control by electromyography (EMG). Subjects with chronic stroke (n = 11) were recruited for the investigation on the assistive capability of the NMES-robot and the evaluation of the rehabilitation effectiveness through a 20-session device assisted upper limb training. In the evaluation, the movement accuracy measured by the root mean squared error (RMSE) during the tracking was significantly improved with the support from both the robot and NMES, in comparison with those without the assistance from the system (P < 0.05). The intra-joint and inter-joint muscular co-contractions measured by EMG were significantly released when the NMES was applied to the agonist muscles in the different phases of the limb motion (P < 0.05). After the physical training, significant improvements (P < 0.05) were captured by the clinical scores, i.e., Modified Ashworth Score (MAS, the elbow and the wrist), Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), and Wolf Motor Function Test (WMFT). The EMG-driven NMES-robotic system could improve the muscular coordination at the elbow, wrist and fingers. ClinicalTrials.gov. NCT02117089 ; date of registration: April 10, 2014.

Functional electrical stimulation mediated by iterative learning control and 3D robotics reduces motor impairment in chronic stroke

PubMed Central

2012-01-01

Background Novel stroke rehabilitation techniques that employ electrical stimulation (ES) and robotic technologies are effective in reducing upper limb impairments. ES is most effective when it is applied to support the patients’ voluntary effort; however, current systems fail to fully exploit this connection. This study builds on previous work using advanced ES controllers, and aims to investigate the feasibility of Stimulation Assistance through Iterative Learning (SAIL), a novel upper limb stroke rehabilitation system which utilises robotic support, ES, and voluntary effort. Methods Five hemiparetic, chronic stroke participants with impaired upper limb function attended 18, 1 hour intervention sessions. Participants completed virtual reality tracking tasks whereby they moved their impaired arm to follow a slowly moving sphere along a specified trajectory. To do this, the participants’ arm was supported by a robot. ES, mediated by advanced iterative learning control (ILC) algorithms, was applied to the triceps and anterior deltoid muscles. Each movement was repeated 6 times and ILC adjusted the amount of stimulation applied on each trial to improve accuracy and maximise voluntary effort. Participants completed clinical assessments (Fugl-Meyer, Action Research Arm Test) at baseline and post-intervention, as well as unassisted tracking tasks at the beginning and end of each intervention session. Data were analysed using t-tests and linear regression. Results From baseline to post-intervention, Fugl-Meyer scores improved, assisted and unassisted tracking performance improved, and the amount of ES required to assist tracking reduced. Conclusions The concept of minimising support from ES using ILC algorithms was demonstrated. The positive results are promising with respect to reducing upper limb impairments following stroke, however, a larger study is required to confirm this. PMID:22676920

Estimation of regional cutaneous cold sensitivity by analysis of the gasping response.

PubMed

Burke, W E; Mekjavić, I B

1991-11-01

Regional cutaneous sensitivity to cooling was assessed in males by separately immersing four discrete skin regions in cold water (15 degrees C) during head-out immersion. The response measured was gasping at the onset of immersion; the gasping response appears to be the result of a nonthermoregulatory neurogenic drive from cutaneous cold receptors. Subjects of similar body proportions wore a neoprene "dry" suit modified to allow exposure to the water of either the arms, upper torso, lower torso, or legs, while keeping the unexposed skin regions thermoneutral. Each subject was immersed to the sternal notch in all four conditions of partial exposure plus one condition of whole body exposure. The five cold water conditions were matched by control immersions in lukewarm (34 degrees C) water, and trials were randomized. The magnitude of the gasping response was determined by mouth occlusion pressure (P0.1). For each subject, P0.1 values for the 1st min of immersion were integrated, and control trial values, although minimal, were subtracted from their cold water counterpart to account for any gasping due to the experimental design. Results were averaged and showed that the highest P0.1 values were elicited from whole body exposure, followed in descending order by exposures of the upper torso, legs, lower torso, and arms. Correction of the P0.1 response for differences in exposed surface area (A) and cooling stimulus (delta T) between regions gave a cold sensitivity index [CSI, P0.1/(A.delta T)] for each region and showed that the index for the upper torso was significantly higher than that for the arms or legs; no significant difference was observed between the indexes for the upper and lower torso.(ABSTRACT TRUNCATED AT 250 WORDS)

Functional electrical stimulation mediated by iterative learning control and 3D robotics reduces motor impairment in chronic stroke.

PubMed

Meadmore, Katie L; Hughes, Ann-Marie; Freeman, Chris T; Cai, Zhonglun; Tong, Daisy; Burridge, Jane H; Rogers, Eric

2012-06-07

Novel stroke rehabilitation techniques that employ electrical stimulation (ES) and robotic technologies are effective in reducing upper limb impairments. ES is most effective when it is applied to support the patients' voluntary effort; however, current systems fail to fully exploit this connection. This study builds on previous work using advanced ES controllers, and aims to investigate the feasibility of Stimulation Assistance through Iterative Learning (SAIL), a novel upper limb stroke rehabilitation system which utilises robotic support, ES, and voluntary effort. Five hemiparetic, chronic stroke participants with impaired upper limb function attended 18, 1 hour intervention sessions. Participants completed virtual reality tracking tasks whereby they moved their impaired arm to follow a slowly moving sphere along a specified trajectory. To do this, the participants' arm was supported by a robot. ES, mediated by advanced iterative learning control (ILC) algorithms, was applied to the triceps and anterior deltoid muscles. Each movement was repeated 6 times and ILC adjusted the amount of stimulation applied on each trial to improve accuracy and maximise voluntary effort. Participants completed clinical assessments (Fugl-Meyer, Action Research Arm Test) at baseline and post-intervention, as well as unassisted tracking tasks at the beginning and end of each intervention session. Data were analysed using t-tests and linear regression. From baseline to post-intervention, Fugl-Meyer scores improved, assisted and unassisted tracking performance improved, and the amount of ES required to assist tracking reduced. The concept of minimising support from ES using ILC algorithms was demonstrated. The positive results are promising with respect to reducing upper limb impairments following stroke, however, a larger study is required to confirm this.

Thermal ecology of Naegleria fowleri from a power plant cooling reservoir

DOE Office of Scientific and Technical Information (OSTI.GOV)

Huizinga, H.W.; McLaughlin, G.L.

1990-07-01

The pathogenic, free-living amoeba Naegleria fowleri is the causative agent of human primary amebic meningoencephalitis. N. fowleri has been isolated from thermally elevated aquatic environments worldwide, but temperature factors associated with occurrence of the amoeba remain undefined. In this study, a newly created cooling reservoir (Clinton Lake, Illinois) was surveyed for Naegleria spp. before and after thermal additions from a nuclear power plant. Water and sediment samples were collected from heated and unheated arms of the reservoir and analyzed for the presence of thermophilic Naegleria spp. and pathogenic N. fowleri. Amoebae were identified by morphology, in vitro cultivation, temperature tolerance,more » mouse pathogenicity assay, and DNA restriction fragment length analysis. N. fowleri was isolated from the thermally elevated arm but not from the ambient-temperature arm of the reservoir. The probability of isolating thermophilic Naegleria and pathogenic N. fowleri increased significantly with temperature. Repetitive DNA restriction fragment profiles of the N. fowleri Clinton Lake isolates and a known N. fowleri strain of human origin were homogeneous.« less

Parallel arms races between garter snakes and newts involving tetrodotoxin as the phenotypic interface of coevolution.

PubMed

Brodie, Edmund D; Feldman, Chris R; Hanifin, Charles T; Motychak, Jeffrey E; Mulcahy, Daniel G; Williams, Becky L; Brodie, Edmund D

2005-02-01

Parallel "arms races" involving the same or similar phenotypic interfaces allow inference about selective forces driving coevolution, as well as the importance of phylogenetic and phenotypic constraints in coevolution. Here, we report the existence of apparent parallel arms races between species pairs of garter snakes and their toxic newt prey that indicate independent evolutionary origins of a key phenotype in the interface. In at least one area of sympatry, the aquatic garter snake, Thamnophis couchii, has evolved elevated resistance to the neurotoxin tetrodotoxin (TTX), present in the newt Taricha torosa. Previous studies have shown that a distantly related garter snake, Thamnophis sirtalis, has coevolved with another newt species that possesses TTX, Taricha granulosa. Patterns of within population variation and phenotypic tradeoffs between TTX resistance and sprint speed suggest that the mechanism of resistance is similar in both species of snake, yet phylogenetic evidence indicates the independent origins of elevated resistance to TTX.

Effects of acute upper-body vibration on strength and power variables in climbers.

PubMed

Cochrane, Darryl J; Hawke, Emma J

2007-05-01

Whole-body vibration training has recently received a lot of attention with reported enhancements of strength and power qualities in athletes. This study investigated whether upper-body vibration would be able to augment muscular attributes for climbing performance. Twelve healthy active climbers volunteered for the study. All participants underwent 3 treatments--arm cranking (AC), upper-body vibration (UBV), and non-UBV (NUBV)--in a balanced random order, conducted on separate days. Upper-body vibration was generated via a commercialized electric-powered dumbbell with a rotating axis that delivered oscillatory movements to the shoulders and arms. The UBV treatment consisted of performing 5 upper-body exercises for a total duration of 5 minutes. The UBV frequency was set at 26 Hz, amplitude 3 mm. For the NUBV treatment, the participants performed the exact exercises and time constraints as UBV; however, the vibration dumbbell was set at 0 Hz and 0 mm amplitude. The third treatment consisted of AC, which was performed at 75 k.min(-1) for 5 minutes. Pre- and postmuscular performance measures of medicine ball throw, hand grip strength, and a specific climbing maneuver were performed after each treatment. There were no significant treatment differences on medicine ball throw, hand grip strength, and the specific climbing maneuver. Acute UBV exposure did not demonstrate the expected potential neuromuscular enhancements on the climbing performance tests selected for this study.

Upper limb movement analysis during gait in multiple sclerosis patients.

PubMed

Elsworth-Edelsten, Charlotte; Bonnefoy-Mazure, Alice; Laidet, Magali; Armand, Stephane; Assal, Frederic; Lalive, Patrice; Allali, Gilles

2017-08-01

Gait disorders in multiple sclerosis (MS) are well studied; however, no previous study has described upper limb movements during gait. However, upper limb movements have an important role during locomotion and can be altered in MS patients due to direct MS lesions or mechanisms of compensation. The aim of this study was to describe the arm movements during gait in a population of MS patients with low disability compared with a healthy control group. In this observational study we analyzed the arm movements during gait in 52 outpatients (mean age: 39.7±9.6years, female: 40%) with relapsing-remitting MS with low disability (mean EDSS: 2±1) and 25 healthy age-matched controls using a 3-dimension gait analysis. MS patients walked slower, with increased mean elbow flexion and decreased amplitude of elbow flexion (ROM) compared to the control group, whereas shoulder and hand movements were similar to controls. These differences were not explained by age or disability. Upper limb alterations in movement during gait in MS patients with low disability can be characterized by an increase in mean elbow flexion and a decrease in amplitude (ROM) for elbow flexion/extension. This upper limb movement pattern should be considered as a new component of gait disorders in MS and may reflect subtle motor deficits or the use of compensatory mechanisms. Copyright © 2017 Elsevier B.V. All rights reserved.

Health Status of Women in the Armed Forces

DTIC Science & Technology

1991-12-01

1984, howeper, women’s rates for acute upper respiratory infection, diarrheal disease, ribella, and infectious mononucleosis had declined to such an...were observed for induced abortions and acute upper respiratory infection for the 1973-77 cohort; alcohol abuse and complications of pregnancy for the...1978-82 cohort; and complications of pregnancy and transient situational disturbances for the 1983-87 cohort. The most vulnerable time for the

Liver Safety of Fasiglifam (TAK-875) in Patients with Type 2 Diabetes: Review of the Global Clinical Trial Experience.

PubMed

Marcinak, John F; Munsaka, Melvin S; Watkins, Paul B; Ohira, Takashi; Smith, Neila

2018-06-01

Fasiglifam (TAK-875) is a G protein-coupled receptor 40 agonist that was being investigated for treatment of type 2 diabetes mellitus (T2DM). A development program was terminated late in phase III clinical trials due to liver safety concerns. The liver safety of fasiglifam was assessed from data based on six phase II and nine phase III double-blind studies and two open-label studies with emphasis on pooled data from 15 double-blind studies from both global and Japanese development programs. Taking into consideration different daily doses of fasiglifam administered in clinical studies, the primary comparisons were between all patients exposed to fasiglifam (any dose) versus placebo, and, where applicable, versus the two active comparators, sitagliptin or glimepiride. A Liver Safety Evaluation Committee consisting of hepatologists blinded to treatment assignments evaluated hepatic adverse events (AEs) and serious AEs (SAEs) for causal relationship to study drug. The analysis included data from 9139 patients with T2DM in 15 double-blind controlled studies who received either fasiglifam (n = 5359, fasiglifam group), fasiglifam and sitagliptin (n = 123), or a comparator agent (n = 3657, non-exposed group consisting of placebo and other antidiabetic agents). Exposure to treatment for more than 1 year ranged from 249 patients in the placebo arm, to 370 patients in the glimepiride arm and 617 patients in the fasiglifam 50 mg arm. The primary focus of the analysis was on the hepatic safety of fasiglifam. The overall safety profile based on treatment-emergent AEs (TEAEs), SAEs, deaths, and withdrawal due to AEs was similar between fasiglifam and placebo (excluding liver test abnormalities). However, there was an increased incidence rate of serum alanine aminotransferase (ALT) elevations > 3 × upper limit of normal (ULN), 5 × ULN, and 10 × ULN in fasiglifam-treated patients compared with those treated with placebo or active comparators. ALT elevations > 3 × ULN for fasiglifam were 2.7% compared with 0.8 and 0.5% for the active comparators and placebo. There did not appear to be a clear dose response in incidence of ALT elevations between patients receiving 25 or 50 mg daily. The cumulative incidence of elevations in serum ALT > 3 × ULN was higher in the first 6 months of treatment with fasiglifam compared with both placebo and the active comparators, but the rate of new ALT elevations appeared to be similar across all treatment groups thereafter. No demographic or baseline patient characteristics were identified to predict elevations exceeding ALT > 3 × ULN in fasiglifam-treated patients. The pattern of liver injury with fasiglifam was hepatocellular, and there were no reports of liver-related deaths, liver failure or life-threatening liver injury. Most fasiglifam-associated ALT elevations were asymptomatic and resolved promptly upon discontinuing treatment, but in two patients the recovery was prolonged. Importantly, three important serious liver injury cases were identified among fasiglifam-treated patients; one case was adjudicated to be a clear Hy's Law case and the two remaining cases were considered to closely approximate Hy's Law cases. Although the incidence of overall AEs, SAEs, and deaths was similar between fasiglifam and placebo, a liver signal was identified based primarily on the difference in liver chemistry values in the fasiglifam group compared with the placebo and active comparator groups. Three serious liver injuries were attributed to fasiglifam treatment. Clinical development of fasiglifam was halted due to these liver safety concerns.

Embodied prosthetic arm stabilizes body posture, while unembodied one perturbs it.

PubMed

Imaizumi, Shu; Asai, Tomohisa; Koyama, Shinichi

2016-10-01

Senses of ownership (this arm belongs to me) and agency (I am controlling this arm) originate from sensorimotor system. External objects can be integrated into the sensorimotor system following long-term use, and recognized as one's own body. We examined how an (un)embodied prosthetic arm modulates whole-body control, and assessed the components of prosthetic embodiment. Nine unilateral upper-limb amputees participated. Four frequently used their prosthetic arm, while the others rarely did. Their postural sway was measured during quiet standing with or without their prosthesis. The frequent users showed greater sway when they removed the prosthesis, while the rare users showed greater sway when they fitted the prosthesis. Frequent users reported greater everyday feelings of postural stabilization by prosthesis and a larger sense of agency over the prosthesis. We suggest that a prosthetic arm maintains or perturbs postural control, depending on the prosthetic embodiment, which involves sense of agency rather than ownership. Copyright © 2016 Elsevier Inc. All rights reserved.

Poor safety climate, long work hours, and musculoskeletal discomfort among Latino horse farm workers.

PubMed

Swanberg, Jennifer; Clouser, Jessica Miller; Gan, Wenqi; Flunker, John C; Westneat, Susan; Browning, Steven R

2017-09-03

This study investigated the prevalence of self-reported musculoskeletal discomfort (MSD) and work-related factors associated with elevated MSD among Latino thoroughbred farm workers. Participants (N = 225) were recruited using a community-based purposive sampling approach to participate in in-person interviews. Of these workers, 85% experienced MSD. MSD was divided into tertiles; the upper tertile was defined as elevated. Multivariable Poisson regression revealed associations between any elevated MSD and longer tenure on horse farms, longer work hours, and poor safety climate. Elevated neck/back MSD was associated with longer tenure, longer work hours, and poor safety climate. Elevated upper extremity MSD was associated with age and poor safety climate. Elevated lower extremity MSD was associated with longer tenure, longer work hours, and being female. Musculoskeletal discomfort is common among these workers. Improving safety climate and minimizing long work hours is recommended.

Training the Unimpaired Arm Improves the Motion of the Impaired Arm and the Sitting Balance in Chronic Stroke Survivors.

PubMed

De Luca, Alice; Giannoni, Psiche; Vernetti, Honore; Capra, Cristina; Lentino, Carmelo; Checchia, Giovanni Antonio; Casadio, Maura

2017-07-01

Robot-assisted rehabilitation of stroke survivors mainly focuses on the impaired side of the body while the role of the unimpaired side in the recovery after stroke is still controversial. The goal of this study is to investigate the influence on sitting balance and paretic arm functions of a training protocol based on movements of the unimpaired arm. Sixteen chronic stroke survivors underwent nineteen training sessions, in which they performed active movements with the unimpaired arm supported by a passive exoskeleton. Performance of the trunk and upper limbs was evaluated before treatment, after treatment and at six months follow up with clinical scales and an instrumented evaluation. A reaching test executed with the exoskeleton was used to assess changes in performance of both arms. The treatment based on the unimpaired arm's movements executed with a correct body posture led to benefits in control of the trunk and of both the trained and the untrained arm. The amount of impaired arm improvement in the Fugl-Meyer score was comparable to the outcome of robotic treatments focused directly on this arm. Our results highlight the importance of taking into account all body schema in the rehabilitation robotic program, instead of focusing only on the impaired side of the body.

Dyssynchronous breathing during arm but not leg exercise in patients with chronic airflow obstruction.

PubMed

Celli, B R; Rassulo, J; Make, B J

1986-06-05

Some patients with chronic airflow obstruction experience dyspnea with mild arm exercise but not with more-intense leg exercise. To investigate why these patients have limited endurance during arm exertion, we studied ventilatory responses to exercise with unsupported arms in 12 patients with chronic airflow obstruction (mean [+/- SD] forced expiratory volume in one second, 0.68 +/- 0.28 liters). Unloaded leg cycling was also studied for comparison. In the five patients who had the most severe airflow obstruction, arm exercise was limited by dyspnea after 3.3 +/- 0.7 minutes, and dyssynchronous thoracoabdominal breathing developed. In the other seven patients, arm exercise was limited by the sensation of muscle fatigue after 6.1 +/- 2.0 minutes (P less than 0.05), and dyssynchronous breathing did not occur. None of the 12 patients had dyssynchronous breathing during unloaded leg cycling. Maximal transdiaphragmatic pressure, a measure of diaphragmatic fatigue, declined similarly after arm and leg exercise in both groups. During unsupported arm work, the accessory muscles of inspiration help position the torso and arms. We hypothesize that the extra demand placed on these muscles during arm exertion leads to early fatigue, an increased load on the diaphragm, and dyssynchronous thoracoabdominal inspirations. This sequence may contribute to dyspnea and limited endurance during upper-extremity exercise.

Acute and subchronic effects of MDMA ("ecstasy") on anxiety in male mice tested in the elevated plus-maze.

PubMed

Navarro, José Francisco; Maldonado, Enrique

2002-10-01

3,4-Methylenedioxymethamphetamine (MDMA) is a compound structurally similar to methamphetamine, which has become one of the most widely used illicit substances. Animal studies investigating acute effects of MDMA on anxiety are unclear since, although an anxiogenic-like action of MDMA in different animal models of anxiety has been mainly described, there is also evidence supporting an anxiolytic-like effect for this drug. An attempt was made to clarify the possible anxiogenic-like profile of MDMA (1, 8 and 15 mg/kg i.p.) by analyzing its effect on behavior of male mice in the elevated plus-maze test. Moreover, the possible development of tolerance to the effects of MDMA on anxiety after its subchronic administration for 5 consecutive days was examined. The parameters evaluated included: (1) total time in open arms, (2) total time in closed arms, (3) total time in central area, (4) number of open arm entries, (5) number of closed arm entries and (6) number of central area entries. Acute treatment with MDMA (8 mg/kg) significantly reduced the time spent in the open arms, as well as markedly increasing the number of entries in the closed arms and in the central area, as compared with the control group, suggesting that MDMA, at this dose, has an anxiogenic-like activity. Mice subchronically treated with the drug (1 and 8 mg/kg) displayed a notable reduction in the time spent in the open arms, accompanied by an increase in the time spent in the closed arms and in the central platform. These results indicate that the anxiogenic-like effect found after acute treatment is not only maintained but also more marked after subchronic treatment. In contrast, mice treated subchronically with the highest dose of MDMA (15 mg/kg) exhibited a significant increase in the time spent in the open arms as well as a marked reduction in the time spent in the closed arms, supporting an anxiolytic-like activity of the drug. A possible dual pharmacological property of MDMA on anxiety is suggested.

6A.03: THE RELATIONSHIP BETWEEN INTER-ARM SYSTOLIC BLOOD PRESSURE AND CARDIOVASCULAR RISK FACTORS.

PubMed

Ma, W; Zhang, B; Yang, Y; Qi, L; Meng, L; Zhang, Y; Huo, Y

2015-06-01

To analyze the relationship between the inter arm blood pressure difference (IASBPD) and other cardiovascular risk factors. To identify what factors are associated with this difference in a general population. The study subjects were 1426 individuals. The BP was measured simultaneously in both arms by VP1000 vascular profiler (Omron Colin, Japan). The inter-arm BP difference was expressed as the absolute difference (|R - L|). The various risk factors, ba-PWV, carotid IMT and plaque were compared between IASBPD more than 10mmHg group and IASBPD less than 10mmHg group. The relationship between IASBPD more than 10mmHg and various cardiovascular risk factors were analyzed by multivariate logistic analysis. Left upper limb systolic blood pressure was higher than the right upper limb, while right upper limb diastolic pressure was higher than the left upper limb. The prevalence of hypertension was higher in IASBPD increasing group than normal group (40.5% vs 22.6%, p < 0.05). The weight, BMI, systolic and diastolic blood pressure were also higher in IASBPD increasing group(p < 0.05). The mean IMT and max IMT in any segment carotid artery except for mean IMT of internal carotid artery were thicker in IASBPD increasing group than normal group(p < 0.05). Ba-PWV was higher, while ABI was lower in IASBPD increasing group(1.04 ± 0.16 vs 1.09 ± 0.16, p < 0.05). By multivariate logistic regression analysis, after adjusting for age, sex, BMI, hypertension, diabetes, smoking, SBP, TC, TG, LDL-C,HDL-C,ABI, PWV, mean IMT and plaque, IASBPD more than 10mmHg was positive associated with BMI(OR 1.081 95%CI: 1.030,1.134,p = 0.002), SBP (OR 1.032 95%CI: 1.023,1.041,p < 0.001), and negative associated with ABI(OR 0.051 95%CI: 0.009,0.273,p = 0.001). The increasing IASBPD was associated with systolic blood pressure, BMI and ABI independently, which may partly explain the mechanism that increasing IASBPD is associated with cardiovascular disease.

Arm Activity During Daily Life in Individuals With Chronic Obstructive Pulmonary Disease.

PubMed

Janaudis-Ferreira, Tania; Mathur, Sunita; Romano, Julia Marie; Goldstein, Roger Samuel; Brooks, Dina

2016-01-01

To determine whether individuals with chronic obstructive pulmonary disease (COPD) have decreased arm activity during daily life compared with healthy controls and explore the relationships between arm activity during daily life and arm functional measures in individuals with COPD. This was a prospective cross-sectional study that included 30 people with COPD and 14 healthy controls. Subjects attended a single assessment session in which measurements of arm exercise capacity, arm functional performance, self-perception of performance during activities of daily living (ADL), shoulder and elbow flexion force and biceps and triceps thickness were performed. On completion of this session, participants were issued a wrist actigraph and asked to wear the device on the dominant arm for 24 hours for 7 consecutive days. Compared with healthy controls, patients with COPD presented decreased total activity level in daily life (P = .001). When corrected for walking, the level of arm activity did not differ between individuals with COPD and healthy controls (P = .62). No correlations were found between arm activity and arm exercise capacity, arm functional performance, upper limb muscle strength, and self-perception of performance during ADL (r =-0.20 to 0.14; all P ≥ .10). Arm activity intensity in individuals with COPD did not differ from that of healthy controls when measured by a wrist actigraph. Moreover, arm activity was not associated with other clinical outcomes of arm function. Disability during ADL is multifactorial, and only limited inferences of function can be made from accelerometer data.

Clinical Signs and Subjective Symptoms of Temporomandibular Disorders in Instrumentalists.

PubMed

Jang, Jae Young; Kwon, Jeong Seung; Lee, Debora H; Bae, Jung Hee; Kim, Seong Taek

2016-11-01

Most of the reports on instrumentalists' experiences of temporomandibular disorders (TMD) have been reported not by clinical examinations but by subjective questionnaires. The aim of this study was to investigate the clinical signs and subjective symptoms of TMD in a large number of instrumentalists objectively. A total of 739 musicians from a diverse range of instrument groups completed a TMD questionnaire. Among those who reported at least one symptom of TMD, 71 volunteers underwent clinical examinations and radiography for diag-nosis. Overall, 453 participants (61.3%) reported having one or more symptoms of TMD. The most frequently reported symptom was a clicking or popping sound, followed by temporomandibular joint (TMJ) pain, muscle pain, crepitus, and mouth opening limitations. Compared with lower-string instrumentalists, a clicking or popping sound was about 1.8 and 2 times more frequent in woodwind and brass instrumentalists, respectively. TMJ pain was about 3.2, 2.8, and 3.2 times more frequent in upper-string, woodwind, and brass instrumentalists, respectively. Muscle pain was about 1.5 times more frequent in instrumentalists with an elevated arm position than in those with a neutral arm position. The most frequent diagnosis was myalgia or myofascial pain (MFP), followed by disc displacement with reduction. Myalgia or MFP was 4.6 times more frequent in those practicing for no less than 3.5 hours daily than in those practicing for less than 3.5 hours. The results indicate that playing instruments can play a contributory role in the development of TMD.

Prevalence of complaints of arm, neck and shoulder among computer office workers and psychometric evaluation of a risk factor questionnaire.

PubMed

Eltayeb, Shahla; Staal, J Bart; Kennes, Janneke; Lamberts, Petra H G; de Bie, Rob A

2007-07-14

Complaints of Arm Neck and Shoulder (CANS) represent a wide range of complaints, which can differ in severity from mild, periodic symptoms to severe, chronic and debilitating conditions. They are thought to be associated with both physical and psychosocial risk factors. The measurement and identification of the various risk factors for these complaints is an important step towards recognizing (a) high risk subgroups that are relevant in profiling CANS; and (b) also for developing targeted and effective intervention plans for treatment. The purpose of the present study was to investigate the prevalence of CANS in a Dutch population of computer workers and to develop a questionnaire aimed at measuring workplace physical and psychosocial risk factors for the presence of these complaints. To examine potential workplace risk factors for the presence of CANS, the Maastricht Upper Extremity Questionnaire (MUEQ), a structured questionnaire, was developed and tested among 264 computer office workers of a branch office of the national social security institution in the Netherlands. The MUEQ holds 95 items covering demographic characteristics, in addition to seven main domains assessing potential risk factors with regard to (1) work station, (2) posture during work, (3) quality of break time, (4) job demands, (5) job control, and (6) social support. The MUEQ further contained some additional questions about the quality of the work environment and the presence of complaints in the neck, shoulder, upper and lower arm, elbow, hand and wrist. The prevalence rates of CANS in the past year were computed. Further, we investigated the psychometric properties of the MUEQ (i.e. factor structure and reliability). The one-year prevalence rate of CANS indicated that 54% of the respondents reported at least one complaint in the arm, neck and/or shoulder. The highest prevalence rates were found for neck and shoulder symptoms (33% and 31% respectively), followed by hand and upper arm complaints (11% to 12%) and elbow, lower arm and wrist complaints (6% to 7%). The psychometric properties of the MUEQ were assessed using exploratory factor analysis which resulted in the identification of 12 factors. The calculation of internal consistency and cross validation provided evidence of reliability and lack of redundancy of items. Neck and shoulder complaints are more frequently reported among Dutch computer workers than arm, elbow and hand complaints. The results further indicate that the MUEQ has satisfactory reliability and internal consistency when used to document CANS among computer workers in the Netherlands.

How Do Changes to the Railroad Causeway in Utah’s Great Salt Lake Affect Water and Salt Flow?

PubMed Central

White, James S.; Null, Sarah E.; Tarboton, David G.

2015-01-01

Managing terminal lake elevation and salinity are emerging problems worldwide. We contribute to terminal lake management research by quantitatively assessing water and salt flow for Utah’s Great Salt Lake. In 1959, Union Pacific Railroad constructed a rock-filled causeway across the Great Salt Lake, separating the lake into a north and south arm. Flow between the two arms was limited to two 4.6 meter wide rectangular culverts installed during construction, an 88 meter opening (referred to locally as a breach) installed in 1984, and the semi porous material of the causeway. A salinity gradient developed between the two arms of the lake over time because the south arm receives approximately 95% of the incoming streamflow entering Great Salt Lake. The north arm is often at, or near, salinity saturation, averaging 317 g/L since 1966, while the south is considerably less saline, averaging 142 g/L since 1966. Ecological and industrial uses of the lake are dependent on long-term salinity remaining within physiological and economic thresholds, although optimal salinity varies for the ecosystem and between diverse stakeholders. In 2013, Union Pacific Railroad closed causeway culverts amid structural safety concerns and proposed to replace them with a bridge, offering four different bridge designs. As of summer 2015, no bridge design has been decided upon. We investigated the effect that each of the proposed bridge designs would have on north and south arm Great Salt Lake elevation and salinity by updating and applying US Geological Survey’s Great Salt Lake Fortran Model. Overall, we found that salinity is sensitive to bridge size and depth, with larger designs increasing salinity in the south arm and decreasing salinity in the north arm. This research illustrates that flow modifications within terminal lakes cannot be separated from lake salinity, ecology, management, and economic uses. PMID:26641101

How Do Changes to the Railroad Causeway in Utah's Great Salt Lake Affect Water and Salt Flow?

PubMed

White, James S; Null, Sarah E; Tarboton, David G

2015-01-01

Managing terminal lake elevation and salinity are emerging problems worldwide. We contribute to terminal lake management research by quantitatively assessing water and salt flow for Utah's Great Salt Lake. In 1959, Union Pacific Railroad constructed a rock-filled causeway across the Great Salt Lake, separating the lake into a north and south arm. Flow between the two arms was limited to two 4.6 meter wide rectangular culverts installed during construction, an 88 meter opening (referred to locally as a breach) installed in 1984, and the semi porous material of the causeway. A salinity gradient developed between the two arms of the lake over time because the south arm receives approximately 95% of the incoming streamflow entering Great Salt Lake. The north arm is often at, or near, salinity saturation, averaging 317 g/L since 1966, while the south is considerably less saline, averaging 142 g/L since 1966. Ecological and industrial uses of the lake are dependent on long-term salinity remaining within physiological and economic thresholds, although optimal salinity varies for the ecosystem and between diverse stakeholders. In 2013, Union Pacific Railroad closed causeway culverts amid structural safety concerns and proposed to replace them with a bridge, offering four different bridge designs. As of summer 2015, no bridge design has been decided upon. We investigated the effect that each of the proposed bridge designs would have on north and south arm Great Salt Lake elevation and salinity by updating and applying US Geological Survey's Great Salt Lake Fortran Model. Overall, we found that salinity is sensitive to bridge size and depth, with larger designs increasing salinity in the south arm and decreasing salinity in the north arm. This research illustrates that flow modifications within terminal lakes cannot be separated from lake salinity, ecology, management, and economic uses.

Spatial Map of Synthesized Criteria for the Redundancy Resolution of Human Arm Movements.

PubMed

Li, Zhi; Milutinovic, Dejan; Rosen, Jacob

2015-11-01

The kinematic redundancy of the human arm enables the elbow position to rotate about the axis going through the shoulder and wrist, which results in infinite possible arm postures when the arm reaches to a target in a 3-D workspace. To infer the control strategy the human motor system uses to resolve redundancy in reaching movements, this paper compares five redundancy resolution criteria and evaluates their arm posture prediction performance using data on healthy human motion. Two synthesized criteria are developed to provide better real-time arm posture prediction than the five individual criteria. Of these two, the criterion synthesized using an exponential method predicts the arm posture more accurately than that using a least squares approach, and therefore is preferable for inferring the contributions of the individual criteria to motor control during reaching movements. As a methodology contribution, this paper proposes a framework to compare and evaluate redundancy resolution criteria for arm motion control. A cluster analysis which associates criterion contributions with regions of the workspace provides a guideline for designing a real-time motion control system applicable to upper-limb exoskeletons for stroke rehabilitation.

Arm lymphoedema and upper limb impairments in sentinel node-negative breast cancer patients: A one year follow-up study.

PubMed

De Groef, An; Van Kampen, Marijke; Tieto, Elena; Schönweger, Petra; Christiaens, Marie-Rose; Neven, Patrick; Geraerts, Inge; Gebruers, Nick; Devoogdt, Nele

2016-10-01

The aim of this study is (1) to investigate the prevalence rate of arm lymphedema, pain, impaired shoulder range of motion, strength and shoulder function one year after a sentinel lymph node biopsy (SLNB) for breast cancer and (2) to determine predictive factors for these complications. A longitudinal study was performed. One hundred patients with a sentinel-lymph node negative breast cancer were included. All patients were measured before surgery and one year after. Arm lymphedema was measured with the perimeter, pain with the Visual Analogue Scale, shoulder range of motion with an inclinometer, strength with a handheld dynamometer and shoulder function with the Disability of Arm, Shoulder and Hand questionnaire. Patient-, breast cancer- and treatment-related variables were recorded. One year after surgery 8% of sentinel node-negative breast cancer patients had developed arm lymphedema. Fifty percent of patients had pain, 30% had an impaired shoulder range of motion, 8% had a decreased handgrip strength and 49% had an impaired shoulder function. Pain, shoulder range of motion, strength and shoulder dysfunctions changed significantly over one year (p < 0.001). Higher Body Mass Index is a predictive variable for shoulder dysfunctions one year post-SLNB. Prevalence rate of lymphedema and other upper limb impairments may not be underestimated after SLNB. Pain, shoulder range of motion, handgrip strength and shoulder function change significantly up to one year compared to preoperative values in sentinel node-negative breast cancer patients. Copyright © 2016 Elsevier Ltd. All rights reserved.

The lateral septum and anterior hypothalamus act in tandem to regulate burying in the shock-probe test but not open-arm avoidance in the elevated plus-maze.

PubMed

Lamontagne, Steven J; Olmstead, Mary C; Menard, Janet L

2016-11-01

Both the lateral septum (LS) and anterior hypothalamus (AHA) regulate behavioural defense. We tested whether those two interconnected structures act in serial in that regard. Infusions of the GABAA agonist muscimol into one side of the LS and the contralateral (but not ipsilateral) AHA suppressed rats' burying in the shock-probe test whereas none of our muscimol infusion approaches altered their open-arm avoidance in the elevated plus-maze. These results suggest that the LS-AHA circuit serves a specialized role in defensive responses towards discrete, localizable threat stimuli but not towards potential threats. Copyright © 2016 Elsevier B.V. All rights reserved.

Acquired bilateral telangiectatic macules: a distinct clinical entity.

PubMed

Park, Ji-Hye; Lee, Dong Jun; Lee, Yoo-Jung; Jang, Yong Hyun; Kang, Hee Young; Kim, You Chan

2014-09-01

We evaluated 13 distinct patients with multiple telangiectatic pigmented macules confined mostly to the upper arms to determine if the clinical and histopathological features of these cases might represent a specific clinical entity. We retrospectively investigated the clinical, histopathologic, and immunohistochemical features of 13 patients with multiple telangiectatic pigmented macules on the upper arms who presented between January 2003 and December 2012. Epidermal pigmentation, melanogenic activity, melanocyte number, vascularity, epidermal thickness, and perivascular mast cell number of the specimens were evaluated. Clinically, the condition favored middle-aged men. On histopathologic examination, the lesional skin showed capillary proliferation and telangiectasia in the upper dermis. Histochemical and immunohistochemical analysis revealed basal hyperpigmentation and increased melanogenic activity in the lesional skin (P < .05). No significant difference in epidermal thickness or mast cell number was observed between the normal perilesional skin and the lesional skin. The clinical and histopathologic features of these lesions were relatively consistent in all patients. In addition, the features are quite distinct from other diseases. Based on clinical and histologic features, we suggest the name acquired bilateral telangiectatic macules for this new entity.

Design and kinematic analysis of a novel upper limb exoskeleton for rehabilitation of stroke patients.

PubMed

Zeiaee, Amin; Soltani-Zarrin, Rana; Langari, Reza; Tafreshi, Reza

2017-07-01

This paper details the design process and features of a novel upper limb rehabilitation exoskeleton named CLEVER (Compact, Low-weight, Ergonomic, Virtual/Augmented Reality Enhanced Rehabilitation) ARM. The research effort is focused on designing a lightweight and ergonomic upper-limb rehabilitation exoskeleton capable of producing diverse and perceptually rich training scenarios. To this end, the knowledge available in the literature of rehabilitation robotics is used along with formal conceptual design techniques. This paper briefly reviews the systematic approach used for design of the exoskeleton, and elaborates on the specific details of the proposed design concept and its advantages over other design possibilities. The kinematic structure of CLEVER ARM has eight degrees of freedom supporting the motion of shoulder girdle, glenohumeral joint, elbow and wrist. Six degrees of freedom of the exoskeleton are active, and the two degrees of freedom supporting the wrist motion are passive. Kinematics of the proposed design is studied analytically and experimentally with the aid of a 3D printed prototype. The paper is concluded by some remarks on the optimization of the design, motorization of device, and the fabrication challenges.

A Multi-Armed Bandit Approach to Following a Markov Chain

DTIC Science & Technology

2017-06-01

focus on the House to Café transition (p1,4). We develop a Multi-Armed Bandit approach for efficiently following this target, where each state takes the...and longitude (each state corresponding to a physical location and a small set of activities). The searcher would then apply our approach on this...the target’s transition probability and the true probability over time. Further, we seek to provide upper bounds (i.e., worst case bounds) on the

The association of dementia with upper arm and waist circumference in seven low- and middle-income countries: the 10/66 cross-sectional surveys.

PubMed

Taylor, Clare L; Albanese, Emiliano; Stewart, Robert

2012-08-01

Weight loss in dementia contributes to morbidity and mortality but the distribution of anthropometric change and its consistency between populations are less clear. Our aim was to investigate and compare the associations of dementia with waist and upper arm circumference in elders from seven low- and middle-income nations. Cross-sectional surveys were conducted of 15,022 residents aged 65 years and older in Cuba, Mexico, Venezuela, Peru, Dominican Republic, China, and India. Dementia was assessed using a cross-culturally validated algorithm, and anthropometric measurements were taken. Associations with dementia and dementia severity (clinical dementia rating scale) were investigated in linear regression models, with fixed-effects meta-analyses used to investigate between-country heterogeneity. Dementia and increased dementia severity were both associated with smaller arm and waist circumferences with little evidence of confounding by sociodemographic and health status. Associations between dementia/clinical dementia rating and arm circumference were homogeneous between countries (Higgins I(2) 0% and 7%, respectively), whereas those with waist circumference were more heterogeneous (Higgins I(2) 67% and 62%, respectively). Although cross-sectional, our findings are consistent with prospective observations of weight loss in dementia and suggest loss of both muscle and fat-the former being consistent across different settings and the latter being more context dependent.

Overview: Mechanism and Control of a Prosthetic Arm.

PubMed

Kulkarni, Tushar; Uddanwadiker, Rashmi

2015-09-01

Continuous growth in industrialization and lack of awareness in safety parameters the cases of amputations are growing. The search of safer, simpler and automated prosthetic arms for managing upper limbs is expected. Continuous efforts have been made to design and develop prosthetic arms ranging from simple harness actuated to automated mechanisms with various control options. However due the cost constraints, the automated prosthetic arms are still out of the reach of needy people. Recent data have shown that there is a wide scope to develop a low cost and light weight upper limb prosthesis. This review summarizes the various designs methodologies, mechanisms and control system developed by the researchers and the advances therein. Educating the patient to develop acceptability to prosthesis and using the same for the most basic desired functions of human hand, post amputation care and to improve patient's independent life is equally important. In conclusion it can be interpreted that there is a wide scope in design in an adaptive mechanism for opening and closing of the fingers using other methods of path and position synthesis. Simple mechanisms and less parts may optimize the cost factor. Reduction in the weight of the prosthesis may be achieved using polymers used for engineering applications. Control system will remain never ending challenge for the researchers, but it is essential to maintain the simplicity from the patients perspective.

New approach to evaluate late arm impairment and effects of dragon boat activity in breast cancer survivors.

PubMed

Melchiorri, Giovanni; Viero, Valerio; Triossi, Tamara; Sorge, Roberto; Tancredi, Virginia; Cafaro, Domenico; Andreis, Caterina; Vulpiani, Maria Chiara; Saraceni, Vincenzo Maria

2017-11-01

To verify the applicability of a new approach based on the strength curves (SCs) methodology in late arm impairment in breast cancer (BC) survivors and to evaluate the effects of dragon boat (DB) activity on the late regaining of the muscle strength, upper limb impairment, and quality of life in patients undergoing surgery for BC.Retrospective observational study on 64 subjects (54.5 ± 9.7 years), 47 of them had undergone unilateral mastectomy surgery and were evaluated for late arm impairment. A clinical evaluation of the shoulder and compilation of functional assessment (DASH, Rowe, Constant-Murley) and quality of life (SF-36) scales were carried out. Assessment of muscle strength with SC obtained with isometric assessments and serratus anterior muscle test were performed.Differences between the SC are evident between healthy and operated subjects. Among the 3 groups of operated subjects the difference in strength is maximum at 0°. Statistically significant difference was found between operated and nonoperated only in SF-36 scale. No significant difference was found between groups for shoulder instability and winged scapula.The SC can be used in the study of upper limb impairment after surgery for BC: measurements carried out at 1st degrees of the range of motion are more useful for clinicians. DB activity is useful to reduce the late arm impairment.

The effects of electromyography-controlled functional electrical stimulation on upper extremity function and cortical perfusion in stroke patients.

PubMed

Hara, Yukihiro; Obayashi, Shigeru; Tsujiuchi, Kazuhito; Muraoka, Yoshihiro

2013-10-01

The relation was investigated between hemiparetic arm function improvement and brain cortical perfusion (BCP) change during voluntary muscle contraction (VOL), EMG-controlled FES (EMG-FES) and simple electrical muscle stimulation (ES) before and after EMG-FES therapy in chronic stroke patients. Sixteen chronic stroke patients with moderate residual hemiparesis underwent 5 months of task-orientated EMG-FES therapy of the paretic arm once or twice a week. Before and after treatment, arm function was clinically evaluated and BCP during VOL, ES and EMG-FES were assessed using multi-channel near-infrared spectroscopy. BCP in the ipsilesional sensory-motor cortex (SMC) was greater during EMG-FES than during VOL or ES; therefore, EMG-FES caused a shift in the dominant BCP from the contralesional to ipsilesional SMC. After EMG-FES therapy, arm function improved in most patients, with some individual variability, and there was significant improvement in Fugl-Meyer (FM) score and maximal grip strength (GS). Clinical improvement was accompanied by an increase in ipsilesional SMC activation during VOL and EMG-FES condition. The EMG-FES may have more influence on ipsilesional BCP than VOL or ES alone. The sensory motor integration during EMG-FES therapy might facilitate BCP of the ipsilesional SMC and result in functional improvement of hemiparetic upper extremity. Copyright © 2013 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

Neck Injuries and Disorders

MedlinePlus

... tendons, ligaments, or nerves - can cause neck problems. Neck pain is very common. Pain may also come from ... upper arms. Muscle strain or tension often causes neck pain. The problem is usually overuse, such as from ...

Genetics Home Reference: facioscapulohumeral muscular dystrophy

MedlinePlus

... those of the face (facio-), around the shoulder blades (scapulo-), and in the upper arms (humeral). The ... Weak shoulder muscles tend to make the shoulder blades (scapulae) protrude from the back, a common sign ...

Complex upper arm reconstruction using an antero-lateral thigh free flap after an extravasation of Yttrium-90-ibritumomab Tiuxetan: A case report and literature review.

PubMed

Baus, A; Keilani, C; Bich, C-S; Entine, F; Brachet, M; Duhamel, P; Amabile, J-C; Malfuson, J V; Bey, E

2018-04-01

Yttrium-90-Ibritumomab Tiuxetan (Zevalin ® ) is used in the treatment of non- Hodgkin's lymphoma. Extravasation is an iatrogenic complication that is fortunately rare. However, the treatment of this complication is often complex due to the risk of extensive skin necrosis and unpredictable evolution of localized irradiation. This vesicant drug requires emergency management when extravasation occured. Radiations burns have specificities. Therefore, wound coverage involves specific plastic surgical techniques. Here, we report the case of a man presenting a chronic and extensive skin necrosis of upper arm treated with an antero-lateral thigh free flap. Moreover, we compare our experience of Zevalin ® extravasation management to other past publications and propose recommendations to prevent this unacceptable complication. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Mid-upper arm circumference is associated with biochemically determined nutritional status indicators among adolescent girls in Central Mozambique.

PubMed

Kulathinal, Sangita; Freese, Riitta; Korkalo, Liisa; Ismael, Carina; Mutanen, Marja

2016-08-01

Biochemically determined nutritional status measurements in low-income countries are often too expensive. Therefore, we hypothesized that some anthropometrical or functional measurements (handgrip) could reflect nutritional status measured by specific biochemical indicators. We did a population-based study from 1 urban area and 2 rural districts in Zambézia Province of Mozambique. The participants (n=386) were non-pregnant adolescent girls between 15 and 18 years of age. 96% had a normal BMI-for-age score. Weight and mid-upper arm circumference (MUAC) were highly correlated (r>0.8) with each other and with total body muscle mass, body mass index (BMI), and with waist circumference, as well as with skinfolds (r>0.6). Upper and total arm lengths were correlated (r>0.7) with height and with each other, and right and left handgrip were correlated only with each other, as were triceps and subscapular skinfolds (r>0.7). Serum albumin correlated negatively with waist circumference (P<.001) and positively with MUAC (P=.007). Stepwise regressions showed that waist circumference, MUAC, weight, and handgrip were important nutritional status indicators in the models using hemoglobin, serum albumin, ferritin, zinc, and plasma retinol concentrations as dependent variables. MUAC could be a valuable anthropometric marker of the overall nutritional status of adolescent girls in low-income countries. When nutrition transition proceeds, waist circumference together with MUAC could form tools for the prediction of worsening of nutritional status. Copyright © 2016 Elsevier Inc. All rights reserved.

Upper arm circumference development in Chinese children and adolescents: a pooled analysis.

PubMed

Tong, Fang; Fu, Tong

2015-05-30

Upper arm development in children is different in different ethnic groups. There have been few reports on upper arm circumference (UAC) at different stages of development in children and adolescents in China. The purpose of this study was to provide a reference for growth with weighted assessment of the overall level of development. Using a pooled analysis, an authoritative journal database search and reports of UAC, we created a new database on developmental measures in children. In conducting a weighted analysis, we compared reference values for 0~60 months of development according to the World Health Organization (WHO) statistics considering gender and nationality and used Z values as interval values for the second sampling to obtain an exponential smooth curve to analyze the mean, standard deviation, and sites of attachment. Ten articles were included in the pooled analysis, and these articles included participants from different areas of China. The point of intersection with the WHO curve was 3.5 years with higher values at earlier ages and lower values at older ages. Boys curve was steeper after puberty. The curves in the studies had a merged line compatible. The Z values of exponential smoothing showed the curves were similar for body weight and had a right normal distribution. The integrated index of UAC in Chinese children and adolescents indicated slightly variations with regions. Exponential curve smoothing was suitable for assessment at different developmental stages.

Reliability and validity of the upper-extremity Motor Activity Log-14 for measuring real-world arm use.

PubMed

Uswatte, Gitendra; Taub, Edward; Morris, David; Vignolo, Mary; McCulloch, Karen

2005-11-01

In research on Constraint-Induced Movement (CI) therapy, a structured interview, the Motor Activity Log (MAL), is used to assess how stroke survivors use their more-impaired arm outside the laboratory. This article examines the psychometrics of the 14-item version of this instrument in 2 chronic stroke samples with mild-to-moderate upper-extremity hemiparesis. Participants (n=41) in the first study completed MALs before and after CI therapy or a placebo control procedure. In addition, caregivers independently completed a MAL on the participants. Participants (n=27) in the second study completed MALs and wore accelerometers that monitored their arm movements for 3 days outside the laboratory before and after an automated form of CI therapy. Validity of the participant MAL Quality of Movement (QOM) scale was supported. Correlations between pretreatment-to-posttreatment change scores on the participant QOM scale and caregiver MAL QOM scale, caregiver MAL amount of use (AOU) scale, and accelerometer recordings were 0.70, 0.73, and 0.91 (P<0.01), respectively. Internal consistency (alpha>0.81), test-retest reliability (r>0.91), stability, and responsiveness (ratio>3) of the participant QOM scale were also supported. The participant AOU and caregiver QOM and AOU scales were internally consistent, stable, and sensitive, but were not reliable. The participant MAL QOM scale can be used exclusively to reliably and validly measure real-world, upper-extremity rehabilitation outcome and functional status in chronic stroke patients with mild-to-moderate hemiparesis.

Validation of the AVITA BPM64 upper-arm blood pressure monitor for home blood pressure monitoring according to the European Society of Hypertension International Protocol revision 2010.

PubMed

Kang, Yuan-Yuan; Chen, Qi; Liu, Chang-Yuan; Li, Yan; Wang, Ji-Guang

2018-02-01

The aim of this study was to evaluate the accuracy of the automated oscillometric upper arm blood pressure (BP) monitor AVITA BPM64 for home BP monitoring according to the International Protocol of the European Society of Hypertension revision 2010. Systolic and diastolic BPs were measured sequentially in 33 adult Chinese (14 women, mean age 47.0 years) using a mercury sphygmomanometer (two observers) and the AVITA BPM64 device (one supervisor). A total of 99 pairs of comparisons were obtained from 33 participants for judgments in two parts with three grading phases. The AVITA BPM64 device achieved the targets in part 1 of the validation study. The number of absolute differences between device and observers within 5, 10, and 15 mmHg was 91/99, 98/99, and 98/99, respectively, for systolic BP and 92/99, 99/99, and 99/99, respectively, for diastolic BP. The device also fulfilled the criteria in part 2 of the validation study. Thirty-two participants for both systolic and diastolic BP had at least two of the three device-observer differences within 5 mmHg (required ≥24). Only one participant for systolic BP had all three device-observer comparisons greater than 5 mmHg. The AVITA upper arm BP monitor BPM64 has passed the requirements of the International Protocol revision 2010, and hence can be recommended for home use in adults.

Validation of the Beurer BM 44 upper arm blood pressure monitor for home measurement, according to the European Society of Hypertension International Protocol 2002.

PubMed

Lüders, Stephan; Krüger, Ralf; Zemmrich, Claudia; Forstner, Klaus; Sturm, Claus-Dieter; Bramlage, Peter

2012-12-01

The present study aimed to validate the automated upper arm blood pressure (BP) measuring device BM 44 for home BP monitoring according to the 2002 Protocol of the European Society of Hypertension. The most important new feature of the new device was an integrated 'WHO indicator', which categorizes the patient's individual result within the WHO recommendations for target BP by a coloured scale. Systolic and diastolic BPs were measured sequentially in 35 adult participants (16 men, 19 women) using a standard mercury y-tubed reference sphygmomanometer (two observers) and the BM 44 device (one supervisor). Ninety-nine pairs of comparisons were obtained from 15 participants in phase 1 and a further 18 participants in phase 2 of the validation study. The BM 44 device passed phase 1 of the validation study successfully with a number of absolute differences between device and observers of 5, 10 and 15 mmHg for at least 28 out of 25, 35 out of 35 and 40 out of 40 measurements, respectively. The device also achieved the targets for phases 2.1 and 2.2, with 23 and 26 participants having had at least two of three device-observers differences within 5 mmHg for systolic and diastolic BP, respectively. The Beurer BM 44 upper arm BP monitor has passed the International Protocol requirements, and hence can be recommended for home use in adults. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Goal setting, using goal attainment scaling, as a method to identify patient selected items for measuring arm function.

PubMed

Ashford, Stephen; Jackson, Diana; Turner-Stokes, Lynne

2015-03-01

Following stroke or brain injury, goals for rehabilitation of the hemiparetic upper limb include restoring active function if there is return of motor control or, if none is possible, improving passive function, and facilitating care for the limb. To inform development of a new patient reported outcome measure (PROM) of active and passive function in the hemiparetic upper limb, the Arm Activity measure, we examined functional goals for the upper limb, identified during goal setting for spasticity intervention (physical therapy and concomitant botulinum toxin A interventions). Using secondary analysis of a prospective observational cohort study, functional goals determined between patients, their carers and the clinical team were assigned into categories by two raters. Goal category identification, followed by assignment of goals to a category, was undertaken and then confirmed by a second reviewer. Participants comprised nine males and seven females of mean (SD) age 54.5 (15.7) years and their carers. Fifteen had sustained a stroke and one a traumatic brain injury. Goals were used to identify five categories: passive function, active function, symptoms, cosmesis and impairment. Two passive function items not previously identified by a previous systematic review were identified. Analysis of goals important to patients and carers revealed items for inclusion in a new measure of arm function and provide a useful alternative method to involve patients and carers in standardised measure development. Copyright © 2014 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Preliminary Study of the Effect of the Proposed Long Lake Valley Project Operation on the Transport of Larval Suckers in Upper Klamath Lake, Oregon

USGS Publications Warehouse

Wood, Tamara M.

2009-01-01

A hydrodynamic model of Upper Klamath and Agency Lakes, Oregon, was used to explore the effects of the operation of proposed offstream storage at Long Lake Valley on transport of larval suckers through the Upper Klamath and Agency Lakes system during May and June, when larval fish leave spawning sites in the Williamson River and springs along the eastern shoreline and become entrained in lake currents. A range in hydrologic conditions was considered, including historically high and low outflows and inflows, lake elevations, and the operation of pumps between Upper Klamath Lake and storage in Long Lake Valley. Two wind-forcing scenarios were considered: one dominated by moderate prevailing winds and another dominated by a strong reversal of winds from the prevailing direction. On the basis of 24 model simulations that used all combinations of hydrology and wind forcing, as well as With Project and No Action scenarios, it was determined that the biggest effect of project operations on larval transport was the result of alterations in project management of the elevation in Upper Klamath Lake and the outflow at the Link River and A Canal, rather than the result of pumping operations. This was because, during the spring time period of interest, the amount of water pumped between Upper Klamath Lake and Long Lake Valley was generally small. The dominant effect was that an increase in lake elevation would result in more larvae in the Williamson River delta and in Agency Lake, an effect that was enhanced under conditions of wind reversal. A decrease in lake elevation accompanied by an increase in the outflow at the Link River had the opposite effect on larval concentration and residence time.

Influence of exercise modality on cardiac parasympathetic and sympathetic indices during post-exercise recovery.

PubMed

Michael, Scott; Jay, Ollie; Graham, Kenneth S; Davis, Glen M

2018-02-12

This study investigated indirect measures of post-exercise parasympathetic reactivation (using heart-rate-variability, HRV) and sympathetic withdrawal (using systolic-time-intervals, STI) following upper- and lower-body exercise. Randomized, counter-balanced, crossover. 13 males (age 26.4±4.7years) performed maximal arm-cranking (MAX-ARM) and leg-cycling (MAX-LEG). Subsequently, participants undertook separate 8-min bouts of submaximal HR-matched exercise of each mode (ARM and LEG). HRV (including natural-logarithm of root-mean-square-of-successive-differences, Ln-RMSSD) and STI (including pre-ejection-period, PEP) were assessed throughout 10-min seated recovery. Peak-HR was higher (p=0.001) during MAX-LEG (182±7beatsmin -1 ) compared with MAX-ARM (171±12beatsmin -1 ), while HR (p<0.001) and Ln-RMSSD (p=0.010) recovered more rapidly following MAX-ARM. PEP recovery was similar between maximal bouts (p=0.106). HR during submaximal exercise was 146±7 (LEG) and 144±8beatsmin -1 (LEG) (p=0.139). Recovery of HR and Ln-RMSSD was also similar between submaximal modalities, remaining below baseline throughout recovery (p<0.001). PEP was similar during submaximal exercise (LEG 70±6ms; ARM 72±9ms; p=0.471) although recovery was slower following ARM (p=0.021), with differences apparent from 1- to 10-min recovery (p≤0.036). By 10-min post-exercise, PEP recovered to baseline (132±21ms) following LEG (130±21ms; p=0.143), but not ARM (121±17ms; p=0.001). Compared with submaximal lower-body exercise, HR-matched upper-body exercise elicited a similar recovery of HR and HRV indices of parasympathetic reactivation, but delayed recovery of PEP (reflecting sympathetic withdrawal). Exercise modality appears to influence post-exercise parasympathetic reactivation and sympathetic withdrawal in an intensity-dependent manner. These results highlight the need for test standardization and may be relevant to multi-discipline athletes and in clinical applications with varying modes of exercise testing. Copyright © 2018 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.