Sample records for upper extremity strength
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Lee, Suhyun; Kim, Yumi; Lee, Byoung-Hee
2016-12-01
In the present study, we aimed to investigate the effect of virtual reality-based bilateral upper extremity training (VRBT) on paretic upper limb function and muscle strength in patients with stroke. Eighteen stroke survivors were assigned to either the VRBT group (n = 10) or the bilateral upper limb training group (BT, n = 8). Patients in the VRBT group performed bilateral upper extremity exercises in a virtual reality environment, whereas those in the BT group performed conventional bilateral upper extremity exercises. All training was conducted for 30 minutes day -1 , 3 days a week, for a period of 6 weeks. Patients were assessed for upper extremity function and hand strength. Compared with the BT group, the VRBT group exhibited significant improvements in upper extremity function and muscle strength (p < 0.05) after the 6-week training programme. The Box and Block test results revealed that upper extremity function and elbow flexion in hand strength were significantly improved in terms of group, time and interaction effect of group by time. Furthermore, the VRBT group demonstrated significant improvements in upper extremity function, as measured by the Jebsen Hand Function Test and Grooved Pegboard test, and in the hand strength test, as measured by elbow extension, grip, palmar pinch, lateral pinch and tip pinch, in both time and the interaction effect of group by time. These results suggest that VRBT is a feasible and beneficial means of improving upper extremity function and muscle strength in individuals following stroke. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.
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Thorborg, K; Bandholm, T; Schick, M; Jensen, J; Hölmich, P
2013-08-01
Handheld dynamometry (HHD) is a promising tool for obtaining reliable hip strength measurements in the clinical setting, but intertester reliability has been questioned, especially in situations where testers exhibit differences in upper-extremity muscle strength (male vs female). The purpose of this study was to examine the intertester reliability concerning strength assessments of hip abduction, adduction, external and internal rotation, flexion and extension using HHD, and to test whether systematic differences in test values exist between testers of different upper-extremity strength. Fifty healthy individuals (29 women), aged 25 ± 5 years were included. Two physiotherapist students (one female, one male) of different upper-extremity strength performed the measurements. The tester order and strength test order were randomized. Intraclass correlation coefficients were used to quantify reliability, and ranged from 0.82 to 0.91 for the six strength test. The female tester systematically measured lower strength values for all isometric strength tests (P < 0.05). In hip strength assessments using HHD, systematic bias exists between testers of different sex, which is likely explained by differences in upper-extremity strength. Hence, to improve intertester reliability, the dynamometer likely needs external fixation, as this will eliminate the influence of differences in upper-extremity strength between testers. © 2011 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
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Upper Extremity Muscle Volumes and Functional Strength After Resistance Training in Older Adults
Daly, Melissa; Vidt, Meghan E.; Eggebeen, Joel D.; Simpson, W. Greg; Miller, Michael E.; Marsh, Anthony P.; Saul, Katherine R.
2014-01-01
Aging leads to a decline in strength and an associated loss of independence. The authors examined changes in muscle volume, maximum isometric joint moment, functional strength, and 1-repetition maximum (1RM) after resistance training (RT) in the upper extremity of older adults. They evaluated isometric joint moment and muscle volume as predictors of functional strength. Sixteen healthy older adults (average age 75 ± 4.3 yr) were randomized to a 6-wk upper extremity RT program or control group. The RT group increased 1RM significantly (p < .01 for all exercises). Compared with controls, randomization to RT led to greater functional pulling strength (p = .003), isometric shoulder-adduction moment (p = .041), elbow-flexor volume (p = .017), and shoulder-adductor volume (p = .009). Shoulder-muscle volumes and isometric moments were good predictors of functional strength. The authors conclude that shoulder strength is an important factor for performing functional reaching and pulling tasks and a key target for upper extremity RT interventions. PMID:22952203
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Muscle Strength and Changes in Physical Function in Women With Systemic Lupus Erythematosus.
Andrews, James S; Trupin, Laura; Schmajuk, Gabriela; Barton, Jennifer; Margaretten, Mary; Yazdany, Jinoos; Yelin, Edward H; Katz, Patricia P
2015-08-01
Cross-sectional studies have observed that muscle weakness is associated with worse physical function among women with systemic lupus erythematosus (SLE). The present study examines whether reduced upper and lower extremity muscle strength predict declines in function over time among adult women with SLE. One hundred forty-six women from a longitudinal SLE cohort participated in the study. All measures were collected during in-person research visits approximately 2 years apart. Upper extremity muscle strength was assessed by grip strength. Lower extremity muscle strength was assessed by peak knee torque of extension and flexion. Physical function was assessed using the Short Physical Performance Battery (SPPB). Regression analyses modeled associations of baseline upper and lower extremity muscle strength with followup SPPB scores controlling for baseline SPPB, age, SLE duration, SLE disease activity (Systemic Lupus Activity Questionnaire), physical activity level, prednisone use, body composition, and depression. Secondary analyses tested whether associations of baseline muscle strength with followup in SPPB scores differed between intervals of varying baseline muscle strength. Lower extremity muscle strength strongly predicted changes over 2 years in physical function even when controlling for covariates. The association of reduced lower extremity muscle strength with reduced physical function in the future was greatest among the weakest women. Reduced lower extremity muscle strength predicted clinically significant declines in physical function, especially among the weakest women. Future studies should test whether therapies that promote preservation of lower extremity muscle strength may prevent declines in function among women with SLE. © 2015, American College of Rheumatology.
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The Effect of Shoulder Plyometric Training on Amortization Time and Upper-Extremity Kinematics.
Swanik, Kathleen A; Thomas, Stephen J; Struminger, Aaron H; Bliven, Kellie C Huxel; Kelly, John D; Swanik, Charles B
2016-12-01
Plyometric training is credited with providing benefits in performance and dynamic restraint. However, limited prospective data exist quantifying kinematic adaptations such as amortization time, glenohumeral rotation, and scapulothoracic position, which may underlie the efficacy of plyometric training for upper-extremity rehabilitation or performance enhancement. To measure upper-extremity kinematics and plyometric phase times before and after an 8-wk upper-extremity strength- and plyometric-training program. Randomized pretest-posttest design. Research laboratory. 40 recreationally active men (plyometric group, age 20.43 ± 1.40 y, height 180.00 ± 8.80 cm, weight 73.07 ± 7.21 kg; strength group, age 21.95 ± 3.40 y, height 173.98 ± 11.91 cm, weight 74.79 ± 13.55 kg). Participants were randomly assigned to either a strength-training group or a strength- and plyometric-training group. Each participant performed the assigned training for 8 wk. Dynamic and static glenohumeral and scapular-rotation measurements were taken before and after the training programs. Dynamic measurement of scapular rotation and time spent in each plyometric phase (concentric, eccentric, and amortization) during a ball-toss exercise were recorded while the subjects were fitted with an electromagnetic tracking system. Static measures included scapular upward rotation at 3 different glenohumeral-abduction angles, glenohumeral internal rotation, and glenohumeral external rotation. Posttesting showed that both groups significantly decreased the time spent in the amortization, concentric, and eccentric phases of a ball-toss exercise (P < .01). Both groups also exhibited significantly decreased static external rotation and increased dynamic scapular upward rotation after the training period (P < .01). The only difference between the training protocols was that the plyometric-training group exhibited an increase in internal rotation that was not present in the strength-training group (P < .01). These findings support the use of both upper-extremity plyometrics and strength training for reducing commonly identified upper-extremity-injury risk factors and improving upper-extremity performance.
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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.
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Özcan Kahraman, Buse; Özsoy, İsmail; Acar, Serap; Özpelit, Ebru; Akdeniz, Bahri; Sevinç, Can; Savcı, Sema
2017-07-01
Pulmonary arterial hypertension (PAH) is a rare disease. Although muscle strength, exercise capacity, quality of life, and activities of daily living of patients with PAH are affected, it is not known how they are affected by disease severity. The purpose of the present study was to investigate effects of disease severity on upper extremity muscle strength, exercise capacity, and performance of activities of daily living in patients with PAH. Twenty-five patients with disease severity classified according to the New York Heart Association (NYHA) as functional class II (n=14) or class III (n=11) were included in the study. Upper-extremity exercise capacity and limitations in performing activities of daily living were assessed with 6-minute pegboard and ring test (6PBRT) and the Milliken activities of daily living scale (MAS), respectively. Shoulder flexion, elbow extension, elbow flexion muscle strength, and handgrip strength were measured with dynamometer. There were no significant differences in age, gender, body mass index, or mean pulmonary artery pressure between groups (p>0.05). The 6PBRT, MAS, and elbow flexion (right) and grip strength (right and left) results were significantly lower in NYHA III group than in NYHA II group (p=0.004, p=0.002, p=0.043, p=0.002 and p=0.003, respectively). There was no significant difference in shoulder flexion, elbow flexion (left), or elbow extension between groups (p>0.05). Results suggest that upper extremity exercise capacity, elbow flexion muscle strength (right), and handgrip strength decrease and that limitations in activities of daily living grow as disease severity increases in patients with PAH. When planning rehabilitation programs, disease severity should be considered and evaluations and treatments for the upper extremities should be included.
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Skinner, Jared W; Otzel, Dana M; Bowser, Andrew; Nargi, Daniel; Agarwal, Sanjay; Peterson, Mark D; Zou, Baiming; Borst, Stephen E; Yarrow, Joshua F
2018-06-01
Inconsistent fat-free mass (FFM) and muscle strength responses have been reported in randomized clinical trials (RCTs) administering testosterone replacement therapy (TRT) to middle-aged and older men. Our objective was to conduct a meta-analysis to determine whether TRT improves FFM and muscle strength in middle-aged and older men and whether the muscular responses vary by TRT administration route. Systematic literature searches of MEDLINE/PubMed and the Cochrane Library were conducted from inception through 31 March 2017 to identify double-blind RCTs that compared intramuscular or transdermal TRT vs. placebo and that reported assessments of FFM or upper-extremity or lower-extremity strength. Studies were identified, and data were extracted and validated by three investigators, with disagreement resolved by consensus. Using a random effects model, individual effect sizes (ESs) were determined from 31 RCTs reporting FFM (sample size: n = 1213 TRT, n = 1168 placebo) and 17 reporting upper-extremity or lower-extremity strength (n = 2572 TRT, n = 2523 placebo). Heterogeneity was examined, and sensitivity analyses were performed. When administration routes were collectively assessed, TRT was associated with increases in FFM [ES = 1.20 ± 0.15 (95% CI: 0.91, 1.49)], total body strength [ES = 0.90 ± 0.12 (0.67, 1.14)], lower-extremity strength [ES = 0.77 ± 0.16 (0.45, 1.08)], and upper-extremity strength [ES = 1.13 ± 0.18 (0.78, 1.47)] (P < 0.001 for all). When administration routes were evaluated separately, the ES magnitudes were larger and the per cent changes were 3-5 times greater for intramuscular TRT than for transdermal formulations vs. respective placebos, for all outcomes evaluated. Specifically, intramuscular TRT was associated with a 5.7% increase in FFM [ES = 1.49 ± 0.18 (1.13, 1.84)] and 10-13% increases in total body strength [ES = 1.39 ± 0.12 (1.15, 1.63)], lower-extremity strength [ES = 1.39 ± 0.17 (1.07, 1.72)], and upper-extremity strength [ES = 1.37 ± 0.17 (1.03, 1.70)] (P < 0.001 for all). In comparison, transdermal TRT was associated with only a 1.7% increase in FFM [ES = 0.98 ± 0.21 (0.58, 1.39)] and only 2-5% increases in total body [ES = 0.55 ± 0.17 (0.22, 0.88)] and upper-extremity strength [ES = 0.97 ± 0.24 (0.50, 1.45)] (P < 0.001). Interestingly, transdermal TRT produced no change in lower-extremity strength vs. placebo [ES = 0.26 ± 0.23 (-0.19, 0.70), P = 0.26]. Subanalyses of RCTs limiting enrolment to men ≥60 years of age produced similar results. Intramuscular TRT is more effective than transdermal formulations at increasing LBM and improving muscle strength in middle-aged and older men, particularly in the lower extremities. © 2018 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of the Society on Sarcopenia, Cachexia and Wasting Disorders.
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Lee, Han Suk; Park, Jeung Hun
2015-08-01
[Purpose] This study investigated the effects of Nordic walking on physical functions and depression in frail people aged 70 years and above. [Subjects] Twenty frail elderly individuals ≥70 years old were assigned to either a Nordic walking group (n=8) or general exercise group (n=10). [Methods] The duration of intervention was equal in both groups (3 sessions/week for 12 weeks, 60 min/session). Physical function (balance, upper extremity strength, lower extremity strength, weakness) and depression were examined before and after the interventions. [Results] With the exception of upper extremity muscle strength, lower extremity strength, weakness, balance, and depression after Nordic walking demonstrated statistically significant improvement. However, in the general exercise group, only balance demonstrated a statistically significant improvement after the intervention. There were significant differences in the changes in lower extremity muscle strength, weakness and depression between the groups. [Conclusion] In conclusion, Nordic walking was more effective than general exercise. Therefore, we suggest that Nordic walking may be an attractive option for significant functional improvement in frail people over 70 years old.
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Isokinetic profile of elbow flexion and extension strength in elite junior tennis players.
Ellenbecker, Todd S; Roetert, E Paul
2003-02-01
Descriptive study. To determine whether bilateral differences exist in concentric elbow flexion and extension strength in elite junior tennis players. The repetitive nature of tennis frequently produces upper extremity overuse injuries. Prior research has identified tennis-specific strength adaptation in the dominant shoulder and distal upper extremity musculature of elite players. No previous study has addressed elbow flexion and extension strength. Thirty-eight elite junior tennis players were bilaterally tested for concentric elbow flexion and extension muscle performance on a Cybex 6000 isokinetic dynamometer at 90 degrees/s, 210 degrees/s, and 300 degrees/s. Repeated-measures ANOVAs were used to test for differences between extremities, muscle groups, and speed. Significantly greater (P<0.002) dominant-arm elbow extension peak torque values were measured at 90 degrees/s, 210 degrees/s, and 300 degrees/s for males. Significantly greater (P<0.002) dominant-arm single-repetition work values were also measured at 90 degrees/s and 210 degrees/s for males. No significant difference was measured between extremities in elbow flexion muscular performance in males and for elbow flexion or extension peak torque and single-repetition work values in females. No significant difference between extremities was measured in elbow flexion/extension strength ratios in females and significant differences between extremities in this ratio were only present at 210 degrees/s in males (P<0.002). These data indicate muscular adaptations around the dominant elbow in male elite junior tennis players but not females. These data have ramifications for clinicians rehabilitating upper extremity injuries in patients from this population.
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Functional studies in 79-year-olds. II. Upper extremity function.
Lundgren-Lindquist, B; Sperling, L
1983-01-01
As part of the Gerontological and Geriatric Population Study of 79-year-old people in Göteborg, a representative subsample comprising 112 women and 93 men took part in a study of upper extremity function. Thirty-eight per cent of the women and 37% of the men had disorders in the upper extremities. The investigation included tests of co-ordination, static strength in the key-grip and the transversal volar grip, power capacity in opening jars and a bottle, basal movements in the upper extremities in personal hygiene and dressing activities, function in the kitchen e.g. reaching shelves, manual tasks including tests of pronation and supination of the forearm. In the key-grip as well as in the transversal volar grip men showed a generally larger decrease in strength with age than women compared to 70-year-olds in a previous population study. Significant correlations were found between strength in the key-grip and the performance time in the test of co-ordination. Women produced about 66% of the muscular force of the men when opening jars. Significant correlations were found between strength in the transversal volar grip and the maximal torque for opening the jars. Female and male subjects who were not capable of handling the electric plug in the manual ability test had significantly weaker strength in the key-grip. The importance of designing products and adapting the environment so as to correspond to the functional capacity of the elderly, is emphasized.
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Lowes, Linda P; Alfano, Lindsay N; Yetter, Brent A; Worthen-Chaudhari, Lise; Hinchman, William; Savage, Jordan; Samona, Patrick; Flanigan, Kevin M; Mendell, Jerry R
2013-03-14
Individuals with dystrophinopathy lose upper extremity strength in proximal muscles followed by those more distal. Current upper extremity evaluation tools fail to fully capture changes in upper extremity strength and function across the disease spectrum as they tend to focus solely on distal ability. The Kinect by Microsoft is a gaming interface that can gather positional information about an individual's upper extremity movement which can be used to determine functional reaching volume, velocity of movement, and rate of fatigue while playing an engaging video game. The purpose of this study was to determine the feasibility of using the Kinect platform to assess upper extremity function in individuals with dystrophinopathy across the spectrum of abilities. Investigators developed a proof-of-concept device, ACTIVE (Abilities Captured Through Interactive Video Evaluation), to measure functional reaching volume, movement velocity, and rate of fatigue. Five subjects with dystrophinopathy and 5 normal controls were tested using ACTIVE during one testing session. A single subject with dystrophinopathy was simultaneously tested with ACTIVE and a marker-based motion analysis system to establish preliminary validity of measurements. ACTIVE proof-of-concept ranked the upper extremity abilities of subjects with dystrophinopathy by Brooke score, and also differentiated them from performance of normal controls for the functional reaching volume and velocity tests. Preliminary test-retest reliability of the ACTIVE for 2 sequential trials was excellent for functional reaching volume (ICC=0.986, p<0.001) and velocity trials (ICC=0.963, p<0.001). The data from our pilot study with ACTIVE proof-of-concept demonstrates that newly available gaming technology has potential to be used to create a low-cost, widely-accessible and functional upper extremity outcome measure for use with children and adults with dystrophinopathy.
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Impact of whole-body rehabilitation in patients receiving chronic mechanical ventilation.
Martin, Ubaldo J; Hincapie, Luis; Nimchuk, Mark; Gaughan, John; Criner, Gerard J
2005-10-01
To evaluate the prevalence and magnitude of weakness in patients receiving chronic mechanical ventilation and the impact of providing aggressive whole-body rehabilitation on conventional weaning variables, muscle strength, and overall functional status. Retrospective analysis of 49 consecutive patients. Multidisciplinary ventilatory rehabilitation unit in an academic medical center. Forty-nine consecutive chronic ventilator-dependent patients referred to a tertiary care hospital ventilator rehabilitation unit. None. Patients were 58 +/- 7 yrs old with multiple etiologies for respiratory failure. On admission, all patients were bedridden and had severe weakness of upper and lower extremities measured by a 5-point muscle strength score and a 7-point Functional Independence Measurement. Postrehabilitation, patients had increases in upper and lower extremity strength (p < .05) and were able to stand and ambulate. All weaned from mechanical ventilation, but three required subsequent intermittent support. Six patients died before hospital discharge. Upper extremity strength on admission inversely correlated with time to wean from mechanical ventilation (R = .72, p < .001). : Patients receiving chronic ventilation are weak and deconditioned but respond to aggressive whole-body and respiratory muscle training with an improvement in strength, weaning outcome, and functional status. Whole-body rehabilitation should be considered a significant component of their therapy.
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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.
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Yildirim, Adem; Sürücü, Gülseren Dost; Karamercan, Ayşe; Gedik, Dilay Eken; Atci, Nermin; Dülgeroǧlu, Deniz; Özgirgin, Neşe
2016-11-21
A number of exercises to strengthen the upper extremities are recommended to increase functional independence and quality of life (QoL) in patients with paraplegia. Circuit resistance training (CRT) is a type of progressive resistive exercise performed repeatedly at fixed mechanical exercise stations. The aim of this study was to investigate the potential benefits of CRT for upper extremity muscle strength, functional independence, and QoL in patients with paraplegia. Twenty-six patients with paraplegia who were participating in a conventional rehabilitation program at a tertiary education and research hospital were enrolled in this study. The participants were randomly assigned to two groups. The exercise group participated in the CRT program, which consisted of repetitive exercises for the upper extremities performed at fixed mechanical stations 5 sessions per week for 6 weeks, in addition to conventional rehabilitation. Participants in the control group received only conventional rehabilitation over the same period. We compared the groups with respect to QoL, as well as isokinetic muscle test outcomes in the upper extremities, using the Functional Independence Measure (FIM) and Borg's scale. We observed significant increases in scores on the physical component of the FIM, Borg's scale, and QoL in both the exercise and control groups. Furthermore, the large majority of isokinetic values were significantly more improved in the exercise group compared to the control group. When post-treatment outcomes were compared between the groups, improvements in scores on the physical component of the FIM and in most isokinetic values were significantly greater in the exercise group. This study showed that CRT has positive effects on muscle strength in the upper extremities and the physical disability components of the FIM when added to conventional rehabilitation programs for paraplegic patients. However, we observed no significant improvement in QoL scores after adding CRT to a conventional treatment regime. Randomized trial (Level II).
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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.
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Munguía-Izquierdo, Diego; Legaz-Arrese, Alejandro
2012-11-01
To evaluate the reliability, standard error of the mean (SEM), clinical significant change, and known group validity of 2 assessments of endurance strength to low loads in patients with fibromyalgia syndrome (FS). Cross-sectional reliability and comparative study. University Pablo de Olavide, Seville, Spain. Middle-aged women with FS (n=95) and healthy women (n=64) matched for age, weight, and body mass index (BMI) were recruited for the study. Not applicable. The endurance strength to low loads tests of the upper and lower extremities and anthropometric measures (BMI) were used for the evaluations. The differences between the readings (tests 1 and 2) and the SDs of the differences, intraclass correlation coefficient (ICC) model (2,1), 95% confidence interval for the ICC, coefficient of repeatability, intrapatient SD, SEM, Wilcoxon signed-rank test, and Bland-Altman plots were used to examine reliability. A Mann-Whitney U test was used to analyze the differences in test values between the patient group and the control group. We hypothesized that patients with FS would have an endurance strength to low loads performance in lower and upper extremities at least twice as low as that of the healthy controls. Satisfactory test-retest reliability and SEMs were found for the lower extremity, dominant arm, and nondominant arm tests (ICC=.973-.979; P<.001; SEMs=1.44-1.66 repetitions). The differences in the mean between the test and retest were lower than the SEM for all performed tests, varying from -.10 to .29 repetitions. No significant differences were found between the test and retest (P>.05 for all). The Bland-Altman plots showed 95% limits of agreement for the lower extremity (4.7 to -4.5), dominant arm (3.8 to -4.4), and nondominant arm (3.9 to -4.1) tests. The endurance strength to low loads test scores for the patients with FS were 4-fold lower than for the controls in all performed tests (P<.001 for all). The endurance strength to low loads tests showed good reliability and known group validity and can be recommended for evaluating endurance strength to low loads in patients with FS. For individual evaluation, however, an improved score of at least 4 and 5 repetitions for the upper and lower extremities, respectively, was required for the differences to be considered as substantial clinical change. Patients with FS showed impaired endurance strength to low loads performance when compared with the general population. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
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Zwaan, Eva M; IJsselmuiden, Alexander J J; van Rosmalen, Joost; van Geuns, Robert-Jan M; Amoroso, Giovanni; Moerman, Esther; Ritt, Marco J P F; Schreuders, Ton A R; Kofflard, Marcel J M; Holtzer, Carlo A J
2016-12-01
The aim of this study is to provide a complete insight in the access-site morbidity and upper extremity function after Transradial Percutaneous Coronary Intervention (TR-PCI). In percutaneous coronary intervention the Transradial Approach (TRA) is gaining popularity as a default technique. It is a very promising technique with respect to post-procedure complications, but the exact effects of TRA on upper extremity function are unknown. The effects of trAnsRadial perCUtaneouS coronary intervention on upper extremity function (ARCUS) trial is a multicenter prospective cohort study that will be conducted in all patients admitted for TR-PCI. Clinical outcomes will be monitored during a follow-up of 6 months, with its primary endpoint at two weeks of follow-up. To investigate the complete upper extremity function, a combination of physical examinations and validated questionnaires will be used to provide information on anatomical integrity, strength, range of motion (ROM), coordination, sensibility, pain, and functioning in everyday life. Procedural and material specifications will be registered in order to include all possible aspects influencing upper extremity function. Results from this study will elucidate the effect of TR-PCI on upper extremity function. This creates the opportunity to further optimize TR-PCI, to make improvements in functional outcome and to prevent morbidity regarding full upper extremity function. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.
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Pedersen, Mogens Theisen; Andersen, Christoffer H; Zebis, Mette K; Sjøgaard, Gisela; Andersen, Lars L
2013-10-09
Previous studies have shown positive effects of physical exercise at the workplace on musculoskeletal disorders. However, long-term adherence remains a challenge. The present study evaluates long-term adherence and effects of a workplace strength training intervention on back, neck and upper extremity pain among laboratory technicians. Cluster-randomized controlled trial involving 537 industrial laboratory technicians. Subjects were randomized at the cluster level to one of two groups: training group 1 (TG1, n = 282) performing supervised strength training from February to June 2009 (round one) or training group 2 (TG2, n = 255) performing supervised strength training from August to December 2009 (round two). The outcome measures were changes in self-reported pain intensity (0-9) in the back, neck and upper extremity as well as Disability of the Arm, Shoulder and Hand (DASH, 0-100). Regular adherence, defined as at least one training session per week, was achieved by around 85% in both groups in the supervised training periods. In the intention-to-treat analyses there were significant group by time effects for pain in the neck, right shoulder, right hand and lower back and DASH-resulting in significant reductions in pain (mean 0.3 to 0.5) and DASH (mean 3.9) in the scheduled training group compared to the reference group. For TG1 there were no significant changes in pain in round two, i.e. they maintained the pain reduction achieved in round one. Subgroup analyses among those with severe pain (> = 3 on a scale of 0-9) showed a significant group by time effect for pain in the neck, right shoulder, upper back and lower back. For these subgroups the pain reduction in response to training ranged from 1.1 to 1.8. Specific strength training at the workplace can lead to significant long-term reductions in spinal and upper extremity pain and DASH. The pain reductions achieved during the intensive training phase with supervision appears to be maintained a half year later.
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Crockett, K; Arnold, C M; Farthing, J P; Chilibeck, P D; Johnston, J D; Bath, B; Baxter-Jones, A D G; Kontulainen, S A
2015-10-01
Distal radius (wrist) fracture (DRF) in women over age 50 years is an early sign of bone fragility. Women with a recent DRF compared to women without DRF demonstrated lower bone strength, muscle density, and strength, but no difference in dual-energy x-ray absorptiometry (DXA) measures, suggesting DXA alone may not be a sufficient predictor for DRF risk. The objective of this study was to investigate differences in bone and muscle properties between women with and without a recent DRF. One hundred sixty-six postmenopausal women (50-78 years) were recruited. Participants were excluded if they had taken bone-altering medications in the past 6 months or had medical conditions that severely affected daily living or the upper extremity. Seventy-seven age-matched women with a fracture in the past 6-24 months (Fx, n = 32) and without fracture (NFx, n = 45) were measured for bone and muscle properties using the nondominant (NFx) or non-fractured limb (Fx). Peripheral quantitative computed tomography (pQCT) was used to estimate bone strength in compression (BSIc) at the distal radius and tibia, bone strength in torsion (SSIp) at the shaft sites, muscle density, and area at the forearm and lower leg. Areal bone mineral density at the ultradistal forearm, spine, and femoral neck was measured by DXA. Grip strength and the 30-s chair stand test were used as estimates of upper and lower extremity muscle strength. Limb-specific between-group differences were compared using multivariate analysis of variance (MANOVA). There was a significant group difference (p < 0.05) for the forearm and lower leg, with the Fx group demonstrating 16 and 19% lower BSIc, 3 and 6% lower muscle density, and 20 and 21% lower muscle strength at the upper and lower extremities, respectively. There were no differences between groups for DXA measures. Women with recent DRF had lower pQCT-derived estimated bone strength at the distal radius and tibia and lower muscle density and strength at both extremities.
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"Ballistic Six" Upper-Extremity Plyometric Training for the Pediatric Volleyball Players.
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.
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Effect of mirror therapy with tDCS on functional recovery of the upper extremity of stroke patients.
Cho, Hyuk-Shin; Cha, Hyun-Gyu
2015-04-01
[Purpose] This study aimed to determine the effect of mirror therapy (MT) with transcranial direct current stimulation (tDCS) on the recovery of the upper extremity function of chronic stroke patients. [Subjects] Twenty-seven patients at least 6 months after stroke onset were divided randomly into an experimental group (14 patients) and a control group (13 patients). [Methods] All subjects received tDCS for 20 min followed by a 5 min rest. Then the experimental group received MT while the control group conducted the same exercises as the experimental group using a mirror that did not show the non-paretic upper extremity. The groups performed the same exercises for 20 min. All subjects received this intervention for 45-min three times a week for 6 weeks. [Results] After the intervention, the experimental group showed significant improvements in the box and block test (BBT), grip strength, and the Fugl-Meyer assessment (FMA), and a significant decrease in the Jebsen-Taylor test. The control group showed a significant increase in grip strength after the intervention, and a significant decrease in the Jebsen-Taylor test. Comparison of the result after the intervention revealed that the experimental group showed more significant increases in the BBT and grip strength than the control group. [Conclusion] These results show that MT with tDCS has a positive effect on the functional recovery of the upper extremity of stroke patients, through activating motor regions in the brain, and thus plays an important role in recovery of neuroplasticity.
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McGinley, Samantha K; Armstrong, Marni J; Boulé, Normand G; Sigal, Ronald J
2015-04-01
Resistance exercise using free weights or weight machines improves glycaemic control and strength in people with type 2 diabetes. Resistance band training is potentially less expensive and more accessible, but the effects of resistance band training on glycaemic control and strength in this population are not well understood. This paper aims to systematically review and meta-analyse the effect of resistance band training on haemoglobin A1c (HbA1c) and strength in adults with type 2 diabetes. Database searches were performed in August 2013 (MEDLINE, SPORTDiscus, EMBASE, and CINAHL). Reference lists of eligible articles were hand-searched for additional studies. Randomised trials evaluating the effects of resistance band training in adults with type 2 diabetes on HbA1c or objectively measured strength were selected. Baseline and post-intervention HbA1c and strength were extracted for the intervention and control groups. Details of the exercise interventions and methodological quality were collected. Seven trials met inclusion criteria. Post-intervention-weighted mean HbA1c was nonsignificantly lower in exercise groups compared to control groups [weighted mean difference (WMD) = -0.18 percentage points (-1.91 mmol/mol); P = 0.27]. Post-intervention strength was significantly higher in the exercise groups compared to the control groups in the lower extremities (WMD = 21.90 kg; P < 0.0001), but not in the upper extremities (WMD = 2.27 kg; P = 0.13) or handgrip (WMD = 1.98 kg; P = 0.46). All trials were small and had methodological limitations. Resistance band training did not significantly affect HbA1c, upper extremity, or handgrip strength but significantly increased the strength of the lower extremities in people with type 2 diabetes.
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Choi, Jun Hwan; Kim, Bo Ryun; Kim, Sun Mi; Im, Sang Hee; Lee, So Young; Hyun, Chul Woong
2014-01-01
Objective To investigate the effectiveness of commercial gaming-based virtual reality (VR) therapy on the recovery of paretic upper extremity in subacute stroke patients. Methods Twenty patients with the first-onset subacute stroke were enrolled and randomly assigned to the case group (n=10) and the control group (n=10). Primary outcome was measured by the upper limb score through the Fugl-Meyer Assessment (FMA-UL) for the motor function of both upper extremities. Secondary outcomes were assessed for motor function of both upper extremities including manual function test (MFT), box and block test (BBT), grip strength, evaluated for activities of daily living (Korean version of Modified Barthel Index [K-MBI]), and cognitive functions (Korean version of the Mini-Mental State Examination [K-MMSE] and continuous performance test [CPT]). The case group received commercial gaming-based VR therapy using Wii (Nintendo, Tokyo, Japan), and the control group received conventional occupational therapy (OT) for 30 minutes a day during the period of 4 weeks. All patients were evaluated before and after the 4-week intervention. Results There were no significant differences in the baseline between the two groups. After 4 weeks, both groups showed significant improvement in the FMA-UL, MFT, BBT, K-MBI, K-MMSE, and correct detection of auditory CPT. However, grip strength was improved significantly only in the case group. There were no significant intergroup differences before and after the treatment. Conclusion These findings suggested that the commercial gaming-based VR therapy was as effective as conventional OT on the recovery of upper extremity motor and daily living function in subacute stroke patients. PMID:25229027
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Choi, Jun Hwan; Han, Eun Young; Kim, Bo Ryun; Kim, Sun Mi; Im, Sang Hee; Lee, So Young; Hyun, Chul Woong
2014-08-01
To investigate the effectiveness of commercial gaming-based virtual reality (VR) therapy on the recovery of paretic upper extremity in subacute stroke patients. Twenty patients with the first-onset subacute stroke were enrolled and randomly assigned to the case group (n=10) and the control group (n=10). Primary outcome was measured by the upper limb score through the Fugl-Meyer Assessment (FMA-UL) for the motor function of both upper extremities. Secondary outcomes were assessed for motor function of both upper extremities including manual function test (MFT), box and block test (BBT), grip strength, evaluated for activities of daily living (Korean version of Modified Barthel Index [K-MBI]), and cognitive functions (Korean version of the Mini-Mental State Examination [K-MMSE] and continuous performance test [CPT]). The case group received commercial gaming-based VR therapy using Wii (Nintendo, Tokyo, Japan), and the control group received conventional occupational therapy (OT) for 30 minutes a day during the period of 4 weeks. All patients were evaluated before and after the 4-week intervention. There were no significant differences in the baseline between the two groups. After 4 weeks, both groups showed significant improvement in the FMA-UL, MFT, BBT, K-MBI, K-MMSE, and correct detection of auditory CPT. However, grip strength was improved significantly only in the case group. There were no significant intergroup differences before and after the treatment. These findings suggested that the commercial gaming-based VR therapy was as effective as conventional OT on the recovery of upper extremity motor and daily living function in subacute stroke patients.
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Izawa, Kazuhiro P; Kasahara, Yusuke; Hiraki, Koji; Hirano, Yasuyuki; Watanabe, Satoshi
2017-11-27
Background: The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire is a valid and reliable patient-reported outcome measure. DASH can be assessed by self-reported upper extremity disability and symptoms. We aimed to examine the relationship between the physiological outcome of muscle strength and the DASH score after cardiac surgery. Methods: This cross-sectional study assessed 50 consecutive cardiac patients that were undergoing cardiac surgery. Physiological outcomes of handgrip strength and knee extensor muscle strength and the DASH score were measured at one month after cardiac surgery and were assessed. Results were analyzed using Spearman correlation coefficients. Results: The final analysis comprised 43 patients (men: 32, women: 11; age: 62.1 ± 9.1 years; body mass index: 22.1 ± 4.7 kg/m²; left ventricular ejection fraction: 53.5 ± 13.7%). Respective handgrip strength, knee extensor muscle strength, and DASH score were 27.4 ± 8.3 kgf, 1.6 ± 0.4 Nm/kg, and 13.3 ± 12.3, respectively. The DASH score correlated negatively with handgrip strength ( r = -0.38, p = 0.01) and with knee extensor muscle strength ( r = -0.32, p = 0.04). Conclusion: Physiological outcomes of both handgrip strength and knee extensor muscle strength correlated negatively with the DASH score. The DASH score appears to be a valuable tool with which to assess cardiac patients with poor physiological outcomes, particularly handgrip strength as a measure of upper extremity function, which is probably easier to follow over time than lower extremity function after patients complete cardiac rehabilitation.
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Characterization of Strength and Function in Ambulatory Adults With GNE Myopathy.
Argov, Zohar; Bronstein, Faye; Esposito, Alicia; Feinsod-Meiri, Yael; Florence, Julaine M; Fowler, Eileen; Greenberg, Marcia B; Malkus, Elizabeth C; Rebibo, Odelia; Siener, Catherine S; Caraco, Yoseph; Kolodny, Edwin H; Lau, Heather A; Pestronk, Alan; Shieh, Perry; Skrinar, Alison M; Mayhew, Jill E
2017-09-01
To characterize the pattern and extent of muscle weakness and impact on physical functioning in adults with GNEM. Strength and function were assessed in GNEM subjects (n = 47) using hand-held dynamometry, manual muscle testing, upper and lower extremity functional capacity tests, and the GNEM-Functional Activity Scale (GNEM-FAS). Profound upper and lower muscle weakness was measured using hand-held dynamometry in a characteristic pattern, previously described. Functional tests and clinician-reported outcomes demonstrated the consequence of muscle weakness on physical functioning. The characteristic pattern of upper and lower muscle weakness associated with GNEM and the resulting functional limitations can be reliably measured using these clinical outcome assessments of muscle strength and function.
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El-Shamy, Shamekh; Alsharif, Rabab
2017-01-01
Objectives: The objective was to evaluate the effects of virtual reality versus conventional physiotherapy on upper extremity function in children with obstetric brachial plexus injury. Methods: Forty children with Erb’s palsy were selected for this randomized controlled study. They were assigned randomly to either group A (conventional physiotherapy program) or group B (virtual reality program using Armeo® spring for 45 min three times/week for 12 successive weeks). Mallet system scores for shoulder function and shoulder abduction, and external rotation range of motion (ROM) were obtained; shoulder abductor, and external rotators isometric strength were evaluated pre-and post-treatment using Mallet scoring system, standard universal goniometer, and handheld dynamometer. Results: The results of this study indicate that the children in both groups showed improvement in shoulder functions post-treatment with greater improvements in group B. The abduction muscle strength after treatment was 8.53 and 11.3 Nm for group A and group B, respectively. The external rotation muscle strength after treatment was 5.88 and 7.45 Nm for group A and group B, respectively. Conclusions: The virtual reality program is a significantly more effective than conventional physiotherapy program in improving the upper extremity functions in children with obstetric brachial plexus injury. PMID:29199193
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Nerve Transfer Surgery for Penetrating Upper Extremity Injuries
Karamanos, Efstathios; Rakitin, Ilya; Dream, Sophie; Siddiqui, Aamir
2018-01-01
Context Nerve transfer surgery is an option for repair of penetrating injuries of the upper extremity. In the right setting, it has advantages over tendon transfers and nerve grafting. Objective To review our experience since 2006 of nerve transfer surgery in the upper extremities. Design We included cases performed to repair penetrating trauma within three months of injury with at least three years’ follow-up. Main Outcome Measures Preoperative and postoperative muscle strength of the affected extremity. Results All 16 patients were males aged 16 to 43 years. Six patients underwent nerve transfer surgery because of elbow flexion; 5, finger extension; 3, finger flexion; and 2, wrist pronation. Nine patients (56%) had associated vascular injury, and 4 (25%) had fractures. Average follow-up was 6 years. No perioperative complications occurred. Patients had a mean of 3.7 operations after the initial trauma. All patients received physical therapy. All patients improved from 0 of 5 muscle strength preoperatively to a mean of 3.8 (range = 2/5 to 5/5) within 1 year after surgery. In all cases, strength was maintained, and 8 (50%) had continued improvement after Year 1. Ten (63%) returned to their previous employment level. Mean Disabilities of the Arm, Shoulder and Hand score improved from 68 to 83 postoperatively. Conclusion Nerve transfer is a safe, effective technique for correcting penetrating trauma-related nerve injury. In appropriate patients it offers advantages over other techniques. Outcomes can be maintained long term, and many patients can return to their previous level of function. PMID:29702048
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Sensory stimulation augments the effects of massed practice training in persons with tetraplegia.
Beekhuizen, Kristina S; Field-Fote, Edelle C
2008-04-01
To compare functional changes and cortical neuroplasticity associated with hand and upper extremity use after massed (repetitive task-oriented practice) training, somatosensory stimulation, massed practice training combined with somatosensory stimulation, or no intervention, in persons with chronic incomplete tetraplegia. Participants were randomly assigned to 1 of 4 groups: massed practice training combined with somatosensory peripheral nerve stimulation (MP+SS), somatosensory peripheral nerve stimulation only (SS), massed practice training only (MP), and no intervention (control). University medical school setting. Twenty-four subjects with chronic incomplete tetraplegia. Intervention sessions were 2 hours per session, 5 days a week for 3 weeks. Massed practice training consisted of repetitive practice of functional tasks requiring skilled hand and upper-extremity use. Somatosensory stimulation consisted of median nerve stimulation with intensity set below motor threshold. Pre- and post-testing assessed changes in functional hand use (Jebsen-Taylor Hand Function Test), functional upper-extremity use (Wolf Motor Function Test), pinch grip strength (key pinch force), sensory function (monofilament testing), and changes in cortical excitation (motor evoked potential threshold). The 3 groups showed significant improvements in hand function after training. The MP+SS and SS groups had significant improvements in upper-extremity function and pinch strength compared with the control group, but only the MP+SS group had a significant change in sensory scores compared with the control group. The MP+SS and MP groups had greater change in threshold measures of cortical excitability. People with chronic incomplete tetraplegia obtain functional benefits from massed practice of task-oriented skills. Somatosensory stimulation appears to be a valuable adjunct to training programs designed to improve hand and upper-extremity function in these subjects.
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Kasahara, Yusuke; Hiraki, Koji; Hirano, Yasuyuki; Watanabe, Satoshi
2017-01-01
Background: The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire is a valid and reliable patient-reported outcome measure. DASH can be assessed by self-reported upper extremity disability and symptoms. We aimed to examine the relationship between the physiological outcome of muscle strength and the DASH score after cardiac surgery. Methods: This cross-sectional study assessed 50 consecutive cardiac patients that were undergoing cardiac surgery. Physiological outcomes of handgrip strength and knee extensor muscle strength and the DASH score were measured at one month after cardiac surgery and were assessed. Results were analyzed using Spearman correlation coefficients. Results: The final analysis comprised 43 patients (men: 32, women: 11; age: 62.1 ± 9.1 years; body mass index: 22.1 ± 4.7 kg/m2; left ventricular ejection fraction: 53.5 ± 13.7%). Respective handgrip strength, knee extensor muscle strength, and DASH score were 27.4 ± 8.3 kgf, 1.6 ± 0.4 Nm/kg, and 13.3 ± 12.3, respectively. The DASH score correlated negatively with handgrip strength (r = −0.38, p = 0.01) and with knee extensor muscle strength (r = −0.32, p = 0.04). Conclusion: Physiological outcomes of both handgrip strength and knee extensor muscle strength correlated negatively with the DASH score. The DASH score appears to be a valuable tool with which to assess cardiac patients with poor physiological outcomes, particularly handgrip strength as a measure of upper extremity function, which is probably easier to follow over time than lower extremity function after patients complete cardiac rehabilitation. PMID:29186880
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Characterization of Strength and Function in Ambulatory Adults With GNE Myopathy
Argov, Zohar; Bronstein, Faye; Esposito, Alicia; Feinsod-Meiri, Yael; Florence, Julaine M.; Fowler, Eileen; Greenberg, Marcia B.; Malkus, Elizabeth C.; Rebibo, Odelia; Siener, Catherine S.; Caraco, Yoseph; Kolodny, Edwin H.; Lau, Heather A.; Pestronk, Alan; Shieh, Perry; Mayhew, Jill E.
2017-01-01
Abstract Objective: To characterize the pattern and extent of muscle weakness and impact on physical functioning in adults with GNEM. Methods: Strength and function were assessed in GNEM subjects (n = 47) using hand-held dynamometry, manual muscle testing, upper and lower extremity functional capacity tests, and the GNEM-Functional Activity Scale (GNEM-FAS). Results: Profound upper and lower muscle weakness was measured using hand-held dynamometry in a characteristic pattern, previously described. Functional tests and clinician-reported outcomes demonstrated the consequence of muscle weakness on physical functioning. Conclusions: The characteristic pattern of upper and lower muscle weakness associated with GNEM and the resulting functional limitations can be reliably measured using these clinical outcome assessments of muscle strength and function. PMID:28827485
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Gagnon, Dany H; Roy, Audrey; Gabison, Sharon; Duclos, Cyril; Verrier, Molly C; Nadeau, Sylvie
2016-01-01
Objectives. To quantify the association between performance-based manual wheelchair propulsion tests (20 m propulsion test, slalom test, and 6 min propulsion test), trunk and upper extremity (U/E) strength, and seated reaching capability and to establish which ones of these variables best predict performance at these tests. Methods. 15 individuals with a spinal cord injury (SCI) performed the three wheelchair propulsion tests prior to discharge from inpatient SCI rehabilitation. Trunk and U/E strength and seated reaching capability with unilateral hand support were also measured. Bivariate correlation and multiple linear regression analyses allowed determining the best determinants and predictors, respectively. Results. The performance at the three tests was moderately or strongly correlated with anterior and lateral flexion trunk strength, anterior seated reaching distance, and the shoulder, elbow, and handgrip strength measures. Shoulder adductor strength-weakest side explained 53% of the variance on the 20-meter propulsion test-maximum velocity. Shoulder adductor strength-strongest side and forward seated reaching distance explained 71% of the variance on the slalom test. Handgrip strength explained 52% of the variance on the 6-minute propulsion test. Conclusion. Performance at the manual wheelchair propulsion tests is explained by a combination of factors that should be considered in rehabilitation.
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McCormick, Zachary L; Nelson, Ariana; Kendall, Mark C; McCarthy, Robert J; Nagpal, Geeta; Walega, David R
2017-12-01
Low-dose local anesthetic is often used in cervical interlaminar epidural steroid injections (CIESI), yet its effect on upper extremity strength has not been studied. The presence of consequent weakness has potential implications for postprocedure safety. This study aimed to determine whether low-dose lidocaine in a C7-T1 CIESI causes objective weakness. Prospective case series. Academic pain center. Adults, cervical radicular pain. Participants underwent CIESI with 1 mL of 1% lidocaine (3 mL total injectate). Elbow flexion (EF), wrist extension (WE), elbow extension (EE), and handgrip strength were measured by dynamometry at baseline, 15 minutes, and 30 minutes postinjection. Changes in strength from baseline and the proportion of participants with a minimum perceptible change in EF, WE, EE, and handgrip strength (≥20%) and 95% confidence intervals (CIs) were calculated. Twenty-seven participants were included. At 15 and 30 minutes postinjection, there was no within-participant difference in EF, WE, EE, and handgrip strength from baseline overall. Nonetheless, five (19%, 95% CI = 4-33) of the participants demonstrated a 20% or greater strength decrease in at least one myotomal distribution. A 20% or greater decrease in strength was present in left EF 4% (95% CI = 0-11%), right EF 7% (95% CI = 0-17%), left WE 4% (95% CI = 0-11%), and right WE 7% (95% CI = 0-17%). The present data suggest that CIESI with an injectate volume of 3 mL that includes 1 mL of 1% lidocaine may result in objective upper extremity weakness that is above the minimum threshold of perception in a subset of patients. © 2017 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com
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Timing of rehabilitation in children with obstetric upper trunk brachial plexus palsy.
Yilmaz, Volkan; Umay, Ebru; Tezel, Nihal; Gundogdu, Ibrahim
2018-06-01
The initiation timing of rehabilitation in children with obstetric brachial plexus palsy is controversial. The aim of the present study is to evaluate the effectiveness of rehabilitation timing to the functional outcomes of patients with obstetric upper trunk brachial plexus palsy. Twenty-nine patients, who did not previously received any rehabilitation programme but attended our outpatient clinic, were included for the study. The electrophysiological findings, obstetric characteristics, and demographic features of the patients were recorded. The range of motion (ROM) of shoulders, elbows, and wrists and the strength of the muscles associated with these joints were evaluated. Modified Mallet Scale (MMS) was used for functional evaluation. A 4-week rehabilitation programme was performed twice at 2-month intervals. Patients were divided into three groups according to their ages as follows: 1-3 years old (group 1), 3-5 years old (group 2), and 5-7 years old (group 3). The ROMs, muscle strengths, and MMS scores of the patients were all evaluated. Two out of 29 patients were female (6.9%) and 27 were male (93.1%). All 29 patients had right upper extremity palsy (100%). The MMS scores, ROMs, and muscle strength of the upper extremities had improved in all the groups following the standardized rehabilitation programme. A rehabilitation programme is the best choice of treatment before surgical procedures in patients with mild to moderate obstetric upper trunk brachial plexus palsy regardless of age and the initiation time.
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Roy, Audrey; Gabison, Sharon; Verrier, Molly C.
2016-01-01
Objectives. To quantify the association between performance-based manual wheelchair propulsion tests (20 m propulsion test, slalom test, and 6 min propulsion test), trunk and upper extremity (U/E) strength, and seated reaching capability and to establish which ones of these variables best predict performance at these tests. Methods. 15 individuals with a spinal cord injury (SCI) performed the three wheelchair propulsion tests prior to discharge from inpatient SCI rehabilitation. Trunk and U/E strength and seated reaching capability with unilateral hand support were also measured. Bivariate correlation and multiple linear regression analyses allowed determining the best determinants and predictors, respectively. Results. The performance at the three tests was moderately or strongly correlated with anterior and lateral flexion trunk strength, anterior seated reaching distance, and the shoulder, elbow, and handgrip strength measures. Shoulder adductor strength-weakest side explained 53% of the variance on the 20-meter propulsion test-maximum velocity. Shoulder adductor strength-strongest side and forward seated reaching distance explained 71% of the variance on the slalom test. Handgrip strength explained 52% of the variance on the 6-minute propulsion test. Conclusion. Performance at the manual wheelchair propulsion tests is explained by a combination of factors that should be considered in rehabilitation. PMID:27635262
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Sallés, Laia; Martín-Casas, Patricia; Gironès, Xavier; Durà, María José; Lafuente, José Vicente; Perfetti, Carlo
2017-04-01
[Purpose] This study aims to describe a protocol based on neurocognitive therapeutic exercises and determine its feasibility and usefulness for upper extremity functionality when compared with a conventional protocol. [Subjects and Methods] Eight subacute stroke patients were randomly assigned to a conventional (control group) or neurocognitive (experimental group) treatment protocol. Both lasted 30 minutes, 3 times a week for 10 weeks and assessments were blinded. Outcome measures included: Motor Evaluation Scale for Upper Extremity in Stroke Patients, Motricity Index, Revised Nottingham Sensory Assessment and Kinesthetic and Visual Imagery Questionnaire. Descriptive measures and nonparametric statistical tests were used for analysis. [Results] The results indicate a more favorable clinical progression in the neurocognitive group regarding upper extremity functional capacity with achievement of the minimal detectable change. The functionality results are related with improvements on muscle strength and sensory discrimination (tactile and kinesthetic). [Conclusion] Despite not showing significant group differences between pre and post-treatment, the neurocognitive approach could be a safe and useful strategy for recovering upper extremity movement following stroke, especially regarding affected hands, with better and longer lasting results. Although this work shows this protocol's feasibility with the panel of scales proposed, larger studies are required to demonstrate its effectiveness.
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Sallés, Laia; Martín-Casas, Patricia; Gironès, Xavier; Durà, María José; Lafuente, José Vicente; Perfetti, Carlo
2017-01-01
[Purpose] This study aims to describe a protocol based on neurocognitive therapeutic exercises and determine its feasibility and usefulness for upper extremity functionality when compared with a conventional protocol. [Subjects and Methods] Eight subacute stroke patients were randomly assigned to a conventional (control group) or neurocognitive (experimental group) treatment protocol. Both lasted 30 minutes, 3 times a week for 10 weeks and assessments were blinded. Outcome measures included: Motor Evaluation Scale for Upper Extremity in Stroke Patients, Motricity Index, Revised Nottingham Sensory Assessment and Kinesthetic and Visual Imagery Questionnaire. Descriptive measures and nonparametric statistical tests were used for analysis. [Results] The results indicate a more favorable clinical progression in the neurocognitive group regarding upper extremity functional capacity with achievement of the minimal detectable change. The functionality results are related with improvements on muscle strength and sensory discrimination (tactile and kinesthetic). [Conclusion] Despite not showing significant group differences between pre and post-treatment, the neurocognitive approach could be a safe and useful strategy for recovering upper extremity movement following stroke, especially regarding affected hands, with better and longer lasting results. Although this work shows this protocol’s feasibility with the panel of scales proposed, larger studies are required to demonstrate its effectiveness. PMID:28533607
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The effects of pilates on balance, mobility and strength in patients with multiple sclerosis.
Guclu-Gunduz, Arzu; Citaker, Seyit; Irkec, Ceyla; Nazliel, Bijen; Batur-Caglayan, Hale Zeynep
2014-01-01
Although there are evidences as to Pilates developing dynamic balance, muscle strength and flexibility in healthy people, evidences related to its effects on Multiple Sclerosis patients are insufficient. The aims of this study were to investigate the effects of Pilates on balance, mobility, and strength in ambulatory patients with Multiple Sclerosis. Twenty six patients were divided into two groups as experimental (n = 18) and control (n = 8) groups for an 8-week treatment program. The experimental group underwent Pilates and the control group did abdominal breathing and active extremity exercises at home. Balance and mobility were measured with Berg Balance Scale and Timed up and go test, upper and lower muscle strength with hand-held dynamometer. Confidence in balance skills while performing daily activities was evaluated with Activities Specific Balance Confidence Scale. Improvements were observed in balance, mobility, and upper and lower extremity muscle strength in the Pilates group (p < 0.05). No significant differences in any outcome measures were observed in the control group (p > 0.05). Due to its structure which is made up of balance and strengthening exercises, Pilates training may develop balance, mobility and muscle strength of MS patients. For this reason, we think that, Pilates exercises which are appropriate for the disability level of the patient may be suggested.
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Yamamoto, Shuhei; Hotta, Kazuki; Ota, Erika; Mori, Rintaro; Matsunaga, Atsuhiko
2016-08-01
Resistance training (RT) is a core component of cardiac rehabilitation. We investigated the effects of RT on exercise capacity, muscle strength, and mobility in middle-aged and elderly patients with coronary artery disease (CAD). We searched for randomized controlled trials of RT versus usual care, or combined RT and aerobic training (AT) versus AT alone, and identified 440 trials in total from inception to January 2014. Participants who had myocardial infarction, coronary revascularization, angina pectoris or CAD were included in the analysis. Those who had heart failure, heart transplants with either cardiac resynchronization therapy or implantable defibrillators were excluded. Twenty-two trials totaling 1095 participants were analyzed. We performed random-effects meta-analysis. In middle-aged participants, RT increased lower extremity muscle strength [standardized mean difference (SMD): 0.65, 95% confidence interval (CI): 0.35 to 0.95], upper extremity muscle strength (SMD: 0.73, 95% CI: 0.48 to 0.99) and peak oxygen consumption (VO2) [weight mean difference (WMD): 0.92mL/kg/min, 95% CI: 0.12 to 1.72], but did not improve mobility compared with the control. In elderly participants, RT increased lower extremity muscle strength (SMD: 0.63, 95% CI: 0.05 to 1.21), upper extremity muscle strength (SMD: 1.18, 95% CI: 0.56 to 1.80), and peak VO2 (WMD: 0.70mL/kg/min, 95% CI: 0.03 to 1.37), and improved mobility (SMD: 0.61, 95% CI: 0.21 to 1.01) compared with the control. Resistance training could increase exercise capacity and muscle strength in middle-aged and elderly patients, and mobility in elderly patients, with CAD. Copyright © 2015 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
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Geertzen, J H; Dijkstra, P U; van Sonderen, E L; Groothoff, J W; ten Duis, H J; Eisma, W H
1998-10-01
To determine the relationship between impairments, disability and handicap in reflex sympathetic dystrophy (RSD) patients. A long-term follow-up study of upper extremity RSD patients. A university hospital. Sixty-five patients, 3-9 years (mean interval 5.5 years) after RSD of the upper extremity (mean age 50.2 years). Impairments: range of motion, moving two point discrimination, muscle strength of the hand and pain were measured. Disability was assessed with the Groningen Activity Restriction Scale (GARS) and handicap was assessed with three subscales (social functioning, role limitations due to physical problems and role limitations due to emotional problems) of the RAND-36. After RSD of the upper extremity, 62% of the patients are limited in activities of daily living (ADL) and/or instrumental ADL (IADL). Pain and restrictions in forward flexion of the shoulder, thumb opposition and grip strength are the most important impairments limiting ADL and IADL. Patients with limitations in ADL and IADL are significantly more handicapped than patients without limitations. Pain is the most important factor contributing to handicap. The relationship between impairments and disability and between disability and handicap in RSD patients is weak to moderate. Pain is the most important factor leading to disability and handicap.
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Lee, Dong Ryul; Kim, Yun Hee; Kim, Dong A; Lee, Jung Ah; Hwang, Pil Woo; Lee, Min Jin; You, Sung Hyun
2014-01-01
In children with cerebral palsy (CP), the never-learned-to-use (NLTU) effect and underutilization suppress the normal development of cortical plasticity in the paretic limb, which further inhibits its functional use and increases associated muscle weakness. To highlight the effects of a novel comprehensive hand repetitive intensive strengthening training system on neuroplastic changes associated with upper extremity (UE) muscle strength and motor performance in children with spastic hemiplegic CP. Two children with spastic hemiplegic CP were recruited. Intervention with the comprehensive hand repetitive intensive strengthening training system was provided for 60 min a day, three times a week, for 10 weeks. Neuroplastic changes, muscle size, strength, and associated motor function were measured using functional magnetic resonance imaging (MRI), ultrasound imaging, and standardized motor tests, respectively. The functional MRI data showed that the comprehensive hand repetitive intensive strengthening training intervention produced measurable neuroplastic changes in the neural substrates associated with motor control and learning. These neuroplastic changes were associated with increased muscle size, strength and motor function. These results provide compelling evidence of neuroplastic changes and associated improvements in muscle size and motor function following innovative upper extremity strengthening exercise.
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Vincent, Joshua I; MacDermid, Joy C; Michlovitz, Susan L; Rafuse, Richard; Wells-Rowsell, Christina; Wong, Owen; Bisbee, Leslie
2014-01-01
Longitudinal clinical measurement study. The push-off test (POT) is a novel and simple measure of upper extremity weight-bearing that can be measured with a grip dynamometer. There are no published studies on the validity and reliability of the POT. The relationship between upper extremity self-report activity/participation and impairment measures remain an unexplored realm. The primary purpose of this study is to estimate the intra and inter-rater reliability and construct validity of the POT. The secondary purpose is to estimate the relationship between upper extremity self-report activity/participation questionnaires and impairment measures. A convenience sample of 22 patients with wrist or elbow injuries were tested for POT, wrist/elbow range of motion (ROM), isometric wrist extension strength (WES) and grip strength; and completed two self-report activity/participation questionnaires: Disability of the Arm, Shoulder and the Hand (DASH) and Work Limitations Questionnaire (WLQ-26). POT's inter and intra-rater reliability and construct validity was tested. Pearson's correlations were run between the impairment measures and self-report questionnaires to look into the relationship amongst them. The POT demonstrated high inter-rater reliability (ICC affected = 0.97; 95% C.I. 0.93-0.99; ICC unaffected = 0.85; 95% C.I. 0.68-0.94) and intra-rater reliability (ICC affected = 0.96; 95% C.I. 0.92-0.97; ICC unaffected = 0.92; 95% C.I. 0.85-0.97). The POT was correlated moderately with the DASH (r = -0.47; p = 0.03). While examining the relationship between upper extremity self-reported activity/participation questionnaires and impairment measures the strongest correlation was between the DASH and the POT (r = -0.47; p = 0.03) and none of the correlations with the other physical impairment measures reached significance. At-work disability demonstrated insignificant correlations with physical impairments. The POT test provides a reliable and easily administered quantitative measure of ability to bear the load through an injured arm. Preliminary evidence supports a moderate relationship between loading bearing measured by the POT and upper extremity function measured by the DASH. 1b. Copyright © 2014 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.
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Physical Function, Hyperuricemia, and Gout in Older Adults.
Burke, Bridget Teevan; Köttgen, Anna; Law, Andrew; Windham, Beverly Gwen; Segev, Dorry; Baer, Alan N; Coresh, Josef; McAdams-DeMarco, Mara A
2015-12-01
Gout prevalence is high in older adults and those affected are at risk of physical disability, yet it is unclear whether they have worse physical function. We studied gout, hyperuricemia, and physical function in 5,819 older adults (age ≥65 years) attending the 2011-2013 Atherosclerosis Risk in Communities Study visit, a prospective US population-based cohort. Differences in lower extremity function (Short Physical Performance Battery [SPPB] and 4-meter walking speed) and upper extremity function (grip strength) by gout status and by hyperuricemia prevalence were estimated in adjusted ordinal logistic regression (SPPB) and linear regression (walking speed and grip strength) models. Lower scores or times signify worse function. The prevalence of poor physical performance (first quartile) by gout and hyperuricemia was estimated using adjusted modified Poisson regression. Ten percent of participants reported a history of gout and 21% had hyperuricemia. There was no difference in grip strength by history of gout (P = 0.77). Participants with gout performed worse on the SPPB test; they had 0.77 times (95% confidence interval [95% CI] 0.65, 0.90, P = 0.001) the prevalence odds of a 1-unit increase in SPPB score and were 1.18 times (95% CI 1.07, 1.32, P = 0.002) more likely to have poor SPPB performance. Participants with a history of gout had slower walking speed (mean difference -0.03; 95% CI -0.05, -0.01, P < 0.001) and were 1.19 times (95% CI 1.06, 1.34, P = 0.003) more likely to have poor walking speed. Similarly, SPPB score and walking speed, but not grip strength, were worse in participants with hyperuricemia. Older adults with gout and hyperuricemia are more likely to have worse lower extremity, but not upper extremity, function. © 2015, American College of Rheumatology.
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Ekstrand, Elisabeth; Rylander, Lars; Lexell, Jan; Brogårdh, Christina
2016-11-02
Despite that disability of the upper extremity is common after stroke, there is limited knowledge how it influences self-perceived ability to perform daily hand activities. The aim of this study was to describe which daily hand activities that persons with mild to moderate impairments of the upper extremity after stroke perceive difficult to perform and to evaluate how several potential factors are associated with the self-perceived performance. Seventy-five persons (72 % male) with mild to moderate impairments of the upper extremity after stroke (4 to 116 months) participated. Self-perceived ability to perform daily hand activities was rated with the ABILHAND Questionnaire. The perceived ability to perform daily hand activities and the potentially associated factors (age, gender, social and vocational situation, affected hand, upper extremity pain, spasticity, grip strength, somatosensation of the hand, manual dexterity, perceived participation and life satisfaction) were evaluated by linear regression models. The activities that were perceived difficult or impossible for a majority of the participants were bimanual tasks that required fine manual dexterity of the more affected hand. The factor that had the strongest association with perceived ability to perform daily hand activities was dexterity (p < 0.001), which together with perceived participation (p = 0.002) explained 48 % of the variance in the final multivariate model. Persons with mild to moderate impairments of the upper extremity after stroke perceive that bimanual activities requiring fine manual dexterity are the most difficult to perform. Dexterity and perceived participation are factors specifically important to consider in the rehabilitation of the upper extremity after stroke in order to improve the ability to use the hands in daily life.
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Reliability and validity of the closed kinetic chain upper extremity stability test.
Lee, Dong-Rour; Kim, Laurentius Jongsoon
2015-04-01
[Purpose] The purpose of this study was to examine the reliability and validity of the Closed Kinetic Chain Upper Extremity Stability (CKCUES) test. [Subjects and Methods] A sample of 40 subjects (20 males, 20 females) with and without pain in the upper limbs was recruited. The subjects were tested twice, three days apart to assess the reliability of the CKCUES test. The CKCUES test was performed four times, and the average was calculated using the data of the last 3 tests. In order to test the validity of the CKCUES test, peak torque of internal/external shoulder rotation was measured using an isokinetic dynamometer, and maximum grip strength was measured using a hand dynamometer, and their Pearson correlation coefficients with the average values of the CKCUES test were calculated. [Results] The reliability of the CKCUES test was very high (ICC=0.97). The correlations between the CKCUES test and maximum grip strength (r=0.78-0.79), and the peak torque of internal/external shoulder rotation (r=0.87-0.94) were high indicating its validity. [Conclusion] The reliability and validity of the CKCUES test were high. The CKCUES test is expected to be used for clinical tests on upper limb stability at low price.
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Hanney, William J.; Kolber, Morey J.; Davies, George J.; Riemann, Bryan
2011-01-01
Introduction: Understanding the relationships between performance tests and sport activity is important to the rehabilitation specialist. The purpose of this study was two- fold: 1) To identify if relationships exist between tests of upper body strength and power (Single Arm Seated Shot Put, Timed Push-Up, Timed Modified Pull-Up, and The Davies Closed Kinetic Chain Upper Extremity Stability Test, and the softball throw for distance), 2) To determine which variable or group of variables best predicts the performance of a sport specific task (the softball throw for distance). Methods: One hundred eighty subjects (111 females and 69 males, aged 18-45 years) performed the 5 upper extremity tests. The Pearson product moment correlation and a stepwise regression were used to determine whether relationships existed between performance on the tests and which upper extremity test result best explained the performance on the softball throw for distance. Results: There were significant correlations (r=.33 to r=.70, p=0.001) between performance on all of the tests. The modified pull-up test was the best predictor of the performance on the softball throw for distance (r2= 48.7), explaining 48.7% of variation in performance. When weight, height, and age were added to the regression equation the r2 values increased to 64.5, 66.2, and 67.5 respectively. Conclusion: The results of this study indicate that several upper extremity tests demonstrate significant relationships with one another and with the softball throw for distance. The modified pull up test was the best predictor of performance on the softball throw for distance. PMID:21712942
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Kas, Tamara; Colby, Megan; Case, Maureen; Vaughn, Dan
2016-10-01
The purpose of this study was to examine the effect of upper and lower body extremity strengthening exercise in patients with Fibromyalgia (FM) within an existing multidisciplinary treatment program. Patients between the ages of 18-65 with the medical diagnosis of FM. Comparative study design. The control and experimental group received the same multidisciplinary treatment except that the experimental group performed upper and lower extremity strengthening exercises. The Fibromyalgia Impact Questionnaire (FIQ) was administered at evaluation and discharge from the program in order to measure change in quality of life (QOL). Statistically significant changes in FIQ scores were found for both groups. The addition of extremity strengthening in the experimental group produced an average 4 points greater reduction in FIQ score, however, these results are not considered statistically significant. This study appears to validate the success of a multidisciplinary approach in treating patients with FM, with the possibility for further benefit with the addition of extremity strengthening. Copyright © 2016 Elsevier Ltd. All rights reserved.
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Vining, Robert D; Gosselin, Donna M; Thurmond, Jeb; Case, Kimberlee; Bruch, Frederick R
2017-08-01
This report describes interdisciplinary rehabilitation for a 51-year-old male recovering from incomplete cervical spinal cord injury (SCI) and multiple comorbidities following an automobile accident. The patient was admitted to a rehabilitation specialty hospital approximately 2 months post SCI and 2 separate surgical fusion procedures (C3-C6). Clinical presentation at the rehabilitation hospital included moderate to severe motor strength loss in both upper and lower extremities, a percutaneous endoscopic gastronomy tube (PEG), dysphagia, bowel/bladder incontinence, dependence on a mechanical lift and tilting wheelchair due to severe orthostatic hypotension, and pre-existing shoulder pain from bilateral joint degeneration. The interdisciplinary team formally coordinated rehabilitative care from multiple disciplines. Internal medicine managed medications, determined PEG removal, monitored co-morbid conditions, and overall progress. Chiropractic care focused on alleviating shoulder and thoracic pain and improving spinal and extremity mobility. Physical therapy addressed upright tolerance, transfer, gait, and strength training. Occupational therapy focused on hand coordination and feeding/dressing activities. Psychology assisted with coping strategies. Nursing ensured medication adherence, nutrient intake, wound prevention, and incontinence management, whereas physiatry addressed abnormal muscle tone. Eleven months post-admission the patient's progress allowed discharge to a long-term care facility. At this time he was without dysphagia or need for a PEG. Orthostatic hypotension and bilateral shoulder pain symptoms were also resolved while bowel/bladder incontinence and upper and lower extremity motor strength loss remained. He was largely independent in transferring from bed to wheelchair and in upper body dressing. Lower body dressing/bathing required maximal assistance. Gait with a 2-wheeled walker was possible up to 150 feet with verbal cues and occasional stabilizing assistance. Several specialties functioning within an interdisciplinary team fulfilled complementary roles to support rehabilitation for a patient with SCI.
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Numerical Analysis of Flood modeling of upper Citarum River under Extreme Flood Condition
NASA Astrophysics Data System (ADS)
Siregar, R. I.
2018-02-01
This paper focuses on how to approach the numerical method and computation to analyse flood parameters. Water level and flood discharge are the flood parameters solved by numerical methods approach. Numerical method performed on this paper for unsteady flow conditions have strengths and weaknesses, among others easily applied to the following cases in which the boundary irregular flow. The study area is in upper Citarum Watershed, Bandung, West Java. This paper uses computation approach with Force2 programming and HEC-RAS to solve the flow problem in upper Citarum River, to investigate and forecast extreme flood condition. Numerical analysis based on extreme flood events that have occurred in the upper Citarum watershed. The result of water level parameter modeling and extreme flood discharge compared with measurement data to analyse validation. The inundation area about flood that happened in 2010 is about 75.26 square kilometres. Comparing two-method show that the FEM analysis with Force2 programs has the best approach to validation data with Nash Index is 0.84 and HEC-RAS that is 0.76 for water level. For discharge data Nash Index obtained the result analysis use Force2 is 0.80 and with use HEC-RAS is 0.79.
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Akınoğlu, Bihter; Kocahan, Tuğba
2017-02-01
The objective of this study was to reveal characteristics of muscle strength of upper extremities of wheelchair (WC) basketball players and to ensure more-specific training program preparation. Isokinetic muscle strength of 12 WC basketball players were assessed by ISOMED 2000 device. The assessment protocol was evaluated at 60°/sec velocity with 5 times repeated force and at 240°/sec with 15 times repeated force. This protocol was carried out individually for shoulder flexion-extension and wrist flexion-extension movements at the right and left extremities. The flexion/extension ratio was determined to be outside of the ratios accepted as normal for primarily shoulder joint and for wrist joint. The extension movement was stronger than flexion movement in the shoulders at both velocities and the flexion movement was stronger than ex-tension movement in the wrist. The repeat times where the peak torque occurred were 2-3 repeats at 60°/sec velocity during flexion and extension movements for the wrist and shoulders, and the peak torque occurred at an average of 5-6 repeats in the shoulders at 240°/sec velocity and it occurred at 3-4 repeats in the wrist. The angles where the peak torque of the shoulder flexion and extension occurred varied between 80°-115° at both velocities, and it varied between 5°-30° angles for the wrist. As this study revealed, determination of muscle strength characteristics of WC athletes and especially using objective isokinetic devices will guide the planning of the appropriate training and exercise programs and preventing sports injuries in long term.
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High-voltage electrical burn injuries: functional upper extremity assessment.
Mazzetto-Betti, K C; Amâncio, A C G; Farina, J A; Barros, M E P M; Fonseca, M C R
2009-08-01
High-voltage electric injuries have many manifestations, and an important complication is the damage of the central/peripheral nervous system. The purpose of this work was to assess the upper limb dysfunction in patients injured by high-voltage current. The evaluation consisted of analysis of patients' records, cutaneous-sensibility threshold, handgrip and pinch strength and a specific questionnaire about upper limb dysfunctions (DASH) in 18 subjects. All subjects were men; the average age at the time of the injury was 38 years. Of these, 72% changed job/retired after the injury. The current entrance was the hand in 94% and grounding in the lower limb in 78%. The average burned surface area (BSA) was 8.6%. The handgrip strength of the injured limb was reduced (p<0.05) and so also that of the three pinch types. The relationship between the handgrip strength and the DASH was statistically significant (p<0.001) as well as the relationship between the three pinch types (p
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Effect of constraint-induced movement therapy and mirror therapy for patients with subacute stroke.
Yoon, Jin A; Koo, Bon Il; Shin, Myung Jun; Shin, Yong Beom; Ko, Hyun-Yoon; Shin, Yong-Il
2014-08-01
To evaluate the effectiveness of constraint-induced movement therapy (CIMT) and combined mirror therapy for inpatient rehabilitation of the patients with subacute stroke. Twenty-six patients with subacute stroke were enrolled and randomly divided into three groups: CIMT combined with mirror therapy group, CIMT only group, and control group. Two weeks of CIMT for 6 hours a day with or without mirror therapy for 30 minutes a day were performed under supervision. All groups received conventional occupational therapy for 40 minutes a day for the same period. The CIMT only group and control group also received additional self-exercise to substitute for mirror therapy. The box and block test, 9-hole Pegboard test, grip strength, Brunnstrom stage, Wolf motor function test, Fugl-Meyer assessment, and the Korean version of Modified Barthel Index were performed prior to and two weeks after the treatment. After two weeks of treatment, the CIMT groups with and without mirror therapy showed higher improvement (p<0.05) than the control group, in most of functional assessments for hemiplegic upper extremity. The CIMT combined with mirror therapy group showed higher improvement than CIMT only group in box and block test, 9-hole Pegboard test, and grip strength, which represent fine motor functions of the upper extremity. The short-term CIMT combined with mirror therapy group showed more improvement compared to CIMT only group and control group, in the fine motor functions of hemiplegic upper extremity for the patients with subacute stroke.
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Dankel, Scott J; Loenneke, Jeremy P; Loprinzi, Paul D
2018-02-01
Skeletal muscle strength and engagement in muscle-strengthening activities are each inversely associated with all-cause mortality; however, less is known on their relationship with cancer-specific mortality. Data from the 1999-2002 National Health and Nutrition Examination Survey were used assessing 2773 individuals aged 50 years or older. Individuals being dichotomized at the 75th percentile for knee extensor strength, and engagement in muscle-strengthening activities was acquired through self-report with ≥2 sessions per week were classified as meeting guidelines. With respect to cancer-specific mortality, individuals in the upper quartile for muscle strength were at a 50% reduced risk (hazard ratio = 0.50; 95% confidence interval, 0.29-0.85; P = .01) and those meeting muscle-strengthening activities were at a nonsignificant 8% reduced risk (hazard ratio = 0.92; 95% confidence interval, 0.45-1.86, P = .81) of cancer-specific mortality after adjusting for covariates. Clinicians should routinely assess lower extremity strength and promote engagement in muscle-strengthening activities aimed at increasing muscle strength.
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Sampson, Michael; Shau, Yio-Wha; King, Marcus James
2012-01-01
Stroke is a leading cause of disability with many survivors having upper limb (UL) hemiparesis. UL rehabilitation using bilateral exercise enhances outcomes and the Bilateral Upper Limb Trainer (BUiLT) was developed to provide symmetrical, bilateral arm exercise in a 'forced' and self-assistive manner, incorporating virtual reality (VR) to provide direction and task specificity to users as well as action observation-execution and greater motivation to exercise. The BUiLT + VR system was trialled on five post-stroke participants with UL hemiparesis: one sub-acute and four chronic. The intervention was supplied for 45 min, 4 days/week for 6 weeks. The Fugl-Meyer Upper Extremity score (FMA-UE) was used as the primary outcome measure. Secondary outcome measures used were UL isometric strength and the Intrinsic Motivation Inventory (IMI) questionnaire. The BUiLT + VR therapy increased FMA-UE scores from 1 to 5 and overall strength in the shoulder and elbow. Motivation at the end of intervention was positive. Therapy using the BUiLT + VR system is reliable, can be administered safely and has a positive trend of benefit as measured by the FMA-UE, isometric strength testing and IMI questionnaire.
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Is the Cerebellum Involved in Motor and Perceptual Timing: A Case Study.
1985-05-15
return to regular employment as a typist. *The visual fields and cranial nerves were intact. The extraocular movements wererfull and there was no nystagmus ...Her saccades were hypermetric, especially on gaze to the left. Examination of motor function in the upper extremities revealed normal strength
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2014-01-01
Background Cross-sectional studies detected associations between physical fitness, living area, and sports participation in children. Yet, their scientific value is limited because the identification of cause-and-effect relationships is not possible. In a longitudinal approach, we examined the effects of living area and sports club participation on physical fitness development in primary school children from classes 3 to 6. Methods One-hundred and seventy-two children (age: 9–12 years; sex: 69 girls, 103 boys) were tested for their physical fitness (i.e., endurance [9-min run], speed [50-m sprint], lower- [triple hop] and upper-extremity muscle strength [1-kg ball push], flexibility [stand-and-reach], and coordination [star coordination run]). Living area (i.e., urban or rural) and sports club participation were assessed using parent questionnaire. Results Over the 4 year study period, urban compared to rural children showed significantly better performance development for upper- (p = 0.009, ES = 0.16) and lower-extremity strength (p < 0.001, ES = 0.22). Further, significantly better performance development were found for endurance (p = 0.08, ES = 0.19) and lower-extremity strength (p = 0.024, ES = 0.23) for children continuously participating in sports clubs compared to their non-participating peers. Conclusions Our findings suggest that sport club programs with appealing arrangements appear to represent a good means to promote physical fitness in children living in rural areas. PMID:24886425
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Golle, Kathleen; Granacher, Urs; Hoffmann, Martin; Wick, Ditmar; Muehlbauer, Thomas
2014-05-23
Cross-sectional studies detected associations between physical fitness, living area, and sports participation in children. Yet, their scientific value is limited because the identification of cause-and-effect relationships is not possible. In a longitudinal approach, we examined the effects of living area and sports club participation on physical fitness development in primary school children from classes 3 to 6. One-hundred and seventy-two children (age: 9-12 years; sex: 69 girls, 103 boys) were tested for their physical fitness (i.e., endurance [9-min run], speed [50-m sprint], lower- [triple hop] and upper-extremity muscle strength [1-kg ball push], flexibility [stand-and-reach], and coordination [star coordination run]). Living area (i.e., urban or rural) and sports club participation were assessed using parent questionnaire. Over the 4 year study period, urban compared to rural children showed significantly better performance development for upper- (p = 0.009, ES = 0.16) and lower-extremity strength (p < 0.001, ES = 0.22). Further, significantly better performance development were found for endurance (p = 0.08, ES = 0.19) and lower-extremity strength (p = 0.024, ES = 0.23) for children continuously participating in sports clubs compared to their non-participating peers. Our findings suggest that sport club programs with appealing arrangements appear to represent a good means to promote physical fitness in children living in rural areas.
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Baik, Jong Sam; Jang, Seong Ho; Park, Dong Sik
2009-01-01
To develop an objective and scientific method to evaluate the brain injured and brain diseased persons with motor dysfunction, American Medical Association's Guides to the Evaluation of Permanent Impairment was used as an exemplar. After the motor dysfunction due to brain injury or brain disease was confirmed, active range of motion and muscle strength of affected extremities were measured. Also, the total function of extremities was evaluated through the assessment of activities of daily living, fine coordination of hand, balance and gait. Then, the total score of manual muscle test and functional assessment of impaired upper and lower extremity were added, respectively. Spasticity of upper and lower extremity was used as minus factors. Patients with movement disorder such as Parkinson's disease were assessed based on the degree of dysfunction in response to medication. We develop a new rating system based on the concept of total score. PMID:19503680
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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
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Allami, Mostafa; Mousavi, Batool; Masoumi, Mehdi; Modirian, Ehsan; Shojaei, Hadi; Mirsalimi, Fatemeh; Hosseini, Maryam; Pirouzi, Pirouz
2016-01-01
Upper limb amputations are one of the unpleasant war injuries that armed forces are exposed to frequently. The present study aimed to assess the musculoskeletal and peripheral nervous systems in Iraq-Iran war veterans with bilateral upper extremity amputation. The study consisted of taking a history and clinical examinations including demographic data, presence and location of pain, level of amputation, passive and active ranges of movement of the joints across the upper and lower extremities and spine, manual palpation, neurological examination, blood circulation pulses and issues related to a prosthetic limb. In this study, 103 Iranian bilateral upper extremity amputees (206 amputations) from the Iran-Iraq war were evaluated, and a detailed questionnaire was also administered. The most common level of amputation was the finger or wrist level (108, 52.4 %). Based on clinical examination, we found high frequencies of limited active and passive joint range of movement across the scapula, shoulder, elbow, wrist and metacarpophalangeal, interphalangeal and thumb joints. Based on muscle strength testing, we found varying degrees of weakness across the upper limbs. Musculoskeletal disorders included epicondylitis (65, 31.6 %), rotator cuff injury (24, 11.7 %), bicipital tendonitis (69, 33.5 %), shoulder drop (42, 20.4 %) and muscle atrophy (19, 9.2 %). Peripheral nerve disorders included carpal tunnel syndrome in 13 (6.3 %) and unilateral brachial plexus injury in 1 (1 %). Fifty-three (51.5 %) were diagnosed with facet joint syndrome at the level of the cervical spine (the most frequent site). Using a prosthesis was reported by 65 (63.1 %), both left and right sides. The back was the most common site of pain (71.8 %). The high prevalence of neuro-musculoskeletal disorders among bilateral upper extremity amputees indicates that they need regular rehabilitation care.
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Clinical concepts for treatment of the elbow in the adolescent overhead athlete.
Ellenbecker, Todd S; Reinold, Michael; Nelson, Cory O
2010-10-01
Injuries to the adolescent elbow are common because of the repetitive overuse inherent in many overhead sport activities. The management of these patients is greatly facilitated through a greater understanding of the demands placed on the upper extremity kinetic chain during these overhead activities as well as a detailed examination and rehabilitation for the entire upper extremity kinetic chain. Particular emphasis on improving rotator cuff strength and muscular endurance, along with scapular stabilization, is a critical part of elbow rehabilitation in these patients. In addition, the use of a strategic and progressive interval sport return program is necessary to minimize reinjury and return the adolescent overhead athlete to full function. Copyright © 2010 Elsevier Inc. All rights reserved.
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Pickett, Craig W; Nosaka, Kazunori; Zois, James; Hopkins, Will G; J, Anthony; Blazevich
2017-12-27
Current training and monitoring methods in sprint kayaking are based on the premise that upper-body muscular strength and aerobic power are both important for performance, but limited evidence exists to support this premise in high-level athletes. Relationships between measures of strength, maximal oxygen uptake (VO2max) and 200-m race times in kayakers competing at national-to-international levels were examined. Data collected from Australian Canoeing training camps and competitions for 7 elite, 7 national and 8 club level male sprint kayakers were analyzed for relationships between maximal isoinertial strength (3-RM bench press, bench row, chin-up and deadlift), VO2max on a kayak ergometer, and 200-m race time. Correlations between race time and bench press, bench row, chin-up, and VO2max were -0.80, -0.76, -0.73, -0.02 and 0.71, respectively (90% confidence limits ∼±0.17). The multiple correlation coefficient for 200-m race time with bench press and VO2max was 0.84. Errors in prediction of 200-m race time in regression analyses were extremely large (∼4%) in relation to the smallest important change of 0.3%. However, from the slopes of the regressions, the smallest important change could be achieved with a 1.4% (±0.5%) change in bench-press strength and a 0.9% (±0.5%) change in VO2max. Substantial relationships were found between upper-body strength or aerobic power and 200-m performances. These measures may not accurately predict individual performance times, but would be practicable for talent identification purposes. Training aimed at improving upper-body strength or aerobic power in lowerperforming athletes could also enhance the performance in 200-m kayak sprints.
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Improved motor performance in chronic spinal cord injury following upper-limb robotic training.
Cortes, Mar; Elder, Jessica; Rykman, Avrielle; Murray, Lynda; Avedissian, Manuel; Stampas, Argyrios; Thickbroom, Gary W; Pascual-Leone, Alvaro; Krebs, Hermano Igo; Valls-Sole, Josep; Edwards, Dylan J
2013-01-01
Recovering upper-limb motor function has important implications for improving independence of patients with tetraplegia after traumatic spinal cord injury (SCI). To evaluate the feasibility, safety and effectiveness of robotic-assisted training of upper limb in a chronic SCI population. A total of 10 chronic tetraplegic SCI patients (C4 to C6 level of injury, American Spinal Injury Association Impairment Scale, A to D) participated in a 6-week wrist-robot training protocol (1 hour/day 3 times/week). The following outcome measures were recorded at baseline and after the robotic training: a) motor performance, assessed by robot-measured kinematics, b) corticospinal excitability measured by transcranial magnetic stimulation (TMS), and c) changes in clinical scales: motor strength (Upper extremity motor score), pain level (Visual Analog Scale) and spasticity (Modified Ashworth scale). No adverse effects were observed during or after the robotic training. Statistically significant improvements were found in motor performance kinematics: aim (pre 1.17 ± 0.11 raduans, post 1.03 ± 0.08 raduans, p = 0.03) and smoothness of movement (pre 0.26 ± 0.03, post 0.31 ± 0.02, p = 0.03). These changes were not accompanied by changes in upper-extremity muscle strength or corticospinal excitability. No changes in pain or spasticity were found. Robotic-assisted training of the upper limb over six weeks is a feasible and safe intervention that can enhance movement kinematics without negatively affecting pain or spasticity in chronic SCI. In addition, robot-assisted devices are an excellent tool to quantify motor performance (kinematics) and can be used to sensitively measure changes after a given rehabilitative intervention.
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Yoga leads to multiple physical improvements after stroke, a pilot study.
Schmid, Arlene A; Miller, Kristine K; Van Puymbroeck, Marieke; DeBaun-Sprague, Erin
2014-12-01
To assess change in physical functioning (pain, range of motion (ROM), strength, and endurance) after 8 weeks of therapeutic-yoga. Planned analyses of data from a randomized pilot study of yoga after stroke. University-based research laboratory. People with chronic stroke (N=47) randomized to therapeutic-yoga (n=37) or wait-list control (n=10). 16 sessions of therapeutic yoga (twice a week/8 weeks). Yoga was delivered in a standardized and progressive format with postures, breathing, and meditation, and relaxation in sitting, standing, and supine. Pain was assessed with the PEG, a 3-item functional measure of the interference of pain. ROM included neck and hip active and passive ROM measurements). Upper and lower extremity strength were assessed with the arm curl test and chair-to-stand test, respectively. Endurance was assessed with the 6-minute walk and modified 2-min step test. After a Bonferroni Correction, pain, neck ROM, hip passive ROM, upper extremity strength, and the 6-min walk scores all significantly improved after 8 weeks of engaging in yoga. No changes occurred in the wait-list control group. A group therapeutic-yoga intervention may improve multiple aspects of physical functioning after stroke. Such an intervention may be complementary to traditional rehabilitation. Copyright © 2014 Elsevier Ltd. All rights reserved.
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Integrative rehabilitation of elderly stroke survivors: the design and evaluation of the BrightArm™.
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.
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Integrative rehabilitation of elderly stroke survivors: The design and evaluation of the BrightArm™
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
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Rate of muscle contraction is associated with cognition in women, not in men.
Tian, Qu; Osawa, Yusuke; Resnick, Susan M; Ferrucci, Luigi; Studenski, Stephanie A
2018-05-08
In older persons, lower hand grip strength is associated with poorer cognition. Little is known about how the rate of muscle contraction relates to cognition and upper extremity motor function, and sex differences are understudied. Linear regression, adjusting for age, race, education, body mass index, appendicular lean mass, and knee pain assessed sex-specific cross-sectional associations of peak torque, rate of torque development (RTD) and rate of velocity development (RVD) with cognition and upper extremity motor function. In men (n=447), higher rate-adjusted peak torque and a greater RVD were associated with faster simple finger tapping speed, and a greater RVD was associated with higher nondominant pegboard performance. In women (n=447), higher peak torque was not associated with any measures, but a greater RTD was associated with faster simple tapping speed and higher language performance, and a greater RVD was associated with higher executive function, attention, memory, and nondominant pegboard performance. In women with low isokinetic peak torque, RVD was associated with attention and memory. RVD capacity may reflect neural health, especially in women with low muscle strength.
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Vining, Robert D.; Gosselin, Donna M.; Thurmond, Jeb; Case, Kimberlee; Bruch, Frederick R.
2017-01-01
Abstract Rationale: This report describes interdisciplinary rehabilitation for a 51-year-old male recovering from incomplete cervical spinal cord injury (SCI) and multiple comorbidities following an automobile accident. Patient concerns: The patient was admitted to a rehabilitation specialty hospital approximately 2 months post SCI and 2 separate surgical fusion procedures (C3–C6). Diagnoses: Clinical presentation at the rehabilitation hospital included moderate to severe motor strength loss in both upper and lower extremities, a percutaneous endoscopic gastronomy tube (PEG), dysphagia, bowel/bladder incontinence, dependence on a mechanical lift and tilting wheelchair due to severe orthostatic hypotension, and pre-existing shoulder pain from bilateral joint degeneration. Interventions: The interdisciplinary team formally coordinated rehabilitative care from multiple disciplines. Internal medicine managed medications, determined PEG removal, monitored co-morbid conditions, and overall progress. Chiropractic care focused on alleviating shoulder and thoracic pain and improving spinal and extremity mobility. Physical therapy addressed upright tolerance, transfer, gait, and strength training. Occupational therapy focused on hand coordination and feeding/dressing activities. Psychology assisted with coping strategies. Nursing ensured medication adherence, nutrient intake, wound prevention, and incontinence management, whereas physiatry addressed abnormal muscle tone. Outcomes: Eleven months post-admission the patient's progress allowed discharge to a long-term care facility. At this time he was without dysphagia or need for a PEG. Orthostatic hypotension and bilateral shoulder pain symptoms were also resolved while bowel/bladder incontinence and upper and lower extremity motor strength loss remained. He was largely independent in transferring from bed to wheelchair and in upper body dressing. Lower body dressing/bathing required maximal assistance. Gait with a 2-wheeled walker was possible up to 150 feet with verbal cues and occasional stabilizing assistance. Lessons: Several specialties functioning within an interdisciplinary team fulfilled complementary roles to support rehabilitation for a patient with SCI. PMID:28834891
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Wilbanks, Susan R; Rogers, Rebecca; Pool, Sean; Bickel, C Scott
2016-11-01
Test the effectiveness of a 6-week functional electrical stimulation (FES)-assisted rowing intervention to increase aerobic fitness and decrease shoulder pain in manual wheelchair users with spinal cord injury (SCI) Methods: Ten adults with SCI (47 ± 12 years, 86 ± 19.7 kg, 175.5 ± 13.2 cm) 18 ± 14 years since injury, AIS classification A-C who had pain in one or both shoulders for >6 months took part in a pre-test, post-test experiment in our human performance laboratory. Participants took part in 30 minutes of FES-assisted rowing, 3 days/week × 6 weeks. Participants were evaluated for VO 2 peak (FES-row and arm bike), distance rowed, arm power output, Wheelchair User Shoulder Pain Index (WUSPI), upper extremity isokinetic strength, scapular stabilization, participation (LIFE-H), quality of life (QOL-SCI), qualitative exit interview. Participants increased distance rowed by 257 ± 266 m and increased arm power output by 6.7 ± 7.9 W. An 8% increase in VO 2 peak and 10.5 ± 4.4 point decrease in shoulder pain were observed (all P < 0.05). There were no changes in upper extremity strength, scapular stabilization, or survey-based measures of participation or quality of life. Qualitative interviewing indicated overall enjoyment of the intervention and improvement in perceived quality of life. FES-assisted rowing is effective to increase aerobic fitness and decrease shoulder pain in manual wheelchair users with SCI. Further research is necessary to determine if rowing without FES can provide similar benefits, and to determine mechanisms driving improvements in shoulder pain, as no changes in measures of upper extremity strength or scapular stabilization were observed.
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Akar, Olcay; Günay, Ersin; Sarinc Ulasli, Sevinc; Ulasli, Alper Murat; Kacar, Emre; Sariaydin, Muzaffer; Solak, Özlem; Celik, Sefa; Ünlü, Mehmet
2017-11-01
Serious problems on muscle strength and functional status can be seen in bedridden-patients with chronic obstructive pulmonary diseases (COPD) receiving mechanical ventilation. We aimed to investigate the impact of active extremity mobilization and neuromuscular electrical stimulation (NMES) on weaning processes, discharge from hospital and inflammatory mediators in COPD patients receiving mechanical ventilation. Thirty conscious COPD patients (F/M:15/15) hospitalized in the intensive care unit (ICU) with diagnosis of respiratory failure were enrolled to this study. Patients were randomized into three groups, including 10 patients for each. Active extremity-exercise training and NMES were applied to Group-1, only NMES was applied to Group-2 and active extremity exercise training was applied to Group-3. Muscle strengths, mobilization duration and weaning situation were evaluated. Serum cytokine levels were evaluated. Lower extremity muscle-strength was significantly improved in Group-1 (from 3.00 to 5.00, P = 0.014) and 2 (from 4.00 to 5.00, P = 0.046). Upper extremity muscle strength was also significantly improved in all three groups (from 4.00 to 5.00 for all groups, P = 0.038, P = 0.046 and P = 0.034, respectively). Duration of mobilization and discharge from the ICU were similar among groups. There was a significant decrease in serum interleukin (IL)-6 level in Group-1 and in serum IL-8 level in Group-1 and Group-2 after rehabilitation. This study indicates that pulmonary rehabilitation can prevent loss of muscle strength in ICU. Nevertheless, we consider that further studies with larger populations are needed to examine the impact of NMES and/or active and passive muscle training in bedridden ICU patients who are mechanically ventilated. © 2015 John Wiley & Sons Ltd.
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Wolf, Steven L.; Winstein, Carolee J.; Miller, J Phillip; Thompson, Paul A.; Taub, Edward; Uswatte, Gitendra; Morris, David; Blanton, Sarah; Nichols-Larsen, Deborah; Clark, Patricia C.
2008-01-01
Summary Background Constraint-Induced Movement therapy (CIMT) uses a variety of treatment components, including restricted use of the better upper extremity, to promote increased use of the contralesional limb for many hours each weekday over two consecutive weeks. The EXCITE Trial demonstrated the efficacy of this intervention for patients 3-9 months post-stroke who were followed for the next 12 months. We assessed the retention of improvements through 24 months. Method Measurements were made every four months for impaired upper extremity function (Wolf Motor Function Test - WMFT and Motor Activity Log - MAL) and health related quality of life (Stroke Impact Scale - SIS) amongst 106/222 participants randomized into one arm of the EXCITE Trial in which they received CIMT rather than usual and customary care. Findings There was no observed regression from the treatment effects observed at 12 months after treatment during the next 12 months for the primary outcome measures of WMFT and MAL. In fact, the additional changes were in the direction of increased therapeutic effect. For the strength components of the WMFT the changes were significant (P < .05) Secondary outcome variables, including the SIS, exhibited a similar pattern. Interpretation Mild to moderately impaired patients who are 3-9 months post-stroke demonstrate substantial improvement in functional use of the paretic upper extremity and quality of life 2 years after receiving a 2-week CIMT intervention. Thus this intervention has persistent benefits. PMID:18077218
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Correlation and prediction of dynamic human isolated joint strength from lean body mass
NASA Technical Reports Server (NTRS)
Pandya, Abhilash K.; Hasson, Scott M.; Aldridge, Ann M.; Maida, James C.; Woolford, Barbara J.
1992-01-01
A relationship between a person's lean body mass and the amount of maximum torque that can be produced with each isolated joint of the upper extremity was investigated. The maximum dynamic isolated joint torque (upper extremity) on 14 subjects was collected using a dynamometer multi-joint testing unit. These data were reduced to a table of coefficients of second degree polynomials, computed using a least squares regression method. All the coefficients were then organized into look-up tables, a compact and convenient storage/retrieval mechanism for the data set. Data from each joint, direction and velocity, were normalized with respect to that joint's average and merged into files (one for each curve for a particular joint). Regression was performed on each one of these files to derive a table of normalized population curve coefficients for each joint axis, direction, and velocity. In addition, a regression table which included all upper extremity joints was built which related average torque to lean body mass for an individual. These two tables are the basis of the regression model which allows the prediction of dynamic isolated joint torques from an individual's lean body mass.
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Karavirta, L; Häkkinen, A; Sillanpää, E; García-López, D; Kauhanen, A; Haapasaari, A; Alen, M; Pakarinen, A; Kraemer, W J; Izquierdo, M; Gorostiaga, E; Häkkinen, K
2011-06-01
Both strength and endurance training have several positive effects on aging muscle and physical performance of middle-aged and older adults, but their combination may compromise optimal adaptation. This study examined the possible interference of combined strength and endurance training on neuromuscular performance and skeletal muscle hypertrophy in previously untrained 40-67-year-old men. Maximal strength and muscle activation in the upper and lower extremities, maximal concentric power, aerobic capacity and muscle fiber size and distribution in the vastus lateralis muscle were measured before and after a 21-week training period. Ninety-six men [mean age 56 (SD 7) years] completed high-intensity strength training (S) twice a week, endurance training (E) twice a week, combined training (SE) four times per week or served as controls (C). SE and S led to similar gains in one repetition maximum strength of the lower extremities [22 (9)% and 21 (8)%, P<0.001], whereas E and C showed minor changes. Cross-sectional area of type II muscle fibers only increased in S [26 (22)%, P=0.002], while SE showed an inconsistent, non-significant change [8 (35)%, P=0.73]. Combined training may interfere with muscle hypertrophy in aging men, despite similar gains in maximal strength between the strength and the combined training groups. © 2009 John Wiley & Sons A/S.
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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.
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Suprak, David N; Dawes, Jay; Stephenson, Mark D
2011-02-01
The push-up is a popular upper-extremity weight-bearing exercise. However, limited information is available regarding its effectiveness. Much of the past research has focused on muscle activation levels, whereas very little has examined the forces encountered during push-up variants. The purpose of the present study was to examine the effect of position within the range of motion on the percentage of body mass (BM) supported by the upper extremities during the traditional and modified (knees-down) push-up. Twenty-eight highly strength-trained male subjects were positioned with their hands on a force platform in 4 static positions, consisting of the up and down position in both the traditional and modified push-up exercise. The performance measures included the average vertical ground reaction force (GRF), expressed as a percentage of BM, supported in each of the 4 static positions and the percentage of change between the up and down positions in each push-up exercise. In both the traditional and modified push-ups, subjects supported less weight in the up vs. the down position. The percentage change in % BM from the up to the down position was greater in the modified push-up variant. The pattern of resistances to the push-up exercises observed in this study may be a result of differing moment arms between the support surface contact point (knees or feet) and the hands. These results may be useful in prescribing programs for strengthening and/or rehabilitation for both the prime movers and stabilizers of the upper extremity. Further, range of motion may need to be altered to accommodate strength differences in beginners and clients rehabilitating from injury.
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NASA Technical Reports Server (NTRS)
Pandya, Abhilash; Maida, James; Hasson, Scott; Greenisen, Michael; Woolford, Barbara
1993-01-01
As manned exploration of space continues, analytical evaluation of human strength characteristics is critical. These extraterrestrial environments will spawn issues of human performance which will impact the designs of tools, work spaces, and space vehicles. Computer modeling is an effective method of correlating human biomechanical and anthropometric data with models of space structures and human work spaces. The aim of this study is to provide biomechanical data from isolated joints to be utilized in a computer modeling system for calculating torque resulting from any upper extremity motions: in this study, the ratchet wrench push-pull operation (a typical extravehicular activity task). Established here are mathematical relationships used to calculate maximum torque production of isolated upper extremity joints. These relationships are a function of joint angle and joint velocity.
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Mirror therapy in children with hemiplegia: a pilot study.
Gygax, Marine Jequier; Schneider, Patrick; Newman, Christopher John
2011-05-01
Mirror therapy, which provides the visual illusion of a functional paretic limb by using the mirror reflection of the non-paretic arm, is used in the rehabilitation of hemiparesis after stroke in adults. We tested the effectiveness and feasibility of mirror therapy in children with hemiplegia by performing a pilot crossover study in ten participants (aged 6-14 y; five males, five females; Manual Ability Classification System levels: one at level I, two at level II, four at level III, three at level IV) randomly assigned to 15 minutes of daily bimanual training with and without a mirror for 3 weeks. Assessments of maximal grasp and pinch strengths, and upper limb function measured by the Shriner's Hospital Upper Extremity Evaluation were performed at weeks 0 (baseline), 3, 6 (intervention), and 9 (wash-out). Testing of grasp strength behind the mirror improved performance by 15% (p=0.004). Training with the mirror significantly improved grasp strength (with mirror +20.4%, p=0.033; without +5.9%, p>0.1) and upper limb dynamic position (with mirror +4.6%, p=0.044; without +1.2%, p>0.1), while training without a mirror significantly improved pinch strength (with mirror +6.9%, p>0.1; without +21.9%, p=0.026). This preliminary study demonstrates the feasibility of mirror therapy in children with hemiplegia and that it may improve strength and dynamic function of the paretic arm. © The Authors. Developmental Medicine & Child Neurology © 2011 Mac Keith Press.
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Segmental Dynamics of Forward Fall Arrests: System Identification Approach
Kim, Kyu-Jung; Ashton-Miller, James A.
2009-01-01
Background Fall-related injuries are multifaceted problems, necessitating thorough biodynamic simulation to identify critical biomechanical factors. Methods A 2-degree-of-freedom discrete impact model was constructed through system identification and validation processes using the experimental data to understand dynamic interactions of various biomechanical parameters in bimanual forward fall arrests. Findings The bimodal reaction force response from the identified models had small identification errors for the first and second force peaks less than 3.5% and high coherence between the measured and identified model responses (R2=0.95). Model validation with separate experimental data also demonstrated excellent validation accuracy and coherence, less than 7% errors and R2=0.87, respectively. The first force peak was usually greater than the second force peak and strongly correlated with the impact velocity of the upper extremity, while the second force peak was associated with the impact velocity of the body. The impact velocity of the upper extremity relative to the body could be a major risk factor to fall-related injuries as observed from model simulations that a 75% faster arm movement relative to the falling speed of the body alone could double the first force peak from soft landing, thereby readily exceeding the fracture strength of the distal radius. Interpretation Considering that the time-critical nature of falling often calls for a fast arm movement, the use of the upper extremity in forward fall arrests is not biomechanically justified unless sufficient reaction time and coordinated protective motion of the upper extremity are available. PMID:19250726
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Fitness characteristics of a suburban special weapons and tactics team.
Pryor, Riana R; Colburn, Deanna; Crill, Matthew T; Hostler, David P; Suyama, J
2012-03-01
Special Weapons and Tactics (SWAT) operators are specialized law enforcement officers who traditionally perform their duties with higher anticipated workloads because of additional body armor, weapons, and equipment used for enhanced operations and protection. This elevated workload increases the need for SWAT operators to improve or maintain their physical fitness to consistently perform routine operations. Typical tasks require trunk rotation, overhead upper extremity use, upper and lower body strength use, and long waiting periods followed by explosive movements while wearing additional equipment. Eleven male SWAT operators from 1 SWAT team performed flexibility, strength, power, and aerobic capacity tests and a variety of job-related tasks. Data were compared with age- and gender-based normative data. Fitness testing revealed that officers ranked high on tests of muscular strength (leg strength, 90th percentile; bench press, 85th percentile); however, body composition (55th percentile), core body strength, and flexibility ranked lower. Furthermore, aerobic capacity and muscular power had a wide range of scores and were also not ideal to support maximal performance during routine operations. These data can assist exercise specialists choose fitness programs specifically for job-related tasks of SWAT operators when creating fitness programs. Fitness programming for law enforcement should focus on improving aerobic fitness, flexibility, core strength, and muscular power while maintaining muscular strength to meet the needs of these specialized officers.
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Nilsen, Tormod S; Raastad, Truls; Skovlund, Eva; Courneya, Kerry S; Langberg, Carl W; Lilleby, Wolfgang; Fosså, Sophie D; Thorsen, Lene
2015-11-01
Androgen deprivation therapy (ADT) increases survival rates in prostate cancer (PCa) patients with locally advanced disease, but is associated with side effects that may impair daily function. Strength training may counteract several side effects of ADT, such as changes in body composition and physical functioning, which in turn may affect health-related quality of life (HRQOL). However, additional randomised controlled trials are needed to expand this knowledge. Fifty-eight PCa patients on ADT were randomised to either 16 weeks of high-load strength training (n = 28) or usual care (n = 30). The primary outcome was change in total lean body mass (LBM) assessed by dual x-ray absorptiometry (DXA). Secondary outcomes were changes in regional LBM, fat mass, and areal bone mineral density (aBMD) measured by DXA; physical functioning assessed by 1-repetition maximum (1RM) tests, sit-to-stand test, stair climbing test and Shuttle walk test; and HRQOL as measured by the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30. No statistically significant effect of high-load strength training was demonstrated on total LBM (p = 0.16), but significant effects were found on LBM in the lower and upper extremities (0.49 kg, p < 0.01 and 0.15 kg, p < 0.05, respectively). Compared to usual care, high-load strength training showed no effect on fat mass, aBMD or HRQOL, but beneficial effects were observed in all 1RM tests, sit-to-stand test and stair climbing tests. Adherence to the training program was 88% for lower body exercises and 84% for upper body exercises. In summary, high-load strength training improved LBM in extremities and physical functioning, but had no effect on fat mass, aBMD, or HRQOL in PCa patients on ADT.
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Yoosefinejad, Amin Kordi; Ghaffarinejad, Farahnaz; Hemati, Mahbubeh; Jamshidi, Narges
2018-05-21
Hyperkyphosis is a common postural defect with high prevalence in the 20 to 50 year old population. It appears to compromise proximal scapular stability. Grip and pinch strength are used to evaluate general upper extremity function. The aim of this study was to compare pinch and grip strength between young women with and without hyperkyphosis. Thirty young women (18-40 years old) with hyperkyphosis and 30 healthy women matched for age and body mass index participated in the study. Hyperkyphosis was confirmed by measuring the kyphosis angle with a flexible ruler. Grip strength was measured with the Waisa method and a dynamometer. Pinch strength was assessed with a pinch meter. Grip (P= 0.03) and pinch strength (P= 0.04) were significantly lower in women with hyperkyphosis compared to the control group. Kyphosis angle correlated weakly with grip (r= 0.26) and pinch strength (r= 0.23). Hyperkyphotic posture has led to decreased grip and pinch strength compared to people without hyperkyphosis.
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Awatani, Takenori; Morikita, Ikuhiro; Mori, Seigo; Shinohara, Junji; Tatsumi, Yasutaka
2018-04-01
[Purpose] The purpose of the present study was to confirm the relationships between shoulder strength (extensor strength and internal rotator strength) of the abducted position and swimming power during arm-only swimming. [Subjects and Methods] Fourteen healthy male collegiate swimmers participated in the study. Main measures were shoulder strength (strength using torque that was calculated from the upper extremity length and the isometric force of the abducted position) and swimming power. [Results] Internal rotation torque of the dominant side in the abducted external rotated position (r=0.85) was significantly correlated with maximum swimming power. The rate of bilateral difference in extension torque in the maximum abducted position (r=-0.728) was significantly correlated with the swimming velocity-to-swimming power ratio. [Conclusion] The results of this study suggest that internal rotator strength measurement in the abducted external rotated position and extensor strength measurement in the maximum abducted position are valid assessment methods for swimmers.
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Applications of biomechanics for prevention of work-related musculoskeletal disorders.
Garg, Arun; Kapellusch, Jay M
2009-01-01
This paper summarises applications of biomechanical principles and models in industry to control musculoskeletal disorders of the low back and upper extremity. Applications of 2-D and 3-D biomechanical models to estimate compressive force on the low back, the strength requirements of jobs, application of guidelines for overhead work and application of strain index and threshold limit value to address distal upper extremity musculoskeletal disorders are presented. Several case studies applied in the railroad industry, manufacturing, healthcare and warehousing are presented. Finally, future developments needed for improved biomechanical applications in industry are discussed. The information presented will be of value to practising ergonomists to recognise how biomechanics has played a significant role in identifying causes of musculoskeletal disorders and controlling them in the workplace. In particular, the information presented will help practising ergonomists with how physical stresses can be objectively quantified.
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Zimmerman, Gregory R.
1994-01-01
Carpal tunnel syndrome is a neuropathy resulting from compression of the median nerve as it passes through a narrow tunnel in the wrist on its way to the hand. The lack of precise objective and clinical tests, along with symptoms that are synonymous with other syndromes in the upper extremity, cause carpal tunnel syndrome to appear to be a rare entity in athletics. However, it should not be ruled out as a possible etiology of upper extremity paralysis in the athlete. More typically, carpal tunnel syndrome is the most common peripheral entrapment neuropathy encountered in industry. Treatment may include rest and/or splinting of the involved wrist, ice application, galvanic stimulation, or iontophoresis to reduce inflammation, and then transition to heat modalities and therapeutic exercises for developing flexibility, strength, and endurance. In addition, an ergonomic assessment should be conducted, resulting in modifications to accommodate the carpal tunnel syndrome patient. ImagesFig 3.Fig 4.Fig 5.Fig 6.Fig 7. PMID:16558255
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Fong, Shirley S M; Ng, Shamay S M; Cheng, Yoyo T Y; Wong, Janet Y H; Yu, Esther Y T; Chow, Gary C C; Chak, Yvonne T C; Chan, Ivy K Y; Zhang, Joni; Macfarlane, Duncan; Chung, Louisa M Y
2016-01-01
Objectives. To evaluate the effects of Ving Tsun (VT) martial art training on the upper extremity muscle strength and eye-hand coordination of middle-aged and older adults. Methods. This study used a nonequivalent pretest-posttest control group design. Forty-two community-dwelling healthy adults participated in the study; 24 (mean age ± SD = 68.5 ± 6.7 years) underwent VT training for 4 weeks (a supervised VT session twice a week, plus daily home practice), and 18 (mean age ± SD = 72.0 ± 6.7 years) received no VT training and acted as controls. Shoulder and elbow isometric muscle strength and eye-hand coordination were evaluated using the Lafayette Manual Muscle Test System and a computerized finger-pointing test, respectively. Results. Elbow extensor peak force increased by 13.9% (P = 0.007) in the VT group and the time to reach peak force decreased (9.9%) differentially in the VT group compared to the control group (P = 0.033). For the eye-hand coordination assessment outcomes, reaction time increased by 2.9% in the VT group and decreased by 5.3% in the control group (P = 0.002). Conclusions. Four weeks of VT training could improve elbow extensor isometric peak force and the time to reach peak force but not eye-hand coordination in community-dwelling middle-aged and older adults.
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Ng, Shamay S. M.; Cheng, Yoyo T. Y.; Yu, Esther Y. T.; Chow, Gary C. C.; Chak, Yvonne T. C.; Chan, Ivy K. Y.; Zhang, Joni; Macfarlane, Duncan
2016-01-01
Objectives. To evaluate the effects of Ving Tsun (VT) martial art training on the upper extremity muscle strength and eye-hand coordination of middle-aged and older adults. Methods. This study used a nonequivalent pretest-posttest control group design. Forty-two community-dwelling healthy adults participated in the study; 24 (mean age ± SD = 68.5 ± 6.7 years) underwent VT training for 4 weeks (a supervised VT session twice a week, plus daily home practice), and 18 (mean age ± SD = 72.0 ± 6.7 years) received no VT training and acted as controls. Shoulder and elbow isometric muscle strength and eye-hand coordination were evaluated using the Lafayette Manual Muscle Test System and a computerized finger-pointing test, respectively. Results. Elbow extensor peak force increased by 13.9% (P = 0.007) in the VT group and the time to reach peak force decreased (9.9%) differentially in the VT group compared to the control group (P = 0.033). For the eye-hand coordination assessment outcomes, reaction time increased by 2.9% in the VT group and decreased by 5.3% in the control group (P = 0.002). Conclusions. Four weeks of VT training could improve elbow extensor isometric peak force and the time to reach peak force but not eye-hand coordination in community-dwelling middle-aged and older adults. PMID:27525020
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Improved forecasts of winter weather extremes over midlatitudes with extra Arctic observations
NASA Astrophysics Data System (ADS)
Sato, Kazutoshi; Inoue, Jun; Yamazaki, Akira; Kim, Joo-Hong; Maturilli, Marion; Dethloff, Klaus; Hudson, Stephen R.; Granskog, Mats A.
2017-02-01
Recent cold winter extremes over Eurasia and North America have been considered to be a consequence of a warming Arctic. More accurate weather forecasts are required to reduce human and socioeconomic damages associated with severe winters. However, the sparse observing network over the Arctic brings errors in initializing a weather prediction model, which might impact accuracy of prediction results at midlatitudes. Here we show that additional Arctic radiosonde observations from the Norwegian young sea ICE expedition (N-ICE2015) drifting ice camps and existing land stations during winter improved forecast skill and reduced uncertainties of weather extremes at midlatitudes of the Northern Hemisphere. For two winter storms over East Asia and North America in February 2015, ensemble forecast experiments were performed with initial conditions taken from an ensemble atmospheric reanalysis in which the observation data were assimilated. The observations reduced errors in initial conditions in the upper troposphere over the Arctic region, yielding more precise prediction of the locations and strengths of upper troughs and surface synoptic disturbances. Errors and uncertainties of predicted upper troughs at midlatitudes would be brought with upper level high potential vorticity (PV) intruding southward from the observed Arctic region. This is because the PV contained a "signal" of the additional Arctic observations as it moved along an isentropic surface. This suggests that a coordinated sustainable Arctic observing network would be effective not only for regional weather services but also for reducing weather risks in locations distant from the Arctic.
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Linder, Susan M; Reiss, Aimee; Buchanan, Sharon; Sahu, Komal; Rosenfeldt, Anson B; Clark, Cindy; Wolf, Steven L; Alberts, Jay L
2013-09-01
After stroke, many individuals lack resources to receive the intensive rehabilitation that is thought to improve upper extremity motor function. This case study describes the application of a telerehabilitation intervention using a portable robotic device combined with a home exercise program (HEP) designed to improve upper extremity function. The participant was a 54-year-old man, 22 weeks following right medullary pyramidal ischemic infarct. At baseline, he exhibited residual paresis of the left upper extremity, resulting in impaired motor control consistent with a flexion synergistic pattern, scoring 22 of 66 on the Fugl-Meyer Assessment. The participant completed 85 total hours of training (38 hours of robotic device and 47 hours of HEP) over the 8-week intervention period. The participant demonstrated an improvement of 26 points on the Action Research Arm Test, 5 points on the Functional Ability Scale portion of the Wolf Motor Function Test, and 20 points on the Fugl-Meyer Assessment, all of which surpassed the minimal clinically important difference. Of the 17 tasks of the Wolf Motor Function Test, he demonstrated improvement on 11 of the 15 time-based tasks and both strength measures. The participant reported an overall improvement in his recovery from stroke on the Stroke Impact Scale quality-of-life questionnaire from 40 of 100 to 65 of 100. His score on the Center for Epidemiologic Studies Depression Scale improved by 19 points. This case demonstrates that robotic-assisted therapy paired with an HEP can be successfully delivered within a home environment to a person with stroke. Robotic-assisted therapy may be a feasible and efficacious adjunct to an HEP program to elicit substantial improvements in upper extremity motor function, especially in those persons with stroke who lack access to stroke rehabilitation centers.
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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
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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.
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Lee, Su-Hyun; Kim, Yu-Mi; Lee, Byoung-Hee
2015-07-01
[Purpose] This study investigated the therapeutic effects of virtual reality-based bilateral upper-extremity training on brain activity in patients with stroke. [Subjects and Methods] Eighteen chronic stroke patients were divided into two groups: the virtual reality-based bilateral upper-extremity training group (n = 10) and the bilateral upper-limb training group (n = 8). The virtual reality-based bilateral upper-extremity training group performed bilateral upper-extremity exercises in a virtual reality environment, while the bilateral upper-limb training group performed only bilateral upper-extremity exercise. All training was conducted 30 minutes per day, three times per week for six weeks, followed by brain activity evaluation. [Results] Electroencephalography showed significant increases in concentration in the frontopolar 2 and frontal 4 areas, and significant increases in brain activity in the frontopolar 1 and frontal 3 areas in the virtual reality-based bilateral upper-extremity training group. [Conclusion] Virtual reality-based bilateral upper-extremity training can improve the brain activity of stroke patients. Thus, virtual reality-based bilateral upper-extremity training is feasible and beneficial for improving brain activation in stroke patients.
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Constrained handgrip force decreases upper extremity muscle activation and arm strength.
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.
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Faria-Fortini, Iza; Michaelsen, Stella Maris; Cassiano, Janine Gomes; Teixeira-Salmela, Luci Fuscaldi
2011-01-01
Upper limb (UL) impairments are the most common disabling deficits after stroke and have complex relationships with activity and participation domains. However, relatively few studies have applied the ICF model to identify the contributions of specific UL impairments, such as muscular weakness, pain, and sensory loss, as predictors of activity and participation. The purposes of this predictive study were to evaluate the relationships between UL variables related to body functions/structures, activity, and participation domains and to determine which would best explain activity and participation with 55 subjects with chronic stroke. Body functions/structures were assessed by measures of grip, pinch, and UL strength, finger tactile sensations, shoulder pain, and cognition (MMSE); activity domain by measures of observed performance (BBT, NHPT, and TEMPA); and participation by measures of quality of life (SSQOL). Upper-limb and grip strength were related to all activity measures (0.52
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Strength changes induced by extreme dieting and exercise in severely obese females.
Pronk, N P; Donnelly, J E; Pronk, S J
1992-04-01
Strength changes, induced by very low-calorie diet (VLCD, 520 kcal/day) alone and in combination with exercise, were determined in 109 severely obese females (46.8 +/- 4.69% fat). Experimental treatments included VLCD alone (LC, n = 40), VLCD with endurance exercise (EE, n = 23), VLCD with endurance exercise and resistance strength training (EERST, n = 23), and VLCD with resistance strength training (RST, n = 23). All subjects participated in the study for 90 days while EE, EERST, and RST exercised four times/week according to specified schedules. Results indicated significant differences for the change scores (baseline to 90 days) for bench press, knee flexion, upper body and lower body composite strength scores between RST and all other groups. RST was the only treatment that increased upper and lower body strength. No differences between groups were found for body mass losses, decrease in percent fat and fat mass. In contrast, these variables showed significant change scores for all groups. Decreases in fat-free mass (FFM) were 5.18 +/- 3.40 kg, 4.79 +/- 4.15 kg (p = 0.001), 4.64 +/- 4.23 kg, and 3.26 +/- 2.67 kg for EE, LC, RST, and EERST, respectively. These data suggest that the combination of resistance strength training and VLCD increases strength despite a loss of FFM. However, endurance exercise and VLCD do not seem to affect body mass loss or FFM loss per se. Moreover, it seems that these increases in strength may represent a training effect which might imply improved central neuromuscular function rather than muscular hypertrophy since FFM decreased in all groups.
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Sequences of upper and lower extremity motions in javelin throwing.
Liu, Hui; Leigh, Steve; Yu, Bing
2010-11-01
Javelin throwing is technically demanding. Sequences of upper and lower extremity motions are important for javelin throwing performance. The purpose of this study was to determine the general sequences of upper and lower extremity motions of elite male and female javelin throwers. Three-dimensional kinematic data were collected for 32 female and 30 male elite javelin throwers during competitions. Shoulder, elbow, wrist, hip, knee, ankle, lower trunk, and upper trunk joint and segment angles were reduced for the best trial of each participant. Beginning times of 6 upper extremity and 10 lower extremity joint and segment angular motions were identified. Sequences of the upper and lower extremity motions were determined through statistical analyses. Upper and lower extremity motions of the male and female elite javelin throwers followed specific sequences (P ≤ 0.050). Upper extremity motions of the male and female elite javelin throwers did not follow a proximal-to-distal sequence as suggested in the literature. Male and female elite javelin throwers apparently employed different sequences for upper and lower extremity motions (P < 0.001). Further studies are needed to determine the effects of sequences of upper and lower extremity motions on javelin throwing performance.
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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
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Duplex sonography for detection of deep vein thrombosis of upper extremities: a 13-year experience.
Chung, Amy S Y; Luk, W H; Lo, Adrian X N; Lo, C F
2015-04-01
To determine the prevalence and characteristics of sonographically evident upper-extremity deep vein thrombosis in symptomatic Chinese patients and identify its associated risk factors. Regional hospital, Hong Kong. Data on patients undergoing upper-extremity venous sonography examinations during a 13-year period from November 1999 to October 2012 were retrieved. Variables including age, sex, history of smoking, history of lower-extremity deep vein thrombosis, major surgery within 30 days, immobilisation within 30 days, cancer (history of malignancy), associated central venous or indwelling catheter, hypertension, diabetes mellitus, sepsis within 30 days, and stroke within 30 days were tested using binary logistic regression to understand the risk factors for upper-extremity deep vein thrombosis. The presence of upper-extremity deep vein thrombosis identified. Overall, 213 patients with upper-extremity sonography were identified. Of these patients, 29 (13.6%) had upper-extremity deep vein thrombosis. The proportion of upper-extremity deep vein thrombosis using initial ultrasound was 0.26% of all deep vein thrombosis ultrasound requests. Upper limb swelling was the most common presentation seen in a total of 206 (96.7%) patients. Smoking (37.9%), history of cancer (65.5%), and hypertension (27.6%) were the more prevalent conditions among patients in the upper-extremity deep vein thrombosis-positive group. No statistically significant predictor of upper-extremity deep vein thrombosis was noted if all variables were included. After backward stepwise logistic regression, the final model was left with only age (P=0.119), female gender (P=0.114), and history of malignancy (P=0.024) as independent variables. History of malignancy remained predictive of upper-extremity deep vein thrombosis. Upper-extremity deep vein thrombosis is uncommon among symptomatic Chinese population. The most common sign is swelling and the major risk factor for upper-extremity deep vein thrombosis identified in this study is malignancy.
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Upper Extremity Deep Vein Thromboses: The Bowler and the Barista.
Stake, Seth; du Breuil, Anne L; Close, Jeremy
2016-01-01
Effort thrombosis of the upper extremity refers to a deep venous thrombosis of the upper extremity resulting from repetitive activity of the upper limb. Most cases of effort thrombosis occur in young elite athletes with strenuous upper extremity activity. This article reports two cases who both developed upper extremity deep vein thromboses, the first being a 67-year-old bowler and the second a 25-year-old barista, and illustrates that effort thrombosis should be included in the differential diagnosis in any patient with symptoms concerning DVT associated with repetitive activity. A literature review explores the recommended therapies for upper extremity deep vein thromboses.
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Upper Extremity Deep Vein Thromboses: The Bowler and the Barista
du Breuil, Anne L.; Close, Jeremy
2016-01-01
Effort thrombosis of the upper extremity refers to a deep venous thrombosis of the upper extremity resulting from repetitive activity of the upper limb. Most cases of effort thrombosis occur in young elite athletes with strenuous upper extremity activity. This article reports two cases who both developed upper extremity deep vein thromboses, the first being a 67-year-old bowler and the second a 25-year-old barista, and illustrates that effort thrombosis should be included in the differential diagnosis in any patient with symptoms concerning DVT associated with repetitive activity. A literature review explores the recommended therapies for upper extremity deep vein thromboses. PMID:27800207
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Laudner, Kevin G; Metz, Betsy; Thomas, David Q
2013-01-01
Approximately 62% of all cheerleaders sustain some type of orthopaedic injury during their cheerleading careers. Furthermore, the occurrence of such injuries has led to inquiry regarding optimal prevention techniques. One possible cause of these injuries may be related to inadequate conditioning in cheerleaders. To determine whether a strength and conditioning program produces quantifiable improvements in anterior glenohumeral (GH) laxity and stiffness. Descriptive laboratory study. University laboratory. A sample of 41 collegiate cheerleaders (24 experimental and 17 control participants) volunteered. No participants had a recent history (in the past 6 months) of upper extremity injury or any history of upper extremity surgery. The experimental group completed a 6-week strength and conditioning program between the pretest and posttest measurements; the control group did not perform any strength training between tests. We measured anterior GH laxity and stiffness with an instrumented arthrometer. We conducted a group × time analysis of variance with repeated measures on time (P < .05) to determine differences between groups. A significant interaction was demonstrated, with the control group having more anterior GH laxity at the posttest session than the strengthening group (P = .03, partial η2 = 0.11). However, no main effect for time (P = .92) or group (P = .97) was observed. In another significant interaction, the control group had less anterior GH stiffness at the posttest session than the strengthening group (P = .03, partial η2 = 0.12). Main effects for time (P = .02) and group (P = .004) were also significant. Cheerleaders who participate in a shoulder-strengthening program developed less anterior GH laxity and more stiffness than cheerleaders in the control group.
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Lee, Jung-Sun; Kim, Chang-Yong; Kim, Hyeong-Dong
2016-08-01
The aim of this study was to determine the effect of whole-body vibration training combined with task-related training on arm function, spasticity, and grip strength in subjects with poststroke hemiplegia. Forty-five subjects with poststroke were randomly allocated to 3 groups, each with 15 subjects as follows: control group, whole-body vibration group, and whole-body vibration plus task-related training group. Outcome was evaluated by clinical evaluation and measurements of the grip strength before and 4 weeks after intervention. Our results show that there was a significantly greater increase in the Fugl-Meyer scale, maximal grip strength of the affected hand, and grip strength normalized to the less affected hand in subjects undergoing the whole-body vibration training compared with the control group after the test. Furthermore, there was a significantly greater increase in the Wolf motor function test and a decrease in the modified Ashworth spasticity total scores in subjects who underwent whole-body vibration plus task-related training compared with those in the other 2 groups after the test. The findings indicate that the use of whole-body vibration training combined with task-related training has more benefits on the improvement of arm function, spasticity, and maximal grip strength than conventional upper limb training alone or with whole-body vibration in people with poststroke hemiplegia.
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Kim, Byeong-Jo; Lee, Jung-Hoon
2015-01-01
[Purpose] The aim of this study was to evaluate the effects of scapula-upward taping (SUT) in a patient with shoulder pain caused by scapular downward rotation (SDR). [Subject] A 26-year-old male with SDR experienced severe pain in the left shoulder when he lifted his left upper extremity to hold the handle in a bus and during and after push-up exercise. [Methods] The patient underwent SUT for a period of 1 month, 5 times per week, for an average of 9 h/d. [Results] The patient’s radiographs showed that the degree of SDR had decreased; the left shoulder pain also decreased in the resting state and during and after push-up exercise. The manual muscle strength test grades of the upper trapezius, lower trapezius, and serratus anterior had increased. The patient was able to lift the left upper extremity to hold the handle in a bus and perform the push-up exercise without experiencing any pain. [Conclusion] Repeated SUT application may be a beneficial treatment method for alleviating the degree of SDR and shoulder pain in SDR patients. PMID:25729213
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Ploegmakers, Joris; The, Bertram; Wang, Allan; Brutty, Mike; Ackland, Tim
2015-10-01
Forearm rotation is a key function in the upper extremity. Following distal radius fracture, residual disability may occur in tasks requiring forearm rotation. The objectives of this study are to define pronation and supination strength profiles tested through the range of forearm rotation in normal individuals, and to evaluate the rotational strength profiles and rotational strength deficits across the testing range in a cohort of patients treated for distal radius fracture associated with an ulnar styloid base fracture. In a normative cohort of 29 subjects the supination strength profile showed an increasing linear relationship from supination to pronation. Twelve subjects were evaluated 2-4 years after anatomical open reduction and volar plate fixation of a distal radius fracture. The injured wrist was consistently weaker (corrected for hand dominance) in both supination and pronation strength in all testing positions, with the greatest loss in 60 degrees supination. Mean supination strength loss across all testing positions was significantly correlated with worse PRWE scores, highlighting the importance of supination in wrist function.
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Lattimer, Lauren J; Lanovaz, Joel L; Farthing, Jonathan P; Madill, Stéphanie; Kim, Soo; Robinovitch, Stephen; Arnold, Cathy
2017-07-01
The purposes of this study were to examine female age differences in: (1) upper extremity (UE) and trunk muscle activity, elbow joint moment, loading force, and UE energy absorption during a controlled forward body descent; and (2) UE muscle strength. Twenty young (mean 24.8 ± 3.4 years) and 20 older (68.4 ± 5.7 years) women were assessed via dynamometry for isometric, concentric, and eccentric UE strength and performed forward descents on force plates at three body lean angles (60°, 45°, and 30° from horizontal). Significant differences (p < .05) were found for muscle strength, biomechanics, and muscle activity. Concentric UE strength averaged 15% lower in older women. At 30° body lean, older women absorbed less energy. Older women had greater biceps brachii activation and less external oblique activation at all body lean angles. Age differences in muscle strength, activation, and energy absorption may contribute to fall-related injury risk.
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Analysis of factors related to arm weakness in patients with breast cancer-related lymphedema.
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.
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Quantifying anti-gravity torques for the design of a powered exoskeleton.
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.
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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.
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Laudner, Kevin G; Metz, Betsy; Thomas, David Q
2013-01-01
Context Approximately 62% of all cheerleaders sustain some type of orthopaedic injury during their cheerleading careers. Furthermore, the occurrence of such injuries has led to inquiry regarding optimal prevention techniques. One possible cause of these injuries may be related to inadequate conditioning in cheerleaders. Objective To determine whether a strength and conditioning program produces quantifiable improvements in anterior glenohumeral (GH) laxity and stiffness. Design Descriptive laboratory study. Setting University laboratory. Patients or Other Participants A sample of 41 collegiate cheerleaders (24 experimental and 17 control participants) volunteered. No participants had a recent history (in the past 6 months) of upper extremity injury or any history of upper extremity surgery. Intervention(s) The experimental group completed a 6-week strength and conditioning program between the pretest and posttest measurements; the control group did not perform any strength training between tests. Main Outcome Measure(s) We measured anterior GH laxity and stiffness with an instrumented arthrometer. We conducted a group × time analysis of variance with repeated measures on time (P < .05) to determine differences between groups. Results A significant interaction was demonstrated, with the control group having more anterior GH laxity at the posttest session than the strengthening group (P = .03, partial η2 = 0.11). However, no main effect for time (P = .92) or group (P = .97) was observed. In another significant interaction, the control group had less anterior GH stiffness at the posttest session than the strengthening group (P = .03, partial η2 = 0.12). Main effects for time (P = .02) and group (P = .004) were also significant. Conclusions Cheerleaders who participate in a shoulder-strengthening program developed less anterior GH laxity and more stiffness than cheerleaders in the control group. PMID:23672322
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Acute Effect of Upper and Lower Body Postactivation Exercises on Shot Put Performance.
Kontou, Eleni I; Berberidou, Fani T; Pilianidis, Theophilos C; Mantzouranis, Nikolaos I; Methenitis, Spyridon K
2018-04-01
Kontou, EI, Berberidou, FT, Pilianidis, TC, Mantzouranis, NI, and Methenitis, SK. Acute effect of upper and lower body postactivation exercises on shot put performance. J Strength Cond Res 32(4): 970-982, 2018-The purpose of this study was to investigate the effect of different types of upper and lower' extremities exercises on acute increase of shot put performance, in moderate experienced throwers. Eight (n = 8) males and 9 (n = 9) female throwers participated in this study. Their bench press and squat maximum strength were measured while their shot put performance from power position was evaluated before and after 4 interventions: (a) plyometric push-ups (Plyo), (b) 6 s isometric push-ups (Iso), (c) 3 countermovement jumps (CMJs) and (d) 10 reps. of skipping (Skip). Interventions were performed in counterbalanced order with a 48-hour interval. Significant increase (p < 0.05) of shot put performances was observed after Plyo, Iso, and CMJ (range: 2.30 ± 1.82%-5.72 ± 4.32%). In addition, Iso induced the highest increase while Skip did not induce any improvement of throwing performance. The highest increases were recorded in men's performance after CMJ (5.72 ± 4.32%) while in women's performance after Iso (3.59 ± 2.7%). Javelin and discus throwers increase higher their performance after CMJs while shot putters after Iso. Significant correlations were found between training experience, maximum/relative strength, shot put performance and increase of throwing performance (%) after the interventions (r: 0.519-0.991, p < 0.05). Percentage increase of performance between Iso and Plyo have negative correlations (r: -0.569, p < 0.05) in contrast of those between Skip and CMJ (r: 0.710, p < 0.05). These results suggest that upper or lower body postactivation interventions may acutely increase the throwing performance. However, experience and strength are significant determinant of this increase.
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Chang, Won Hyuk; Park, Eunhee; Lee, Jungsoo; Lee, Ahee; Kim, Yun-Hee
2017-06-01
The identification of intrinsic factors for predicting upper extremity motor outcome could aid the design of individualized treatment plans in stroke rehabilitation. The aim of this study was to identify prognostic factors, including intrinsic genetic factors, for upper extremity motor outcome in patients with subacute stroke. A total of 97 patients with subacute stroke were enrolled. Upper limb motor impairment was scored according to the upper limb of Fugl-Meyer assessment score at 3 months after stroke. The prediction of upper extremity motor outcome at 3 months was modeled using various factors that could potentially influence this impairment, including patient characteristics, baseline upper extremity motor impairment, functional and structural integrity of the corticospinal tract, and brain-derived neurotrophic factor genotype. Multivariate ordinal logistic regression models were used to identify the significance of each factor. The independent predictors of motor outcome at 3 months were baseline upper extremity motor impairment, age, stroke type, and corticospinal tract functional integrity in all stroke patients. However, in the group with severe motor impairment at baseline (upper limb score of Fugl-Meyer assessment <25), the number of Met alleles in the brain-derived neurotrophic factor genotype was also an independent predictor of upper extremity motor outcome 3 months after stroke. Brain-derived neurotrophic factor genotype may be a potentially useful predictor of upper extremity motor outcome in patients with subacute stroke with severe baseline motor involvement. © 2017 American Heart Association, Inc.
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Hays, Ron D; Spritzer, Karen L; Amtmann, Dagmar; Lai, Jin-Shei; Dewitt, Esi Morgan; Rothrock, Nan; Dewalt, Darren A; Riley, William T; Fries, James F; Krishnan, Eswar
2013-11-01
To create upper-extremity and mobility subdomain scores from the Patient-Reported Outcomes Measurement Information System (PROMIS) physical functioning adult item bank. Expert reviews were used to identify upper-extremity and mobility items from the PROMIS item bank. Psychometric analyses were conducted to assess empirical support for scoring upper-extremity and mobility subdomains. Data were collected from the U.S. general population and multiple disease groups via self-administered surveys. The sample (N=21,773) included 21,133 English-speaking adults who participated in the PROMIS wave 1 data collection and 640 Spanish-speaking Latino adults recruited separately. Not applicable. We used English- and Spanish-language data and existing PROMIS item parameters for the physical functioning item bank to estimate upper-extremity and mobility scores. In addition, we fit graded response models to calibrate the upper-extremity items and mobility items separately, compare separate to combined calibrations, and produce subdomain scores. After eliminating items because of local dependency, 16 items remained to assess upper extremity and 17 items to assess mobility. The estimated correlation between upper extremity and mobility was .59 using existing PROMIS physical functioning item parameters (r=.60 using parameters calibrated separately for upper-extremity and mobility items). Upper-extremity and mobility subdomains shared about 35% of the variance in common, and produced comparable scores whether calibrated separately or together. The identification of the subset of items tapping these 2 aspects of physical functioning and scored using the existing PROMIS parameters provides the option of scoring these subdomains in addition to the overall physical functioning score. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
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Predictors of Upper-Extremity Physical Function in Older Adults.
Hermanussen, Hugo H; Menendez, Mariano E; Chen, Neal C; Ring, David; Vranceanu, Ana-Maria
2016-10-01
Little is known about the influence of habitual participation in physical exercise and diet on upper-extremity physical function in older adults. To assess the relationship of general physical exercise and diet to upper-extremity physical function and pain intensity in older adults. A cohort of 111 patients 50 or older completed a sociodemographic survey, the Rapid Assessment of Physical Activity (RAPA), an 11-point ordinal pain intensity scale, a Mediterranean diet questionnaire, and three Patient- Reported Outcomes Measurement Information System (PROMIS) based questionnaires: Pain Interference to measure inability to engage in activities due to pain, Upper-Extremity Physical Function, and Depression. Multivariable linear regression modeling was used to characterize the association of physical activity, diet, depression, and pain interference to pain intensity and upper-extremity function. Higher general physical activity was associated with higher PROMIS Upper-Extremity Physical Function and lower pain intensity in bivariate analyses. Adherence to the Mediterranean diet did not correlate with PROMIS Upper-Extremity Physical Function or pain intensity in bivariate analysis. In multivariable analyses factors associated with higher PROMIS Upper-Extremity Physical Function were male sex, non-traumatic diagnosis and PROMIS Pain Interference, with the latter accounting for most of the observed variability (37%). Factors associated with greater pain intensity in multivariable analyses included fewer years of education and higher PROMIS Pain Interference. General physical activity and diet do not seem to be as strongly or directly associated with upper-extremity physical function as pain interference.
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Wee, Seng Kwee; Hughes, Ann-Marie; Warner, Martin; Burridge, Jane H
2014-09-01
Many stroke patients exhibit excessive compensatory trunk movements during reaching. Compensatory movement behaviors may improve upper extremity function in the short-term but be detrimental to long-term recovery. To evaluate the evidence that trunk restraint limits compensatory trunk movement and/or promotes better upper extremity recovery in stroke patients. A search was conducted through electronic databases from January 1980 to June 2013. Only randomized controlled trials (RCTs) comparing upper extremity training with and without trunk restraint were selected for review. Three review authors independently assessed the methodological quality and extracted data from the studies. Meta-analysis was conducted when there was sufficient homogenous data. Six RCTs involving 187 chronic stroke patients were identified. Meta-analysis of key outcome measures showed that trunk restraint has a moderate statistically significant effect on improving Fugl-Meyer Upper Extremity (FMA-UE) score, active shoulder flexion, and reduction in trunk displacement during reaching. There was a small, nonsignificant effect of trunk restraint on upper extremity function. Trunk restraint has a moderate effect on reduction of upper extremity impairment in chronic stroke patients, in terms of FMA-UE score, increased shoulder flexion, and reduction in excessive trunk movement during reaching. There is insufficient evidence to demonstrate that trunk restraint improves upper extremity function and reaching trajectory smoothness and straightness in chronic stroke patients. Future research on stroke patients at different phases of recovery and with different levels of upper extremity impairment is recommended. © The Author(s) 2014.
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Argov, Zohar; Caraco, Yoseph; Lau, Heather; Pestronk, Alan; Shieh, Perry B; Skrinar, Alison; Koutsoukos, Tony; Ahmed, Ruhi; Martinisi, Julia; Kakkis, Emil
2016-03-03
GNE Myopathy (GNEM) is a progressive adult-onset myopathy likely caused by deficiency of sialic acid (SA) biosynthesis. Evaluate the safety and efficacy of SA (delivered by aceneuramic acid extended-release [Ace-ER]) as treatment for GNEM. A Phase 2, randomized, double-blind, placebo-controlled study evaluating Ace-ER 3 g/day or 6 g/day versus placebo was conducted in GNEM subjects (n = 47). After the first 24 weeks, placebo subjects crossed over to 3 g/day or 6 g/day for 24 additional weeks (dose pre-assigned during initial randomization). Assessments included serum SA, muscle strength by dynamometry, functional assessments, clinician- and patient-reported outcomes, and safety. Dose-dependent increases in serum SA levels were observed. Supplementation with Ace-ER resulted in maintenance of muscle strength in an upper extremity composite (UEC) score at 6 g/day compared with placebo at Week 24 (LS mean difference +2.33 kg, p = 0.040), and larger in a pre-specified subgroup able to walk ≥200 m at Screening (+3.10 kg, p = 0.040). After cross-over, a combined 6 g/day group showed significantly better UEC strength than a combined 3 g/day group (+3.46 kg, p = 0.0031). A similar dose-dependent response was demonstrated within the lower extremity composite score, but was not significant (+1.06 kg, p = 0.61). The GNEM-Functional Activity Scale demonstrated a trend improvement in UE function and mobility in a combined 6 g/day group compared with a combined 3 g/day group. Patients receiving Ace-ER tablets had predominantly mild-to-moderate AEs and no serious adverse events. This is the first clinical study to provide evidence that supplementation with SA delivered by Ace-ER may stabilize muscle strength in individuals with GNEM and initiating treatment earlier in the disease course may lead to better outcomes.
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Argov, Zohar; Caraco, Yoseph; Lau, Heather; Pestronk, Alan; Shieh, Perry B.; Skrinar, Alison; Koutsoukos, Tony; Ahmed, Ruhi; Martinisi, Julia; Kakkis, Emil
2016-01-01
Background: GNE Myopathy (GNEM) is a progressive adult-onset myopathy likely caused by deficiency of sialic acid (SA) biosynthesis. Objective: Evaluate the safety and efficacy of SA (delivered by aceneuramic acid extended-release [Ace-ER]) as treatment for GNEM. Methods: A Phase 2, randomized, double-blind, placebo-controlled study evaluating Ace-ER 3 g/day or 6 g/day versus placebo was conducted in GNEM subjects (n = 47). After the first 24 weeks, placebo subjects crossed over to 3 g/day or 6 g/day for 24 additional weeks (dose pre-assigned during initial randomization). Assessments included serum SA, muscle strength by dynamometry, functional assessments, clinician- and patient-reported outcomes, and safety. Results: Dose-dependent increases in serum SA levels were observed. Supplementation with Ace-ER resulted in maintenance of muscle strength in an upper extremity composite (UEC) score at 6 g/day compared with placebo at Week 24 (LS mean difference +2.33 kg, p = 0.040), and larger in a pre-specified subgroup able to walk ≥200 m at Screening (+3.10 kg, p = 0.040). After cross-over, a combined 6 g/day group showed significantly better UEC strength than a combined 3 g/day group (+3.46 kg, p = 0.0031). A similar dose-dependent response was demonstrated within the lower extremity composite score, but was not significant (+1.06 kg, p = 0.61). The GNEM-Functional Activity Scale demonstrated a trend improvement in UE function and mobility in a combined 6 g/day group compared with a combined 3 g/day group. Patients receiving Ace-ER tablets had predominantly mild-to-moderate AEs and no serious adverse events. Conclusions: This is the first clinical study to provide evidence that supplementation with SA delivered by Ace-ER may stabilize muscle strength in individuals with GNEM and initiating treatment earlier in the disease course may lead to better outcomes. PMID:27854209
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Park, Jung Ho; Kim, Hee-Chun; Lee, Jae Hoon; Kim, Jin Soo; Roh, Si Young; Yi, Cheol Ho; Kang, Yoon Kyoo; Kwon, Bum Sun
2009-05-01
While the lower extremities support the weight and move the body, the upper extremities are essential for the activities of daily living, which require many detailed movements. Therefore, a disability of the upper extremity function should include a limitation of all motions of the joints and sensory loss, which affects the activities. In this study, disabilities of the upper extremities were evaluated according to the following conditions: 1) amputation, 2) joint contracture, 3) diseases of upper extremity, 4) weakness, 5) sensory loss of the finger tips, and 6) vascular and lymphatic diseases. The order of 1) to 6) is the order of major disability and there is no need to evaluate a lower order disability when a higher order one exists in the same joint or a part of the upper extremity. However, some disabilities can be either added or substituted when there are special contributions from multiple disabilities. An upper extremity disability should be evaluated after the completion of treatment and full adaptation when further functional changes are not expected. The dominance of the right or left hand before the disability should not be considered when there is a higher rate of disability.
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Jung, Kyoungsim; Jung, Jinhwa; In, Taesung; Kim, Taehoon; Cho, Hwi-Young
2017-01-01
This study investigated the efficacy of Task-Related Training (TRT) Combined with Transcutaneous Electrical Nerve Stimulation (TENS) on the improvement of upper limb muscle activation in chronic stroke survivors with mild or moderate paresis. A single-blind, randomized clinical trial was conducted with 46stroke survivors with chronic paresis. They were randomly allocated two groups: the TRT+TENS group (n = 23) and the TRT+ placebo TENS (TRT+PLBO) group (n = 23). The TRT+TENS group received 30 minutes of high-frequency TENS on wrist and elbow extensors, while the TRT+PLBO group received placebo TENS that was not real ES. Both groups did 30 minutes of TRT after TENS application. Intervention was given five days a week for four weeks. The primary outcomes of upper limb muscle activation were measured by integrated EMG (IEMG), a digital manual muscle tester for muscle strength, active range of motion (AROM) and Fugl-Meyer Assessment of the upper extremity (FMA-UE). The measurements were performed before and after the 4 weeks intervention period. Both groups demonstrated significant improvements of outcomes in IEMG, AROM, muscle strength and FMA-UE during intervention period. When compared with the TRT+PLBO group, the TRT+TENS group showed significantly greater improvement in muscle activation (wrist extensors, P = 0.045; elbow extensors, P = 0.004), muscle strength (wrist extensors, P = 0.044; elbow extensors, P = 0.012), AROM (wrist extension, P = 0.042; elbow extensors, P = 0.040) and FMA-UE (total, P < 0.001; shoulder/elbow/forearm, P = 0.001; wrist, P = 0.002; coordination, P = 0.008) at the end of intervention. Our findings indicate that TRT Combined with TENS can improve paretic muscle activity in upper limb paresis, highlighting the benefits of somatosensory stimulation from TENS.
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Roller skating injuries in children.
Inkelis, S H; Stroberg, A J; Keller, E L; Christenson, P D
1988-06-01
Many children who roller skate sustain injuries. To determine the type and severity of these mishaps, the medical records of 76 children less than 16 years of age with roller skating injuries presenting to two pediatric emergency departments were reviewed. Seventy-five percent were girls, and 25% were boys. The upper extremity was the most common body part injured (74%) (P less than 0.0001). Lower extremity injuries occurred in 12%, head and face injuries in 10%, and chest injuries in 4%. The most common type of injury was a fracture (69%), with the wrist and forearm being most frequently fractured (53%). Hospitalization and long-term sequelae were infrequent. Younger children (less than or equal to 9) had an increased frequency of fracture injury (P less than 0.02). This is most likely because maturation of lower and upper extremity speed, strength, agility, coordination, balance, and reaction time and morphologically stronger bones combine to afford relative protection to the older child. Physicians and parents need to be aware of a child's skill level before the child is encouraged to roller skate. Measures which may decrease the likelihood of injury include protective gear, instruction in roller skating technique, learning to skate in an uncongested area on level, familiar terrain, and learning to fall properly.
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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
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Anttila, Heidi; Autti-Rämö, Ilona; Suoranta, Jutta; Mäkelä, Marjukka; Malmivaara, Antti
2008-01-01
Background To assess the effectiveness of physical therapy (PT) interventions on functioning in children with cerebral palsy (CP). Methods A search was made in Medline, Cinahl, PEDro and the Cochrane library for the period 1990 to February 2007. Only randomized controlled trials (RCTs) on PT interventions in children with diagnosed CP were included. Two reviewers independently assessed the methodological quality and extracted the data. The outcomes measured in the trials were classified using the International Classification of Functioning, Disability and Health (ICF). Results Twenty-two trials were identified. Eight intervention categories were distinguished. Four trials were of high methodological quality. Moderate evidence of effectiveness was established for two intervention categories: effectiveness of upper extremity treatments on attained goals and active supination, and of prehensile hand treatment and neurodevelopmental therapy (NDT) or NDT twice a week on developmental status, and of constraint-induced therapy on amount and quality of hand use. Moderate evidence of ineffectiveness was found of strength training on walking speed and stride length. Conflicting evidence was found for strength training on gross motor function. For the other intervention categories the evidence was limited due to low methodological quality and the statistically insignificant results of the studies. Conclusion Due to limitations in methodological quality and variations in population, interventions and outcomes, mostly limited evidence on the effectiveness of most PT interventions is available through RCTs. Moderate evidence was found for some effectiveness of upper extremity training. Well-designed trials are needed especially for focused PT interventions. PMID:18435840
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Evaluation of pediatric upper extremity peripheral nerve injuries.
Ho, Emily S
2015-01-01
The evaluation of motor and sensory function of the upper extremity after a peripheral nerve injury is critical to diagnose the location and extent of nerve injury as well as document functional recovery in children. The purpose of this paper is to describe an approach to the evaluation of the pediatric upper extremity peripheral nerve injuries through a critical review of currently used tests of sensory and motor function. Outcome studies on pediatric upper extremity peripheral nerve injuries in the Medline database were reviewed. The evaluation of the outcome in children less than 10 years of age with an upper extremity peripheral nerve injury includes careful observation of preferred prehension patterns, examination of muscle atrophy and sudomotor function, provocative tests, manual muscle testing and tests of sensory threshold and tactile gnosis. The evaluation of outcome in children with upper extremity peripheral nerve injuries warrants a unique approach. Copyright © 2015 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.
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Evidence-based therapies for upper extremity dysfunction.
Liepert, Joachim
2010-12-01
The diversity of interventions aimed at improving upper extremity dysfunction is increasing. This article reviews the effectiveness of different therapeutic approaches that have been published in 2009 and 2010. Evidence is based on randomized controlled trials, systematic reviews, and meta-analyses. Application of constraint-induced movement therapy in acute stroke patients was not more effective than a control intervention, and a more intense therapy may even be harmful. Botulinum toxin injections do not only reduce spasticity but, in children, also improve motor functions if combined with occupational therapy. Strength training improves arm function but not necessarily activities of daily living. Bilateral arm training is as effective as other interventions. Extrinsic feedback and sensory training may further improve motor functions. Mirror therapy was particularly effective for patients with initial hand plegia. For some interventions (e.g. constraint-induced movement therapy, botulinum toxin), efficacy is evident, for others (e.g. mental practice, virtual reality), well designed studies with sufficient numbers of patients are needed. The ultimate goal still is to develop evidence-based therapies for all different degrees of motor impairment.
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Physical examination of upper extremity compressive neuropathies.
Popinchalk, Samuel P; Schaffer, Alyssa A
2012-10-01
A thorough history and physical examination are vital to the assessment of upper extremity compressive neuropathies. This article summarizes relevant anatomy and physical examination findings associated with upper extremity compressive neuropathies. Copyright © 2012 Elsevier Inc. All rights reserved.
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Yang, Hwan-Seo; Oh, Young-Min; Eun, Jong-Pil
2016-02-01
Cervical intradural disc herniation (IDH) is an extremely rare condition, comprising only 0.27% of all disc herniations. Three percent of IDHs occur in the cervical, 5% in the thoracic, and over 92% in the lumbar spinal canal. There have been a total of 31 cervical IDHs reported in the literature. The pathogenesis and imaging characteristics of IDH are not fully understood. A preoperative diagnosis is key to facilitating prompt intradural exploration in patients with ambivalent findings, as well as in preventing reoperation. The purpose of reporting our case is to remind clinicians to consider the possibility of cervical IDH during spinal manipulation therapy in patient with chronic neck pain.The patient signed informed consent for publication of this case report and any accompanying image. The ethical approval of this study was waived by the ethics committee of Chonbuk National University Hospital, because this study was case report and the number of patients was <3.A 32-year-old man was transferred our emergency department with progressive quadriparesis. He had no history of trauma, but had received physical therapy with spinal manipulation for chronic neck pain over the course of a month. The day prior, he had noticed neck pain and tingling in the bilateral upper and lower extremities during the manipulation procedure. The following day, he presented with bilateral weakness of all 4 extremities, which rendered him unable to walk. Neurological examination demonstrated a positive Hoffmann sign and ankle clonus bilaterally, hypoesthesia below the C5 dermatome, 3/5 strength in the bilateral upper extremities, and 2/5 strength in the lower extremities. This motor weakness was progressive, and he further complained of voiding difficulty.Urgent magnetic resonance imaging (MRI) of the cervical spine revealed large, central disc herniations at C4-C5 and C5-C6 that caused severe spinal cord compression and surrounding edema. We performed C4-C5-C6 anterior cervical discectomy and fusion.The patient's limb weakness improved rapidly within 1 day postoperatively, and he was discharged 4 weeks later. At his 12-month follow-up, the patient had recovered nearly full muscle power.We presented an extremely rare case of cervical IDH causing progressive quadriparesis after excessive spinal manipulation therapy. The presence of a "halo" and "Y-sign" were useful MRI markers for cervical IDH in this case.
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Cavuoto, Lora A; Nussbaum, Maury A
2014-01-01
In this study, the main and interactive effects of obesity and age on functional performance were assessed during intermittent exertions involving the upper extremity. The prevalence of obesity has doubled over the past 30 years and this increase is associated with higher health care costs, rates of workplace injury, and lost workdays. Obesity and aging can modify job demands and affect worker capacity in terms of muscular and psychomotor function. However, there is a lack of empirical studies quantifying the work-relevant (or ergonomic) impacts related to task demands, capacities, and their potential imbalance. Eight obese and eight non-obese participants from each of two age groups (18-25 and 50-65 years) completed three endurance tasks involving fixed levels of task demands: hand grip, shoulder flexion, and a simulated assembly task using the upper extremity. Measures of functional performance including endurance, discomfort, motor control, and task performance were recorded for each of the task conditions. Endurance times were ∼60% longer for the non-obese group, and older participants had longer endurance times; however there was no evidence of interactive effects of obesity and age. Obesity also impaired functional performance, as indicated by higher rates of strength loss, increases in discomfort, and declines in task performance. These observed impairments may reflect underlying physiological differences among individuals who are obese, but that are independent of age. Obesity-related impairments may have implications for the design of work duration and demand level to prevent fatigue development for workers who are obese.
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Kalsi-Ryan, Sukhvinder; Beaton, Dorcas; Ahn, Henry; Askes, Heather; Drew, Brian; Curt, Armin; Popovic, Milos R; Wang, Justin; Verrier, Mary C; Fehlings, Michael G
2016-02-01
As spinal cord injury (SCI) trials begin to involve subjects with acute cervical SCI, establishing the property of an upper limb outcome measure to detect change over time is critical for its usefulness in clinical trials. The objectives of this study were to define responsiveness, sensitivity, and minimally detectable difference (MDD) of the Graded Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP). An observational, longitudinal study was conducted. International Standards of Neurological Classification of SCI (ISNCSCI), GRASSP, Capabilities of Upper Extremity Questionnaire (CUE-Q), and Spinal Cord Independence Measure (SCIM) were administered 0-10 days, 1, 3, 6, and 12 months post-injury. Standardized Response Means (SRM) for GRASSP and ISNCSCI measures were calculated. Longitudinal construct validity was calculated using Pearson correlation coefficients. Smallest real difference for all subtests was calculated to define the MDD values for all GRASSP subtests. Longitudinal construct validity demonstrated GRASSP and all external measures to be responsive to neurological change for 1 year post-injury. SRM values for the GRASSP subtests ranged from 0.25 to 0.85 units greater than that for ISNCSCI strength and sensation, SCIM-SS, and CUE-Q. MDD values for GRASSP subtests ranged from 2-5 points. GRASSP demonstrates good responsiveness and excellent sensitivity that is superior to ISNCSCI and SCIM III. MDD values are useful in the evaluation of interventions in both clinical and research settings. The responsiveness and sensitivity of GRASSP make it a valuable condition-specific measure in tetraplegia, where changes in upper limb neurological and functional outcomes are essential for evaluating the efficacy of interventions.
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Enhanced left-finger deftness following dominant upper- and lower-limb amputation.
Swanberg, Kelley M; Clark, Abigail M; Kline, Julia E; Yurkiewicz, Ilana R; Chan, Brenda L; Pasquina, Paul F; Heilman, Kenneth M; Tsao, Jack W
2011-09-01
After amputation, the sensorimotor cortex reorganizes, and these alterations might influence motor functions of the remaining extremities. The authors examined how amputation of the dominant or nondominant upper or lower extremity alters deftness in the intact limbs. The participants were 32 unilateral upper- or lower-extremity amputees and 6 controls. Upper-extremity deftness was tested by coin rotation (finger deftness) and pegboard (arm, hand, and finger deftness) tasks. Following right-upper- or right-lower-extremity amputation, the left hand's finger movements were defter than the left-hand fingers of controls. In contrast, with left-upper- or left-lower-extremity amputation, the right hand's finger performance was the same as that of the controls. Although this improvement might be related to increased use (practice), the finding that right-lower-extremity amputation also improved the left hand's finger deftness suggests an alternative mechanism. Perhaps in right-handed persons the left motor cortex inhibits the right side of the body more than the right motor cortex inhibits the left side, and the physiological changes induced by right-sided amputation reduced this inhibition.
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Survey of upper extremity injuries among martial arts participants.
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.
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Page, Stephen J; Hill, Valerie; White, Susan
2013-06-01
To compare the efficacy of a repetitive task-specific practice regimen integrating a portable, electromyography-controlled brace called the 'Myomo' versus usual care repetitive task-specific practice in subjects with chronic, moderate upper extremity impairment. Sixteen subjects (7 males; mean age 57.0 ± 11.02 years; mean time post stroke 75.0 ± 87.63 months; 5 left-sided strokes) exhibiting chronic, stable, moderate upper extremity impairment. Subjects were administered repetitive task-specific practice in which they participated in valued, functional tasks using their paretic upper extremities. Both groups were supervised by a therapist and were administered therapy targeting their paretic upper extremities that was 30 minutes in duration, occurring 3 days/week for eight weeks. One group participated in repetitive task-specific practice entirely while wearing the portable robotic, while the other performed the same activity regimen manually. The upper extremity Fugl-Meyer, Canadian Occupational Performance Measure and Stroke Impact Scale were administered on two occasions before intervention and once after intervention. After intervention, groups exhibited nearly identical Fugl-Meyer score increases of ≈2.1 points; the group using robotics exhibited larger score changes on all but one of the Canadian Occupational Performance Measure and Stroke Impact Scale subscales, including a 12.5-point increase on the Stroke Impact Scale recovery subscale. Findings suggest that therapist-supervised repetitive task-specific practice integrating robotics is as efficacious as manual practice in subjects with moderate upper extremity impairment.
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Paik, Young-Rim; Lee, Jeong-Hoon; Lee, Doo-Ho; Park, Hee-Su; Oh, Dong-Hwan
2017-12-01
[Purpose] This study investigated the effects of mirror therapy and neuromuscular electrical stimulation on upper extremity function in stroke patients. [Subjects and Methods] This study recruited 8 stroke patients. All patients were treated with mirror therapy and neuromuscular electrical stimulation five times per week for 4 weeks. Upper limb function evaluation was performed using upper extremity part of fugl meyer assessment. [Results] Before and after intervention, fugl meyer assessment showed significant improvement. [Conclusion] In this study, mirror therapy and neuromuscular electrical stimulation are effective methods for upper extremity function recovery in stroke patients.
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Gil, Joseph A; Elia, Gregory; Shah, Kalpit N; Owens, Brett D; Got, Christopher
2018-04-16
Fishing injuries commonly affect the hands. The goal of this study was to quantify the incidence of fishing-related upper extremity injuries that present to emergency departments in the United States. We examined the reported cases of fishing-related upper extremity injuries in the National Electronic Injury Surveillance System database. Analysis was performed based on age, sex and the type of injury reported. The national incidence of fishing-related upper extremity injuries was 119.6 per 1 million person-years in 2014. The most common anatomic site for injury was the finger (63.3%), followed by the hand (20.3%). The most common type of injury in the upper extremity was the presence of a foreign body (70.4%). The incidence of fishing-related upper extremity injuries in males was 200 per 1 million person-years, which was significantly higher than the incidence in females (41 per 1 million person-years). The incidence of fishing-related upper extremity injuries that present to the Emergency Department was 120 per 1 million person-years. The incidence was significantly higher in males. With the widespread popularity of the activity, it is important for Emergency Physicians and Hand Surgeons to understand how to properly evaluate and manage these injuries.
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Tosun, Aliye; Türe, Sabiha; Askin, Ayhan; Yardimci, Engin Ugur; Demirdal, Secil Umit; Kurt Incesu, Tülay; Tosun, Ozgur; Kocyigit, Hikmet; Akhan, Galip; Gelal, Fazıl Mustafa
2017-07-01
To assess the efficacy of inhibitory repetitive transcranial magnetic stimulation (rTMS) and neuromuscular electrical stimulation (NMES) on upper extremity motor function in patients with acute/subacute ischemic stroke. Twenty-five ischemic acute/subacute stroke subjects were enrolled in this randomized controlled trial. Experimental group 1 received low frequency (LF) rTMS to the primary motor cortex of the unaffected side + physical therapy (PT) including activities to improve strength, flexibility, transfers, posture, balance, coordination, and activities of daily living, mainly focusing on upper limb movements; experimental group 2 received the same protocol combined with NMES to hand extensor muscles; and the control group received only PT. Functional magnetic resonance imaging (fMRI) scan was used to evaluate the activation or inhibition of the affected and unaffected primary motor cortex. No adverse effect was reported. Most of the clinical outcome scores improved significantly in all groups, however no statistically significant difference was found between groups due to the small sample sizes. The highest percent improvement scores were observed in TMS + NMES group (varying between 48 and 99.3%) and the lowest scores in control group (varying between 13.1 and 28.1%). Hand motor recovery was significant in both experimental groups while it did not change in control group. Some motor cortex excitability changes were also observed in fMRI. LF-rTMS with or without NMES seems to facilitate the motor recovery in the paretic hand of patients with acute/subacute ischemic stroke. TMS or the combination of TMS + NMES may be a promising additional therapy in upper limb motor training. Further studies with larger numbers of patients are needed to establish their effectiveness in upper limb motor rehabilitation of stroke.
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The home stroke rehabilitation and monitoring system trial: a randomized controlled trial.
Linder, Susan M; Rosenfeldt, Anson B; Reiss, Aimee; Buchanan, Sharon; Sahu, Komal; Bay, Curtis R; Wolf, Steven L; Alberts, Jay L
2013-01-01
Because many individuals poststroke lack access to the quality and intensity of rehabilitation to improve upper extremity motor function, a home-based robotic-assisted upper extremity rehabilitation device is being paired with an individualized home exercise program. The primary aim of this project is to determine the effectiveness of robotic-assisted home therapy compared with a home exercise program on upper extremity motor recovery and health-related quality of life for stroke survivors in rural and underserved locations. The secondary aim is to explore whether initial degree of motor function of the upper limb may be a factor in predicting the extent to which patients with stroke may be responsive to a home therapy approach. We hypothesize that the home exercise program intervention, when enhanced with robotic-assisted therapy, will result in significantly better outcomes in motor function and quality of life. A total of 96 participants within six-months of a single, unilateral ischemic, or hemorrhagic stroke will be recruited in this prospective, single-blind, multisite randomized clinical trial. The primary outcome is the change in upper extremity function using the Action Research Arm Test. Secondary outcomes include changes in: upper extremity function (Wolf Motor Function Test), upper extremity impairment (upper extremity portion of the Fugl-Meyer Test), self-reported quality of life (Stroke Impact Scale), and affect (Centers for Epidemiologic Studies Depression Scale). Similar or greater improvements in upper extremity function using the combined robotic home exercise program intervention compared with home exercise program alone will be interpreted as evidence that supports the introduction of in-home technology to augment the recovery of function poststroke. © 2012 The Authors. International Journal of Stroke © 2012 World Stroke Organization.
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Knowles, Martyn; Nation, David A; Timaran, David E; Gomez, Luis F; Baig, M Shadman; Valentine, R James; Timaran, Carlos H
2015-01-01
Fenestrated endovascular aortic aneurysm repair (FEVAR) is an alternative to open repair in patients with complex abdominal aortic aneurysms who are neither fit nor suitable for standard open or endovascular repair. Chimney and snorkel grafts are other endovascular alternatives but frequently require bilateral upper extremity access that has been associated with a 3% to 10% risk of stroke. However, upper extremity access is also frequently required for FEVAR because of the caudal orientation of the visceral vessels. The purpose of this study was to assess the use of upper extremity access for FEVAR and the associated morbidity. During a 5-year period, 148 patients underwent FEVAR, and upper extremity access for FEVAR was used in 98 (66%). Outcomes were compared between those who underwent upper extremity access and those who underwent femoral access alone. The primary end point was a cerebrovascular accident or transient ischemic attack, and the secondary end point was local access site complications. The mean number of fenestrated vessels was 3.07 ± 0.81 (median, 3) for a total of 457 vessels stented. Percutaneous upper extremity access was used in 12 patients (12%) and open access in 86 (88%). All patients who required a sheath size >7F underwent high brachial open access, with the exception of one patient who underwent percutaneous axillary access with a 12F sheath. The mean sheath size was 10.59F ± 2.51F (median, 12F), which was advanced into the descending thoracic aorta, allowing multiple wire and catheter exchanges. One hemorrhagic stroke (one of 98 [1%]) occurred in the upper extremity access group, and one ischemic stroke (one of 54 [2%]) occurred in the femoral-only access group (P = .67). The stroke in the upper extremity access group occurred 5 days after FEVAR and was related to uncontrolled hypertension, whereas the stroke in the femoral group occurred on postoperative day 3. Neither patient had signs or symptoms of a stroke immediately after FEVAR. The right upper extremity was accessed six times without a stroke (0%) compared with the left being accessed 92 times with one stroke (1%; P = .8). Four patients (4%) had local complications related to upper extremity access. One (1%) required exploration for an expanding hematoma after manual compression for a 7F sheath, one (1%) required exploration for hematoma and neurologic symptoms after open access for a 12F sheath, and two patients (2%) with small hematomas did not require intervention. Two (two of 12 [17%]) of these complications were in the percutaneous access group, which were significantly more frequent than in the open group (two of 86 [2%]; P = .02). Upper extremity access appears to be a safe and feasible approach for patients undergoing FEVAR. Open exposure in the upper extremity may be safer than percutaneous access during FEVAR. Unlike chimney and snorkel grafts, upper extremity access during FEVAR is not associated with an increased risk of stroke, despite the need for multiple visceral vessel stenting. Copyright © 2015 Society for Vascular Surgery. All rights reserved.
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Upper extremity deep venous thrombosis after port insertion: What are the risk factors?
Tabatabaie, Omidreza; Kasumova, Gyulnara G; Kent, Tara S; Eskander, Mariam F; Fadayomi, Ayotunde B; Ng, Sing Chau; Critchlow, Jonathan F; Tawa, Nicholas E; Tseng, Jennifer F
2017-08-01
Totally implantable venous access devices (ports) are widely used, especially for cancer chemotherapy. Although their use has been associated with upper extremity deep venous thrombosis, the risk factors of upper extremity deep venous thrombosis in patients with a port are not studied adequately. The Healthcare Cost and Utilization Project's Florida State Ambulatory Surgery and Services Database was queried between 2007 and 2011 for patients who underwent outpatient port insertion, identified by Current Procedural Terminology code. Patients were followed in the State Ambulatory Surgery and Services Database, State Inpatient Database, and State Emergency Department Database for upper extremity deep venous thrombosis occurrence. The cohort was divided into a test cohort and a validation cohort based on the year of port placement. A multivariable logistic regression model was developed to identify risk factors for upper extremity deep venous thrombosis in patients with a port. The model then was tested on the validation cohort. Of the 51,049 patients in the derivation cohort, 926 (1.81%) developed an upper extremity deep venous thrombosis. On multivariate analysis, independently significant predictors of upper extremity deep venous thrombosis included age <65 years (odds ratio = 1.22), Elixhauser score of 1 to 2 compared with zero (odds ratio = 1.17), end-stage renal disease (versus no kidney disease; odds ratio = 2.63), history of any deep venous thrombosis (odds ratio = 1.77), all-cause 30-day revisit (odds ratio = 2.36), African American race (versus white; odds ratio = 1.86), and other nonwhite races (odds ratio = 1.35). Additionally, compared with genitourinary malignancies, patients with gastrointestinal (odds ratio = 1.55), metastatic (odds ratio = 1.76), and lung cancers (odds ratio = 1.68) had greater risks of developing an upper extremity deep venous thrombosis. This study identified major risk factors of upper extremity deep venous thrombosis. Further studies are needed to evaluate the appropriateness of thromboprophylaxis in patients at greater risk of upper extremity deep venous thrombosis. Copyright © 2017 Elsevier Inc. All rights reserved.
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Page, Stephen J.; Hill, Valerie; White, Susan
2013-01-01
Objective To compare the efficacy of a repetitive task specific practice regimen integrating a portable, electromyography-controlled brace called the “Myomo” versus usual care repetitive task specific practice in subjects with chronic, moderate upper extremity impairment. Subjects 16 subjects (7 males; mean age = 57.0 ± 11.02 years; mean time post stroke = 75.0 ± 87.63 months; 5 left-sided strokes) exhibiting chronic, stable, moderate upper extremity impairment. Interventions Subjects were administered repetitive task specific practice in which they participated in valued, functional tasks using their paretic upper extremities. Both groups were supervised by a therapist and were administered therapy targeting their paretic upper extremities that was 30-minutes in duration, occurring 3 days/week for 8 weeks. However, one group participated in repetitive task specific practice entirely while wearing the portable robotic while the other performed the same activity regimen manually.. Main Outcome Measures The upper extremity Fugl-Meyer, Canadian Occupational Performance measure and Stroke Impact Scale were administered on two occasions before intervention and once after intervention. Results After intervention, groups exhibited nearly-identical Fugl-Meyer score increases of ≈ 2.1 points; the group using robotics exhibited larger score changes on all but one of the Canadian occupational performance measure and Stroke Impact Scale subscales, including a 12.5-point increase on the Stroke Impact Scale recovery subscale. Conclusions Findings suggest that therapist-supervised repetitive task specific practice integrating robotics is as efficacious as manual in subjects with moderate upper extremity impairment. PMID:23147552
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Application of RFID technology-upper extremity rehabilitation training.
Chen, Chih-Chen; Chen, Yu-Luen; Chen, Shih-Ching
2016-01-01
[Purpose] Upper extremity rehabilitation after an injury is very important. This study proposes radio frequency identification (RFID) technology to improve and enhance the effectiveness of the upper extremity rehabilitation. [Subjects and Methods] People use their upper extremities to conduct daily activities. When recovering from injuries, many patients neglect the importance of rehabilitation, which results in degraded function. This study recorded the training process using the traditional rehabilitation hand gliding cart with a RFID reader, RFID tags in the panel, and a servo host computer. [Results] Clinical evidence, time taken to achieve a full score, counts of missing the specified spots, and Brunnstrom stage of aided recovery, the proximal part of the upper extremity show that the RFID-based upper extremity training significantly and reduce negative impacts of the disability in daily life and activities. [Conclusion] This study combined a hand-gliding cart with an RFID reader, and when patients moved the cart, the movement could be observed via the activated RFID tags. The training data was collected and quantified for a better understanding of the recovery status of the patients. Each of the participating patients made progress as expected.
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Tissue expansion in the treatment of giant congenital melanocytic nevi of the upper extremity
Ma, Tengxiao; Fan, Ke; Li, Lei; Xie, Feng; Li, Hao; Chou, Haiyan; Zhang, Zhengwen
2017-01-01
Abstract The aim of our study was to use tissue expansion for the treatment of giant congenital melanocytic nevi of the upper extremity and examine potential advantages over traditional techniques. There were 3 stages in the treatment of giant congenital melanocytic nevi of the upper extremities using tissue expansion: first, the expander was inserted into the subcutaneous pocket; second, the expander was removed, lesions were excised, and the wound of the upper extremity was placed into the pocket to delay healing; third, the residual lesion was excised and the pedicle was removed. The pedicle flap was then unfolded to resurface the wound. During the period between June 2007 and December 2015, there were 11 patients with giant congenital melanocytic nevi of the upper extremities who underwent reconstruction at our department with skin expansion. Few complications were noted in each stage of treatment. The functional and aesthetic results were observed and discussed in this study. Optimal aesthetic and functional results were obtained using tissue expansion to reconstruct the upper extremities due to the giant congenital melanocytic nevi. PMID:28353563
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Bipolar Latissimus Dorsi Transfer for Restoration of Pectoralis Major Function in Poland Syndrome.
Buchanan, Patrick; Leyngold, Mark; Mast, Bruce A
2016-01-01
Poland syndrome typically presents as a unilateral congenital complete or partial absence of the pectoralis major muscle, variably with other associated anomalies. Reconstruction of the defect typically concentrates on aesthetic restoration with functional outcomes being unsuccessful or limited. We present an innovative means of true muscle transfer that provided functional benefit to increase upper extremity strength. A 16-year-old adolescent boy with Poland syndrome manifesting as left pectoralis major muscle agenesis wished to undergo functional reconstruction. He wanted to play on his high school football team, but could not meet the minimum weightlifting requirements. An ipsilateral latissimus dorsi muscle bipolar functional transfer was done with bone-anchored inset into the sternum and humerus so that muscle flexion would replace the absent pectoralis major. A progressive weight training program was then instituted postoperatively. At 9 months, a significant increase in left upper extremity strength was confirmed. The patient ultimately was able to surpass the weightlifting requirements for his high school football team, and joined the team. Our highlighted procedure restored functional outcome using both plastic surgical principles and orthopedic techniques for muscle and tendon repair: bipolar muscle transfer and load-bearing muscle inset. Heretofore, transfer of the latissimus for provision of pectoralis major function has not been reported. Functional reconstruction was possible due to stable, bipolar muscle transfer with load-bearing muscle attachments into cortical bone of the anterior sternum and anteromedial aspect of the humerus. The techniques described should be within the skill set of most plastic surgeons, so that functional restoration for those with Poland syndrome is possible and accessible.
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Evaluation of rotator cuff muscle strength in healthy individuals
Cortez, Paulo José Oliveira; Tomazini, José Elias
2015-01-01
OBJECTIVE: To compare the strength generated by the rotator muscles of the shoulder joint between the right upper limb and left upper limb among healthy individuals. METHODS: To evaluate the muscle strength of upper limbs from isometric contractions in the horizontal direction (rotation) an isometric dynamometer was used, equipped with transducers, signal conditioning, a data acquisition board, and finally, a computer. Study participants were 22 male military subjects, aged between 18 and 19 years old, body mass between 57.7 and 93.0 kg (71.8 ± 9.45 kg) and height between 1.67 and 1.90 m (1.75 ± 0.06 m), healthy and without clinical diseases or any type of orthopedic injury in the muscle skeletal system. RESULTS: The internal rotation in the right upper limb (RUL) was higher than the average strength of internal rotation in the left upper limb (LUL) (p = 0.723). The external rotation strength in RUL was lower than the average strength of external rotation in the LUL (p=0.788). No statistical difference was observed by comparing the strength values of all isometric strength tests. CONCLUSION: For the sample and methodology used to assess muscle strength, there was no statistical difference between the strength generated by the muscles of the rotator cuff of the right and left upper limbs. Experimental Study. PMID:26207091
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Nonlinear relationship between waist to hip ratio, weight and strength in elders: is gender the key?
Castillo, Carmen; Carnicero, José A; de la Torre, Mari Ángeles; Amor, Solange; Guadalupe-Grau, Amelia; Rodríguez-Mañas, Leocadio; García-García, Francisco J
2015-10-01
Visceral fat has a high metabolic activity with deleterious effects on health contributing to the risk for the frailty syndrome. We studied the association between waist to hip ratio (an indirect measure of visceral fat stores) on upper and lower extremities strength. 1741 individuals aged ≥65 participated in this study. The data was obtained from the Toledo Study for Healthy Aging. For each gender, we studied the relationship between the waist-to-hip ratio (WHR), body mass index (BMI) and regional muscle strength (grip, shoulder, knee and hip) using multivariate linear regression and kernel regression statistical models. WHR was higher in men than in women (0.98 ± 0.07 vs. 0.91 ± 0.08, respectively, P < 0.05). In women with high WHR, we observed a decrease in strength especially in those with a normal BMI. As the WHR lowered, the strength increased regardless of the BMI. In men, lower strength was generally related to the lowest and highest WHR's. Maximum strength in men corresponded at a WHR around 1 and the highest BMI. Muscle strength depends on the joined distribution of WHR and BMI according to gender. In consequence, sex, WHR and BMI should be analyzed conjointly to study the relationship among fat distribution, weight and muscle strength.
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Hamilton, Clayon B; Chesworth, Bert M
2013-11-01
The original 20-item Upper Extremity Functional Index (UEFI) has not undergone Rasch validation. The purpose of this study was to determine whether Rasch analysis supports the UEFI as a measure of a single construct (ie, upper extremity function) and whether a Rasch-validated UEFI has adequate reproducibility for individual-level patient evaluation. This was a secondary analysis of data from a repeated-measures study designed to evaluate the measurement properties of the UEFI over a 3-week period. Patients (n=239) with musculoskeletal upper extremity disorders were recruited from 17 physical therapy clinics across 4 Canadian provinces. Rasch analysis of the UEFI measurement properties was performed. If the UEFI did not fit the Rasch model, misfitting patients were deleted, items with poor response structure were corrected, and misfitting items and redundant items were deleted. The impact of differential item functioning on the ability estimate of patients was investigated. A 15-item modified UEFI was derived to achieve fit to the Rasch model where the total score was supported as a measure of upper extremity function only. The resultant UEFI-15 interval-level scale (0-100, worst to best state) demonstrated excellent internal consistency (person separation index=0.94) and test-retest reliability (intraclass correlation coefficient [2,1]=.95). The minimal detectable change at the 90% confidence interval was 8.1. Patients who were ambidextrous or bilaterally affected were excluded to allow for the analysis of differential item functioning due to limb involvement and arm dominance. Rasch analysis did not support the validity of the 20-item UEFI. However, the UEFI-15 was a valid and reliable interval-level measure of a single dimension: upper extremity function. Rasch analysis supports using the UEFI-15 in physical therapist practice to quantify upper extremity function in patients with musculoskeletal disorders of the upper extremity.
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Chesworth, Bert M.
2013-01-01
Background The original 20-item Upper Extremity Functional Index (UEFI) has not undergone Rasch validation. Objective The purpose of this study was to determine whether Rasch analysis supports the UEFI as a measure of a single construct (ie, upper extremity function) and whether a Rasch-validated UEFI has adequate reproducibility for individual-level patient evaluation. Design This was a secondary analysis of data from a repeated-measures study designed to evaluate the measurement properties of the UEFI over a 3-week period. Methods Patients (n=239) with musculoskeletal upper extremity disorders were recruited from 17 physical therapy clinics across 4 Canadian provinces. Rasch analysis of the UEFI measurement properties was performed. If the UEFI did not fit the Rasch model, misfitting patients were deleted, items with poor response structure were corrected, and misfitting items and redundant items were deleted. The impact of differential item functioning on the ability estimate of patients was investigated. Results A 15-item modified UEFI was derived to achieve fit to the Rasch model where the total score was supported as a measure of upper extremity function only. The resultant UEFI-15 interval-level scale (0–100, worst to best state) demonstrated excellent internal consistency (person separation index=0.94) and test-retest reliability (intraclass correlation coefficient [2,1]=.95). The minimal detectable change at the 90% confidence interval was 8.1. Limitations Patients who were ambidextrous or bilaterally affected were excluded to allow for the analysis of differential item functioning due to limb involvement and arm dominance. Conclusion Rasch analysis did not support the validity of the 20-item UEFI. However, the UEFI-15 was a valid and reliable interval-level measure of a single dimension: upper extremity function. Rasch analysis supports using the UEFI-15 in physical therapist practice to quantify upper extremity function in patients with musculoskeletal disorders of the upper extremity. PMID:23813086
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Dunaway, Stefanie; Dezsi, D Brianna; Perkins, Jessica; Tran, Daniel; Naft, Jonathan
2017-07-01
This case study describes the application of a commercially available, custom myoelectric elbow-wrist-hand orthosis (MEWHO), on a veteran diagnosed with chronic stroke with residual left hemiparesis. The MEWHO provides powered active assistance for elbow flexion/extension and 3 jaw chuck grip. It is a noninvasive orthosis that is driven by the user's electromyographic signal. Experience with the MEWHO and associated outcomes are reported. The participant completed 21 outpatient occupational therapy sessions that incorporated the use of a custom MEWHO without grasp capability into traditional occupational therapy interventions. He then upgraded to an advanced version of that MEWHO that incorporated grasp capability and completed an additional 14 sessions. Range of motion, strength, spasticity (Modified Ashworth Scale [MAS]), the Box and Blocks test, the Fugl-Meyer assessment and observation of functional tasks were used to track progress. The participant also completed a home log and a manufacturers' survey to track usage and user satisfaction over a 6-month period. Active left upper extremity range of motion and strength increased significantly (both with and without the MEWHO) and tone decreased, demonstrating both a training and an assistive effect. The participant also demonstrated an improved ability to incorporate his affected extremity (with the MEWHO) into a wide variety of bilateral, gross motor activities of daily living such as carrying a laundry basket, lifting heavy objects (e.g. a chair), using a tape measure, meal preparation, and opening doors. Custom myoelectric orthoses offer an exciting opportunity for individuals diagnosed with a variety of neurological conditions to make advancements toward their recovery and independence, and warrant further research into their training effects as well as their use as assistive devices. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.
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Gender differentiations of cognitive-motor functioning in prepubertal and pubertal children.
Katić, Ratko; Bala, Gustav; Barović, Zdenka
2012-06-01
The aim of this study was to determine cognitive and motor status factors in female and male children aged 10-14, as well as developmental and/or integration functions according to gender. The study included 162 girls and 134 boys aged 10-14, divided into four groups: 84 girls aged 10-12 (mean age 11.26, SD 0.68), 84 boys aged 10-12 (mean age 11.41, SD 0.50), 78 girls aged 13-14 (mean age 13.52, SD 0.63) and 50 boys aged 13-14 (mean age 13.21, SD 0.53). The significance of quantitative differences between boys and girls in the overall system of variables was defined based on the results of canonic discriminant analysis of variance, and within each variable based on the results on univariate analysis of variance (ANOVA). In the younger age group (10-12 years), girls were superior to boys in a test assessing flexibility (Seated straddle stretch), whereas, compared to girls, boys had greater strength of the trunk (Crossed-arm sit-ups), greater explosive strength ofjump and sprint type (Standing broad jump and 20 m dash), and coordination (Obstacle course backwards and Steps laterally). In the older age group (13-14 years) differences in flexibility were even more prominent in favor of girls, whereas the differences in explosive strength increased in favor of boys, especially of the throwing type with better agility (Steps laterally), balance (Board balance) and greater static strength of arms and shoulders (Bent-arm hang). In order to determine qualitative differences between pubertal and prepubertal girls and boys, the matrix of variable inter-correlations was factorized by the procedure of principal components procedure, that were then transformed to promax solution. The results showed that cognitive functioning had a significant role in the motor efficacy of girls and boys aged 10 to 14. In the age group of 10-12 years, in females, cognitive functioning is related to the motor system which integrates the regulation of muscle tone with agility/coordination, whereas in males there is a relation between cognitive abilities and the regulator of speed of upper extremities movement frequency. In the age group of 13-14 years, in females, cognitive functioning is involved in forming the factors for regulation of coordination and the intensity of energy mobilization in lower extremities, and to some degree, in the factor for regulation of intensity of energy mobilization in upper extremities and strength of the trunk, whereas in males the integration of synergetic regulation of movement in terms of balance and agility in terms of speed of direction change is carried out with significant involvement of cognitive abilities.
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Tedesco Triccas, L; Burridge, J H; Hughes, A M; Pickering, R M; Desikan, M; Rothwell, J C; Verheyden, G
2016-01-01
To systematically review the methodology in particular treatment options and outcomes and the effect of multiple sessions of transcranial direct current stimulation (tDCS) with rehabilitation programmes for upper extremity recovery post stroke. A search was conducted for randomised controlled trials involving tDCS and rehabilitation for the upper extremity in stroke. Quality of included studies was analysed using the Modified Downs and Black form. The extent of, and effect of variation in treatment parameters such as anodal, cathodal and bi-hemispheric tDCS on upper extremity outcome measures of impairment and activity were analysed using meta-analysis. Nine studies (371 participants with acute, sub-acute and chronic stroke) were included. Different methodologies of tDCS and upper extremity intervention, outcome measures and timing of assessments were identified. Real tDCS combined with rehabilitation had a small non-significant effect of +0.11 (p=0.44) and +0.24 (p=0.11) on upper extremity impairments and activities at post-intervention respectively. Various tDCS methods have been used in stroke rehabilitation. The evidence so far is not statistically significant, but is suggestive of, at best, a small beneficial effect on upper extremity impairment. Future research should focus on which patients and rehabilitation programmes are likely to respond to different tDCS regimes. Copyright © 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.
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ERIC Educational Resources Information Center
Montpetit, Kathleen; Haley, Stephen; Bilodeau, Nathalie; Ni, Pengsheng; Tian, Feng; Gorton, George, III; Mulcahey, M. J.
2011-01-01
This article reports on the content range and measurement precision of an upper extremity (UE) computer adaptive testing (CAT) platform of physical function in children with cerebral palsy. Upper extremity items representing skills of all abilities were administered to 305 parents. These responses were compared with two traditional standardized…
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Moraes, Wilson Max Almeida Monteiro de; Santos, Neucilane Silveira Dos; Aguiar, Larissa Pereira; Sousa, Luís Gustavo Oliveira de
2017-01-01
To investigate whether maintenance of exercise training benefits is associated with adequate milk and dairy products intake in hypertensive elderly subjects after detraining. Twenty-eight elderly hypertensive patients with optimal clinical treatment underwent 16 weeks of multicomponent exercise training program followed by 6 weeks of detraining, and were classified according to milk and dairy products intake as low milk (<3 servings) and high milk (≥3 servings) groups. After exercise training, there was a significant reduction (p<0.001) in body weight, systolic, diastolic and mean blood pressure, an increase in lower and upper limb strength (chair-stand test and elbow flexor test) as well as in aerobic capacity (stationary gait test) and functional capacity (sit down, stand up, and move around the house) in both groups. However, in the Low Milk Intake Group significant changes were observed: body weight (+0.5%), systolic, diastolic and mean blood pressure (+0.9%,+1.4% and +1.1%, respectively), lower extremity strength (-7.0%), aerobic capacity (-3.9%) and functional capacity (+5.4) after detraining. These parameters showed no significant differences between post-detraining and post-training period in High Milk Intake Group. Maintenance of exercise training benefits related to pressure levels, lower extremity strength and aerobic capacity, is associated with adequate milk and dairy products intake in hypertensive elderly subjects following 6 weeks of detraining.
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Effect of mirror use on lower extremity muscle strength of patients with chronic stroke.
Kim, Myoung-Kwon; Choe, Yu-Won; Shin, Young-Jun; Peng, Cheng; Choi, Eun-Hong
2018-02-01
[Purpose] This study examines the effect on muscle strength of lower extremity muscle strength exercise while using a mirror on the non-paretic side in patients with chronic stroke. [Subjects and Methods] Subjects were randomly assigned to a non-mirror lower extremity exercise group (n=10), a mirror lower extremity exercise group (n=10), or a mirror lower extremity muscle strength exercise group (n=10). Subjects were asked to do the exercise assigned to their group (5 sets 30 times a day, 5 times weekly for 4 weeks) with general physical therapy in the hospital. Muscle strength in the knee extensor and flexor of paretic and non-paretic side were measured using electrical muscle testing device before and after the intervention. [Results] Muscle strength significantly increased within each group after intervention. No significant differences were found among the three groups. [Conclusion] This study showed that the lower extremity muscle strength exercise of the non-paretic side using a mirror has a positive effect on muscle strength in patient with chronic stroke.
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Upper Extremity Amputations and Prosthetics
Ovadia, Steven A.; Askari, Morad
2015-01-01
Upper extremity amputations are most frequently indicated by severe traumatic injuries. The location of the injury will determine the level of amputation. Preservation of extremity length is often a goal. The amputation site will have important implications on the functional status of the patient and options for prosthetic reconstruction. Advances in amputation techniques and prosthetic reconstructions promote improved quality of life. In this article, the authors review the principles of upper extremity amputation, including techniques, amputation sites, and prosthetic reconstructions. PMID:25685104
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Imaging of upper extremity stress fractures in the athlete.
Anderson, Mark W
2006-07-01
Although it is much less common than injuries in the lower extremities, an upper extremity stress injury can have a significant impact on an athlete. If an accurate and timely diagnosis is to be made, the clinician must have a high index of suspicion of a stress fracture in any athlete who is involved in a throwing, weightlifting, or upper extremity weight-bearing sport and presents with chronic pain in the upper extremity. Imaging should play an integral role in the work-up of these patients; if initial radiographs are unrevealing, further cross-sectional imaging should be strongly considered. Although a three-phase bone scan is highly sensitive in this regard, MRI has become the study of choice at most centers.
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Ji, Eun-Kyu; Lee, Sang-Heon
2016-11-01
[Purpose] The purpose of this study was to investigate the effects of virtual reality training combined with modified constraint-induced movement therapy on upper extremity motor function recovery in acute stage stroke patients. [Subjects and Methods] Four acute stage stroke patients participated in the study. A multiple baseline single subject experimental design was utilized. Modified constraint-induced movement therapy was used according to the EXplaining PLastICITy after stroke protocol during baseline sessions. Virtual reality training with modified constraint-induced movement therapy was applied during treatment sessions. The Manual Function Test and the Box and Block Test were used to measure upper extremity function before every session. [Results] The subjects' upper extremity function improved during the intervention period. [Conclusion] Virtual reality training combined with modified constraint-induced movement is effective for upper extremity function recovery in acute stroke patients.
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Lee, Hsin-Yi; Yeh, Wen-Yu; Chen, Chun-Wan; Wang, Jung-Der
2005-07-01
Prevalence of upper extremity disorders and their associations with psychosocial factors in the workplace have received more attention recently. A national survey of cross-sectional design was performed to determine the prevalence rates of upper extremity disorders among different industries. Trained interviewers administered questionnaires to 17,669 workers and data on musculoskeletal complaints were obtained along with information on risk factors. Overall the 1-year prevalence of neck (14.8%), shoulder (16.6%), and hand (12.4%) disorders were higher than those of the upper back (7.1%) and elbow (8.3%) among those who sought medical treatment due to the complaint. Workers in construction and agriculture-related industries showed a higher prevalence of upper extremity disorders. After multiple logistic regression adjusted for age, education, and employment duration, we found job content, physical working condition, a harmonious interpersonal relationship at the workplace and organizational problems were significant determinants of upper extremity disorders in manufacturing and service industries. Male workers in manufacturing industries showed more concern about physical working conditions while female workers in public administration emphasized problems of job content and interpersonal relationships. We concluded that these factors were major job stressors contributing to musculoskeletal pain of the upper extremity.
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Frouzan, Arash; Masoumi, Kambiz; Delirroyfard, Ali; Mazdaie, Behnaz; Bagherzadegan, Elnaz
2017-08-01
Long bone fractures are common injuries caused by trauma. Some studies have demonstrated that ultrasound has a high sensitivity and specificity in the diagnosis of upper and lower extremity long bone fractures. The aim of this study was to determine the accuracy of ultrasound compared with plain radiography in diagnosis of upper and lower extremity long bone fractures in traumatic patients. This cross-sectional study assessed 100 patients admitted to the emergency department of Imam Khomeini Hospital, Ahvaz, Iran with trauma to the upper and lower extremities, from September 2014 through October 2015. In all patients, first ultrasound and then standard plain radiography for the upper and lower limb was performed. Data were analyzed by SPSS version 21 to determine the specificity and sensitivity. The mean age of patients with upper and lower limb trauma were 31.43±12.32 years and 29.63±5.89 years, respectively. Radius fracture was the most frequent compared to other fractures (27%). Sensitivity, specificity, positive predicted value, and negative predicted value of ultrasound compared with plain radiography in the diagnosis of upper extremity long bones were 95.3%, 87.7%, 87.2% and 96.2%, respectively, and the highest accuracy was observed in left arm fractures (100%). Tibia and fibula fractures were the most frequent types compared to other fractures (89.2%). Sensitivity, specificity, PPV and NPV of ultrasound compared with plain radiography in the diagnosis of upper extremity long bone fractures were 98.6%, 83%, 65.4% and 87.1%, respectively, and the highest accuracy was observed in men, lower ages and femoral fractures. The results of this study showed that ultrasound compared with plain radiography has a high accuracy in the diagnosis of upper and lower extremity long bone fractures.
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Muscle strength in breast cancer patients receiving different treatment regimes
Klassen, Oliver; Schmidt, Martina E.; Ulrich, Cornelia M.; Schneeweiss, Andreas; Potthoff, Karin; Steindorf, Karen
2016-01-01
Abstract Background Muscle dysfunction and sarcopenia have been associated with poor performance status, an increased mortality risk, and greater side effects in oncologic patients. However, little is known about how performance is affected by cancer therapy. We investigated muscle strength in breast cancer patients in different adjuvant treatment settings and also compared it with data from healthy individuals. Methods Breast cancer patients (N = 255) from two randomized controlled exercise trials, staged 0–III and aged 54.4 ± 9.4 years, were categorized into four groups according to their treatment status. In a cross‐sectional design, muscle function was assessed bilaterally by isokinetic dynamometry (0°, 60°, 180°/s) as maximal voluntary isometric contraction (MVIC) and maximal isokinetic peak torque (MIPT) in shoulder rotators and knee flexors and extensors. Additionally, muscular fatigue index (FI%) and shoulder flexibility were evaluated. Healthy women (N = 26), aged 53.3 ± 9.8 years, were tested using the same method. Analysis of covariance was used to estimate the impact of different cancer treatments on skeletal muscle function with adjustment for various clinical and socio‐demographic factors. Results Consistently, lower muscle strength was measured in shoulder and knee strength in patients after chemotherapy. On average, patients had up to 25% lower strength in lower extremities and 12–16% in upper extremities in MVIC and MIPT during cancer treatment compared with healthy women. No substantial difference between patient groups in shoulder strength, but significantly lower shoulder flexibility in patients with radical mastectomy was measured. Chemotherapy‐treated patients had consistently higher FI%. No serious adverse events were reported. Conclusions Breast cancer patients showed markedly impaired muscle strength and joint dysfunctions before and after anticancer treatment. The significant differences between patients and healthy individuals underline the need of exercise therapy as early as possible in order to prevent or counteract the loss of muscle function after curative surgery as well as the consequences of neo‐/adjuvant chemotherapy. PMID:27896952
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Ibrahim, Marize; Muanza, Thierry; Smirnow, Nadia; Sateren, Warren; Fournier, Beatrice; Kavan, Petr; Palumbo, Michael; Dalfen, Richard; Dalzell, Mary-Ann
2018-02-01
The diagnosis of breast cancer in young women (aged 18-45 years) has been increasing. Women are commonly left coping with treatment-related disabilities of the upper limb that can persist for > 2 years postoperatively. A total of 59 young breast cancer patients (29 in the intervention group and 30 in the control group) participated in a pilot prospective randomized controlled trial to determine whether a 12-week postradiation exercise program would improve long-term arm mobility, pain, and handgrip strength. During an 18-month period, range of motion, handgrip strength, and pain with shoulder movements were evaluated at 6 points. Although the differences were not statistically significant, external rotation and horizontal abduction of the shoulder improved in the intervention group immediately after the exercise intervention (3 months) and showed a trend toward less pain on movement. However, at 18 months after radiation the control and intervention groups both retained a residual loss of range and persistent pain with movement. Radiation to the axilla and/or chest wall yielded long-term (18 months) limitations in flexion and horizontal abduction compared with hypofractionation, which resulted in greater flexion and external rotation at 18 months. The median grip strength of the study participants corresponded to the 10th percentile of healthy aged-matched white women. The exercise intervention timed shortly after radiation improved short-term shoulder mobility and pain; however, these gains were not sustained at 18 months after radiation. Copyright © 2017 Elsevier Inc. All rights reserved.
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Strifling, Kelly M B; Konop, Katherine A; Wang, Mei; Harris, Gerald F
2009-01-01
Walkers are prescribed with the notion that one type of walker will be better for a child than another. One underlying justification for this practice is the theory that one walker may produce less stress on the upper extremities as the patient uses the walker. Nevertheless, upper extremity joint loading is not typically analyzed during walker assisted gait in children with spastic diplegic cerebral palsy. It has been difficult to evaluate the theory of walker prescription based on upper extremity stresses because loading on the upper extremities however has not been quantified until recently. In this study, weight bearing on the glenohumeral joints was analyzed in five children with spastic diplegic cerebral palsy using both anterior and posterior walkers fitted with 6-axis handle transducers. Though walkers' effects on the upper extremities proved to be similar between walker types, the differences between the walkers may have some clinical significance in the long run. In general, posterior walker use created larger glenohumeral joint forces. Though these differences are not statistically significant, over time and with repetitive loading they may be clinically significant.
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Stover, Bert; Silverstein, Barbara; Wickizer, Thomas; Martin, Diane P; Kaufman, Joel
2007-06-01
Work related upper extremity musculoskeletal disorders (MSD) result in substantial disability, and expense. Identifying workers or jobs with high risk can trigger intervention before workers are injured or the condition worsens. We investigated a disability instrument, the QuickDASH, as a workplace screening tool to identify workers at high risk of developing upper extremity MSDs. Subjects included workers reporting recurring upper extremity MSD symptoms in the past 7 days (n = 559). The QuickDASH was reasonably accurate at baseline with sensitivity of 73% for MSD diagnosis, and 96% for symptom severity. Specificity was 56% for diagnosis, and 53% for symptom severity. At 1-year follow-up sensitivity and specificity for MSD diagnosis was 72% and 54%, respectively, as predicted by the baseline QuickDASH score. For symptom severity, sensitivity and specificity were 86% and 52%. An a priori target sensitivity of 70% and specificity of 50% was met by symptom severity, work pace and quality, and MSD diagnosis. The QuickDASH may be useful for identifying jobs or workers with increased risk for upper extremity MSDs. It may provide an efficient health surveillance screening tool useful for targeting early workplace intervention for prevention of upper extremity MSD problems.
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Higgins, Johanne; Finch, Lois E; Kopec, Jacek; Mayo, Nancy E
2010-02-01
To create and illustrate the development of a method to parsimoniously and hierarchically assess upper extremity function in persons after stroke. Data were analyzed using Rasch analysis. Re-analysis of data from 8 studies involving persons after stroke. Over 4000 patients with stroke who participated in various studies in Montreal and elsewhere in Canada. Data comprised 17 tests or indices of upper extremity function and health-related quality of life, for a total of 99 items related to upper extremity function. Tests and indices included, among others, the Box and Block Test, the Nine-Hole Peg Test and the Stroke Impact Scale. Data were collected at various times post-stroke from 3 days to 1 year. Once the data fit the model, a bank of items measuring upper extremity function with persons and items organized hierarchically by difficulty and ability in log units was produced. This bank forms the basis for eventual computer adaptive testing. The calibration of the items should be tested further psychometrically, as should the interpretation of the metric arising from using the item calibration to measure the upper extremity of individuals.
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Ciesla, Nancy; Dinglas, Victor; Fan, Eddy; Kho, Michelle; Kuramoto, Jill; Needham, Dale
2011-04-12
Survivors of acute respiratory distress syndrome (ARDS) and other causes of critical illness often have generalized weakness, reduced exercise tolerance, and persistent nerve and muscle impairments after hospital discharge. Using an explicit protocol with a structured approach to training and quality assurance of research staff, manual muscle testing (MMT) is a highly reliable method for assessing strength, using a standardized clinical examination, for patients following ARDS, and can be completed with mechanically ventilated patients who can tolerate sitting upright in bed and are able to follow two-step commands. (7, 8) This video demonstrates a protocol for MMT, which has been taught to ≥ 43 research staff who have performed >800 assessments on >280 ARDS survivors. Modifications for the bedridden patient are included. Each muscle is tested with specific techniques for positioning, stabilization, resistance, and palpation for each score of the 6-point ordinal Medical Research Council scale. Three upper and three lower extremity muscles are graded in this protocol: shoulder abduction, elbow flexion, wrist extension, hip flexion, knee extension, and ankle dorsiflexion. These muscles were chosen based on the standard approach for evaluating patients for ICU-acquired weakness used in prior publications. (1,2).
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Wang Dian, E-mail: dwang@mcw.edu; Bosch, Walter; Kirsch, David G.
Purpose: To evaluate variability in the definition of preoperative radiotherapy gross tumor volume (GTV) and clinical target volume (CTV) delineated by sarcoma radiation oncologists. Methods and Materials: Extremity sarcoma planning CT images along with the corresponding diagnostic MRI from two patients were distributed to 10 Radiation Therapy Oncology Group sarcoma radiation oncologists with instructions to define GTV and CTV using standardized guidelines. The CT data with contours were then returned for central analysis. Contours representing statistically corrected 95% (V95) and 100% (V100) agreement were computed for each structure. Results: For the GTV, the minimum, maximum, mean (SD) volumes (mL) weremore » 674, 798, 752 {+-} 35 for the lower extremity case and 383, 543, 447 {+-} 46 for the upper extremity case. The volume (cc) of the union, V95 and V100 were 882, 761, and 752 for the lower, and 587, 461, and 455 for the upper extremity, respectively. The overall GTV agreement was judged to be almost perfect in both lower and upper extremity cases (kappa = 0.9 [p < 0.0001] and kappa = 0.86 [p < 0.0001]). For the CTV, the minimum, maximum, mean (SD) volumes (mL) were 1145, 1911, 1605 {+-} 211 for the lower extremity case and 637, 1246, 1006 {+-} 180 for the upper extremity case. The volume (cc) of the union, V95, and V100 were 2094, 1609, and 1593 for the lower, and 1533, 1020, and 965 for the upper extremity cases, respectively. The overall CTV agreement was judged to be almost perfect in the lower extremity case (kappa = 0.85 [p < 0.0001]) but only substantial in the upper extremity case (kappa = 0.77 [p < 0.0001]). Conclusions: Almost perfect agreement existed in the GTV of these two representative cases. Tshere was no significant disagreement in the CTV of the lower extremity, but variation in the CTV of upper extremity was seen, perhaps related to the positional differences between the planning CT and the diagnostic MRI.« less
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EXPERIMENTALLY MEASURED RADIATIVE LIFETIMES AND OSCILLATOR STRENGTHS IN NEUTRAL VANADIUM
DOE Office of Scientific and Technical Information (OSTI.GOV)
Holmes, C. E.; Pickering, J. C.; Ruffoni, M. P.
2016-06-01
We report a new study of the V i atom using a combination of time-resolved laser-induced fluorescence and Fourier transform spectroscopy that contains newly measured radiative lifetimes for 25 levels between 24,648 cm{sup −1} and 37,518 cm{sup −1} and oscillator strengths for 208 lines between 3040 and 20000 Å from 39 upper energy levels. Thirteen of these oscillator strengths have not been reported previously. This work was conducted independently of the recent studies of neutral vanadium lifetimes and oscillator strengths carried out by Den Hartog et al. and Lawler et al., and thus serves as a means to verify thosemore » measurements. Where our data overlap with their data, we generally find extremely good agreement in both level lifetimes and oscillator strengths. However, we also find evidence that Lawler et al. have systematically underestimated oscillator strengths for lines in the region of 9000 ± 100 Å. We suggest a correction of 0.18 ± 0.03 dex for these values to bring them into agreement with our results and those of Whaling et al. We also report new measurements of hyperfine structure splitting factors for three odd levels of V i lying between 24,700 and 28,400 cm{sup −1}.« less
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Isometric Shoulder Strength Reference Values for Physically Active Collegiate Males and Females
Westrick, Richard B.; Duffey, Michele L.; Cameron, Kenneth L.; Gerber, J. Parry; Owens, Brett D.
2013-01-01
Background: It is common clinical practice to assess muscle strength during examination of patients following shoulder injury or surgery. Strength comparisons are often made between the patient’s injured and uninjured shoulders, with the uninjured side used as a reference without regard to upper extremity dominance. Despite the importance of strength measurements, little is known about expected normal baselines of the uninjured shoulder. The purpose of this study was to report normative values for isometric shoulder strength for physically active college-age men and women without history of shoulder injury. Methods: University students—546 males (18.8 ± 1.0 years, 75.3 ± 12.2 kg) and 73 females (18.7 ± 0.9 years, 62.6 ± 7.0 kg)—underwent thorough shoulder evaluations by an orthopaedic surgeon and completed bilateral isometric strength measurements with a handheld dynamometer. Variables measured included internal rotation, external rotation, abduction, supine internal rotation and external rotation at 45°, and lower trapezius in prone flexion. Results: Significant differences were found between the dominant and nondominant shoulder for internal rotation, internal rotation at 45°, abduction, and prone flexion in males and in internal rotation at 45° and prone flexion for females (P ≤ 0.01). PMID:24381696
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Complex strength performance in patients with haemophilia A. Method development and testing.
Runkel, B; Kappelhoff, M; Hilberg, T
2015-01-01
The aim of this study was to develop a complex strength measurement method and to apply this new method for the first time in patients with haemophilia (PwH). 20 PwH with severe haemophilia A and 20 controls were included into the study. All subjects completed ten measurements of maximum isometric strength. Furthermore, the 20 control subjects completed re-test-measurements to evaluate the method. As a result, the method showed a high reliability (ICC 0.764 to 0.934). Between the two groups significant reductions in PwH between -(19-35%) were detected, regarding the relative force of the M. triceps brachii (-19%; p = 0.008), M. biceps brachii (-19%; p = 0.031), M. latissimus dorsi (-17%; p = 0.019), M. biceps femoris right (-20%; p = 0.036) and M. quadriceps femoris (right: -29%; p = 0.004; left: -35%; p = 0.002). No differences were found for M. rectus abdominis and in the hand strength. Thus, there is no general deficit in the muscle strength in PwH. The most obvious deficits exist in the upper and lower extremities and in the back muscles. PwH should carry out complex muscle strength training and integrate it early into a comprehensive treatment concept.
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Eliakim, Alon; Cale-Benzoor, Mia; Klinger-Cantor, Beatrice; Freud, Enrique; Nemet, Dan; Feigin, Elad; Weintrob, Neomi
2011-01-01
A 14-year-old Caucasian girl was referred to the endocrine clinic for evaluation of voice deepening, facial hirsutism, and acne starting 2 years previously. She had been a competitive tennis player since age 7 years, practicing for 4-6 hours daily. On physical examination she was noticed to have a masculine appearance with mild facial acne and moderate hirsutism. Tanner stage was 1 for breast tissue and 5 for pubic hair. Her androgen levels (testosterone, androstenedione, dehydroepiandrosterone sulfate) were extremely elevated. Adrenal ultrasonography revealed a round left 4.6 × 5.3-cm adrenal mass. Laparoscopic left adrenalectomy was performed. The histologic findings were compatible with a benign adrenocortical tumor. Postoperatively, androgen levels dropped to within the normal range. Breast development proceeded normally, menarche occurred 2 months after tumor resection, and menses has been regular since then. Muscle strength of the dominant and nondominant upper and lower extremities was measured 1 month before surgery and 1 year later, using an isokinetic dynamometer (Biodex Systems II, Biodex, Shirley, NY, USA). There was no significant decrease in overall muscle strength after removal of the virilizing tumor and the marked drop in circulating androgens. In addition, the patient maintained her age category, number 1, national tennis ranking. The results suggest that even extremely high levels of tumor-related circulating androgens had no evident effect on muscle strength and competitive performance in a female adolescent tennis player. The lack of beneficial effect on performance in adolescents, combined with the potentially hazardous side effects of anabolic steroids, suggests that teenage athletes should avoid their use.
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Prevalence of upper extremity symptoms and disorders among dental and dental hygiene students.
Werner, Robert A; Franzblau, Alfred; Gell, Nancy; Hamann, Curt; Rodgers, Pamela A; Caruso, Timothy J; Perry, Frank; Lamb, Courtney; Beaver, Shirley; Hinkamp, David; Eklund, Kathy; Klausner, Christine P
2005-02-01
Upper extremity musculoskeletal disorders are common among dental professionals. The natural history of these disorders is not well-understood. These disorders are more common in older workers, but the prevalence among younger workers has not been well-studied. The objective of this study was to determine if dental/dental hygiene students had a similar prevalence of upper extremity musculoskeletal disorders compared to age-matched clerical workers. We hypothesize students will have a lower prevalence of upper extremity musculoskeletal disorders compared to clerical workers. This was a cross-sectional design. Dental and dental hygiene students from three schools were compared to clerical workers from three locations (an insurance company and two data processing plants). There were 343 dental and dental hygiene students and 164 age-matched clerical workers. Regional discomfort was the primary outcome. The secondary health outcomes were diagnoses of carpal tunnel syndrome and upper extremity tendinitis. Clerical workers had a higher prevalence of hand symptoms (62 percent vs. 20 percent), elbow symptoms (34 percent vs. 6 percent) and shoulder/neck symptoms (48 percent vs. 16 percent) and a higher prevalence of carpal tunnel syndrome (2.5 percent vs. .6 percent) and upper extremity tendinitis (12 percent vs. 5 percent). The clerical workers were more obese, smoked more, exercised less frequently, and had lower educational levels and less control of their work environment. Dental and dental hygiene students have a very low prevalence of upper extremity musculoskeletal disorders. A longitudinal study is necessary to evaluate ergonomic and personal risk factors.
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Ege, Tolga; Unlu, Aytekin; Tas, Huseyin; Bek, Dogan; Turkan, Selim; Cetinkaya, Aytac
2015-01-01
Decision of limb salvage or amputation is generally aided with several trauma scoring systems such as the mangled extremity severity score (MESS). However, the reliability of the injury scores in the settling of open fractures due to explosives and missiles is challenging. Mortality and morbidity of the extremity trauma due to firearms are generally associated with time delay in revascularization, injury mechanism, anatomy of the injured site, associated injuries, age and the environmental circumstance. The purpose of the retrospective study was to evaluate the extent of extremity injuries due to ballistic missiles and to detect the reliability of mangled extremity severity score (MESS) in both upper and lower extremities. Between 2004 and 2014, 139 Gustillo Anderson Type III open fractures of both the upper and lower extremities were enrolled in the study. Data for patient age, fire arm type, transporting time from the field to the hospital (and the method), injury severity scores, MESS scores, fracture types, amputation levels, bone fixation methods and postoperative infections and complications retrieved from the two level-2 trauma center's data base. Sensitivity, specificity, positive and negative predictive values of the MESS were calculated to detect the ability in deciding amputation in the mangled limb. Amputation was performed in 39 extremities and limb salvage attempted in 100 extremities. The mean followup time was 14.6 months (range 6-32 months). In the amputated group, the mean MESS scores for upper and lower extremity were 8.8 (range 6-11) and 9.24 (range 6-11), respectively. In the limb salvage group, the mean MESS scores for upper and lower extremities were 5.29 (range 4-7) and 5.19 (range 3-8), respectively. Sensitivity of MESS in upper and lower extremities were calculated as 80% and 79.4% and positive predictive values detected as 55.55% and 83.3%, respectively. Specificity of MESS score for upper and lower extremities was 84% and 86.6%; negative predictive values were calculated as 95.45% and 90.2%, respectively. MESS is not predictive in combat related extremity injuries especially if between a score of 6-8. Limb ischemia and presence or absence of shock can be used in initial decision-making for amputation.
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Ege, Tolga; Unlu, Aytekin; Tas, Huseyin; Bek, Dogan; Turkan, Selim; Cetinkaya, Aytac
2015-01-01
Background: Decision of limb salvage or amputation is generally aided with several trauma scoring systems such as the mangled extremity severity score (MESS). However, the reliability of the injury scores in the settling of open fractures due to explosives and missiles is challenging. Mortality and morbidity of the extremity trauma due to firearms are generally associated with time delay in revascularization, injury mechanism, anatomy of the injured site, associated injuries, age and the environmental circumstance. The purpose of the retrospective study was to evaluate the extent of extremity injuries due to ballistic missiles and to detect the reliability of mangled extremity severity score (MESS) in both upper and lower extremities. Materials and Methods: Between 2004 and 2014, 139 Gustillo Anderson Type III open fractures of both the upper and lower extremities were enrolled in the study. Data for patient age, fire arm type, transporting time from the field to the hospital (and the method), injury severity scores, MESS scores, fracture types, amputation levels, bone fixation methods and postoperative infections and complications retrieved from the two level-2 trauma center's data base. Sensitivity, specificity, positive and negative predictive values of the MESS were calculated to detect the ability in deciding amputation in the mangled limb. Results: Amputation was performed in 39 extremities and limb salvage attempted in 100 extremities. The mean followup time was 14.6 months (range 6–32 months). In the amputated group, the mean MESS scores for upper and lower extremity were 8.8 (range 6–11) and 9.24 (range 6–11), respectively. In the limb salvage group, the mean MESS scores for upper and lower extremities were 5.29 (range 4–7) and 5.19 (range 3–8), respectively. Sensitivity of MESS in upper and lower extremities were calculated as 80% and 79.4% and positive predictive values detected as 55.55% and 83.3%, respectively. Specificity of MESS score for upper and lower extremities was 84% and 86.6%; negative predictive values were calculated as 95.45% and 90.2%, respectively. Conclusion: MESS is not predictive in combat related extremity injuries especially if between a score of 6–8. Limb ischemia and presence or absence of shock can be used in initial decision-making for amputation. PMID:26806974
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Gutefeldt, Kerstin; Hedman, Christina A; Thyberg, Ingrid S M; Bachrach-Lindström, Margareta; Arnqvist, Hans J; Spångeus, Anna
2017-11-05
To investigate the prevalence, activity limitations and potential risk factors of upper extremity impairments in type 1 diabetes in comparison to controls. In a cross-sectional population-based study in the southeast of Sweden, patients with type 1 diabetes <35 years at onset, duration ≥20 years, <67 years old and matched controls were invited to answer a questionnaire on upper extremity impairments and activity limitations and to take blood samples. Seven hundred and seventy-three patients (ages 50 ± 10 years, diabetes duration 35 ± 10 years) and 708 controls (ages 54 ± 9 years) were included. Shoulder pain and stiffness, hand paraesthesia and finger impairments were common in patients with a prevalence of 28-48%, which was 2-4-folds higher than in controls. Compared to controls, the patients had more bilateral impairments, often had coexistence of several upper extremity impairments, and in the presence of impairments, reported more pronounced activity limitations. Female gender (1.72 (1.066-2.272), p = 0.014), longer duration (1.046 (1.015-1.077), p = 0.003), higher body mass index (1.08 (1.017-1.147), p = 0.013) and HbA1c (1.029 (1.008-1.05), p = 0.007) were associated with upper extremity impairments. Compared to controls, patients with type 1 diabetes have a high prevalence of upper extremity impairments, often bilateral, which are strongly associated with activity limitations. Recognising these in clinical practise is crucial, and improved preventative, therapeutic and rehabilitative interventions are needed. Implications for rehabilitation Upper extremity impairments affecting the shoulder, hand and fingers are common in patients with type 1 diabetes, the prevalence being 2-4-fold higher compared to non-diabetic persons. Patients with diabetes type 1 with upper extremity impairments have more pronounced limitations in daily activities compared to controls with similar impairments. Recognising upper extremity impairments and activity limitations are important and improved preventive, therapeutic and rehabilitation methods are needed.
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Velstra, Inge-Marie; Bolliger, Marc; Krebs, Jörg; Rietman, Johan S; Curt, Armin
2016-05-01
To determine which single or combined upper limb muscles as defined by the International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI); upper extremity motor score (UEMS) and the Graded Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP), best predict upper limb function and independence in activities of daily living (ADLs) and to assess the predictive value of qualitative grasp movements (QlG) on upper limb function in individuals with acute tetraplegia. As part of a Europe-wide, prospective, longitudinal, multicenter study ISNCSCI, GRASSP, and Spinal Cord Independence Measure (SCIM III) scores were recorded at 1 and 6 months after SCI. For prediction of upper limb function and ADLs, a logistic regression model and unbiased recursive partitioning conditional inference tree (URP-CTREE) were used. Results: Logistic regression and URP-CTREE revealed that a combination of ISNCSCI and GRASSP muscles (to a maximum of 4) demonstrated the best prediction (specificity and sensitivity ranged from 81.8% to 96.0%) of upper limb function and identified homogenous outcome cohorts at 6 months. The URP-CTREE model with the QlG predictors for upper limb function showed similar results. Prediction of upper limb function can be achieved through a combination of defined, specific upper limb muscles assessed in the ISNCSCI and GRASSP. A combination of a limited number of proximal and distal muscles along with an assessment of grasping movements can be applied for clinical decision making for rehabilitation interventions and clinical trials. © The Author(s) 2015.
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Takakura, Tomokazu; Muragaki, Yoshihiro; Tamura, Manabu; Maruyama, Takashi; Nitta, Masayuki; Niki, Chiharu; Kawamata, Takakazu
2017-10-01
OBJECTIVE The aim of the present study was to evaluate the usefulness of navigated transcranial magnetic stimulation (nTMS) as a prognostic predictor for upper-extremity motor functional recovery from postsurgical neurological deficits. METHODS Preoperative and postoperative nTMS studies were prospectively applied in 14 patients (mean age 39 ± 12 years) who had intraparenchymal brain neoplasms located within or adjacent to the motor eloquent area in the cerebral hemisphere. Mapping by nTMS was done 3 times, i.e., before surgery, and 1 week and 3 weeks after surgery. To assess the response induced by nTMS, motor evoked potential (nTMS-MEP) was recorded using a surface electromyography electrode attached to the abductor pollicis brevis (APB). The cortical locations that elicited the largest electromyography response by nTMS were defined as hotspots. Hotspots for APB were confirmed as positive responsive sites by direct electrical stimulation (DES) during awake craniotomy. The distances between hotspots and lesions (D HS-L ) were measured. Postoperative neurological deficits were assessed by manual muscle test and dynamometer. To validate the prognostic value of nTMS in recovery from upper-extremity paresis, the following were investigated: 1) the correlation between D HS-L and the serial grip strength change, and 2) the correlation between positive nTMS-MEP at 1 week after surgery and the serial grip strength change. RESULTS From the presurgical nTMS study, MEPs from targeted muscles were identified in 13 cases from affected hemispheres. In one case, MEP was not evoked due to a huge tumor. Among 9 cases from which intraoperative DES mapping for hand motor area was available, hotspots for APB identified by nTMS were concordant with DES-positive sites. Compared with the adjacent group (D HS-L < 10 mm, n = 6), the nonadjacent group (D HS-L ≥ 10 mm, n = 7) showed significantly better recovery of grip strength at 3 months after surgery (p < 0.01). There were correlations between D HS-L and recovery of grip strength at 1 week, 3 weeks, and 3 months after surgery (r = 0.74, 0.68, and 0.65, respectively). Postsurgical nTMS was accomplished in 13 patients. In 9 of 13 cases, nTMS-MEP from APB muscle was positive at 1 week after surgery. Excluding the case in which nTMS-MEP was negative from the presurgical nTMS study, recoveries in grip strength were compared between 2 groups, in which nTMS-MEP at 1 week after surgery was positive (n = 9) or negative (n = 3). Significant differences were observed between the 2 groups at 1 week, 3 weeks, and 3 months after surgery (p < 0.01). Positive nTMS-MEP at 1 week after surgery correlated well with the motor recovery at 1 week, 3 weeks, and 3 months after surgery (r = 0.87, 0.88, and 0.77, respectively). CONCLUSIONS Navigated TMS is a useful tool for identifying motor eloquent areas. The results of the present study have demonstrated the predictive value of nTMS in upper-extremity motor function recovery from postsurgical neurological deficits. The longer D HS-L and positive nTMS-MEP at 1 week after surgery have prognostic values of better recovery from postsurgical neurological deficits.
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Sheppard, Jeremy M; McNamara, Phil; Osborne, Mark; Andrews, Mark; Oliveira Borges, Thiago; Walshe, Phil; Chapman, Dale W
2012-12-01
This study aimed to evaluate the potential association with anthropometry and upper-body pulling strength with sprint kinematics of competitive surfers. Ten competitive male surfers (23.9 ± 6.8 years, 177.0 ± 6.5 cm, 72.2 ± 2.4 kg) were assessed for stature, mass, arm span, ∑ 7 site skinfold thickness, pronated pull-up strength, and sprint paddling performance from a stationary start to 15 m. Pearson correlation analysis, and independent t-tests were used to compare potential differences between the slower and faster group of sprint paddlers. Strong associations were found between relative (total kilograms lifted per athlete mass) upper-body pulling strength and sprint paddling time to 5, 10, and 15 m, and peak sprint paddling velocity (r = 0.94, 0.93, 0.88, 0.66, respectively, p < 0.05) and relative upper-body pulling strength was found to be superior (p < 0.05) in the faster group, with large effect (d = 1.88). The results of this study demonstrate a strong association between relative upper-body pulling strength and sprint paddling ability in surfers. Strength and conditioning coaches working with competitive surfers should implement strength training with surfers, including an emphasis on developing relative strength, because this may have a strong influence on sprint paddling performance.
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Findlater, Sonja E; Dukelow, Sean P
2017-01-01
Proprioception is an important aspect of function that is often impaired in the upper extremity following stroke. Unfortunately, neurorehabilitation has few evidence based treatment options for those with proprioceptive deficits. The authors consider potential reasons for this disparity. In doing so, typical assessments and proprioceptive intervention studies are discussed. Relevant evidence from the field of neuroscience is examined. Such evidence may be used to guide the development of targeted interventions for upper extremity proprioceptive deficits after stroke. As researchers become more aware of the impact of proprioceptive deficits on upper extremity motor performance after stroke, it is imperative to find successful rehabilitation interventions to target these deficits and ultimately improve daily function.
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Park, Jin-Young; Chang, Moonyoung; Kim, Kyeong-Mi; Kim, Hee-Jung
2015-06-01
The purpose of this study was to examine the effects of mirror therapy on upper-extremity function and activities of daily living in chronic stroke patients. [Subjects and Methods] Fifteen subjects were each assigned to a mirror therapy group and a sham therapy group. The Fugl-Meyer Motor Function Assessment and the Box and Block Test were performed to compare paretic upper-extremity function and hand coordination abilities. The functional independence measurement was conducted to compare abilities to perform activities of daily living. [Results] Paretic upper-extremity function and hand coordination abilities were significantly different between the mirror therapy and sham therapy groups. Intervention in the mirror therapy group was more effective than in the sham therapy group for improving the ability to perform activities of daily living. Self-care showed statistically significant differences between the two groups. [Conclusion] Mirror therapy is effective in improving paretic upper-extremity function and activities of daily living in chronic stroke patients.
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Park, Jin-Young; Chang, Moonyoung; Kim, Kyeong-Mi; Kim, Hee-Jung
2015-01-01
The purpose of this study was to examine the effects of mirror therapy on upper-extremity function and activities of daily living in chronic stroke patients. [Subjects and Methods] Fifteen subjects were each assigned to a mirror therapy group and a sham therapy group. The Fugl-Meyer Motor Function Assessment and the Box and Block Test were performed to compare paretic upper-extremity function and hand coordination abilities. The functional independence measurement was conducted to compare abilities to perform activities of daily living. [Results] Paretic upper-extremity function and hand coordination abilities were significantly different between the mirror therapy and sham therapy groups. Intervention in the mirror therapy group was more effective than in the sham therapy group for improving the ability to perform activities of daily living. Self-care showed statistically significant differences between the two groups. [Conclusion] Mirror therapy is effective in improving paretic upper-extremity function and activities of daily living in chronic stroke patients. PMID:26180297
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An advanced rehabilitation robotic system for augmenting healthcare.
Hu, John; Lim, Yi-Je; Ding, Ye; Paluska, Daniel; Solochek, Aaron; Laffery, David; Bonato, Paolo; Marchessault, Ronald
2011-01-01
Emerging technologies such as rehabilitation robots (RehaBot) for retraining upper and lower limb functions have shown to carry tremendous potential to improve rehabilitation outcomes. Hstar Technologies is developing a revolutionary rehabilitation robot system enhancing healthcare quality for patients with neurological and muscular injuries or functional impairments. The design of RehaBot is a safe and robust system that can be run at a rehabilitation hospital under the direct monitoring and interactive supervision control and at a remote site via telepresence operation control. RehaBot has a wearable robotic structure design like exoskeleton, which employs a unique robotic actuation--Series Elastic Actuator. These electric actuators provide robotic structural compliance, safety, flexibility, and required strength for upper extremity dexterous manipulation rehabilitation training. RehaBot also features a novel non-treadmill paddle platform capable of haptics feedback locomotion rehabilitation training. In this paper, we concern mainly about the motor incomplete patient and rehabilitation applications.
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Mazor, Melissa; Lee, Jeannette Q; Peled, Anne; Zerzan, Sarah; Irwin, Chetan; Chesney, Margaret A; Serrurier, Katherine; Sbitany, Hani; Dhruva, Anand; Sacks, Devorah; Smoot, Betty
2018-02-01
To assess the feasibility, safety, and initial estimates of efficacy of a yoga program in postoperative care for women at high risk for breast cancer-related lymphedema (BCRL). Single-group pretest-post-test design. Patients were recruited from the University of California, San Francisco Carol Franc Buck Breast Care Center. Twenty-one women were enrolled in the study. Women were >18 years of age, had undergone surgical treatment for breast cancer, and were at high risk for BCRL. The women participated in an Ashtanga yoga intervention for 8 weeks. Sessions consisted of once/week instructor-led practice and once/week home practice. Particular attention was given to poses that emphasized upper body strength and flexibility, while avoiding significant time with the upper extremity (UE) in a dependent position. UE volume was assessed through circumferential forearm measurement, which was converted to volume using the formula for a truncated cone. Range of motion (ROM) was assessed for the shoulders, elbows, and wrists, using a standard goniometer. UE strength was assessed for shoulder abduction, elbow flexion, wrist flexion, and grip using a dynamometer. Twenty women completed the yoga intervention, with 17 returning for final assessment. Mean age was 52 (±9.1) years and body mass index was 24.8 (±5.1) kg/m 2 . Postintervention, mean volume in the at-risk UE was slightly reduced (p = 0.397). ROM for shoulder flexion (p < 0.01) and external rotation (p < 0.05) significantly increased bilaterally. Shoulder abduction ROM significantly improved for the unaffected limb (p = 0.001). Following intervention, strength improved on the affected side for shoulder abduction and grip strength, and bilaterally for elbow flexion (p < 0.05 for all). These preliminary findings suggest that yoga is feasible and safe for women who are at risk for BCRL and may result in small improvements in shoulder ROM and UE strength.
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Individual muscle contributions to push and recovery subtasks during wheelchair propulsion.
Rankin, Jeffery W; Richter, W Mark; Neptune, Richard R
2011-04-29
Manual wheelchair propulsion places considerable physical demand on the upper extremity and is one of the primary activities associated with the high prevalence of upper extremity overuse injuries and pain among wheelchair users. As a result, recent effort has focused on determining how various propulsion techniques influence upper extremity demand during wheelchair propulsion. However, an important prerequisite for identifying the relationships between propulsion techniques and upper extremity demand is to understand how individual muscles contribute to the mechanical energetics of wheelchair propulsion. The purpose of this study was to use a forward dynamics simulation of wheelchair propulsion to quantify how individual muscles deliver, absorb and/or transfer mechanical power during propulsion. The analysis showed that muscles contribute to either push (i.e., deliver mechanical power to the handrim) or recovery (i.e., reposition the arm) subtasks, with the shoulder flexors being the primary contributors to the push and the shoulder extensors being the primary contributors to the recovery. In addition, significant activity from the shoulder muscles was required during the transition between push and recovery, which resulted in increased co-contraction and upper extremity demand. Thus, strengthening the shoulder flexors and promoting propulsion techniques that improve transition mechanics have much potential to reduce upper extremity demand and improve rehabilitation outcomes. Copyright © 2011 Elsevier Ltd. All rights reserved.
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Quinn, Lori; Busse, Monica; Dal Bello-Haas, Vanina
2013-01-01
Parkinson Disease (PD) and Huntington Disease (HD) are degenerative neurological diseases, which can result in impairments and activity limitations affecting the upper extremities from early in the disease process. The progressive nature of these diseases poses unique challenges for therapists aiming to effectively maximize physical functioning and minimize participation restrictions in these patient groups. Research is underway in both diseases to develop effective disease-modifying agents and pharmacological interventions, as well as mobility-focused rehabilitation protocols. Rehabilitation, and in particular task-specific interventions, has the potential to influence the upper extremity functional abilities of patients with these degenerative conditions. However to date, investigations of interventions specifically addressing upper extremity function have been limited in both PD, and in particular HD. In this paper, we provide an update of the known pathological features of PD and HD as they relate to upper extremity function. We further review the available literature on the use of outcome measures, and the clinical management of upper extremity function in both conditions. Due to the currently limited evidence base in both diseases, we recommend utilization of a clinical management framework specific for degenerative conditions that can serve as a guideline for disease management. Copyright © 2013. Published by Elsevier Inc.
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NASA Technical Reports Server (NTRS)
Chao, Luen-Yuan; Shetty, Dinesh K.
1992-01-01
Statistical analysis and correlation between pore-size distribution and fracture strength distribution using the theory of extreme-value statistics is presented for a sintered silicon nitride. The pore-size distribution on a polished surface of this material was characterized, using an automatic optical image analyzer. The distribution measured on the two-dimensional plane surface was transformed to a population (volume) distribution, using the Schwartz-Saltykov diameter method. The population pore-size distribution and the distribution of the pore size at the fracture origin were correllated by extreme-value statistics. Fracture strength distribution was then predicted from the extreme-value pore-size distribution, usin a linear elastic fracture mechanics model of annular crack around pore and the fracture toughness of the ceramic. The predicted strength distribution was in good agreement with strength measurements in bending. In particular, the extreme-value statistics analysis explained the nonlinear trend in the linearized Weibull plot of measured strengths without postulating a lower-bound strength.
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Elbow joint fatigue and bench-press training.
Huang, Yen-Po; Chou, You-Li; Chen, Feng-Chun; Wang, Rong-Tyai; Huang, Ming-Jer; Chou, Paul Pei-Hsi
2014-01-01
Bench-press exercises are among the most common form of training exercise for the upper extremity because they yield a notable improvement in both muscle strength and muscle endurance. The literature contains various investigations into the effects of different bench-press positions on the degree of muscle activation. However, the effects of fatigue on the muscular performance and kinetics of the elbow joint are not understood fully. To investigate the effects of fatigue on the kinetics and myodynamic performance of the elbow joint in bench-press training. Controlled laboratory study. Motion research laboratory. A total of 18 physically healthy male students (age = 19.6 ± 0.8 years, height = 168.7 ± 5.5 cm, mass = 69.6 ± 8.6 kg) participated in the investigation. All participants were right-hand dominant, and none had a history of upper extremity injuries or disorders. Participants performed bench-press training until fatigued. Maximal possible number of repetitions, cycle time, myodynamic decline rate, elbow-joint force, and elbow-joint moment. We observed a difference in cycle time in the initial (2.1 ± 0.42 seconds) and fatigue (2.58 ± 0.46 seconds) stages of the bench-press exercise (P = .04). As the participants fatigued, we observed an increase in the medial-lateral force (P = .03) and internal-external moment (P ≤ .04) acting on the elbow joint. Moreover, a reduction in the elbow muscle strength was observed in the elbow extension-flexion (P ≤ .003) and forearm supination-pronation (P ≤ .001) conditions. The results suggest that performing bench-press exercises to the point of fatigue increases elbow-joint loading and may further increase the risk of injury. Therefore, when clinicians design bench-press exercise regimens for general athletic training, muscle strengthening, or physical rehabilitation, they should control carefully the maximal number of repetitions.
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Murga, Allen G; Chiriano, Jason T; Bianchi, Christian; Sheng, Neha; Patel, Sheela; Abou-Zamzam, Ahmed M; Teruya, Theodore H
2017-07-01
Central venous occlusion is a common occurrence in patients with end-stage renal disease. Placement of upper extremity arteriovenous access in patients with occlusion of the brachiocephalic veins is often not an option. Avoidance of lower extremity vascular access can decrease morbidity and infection. The central venous lesions were crossed centrally via femoral access. The wire was retrieved in the neck extravascularly. A Hemodialysis Reliable Outflow catheter was then placed in the right atrium and completed with an arterial anastomosis. We describe a novel technique for placing upper extremity arteriovenous access in patients with occlusion of the brachiocephalic veins. This technique was utilized in 3 patients. The technical success was 100%. The placement of upper extremity arteriovenous access in patients with central venous occlusions is technically feasible. Published by Elsevier Inc.
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Kim, Jin-young; Kim, Jong-man; Ko, Eun-young
2014-01-01
The purpose this study was to investigate the effect of action observation physical training (AOPT) on the functioning of the upper extremities in children with cerebral palsy (CP), using an evaluation framework based on that of the International Classification of Functioning, Disability and Health (ICF). The subjects were divided into an AOPT group and a physical training (PT) group. AOPT group practiced repeatedly the actions they observed on video clips, in which normal child performed an action with their upper extremities. PT group performed the same actions as the AOPT group did after observing landscape photographs. The subjects participated in twelve 30-min sessions, 3 days a week, for 4 weeks. Evaluation of upper extremity function using the following: the power of grasp and Modified Ashworth Scale for body functions and structures, a Box and Block test, an ABILHAND-Kids questionnaire, and the WeeFIM scale for activity and participation. Measurements were performed before and after the training, and 2 weeks after the end of training. The results of this study showed that, in comparison with the PT group, the functioning of the upper extremities in the AOPT group was significantly improved in body functions and activity and participation according to the ICF framework. This study demonstrates that AOPT has a positive influence on the functioning of the upper extremities in children with CP. It is suggested that this alternative approach for functioning of the upper extremities could be an effective method for rehabilitation in children with CP. PMID:25061598
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Rankin, Jeffery W.; Kwarciak, Andrew M.; Richter, W. Mark; Neptune, Richard R.
2010-01-01
Manual wheelchair propulsion has been linked to a high incidence of overuse injury and pain in the upper extremity, which may be caused by the high load requirements and low mechanical efficiency of the task. Previous studies have suggested that poor mechanical efficiency may be due to a low effective handrim force (i.e. applied force that is not directed tangential to the handrim). As a result, studies attempting to reduce upper extremity demand have used various measures of force effectiveness (e.g. fraction effective force, FEF) as a guide for modifying propulsion technique, developing rehabilitation programs and configuring wheelchairs. However, the relationship between FEF and upper extremity demand is not well understood. The purpose of this study was to use forward dynamics simulations of wheelchair propulsion to determine the influence of FEF on upper extremity demand by quantifying individual muscle stress, work and handrim force contributions at different values of FEF. Simulations maximizing and minimizing FEF resulted in higher average muscle stresses (23% and 112%) and total muscle work (28% and 71%) compared to a nominal FEF simulation. The maximal FEF simulation also shifted muscle use from muscles crossing the elbow to those at the shoulder (e.g. rotator cuff muscles), placing greater demand on shoulder muscles during propulsion. The optimal FEF value appears to represent a balance between increasing push force effectiveness to increase mechanical efficiency and minimizing upper extremity demand. Thus, care should be taken in using force effectiveness as a metric to reduce upper extremity demand. PMID:20674921
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Frouzan, Arash; Masoumi, Kambiz; Delirroyfard, Ali; Mazdaie, Behnaz; Bagherzadegan, Elnaz
2017-01-01
Background Long bone fractures are common injuries caused by trauma. Some studies have demonstrated that ultrasound has a high sensitivity and specificity in the diagnosis of upper and lower extremity long bone fractures. Objective The aim of this study was to determine the accuracy of ultrasound compared with plain radiography in diagnosis of upper and lower extremity long bone fractures in traumatic patients. Methods This cross-sectional study assessed 100 patients admitted to the emergency department of Imam Khomeini Hospital, Ahvaz, Iran with trauma to the upper and lower extremities, from September 2014 through October 2015. In all patients, first ultrasound and then standard plain radiography for the upper and lower limb was performed. Data were analyzed by SPSS version 21 to determine the specificity and sensitivity. Results The mean age of patients with upper and lower limb trauma were 31.43±12.32 years and 29.63±5.89 years, respectively. Radius fracture was the most frequent compared to other fractures (27%). Sensitivity, specificity, positive predicted value, and negative predicted value of ultrasound compared with plain radiography in the diagnosis of upper extremity long bones were 95.3%, 87.7%, 87.2% and 96.2%, respectively, and the highest accuracy was observed in left arm fractures (100%). Tibia and fibula fractures were the most frequent types compared to other fractures (89.2%). Sensitivity, specificity, PPV and NPV of ultrasound compared with plain radiography in the diagnosis of upper extremity long bone fractures were 98.6%, 83%, 65.4% and 87.1%, respectively, and the highest accuracy was observed in men, lower ages and femoral fractures. Conclusion The results of this study showed that ultrasound compared with plain radiography has a high accuracy in the diagnosis of upper and lower extremity long bone fractures. PMID:28979747
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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
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Abaïdia, Abd-Elbasset; Delecroix, Barthélémy; Leduc, Cédric; Lamblin, Julien; McCall, Alan; Baquet, Georges; Dupont, Grégory
2017-01-01
Abaïdia, A-E, Delecroix, B, Leduc, C, Lamblin, J, McCall, A, Baquet, G, and Dupont, G. Effects of a strength training session after an exercise inducing muscle damage on recovery kinetics. J Strength Cond Res 31(1): 115-125, 2017-The purpose of this study was to investigate the effects of an upper-limb strength training session the day after an exercise inducing muscle damage on recovery of performance. In a randomized crossover design, subjects performed the day after the exercise, on 2 separate occasions (passive vs. active recovery conditions) a single-leg exercise (dominant in one condition and nondominant in the other condition) consisting of 5 sets of 15 eccentric contractions of the knee flexors. Active recovery consisted of performing an upper-body strength training session the day after the exercise. Creatine kinase, hamstring strength, and muscle soreness were assessed immediately and 20, 24, and 48 hours after exercise-induced muscle damage. The upper-body strength session, after muscle-damaging exercise accelerated the recovery of slow concentric force (effect size = 0.65; 90% confidence interval = -0.06 to 1.32), but did not affect the recovery kinetics for the other outcomes. The addition of an upper-body strength training session the day after muscle-damaging activity does not negatively affect the recovery kinetics. Upper-body strength training may be programmed the day after a competition.
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Incidence and prevalence of complaints of the neck and upper extremity in general practice
Bot, S; van der Waal, J M; Terwee, C; van der Windt, D A W M; Schellevis, F; Bouter, L; Dekker, J
2005-01-01
Objective: To study the incidence and prevalence of neck and upper extremity musculoskeletal complaints in Dutch general practice. Methods: Data were obtained from the second Dutch national survey of general practice. In all, 195 general practitioners (GPs) from 104 practices across the Netherlands recorded all contacts with patients during 12 consecutive months. Incidence densities and consultation rates were calculated. Results: The total number of contacts during the registration period of one year was 1 524 470. The most commonly reported complaint was neck symptoms (incidence 23.1 per 1000 person-years), followed by shoulder symptoms (incidence 19.0 per 1000 person-years). Sixty six GP consultations per 1000 person-years were attributable to a new complaint or new episode of complaint of the neck or upper extremity (incidence density). In all, the GPs were consulted 147 times per 1000 registered persons for complaints of the neck or upper extremity. For most complaints the incidence densities and consultation rates were higher for women than for men. Conclusions: Neck and upper extremity symptoms are common in Dutch general practice. The GP is consulted approximately seven times each week for a complaint relating to the neck or upper extremity; of these, three are new complaints or new episodes. Attention should be paid to training GPs to deal with neck and upper limb complaints, and to research on the prognosis and treatment of these common complaints in primary care. PMID:15608309
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Liu, Chiung-Ju; Marie, Deana; Fredrick, Aaron; Bertram, Jessica; Utley, Kristen; Fess, Elaine Ewing
2017-08-01
Hand function is critical for independence in activities of daily living for older adults. The purpose of this study was to examine how grip strength, arm curl strength, and manual dexterous coordination contributed to time-based versus self-report assessment of hand function in community-dwelling older adults. Adults aged ≥60 years without low vision or neurological disorders were recruited. Purdue Pegboard Test, Jamar hand dynamometer, 30-second arm curl test, Jebsen-Taylor Hand Function Test, and the Late-Life Function and Disability Instrument were administered to assess manual dexterous coordination, grip strength, arm curl strength, time-based hand function, and self-report of hand function, respectively. Eighty-four adults (mean age = 72 years) completed the study. Hierarchical multiple regressions show that older adults with better arm curl strength (β = -.25, p < .01) and manual dexterous coordination (β = -.52, p < .01) performed better on the time-based hand function test. In comparison, older adults with better grip strength (β = .40, p < .01), arm curl strength (β = .23, p < .05), and manual dexterous coordination (β = .23, p < .05) were associated with better self-report of upper extremity function. The relationship between grip strength and hand function may be test-specific. Grip strength becomes a significant factor when the test requires grip strength to successfully complete the test tasks. Arm curl strength independently contributed to hand function in both time-based and self-report assessments, indicating that strength of extrinsic muscles of the hand are essential for hand function.
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Stress fractures of the ribs and upper extremities: causation, evaluation, and management.
Miller, Timothy L; Harris, Joshua D; Kaeding, Christopher C
2013-08-01
Stress fractures are common troublesome injuries in athletes and non-athletes. Historically, stress fractures have been thought to predominate in the lower extremities secondary to the repetitive stresses of impact loading. Stress injuries of the ribs and upper extremities are much less common and often unrecognized. Consequently, these injuries are often omitted from the differential diagnosis of rib or upper extremity pain. Given the infrequency of this diagnosis, few case reports or case series have reported on their precipitating activities and common locations. Appropriate evaluation for these injuries requires a thorough history and physical examination. Radiographs may be negative early, requiring bone scintigraphy or MRI to confirm the diagnosis. Nonoperative and operative treatment recommendations are made based on location, injury classification, and causative activity. An understanding of the most common locations of upper extremity stress fractures and their associated causative activities is essential for prompt diagnosis and optimal treatment.
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Citaker, Seyit; Guclu-Gunduz, Arzu; Yazici, Gokhan; Bayraktar, Deniz; Nazliel, Bijen; Irkec, Ceyla
2013-01-01
Muscle strength and standing balance decrease in patients with Multiple Sclerosis (MS). The aim of the present study was to investigate the relationship between the lower extremity isometric muscle strength and standing balance in patients with MS. Forty-seven patients with MS and 10 healthy volunteers were included. Neurological disability level was assessed using Expanded Disability Status Scale (EDSS). Isometric strength of seven lower extremity muscles (hip flexor-extensor-abductor-adductor, knee flexor-extensor, and ankle dorsal flexor) was assessed using hand-held dynamometer. Duration of static one-leg standing balance was measured using digital chronometer. Hip flexor-extensor-abductor-adductor, knee flexor-extensor, and ankle dorsal flexor isometric muscle strength, and duration of one-leg standing balance were decreased in patients with MS when compared with controls (p < 0.05). All assessed lower extremity isometric muscle strength and EDSS level was related duration of one-leg standing balance in patients with MS. All assessed lower extremity isometric muscle strength (except ankle dorsal flexor) was related with EDSS. Hip flexor-extensor-abductor-adductor, knee flexor-extensor, and ankle dorsal flexor isometric muscle strength decreases in ambulatory MS patients. Lower extremity muscle weakness and neurological disability level are related with imbalance in MS population. Hip and knee region muscles weakness increases the neurological disability level. For the better balance and decrease neurological disability level whole lower extremity muscle strengthening should be included in rehabilitation programs.
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Elbow isokinetic strength characteristics among collegiate baseball players.
Laudner, Kevin G; Wilson, James T; Meister, Keith
2012-05-01
To compare the bilateral strength characteristics of the wrist flexors, extensors, pronators, and supinators among baseball players. Cross-sectional. Laboratory. 30 collegiate baseball players with no recent history of upper extremity injury. Bilateral pronation, supination, wrist flexion, and wrist extension peak torque (PT) and peak torque to body weight (PT/BW) strength were measured at speeds of 90 and 180°/second. Paired t-tests showed that the throwing arm of baseball players produced significantly less PT/BW strength for supination at 90°/second compared to the non-throwing arm (P = .001). The throwing arm produced significantly more PT/BW strength for pronation (P = .001) at 180°/second compared to the non-throwing arm. Furthermore, the throwing arm had more PT and PT/BW strength for wrist extension (P < .005) at 180°/second. Conversely, the throwing arm had less PT and PT/BW strength for supination (P < .004) and wrist flexion (P < .004) at 180°/second compared to the non-throwing arm. Significant bilateral strength differences exist in pronation, supination, wrist flexion, and wrist extension among collegiate baseball players. With the steady increase in ulnar collateral ligament injuries of the elbow among baseball players and the proven resistance to valgus force provided by the flexor-pronator mass of the elbow, the results of this study may prove beneficial in the prevention, evaluation, and rehabilitation of such dysfunctions. Copyright © 2011 Elsevier Ltd. All rights reserved.
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Upper extremity sensorimotor control among collegiate football players.
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.
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Black breast cancer survivors experience greater upper extremity disability.
Dean, Lorraine T; DeMichele, Angela; LeBlanc, Mously; Stephens-Shields, Alisa; Li, Susan Q; Colameco, Chris; Coursey, Morgan; Mao, Jun J
2015-11-01
Over one-third of breast cancer survivors experience upper extremity disability. Black women present with factors associated with greater upper extremity disability, including: increased body mass index (BMI), more advanced disease stage at diagnosis, and varying treatment type compared with Whites. No prior research has evaluated the relationship between race and upper extremity disability using validated tools and controlling for these factors. Data were drawn from a survey study among 610 women with stage I-III hormone receptor positive breast cancer. The disabilities of the arm, shoulder and hand (QuickDASH) is an 11-item self-administered questionnaire that has been validated for breast cancer survivors to assess global upper extremity function over the past 7 days. Linear regression and mediation analysis estimated the relationships between race, BMI and QuickDASH score, adjusting for demographics and treatment types. Black women (n = 98) had 7.3 points higher average QuickDASH scores than White (n = 512) women (p < 0.001). After adjusting for BMI, age, education, cancer treatment, months since diagnosis, and aromatase inhibitor status, Black women had an average 4-point (95 % confidence interval 0.18-8.01) higher QuickDASH score (p = 0.04) than White women. Mediation analysis suggested that BMI attenuated the association between race and disability by 40 %. Even several years post-treatment, Black breast cancer survivors had greater upper extremity disability, which was partially mediated by higher BMIs. Close monitoring of high BMI Black women may be an important step in reducing disparities in cancer survivorship. More research is needed on the relationship between race, BMI, and upper extremity disability.
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Huri, Meral; Şahin, Sedef; Kayıhan, Hülya
2016-11-01
The present study was designed to compare hand function in autistic children with history of upper extremity trauma with that of autistic children those who do not have history of trauma. The study group included total of 65 children diagnosed with autism spectrum disorder (ASD) and was divided into 2 groups: children with trauma history (Group I) and control group (Group II) (Group I: n=28; Group II: n=37). Hand function was evaluated with 9-Hole Peg Test and Jebsen Hand Function Test. Somatosensory function was evaluated using somatosensory subtests of Sensory Integration and Praxis Test. Results were analyzed with Student's t-test and Mann-Whitney U test using SPSS version 20 software. Hand function and somatosensory perception test scores were statistically significantly better in children without upper extremity trauma history (p<0.05). When association between hand function tests and upper extremity somatosensory perception tests was taken into account, statistically significant correlations were found between all parameters of hand function tests and Manual Form Perception and Localization of Tactile Stimuli Test results (p<0.05). Autistic children with upper extremity trauma history had poor somatosensory perception and hand function. It is important to raise awareness among emergency service staff and inform them about strong relationship between somatosensory perception, hand function, and upper extremity trauma in children with ASD in order to develop appropriate rehabilitation process and prevent further trauma.
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Alon, Gad; Levitt, Alan F; McCarthy, Patricia A
2007-01-01
To test if functional electrical stimulation (FES) can enhance the recovery of upper extremity function during early stroke rehabilitation. Open-label block-randomized trial, begun during inpatient rehabilitation and continued at the patients' home. Patients were assigned to either FES combined with task-specific upper extremity rehabilitation (n = 7) or a control group that received task-specific therapy alone (n = 8) over 12 weeks. Outcome measures . Hand function (Box & Blocks, B & B; Jebsen-Taylor light object lift, J-T) and motor control (modified Fugl-Meyer, mF-M) were video-recorded for both upper extremities at baseline, 4, 8, and 12 weeks. B&B mean score at 12 weeks favored (P = .049) the FES group (42.3 +/- 16.6 blocks) over the control group (26.3 +/- 11.0 blocks). The FES group J-T task was 6.7 +/- 2.9 seconds and faster (P = .049) than the 11.8 +/- 5.4 seconds of the control group. Mean mF-M score of the FES group at 12 weeks was 49.3 +/- 5.1 points out of 54, compared to the control group that scored 40.6 +/- 8.2 points (P = .042). All patients regained hand function. Upper extremity task-oriented training that begins soon after stroke that incorporates FES may improve upper extremity functional use in patients with mild/moderate paresis more than task-oriented training without FES.
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Deschenes, Beth K; Zafereo, Jason
2017-01-01
Patients with cervical radiculopathy (CR) may present with accompanying symptoms of hyperalgesia, allodynia, heaviness in the arm, and non-segmental pain that do not appear to be related to a peripheral spinal nerve. These findings may suggest the presence of central or autonomic nervous system involvement, requiring a modified management approach. The purpose of this case report is to describe the treatment of a patient with signs of CR and upper extremity (UE) hyperalgesia who had a significant decrease in her UE pain and hypersensitivity after a single thoracic spine manipulation (TSM). A 48-year-old female presented to physical therapy with acute neck pain radiating into her left UE that significantly limited her ability to sleep and work. After a single TSM, the patient demonstrated immediate and lasting reduction in hyperalgesia, hypersensitivity to touch, elimination of perceived heaviness and coldness in her left UE, and improved strength in the C6-8 myotome, allowing for improved functional activity capacity and tolerance to a multi-modal PT program. Based on these results, clinicians should consider the early application of TSM in patients with CR who have atypical, widespread, or severe neurological symptoms that limit early mobilization and tolerance to treatment at the painful region.
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Schmidt, Christopher C; Jarrett, Claudius D; Brown, Brandon T
2013-04-01
Distal biceps tendon ruptures continue to be an important injury seen and treated by upper extremity surgeons. Since the mid-1980s, the emphasis has been placed on techniques that limit complications or improve initial tendon-to-bone fixation strength. Recently, basic science research has expanded the knowledge base regarding the biceps tendon structure, footprint anatomy, and biomechanics. Clinical data have further delineated the results of conservative and surgical management of both partial and complete tears in acute or chronic states. The current literature on the distal biceps tendon is described in detail. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
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Villafañe, Jorge H; Valdes, Kristin; Angulo-Diaz-Parreño, Santiago; Pillastrini, Paolo; Negrini, Stefano
2015-06-01
Grip testing is commonly used as an objective measure of strength in the hand and upper extremity and is frequently used clinically as a proxy measure of function. Increasing knowledge of hand biomechanics, muscle strength, and prehension patterns can provide us with a better understanding of the functional capabilities of the hand. The objectives of this study were to determine the contribution of ulnar digits to overall grip strength in individuals with thumb carpometacarpal (CMC) osteoarthritis (OA). Thirty-seven subjects participated in the study. This group consisted of 19 patients with CMC OA (aged 60-88 years) and 18 healthy subjects (60-88 years). Three hand configurations were used by the subjects during grip testing: use of the entire hand (index, middle, ring, and little fingers) (IMRL); use of the index, middle, and ring fingers (IMR); and use of only the index and middle fingers (IM). Grip strength findings for the two groups found that compared to their healthy counterparts, CMC OA patients had, on average, a strength deficiency of 45.6, 35.5, and 28.8 % in IMRL, IMR, and IM, respectively. The small finger contribution to grip is 14.3 % and the ring and small finger contribute 34 % in subjects with CMC OA. Grip strength decreases as the number of digits contributing decreased in both groups. The ulnar digits contribution to grip strength is greater than one third of total grip strength in subjects with CMC OA. Individuals with CMC OA demonstrate significantly decreased grip strength when compared to their healthy counterparts.
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Strifling, Kelly M B; Lu, Na; Wang, Mei; Cao, Kevin; Ackman, Jeffrey D; Klein, John P; Schwab, Jeffrey P; Harris, Gerald F
2008-10-01
This prospective study analyzes the upper extremity kinematics of 10 children with spastic diplegic cerebral palsy using anterior and posterior walkers. Although both types of walkers are commonly prescribed by clinicians, no quantitative data comparing the two in regards to upper extremity motion has been published. The study methodology included testing of each subject with both types of walkers in a motion analysis laboratory after an acclimation period of at least 1 month. Overall results showed that statistically, both walkers are relatively similar. With both anterior and posterior walkers, the shoulders were extended, elbows flexed, and wrists extended. Energy expenditure, walking speed and stride length was also similar with both walker types. Several differences were also noted although not statistically significant. Anterior torso tilt was reduced with the posterior walker and shoulder extension and elbow flexion were increased. Outcomes analysis indicated that differences in upper extremity torso and joint motion were not dependent on spasticity or hand dominance. These findings may help to build an understanding of upper extremity motion in walker-assisted gait and potentially to improve walker prescription.
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Villeneuve, Myriam; Penhune, Virginia; Lamontagne, Anouk
2014-01-01
Music-supported therapy was shown to induce improvements in motor skills in stroke survivors. Whether all stroke individuals respond similarly to the intervention and whether gains can be maintained over time remain unknown. We estimated the immediate and retention effects of a piano training program on upper extremity function in persons with chronic stroke. Thirteen stroke participants engaged in a 3-week piano training comprising supervised sessions (9 × 60 min) and home practice. Fine and gross manual dexterity, movement coordination, and functional use of the upper extremity were assessed at baseline, pre-intervention, post-intervention, and at a 3-week follow-up. Significant improvements were observed for all outcomes at post-intervention and follow-up compared to pre-intervention scores. Larger magnitudes of change in manual dexterity and functional use of the upper extremity were associated with higher initial levels of motor recovery. Piano training can result in sustainable improvements in upper extremity function in chronic stroke survivors. Individuals with a higher initial level of motor recovery at baseline appear to benefit the most from this intervention.
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Fan, Zheng; Kocis, Keith; Valley, Robert; Howard, James F; Chopra, Manisha; Chen, Yasheng; An, Hongyu; Lin, Weili; Muenzer, Joseph; Powers, William
2015-09-01
We evaluated safety and feasibility of high-pressure transvenous limb perfusion in an upper extremity of adult patients with muscular dystrophy, after completing a similar study in a lower extremity. A dose escalation study of single-limb perfusion with 0.9% saline was carried out in nine adults with muscular dystrophies under intravenous analgesia. Our study demonstrates that it is feasible and definitely safe to perform high-pressure transvenous perfusion with 0.9% saline up to 35% of limb volume in the upper extremities of young adults with muscular dystrophy. Perfusion at 40% limb volume is associated with short-lived physiological changes in peripheral nerves without clinical correlates in one subject. This study provides the basis for a phase 1/2 clinical trial using pressurized transvenous delivery into upper limbs of nonambulatory patients with Duchenne muscular dystrophy. Furthermore, our results are applicable to other conditions such as limb girdle muscular dystrophy as a method for delivering regional macromolecular therapeutics in high dose to skeletal muscles of the upper extremity.
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Gant, Katie L; Nagle, Kathleen G; Cowan, Rachel E; Field-Fote, Edelle C; Nash, Mark S; Kressler, Jochen; Thomas, Christine K; Castellanos, Mabelin; Widerström-Noga, Eva; Anderson, Kimberly D
2018-02-01
The safety and efficacy of pharmacological and cellular transplantation strategies are currently being evaluated in people with spinal cord injury (SCI). In studies of people with chronic SCIs, it is thought that functional recovery will be best achieved when drug or cell therapies are combined with rehabilitation protocols. However, any functional recovery attributed to the therapy may be confounded by the conditioned state of the body and by training-induced effects on neuroplasticity. For this reason, we sought to investigate the effects of a multi-modal training program on several body systems. The training program included body-weight-supported treadmill training for locomotion, circuit resistance training for upper body conditioning, functional electrical stimulation for activation of sublesional muscles, and wheelchair skills training for overall mobility. Eight participants with chronic, thoracic-level, motor-complete SCI completed the 12-week training program. After 12 weeks, upper extremity muscular strength improved significantly for all participants, and some participants experienced improvements in function, which may be explained by increased strength. Neurological function did not change. Changes in pain and spasticity were highly variable between participants. This is the first demonstration of the effect of this combination of four training modalities. However, balancing participant and study-site burden with capturing meaningful outcome measures is also an important consideration.
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Upper extremity pain and computer use among engineering graduate students.
Schlossberg, Eric B; Morrow, Sandra; Llosa, Augusto E; Mamary, Edward; Dietrich, Peter; Rempel, David M
2004-09-01
The objective of this study was to investigate risk factors associated with persistent or recurrent upper extremity and neck pain among engineering graduate students. A random sample of 206 Electrical Engineering and Computer Science (EECS) graduate students at a large public university completed an online questionnaire. Approximately 60% of respondents reported upper extremity or neck pain attributed to computer use and reported a mean pain severity score of 4.5 (+/-2.2; scale 0-10). In a final logistic regression model, female gender, years of computer use, and hours of computer use per week were significantly associated with pain. The high prevalence of upper extremity pain reported by graduate students suggests a public health need to identify interventions that will reduce symptom severity and prevent impairment.
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Exercise capacity, muscle strength and fatigue in sarcoidosis.
Marcellis, R G J; Lenssen, A F; Elfferich, M D P; De Vries, J; Kassim, S; Foerster, K; Drent, M
2011-09-01
The aim of this case-control study was to investigate the prevalence of exercise intolerance, muscle weakness and fatigue in sarcoidosis patients. Additionally, we evaluated whether fatigue can be explained by exercise capacity, muscle strength or other clinical characteristics (lung function tests, radiographic stages, prednisone usage and inflammatory markers). 124 sarcoidosis patients (80 males) referred to the Maastricht University Medical Centre (Maastricht, the Netherlands) were included (mean age 46.6±10.2 yrs). Patients performed a 6-min walk test (6MWT) and handgrip force (HGF), elbow flexor muscle strength (EFMS), quadriceps peak torque (QPT) and hamstring peak torque (HPT) tests. Maximal inspiratory pressure (P(I,max)) was recorded. All patients completed the Fatigue Assessment Scale (FAS) questionnaire. The 6MWT was reduced in 45% of the population, while HGF, EFMS, QPT and HPT muscle strength were reduced in 15, 12, 27 and 18%, respectively. P(I,max) was reduced in 43% of the population. The majority of the patients (81%) reported fatigue (FAS ≥22). Patients with reduced peripheral muscle strength of the upper and/or lower extremities were more fatigued and demonstrated impaired lung functions, fat-free mass, P(I,max), 6MWT and quality of life. Fatigue was neither predicted by exercise capacity, nor by muscle strength. Besides fatigue, exercise intolerance and muscle weakness are frequent problems in sarcoidosis. We therefore recommend physical tests in the multidisciplinary management of sarcoidosis patients, even in nonfatigued patients.
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Atalay, Erdem; Akova, Bedrettin; Gür, Hakan; Sekir, Ufuk
2017-12-01
The present study aimed to analyze the impacts of a low back rehabilitation program accompanied with neck, shoulder and upper back exercises on pain, disability, and physical characteristics of patients with chronic low back pain. Twenty sedentary male patients with chronic low back pain participated in the study on a voluntary basis. The patients were randomly allocated into two groups: a conventional low back exercise group (CE) and a supported exercise group (SE; CE plus upper back, neck, and shoulder exercises). The Modified Oswestry Disability Questionnaire (MODQ) was used to evaluate the disability status and the Visual Analog Scale (VAS) was used to identify the pain states of the patients. In addition, neck, lumbar and shoulder isokinetic and isometric strengths of the patients were evaluated. The CE group performed lumbar stretching, mobilization and stabilization exercises in addition to low-back and abdominal isometric and concentric strengthening exercises. The SE group performed static stretching and isotonic exercises for the neck, upper-back, and shoulder muscles, in addition to the exercises performed in CE group. The exercises were implemented 3 days a week for 6 weeks in both groups. Following the 6-week exercise periods in both groups, statistically significant (p < 0.01) improvements were observed in the patients' levels of pain and the scores of MODQ reflecting an easing of disability. With respect to the levels of pain and disability, the improvements observed in the SE group was significantly (p < 0.01) greater than the improvement observed in the CE group. Based on the findings of this study, we can conclude that a low back exercise program used in combination with neck, shoulder and upper back exercises reduces the level of pain and disability in patients with chronic low back pain more prominently than conventional low back exercises.
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Biomotor structures in elite female handball players according to performance.
Cavala, Marijana; Rogulj, Nenad; Srhoj, Vatromir; Srhoj, Ljerka; Katić, Ratko
2008-03-01
In order to identify biomotor structures in elite female handball players, factor structures of morphological characteristics and basic motor abilities, and of variables evaluating situation motor abilities of elite female handball players (n = 53) were determined first, followed by determination of differences and relations of the morphological, motor and specific motor space according to handball performance. Factor analysis of 16 morphological measures produced three morphological factors, i.e. factor of absolute voluminosity, i.e. mesoendomorphy, factor of longitudinal skeleton dimensionality, and factor of transverse hand dimensionality. Factor analysis of 15 motor variables yielded five basic motor dimensions, i.e. factor of agility, factor of throwing explosive strength, factor of running explosive strength (sprint), factor of jumping explosive strength and factor of movement frequency rate. Factor analysis of 5 situation motor variables produced two dimensions: factor of specific agility with explosiveness and factor of specific precision with ball manipulation. Analysis of variance yielded greatest differences relative to handball performance in the factor of specific agility and throwing strength, and the factor of basic motoricity that integrates the ability of coordination (agility) with upper extremity throwing explosiveness and lower extremity sprint (30-m sprint) and jumping (standing triple jump). Considering morphological factors, the factor of voluminosity, i.e. mesoendomorphy, which is defined by muscle mass rather than adipose tissue, was found to contribute significantly to the players'performance. Results of regression analysis indicated the handball performance to be predominantly determined by the general specific motor factor based on specific agility and explosiveness, and by the morphological factor based on body mass and volume, i.e. muscle mass. Concerning basic motor abilities, the factor of movement frequency rate, which is associated with the ability of ball manipulation, was observed to predict significantly the handball players' performance.
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Seuser, A; Boehm, P; Ochs, S; Trunz-Carlisi, E; Halimeh, S; Klamroth, R
2015-07-01
There are a lot of publications on the physical fitness of patients with haemophilia (PWH), however, most studies only reflect individual sport-specific motor capacities or focus on a single fitness ability. They involve small patient populations. In this respect principal objective of this study was to compare the physical fitness in all respects and the body composition of young PWH to healthy peers based on the most valid data we could get. Twenty-one German haemophilia treatment centres were visited from 2002 to 2009. PWH between 8 and 25 years were included. They performed a five-stage fitness test covering the sport-specific motor capacities for coordination, measured by one leg stand, strength, aerobic fitness and mobility as well as body composition. The patients' results were compared with age- and gender-specific reference values of healthy subjects. Two hundred and eighty-five PWH (mean age 13.2 ± 4.5 years, 164 PWH with severe disease) were included prospectively in the study. PWH are significantly below the reference values of healthy subjects in the one-leg stand test, the mobility of the lower extremity, the strength ratio of chest and back muscles and the endurance test. In body composition, the back strength and the mobility of the upper extremity PWH are significantly above the reference values. There are no significant differences in abdominal strength. In conclusion we found specific differences in different fitness abilities between PWH and healthy subjects. Knowing this, we are able to work out exercise programmes to compensate the diminished fitness abilities for our PWH. © 2015 John Wiley & Sons Ltd.
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Shoulder injuries from alpine skiing and snowboarding. Aetiology, treatment and prevention.
Kocher, M S; Dupré, M M; Feagin, J A
1998-03-01
There has been a decrease in the overall injury rate and the rate of lower extremity injuries for alpine skiing, with a resultant increase in the ratio of upper extremity to lower extremity injuries. Upper extremity injuries account for 20 to 35% of all injuries during alpine skiing and nearly 50% of all injuries during snowboarding. The most common upper extremity injuries during skiing are sprain of the thumb metacarpal-phalangeal joint ulnar collateral ligament, and the most common in snowboarding is wrist fracture. Shoulder injuries from skiing and snowboarding have been less well characterised. With the increased ratio of upper to lower extremity injuries during alpine skiing and the boom in popularity of snowboarding, shoulder injuries will be seen with increasing frequency by those who care for alpine sport injuries. Shoulder injuries account for 4 to 11% of all alpine skiing injuries and 22 to 41% of upper extremity injuries. The rate of shoulder injuries during alpine skiing is 0.2 to 0.5 injuries per thousand skier-days. During snowboarding, shoulder injuries account for 8 to 16% of all injuries and 20 to 34% of upper extremity injuries. Falls are the most common mechanism of shoulder injury, in addition to pole planting during skiing and aerial manoeuvres during snowboarding. Common shoulder injuries during skiing and snowboarding are glenohumeral instability, rotator cuff strains, acromioclavicular separations and clavicle fractures. Less common shoulder injuries include greater tuberosity fractures, trapezius strains, proximal humerus fractures, biceps strains, glenoid fractures, scapula fractures, humeral head fractures, sterno-clavicular separations, acromion fractures and biceps tendon dislocation. Prevention of shoulder injuries during skiing and snowboarding may be possible through interventions in education and technique, conditioning and equipment and environment.
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Bučar Pajek, Maja; Leskošek, Bojan; Vivoda, Tjaša; Svilan, Katarina; Čuk, Ivan; Pajek, Jernej
2016-06-01
To reduce the need for a large number of executed physical function tests we examined inter-relations and determined predictive power for daily physical activity of the following tests: 6-min walk, 10 repetition sit-to-stand, time up-and-go, Storke balance, handgrip strength, upper limb tapping and sitting forward bend tests. In 90 dialysis and 140 healthy control subjects we found high correlations between all tests, especially those engaging lower extremities. Sit-to-stand, forward bend and handgrip strength were selected for the test battery and composite motor performance score. Sit-to-stand test was superior in terms of sensitivity to uremia effects and association with daily physical function in adjusted analyses. There was no incremental value in calculating the composite performance score. We propose to standardize the physical function assessment of dialysis patients for cross-sectional and longitudinal observations with three simple, cheap, well-accessible and easily performed test tools: sit-to-stand test, handgrip strength and Human Activity Profile questionnaire. © 2016 International Society for Apheresis, Japanese Society for Apheresis, and Japanese Society for Dialysis Therapy.
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Şimşek, Tülay Tarsuslu; Çekok, Kübra
2016-12-01
The aim of this study was to investigate the effects of Nintendo Wii(TM)-based balance and upper extremity training on activities of daily living and quality of life in patients with subacute stroke. 42 adults with stroke (mean age (SD) = 58.04 (16.56) years and mean time since stroke (SD) = (55.2 ± 22.02 days (∼8 weeks)) were included in the study. Participants were enrolled from the rehabilitation department of a medical center (a single inpatient rehabilitation facility). Participants were randomly assigned to Nintendo Wii group (n = 20) or Bobath neurodevelopmental treatment (NDT) (n = 22). The treatments were applied for 10 weeks (45-60 minutes/day, 3 days/week) for both of two groups. Nintendo Wii group used five games selected from the Wii sports and Wii Fit packages for upper limb and balance training, respectively. The patients in Bobath NDT group were applied a therapy program included upper extremity activites, strength, balance gait and functional training. The functional independence in daily life activities and health-related quality of life was assessed with Functional Independence Measure (FIM) and Nottingham Health Profile (NHP), respectively. Participant's treatment satisfaction was recorded by using Visual Analogue Scale. A second evaluation (FIM and NHP) occurred after 10 weeks at the end of rehabilitative treatment (post-training). Treatment satisfaction was measured after 10 sessions. There were significant difference between FIM and NHP values in NDT and Nintendo Wii group (p < 0.05). However, a significant difference was not found between the groups with regard to FIM and NHP (p > 0.05). The patients in Nintendo Wii group were detected to be better satisfied from the therapy (p < 0.05). A significant difference was found between subparameters and total FIM score, all subparameters and total NHP score in both groups (p < 0.05). These findings suggested that the Nintendo Wii training was as effective as Bobath NDT on daily living functions and quality of life in subacute stroke patients.
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NASA Astrophysics Data System (ADS)
Sulca, Juan C.
In this Master's dissertation, atmospheric circulation patterns associated with extreme hydrometeorological events in the Mantaro Basin, Peruvian Central Andes, and their teleconnections during the austral summer (December-January-February-March) are addressed. Extreme rainfall events in the Mantaro basin are related to variations of the large-scale circulation as indicated by the changing strength of the Bolivian High-Nordeste Low (BH-NL) system. Dry (wet) spells are associated with a weakening (strengthening) of the BH-NL system and reduced (enhanced) influx of moist air from the lowlands to the east due to strengthened westerly (easterly) wind anomalies at mid- and upper-tropospheric levels. At the same time extreme rainfall events of the opposite sign occur over northeastern Brazil (NEB) due to enhanced (inhibited) convective activity in conjunction with a strengthened (weakened) Nordeste Low. Cold episodes in the Mantaro Basin are grouped in three types: weak, strong and extraordinary cold episodes. Weak and strong cold episodes in the MB are mainly associated with a weakening of the BH-NL system due to tropical-extratropical interactions. Both types of cold episodes are associated with westerly wind anomalies at mid- and upper-tropospheric levels aloft the Peruvian Central Andes, which inhibit the influx of humid air masses from the lowlands to the east and hence limit the potential for development of convective cloud cover. The resulting clear sky conditions cause nighttime temperatures to drop, leading to cold extremes below the 10-percentile. Extraordinary cold episodes in the MB are associated with cold and dry polar air advection at all tropospheric levels toward the central Peruvian Andes. Therefore, weak and strong cold episodes in the MB appear to be caused by radiative cooling associated with reduced cloudiness, rather than cold air advection, while the latter plays an important role for extraordinary cold episodes only.
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Slavens, Brooke A; Harris, Gerald F
2008-01-01
Human motion analysis has evolved from the lower extremity to the upper extremity. Rehabilitation engineering is reliant upon three-dimensional biome-chanical models for a thorough understanding of upper body motions and forces in order to improve treatment methods, rehabilitation strategies and to prevent injury. Due to the complex nature of upper body movements, a standard biomechanical model does not exist. This paper reviews several kinematic and kinetic rehabilitation engineering models from the literature. These models may capture a single joint; multijoints such as the shoulder, elbow and wrist; or a combination of joints and an ambulatory aid, which serves as the extension of the upper arm. With advances in software and hardware, new models continuously arise due to the clinical questions at hand. When designing a biomechanical upper extremity model, several key components must be determined. These include deciding on the anatomic segments of the model, the number of markers and placement on bony landmarks, the definition of joint coordinate systems, and the description of the joint motions. It is critical to apply the proper model to further our understanding of pathologic populations.
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Yeldan, Ipek; Huseyınsınoglu, Burcu Ersoz; Akıncı, Buket; Tarakcı, Ela; Baybas, Sevim; Ozdıncler, Arzu Razak
2015-11-01
[Purpose] The aim of the study was to evaluate the effects of a very early mirror therapy program on functional improvement of the upper extremity in acute stroke patients. [Subjects] Eight stroke patients who were treated in an acute neurology unit were included in the study. [Methods] The patients were assigned alternatively to either the mirror therapy group receiving mirror therapy and neurodevelopmental treatment or the neurodevelopmental treatment only group. The primary outcome measures were the upper extremity motor subscale of the Fugl-Meyer Assessment, Motricity Index upper extremity score, and the Stroke Upper Limb Capacity Scale. Somatosensory assessment with the Ayres Southern California Sensory Integration Test, and the Barthel Index were used as secondary outcome measures. [Results] No statistically significant improvements were found for any measures in either group after the treatment. In terms of minimally clinically important differences, there were improvements in Fugl-Meyer Assessment and Barthel Index in both mirror therapy and neurodevelopmental treatment groups. [Conclusion] The results of this pilot study revealed that very early mirror therapy has no additional effect on functional improvement of upper extremity function in acute stroke patients. Multicenter trials are needed to determine the results of early application of mirror therapy in stroke rehabilitation.
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Maximal strength and power assessment in novice weight trainers.
Cronin, John B; Henderson, Melanie E
2004-02-01
The purpose of this study was to investigate whether changes in maximal strength and power output occurred over time in the absence of strength and power training in novice weight trainers. It also investigated whether differences existed between upper- and lower-body assessments and unilateral and bilateral assessments. The power output and maximal strength (1 repetition maximum [1RM]) of 10 male novice subjects were measured on 4 occasions, each assessment 7-10 days apart. The exercises used to measure the upper- and lower-body strength and power outputs were the bench press and supine squat, respectively. Significant (p < 0.05) changes in unilateral (9.8-16.8%) and bilateral 1RM (6.8-15.0%) leg strength were found, the first assessment being significantly different from all other assessments and assessment 2 significantly different from assessment 4. Changes in the upper body (10-13.6%) were also observed. The only significant difference was between assessment 1 and the other testing occasions. No differences in power output were observed for both the upper and lower body during the study. It would seem that considerable changes in maximal strength occur rapidly and in the absence of any formal strength training program in novice weight trainers.
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Benaya, A; Schwartz, Y; Kory, R; Yinnon, A M; Ben-Chetrit, E
2015-05-01
Peripheral venous access in elderly, hospitalized patients is often challenging. The usual alternative is insertion of a central venous catheter, with associated risk for complications. The purpose of this investigation was to determine the relative incidence of phlebitis secondary to lower as compared to upper extremity intravenous catheters (IVCs) and associated risk factors. A non-randomized, observational, cohort-controlled study was carried out. Consecutive patients receiving a lower extremity IVC were enrolled and compared with patients receiving an upper extremity IVC. Patients were followed from insertion until removal of the IVC. The major endpoint was phlebitis. The incidence of phlebitis secondary to upper extremity IVCs was 3/50 (6 %) compared to 5/53 (9.4 %) in lower extremity IVCs (χ(2) Yates = 0.08, p = 0.776). Age, gender, obesity, diabetes mellitus, site (arm versus leg, left versus right), and size of needle were not found to be risk factors for phlebitis according to univariate analysis. None of the patients developed bloodstream infection. In elderly patients with poor venous access, lower extremity IVCs are a reasonable and low-risk alternative to central venous catheters.
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Hegge, Ann Magdalen; Myhre, Kenneth; Welde, Boye; Holmberg, Hans-Christer; Sandbakk, Øyvind
2015-01-01
In the current study, we evaluated the impact of exercise intensity on gender differences in upper-body poling among cross-country skiers, as well as the associated differences in aerobic capacity, maximal strength, body composition, technique and extent of training. Eight male and eight female elite skiers, gender-matched for level of performance by FIS points, carried out a 4-min submaximal, and a 3-min and 30-sec maximal all-out test of isolated upper-body double poling on a Concept2 ski ergometer. Maximal upper-body power and strength (1RM) were determined with a pull-down exercise. In addition, body composition was assessed with a DXA scan and training during the previous six months quantified from diaries. Relative to the corresponding female values (defined as 100%), the power output produced by the men was 88%, 95% and 108% higher during the submaximal, 3-min and 30-sec tests, respectively, and peak power in the pull-down strength exercise was 118% higher (all P<0.001). During the ergometer tests the work performed per cycle by the men was 97%, 102% and 91% greater, respectively, and the men elevated their cycle rate to a greater extent at higher intensities (both P<0.01). Furthermore, men had a 61% higher VO2peak, 58% higher 1RM, relatively larger upper-body mass (61% vs 56%) and reported considerably more upper-body strength and endurance training (all P<0.05). In conclusion, gender differences in upper-body power among cross-country skiers augmented as the intensity of exercise increased. The gender differences observed here are greater than those reported previously for both lower- and whole-body sports and coincided with greater peak aerobic capacity and maximal upper-body strength, relatively more muscle mass in the upper-body, and more extensive training of upper-body strength and endurance among the male skiers.
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Hegge, Ann Magdalen; Myhre, Kenneth; Welde, Boye; Holmberg, Hans-Christer; Sandbakk, Øyvind
2015-01-01
In the current study, we evaluated the impact of exercise intensity on gender differences in upper-body poling among cross-country skiers, as well as the associated differences in aerobic capacity, maximal strength, body composition, technique and extent of training. Eight male and eight female elite skiers, gender-matched for level of performance by FIS points, carried out a 4-min submaximal, and a 3-min and 30-sec maximal all-out test of isolated upper-body double poling on a Concept2 ski ergometer. Maximal upper-body power and strength (1RM) were determined with a pull-down exercise. In addition, body composition was assessed with a DXA scan and training during the previous six months quantified from diaries. Relative to the corresponding female values (defined as 100%), the power output produced by the men was 88%, 95% and 108% higher during the submaximal, 3-min and 30-sec tests, respectively, and peak power in the pull-down strength exercise was 118% higher (all P<0.001). During the ergometer tests the work performed per cycle by the men was 97%, 102% and 91% greater, respectively, and the men elevated their cycle rate to a greater extent at higher intensities (both P<0.01). Furthermore, men had a 61% higher VO2peak, 58% higher 1RM, relatively larger upper-body mass (61% vs 56%) and reported considerably more upper-body strength and endurance training (all P<0.05). In conclusion, gender differences in upper-body power among cross-country skiers augmented as the intensity of exercise increased. The gender differences observed here are greater than those reported previously for both lower- and whole-body sports and coincided with greater peak aerobic capacity and maximal upper-body strength, relatively more muscle mass in the upper-body, and more extensive training of upper-body strength and endurance among the male skiers. PMID:26000713
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Shim, Je-Myung; Kwon, Hae-Yeon; Kim, Ha-Roo; Kim, Bo-In; Jung, Ju-Hyeon
2013-12-01
[Purpose] The aim of this study was to assess the effect of Nordic pole walking on the electromyographic activities of upper extremity and lower extremity muscles. [Subjects and Methods] The subjects were randomly divided into two groups as follows: without Nordic pole walking group (n=13) and with Nordic pole walking group (n=13). The EMG data were collected by measurement while the subjects walking on a treadmill for 30 minutes by measuring from one heel strike to the next. [Results] Both the average values and maximum values of the muscle activity of the upper extremity increased in both the group that used Nordic poles and the group that did not use Nordic poles, and the values showed statistically significant differences. There was an increase in the average value for muscle activity of the latissimus dorsi, but the difference was not statistically significant, although there was a statistically significant increase in its maximum value. The average and maximum values for muscle activity of the lower extremity did not show large differences in either group, and the values did not show any statistically significant differences. [Conclusion] The use of Nordic poles by increased muscle activity of the upper extremity compared with regular walking but did not affect the lower extremity.
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Shim, Je-myung; Kwon, Hae-yeon; Kim, Ha-roo; Kim, Bo-in; Jung, Ju-hyeon
2014-01-01
[Purpose] The aim of this study was to assess the effect of Nordic pole walking on the electromyographic activities of upper extremity and lower extremity muscles. [Subjects and Methods] The subjects were randomly divided into two groups as follows: without Nordic pole walking group (n=13) and with Nordic pole walking group (n=13). The EMG data were collected by measurement while the subjects walking on a treadmill for 30 minutes by measuring from one heel strike to the next. [Results] Both the average values and maximum values of the muscle activity of the upper extremity increased in both the group that used Nordic poles and the group that did not use Nordic poles, and the values showed statistically significant differences. There was an increase in the average value for muscle activity of the latissimus dorsi, but the difference was not statistically significant, although there was a statistically significant increase in its maximum value. The average and maximum values for muscle activity of the lower extremity did not show large differences in either group, and the values did not show any statistically significant differences. [Conclusion] The use of Nordic poles by increased muscle activity of the upper extremity compared with regular walking but did not affect the lower extremity. PMID:24409018
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Nerve Injuries of the Upper Extremity
... Upper Extremity Find a hand surgeon near you. Videos Figures Figure 1 - Nerve with bundles of individual ... or "in." Also, avoid using media types like "video," "article," and "picture." Tip 4: Your results can ...
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Congenital Differences of the Upper Extremity: Classification and Treatment Principles
2011-01-01
For hand surgeons, the treatment of children with congenital differences of the upper extremity is challenging because of the diverse spectrum of conditions encountered, but the task is also rewarding because it provides surgeons with the opportunity to impact a child's growth and development. An ideal classification of congenital differences of the upper extremity would reflect the full spectrum of morphologic abnormalities and encompass etiology, a guide to treatment, and provide prognoses. In this report, I review current classification systems and discuss their contradictions and limitations. In addition, I present a modified classification system and provide treatment principles. As our understanding of the etiology of congenital differences of the upper extremity increases and as experience of treating difficult cases accumulates, even an ideal classification system and optimal treatment strategies will undoubtedly continue to evolve. PMID:21909463
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Innovations in prosthetic interfaces for the upper extremity.
Kung, Theodore A; Bueno, Reuben A; Alkhalefah, Ghadah K; Langhals, Nicholas B; Urbanchek, Melanie G; Cederna, Paul S
2013-12-01
Advancements in modern robotic technology have led to the development of highly sophisticated upper extremity prosthetic limbs. High-fidelity volitional control of these devices is dependent on the critical interface between the patient and the mechanical prosthesis. Recent innovations in prosthetic interfaces have focused on several control strategies. Targeted muscle reinnervation is currently the most immediately applicable prosthetic control strategy and is particularly indicated in proximal upper extremity amputations. Investigation into various brain interfaces has allowed acquisition of neuroelectric signals directly or indirectly from the central nervous system for prosthetic control. Peripheral nerve interfaces permit signal transduction from both motor and sensory nerves with a higher degree of selectivity. This article reviews the current developments in each of these interface systems and discusses the potential of these approaches to facilitate motor control and sensory feedback in upper extremity neuroprosthetic devices.
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Park, Junhyuck; Gong, Jihwan; Yim, Jongeun
2017-01-01
Boxing training including traditional stretching, muscular strength training, and duration training would be considered to be effective for improved functional stretching, dynamic balance, walking speed, and quality of life. We aimed to investigate upper limb function, balance, gait, and quality of life in stroke patients before and after a sitting boxing program. Twenty-six participants were randomly allocated to a boxing group (n = 13) and control group (n = 13) after the upper limb function, balance, gait, and quality of Life were recorded. The boxing group underwent a sitting boxing program (3 times/week) as well as conventional physical therapy (3 times/week) for 6 weeks. The control group only underwent conventional physical therapy (3 times/week) for 6 weeks. The Manual Functional Test (MFT), non-affected hand grip, Berg Balance Scale (BBS), velocity moment with eye opened, 10-m Walk Test (10 MWT), and Stroke-Specific Quality of Life questionnaire (SS-QOL) were significantly improved in the boxing group (p < 0.05) and showed significantly greater improvements in the boxing group compared to the control group (p < 0.05) after 6 weeks. The sitting boxing program group had positive effects on upper extremity function, balance, gait, and quality of life in stroke patients.
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[A case of chronic multifocal myositis].
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)
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New options for vascularized bone reconstruction in the upper extremity.
Houdek, Matthew T; Wagner, Eric R; Wyles, Cody C; Nanos, George P; Moran, Steven L
2015-02-01
Originally described in the 1970s, vascularized bone grafting has become a critical component in the treatment of bony defects and non-unions. Although well established in the lower extremity, recent years have seen many novel techniques described to treat a variety of challenging upper extremity pathologies. Here the authors review the use of different techniques of vascularized bone grafts for the upper extremity bone pathologies. The vascularized fibula remains the gold standard for the treatment of large bone defects of the humerus and forearm, while also playing a role in carpal reconstruction; however, two other important options for larger defects include the vascularized scapula graft and the Capanna technique. Smaller upper extremity bone defects and non-unions can be treated with the medial femoral condyle (MFC) free flap or a vascularized rib transfer. In carpal non-unions, both pedicled distal radius flaps and free MFC flaps are viable options. Finally, in skeletally immature patients, vascularized fibular head epiphyseal transfer can provide growth potential in addition to skeletal reconstruction.
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Wu, Feng L; Sun, Yu; Pan, Sheng F; Zhang, Li; Liu, Zhong J
2014-06-01
Postoperative paresis, so-called C5 palsy, of the upper extremities is a common complication of cervical surgery. There have been several reports about upper extremity palsy after cervical laminoplasty for patients with cervical myelopathy. However, the possible risk factors remain unclear. To investigate the factors associated with the development of upper extremity palsy after expansive open-door laminoplasty for cervical myelopathy. A retrospective review of medical records. A total of 102 patients (76 men and 26 women) were eligible for analysis in this study. The mean age of the patients was 58.7 years (range 35-81 years). Sixteen patients (13 men and 3 women, average age 62.8 years) with palsy were categorized as Group P, and eighty-six patients (63 men and 23 women, average age 57.8 years) without palsy as Group C. The demographic data collected from both groups were age, sex, duration of symptoms, disease, and type of surgical procedure. Cervical curvature index, width of the intervertebral foramen (WIF) at C5, anterior protrusion of the superior articular process (APSAP), number of compressed segments, high-signal intensity zone at the level corresponding to C3-C5 (HIZ:C3-C5), and posterior shift of the spinal cord (PSSC) were also evaluated. Upper extremity palsy was defined as weakness of Grade 4 or less of the key muscles in the upper extremity by manual muscle test without any deterioration of myelopathic symptoms after surgery. Comparisons were made with screen for the parameters with significant differences, and then we further analyzed these parameters by logistic regression analysis (the forward method) to verify the risk factors of the upper extremity palsy. Significant differences in diagnosis, the type of procedure, WIF, APSAP, and HIZ:C3-C5 were observed between the two groups. No statistical difference in PSSC between the groups was noted (2.06 vs. 2.53 mm, p=.247). In logistic regression analysis, ossification of the posterior longitudinal ligament (OPLL), cervical open-door laminoplasty together with posterior instrumented fusion (CLP+PIF), and WIF were found to be significant risk factors for postoperative upper extremity palsy. Patients with preoperative foraminal stenosis, OPLL, and additional iatrogenic foraminal stenosis because of CLP+PIF were more likely to develop postoperative upper extremity palsy. Attention should be given to the WIF determined on preoperative computed tomography of the C5 root. To prevent iatrogenic foraminal stenosis, appropriate distraction between spine segments should be provided during placement of the rod. Copyright © 2014 Elsevier Inc. All rights reserved.
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d'Errico, Angelo; Katz, Jeffrey N.; Gore, Rebecca; Punnett, Laura
2009-01-01
Objective A longitudinal cohort of automobile manufacturing workers (n = 1214) was examined for: 1) prevalence and persistence of specific upper extremity musculoskeletal disorders (UEMSDs) such as lateral epicondylitis and de Quervain's disease, and non-specific disorders (NSDs) defined in symptomatic individuals without any specific disorder, and 2) disorder prognoses based on symptom characteristics and other factors. Methods Eight specific disorders were identified through case definitions based on upper extremity physical examinations and symptom surveys administered on three occasions over six years. Results At baseline, 41% of the cohort reported upper extremity symptoms; 18% (n = 214) of these had NSDs. In each survey, tendon-related conditions accounted for over half of the specific morbidity. Twenty-five percent had UEMSDs in multiple anatomical sites, and most with hand/wrist disorders had two or more hand/wrist UEMSDs. Persistence for all specific disorders decreased with length of follow-up. Specific UEMSDs were characterized by greater pain severity and functional impairment, and more lost work days than NSDs. Conclusions Upper extremity symptoms and diagnoses vary over time. NSDs may be the early stages of conditions that will eventually become more specific. NSDs and overlapping specific UEMSDs should be taken into account in UEMSD classification. PMID:19016265
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Villeneuve, Myriam; Penhune, Virginia; Lamontagne, Anouk
2014-01-01
Objective: Music-supported therapy was shown to induce improvements in motor skills in stroke survivors. Whether all stroke individuals respond similarly to the intervention and whether gains can be maintained over time remain unknown. We estimated the immediate and retention effects of a piano training program on upper extremity function in persons with chronic stroke. Methods: Thirteen stroke participants engaged in a 3-week piano training comprising supervised sessions (9 × 60 min) and home practice. Fine and gross manual dexterity, movement coordination, and functional use of the upper extremity were assessed at baseline, pre-intervention, post-intervention, and at a 3-week follow-up. Results: Significant improvements were observed for all outcomes at post-intervention and follow-up compared to pre-intervention scores. Larger magnitudes of change in manual dexterity and functional use of the upper extremity were associated with higher initial levels of motor recovery. Conclusion: Piano training can result in sustainable improvements in upper extremity function in chronic stroke survivors. Individuals with a higher initial level of motor recovery at baseline appear to benefit the most from this intervention. PMID:25202258
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Bilateral macrodystrophia lipomatosa of the upper extremities with syndactyly and multiple lipomas.
van der Meer, Saskia; Nicolai, Jean-Philippe A; Schut, Simone M; Meek, Marcel F
2011-12-01
Macrodystrophia lipomatosa is a rare disease that causes congenital local gigantism of part of an extremity, which is characterised by an increase in all mesenchymal elements, particularly fibroadipose tissue. This is the first report to our knowledge of a case of histologically confirmed bilateral macrodystrophia lipomatosa of the upper extremities with syndactyly and multiple lipomas.
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Goldfarb, Charles A; Shaw, Neil; Steffen, Jennifer A; Wall, Lindley B
2017-03-01
There have been few publications regarding the prevalence of congenital upper extremity anomalies and no recent reports from the United States. The purpose of this investigation was to examine the prevalence of congenital upper extremity anomalies in the total birth population of New York State over a 19-year period utilizing the New York Congenital Malformations Registry (NYCMR) database. The NYCMR includes children with at least 1 birth anomaly diagnosed by 2 years of age and listed by diagnosis code. We scrutinized these codes for specific upper extremity anomalies, including polydactyly, syndactyly, reduction defects, clubhand malformations, and syndromes with upper limb anomalies. We included children born between 1992 and 2010. There were a total of 4,883,072 live births in New York State during the study period. The overall prevalence of congenital upper extremity anomalies was 27.2 cases per 10,000 live births. Polydactyly was most common with 12,418 cases and a prevalence rate of 23.4 per 10,000 live births. The next most common anomalies included syndactyly with 627 cases affecting the hands (1498 total) and reduction defects (1111 cases). Specific syndromes were quite rare and were noted in a total of 215 live births. The prevalence of anomalies was higher in New York City compared with New York State populations at 33.0 and 21.9 per 10,000 live births, respectively. The NYCMR data demonstrate that congenital upper extremity anomalies are more common than previously reported. This is in large part due to the high prevalence of polydactyly. Although registries are imperfect, such data are helpful in monitoring prevalence rates over time, identifying potential causes or associations, and guiding health care planning and future research. Level I-diagnostic.
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Hoozemans, M J M; Knelange, E B; Frings-Dresen, M H W; Veeger, H E J; Kuijer, P P F M
2014-11-01
Systematically review observational studies concerning the question whether workers that perform pushing/pulling activities have an increased risk for upper extremity symptoms as compared to workers that perform no pushing/pulling activities. A search in MEDLINE via PubMed and EMBASE was performed with work-related search terms combined with push/pushing/pull/pulling. Studies had to examine exposure to pushing/pulling in relation to upper extremity symptoms. Two authors performed the literature selection and assessment of the risk of bias in the studies independently. A best evidence synthesis was used to draw conclusions in terms of strong, moderate or conflicting/insufficient evidence. The search resulted in 4764 studies. Seven studies were included, with three of them of low risk of bias, in total including 8279 participants. A positive significant relationship with upper extremity symptoms was observed in all four prospective cohort studies with effect sizes varying between 1.5 and 4.9. Two out of the three remaining studies also reported a positive association with upper extremity symptoms. In addition, significant positive associations with neck/shoulder symptoms were found in two prospective cohort studies with effect sizes of 1.5 and 1.6, and with shoulder symptoms in one of two cross-sectional studies with an effect size of 2.1. There is strong evidence that pushing/pulling is related to upper extremity symptoms, specifically for shoulder symptoms. There is insufficient or conflicting evidence that pushing/pulling is related to (combinations of) upper arm, elbow, forearm, wrist or hand symptoms. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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Using commercial video games for upper limb stroke rehabilitation: is this the way of the future?
Pietrzak, Eva; Cotea, Cristina; Pullman, Stephen
2014-01-01
The increasing number of people living with poststroke sequelae has stimulated the search for novel ways of providing poststroke rehabilitation without putting additional stress on overburdened health care systems. One of them is the use of commercially available technology and off-the-shelf video games for hemiparetic upper limb rehabilitation. The MEDLINE, EMBASE, and Cochrane Library databases were searched using key word synonyms for stroke, upper limb, and video games. Included studies investigated upper limb stroke rehabilitation using commercially available consoles and video games, reported outcomes that included measures of upper limb functionality, and were published in a peer-reviewed journal written in English. Thirteen studies were identified - 6 published as full articles and 7 as abstracts. Studies were generally small and only 3 were randomized. The gaming systems investigated were the Nintendo Wii (n = 10), EyeToy PlayStation (n = 2), and CyWee Z (n = 1). The Nintendo Wii appears to provide the greatest benefits to patients, with improvements seen in upper extremity function measures such as joint range of motion, hand motor function, grip strength, and dexterity. Three studies indicate that video therapy appears to be safe and that long-term improvements continue at follow-up. At present, the evidence that the use of commercial video games in rehabilitation improves upper limb functionality after stroke is very limited. However, this approach has the potential to provide easily available and affordable stroke rehabilitation therapy in settings where access to therapy is limited by geographical or financial constraints.
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ERIC Educational Resources Information Center
Faigenbaum, Avery D.; Loud, Rita LaRosa; O'Connell, Jill; Glover, Scott; O'Connell, Jason; Westcott, Wayne L.
2001-01-01
Examined the effects of four resistance training protocols on upper body strength and muscular endurance development in children. Untrained children trained twice per week for 8 weeks, using general conditioning exercises and different upper-body conditioning protocols. Results indicated that higher-repetition training protocols enhanced…
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Qiu, Qinyin; Adamovich, Sergei; Saleh, Soha; Lafond, Ian; Merians, Alma S.; Fluet, Gerard G.
2015-01-01
Nine children with cerebral palsy and nine adults with stroke were trained using 5 different upper extremity simulations using the NJIT-RAVR system for approximately nine to twelve hours over a three week period. Both groups made improvements in clinical measurements of upper extremity function and reaching kinematics. Patterns and magnitudes of improvement differ between the two groups. Responses to training required adjustment of the robotic system to accommodate the rehabilitation needs of children with cerebral palsy. PMID:22275632
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Vaara, Jani P; Kokko, Juha; Isoranta, Manne; Kyröläinen, Heikki
2015-11-01
A high volume of military training has been shown to compromise muscle strength development. We examined effects of added low-volume resistance training during special military training (ST) period, which took place after basic training period. Male conscripts (n = 25) were assigned to standardized ST with added resistance training group (TG, n = 13) and group with standardized ST only (control) (CG, n = 12). Standardized ST with added resistance training group performed 2 resistance training sessions per week for 8 weeks: hypertrophic strength (weeks 1-3), maximal strength (weeks 4-6) and power training (weeks 7-8). Maximal strength tests, load carriage performance (3.2 km, 27 kg), and hormone concentrations were measured before and after ST (mean ± SD). Both groups improved similarly in their load carriage performance time (TG: 1,162 ± 116 seconds vs. 1,047 ± 81 seconds; CG: 1,142 ± 95 seconds vs. 1,035 ± 81 seconds) (p < 0.001) but decreased maximal strength of the lower extremities (TG: 5,250 ± 1,110 N vs. 4,290 ± 720 N; CG: 5,170 ± 1,050 N vs. 4,330 ± 1,230 N) and back muscles (TG: 4,290 ± 990 N vs. 3,570 ± 48 N; CG: 3,920 ± 72 N vs. 3,410 ± 53 N) (p ≤ 0.05). Maximal strength of the upper extremities improved in CG (1,040 ± 200 N vs. 1,140 ± 200 N) (p ≤ 0.05) but not in TG. Maximal strength of the abdominal muscles improved in TG (3,260 ± 510 N vs. 3,740 ± 75 N) (p ≤ 0.05) but not in CG. Testosterone concentration increased in CG (15.2 ± 3.6 nmol·L⁻¹ vs. 21.6 ± 5.0 nmol·L⁻¹) (p < 0.01) but not in TG (18.6 ± 4.3 nmol·L⁻¹ vs. 19.5 ± 9.4 nmol·L⁻¹). In conclusion, interference with strength gains might be related to the high volume of aerobic activities and too low volume of resistance training during ST. To develop strength characteristics, careful periodization and individualization should be adopted in ST.
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Lee, Dong Ryul; You, Joshua H; Lee, Nam Gi; Oh, Jin Hwan; Cha, You Jin
2009-01-01
This case study was conducted to determine Comprehensive Hand Repetitive Intensive Strengthening Training (CHRIST)-induced morphological changes in the commonly affected extensor carpi radialis (ECR) and triceps brachii (TRI) muscle and associated muscle strength and motor performance in a child with hemiparetic cerebral palsy (CP) using standardized clinical tests and ultrasound imaging. A single case study with pre-/post-test. A 4.9-year-old female, diagnosed with hemiparetic CP. The child received a 5-week course of CHRIST course, comprising of 60-minute periods a day, five times a week. A real-time ultrasound imaging was performed to determine the CHRIST-induced changes in cross-sectional area (CSA) of the ECR and TRI. Clinical tests including the modified Wolf Motor function test (WMFT), the modified Jebsen-taylor hand function test (Jebsen hand) and the modified Pediatric Motor Activity Log (PMAL) questionnaire were used to compare the intervention-related changes in motor performance in upper extremity. Ultrasound imaging data showed that the CSAs of both ECR and TRI muscles of the affected upper limb at relaxation and contraction states were enhanced and these therapy-induced morphological changes were associated with enhanced muscle strength and gross motor performance in reaching and grasping skills. Our results suggest that the CHRIST is effective in treating muscle weakness and motor function in a child with hemiparetic CP. This is the first evidence in literature that might shed light on the therapeutic efficacy of our novel intervention on muscle size, associated muscle strength and motor improvement.
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Peters, Denise M; Fridriksson, Julius; Stewart, Jill C; Richardson, Jessica D; Rorden, Chris; Bonilha, Leonardo; Middleton, Addie; Gleichgerrcht, Ezequiel; Fritz, Stacy L
2018-01-01
Advances in neuroimaging have enabled the mapping of white matter connections across the entire brain, allowing for a more thorough examination of the extent of white matter disconnection after stroke. To assess how cortical disconnection contributes to motor impairments, we examined the relationship between structural brain connectivity and upper and lower extremity motor function in individuals with chronic stroke. Forty-three participants [mean age: 59.7 (±11.2) years; time poststroke: 64.4 (±58.8) months] underwent clinical motor assessments and MRI scanning. Nonparametric correlation analyses were performed to examine the relationship between structural connectivity amid a subsection of the motor network and upper/lower extremity motor function. Standard multiple linear regression analyses were performed to examine the relationship between cortical necrosis and disconnection of three main cortical areas of motor control [primary motor cortex (M1), premotor cortex (PMC), and supplementary motor area (SMA)] and motor function. Anatomical connectivity between ipsilesional M1/SMA and the (1) cerebral peduncle, (2) thalamus, and (3) red nucleus were significantly correlated with upper and lower extremity motor performance (P ≤ 0.003). M1-M1 interhemispheric connectivity was also significantly correlated with gross manual dexterity of the affected upper extremity (P = 0.001). Regression models with M1 lesion load and M1 disconnection (adjusted for time poststroke) explained a significant amount of variance in upper extremity motor performance (R 2 = 0.36-0.46) and gait speed (R 2 = 0.46), with M1 disconnection an independent predictor of motor performance. Cortical disconnection, especially of ipsilesional M1, could significantly contribute to variability seen in locomotor and upper extremity motor function and recovery in chronic stroke. Hum Brain Mapp 39:120-132, 2018. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.
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A rare disease in an atypical location-Kimura's Disease of the upper extremity.
Lam, Alan Cheuk Si; Au Yeung, Rex Kwok Him; Lau, Vince Wing Hang
2015-12-01
Kimura's disease is a rare chronic inflammatory disorder predominantly affecting young Asian male patients, occurring mainly in the head and neck regions. Kimura's disease of the upper extremity is extremely rare, and previous case reports in the literature show similar imaging characteristics with consistent location at the medial epitrochlear region, predominantly with unilateral involvement. We present the first reported case of Kimura's disease affecting the anterolateral aspect of the upper arm, sparing the medial epitrochlear region, illustrating that with typical MR appearance and serology, the involvement of this rare disease in an atypical location still warrants consideration of this diagnosis. There was also bilateral asymmetrical involvement in our patient, suggesting the possibility of a propensity for Kimura's disease affecting the upper extremities to have bilateral involvement, which may necessitate imaging of the clinically asymptomatic contralateral limb in these patients for early lesion identification and treatment.
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Severe upper extremity injuries in frontal automobile crashes: the effects of depowered airbags.
Jernigan, M Virginia; Rath, Amber L; Duma, Stefan M
2005-03-01
The purpose of this study was to determine the effects of depowered frontal airbags on the incidence of severe upper extremity injuries. The National Automotive Sampling System database files from 1993 to 2000 were examined in a study that included 2,413,347 occupants who were exposed to an airbag deployment in the United States. Occupants exposed to a depowered airbag deployment were significantly more likely to sustain a severe upper extremity injury (3.9%) than those occupants exposed to a full-powered airbag deployment (2.5%) (P=.01). Full-powered systems resulted in an injury distribution of 89.2% fractures and 7.9% dislocations compared with depowered systems with 55.3% fractures and 44.3% dislocations. Although depowered airbags were designed to reduce the risk of injuries, they appear to have increased the overall incidence of severe upper extremity injuries through a shift from long bone fractures to joint dislocations.
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Forearm fracture bending risk functin for the 50th percentile male.
Santago, Anthony C; Cormier, Joseph M; Duma, Stefan M; Yoganandan, Narayan; Pintar, Frank A
2008-01-01
The increase in upper extremity injuries in automobile collisions, because of the widespread implantation of airbags, has lead to a better understanding of forearm injury criteria. Risk functions for upper extremity injury that can be used in instrumented upper extremities would be useful. This paper presents a risk function for forearm injury for the 50th percentile male based on bending fracture moment data gathered from previous studies. The data was scaled using two scaling factors, one for orientation and one for mass, and the Weibull survival analysis model was then used to develop the risk function. It was determined that a 25% risk of injury corresponds to an 82 Nm bending load, a 50% risk of injury corresponds to a 100 Nm bending load, and a 75% risk of injury corresponds to a 117 Nm bending load. It is believed the risk function can be used with an instrumented upper extremity during vehicle testing.
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Humerus fracture bending risk function for the 50th percentile male.
Santago, Anthony C; Cormier, Joseph M; Duma, Stefan M
2008-01-01
The increase in upper extremity injuries in automobile collisions, because of the widespread implantation of airbags, has lead to an increased focus in humerus injury criteria. Risk functions for upper extremity injury that can be used in instrumented upper extremities would be useful. This paper presents a risk function for humerus injury for the 50th percentile male based on bending fracture moment data gathered from previous studies. The data was scaled using two scaling factors, one for mass and one for rate, and the Weibull survival analysis model was then used to develop the risk function. It was determined that a 25% risk of injury corresponds to a 214 Nm bending load, a 50% risk of injury corresponds to a 257 Nm bending load, and a 75% risk of injury corresponds to a 296 Nm bending load. It is believed the risk function can be used with an instrumented upper extremity during vehicle testing.
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Boo, Jung-A; Moon, Sang-Hyun; Lee, Sun-Min; Choi, Jung-Hyun; Park, Si-Eun
2016-01-01
[Purpose] The purpose of this study was to determine the effect of whole-body vibration exercise in a sitting position prior to therapy in stroke patients. [Subjects and Methods] Fourteen chronic stroke patients were included in this study. Prior to occupational therapy, whole-body exercise was performed for 10 minutes, 5 times per week, for a total of 8 weeks. Muscle tone and upper extremity function were measured. The Modified Ashworth Scale (MAS) was used to measure muscle tone, and the Manual Function Test (MFT) and Fugl-Meyer Assessment scale (FugM) were used to measure upper extremity function. [Results] MAS score was significantly decreased, and MFT and FugM were significantly increased. [Conclusion] These results indicate that whole-body vibration exercise in a sitting position prior to therapy had a positive effect on muscle tone, and upper extremity function in stroke patients.
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Montpetit, Kathleen; Haley, Stephen; Bilodeau, Nathalie; Ni, Pengsheng; Tian, Feng; Gorton, George; Mulcahey, M J
2011-02-01
This article reports on the content range and measurement precision of an upper extremity (UE) computer adaptive testing (CAT) platform of physical function in children with cerebral palsy. Upper extremity items representing skills of all abilities were administered to 305 parents. These responses were compared with two traditional standardized measures: Pediatric Outcomes Data Collection Instrument and Functional Independence Measure for Children. The UE CAT correlated strongly with the upper extremity component of these measures and had greater precision when describing individual functional ability. The UE item bank has wider range with items populating the lower end of the ability spectrum. This new UE item bank and CAT have the capability to quickly assess children of all ages and abilities with good precision and, most importantly, with items that are meaningful and appropriate for their age and level of physical function.
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McLaughlin Gray, Julie; Frank, Gelya; Wolkoff, Monique
2015-01-01
OBJECTIVE. To identify the potential utility of musculoskeletal sonographic imaging in upper-extremity rehabilitation. METHOD. Two occupational therapists in an outpatient hand rehabilitation clinic were recruited by convenience, were trained in the use of sonography, and implemented sonographic imaging in their clinical practice. Qualitative data were obtained during and after the implementation period by means of questionnaires and interviews. Data collection, analysis, and interpretation were completed in an iterative process that culminated in a thematic analysis of the therapists’ perceptions. RESULTS. The data indicate four potential areas of utility for musculoskeletal sonography in upper-extremity rehabilitation: (1) mastering anatomy and pathology, (2) augmenting clinical reasoning, (3) supplementing intervention, and (4) building evidence. CONCLUSION. Numerous potential uses were identified that would benefit both therapist and client. Further exploration of complexities and efficacy for increasing patient outcomes is recommended to determine best practices for the use of musculoskeletal sonography in upper-extremity rehabilitation. PMID:26114469
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Age-Related, Sport-Specific Adaptions of the Shoulder Girdle in Elite Adolescent Tennis Players
Cools, Ann M.; Palmans, Tanneke; Johansson, Fredrik R.
2014-01-01
Context: Tennis requires repetitive overhead movements that can lead to upper extremity injury. The scapula and the shoulder play a vital role in injury-free playing. Scapular dysfunction and glenohumeral changes in strength and range of motion (ROM) have been associated with shoulder injury in the overhead athlete. Objective: To compare scapular position and strength and shoulder ROM and strength between Swedish elite tennis players of 3 age categories (<14, 14–16, and >16 years). Design: Cross-sectional study. Setting: Tennis training sports facilities. Patients or Other Participants: Fifty-nine adolescent Swedish elite tennis players (ages 10–20 years) selected based on their national ranking. Main Outcome Measure(s): We used a clinical screening protocol with a digital inclinometer and a handheld dynamometer to measure scapular upward rotation at several angles of arm elevation, isometric scapular muscle strength, glenohumeral ROM, and isometric rotator cuff strength. Results: Players older than 16 years showed less scapular upward rotation on the dominant side at 90° and 180° (P < .05). Although all absolute scapular muscle strength values increased with age, there was no change in the body-weight–normalized strength of the middle (P = .9) and lower (P = .81) trapezius or serratus anterior (P = .17). Glenohumeral internal-rotation ROM and total ROM tended to decrease, but this finding was not statistically significant (P = .052 and P = .06, respectively). Whereas normalized internal-rotator strength increased from 14 to 16 years to older than 16 years (P = .009), normalized external-rotator and supraspinatus strength remained unchanged. Conclusions: Age-related changes in shoulder and scapular strength and ROM were apparent in elite adolescent tennis players. Future authors should examine the association of these adaptations with performance data and injury incidence. PMID:25098662
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Age-related, sport-specific adaptions of the shoulder girdle in elite adolescent tennis players.
Cools, Ann M; Palmans, Tanneke; Johansson, Fredrik R
2014-01-01
Tennis requires repetitive overhead movements that can lead to upper extremity injury. The scapula and the shoulder play a vital role in injury-free playing. Scapular dysfunction and glenohumeral changes in strength and range of motion (ROM) have been associated with shoulder injury in the overhead athlete. To compare scapular position and strength and shoulder ROM and strength between Swedish elite tennis players of 3 age categories (<14, 14-16, and >16 years). Cross-sectional study. Tennis training sports facilities. Fifty-nine adolescent Swedish elite tennis players (ages 10-20 years) selected based on their national ranking. We used a clinical screening protocol with a digital inclinometer and a handheld dynamometer to measure scapular upward rotation at several angles of arm elevation, isometric scapular muscle strength, glenohumeral ROM, and isometric rotator cuff strength. Players older than 16 years showed less scapular upward rotation on the dominant side at 90° and 180° (P < .05). Although all absolute scapular muscle strength values increased with age, there was no change in the body-weight-normalized strength of the middle (P = .9) and lower (P = .81) trapezius or serratus anterior (P = .17). Glenohumeral internal-rotation ROM and total ROM tended to decrease, but this finding was not statistically significant (P = .052 and P = .06, respectively). Whereas normalized internal-rotator strength increased from 14 to 16 years to older than 16 years (P = .009), normalized external-rotator and supraspinatus strength remained unchanged. Age-related changes in shoulder and scapular strength and ROM were apparent in elite adolescent tennis players. Future authors should examine the association of these adaptations with performance data and injury incidence.
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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.
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Characteristics of Patients at First Visit to a Polio Clinic in Sweden
Vreede, Katarina Skough; Sunnerhagen, Katharina S.
2016-01-01
Aim Describe polio patients visiting a polio clinic in Sweden, a country where vaccination was introduced in 1957. Design A consecutive cohort study. Patients Prior polio patients. Methods All patients (n = 865) visiting the polio clinic at Sahlgrenska University Hospital, Gothenburg Sweden, between 1994 and 2012 were included in this study. Data at first visit regarding patient characteristics, polio classification, data of electromyography, origin, assistive devices and gait speed as well as muscle strength were collected for these patients. Twenty-three patients were excluded because no polio diagnosis could be established. A total of 842 patients with confirmed polio remained in the study. Results More than twenty percent of the patients were from countries outside the Nordic region and considerably younger than those from the Nordic region. The majority of the emigrants were from Asia and Africa followed by Europe (outside the Nordic region). Of all patients included ninety-seven percent (n = 817) had polio in the lower extremity and almost 53% (n = 444) had polio in the upper extremity while 28% (n = 238) had polio in the trunk, according to clinical classification of polio. Compared with a sample of the normal population, the polio patients walked 61–71% slower, and were 53–77% weaker in muscle strength of the knee and foot as well as grip strength. Conclusion The younger patients with polio emigrating from countries with different cultures may lead to a challenge for the multi professional teams working with post-polio rehabilitation and are of importance when planning for the care of polio patients the coming years. PMID:26981623
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Characteristics of Patients at First Visit to a Polio Clinic in Sweden.
Vreede, Katarina Skough; Sunnerhagen, Katharina S
2016-01-01
Describe polio patients visiting a polio clinic in Sweden, a country where vaccination was introduced in 1957. A consecutive cohort study. Prior polio patients. All patients (n = 865) visiting the polio clinic at Sahlgrenska University Hospital, Gothenburg Sweden, between 1994 and 2012 were included in this study. Data at first visit regarding patient characteristics, polio classification, data of electromyography, origin, assistive devices and gait speed as well as muscle strength were collected for these patients. Twenty-three patients were excluded because no polio diagnosis could be established. A total of 842 patients with confirmed polio remained in the study. More than twenty percent of the patients were from countries outside the Nordic region and considerably younger than those from the Nordic region. The majority of the emigrants were from Asia and Africa followed by Europe (outside the Nordic region). Of all patients included ninety-seven percent (n = 817) had polio in the lower extremity and almost 53% (n = 444) had polio in the upper extremity while 28% (n = 238) had polio in the trunk, according to clinical classification of polio. Compared with a sample of the normal population, the polio patients walked 61-71% slower, and were 53-77% weaker in muscle strength of the knee and foot as well as grip strength. The younger patients with polio emigrating from countries with different cultures may lead to a challenge for the multi professional teams working with post-polio rehabilitation and are of importance when planning for the care of polio patients the coming years.
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Lee, Myung Mo; Lee, Kyeong Jin; Song, Chang Ho
2018-04-27
BACKGROUND Virtual reality (VR) training with motion-controlled console games can be incorporated into stroke rehabilitation programs. The use of a variety of gaming software can provide the patient with an opportunity to perform activities that are exciting, entertaining, and that may not be feasible in clinical environments. The aim of this preliminary randomized controlled study was to investigate the effects of game-based VR canoe paddling training, when combined with conventional physical rehabilitation programs, on postural balance and upper extremity function in 30 patients with subacute stroke. MATERIAL AND METHODS Thirty patients, who were within six months following the diagnosis of stroke, were randomly allocated to either the experimental group (n=15) or the control group (n=15). All participants participated in a conventional rehabilitation program. Also, the experimental group (n=15) performed the VR canoe paddling training for 30 minutes each day, three times per week, for five weeks. After five weeks, outcomes of changes in postural balance and upper extremity function were evaluated and compared between the two groups. RESULTS At five weeks, postural balance and upper extremity function showed significant improvements in both patients groups when compared with the baseline measurements (p<0.05). However, postural balance and upper extremity function were significantly improved in the experimental group when compared with the control group (p<0.05). CONCLUSIONS Game-based VR canoe paddling training is an effective rehabilitation therapy that enhances postural balance and upper extremity function in patients with subacute stroke when combined with conventional physical rehabilitation programs.
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The Influence of Wheelchair Propulsion Hand Pattern on Upper Extremity Muscle Power and Stress
Slowik, Jonathan S.; Requejo, Philip S.; Mulroy, Sara J.; Neptune, Richard R.
2016-01-01
The hand pattern (i.e., full-cycle hand path) used during manual wheelchair propulsion is frequently classified as one of four distinct hand pattern types: arc, single loop, double loop and semicircular. Current clinical guidelines recommend the use of the semicircular pattern, which is based on advantageous levels of broad biomechanical metrics implicitly related to the demand placed on the upper extremity (e.g., lower cadence). However, an understanding of the influence of hand pattern on specific measures of upper extremity muscle demand (e.g., muscle power and stress) is needed to help make such recommendations, but these quantities are difficult and impractical to measure experimentally. The purpose of this study was to use musculoskeletal modeling and forward dynamics simulations to investigate the influence of the hand pattern used on specific measures of upper extremity muscle demand. The simulation results suggest that the double loop and semicircular patterns produce the most favorable levels of overall muscle stress and total muscle power. The double loop pattern had the lowest full-cycle and recovery-phase upper extremity demand but required high levels of muscle power during the relatively short contact phase. The semicircular pattern had the second-lowest full-cycle levels of overall muscle stress and total muscle power, and demand was more evenly distributed between the contact and recovery phases. These results suggest that in order to decrease upper extremity demand, manual wheelchair users should use either the double loop or semicircular pattern when propelling their wheelchairs at a self-selected speed on level ground. PMID:27062591
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Luria, Shai; Rivkin, Gurion; Avitzour, Malka; Liebergall, Meir; Mintz, Yoav; Mosheiff, Ram
2013-03-01
Explosion injuries to the upper extremity have specific clinical characteristics that differ from injuries due to other mechanisms. To evaluate the upper extremity injury pattern of attacks on civilian targets, comparing bomb explosion injuries to gunshot injuries and their functional recovery using standard outcome measures. Of 157 patients admitted to the hospital between 2000 and 2004, 72 (46%) sustained explosion injuries and 85 (54%) gunshot injuries. The trauma registry files were reviewed and the patients completed the DASH Questionnaire (Disabilities of Arm, Shoulder and Hand) and SF-12 (Short Form-12) after a minimum period of 1 year. Of the 157 patients, 72 (46%) had blast injuries and 85 (54%) had shooting injuries. The blast casualties had higher Injury Severity Scores (47% vs. 22% with a score of > 16, P = 0.02) and higher percent of patients treated in intensive care units (47% vs. 28%, P = 0.02). Although the Abbreviated Injury Scale score of the upper extremity injury was similar in the two groups, the blast casualties were found to have more bilateral and complex soft tissue injuries and were treated surgically more often. No difference was found in the SF-12 or DASH scores between the groups at follow up. The casualties with upper extremity blast injuries were more severely injured and sustained more bilateral and complex soft tissue injuries to the upper extremity. However, the rating of the local injury to the isolated limb is similar, as was the subjective functional recovery.
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Peripheral neuropathy: an often-overlooked cause of falls in the elderly.
Richardson, J K; Ashton-Miller, J A
1996-06-01
Peripheral neuropathy is common in the elderly and results in impairments in distal proprioception and strength that hinder balance and predispose them to falls. The loss of heel reflexes, decreased vibratory sense that improves proximally, impaired position sense at the great toe, and inability to maintain unipedal stance for 10 seconds in three attempts all suggest functionally significant peripheral neuropathy. Physicians can help their patients with peripheral neuropathy to prevent falls by teaching them and their families about peripheral nerve dysfunction and its effects on balance and by advising patients to substitute vision for the lost somatosensory function, correctly use a cane, wear proper shoes and orthotics, and perform balance and upper extremity strengthening exercises.
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A multimodal assessment of balance in elderly and young adults.
King, Gregory W; Abreu, Eduardo L; Cheng, An-Lin; Chertoff, Keyna K; Brotto, Leticia; Kelly, Patricia J; Brotto, Marco
2016-03-22
Falling is a significant health issue among elderly adults. Given the multifactorial nature of falls, effective balance and fall risk assessment must take into account factors from multiple sources. Here we investigate the relationship between fall risk and a diverse set of biochemical and biomechanical variables including: skeletal muscle-specific troponin T (sTnT), maximal strength measures derived from isometric grip and leg extension tasks, and postural sway captured from a force platform during a quiet stance task. These measures were performed in eight young and eleven elderly adults, along with estimates of fall risk derived from the Tinetti Balance Assessment. We observed age-related effects in all measurements, including a trend toward increased sTnT levels, increased postural sway, reduced upper and lower extremity strength, and reduced balance scores. We observed a negative correlation between balance scores and sTnT levels, suggesting its use as a biomarker for fall risk. We observed a significant positive correlation between balance scores and strength measures, adding support to the notion that muscle strength plays a significant role in postural control. We observed a significant negative correlation between balance scores and postural sway, suggesting that fall risk is associated with more loosely controlled center of mass regulation.
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A multimodal assessment of balance in elderly and young adults
King, Gregory W.; Abreu, Eduardo L.; Cheng, An-Lin; Chertoff, Keyna K.; Brotto, Leticia; Kelly, Patricia J.; Brotto, Marco
2016-01-01
Falling is a significant health issue among elderly adults. Given the multifactorial nature of falls, effective balance and fall risk assessment must take into account factors from multiple sources. Here we investigate the relationship between fall risk and a diverse set of biochemical and biomechanical variables including: skeletal muscle-specific troponin T (sTnT), maximal strength measures derived from isometric grip and leg extension tasks, and postural sway captured from a force platform during a quiet stance task. These measures were performed in eight young and eleven elderly adults, along with estimates of fall risk derived from the Tinetti Balance Assessment. We observed age-related effects in all measurements, including a trend toward increased sTnT levels, increased postural sway, reduced upper and lower extremity strength, and reduced balance scores. We observed a negative correlation between balance scores and sTnT levels, suggesting its use as a biomarker for fall risk. We observed a significant positive correlation between balance scores and strength measures, adding support to the notion that muscle strength plays a significant role in postural control. We observed a significant negative correlation between balance scores and postural sway, suggesting that fall risk is associated with more loosely controlled center of mass regulation. PMID:26934319
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Santago, Anthony C; Vidt, Meghan E; Li, Xiaotong; Tuohy, Christopher J; Poehling, Gary G; Freehill, Michael T; Saul, Katherine R
2017-12-01
Understanding upper limb strength requirements for daily tasks is imperative for early detection of strength loss that may progress to disability due to age or rotator cuff tear. We quantified shoulder strength requirements for 5 upper limb tasks performed by 3 groups: uninjured young adults and older adults, and older adults with a degenerative supraspinatus tear prior to repair. Musculoskeletal models were developed for each group representing age, sex, and tear-related strength losses. Percentage of available strength used was quantified for the subset of tasks requiring the largest amount of shoulder strength. Significant differences in strength requirements existed across tasks: upward reach 105° required the largest average strength; axilla wash required the largest peak strength. However, there were limited differences across participant groups. Older adults with and without a tear used a larger percentage of their shoulder elevation (p < .001, p < .001) and external rotation (p < .001, p = .017) strength than the young adults, respectively. Presence of a tear significantly increased percentage of internal rotation strength compared to young (p < .001) and uninjured older adults (p = .008). Marked differences in strength demand across tasks indicate the need for evaluating a diversity of functional tasks to effectively detect early strength loss, which may lead to disability.
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Yasuda, Tomohiro; Fukumura, Kazuya; Nakajima, Toshiaki
2017-04-01
[Purpose] To examine if the SPPB is higher with healthy subjects than outpatients, which was higher than inpatients and if the SPPB can be validated assessment tool for strength tests and lower extremity morphological evaluation in cardiovascular disease patients. [Subjects and Methods] Twenty-four middle aged and older adults with cardiovascular disease were recruited from inpatient and outpatient facilities and assigned to separate experimental groups. Twelve age-matched healthy volunteers were assigned to a control group. SPPB test was used to assess balance and functional motilities. The test outcomes were compared with level of care (inpatient vs. outpatient), physical characteristics, strength and lower extremity morphology. [Results] Total SPPB scores, strength tests (knee extensor muscle strength), and lower extremity morphological evaluation (muscle thickness of anterior and posterior mid-thigh and posterior lower-leg) were greater in healthy subjects and outpatients groups compared with inpatients. To predict total Short Physical Performance Battery scores, the predicted knee extension and anterior mid-thigh muscle thickness were calculated. [Conclusion] The SPPB is an effective tool as the strength tests and lower extremity morphological evaluation for middle-aged and older adult cardiovascular disease patients. Notably, high knee extensor muscle strength and quadriceps femoris muscle thickness are positively associated with high SPPB scores.
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Hayashi, Hiroyuki; Nakashima, Daiki; Matsuoka, Hiroka; Iwai, Midori; Nakamura, Shugo; Kubo, Ayumi; Tomiyama, Naoki
2017-11-06
Upper-limb function is important in patients with hip fracture so they can perform activities of daily living and participate in leisure activities. Upper-limb function of these patients, however, has not been thoroughly investigated. The aim of this study was to evaluate the upper-limb motor and sensory functions in patients with hip fracture by comparing these functions with those of community-dwelling older adults (control group). We compared the results of motor and sensory function tests of upper-limb function - range of motion, strength, sensibility, finger dexterity, comprehensive hand function - between patients with hip fracture (n= 32) and the control group (n= 32). Patients with hip fracture had significantly reduced grip strength, pinch strength, finger dexterity, and comprehensive hand function compared with the control group. Most upper-limb functions are impaired in the patients with hip fracture. Thus, upper-limb function of patients with hip fracture should be considered during treatment.
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Balliet, R; Levy, B; Blood, K M
1986-05-01
Electromyographic (EMG) sensory feedback therapy (SFT) was used in the neuromuscular retraining of the nonfunctional upper extremity in five chronic left cerebrovascular accident (CVA) patients with impaired expressive and auditory comprehension. Speech diagnoses included global, moderate-to-severe Broca, and Wernicke aphasias. These patients had experienced increased despondency associated with previous therapy failures and often had indicated that they wished to have their involved extremity amputated, so that it would no longer be in the way. In this study, specific behavioral training strategies to increase patient involvement were used, including: general relaxation, modified SFT instruction, and home exercises, which were supported by family and/or friends. After an average of 50 therapy sessions, all patients were successfully retrained to use their right upper extremity at the gross-assist level. This resulted in feelings of increased self-esteem to the extent that amputation was no longer requested. It is concluded that EMG SFT can be beneficial in the neuromuscular reeducation of paretic upper extremity muscles of CVA patients with expressive aphasia and (impaired) auditory comprehension.
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Moriello, Gabriele; Denio, Christopher; Abraham, Megan; DeFrancesco, Danielle; Townsley, Jill
2013-10-01
The purpose of this case report was to document outcomes following an intense exercise program integrating yoga with physical therapy exercise in a male with Parkinson's disease. The participant performed an intense 1½-hour program (Phase A) incorporating strengthening, balance, agility and yoga exercises twice weekly for 12 weeks. He then completed a new home exercise program developed by the researchers (Phase B) for 12 weeks. His score on the Parkinson's Disease Questionnaire improved 16 points while his score on the High Level Mobility Assessment tool improved 11 points. There were also improvements in muscle length of several lower extremity muscles, in upper and lower extremity muscle strength, in dynamic balance and he continues to work full time 29 months later. There were no improvements in thoracic posture or aerobic power. This intense program was an effective dose of exercise for someone with Parkinson's disease and allowed him to continue to participate in work, leisure, and community activities. Copyright © 2013 Elsevier Ltd. All rights reserved.
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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].
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Gold, Judith E; d'Errico, Angelo; Katz, Jeffrey N; Gore, Rebecca; Punnett, Laura
2009-02-01
A longitudinal cohort of automobile manufacturing workers (n = 1,214) was examined for: (1) prevalence and persistence of specific upper extremity musculoskeletal disorders (UEMSDs) such as lateral epicondylitis and de Quervain's disease, and non-specific disorders (NSDs) defined in symptomatic individuals without any specific disorder, and (2) disorder prognoses based on symptom characteristics and other factors. Eight specific disorders were identified through case definitions based on upper extremity physical examinations and symptom surveys administered on three occasions over 6 years. At baseline, 41% of the cohort reported upper extremity symptoms; 18% (n = 214) of these had NSDs. In each survey, tendon-related conditions accounted for over half of the specific morbidity. Twenty-five percent had UEMSDs in multiple anatomical sites, and most with hand/wrist disorders had two or more hand/wrist UEMSDs. Persistence for all specific disorders decreased with length of follow-up. Specific UEMSDs were characterized by greater pain severity and functional impairment, and more lost work days than NSDs. Upper extremity symptoms and diagnoses vary over time. NSDs may be the early stages of conditions that will eventually become more specific. NSDs and overlapping specific UEMSDs should be taken into account in UEMSD classification. Am. J. Ind. Med. 52:124-132, 2009. (c) 2008 Wiley-Liss, Inc.
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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.
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Ju, Yumi; Yoon, In-Jin
2018-01-01
[Purpose] Modified constraint-induced movement therapy and mirror therapy are recognized as stroke rehabilitation methods. The aim of the present study was to determine whether these therapies influence upper extremity function and whether upper extremity function influences the ability to perform activities of daily living in further. [Subjects and Methods] Twenty-eight stroke patients participated in the study. Interventions were administered five times per week for 3 weeks. Activities of daily living or self-exercise were performed after modified constraint-induced movement therapy or mirror therapy, respectively. Analyses were performed on the results of the Manual Function Test and the Korean version of the Modified Barthel Index to determine the factors influencing activities of daily living. [Results] Both groups showed improvement in upper extremity function, but only the modified constraint-induced movement therapy group showed a correlation between upper extremity function and performance in the hygiene, eating, and dressing. The improved hand manipulation function found in the modified constraint-induced movement therapy had statistically significant influences on eating and dressing. [Conclusion] Our results suggest that a patient's attempts to move the affected side result in improved performance in activities of daily living as well as physical function.
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Ju, Yumi; Yoon, In-Jin
2018-01-01
[Purpose] Modified constraint-induced movement therapy and mirror therapy are recognized as stroke rehabilitation methods. The aim of the present study was to determine whether these therapies influence upper extremity function and whether upper extremity function influences the ability to perform activities of daily living in further. [Subjects and Methods] Twenty-eight stroke patients participated in the study. Interventions were administered five times per week for 3 weeks. Activities of daily living or self-exercise were performed after modified constraint-induced movement therapy or mirror therapy, respectively. Analyses were performed on the results of the Manual Function Test and the Korean version of the Modified Barthel Index to determine the factors influencing activities of daily living. [Results] Both groups showed improvement in upper extremity function, but only the modified constraint-induced movement therapy group showed a correlation between upper extremity function and performance in the hygiene, eating, and dressing. The improved hand manipulation function found in the modified constraint-induced movement therapy had statistically significant influences on eating and dressing. [Conclusion] Our results suggest that a patient’s attempts to move the affected side result in improved performance in activities of daily living as well as physical function. PMID:29410571
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ATMOSPHERE AND SPECTRAL MODELS OF THE KEPLER-FIELD PLANETS HAT-P-7b AND TrES-2
DOE Office of Scientific and Technical Information (OSTI.GOV)
Spiegel, David S.; Burrows, Adam, E-mail: dsp@astro.princeton.ed, E-mail: burrows@astro.princeton.ed
2010-10-10
We develop atmosphere models of two of the three Kepler-field planets that were known prior to the start of the Kepler mission (HAT-P-7b and TrES-2). We find that published Kepler and Spitzer data for HAT-P-7b appear to require an extremely hot upper atmosphere on the dayside, with a strong thermal inversion and little day-night redistribution. The Spitzer data for TrES-2 suggest a mild thermal inversion with moderate day-night redistribution. We examine the effect of nonequilibrium chemistry on TrES-2 model atmospheres and find that methane levels must be adjusted by extreme amounts in order to cause even mild changes in atmosphericmore » structure and emergent spectra. Our best-fit models to the Spitzer data for TrES-2 lead us to predict a low secondary eclipse planet-star flux ratio ({approx}<2 x 10{sup -5}) in the Kepler bandpass, which is consistent with what very recent observations have found. Finally, we consider how the Kepler-band optical flux from a hot exoplanet depends on the strength of a possible extra optical absorber in the upper atmosphere. We find that the optical flux is not monotonic in optical opacity, and the non-monotonicity is greater for brighter, hotter stars.« less
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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.
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Rankin, Jeffery W; Kwarciak, Andrew M; Richter, W Mark; Neptune, Richard R
2012-11-01
The majority of manual wheelchair users will experience upper extremity injuries or pain, in part due to the high force requirements, repetitive motion and extreme joint postures associated with wheelchair propulsion. Recent studies have identified cadence, contact angle and peak force as important factors for reducing upper extremity demand during propulsion. However, studies often make comparisons between populations (e.g., able-bodied vs. paraplegic) or do not investigate specific measures of upper extremity demand. The purpose of this study was to use a musculoskeletal model and forward dynamics simulations of wheelchair propulsion to investigate how altering cadence, peak force and contact angle influence individual muscle demand. Forward dynamics simulations of wheelchair propulsion were generated to emulate group-averaged experimental data during four conditions: 1) self-selected propulsion technique, and while 2) minimizing cadence, 3) maximizing contact angle, and 4) minimizing peak force using biofeedback. Simulations were used to determine individual muscle mechanical power and stress as measures of muscle demand. Minimizing peak force and cadence had the lowest muscle power requirements. However, minimizing peak force increased cadence and recovery power, while minimizing cadence increased average muscle stress. Maximizing contact angle increased muscle stress and had the highest muscle power requirements. Minimizing cadence appears to have the most potential for reducing muscle demand and fatigue, which could decrease upper extremity injuries and pain. However, altering any of these variables to extreme values appears to be less effective; instead small to moderate changes may better reduce overall muscle demand. Copyright © 2012 Elsevier Ltd. All rights reserved.
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Functional fitness norms for community-dwelling older adults in Hong Kong.
Chung, Pak-Kwong; Zhao, Yanan; Liu, Jing-Dong; Quach, Binh
2016-01-01
This study aimed to establish normative data for older adults in Hong Kong and explore age and sex differences in functional fitness. A sample of 944 independent community-dwellers, aged 65-74 years, was evaluated using the Senior Fitness Test battery in addition to hand grip and single leg stance tests. Normative data were reported for the 10th, 25th, 50th, 75th, and 90th percentiles in 5-year age groups. Except for upper extremity muscle strength in women and body mass index (BMI) in both sexes, ageing-associated degradation was observed in all testing parameters especially in flexibility, balance, and agility. Significant sex differences were found in all testing parameters with the exception of BMI and static balance with eyes open. Moreover, men demonstrated higher capacities for muscle strength, agility, balance, and aerobic endurance, whereas women showed superior flexibility. The normative values enable the evaluation of individual performance regarding the fitness status of older adults in Hong Kong. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
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NASA Astrophysics Data System (ADS)
Gao, Weilu; Li, Xinwei; Bamba, Motoaki; Kono, Junichiro
2018-06-01
Non-perturbative coupling of photons and excitons produces hybrid particles, exciton-polaritons, which have exhibited a variety of many-body phenomena in various microcavity systems. However, the vacuum Rabi splitting (VRS), which defines the strength of photon-exciton coupling, is usually a single constant for a given system. Here, we have developed a unique architecture in which excitons in an aligned single-chirality carbon nanotube film interact with cavity photons in polarization-dependent manners. The system reveals ultrastrong coupling (VRS up to 329 meV or a coupling-strength-to-transition-energy ratio of 13.3%) for polarization parallel to the nanotube axis, whereas VRS is absent for perpendicular polarization. Between these two extremes, VRS is continuously tunable through polarization rotation with exceptional points separating crossing and anticrossing. The points between exceptional points form equienergy arcs onto which the upper and lower polaritons coalesce. The demonstrated on-demand ultrastrong coupling provides ways to explore topological properties of polaritons and quantum technology applications.
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Spratford, Wayne; Campbell, Rhiannon
2017-06-01
Recurve archery is an Olympic sport that requires extreme precision, upper body strength and endurance. The purpose of this research was to quantify how postural stability variables both pre- and post-arrow release, draw force, flight time, arrow length and clicker reaction time, collectively, impacted on the performance or scoring outcomes in elite recurve archery athletes. Thirty-nine elite-level recurve archers (23 male and 16 female; mean age = 24.7 ± 7.3 years) from four different countries volunteered to participate in this study prior to competing at a World Cup event. An AMTI force platform (1000Hz) was used to obtain centre of pressure (COP) measurements 1s prior to arrow release and 0.5s post-arrow release. High-speed footage (200Hz) allowed for calculation of arrow flight time and score. Results identified clicker reaction time, draw force and maximum sway speed as the variables that best predicted shot performance. Specifically, reduced clicker reaction time, greater bow draw force and reduced postural sway speed post-arrow release were predictors of higher scoring shots. It is suggested that future research should focus on investigating shoulder muscle tremors at full draw in relation to clicker reaction time, and the effect of upper body strength interventions (specifically targeting the musculature around the shoulder girdle) on performance in recurve archers.
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System Characterization of MAHI EXO-II: A Robotic Exoskeleton for Upper Extremity Rehabilitation
French, James A.; Rose, Chad G.; O'Malley, Marcia K.
2015-01-01
This paper presents the performance characterization of the MAHI Exo-II, an upper extremity exoskeleton for stroke and spinal cord injury (SCI) rehabilitation, as a means to validate its clinical implementation and to provide depth to the literature on the performance characteristics of upper extremity exoskeletons. Individuals with disabilities arising from stroke and SCI need rehabilitation of the elbow, forearm, and wrist to restore the ability to independently perform activities of daily living (ADL). Robotic rehabilitation has been proposed to address the need for high intensity, long duration therapy and has shown promising results for upper limb proximal joints. However, upper limb distal joints have historically not benefitted from the same focus. The MAHI Exo-II, designed to address this shortcoming, has undergone a static and dynamic performance characterization, which shows that it exhibits the requisite qualities for a rehabilitation robot and is comparable to other state-of-the-art designs. PMID:25984380
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System Characterization of MAHI EXO-II: A Robotic Exoskeleton for Upper Extremity Rehabilitation.
French, James A; Rose, Chad G; O'Malley, Marcia K
2014-10-01
This paper presents the performance characterization of the MAHI Exo-II, an upper extremity exoskeleton for stroke and spinal cord injury (SCI) rehabilitation, as a means to validate its clinical implementation and to provide depth to the literature on the performance characteristics of upper extremity exoskeletons. Individuals with disabilities arising from stroke and SCI need rehabilitation of the elbow, forearm, and wrist to restore the ability to independently perform activities of daily living (ADL). Robotic rehabilitation has been proposed to address the need for high intensity, long duration therapy and has shown promising results for upper limb proximal joints. However, upper limb distal joints have historically not benefitted from the same focus. The MAHI Exo-II, designed to address this shortcoming, has undergone a static and dynamic performance characterization, which shows that it exhibits the requisite qualities for a rehabilitation robot and is comparable to other state-of-the-art designs.
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Tajika, Tsuyoshi; Kobayashi, Tsutomu; Yamamoto, Atsushi; Shitara, Hitoshi; Ichinose, Tsuyoshi; Shimoyama, Daisuke; Okura, Chisa; Kanazawa, Saeko; Nagai, Ayako; Takagishi, Kenji
2015-03-01
Grip and pinch strength are crucially important attributes and standard parameters related to the functional integrity of the hand. It seems significant to investigate normative data for grip and pinch strength of baseball players to evaluate their performance and condition. Nevertheless, few reports have explained the association between grip and pinch strength and anthropometric variables and types of pitch throwing for baseball pitchers. The aim of this study was to measure and evaluate clinical normative data for grip and tip, key, palmar pinch strength and to assess the relationship between these data and anthropometric variables and types of pitch throwing among Japanese high-school baseball pitchers. One hundred-thirty three healthy high school baseball pitchers were examined and had completed a self-administered questionnaire including items related to age, hand dominance, throwing ratio of type of pitch. A digital dynamometer was used to measure grip strength and a pinch gauge to measure tip, key and palmer pinch in both dominant and nondominant side. Body composition was measured by the multi frequency segmental body composition analyzer. Grip strength and tip and palmer pinch strength in dominant side were statistically greater than them in nondominant side (P < 0.05). There were significant associations between grip strength and height (r = 0.33, P < 0.001), body mass (r = 0.50, P < 0.001), BMI (r = 0.37, P < 0.001), muscle mass of upper extremity (r = 0.56, P < 0.001), fat free mass (r = 0.57, P < 0.001), fat mass (r = 0.22, P < 0.05) in dominant side. A stepwise multiple regression analysis revealed that fat free mass and tip, palmer, key pinch strength were predictors of grip strength in dominant side. No statistical significant correlations were found between the throwing ratio of types of pitches thrown and grip strength and tip, key, palmar pinch strength. Our result provides normative values and evidences for grip and pinch strengths in high school baseball pitchers.
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Huang, C-C; Yang, Y-H; Chen, C-H; Chen, T-W; Lee, C-L; Wu, C-L; Chuang, S-H; Huang, M-H
2008-03-01
The aim of this study was to compare the flexibility of the upper extremities in collegiate students involved in Aikido (a kind of soft martial art attracting youth) training with those involved in other sports. Fifty freshmen with a similar frequency of exercise were divided into the Aikido group (n = 18), the upper-body sports group (n = 17), and the lower-body sports group (n = 15) according to the sports that they participated in. Eight classes of range of motion in upper extremities were taken for all subjects by the same clinicians. The Aikido group had significantly better flexibility than the upper-body sports group except for range of motion in shoulder flexion (p = 0.22), shoulder lateral rotation (p > 0.99), and wrist extension (p > 0.99). The Aikido group also had significantly better flexibility than the lower-body sports group (p < 0.01) and the sedentary group (p < 0.01) in all classes of range of motion. The upper-body sports group was significantly more flexible in five classes of range of motion and significantly tighter in range of motion of wrist flexion (p < 0.01) compared to the lower-body sports group. It was concluded that the youths participating in soft martial arts had good upper extremities flexibility that might not result from regular exercise alone.
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Hypothyroid-induced acute compartment syndrome in all extremities.
Musielak, Matthew C; Chae, Jung Hee
2016-12-20
Acute compartment syndrome (ACS) is an uncommon complication of uncontrolled hypothyroidism. If unrecognized, this can lead to ischemia, necrosis and potential limb loss. A 49-year-old female presented with the sudden onset of bilateral lower and upper extremity swelling and pain. The lower extremity anterior compartments were painful and tense. The extensor surface of the upper extremities exhibited swelling and pain. Motor function was intact, however, limited due to pain. Bilateral lower extremity fasciotomies were performed. Postoperative Day 1, upper extremity motor function decreased significantly and paresthesias occurred. She therefore underwent bilateral forearm fasciotomies. The pathogenesis of hypothyroidism-induced compartment syndrome is unclear. Thyroid-stimulating hormone-induced fibroblast activation results in increased glycosaminoglycan deposition. The primary glycosaminoglycan in hypothyroid myxedematous changes is hyaluronic acid, which binds water causing edema. This increases vascular permeability, extravasation of proteins and impaired lymphatic drainage. These contribute to increased intra-compartmental pressure and subsequent ACS. Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author 2016.
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Macke, C; Winkelmann, M; Mommsen, P; Probst, C; Zelle, B; Krettek, C; Zeckey, C
2017-02-01
To analyse the influence of upper extremity trauma on the long-term outcome of polytraumatised patients. A total of 629 multiply injured patients were included in a follow-up study at least ten years after injury (mean age 26.5 years, standard deviation 12.4). The extent of the patients' injury was classified using the Injury Severity Score. Outcome was measured using the Hannover Score for Polytrauma Outcome (HASPOC), Short Form (SF)-12, rehabilitation duration, and employment status. Outcomes for patients with and without a fracture of the upper extremity were compared and analysed with regard to specific fracture regions and any additional brachial plexus lesion. In all, 307 multiply-injured patients with and 322 without upper extremity injuries were included in the study. The groups with and without upper limb injuries were similar with respect to demographic data and injury pattern, except for midface trauma. There were no significant differences in the long-term outcome. In patients with brachial plexus lesions there were significantly more who were unemployed, required greater retraining and a worse HASPOC. Injuries to the upper extremities seem to have limited effect on long-term outcome in patients with polytrauma, as long as no injury was caused to the brachial plexus. Cite this article: Bone Joint J 2017;99-B:255-60. ©2017 The British Editorial Society of Bone & Joint Surgery.
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Willcocks, RJ; Triplett, WT; Forbes, SC; Arora, H; Senesac, CR; Lott, DJ; Nicholson, TR; Rooney, WD; Walter, GA; Vandenborne, K
2016-01-01
There is a pressing need for biomarkers and outcomes that can be used across disease stages in Duchenne muscular dystrophy (DMD), to facilitate the inclusion of a wider range of participants in clinical trials and to improve our understanding of the natural history of DMD. Quantitative magnetic resonance imaging (qMRI) and spectroscopy (MRS) biomarkers show considerable promise in both the legs and forearms of individuals with DMD, but have not yet been examined in functionally important proximal upper extremity muscles such as the biceps brachii and deltoid. The primary objective of this study was to examine the feasibility of implementing qMRI and MRS biomarkers in the proximal upper extremity musculature, and the secondary objective was to examine the relationship between MR measures of arm muscle pathology and upper extremity functional endpoints. Biomarkers included MRS and MRI measures of fat fraction and transverse relaxation time (T2). The MR exam was well tolerated in both ambulatory and nonambulatory boys. qMR biomarkers differentiated affected and unaffected participants and correlated strongly with upper extremity function (r=0.91 for biceps brachii T2 versus Performance of Upper Limb score). These qMR outcome measures could be highly beneficial to the neuromuscular disease community, allowing measurement of the quality of functionally important muscles across disease stages to understand the natural history of DMD and particularly to broaden the opportunity for clinical trial participation. PMID:27778157
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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…
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Lee, Myung Mo; Lee, Kyeong Jin
2018-01-01
Background Virtual reality (VR) training with motion-controlled console games can be incorporated into stroke rehabilitation programs. The use of a variety of gaming software can provide the patient with an opportunity to perform activities that are exciting, entertaining, and that may not be feasible in clinical environments. The aim of this preliminary randomized controlled study was to investigate the effects of game-based VR canoe paddling training, when combined with conventional physical rehabilitation programs, on postural balance and upper extremity function in 30 patients with subacute stroke. Material/Methods Thirty patients, who were within six months following the diagnosis of stroke, were randomly allocated to either the experimental group (n=15) or the control group (n=15). All participants participated in a conventional rehabilitation program. Also, the experimental group (n=15) performed the VR canoe paddling training for 30 minutes each day, three times per week, for five weeks. After five weeks, outcomes of changes in postural balance and upper extremity function were evaluated and compared between the two groups. Results At five weeks, postural balance and upper extremity function showed significant improvements in both patients groups when compared with the baseline measurements (p<0.05). However, postural balance and upper extremity function were significantly improved in the experimental group when compared with the control group (p<0.05). Conclusions Game-based VR canoe paddling training is an effective rehabilitation therapy that enhances postural balance and upper extremity function in patients with subacute stroke when combined with conventional physical rehabilitation programs. PMID:29702630
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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.
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Toshniwal, Gokul; Sunder, Rani; Thomas, Ronald; Dureja, G P
2012-01-01
Interventional pain management techniques play an important role in the multidisciplinary approach to management of complex regional pain syndrome (CRPS). In this preliminary study we compared the efficacy of continuous stellate ganglion (CSG) block with that of continuous infraclavicular brachial plexus (CIBP) block in management of CRPS type I of upper extremity. Thirty-three patients with CRPS type I of upper extremity were randomly assigned to either CSG or CIBP group. Patients were treated for 1 week with continuous infusion of 0.125% bupivacaine at 2and 5mL/h, respectively. Catheter was removed at 1 week and patients were followed up for 4 weeks. The outcome was evaluated in terms of neuropathic pain scale score (NPSS), edema scores (Grades 0-2), and range of motion (ROM) of all upper extremity joints (Grades 0-2). CIBP group showed statistically significant improvement in NPSS compared with CSG group during the first 12 hours after the procedures (P value <0.05). After 12 hours, the NPSS was comparable between the groups. At 4 weeks, both groups showed clinically significant improvement in edema score and ROM of all upper extremity joints when compared with the baseline. This preliminary study suggests that CIBP block and CSG block may be feasible and effective interventional techniques for the management of CRPS type I of upper extremities. Hence, we recommend a larger well-randomized, well-controlled, clinical trial to confirm our findings and determine if any significant difference exists between the groups in terms of long-term pain relief and functional restoration. Wiley Periodicals, Inc.
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Kim, HyunJin; Lee, GyuChang; Song, ChangHo
2014-04-01
Motor recovery of the upper extremity in stroke patients is an important goal of rehabilitation. In particular, motor recovery can be accelerated when physical and cognitive interventions are combined. Thus, the aim of this study was to investigate the effects of functional electrical stimulation (FES) with mirror therapy (MT) on motor function of upper extremity in stroke patients. Twenty-seven stroke patients were recruited, and the 23 subjects who met the inclusion criteria were randomly allocated into 2 groups: the experimental group (n = 12) and the control group (n = 11). Both groups received conventional rehabilitation training for 60 minutes/day and 5 days/week for 4 weeks. In addition, members of the experimental group received FES with MT and members of the control group received FES without MT for 30 minutes/day and 5 days/week for 4 weeks. Immediately before and after intervention, motor recovery was measured using the Fugl-Meyer (FM) assessment, Brunnstrom's motor recovery stage (BMRS), the Manual Function Test (MFT), and the Box and Block Test (BBT). Significant upper extremity motor improvements were observed in the experimental and control groups according to the FM, BMRS, MFT, and BBT (P < .05). In particular, FM subscores for wrist, hand, and co-ordination and MFT subscores for hand function were more significantly improved in the experimental group (P < .05). Motor functions of the upper extremity were improved by FES with MT versus controls. The study shows that FES with MT during poststroke rehabilitation may effectively improve motor functions of the upper extremity. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.
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The active movement scale: an evaluative tool for infants with obstetrical brachial plexus palsy.
Curtis, Christine; Stephens, Derek; Clarke, Howard M; Andrews, David
2002-05-01
Newborns with peripheral nerve lesions involving the upper extremity are difficult to evaluate. The reliability of the Active Movement Scale (AMS), a tool for assessing motor function in infants with obstetrical brachial plexus palsy (OBPP), was examined in 2 complementary studies. Part A was an interrater reliability study in which 63 infants younger than 1 year with OBPP were independently evaluated by 2 physical therapists using the AMS. The scores were compared for reliability and controlled for chance agreement by using kappa statistics. Overall kappa analysis of the 15 tested movements showed a moderate strength of score agreement (kappa = 0.51). Quadratic-weighted kappa (kappa(quad)) statistics showed that 8 of the 15 movements tested were in the highest strength of agreement category (kappa(quad) = 0.81-1.00). Five movements showed substantial agreement (kappa(quad) = 0.61-0.80), and 2 movements had moderate agreement (kappa(quad) = 0.41- 0.60). The overall kappa(quad) was 0.89. Part B was a variability study designed to examine the dispersion of scores when infants with OBPP were evaluated with the AMS by multiple raters. Ten pediatric physical therapists with varying degrees of experience using the scale attended a 1(1/2)-hour instructional workshop on administration of the tool for infants with OBPP. A chain-block study design was used to obtain 30 assessments of 10 infants by 10 raters. A 2-way analysis of variance indicated that the variability of scores due to rater factors was low compared with the variability due to patient factors and that variation in scores due to rater experience was minimal. The results of part A indicate that the AMS is a reliable tool for the assessment of infants with OBPP when raters familiar with the scale are compared. The results of part B suggest that, with minimal training, raters with a range of experience using the AMS are able to reliably evaluate infants with upper-extremity paralysis.
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Wang, Man-Ying; Salem, George J
2004-06-01
The relations among the reaction forces engendered during an upper-extremity dynamic impact-loading exercise (DILE) program and bone mineral density adaptations (DeltaBMD) in the radius were investigated in 24 healthy premenopausal women (mean age = 29 +/- 6 years). Subjects performed DILE 36 cycles/day, 3 days/week for 24 weeks. The exercised arm was allocated randomly to either the dominant or the nondominant limb. In addition, subjects were assigned randomly into either damped or nondamped treatment arms to examine the effects of both higher- and lower-magnitude loading prescriptions. Measurements including anthropometrics, self-reported physical activity levels, hand-grip strength, radial BMD (DEXA, Hologic QDR1500, MA) at the ultradistal radius (UD), distal 1/3 radius (DR), and total distal radius (TOTAL), and exercise-related loading characteristics (impact load, loading rate, and impulse) were recorded at baseline and at 6 months. Simple linear regression models were used to fit the regional BMD changes to the reaction force, changes in hand-grip strength (DeltaGRIP), and changes in body weight (DeltaBW). Findings demonstrated that the damping condition utilized during DILE influenced the relations between loading events and BMD changes. Specifically, none of the reaction-force characteristics significantly predicted changes in BMD in participants performing DILE using the damped condition, whereas, in the nondamped condition, impact load accounted for 58% of the variance in BMD change at DR and 66% of the variance in BMD change at TOTAL. Thresholds of 345 and 285 N of impact force to promote BMD increases at DR and TOTAL, respectively, were obtained from the regression models in the nondamped group. Impulse was also an independent predictor of BMD changes at TOTAL, accounting for 56% of the variance. Neither DeltaGRIP nor DeltaBW significantly predicted DeltaBMD at any radial site. These findings, in young adult women, parallel previous reports identifying significant, regionally specific relations among external loading events and BMD changes in both animal and human models.
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Elbow Joint Fatigue and Bench-Press Training
Huang, Yen-Po; Chou, You-Li; Chen, Feng-Chun; Wang, Rong-Tyai; Huang, Ming-Jer; Chou, Paul Pei-Hsi
2014-01-01
Context: Bench-press exercises are among the most common form of training exercise for the upper extremity because they yield a notable improvement in both muscle strength and muscle endurance. The literature contains various investigations into the effects of different bench-press positions on the degree of muscle activation. However, the effects of fatigue on the muscular performance and kinetics of the elbow joint are not understood fully. Objective: To investigate the effects of fatigue on the kinetics and myodynamic performance of the elbow joint in bench-press training. Design: Controlled laboratory study. Setting: Motion research laboratory. Patients or Other Participants: A total of 18 physically healthy male students (age = 19.6 ± 0.8 years, height = 168.7 ± 5.5 cm, mass = 69.6 ± 8.6 kg) participated in the investigation. All participants were right-hand dominant, and none had a history of upper extremity injuries or disorders. Intervention(s): Participants performed bench-press training until fatigued. Main Outcome Measure(s): Maximal possible number of repetitions, cycle time, myodynamic decline rate, elbow-joint force, and elbow-joint moment. Results: We observed a difference in cycle time in the initial (2.1 ± 0.42 seconds) and fatigue (2.58 ± 0.46 seconds) stages of the bench-press exercise (P = .04). As the participants fatigued, we observed an increase in the medial-lateral force (P = .03) and internal-external moment (P ≤ .04) acting on the elbow joint. Moreover, a reduction in the elbow muscle strength was observed in the elbow extension-flexion (P ≤ .003) and forearm supination-pronation (P ≤ .001) conditions. Conclusions: The results suggest that performing bench-press exercises to the point of fatigue increases elbow-joint loading and may further increase the risk of injury. Therefore, when clinicians design bench-press exercise regimens for general athletic training, muscle strengthening, or physical rehabilitation, they should control carefully the maximal number of repetitions. PMID:24533529
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Pressure pain thresholds and musculoskeletal morbidity in automobile manufacturing workers.
Gold, Judith E; Punnett, Laura; Katz, Jeffrey N
2006-02-01
Reduced pressure pain thresholds (PPTs) have been reported in occupational groups with symptoms of upper extremity musculoskeletal disorders (UEMSDs). The purpose of this study was to determine whether automobile manufacturing workers (n=460) with signs and symptoms of UEMSDs had reduced PPTs (greater sensitivity to pain through pressure applied to the skin) when compared with unaffected members of the cohort, which served as the reference group. The association of PPTs with symptom severity and localization of PE findings was investigated, as was the hypothesis that reduced thresholds would be found on the affected side in those with unilateral physical examination (PE) findings. PPTs were measured during the workday at 12 upper extremity sites. A PE for signs of UEMSDs and symptom questionnaire was administered. After comparison of potential covariates using t tests, linear regression multivariable models were constructed with the average of 12 sites (avgPPT) as the outcome. Subjects with PE findings and/or symptoms had a statistically significant lower avgPPT than non-cases. AvgPPT was reduced in those with more widespread PE findings and in those with greater symptom severity (test for trend, P
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Masaki, Mitsuhiro; Ikezoe, Tome; Kamiya, Midori; Araki, Kojiro; Isono, Ryo; Kato, Takehiro; Kusano, Ken; Tanaka, Masayo; Sato, Syunsuke; Hirono, Tetsuya; Kita, Kiyoshi; Tsuboyama, Tadao; Ichihashi, Noriaki
2018-04-19
This study aimed to examine the association of independence in ADL with the loads during step ascent motion and other motor functions in 32 nursing home-residing elderly individuals. Independence in ADL was assessed by using the functional independence measure (FIM). The loads at the upper (i.e., pulling up) and lower (i.e., pushing up) levels during step ascent task was measured on a step ascent platform. Hip extensor, knee extensor, plantar flexor muscle, and quadriceps setting strengths; lower extremity agility using the stepping test; and hip and knee joint pain severities were measured. One-legged stance and functional reach distance for balance, and maximal walking speed, timed up-and-go (TUG) time, five-chair-stand time, and step ascent time were also measured to assess mobility. Stepwise regression analysis revealed that the load at pushing up during step ascent motion and TUG time were significant and independent determinants of FIM score. FIM score decreased with decreased the load at pushing up and increased TUG time. The study results suggest that depending on task specificity, both one step up task's push up peak load during step ascent motion and TUG, can partially explain ADL's FIM score in the nursing home-residing elderly individuals. Lower extremity muscle strength, agility, pain or balance measures did not add to the prediction.
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Chu, Kelly S; Eng, Janice J; Dawson, Andrew S; Harris, Jocelyn E.; Ozkaplan, Atila; Gylfadóttir, Sif
2011-01-01
Objective To evaluate the effect of an 8-week water-based exercise program (experimental group) over an upper extremity function program (control group) to increase cardiovascular fitness within a community setting for individuals with stroke. Design Single-blind randomized controlled trial Setting Public community centre Participants 12 community-dwelling individuals who have had a stroke with mild to moderate motor deficits; volunteer sample Intervention Experimental and control groups participated in group exercise programs undertaken in one hour sessions, three times per week for 8 weeks. The experimental group undertook chest deep water exercises at targeted heart rates. The control group performed arm and hand exercises while sitting. Main Outcome Measures The primary outcome measure was cardiovascular fitness (VO2max). Secondary measures were maximal workload, muscle strength, gait speed, and the Berg Balance Score. Results The experimental group attained significant improvements over the control group in cardiovascular fitness, maximal workload, gait speed, and paretic lower extremity muscle strength. The relatively short program (8 weeks) of water-based exercise resulted in a large improvement (22%) in cardiovascular fitness in a small group of individuals with stroke with relatively high function. Conclusions A water-based exercise program can be undertaken in the community as a group program and may be an effective means to promote fitness in individuals with stroke. PMID:15179638
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Skinner, Jared W.; Otzel, Dana M.; Bowser, Andrew; Nargi, Daniel; Agarwal, Sanjay; Peterson, Mark D.; Zou, Baiming; Borst, Stephen E.
2018-01-01
Abstract Background Inconsistent fat‐free mass (FFM) and muscle strength responses have been reported in randomized clinical trials (RCTs) administering testosterone replacement therapy (TRT) to middle‐aged and older men. Our objective was to conduct a meta‐analysis to determine whether TRT improves FFM and muscle strength in middle‐aged and older men and whether the muscular responses vary by TRT administration route. Methods Systematic literature searches of MEDLINE/PubMed and the Cochrane Library were conducted from inception through 31 March 2017 to identify double‐blind RCTs that compared intramuscular or transdermal TRT vs. placebo and that reported assessments of FFM or upper‐extremity or lower‐extremity strength. Studies were identified, and data were extracted and validated by three investigators, with disagreement resolved by consensus. Using a random effects model, individual effect sizes (ESs) were determined from 31 RCTs reporting FFM (sample size: n = 1213 TRT, n = 1168 placebo) and 17 reporting upper‐extremity or lower‐extremity strength (n = 2572 TRT, n = 2523 placebo). Heterogeneity was examined, and sensitivity analyses were performed. Results When administration routes were collectively assessed, TRT was associated with increases in FFM [ES = 1.20 ± 0.15 (95% CI: 0.91, 1.49)], total body strength [ES = 0.90 ± 0.12 (0.67, 1.14)], lower‐extremity strength [ES = 0.77 ± 0.16 (0.45, 1.08)], and upper‐extremity strength [ES = 1.13 ± 0.18 (0.78, 1.47)] (P < 0.001 for all). When administration routes were evaluated separately, the ES magnitudes were larger and the per cent changes were 3–5 times greater for intramuscular TRT than for transdermal formulations vs. respective placebos, for all outcomes evaluated. Specifically, intramuscular TRT was associated with a 5.7% increase in FFM [ES = 1.49 ± 0.18 (1.13, 1.84)] and 10–13% increases in total body strength [ES = 1.39 ± 0.12 (1.15, 1.63)], lower‐extremity strength [ES = 1.39 ± 0.17 (1.07, 1.72)], and upper‐extremity strength [ES = 1.37 ± 0.17 (1.03, 1.70)] (P < 0.001 for all). In comparison, transdermal TRT was associated with only a 1.7% increase in FFM [ES = 0.98 ± 0.21 (0.58, 1.39)] and only 2–5% increases in total body [ES = 0.55 ± 0.17 (0.22, 0.88)] and upper‐extremity strength [ES = 0.97 ± 0.24 (0.50, 1.45)] (P < 0.001). Interestingly, transdermal TRT produced no change in lower‐extremity strength vs. placebo [ES = 0.26 ± 0.23 (−0.19, 0.70), P = 0.26]. Subanalyses of RCTs limiting enrolment to men ≥60 years of age produced similar results. Conclusions Intramuscular TRT is more effective than transdermal formulations at increasing LBM and improving muscle strength in middle‐aged and older men, particularly in the lower extremities. PMID:29542875
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Peng, Feng; Chen, Lin; Han, Dong; Xiao, Chenwei; Bao, Qiyuan; Wang, Tao
2013-11-01
We presented our experience on the use of anterolateral thigh (ALT) chimeric flap to reconstruct two separate defects in upper extremity. From December 2009 to August 2012, we used this ALT chimeric flap to reconstruct two separate defects in upper extremity on five patients (mean age: 36.6 years; range: 15 ∼ 47 years). The locations of defect were palm and fingers in four patients and forearm in the other patient. The sizes of defect ranged from 4.5 × 1.5 cm to 20 × 10 cm. A minimum of two separate perforator vessels in the flap were identified. The skin paddle was then split between the two perforators to shape two separate paddles with a common vascular supply. There were no cases of flap failure or re-exploration. Four donor sites were directly closed and one was covered by a skin graft. Donor-site morbidity was negligible. The ALT chimeric flap provides customized cover for two separate defects in upper extremity. Copyright © 2013 Wiley Periodicals, Inc.
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Sethi, Amit; Davis, Sandra; McGuirk, Theresa; Patterson, Tara S.; Richards, Lorie G.
2012-01-01
Study Design Quasi-experimental design Introduction Although the effectiveness of constraint induced movement therapy (CIMT) in upper extremity (UE) rehabilitation post stroke is well known, the efficacy of CIMT to enhance the temporal structure of variability in upper extremity movement is not known. Purpose The purpose of this study was to investigate whether CIMT could enhance temporal structure of variability in upper extremity movement in individuals with chronic stroke. Methods Six participants with chronic stroke underwent CIMT for 4 hours/day for 2 weeks. Participants performed three trials of functional reach-to-grasp before and after CIMT. Temporal structure of variability was determined by calculating approximate entropy (ApEn) in shoulder, elbow and wrist flexion/extension joint angles. Results ApEn increased post CIMT, however, statistical significance was not achieved (p > 0.0167). Conclusion Future studies with larger sample size are warranted to investigate the effect of CIMT upon temporal structure of variability in UE movement. PMID:23084461
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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.
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Su, Ning; Zhai, Fei-Fei; Zhou, Li-Xin; Ni, Jun; Yao, Ming; Li, Ming-Li; Jin, Zheng-Yu; Gong, Gao-Lang; Zhang, Shu-Yang; Cui, Li-Ying; Tian, Feng; Zhu, Yi-Cheng
2017-01-01
Objective: To investigate the correlation between cerebral small vessel disease (CSVD) burden and motor performance of lower and upper extremities in community-dwelling populations. Methods: We performed a cross-sectional analysis on 770 participants enrolled in the Shunyi study, which is a population-based cohort study. CSVD burden, including white matter hyperintensities (WMH), lacunes, cerebral microbleeds (CMBs), perivascular spaces (PVS), and brain atrophy were measured using 3T magnetic resonance imaging. All participants underwent quantitative motor assessment of lower and upper extremities, which included 3-m walking speed, 5-repeat chair-stand time, 10-repeat pronation–supination time, and 10-repeat finger-tapping time. Data on demographic characteristics, vascular risk factors, and cognitive functions were collected. General linear model analysis was performed to identify potential correlations between motor performance measures and imaging markers of CSVD after controlling for confounding factors. Results: For motor performance of the lower extremities, WMH was negatively associated with gait speed (standardized β = -0.092, p = 0.022) and positively associated with chair-stand time (standardized β = 0.153, p < 0.0001, surviving FDR correction). For motor performance of the upper extremities, pronation–supination time was positively associated with WMH (standardized β = 0.155, p < 0.0001, surviving FDR correction) and negatively with brain parenchymal fraction (BPF; standardized β = -0.125, p = 0.011, surviving FDR correction). Only BPF was found to be negatively associated with finger-tapping time (standardized β = -0.123, p = 0.012). However, lacunes, CMBs, or PVS were not found to be associated with motor performance of lower or upper extremities in multivariable analysis. Conclusion: Our findings suggest that cerebral microstructural changes related to CSVD may affect motor performance of both lower and upper extremities. WMH and brain atrophy are most strongly associated with motor function deterioration in community-dwelling populations. PMID:29021757
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Su, Ning; Zhai, Fei-Fei; Zhou, Li-Xin; Ni, Jun; Yao, Ming; Li, Ming-Li; Jin, Zheng-Yu; Gong, Gao-Lang; Zhang, Shu-Yang; Cui, Li-Ying; Tian, Feng; Zhu, Yi-Cheng
2017-01-01
Objective: To investigate the correlation between cerebral small vessel disease (CSVD) burden and motor performance of lower and upper extremities in community-dwelling populations. Methods: We performed a cross-sectional analysis on 770 participants enrolled in the Shunyi study, which is a population-based cohort study. CSVD burden, including white matter hyperintensities (WMH), lacunes, cerebral microbleeds (CMBs), perivascular spaces (PVS), and brain atrophy were measured using 3T magnetic resonance imaging. All participants underwent quantitative motor assessment of lower and upper extremities, which included 3-m walking speed, 5-repeat chair-stand time, 10-repeat pronation-supination time, and 10-repeat finger-tapping time. Data on demographic characteristics, vascular risk factors, and cognitive functions were collected. General linear model analysis was performed to identify potential correlations between motor performance measures and imaging markers of CSVD after controlling for confounding factors. Results: For motor performance of the lower extremities, WMH was negatively associated with gait speed (standardized β = -0.092, p = 0.022) and positively associated with chair-stand time (standardized β = 0.153, p < 0.0001, surviving FDR correction). For motor performance of the upper extremities, pronation-supination time was positively associated with WMH (standardized β = 0.155, p < 0.0001, surviving FDR correction) and negatively with brain parenchymal fraction (BPF; standardized β = -0.125, p = 0.011, surviving FDR correction). Only BPF was found to be negatively associated with finger-tapping time (standardized β = -0.123, p = 0.012). However, lacunes, CMBs, or PVS were not found to be associated with motor performance of lower or upper extremities in multivariable analysis. Conclusion: Our findings suggest that cerebral microstructural changes related to CSVD may affect motor performance of both lower and upper extremities. WMH and brain atrophy are most strongly associated with motor function deterioration in community-dwelling populations.
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Interventional Therapy for Upper Extremity Deep Vein Thrombosis
Carlon, Timothy A.; Sudheendra, Deepak
2017-01-01
Approximately 10% of all deep vein thromboses occur in the upper extremity, and that number is increasing due to the use of peripherally inserted central catheters. Sequelae of upper extremity deep vein thrombosis (UEDVT) are similar to those for lower extremity deep vein thrombosis (LEDVT) and include postthrombotic syndrome and pulmonary embolism. In addition to systemic anticoagulation, there are multiple interventional treatment options for UEDVT with the potential to reduce the incidence of these sequelae. To date, there have been no randomized trials to define the optimal management strategy for patients presenting with UEDVT, so many conclusions are drawn from smaller, single-center studies or from LEDVT research. In this article, the authors describe the evidence for the currently available treatment options and an approach to a patient with acute UEDVT. PMID:28265130
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Median and ulnar neuropathies in university guitarists.
Kennedy, Rachel H; Hutcherson, Kimberly J; Kain, Jennifer B; Phillips, Alicia L; Halle, John S; Greathouse, David G
2006-02-01
Descriptive study. To determine the presence of median and ulnar neuropathies in both upper extremities of university guitarists. Peripheral nerve entrapment syndromes of the upper extremities are well documented in musicians. Guitarists and plucked-string musicians are at risk for entrapment neuropathies in the upper extremities and are prone to mild neurologic deficits. Twenty-four volunteer male and female guitarists (age range, 18-26 years) were recruited from the Belmont University School of Music and the Vanderbilt University Blair School of Music. Individuals were excluded if they were pregnant or had a history of recent upper extremity or neck injury. Subjects completed a history form, were interviewed, and underwent a physical examination. Nerve conduction status of the median and ulnar nerves of both upper extremities was obtained by performing motor, sensory, and F-wave (central) nerve conduction studies. Descriptive statistics of the nerve conduction study variables were computed using Microsoft Excel. Six subjects had positive findings on provocative testing of the median and ulnar nerves. Otherwise, these guitarists had normal upper extremity neural and musculoskeletal function based on the history and physical examinations. When comparing the subjects' nerve conduction study values with a chart of normal nerve conduction studies values, 2 subjects had prolonged distal motor latencies (DMLs) of the left median nerve of 4.3 and 4.7 milliseconds (normal, < 4.2 milliseconds). Prolonged DMLs are compatible with median neuropathy at or distal to the wrist. Otherwise, all electrophysiological variables were within normal limits for motor, sensory, and F-wave (central) values. However, comparison studies of median and ulnar motor latencies in the same hand demonstrated prolonged differences of greater than 1.0 milliseconds that affected the median nerve in 2 additional subjects, and identified contralateral limb involvement in a subject with a prolonged distal latency. The other 20 subjects demonstrated normal comparison studies of the median and ulnar nerves in both upper extremities. In this descriptive study of a population of 24 university guitarists, 4 musicians (17%) were found to have electrophysiologic evidence of median neuropathy at or distal to the wrist or carpal tunnel syndrome. Ulnar nerve electrophysiological function was within normal limits for all subjects examined.
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Anshul
2011-01-01
ABSTRACT Purpose: The purpose of this article was to determine whether strength is altered in the upper trapezius in the presence of latent myofascial trigger points (MTrP). Methods: This study was case controlled and used convenience sampling. The sample recruited was homogeneous with respect to age, sex, height, and body mass. Participants were assessed for the presence of latent MTrP in the upper trapezius and placed into two groups: an experimental group that had latent MTrP in the upper trapezius and a control group that did not. Eighteen women (mean age 21.4 y, SD 1.89; mean height 156.9 cm, SD 4.03; and mean body mass 51.7 kg, SD 5.84) made up the experimental group, and 19 women (mean age 20.3 y, SD 1.86; mean height 158.6 cm, SD 3.14; and mean body mass 53.2 kg, SD 5.17) made up the control group. We obtained strength measurements of the non-dominant arm using a handheld dynamometer and compared them between the two groups. Results: The difference in the strength measurements between the two groups was not statistically significant (p=0.59). Conclusions: The presence of latent MTrPs may not affect the strength of the upper trapezius. PMID:22942517
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Detecting severe injuries of the upper body in multiple trauma patients.
Horst, Klemens; Hildebrand, Frank; Kobbe, Philipp; Pfeifer, Roman; Lichte, Philipp; Andruszkow, Hagen; Lefering, Rolf; Pape, Hans Christoph
2015-12-01
The clavicle limits the upper thoracic cage and connects the body and upper extremities. The clavicle is easy to examine and is visible on standard emergency room radiographs. We hypothesized that clavicular fracture in polytrauma patients would indicate the presence of further injuries of the upper extremities, head, neck, and thorax. A population-based trauma registry was used. All patients were documented between 2002 and 2013. Inclusion criteria were age ≥16 y and injury severity score (ISS) ≥16. Patients were divided into two groups according to the presence or absence of a clavicular fracture (group C+ and group C-). Scoring was based on the abbreviated injury scale, ISS, and new injury severity score. Trauma mechanisms, demographics, and the posttraumatic clinical course were compared. In total, 4790 patients with clavicular fracture (C+) and 41,775 without (C-) were included; the mean ISS was 30 ± 11 (C+) versus 28 ± 12 (C-). Patients with clavicular fracture had a longer stay on the intensive care unit with 12 ± 14 versus 10 ± 13 d. Injuries to the thoracic wall, severe lung injuries as well as injuries to the cervical spine were significantly increased in C+ patients. Thoracic injuries as well as injuries of the shoulder girdle and/or arm showed an increased abbreviated injury scale in the C+ group. A clinically relevant coincidence of clavicular fractures with injuries of the chest and upper extremity was found. As clavicular fractures can be diagnosed easily, it might also help to reduce the incidence of missed injuries of the chest and upper extremity. Therefore, special attention should be paid on thoracic as well as upper extremity injures during the second and tertiary surveys in case of clavicular fractures. Copyright © 2015 Elsevier Inc. All rights reserved.
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Explaining the sex difference in depression with a unified bargaining model of anger and depression
Hagen, Edward H.; Rosenström, Tom
2016-01-01
Background: Women are twice as likely as men to be depressed, a bias that is poorly understood. One evolutionary model proposes that depression is a bargaining strategy to compel reluctant social partners to provide more help in the wake of adversity. An evolutionary model of anger proposes that high upper body strength predisposes individuals to angrily threaten social partners who offer too few benefits or impose too many costs. Here, we propose that when social partners provide too few benefits or impose too many costs, the physically strong become overtly angry and the physically weak become depressed. The sexual dimorphism in upper body strength means that men will be more likely to bargain with anger and physical threats and women with depression. Methodology: We tested this idea using the 2011–12 National Health and Nutrition Examination Survey (NHANES), a large nationally representative sample of US households that included measures of depression and upper body strength. Results: A 2 SD increase in grip strength decreased the odds of depression by more than half (OR=0.4, P=0.0079), which did not appear to be a consequence of confounds with anthropometric, hormonal or socioeconomic variables, but was partially explained by a confound with physical disability. Nevertheless, upper body strength mediated 63% of the effect of sex on depression, but the mediation effect was unexpectedly moderated by age. Conclusions: Low upper body strength is a risk factor for depression, especially in older adults, and the sex difference in body strength appears to explain much of the perplexing sex difference in depression. PMID:26884416
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Specialized connective tissue: bone, the structural framework of the upper extremity
Weatherholt, Alyssa M.; Fuchs, Robyn K.; Warden, Stuart J.
2011-01-01
Bone is a connective tissue containing cells, fibers and ground substance. There are many functions in the body in which the bone participates, such as storing minerals, providing internal support, protecting vital organs, enabling movement, and providing attachment sites for muscles and tendons. Bone is unique because its collagen framework absorbs energy, while the mineral encased within the matrix allows bone to resist deformation. This article provides an overview of the structure and function of bone tissue from a macroscopic to microscopic level and discusses the physiological processes contributing to upper extremity bone health. It concludes by discussing common conditions influencing upper extremity bone health. PMID:22047807
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Goldfarb, Charles A.; Wall, Lindley B.; Bohn, Deborah C.; Moen, Patrick; Van Heest, Ann E.
2014-01-01
Purpose To examine the relative presentation frequency of children with upper limb congenital anomalies at 3 Midwestern referral centers using the Oberg, Manske, and Tonkin (OMT) classification and to assess the utility of this new classification system. Methods 641 individuals with 653 congenital upper extremity anomalies were identified at 3 hospitals in 2 large metropolitan areas during a 1-year interval. Patients were identified prospectively and the specific upper extremity anomaly and any associated syndromes were confirmed using medical records and radiographs. We applied the OMT classification that categorizes anomalies using a dysmorphology outline as malformations, dysplasias, deformations, and syndromes, and assessed its utility and ease of use. Results There were 480 extremities (74%) with a limb malformation including 184 involving the entire limb. Arthrogryposis was the most common of these (53 extremities). Anomalies affecting only the hand plate accounted for 62% (296) of the malformations. Of these, radial polydactyly (15%) was the most common specific anomaly, followed by symbrachydactyly (13%) and cleft hand (11%). Dysplasias were noted in 86 extremities; 55 of these were multiple hereditary exostoses. There were 87 extremities with deformations and 58 of these were trigger digits. A total of 98 children had a syndrome or association. Constriction ring sequence was most common. The OMT was straightforward to use and most anomalies could be easily assigned. There were a few conditions, such as Madelung deformity and symbrachydactyly, that would benefit from clarification on how to best classify them. Conclusions Malformations were the most common congenital anomalies in the 653 upper extremities evaluated over a 1-year period at 3 institutions. We were able to classify all individuals using the OMT classification system. PMID:25534840
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Goldfarb, Charles A; Wall, Lindley B; Bohn, Deborah C; Moen, Patrick; Van Heest, Ann E
2015-01-01
To examine the relative presentation frequency of children with upper limb congenital anomalies at 3 Midwestern referral centers using the Oberg, Manske, and Tonkin (OMT) classification and to assess the utility of this new classification system. 641 individuals with 653 congenital upper extremity anomalies were identified at 3 hospitals in 2 large metropolitan areas during a 1-year interval. Patients were identified prospectively and the specific upper extremity anomaly and any associated syndromes were confirmed using medical records and radiographs. We applied the OMT classification that categorizes anomalies using a dysmorphology outline as malformations, dysplasias, deformations, and syndromes, and assessed its utility and ease of use. There were 480 extremities (74%) with a limb malformation including 184 involving the entire limb. Arthrogryposis was the most common of these (53 extremities). Anomalies affecting only the hand plate accounted for 62% (296) of the malformations. Of these, radial polydactyly (15%) was the most common specific anomaly, followed by symbrachydactyly (13%) and cleft hand (11%). Dysplasias were noted in 86 extremities; 55 of these were multiple hereditary exostoses. There were 87 extremities with deformations and 58 of these were trigger digits. A total of 109 children had a syndrome or association. Constriction ring sequence was most common. The OMT was straightforward to use and most anomalies could be easily assigned. There were a few conditions, such as Madelung deformity and symbrachydactyly, that would benefit from clarification on how to best classify them. Malformations were the most common congenital anomalies in the 653 upper extremities evaluated over a 1-year period at 3 institutions. We were able to classify all individuals using the OMT classification system. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
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White, Jennifer; Mills, Chris; Ball, Nick; Scurr, Joanna
2015-01-01
The relationship between inappropriate breast support and upper-extremity kinematics for female runners is unclear. The purpose of this study was to investigate the effect of breast support and breast pain on upper-extremity kinematics during running. Eleven female recreational runners with larger breasts (UK D and E cup) completed a 7 min 20 s treadmill run (2.58 m · s(-1)) in a high and low breast support condition. Multi-planar breast and upper-extremity kinematic data were captured in each breast support condition by eight infrared cameras for 30 s towards the end of the run. Breast pain was rated at the end of each treadmill run using a numeric analogue scale. The high support bra reduced breast kinematics and decreased breast pain (P < 0.05). Upper-extremity kinematics did not differ between breast support conditions (P > 0.05), although some moderate positive correlations were found between thorax range of motion and breast kinematics (r = 0.54 to 0.73). Thorax and arm kinematics do not appear to be influenced by breast support level in female runners with large breasts. A high support bra that offers good multi-planar breast support is recommended for female runners with larger breasts to reduce breast pain.
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One-per-mil tumescent technique for upper extremity surgeries: broadening the indication.
Prasetyono, Theddeus O H; Biben, Johannes A
2014-01-01
We studied the effect of 1:1,000,000 epinephrine concentration (1 per mil) to attain a bloodless operative field in hand and upper extremity surgery and to explore its effectiveness and safety profile. This retrospective observational study enrolled 45 consecutive patients with 63 operative fields consisting of various hand and upper extremity problems. One-per-mil solution was injected into the operative field with tumescent technique to create a bloodless operating field without tourniquet. The solution was formulated by adding a 1:1,000,000 concentration of epinephrine and 100 mg of lidocaine into saline solution to form 50 mL of tumescent solution. Observation was performed on the clarity of the operative field, which we described as totally bloodless, minimal bleeding, acceptable bleeding, or bloody. The volume of tumescent solution injected, duration of surgery, and surgical outcome were also reviewed. The tumescent technique with 1-per-mil solution achieved 29% totally bloodless, 48% minimal bleeding, 22% acceptable bleeding, and 2% bloody operative fields in cases that included burn contracture and congenital hand and upper extremity surgeries. One-per-mil tumescent solution created a clear operative field in hand and upper extremity surgery. It proved safe and effective for a wide range of indications. Therapeutic IV. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
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Bowman, Mary H; Taub, Edward; Uswatte, Gitendra; Delgado, Adriana; Bryson, Camille; Morris, David M; McKay, Staci; Mark, Victor W
2006-01-01
Constraint-Induced Movement therapy (CI therapy) is a recognized rehabilitation approach for persons having stroke with mild to moderately severe motor upper extremity deficits. To date, no rehabilitation treatment protocol has been proven effective that addresses both motor performance and spontaneous upper extremity use in the life situation for chronic stroke participants having severe upper extremity impairment with no active finger extension or thumb abduction. This case report describes treatment of a chronic stroke participant with a plegic hand using a CI therapy protocol that combines CI therapy with selected occupational and physical therapy techniques. Treatment consisted of six sessions of adaptive equipment and upper extremity orthotics training followed by a three-week, six-hour daily intervention of CI therapy plus neurodevelopmental treatment. Outcome measures included the Motor Activity Log for very low functioning patients (Grade 5 MAL), upper extremity portion of the Fugl-Meyer Motor Assessment, Graded Wolf Motor Function Test - for very low functioning patients (gWMFT- Grade 5), and Modified Ashworth Scale. The participant showed improvement on each outcome measure with the largest improvement on the Grade 5 MAL. In follow-up, the participant had good retention of his gains in motor performance and use of his more affected arm for real world activities after 3 months; after a one-week brush-up at 3 months, and at one year post-treatment.
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Sood, Aditya; Therattil, Paul J; Russo, Gerardo; Lee, Edward S
2017-01-01
Objective: The latissimus dorsi flap is a workhorse for plastic surgeons, being used for many years for soft-tissue coverage of the upper extremity as well as for functional reconstruction to restore motion to the elbow and shoulder. The authors present a case of functional latissimus dorsi transfer for restoration of elbow flexion and review the literature on technique and outcomes. Methods: A literature review was performed using MEDLINE and the Cochrane Collaboration Library for primary research articles on functional latissimus dorsi flap transfer. Data related to surgical techniques and outcomes were extracted. Results: The literature search yielded 13 relevant studies, with a total of 52 patients who received pedicled, functional latissimus dorsi flaps for upper-extremity reconstruction. The most common etiology requiring reconstruction was closed brachial plexus injury (n = 13). After flap transfer, 98% of patients were able to flex the elbow against gravity and 82.3% were able to flex against resistance. In the presented case, a 77-year-old man underwent resection of myxofibrosarcoma of the upper arm with elbow prosthesis placement and functional latissimus dorsi transfer. The patient was able to actively flex against gravity at 3-month follow-up. Conclusions: A review of the literature shows that nearly all patients undergoing functional latissimus dorsi transfer for upper-extremity reconstruction regain at least motion against gravity whereas a large proportion regain motion against resistance. Considerations when planning for functional latissimus dorsi transfer include patient positioning, appropriate tensioning of the muscle, safe inset, polarity, management of other affected upper-extremity joints, and educating patients on the expected outcomes.
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Therattil, Paul J.; Russo, Gerardo; Lee, Edward S.
2017-01-01
Objective: The latissimus dorsi flap is a workhorse for plastic surgeons, being used for many years for soft-tissue coverage of the upper extremity as well as for functional reconstruction to restore motion to the elbow and shoulder. The authors present a case of functional latissimus dorsi transfer for restoration of elbow flexion and review the literature on technique and outcomes. Methods: A literature review was performed using MEDLINE and the Cochrane Collaboration Library for primary research articles on functional latissimus dorsi flap transfer. Data related to surgical techniques and outcomes were extracted. Results: The literature search yielded 13 relevant studies, with a total of 52 patients who received pedicled, functional latissimus dorsi flaps for upper-extremity reconstruction. The most common etiology requiring reconstruction was closed brachial plexus injury (n = 13). After flap transfer, 98% of patients were able to flex the elbow against gravity and 82.3% were able to flex against resistance. In the presented case, a 77-year-old man underwent resection of myxofibrosarcoma of the upper arm with elbow prosthesis placement and functional latissimus dorsi transfer. The patient was able to actively flex against gravity at 3-month follow-up. Conclusions: A review of the literature shows that nearly all patients undergoing functional latissimus dorsi transfer for upper-extremity reconstruction regain at least motion against gravity whereas a large proportion regain motion against resistance. Considerations when planning for functional latissimus dorsi transfer include patient positioning, appropriate tensioning of the muscle, safe inset, polarity, management of other affected upper-extremity joints, and educating patients on the expected outcomes. PMID:28293330
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Brown-Séquard syndrome after a gun shot wound to the cervical spine: a case report.
Leven, Dante; Sadr, Ali; Aibinder, William R
2013-12-01
Brown-Séquard syndrome is characterized by a hemisection of the spinal cord most commonly after spinal trauma or neoplastic disease. The injury causes ipsilateral hemiplegia and proprioceptive sensory disturbances with contralateral loss of pain and temperature sensation. Patients with Brown-Séquard syndrome have the best prognosis of all spinal cord injury patterns. At this time, the ideal management for Brown-Séquard syndrome after penetrating trauma has yet to be defined. To report a case of a gun shot wound to the upper cervical spine that resulted in Brown-Séquard syndrome and was treated effectively with early cervical spine decompression and fusion. Observational case report. A 28-year-old woman presented after sustaining a low-velocity gun shot wound in to the upper cervical spine in a civilian assault. On initial presentation, she had 0/5 motor scores in the left upper and lower extremities and normal motor scores on the right. Sensory examination was limited as she was intubated and sedated on admission due to airway compromise. A computed tomography scan revealed a bullet lodged in the vertebral body of C3 with boney fragments and soft tissue encroaching on the spinal cord. Subsequently, she underwent C3 corpectomy, bulletectomy, and anterior cervical decompression with fusion. Intraoperatively, no dural disruption or cerebral spinal fluid leak was noted, and her posterior longitudinal ligament was intact. One month postoperatively, her left lower extremity motor score was 5/5 with movement of her left thumb and all fingers. Strength in her biceps, triceps, and wrist extensors and flexors was 3/5. Her functional capacity and strength gradually improved. Reinke et al. support surgical intervention for patients with incomplete paraplegia after the patient is medically stabilized, although their case report discussed lower thoracic injury, which carries a more favorable prognosis. All other prior case reports and prospective studies that reported favorable outcomes after Brown-Séquard syndrome involved the midthoracic, low thoracic, or lumbar spinal levels. This report is the first case of Brown-Séquard syndrome after a high cervical gun shot wound, which was managed with immediate decompression and fusion, where near complete recovery was obtained. Copyright © 2013 Elsevier Inc. All rights reserved.
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Free style perforator based propeller flaps: Simple solutions for upper extremity reconstruction!
Panse, Nikhil; Sahasrabudhe, Parag
2014-01-01
The introduction of perforator flaps by Koshima et al. was met with much animosity in the plastic surgery fraternity. The safety concerns of these flaps following the intentional twist of the perforators have prevented widespread adoption of this technique. Use of perforator based propeller flaps in the lower extremity is gradually on the rise, but their use in upper extremity reconstruction is infrequently reported, especially in the Indian subcontinent. We present a retrospective series of 63 free style perforator flaps used for soft tissue reconstruction of the upper extremity from November 2008 to June 2013. Flaps were performed by a single surgeon for various locations and indications over the upper extremity. Patient demographics, surgical indication, defect features, complications and clinical outcome are evaluated and presented as an uncontrolled case series. 63 free style perforator based propeller flaps were used for soft tissue reconstruction of 62 patients for the upper extremity from November 2008 to June 2013. Of the 63 flaps, 31 flaps were performed for trauma, 30 for post burn sequel, and two for post snake bite defects. We encountered flap necrosis in 8 flaps, of which there was complete necrosis in 4 flaps, and partial necrosis in four flaps. Of these 8 flaps, 7 needed a secondary procedure, and one healed secondarily. Although we had a failure rate of 12-13%, most of our failures were in the early part of the series indicative of a learning curve associated with the flap. Free style perforator based propeller flaps are a reliable option for coverage of small to moderate sized defects. Therapeutic IV.
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Strong magnetic field generated by the extreme oxygen-rich red supergiant VY Canis Majoris
NASA Astrophysics Data System (ADS)
Shinnaga, Hiroko; Claussen, Mark J.; Yamamoto, Satoshi; Shimojo, Masumi
2017-12-01
Evolved stars experience high mass-loss rates forming thick circumstellar envelopes (CSEs). The circumstellar material is made of the result of stellar nucleosynthesis and, as such, plays a crucial role in the chemical evolution of galaxies and the universe. Since asymmetric geometries of CSEs are common, and with very complex structures for some cases, radiative pressure from the stars can explain only a small portion of the mass-loss processes; thus the essential driving mechanism is still unknown, particularly for high-mass stars. Here we report on magnetic field measurements associated with the well-known extreme red supergiant (RSG) VY Canis Majoris (VY CMa). We measured the linear polarization and the Zeeman splitting of the SiO v = 0, J = 1-0 transition using a sensitive radio interferometer. The measured magnetic field strengths are surprisingly high; their upper limits range between 150 and 650 G within 530 au (˜80 R*) of the star. The lower limit of the field strength is expected to be at least ˜10 G based on the high degree of linear polarization. Since the field strengths are very high, the magnetic field must be a key element in understanding the stellar evolution of VY CMa, as well as the dynamical and chemical evolution of the complex CSE of the star. M-type RSGs, with large stellar surface, were thought to be very slow rotators. This would seem to make a dynamo in operation difficult, and would also dilute any fossil magnetic field. At least for VY CMa, we expect that powerful dynamo processes must still be active to generate the intense magnetic field.
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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.
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Vandbakk, Kristine; Welde, Boye; Kruken, Andrea Hovstein; Baumgart, Julia; Ettema, Gertjan; Karlsen, Trine; Sandbakk, Øyvind
2017-01-01
This study compared the effects of adding upper-body sprint-intervals or continuous double poling endurance training to the normal training on maximal upper-body strength and endurance capacity in female cross-country skiers. In total, 17 female skiers (age: 18.1±0.8yr, body mass: 60±7 kg, maximal oxygen uptake (VO2max): 3.30±0.37 L.min-1) performed an 8-week training intervention. Here, either two weekly sessions of six to eight 30-s maximal upper-body double poling sprint-intervals (SIG, n = 8) or 45–75 min of continuous low-to-moderate intensity double poling on roller skis (CG, n = 9) were added to their training. Before and after the intervention, the participants were tested for physiological and kinematical responses during submaximal and maximal diagonal and double poling treadmill roller skiing. Additionally, we measured maximal upper-body strength (1RM) and average power at 40% 1RM in a poling-specific strength exercise. SIG improved absolute VO2max in diagonal skiing more than CG (8% vs 2%, p<0.05), and showed a tendency towards higher body-mass normalized VO2max (7% vs 2%, p = 0.07). Both groups had an overall improvement in double poling peak oxygen uptake (10% vs 6% for SIG and CG) (both p<0.01), but no group-difference was observed. SIG improved 1RM strength more than CG (18% vs 10%, p<0.05), while there was a tendency for difference in average power at 40% 1RM (20% vs 14%, p = 0.06). Oxygen cost and kinematics (cycle length and rate) in double poling and diagonal remained unchanged in both groups. In conclusion, our study demonstrates that adding upper-body sprint-interval training is more effective than continuous endurance training in improving upper-body maximal strength and VO2max. PMID:28241030
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Pullout strength of standard vs. cement-augmented rotator cuff repair anchors in cadaveric bone.
Aziz, Keith T; Shi, Brendan Y; Okafor, Louis C; Smalley, Jeremy; Belkoff, Stephen M; Srikumaran, Uma
2018-05-01
We evaluate a novel method of rotator cuff repair that uses arthroscopic equipment to inject bone cement into placed suture anchors. A cadaver model was used to assess the pullout strength of this technique versus anchors without augmentation. Six fresh-frozen matched pairs of upper extremities were screened to exclude those with prior operative procedures, fractures, or neoplasms. One side from each pair was randomized to undergo standard anchor fixation with the contralateral side to undergo anchor fixation augmented with bone cement. After anchor fixation, specimens were mounted on a servohydraulic testing system and suture anchors were pulled at 90° to the insertion to simulate the anatomic pull of the rotator cuff. Sutures were pulled at 1 mm/s until failure. The mean pullout strength was 540 N (95% confidence interval, 389 to 690 N) for augmented anchors and 202 N (95% confidence interval, 100 to 305 N) for standard anchors. The difference in pullout strength was statistically significant (P < 0.05). This study shows superior pullout strength of a novel augmented rotator cuff anchor technique. The described technique, which is achieved by extruding polymethylmethacrylate cement through a cannulated in situ suture anchor with fenestrations, significantly increased the ultimate failure load in cadaveric human humeri. This novel augmented fixation technique was simple and can be implemented with existing instrumentation. In osteoporotic bone, it may substantially reduce the rate of anchor failure. Copyright © 2018 Elsevier Ltd. All rights reserved.
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Wii™-habilitation of upper extremity function in children with cerebral palsy. An explorative study.
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.
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Upper-extremity phocomelia reexamined: a longitudinal dysplasia.
Goldfarb, Charles A; Manske, Paul R; Busa, Riccardo; Mills, Janith; Carter, Peter; Ezaki, Marybeth
2005-12-01
In contrast to longitudinal deficiencies, phocomelia is considered a transverse, intercalated segmental dysplasia. Most patients demonstrate severe, but not otherwise classifiable, upper-extremity deformities, which usually cannot be placed into one of three previously described phocomelia groups. Additionally, these phocomelic extremities do not demonstrate true segmental deficits; the limb is also abnormal proximal and distal to the segmental defect. The purpose of this investigation was to present evidence that upper-extremity abnormalities in patients previously diagnosed as having phocomelia in fact represent a proximal continuum of radial or ulnar longitudinal dysplasia. The charts and radiographs of forty-one patients (sixty extremities) diagnosed as having upper-extremity phocomelia were reviewed retrospectively. On the basis of the findings on the radiographs, the disorders were categorized into three groups: (1) proximal radial longitudinal dysplasia, which was characterized by an absent proximal part of the humerus, a nearly normal distal part of the humerus, a completely absent radius, and a radial-sided hand dysplasia; (2) proximal ulnar longitudinal dysplasia, characterized by a short one-bone upper extremity that bifurcated distally and by severe hand abnormalities compatible with ulnar dysplasia; and (3) severe combined dysplasia, with type A characterized by an absence of the forearm segment (i.e., the radius and ulna) and type B characterized by absence of the arm and forearm (i.e., the hand attached to the thorax). Twenty-nine limbs in sixteen patients could be classified as having proximal radial longitudinal dysplasia. Systemic medical conditions such as thrombocytopenia-absent radius syndrome were common in those patients, but additional musculoskeletal conditions were rare. Twenty limbs in seventeen patients could be classified as having proximal ulnar longitudinal dysplasia. Associated musculoskeletal abnormalities, such as proximal femoral focal deficiency, were common in those patients. Eleven limbs in ten patients were identified as having severe combined dysplasia, which was type A in seven of them and type B in four. Four patients with severe combined dysplasia had congenital cardiac anomalies, and four had associated musculoskeletal abnormalities. Three of the four patients with the type-B disorder had a contralateral ulnar longitudinal dysplasia. We propose that cases previously classified as upper-extremity phocomelia represent a spectrum of severe longitudinal dysplasia, as none of the sixty extremities that we studied demonstrated a true intercalary deficiency. These findings have both developmental and genetic implications.
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Explaining the sex difference in depression with a unified bargaining model of anger and depression.
Hagen, Edward H; Rosenström, Tom
2016-01-01
Women are twice as likely as men to be depressed, a bias that is poorly understood. One evolutionary model proposes that depression is a bargaining strategy to compel reluctant social partners to provide more help in the wake of adversity. An evolutionary model of anger proposes that high upper body strength predisposes individuals to angrily threaten social partners who offer too few benefits or impose too many costs. Here, we propose that when social partners provide too few benefits or impose too many costs, the physically strong become overtly angry and the physically weak become depressed. The sexual dimorphism in upper body strength means that men will be more likely to bargain with anger and physical threats and women with depression. We tested this idea using the 2011-12 National Health and Nutrition Examination Survey (NHANES), a large nationally representative sample of US households that included measures of depression and upper body strength. A 2 SD increase in grip strength decreased the odds of depression by more than half ([Formula: see text],[Formula: see text]), which did not appear to be a consequence of confounds with anthropometric, hormonal or socioeconomic variables, but was partially explained by a confound with physical disability. Nevertheless, upper body strength mediated 63% of the effect of sex on depression, but the mediation effect was unexpectedly moderated by age. Low upper body strength is a risk factor for depression, especially in older adults, and the sex difference in body strength appears to explain much of the perplexing sex difference in depression. © The Author(s) 2016. Published by Oxford University Press on behalf of the Foundation for Evolution, Medicine, and Public Health.
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Upper Body Strength. Helping Kids Win the Battle.
ERIC Educational Resources Information Center
Rupnow, Allan
1985-01-01
A sedentary lifestyle, along with program cutbacks and changes in teaching emphasis, have led to lower scores every year on tests of upper body strength of elementary school children. Pulling, pushing and hanging activities are described, and a yearly program of fitness activities is suggested. (MT)
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Lee, GyuChang
2013-01-01
[Purpose] The purpose of this study was to investigate the effects of training using video games played on the Xbox Kinect on the muscle strength, muscle tone, and activities of daily living of post-stroke patients. [Subjects] Fourteen stroke patients were recruited. They were randomly allocated into two groups; the experimental group (n=7) and the control group (n=7). [Methods] The experimental group performed training using video games played on the Xbox Kinect together with conventional occupational therapy for 6 weeks (1 hour/day, 3 days/week), and the control group received conventional occupational therapy only for 6 weeks (30 min/day, 3 days/week). Before and after the intervention, the participants were measured for muscle strength, muscle tone, and performance of activities of daily living. [Results] There were significant differences pre- and post-test in muscle strength of the upper extremities, except the wrist, and performance of activities of daily living in the experimental group. There were no significant differences between the two groups at post-test. [Conclusion] The training using video games played on the Xbox Kinect had a positive effect on the motor function and performance of activities of daily living. This study showed that training using video games played on the Xbox Kinect may be an effective intervention for the rehabilitation of stroke patients. PMID:24259810
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Rabelo, Michelle; Nunes, Guilherme S; da Costa Amante, Natália Menezes; de Noronha, Marcos; Fachin-Martins, Emerson
2016-02-01
Muscle weakness is the main cause of motor impairment among stroke survivors and is associated with reduced peak muscle torque. To systematically investigate and organize the evidence of the reliability of muscle strength evaluation measures in post-stroke survivors with chronic hemiparesis. Two assessors independently searched four electronic databases in January 2014 (Medline, Scielo, CINAHL, Embase). Inclusion criteria comprised studies on reliability on muscle strength assessment in adult post-stroke patients with chronic hemiparesis. We extracted outcomes from included studies about reliability data, measured by intraclass correlation coefficient (ICC) and/or similar. The meta-analyses were conducted only with isokinetic data. Of 450 articles, eight articles were included for this review. After quality analysis, two studies were considered of high quality. Five different joints were analyzed within the included studies (knee, hip, ankle, shoulder, and elbow). Their reliability results varying from low to very high reliability (ICCs from 0.48 to 0.99). Results of meta-analysis for knee extension varying from high to very high reliability (pooled ICCs from 0.89 to 0.97), for knee flexion varying from high to very high reliability (pooled ICCs from 0.84 to 0.91) and for ankle plantar flexion showed high reliability (pooled ICC = 0.85). Objective muscle strength assessment can be reliably used in lower and upper extremities in post-stroke patients with chronic hemiparesis.
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Kenny, Anne M; Biskup, Bradley; Robbins, Bertha; Marcella, Glenn; Burleson, Joseph A
2003-12-01
To study the effects of vitamin D supplementation in healthier populations of men. : Randomized, controlled trial. General clinical research center. Sixty-five healthy, community-dwelling men (mean age+/-standard deviation=76+/-4, range 65-87). Cholecalciferol (1,000 IU/d) or placebo supplementation for 6 months; all received 500 mg supplemental calcium. Upper and lower extremity muscle strength and power, physical performance and activity, health perception, calcium and vitamin D intake, and biochemical assessment, including 25-hydroxyvitamin D (25OHD), parathyroid hormone (PTH), and ionized calcium levels. The levels of 25OHD increased and PTH decreased in the cholecalciferol group, whereas there were no significant changes in the control group (P<.001). Baseline 25OHD levels correlated with baseline single-leg stance time and physical activity score. Baseline PTH levels correlated with baseline 8-foot walk time and physical activity score. No significant difference in strength, power, physical performance, or health perception was found between groups. The 25OHD or PTH levels correlated with physical activity and physical performance in older, community-dwelling men with normal 25OHD status. Vitamin D supplementation increased 25OHD levels and decreased PTH levels but did not increase muscle strength or improve physical performance or health perception in this group of healthy, older men. Further investigations of the effects of vitamin D supplementation should focus on individuals with low levels of vitamin D.
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Buyukavci, Raikan; Akturk, Semra; Ersoy, Yüksel
2018-02-07
Ultrasound-guided botulinum toxin type A injection is an effective treatment for spasticity. Euro-musculus spasticity approach is a new method for administering injections to the correct point of the correct muscle. The clinical outcomes of this practical approach is not yet available in the literature. The purpose of this study was to evaluate the effects on spasticity and the functional outcomes of ultrasound guided botulinum toxin type A injections via the Euro-musculus spasticity approach to treat upper limb spasticity in post-stroke patients. An observational study. Inpatient post-stroke patients. Twenty five post-stroke patients with post-stroke upper limb spasticity were recruited. The ultrasound-guided botulinum toxin type A injections were administered into the spastic target muscles using the Euro-musculus spasticity approach, and all of the patients were enrolled in rehabilitation programmes after the injections. This research included the innervation zone and injection site figures and ultrasound images of each muscle in the upper limb. The degree of spasticity was assessed via the Modified Ashworth Scale and the upper limb motor function via the Fugl Meyer Upper Extremity Scale at the baseline and 4 and 12 weeks after the botulinum toxin type A injection. Significant decreases in the Modified Ashworth Scale scores of the upper limb flexor muscle tone measured 4 and 12 weeks after the botulinum toxin type A injection were found when compared to the baseline scores (p<0.025). When compared with the baseline Fugl Meyer Upper Extremity subgroup scores, the sitting position, wrist and total scores at 4 and 12 weeks were significantly improved (p<0.025). However, only the Fugl Meyer Upper Extremity hand scores were significantly improved 12 weeks after the injection (p<0.025). Ultrasound-guided botulinum toxin type A injection via the Euro- musculus spasticity approach is a practical and effective method for administering injections to the correct point of the correct muscle. Ultrasound-guided botulinum toxin type A injections combined with rehabilitation programmes decrease spasticity and improve the upper extremity motor functions in stroke patients. This new approach for ultrasound- guided botulinum toxin type A injection is very practical and effective method for upper extremity spasticity.
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Huang, Shih-Wei; Ku, Jan-Wen; Lin, Li-Fong; Liao, Chun-De; Chou, Lin-Chuan; Liou, Tsan-Hon
2017-08-01
Sarcopenia involves age-related decreases in muscle strength and muscle mass, leading to frailty and disability in elderly people. When combined with obesity, it is defined as sarcopenic obesity (SO), which can result in more functional limitations and metabolic disorders than either disorder alone. The aim of this study was to investigate body composition changes after elastic band resistance training in elderly women with SO. Randomized single-blinded (assessor blinded) controlled pilot trial. Academic medical center. Thirty-five elderly (>60 years old) women with SO. This pilot randomized controlled trial focused on elderly women with SO. The study group underwent progressive elastic band resistance training for 12 weeks (3 times per week). The control group received only a 40-minute lesson about the exercise concept. Dual-energy X-ray absorptiometry was performed before and after intervention to evaluate body composition. Mann-Whitney U and Wilcoxon signed rank tests were used to analyze the differences within and between these groups. In total, 35 elderly women with SO were enrolled and divided into study (N.=18) and control groups (N.=17). No difference was observed in age, biochemical parameters, or Body Mass Index between both groups. After the intervention, the fat proportion of body composition in the right upper extremity (P=0.03), left upper extremity (P=0.04), total fat (P=0.035), and fat percentage (P=0.012) had decreased, and bone mineral density (BMD) (P=0.026), T-score (P=0.028), and Z-score (P=0.021) had increased in the study group. Besides, statistical difference was observed in outcome measurements of right upper extremity (P=0.013), total fat (P=0.023), and fat percentage (P=0.012) between the groups. Our study demonstrated that progressive elastic band resistance exercise can reduce fat mass and increase BMD in elderly women with SO, and that this exercise program is feasible for this demographic. Additional studies with larger sample sizes and longer intervention periods should be conducted. Twelve weeks of progressive elastic band resistance exercise program is safe and effective for SO elder women.
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Designing instrumented walker to measure upper-extremity's efforts: A case study.
Khodadadi, Mohammad; Baniasad, Mina Arab; Arazpour, Mokhtar; Farahmand, Farzam; Zohoor, Hassan
2018-02-26
The high prevalence of shoulder pain in using walkers in patients who have spinal cord injury (SCI). Also, the limited options available to economically measure grip forces in walkers, which drove the need to create one. This article describes a method to obtain upper-extremities' forces and moments in a person with SCI by designing an appropriate instrumented walker. First, since the commercial multidirectional loadcells are too expensive, custom loadcells are fabricated. Ultimately, a complete gait analysis by means of VICON motion analysis and using inverse dynamic method has been held to measure upper-extremities' efforts. The results for a person with SCI using a two-wheel walker in low and high heights and a basic walker show that there are higher shoulder and elbow flexion-extension moments and also higher shoulder forces in superior-inferior direction and higher elbow and wrist forces in anterior-posterior directions. The results are not much different in using two different types of walker. By using the proposed method, upper-extremities' forces and moments were obtained and the results were compared to each other in using two different walkers.
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An Evaluation of Agonist: Antagonist Strength Ratios and Posture Among Powerlifters.
Cutrufello, Paul T; Gadomski, Stephen J; Ratamess, Nicholas A
2017-02-01
Cutrufello, PT, Gadomski, SJ, and Ratamess, NA. An evaluation of agonist:antagonist strength ratios and posture among powerlifters. J Strength Cond Res 31(2): 298-304, 2017-Powerlifters routinely focus on 3 exercises: bench press, squat, and deadlift. This focus may predispose them to the development of muscle imbalances in either the upper or lower extremity which might also influence posture. Therefore, the purpose of the present study was to examine the agonist:antagonist strength ratios and their relationship to postural measures among powerlifters. An ex post facto study design compared 15 male powerlifters (35.3 ± 13.7 years old) and 15 age-matched controls (34.9 ± 14.6 years old). Maximal isometric strength tests were conducted using handheld dynamometry. Posture was evaluated using pectoralis minor length, pelvic tilt, thoracic kyphosis, and lumbar lordosis. Strength imbalances were observed for shoulder horizontal adduction:abduction (2.57 ± 0.58 vs. 1.78 ± 0.28; p < 0.001) and knee flexion:extension (0.61 ± 0.15 vs. 0.50 ± 0.10; p = 0.033). Pectoralis minor length was significantly shorter among the powerlifters (6.1 ± 1.9 vs. 4.2 ± 1.4; p = 0.005); however, there was no statistical difference in thoracic kyphosis (37.7 ± 9.4 vs. 39.1 ± 10.9; p = 0.722), pelvic tilt (10.6 ± 3.6 vs. 11.3 ± 3.7; p = 0.622), or lumbar lordosis (25.0 ± 7.6 vs. 23.0 ± 8.4; p = 0.500) angles. Strength imbalances, including shoulder horizontal adduction:abduction and knee flexion:extension, and a shortened pectoralis minor may evolve as training adaptations among powerlifters, whereas thoracic kyphosis, pelvic tilt, and lumbar lordosis remain unchanged.
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Yavuzer, G; Senel, A; Atay, M B; Stam, H J
2008-09-01
To evaluate the effects of ''Playstation EyeToy Games'' on upper extremity motor recovery and upper extremity-related motor functioning of patients with subacute stroke. The authors designed a randomized, controlled, assessor-blinded, 4-week trial, with follow-up at 3 months. A total of 20 hemiparetic inpatients (mean age 61.1 years), all within 12 months post-stroke, received 30 minutes of treatment with ''Playstation EyeToy Games'' per day, consisting of flexion and extension of the paretic shoulder, elbow and wrist as well as abduction of the paretic shoulder or placebo therapy (watching the games for the same duration without physical involvement into the games) in addition to conventional program, 5 days a week, 2-5 hours/day for 4 weeks. Brunnstrom's staging and self-care sub-items of the functional independence measure (FIM) were performed at 0 month (baseline), 4 weeks (post-treatment), and 3 months (follow-up) after the treatment. The mean change score (95% confidence interval) of the FIM self-care score (5.5 [2.9-8.0] vs 1.8 [0.1-3.7], P=0.018) showed significantly more improvement in the EyeToy group compared to the control group. No significant differences were found between the groups for the Brunnstrom stages for hand and upper extremity. ''Playstation EyeToy Games'' combined with a conventional stroke rehabilitation program have a potential to enhance upper extremity-related motor functioning in subacute stroke patients.
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The incidence of upper extremity injuries in endoscopy nurses working in the United States.
Drysdale, Susan A
2013-01-01
Numerous studies have addressed musculoskeletal disorders in the international working population. The literature indicates that injuries exist at astounding rates with significant economic impact. Attempts have been made by government, private industry, and special interest groups to address the issues related to the occurrence and prevention of musculoskeletal injuries. Because of the limited research on the gastrointestinal (GI) endoscopy nursing sector, this descriptive, correlational study explored the incidence of upper extremity injuries in GI endoscopy nurses and technicians in the United States. A total of 215 subjects were included in the study. Findings show that upper extremity injuries exist among nurses working in GI endoscopy. Twenty-two percent of respondents missed work for upper extremity injuries. The findings also show that the severity of disability is related to the type of work done, type of assistive aids available at work, and whether or not ergonomic or physiotherapy assessments were provided at the place of employment. In reference to rate of injury and the availability of ergonomics and physiotherapy assessments, those who had ergonomic assessments available to them had scores on the Disabilities of the Arm, Shoulder, and Hand (DASH) inventory (indicating upper extremity disability) that were significantly lower (DASH score, 9.96) than those who did not have the assessments available (DASH score, 14.66). The results suggest that there are a significant number of subjects who are disabled to varying degrees and the majority of these are employed in full-time jobs.
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Yoon, Jisun; Chun, Min Ho; Lee, Sook Joung; Kim, Bo Ryun
2015-06-01
The aim of this study was to evaluate the benefit of virtual reality-based rehabilitation on upper-extremity function in patients with brain tumor. Patients with upper-extremity dysfunction were divided into age-matched and tumor type-matched two groups. The intervention group performed the virtual reality program 30 mins per session for 9 sessions and conventional occupational therapy 30 mins per session for 6 sessions for 3 wks, whereas the control group received conventional occupational therapy alone 30 mins per session for 15 sessions for 3 wks. The Box and Block test, the Manual Function test, and the Fugl-Meyer scale were used to evaluate upper-extremity function. The Korean version of the Modified Barthel Index was used to assess activities of daily living. Forty patients completed the study (20 for each group). Each group exhibited significant posttreatment improvements in the Box and Block test, Manual Function test, Fugl-Meyer scale, and Korean version of the Modified Barthel Index scores. The Box and Block test, the Fugl-Meyer scale, and the Manual Function test showed greater improvements in shoulder/elbow/forearm function in the intervention group and hand function in the control group. Virtual reality-based rehabilitation combined with conventional occupational therapy may be more effective than conventional occupational therapy, especially for proximal upper-extremity function in patients with brain tumor. Further studies considering hand function, such as use of virtual reality programs that targeting hand use, are required.
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Grantham, W Jeffrey; To, Philip; Watson, Jeffry T; Brywczynski, Jeremy; Lee, Donald H
2016-08-01
Air transportation to tertiary care centers of patients with upper extremity amputations has been utilized in hopes of reducing the time to potential replantation; however, this mode of transportation is expensive and not all patients will undergo replantation. The purpose of this study is to review the appropriateness and cost of air transportation in upper extremity amputations. Consecutive patients transported by aircraft with upper extremity amputations in a 7-year period at a level-1 trauma center were retrospectively reviewed. The distance traveled was recorded, along with the times of the injury, referral, transportation duration, arrival, and start of the operation. The results of the transfer were defined as replantation or revision amputation. Overall, 47 patients were identified with 43 patients going to the operating room, but only 14 patients (30%) undergoing replantation. Patients arrived at the tertiary hand surgery center with a mean time of 182.3 minutes following the injury, which includes 105.2 minutes of transportation time. The average distance traveled was 105.4 miles (range, 22-353 miles). The time before surgery of those who underwent replantation was 154.6 minutes. The average cost of transportation was $20,482. Air transportation for isolated upper extremity amputations is costly and is not usually the determining factor for replantation. The type of injury and patients' expectations often dictate the outcome, and these may be better determined at the time of referral with use of telecommunication photos, discussion with a hand surgeon, and patient counseling. III.
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Back and upper extremity disorders among enlisted U.S. Marines: burden and individual risk factors.
Huang, G D; Feuerstein, M; Arroyo, F
2001-11-01
Although musculoskeletal disorders of the low back and upper extremities can affect military readiness, little is known about their extent and risk factors in the U.S. Marine Corps. Using the Defense Medical Epidemiology and Defense Medical Surveillance System databases, back and upper extremity diagnostic categories were among the top four sources of outpatient visits and duty limitation among enlisted Marines. Back disorders were also found to be the fifth most common cause for lost time. Subsequently, high-risk occupations were identified, age-related trends for clinic visit rates were determined, and rate ratios were computed for the top 15 low back and upper extremity diagnoses among enlisted Marines from 1997 through 1998. Occupational categories with the highest rates of musculoskeletal-related outpatient visits included image interpretation, auditing and accounting, disturbsing, surveillance/target acquisition, and aircraft launch equipment. Significantly increasing linear trends in rates across age groups were found for most diagnoses. For 1998, age-specific rate ratios indicated significantly higher rates for most low back and upper extremity disorders for females; lower rank (i.e., E1-E4) was also a risk, but for fewer diagnoses. The findings emphasize the need to identify modifiable (e.g., work-related, individual) risk factors and to develop focused primary and secondary prevention programs for musculoskeletal disorders in the Marine Corps. Subsequently, these efforts can assist in reducing associated effects, maximizing resource utilization, and enhancing operational readiness.
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A systematic review of the effects of upper body warm-up on performance and injury.
McCrary, J Matt; Ackermann, Bronwen J; Halaki, Mark
2015-07-01
This systematic review was conducted to identify the impact of upper body warm-up on performance and injury prevention outcomes. Web of Science, MEDLINE, SPORTDiscus, PsycINFO and Cochrane databases were searched using terms related to upper extremity warm-up. Inclusion criteria were English language randomised controlled trials from peer-reviewed journals in which investigation of upper body warm-up on performance and injury prevention outcomes was a primary aim. Included studies were assessed for methodological quality using the PEDro scale. A wide variety of warm-up modes and outcomes precluded meta-analysis except for one group of studies. The majority of warm-ups were assessed as having 'positive', 'neutral', 'negative' or 'specific' effects on outcomes. Thirty-one studies met the inclusion criteria with 21 rated as having 'good' methodological quality. The studies investigated a total of 25 warm-up modes and 43 outcome factors that could be grouped into eight mode and performance outcome categories. No studies of upper body warm-up effects on injury prevention were discovered. Strong research-based evidence was found for the following: high-load dynamic warm-ups enhance power and strength performance; warm-up swings with a standard weight baseball bat are most effective for enhancing bat speed; short-duration static stretching warm-up has no effect on power outcomes; and passive heating/cooling is a largely ineffective warm-up mode. A clear knowledge gap in upper body warm-up literature is the lack of investigation of injury prevention outcomes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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NASA Astrophysics Data System (ADS)
Hasbullah Mohd Isa, Wan; Taha, Zahari; Mohd Khairuddin, Ismail; Majeed, Anwar P. P. Abdul; Fikri Muhammad, Khairul; Abdo Hashem, Mohammed; Mahmud, Jamaluddin; Mohamed, Zulkifli
2016-02-01
This paper presents the modelling and control of a two degree of freedom upper extremity exoskeleton by means of an intelligent active force control (AFC) mechanism. The Newton-Euler formulation was used in deriving the dynamic modelling of both the anthropometry based human upper extremity as well as the exoskeleton that consists of the upper arm and the forearm. A proportional-derivative (PD) architecture is employed in this study to investigate its efficacy performing joint-space control objectives. An intelligent AFC algorithm is also incorporated into the PD to investigate the effectiveness of this hybrid system in compensating disturbances. The Mamdani Fuzzy based rule is employed to approximate the estimated inertial properties of the system to ensure the AFC loop responds efficiently. It is found that the IAFC-PD performed well against the disturbances introduced into the system as compared to the conventional PD control architecture in performing the desired trajectory tracking.
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Park, Youngju; Chang, Moonyoung; Kim, Kyeong-Mi; An, Duk-Hyun
2015-05-01
[Purpose] The purpose of this study was to determine the effects of mirror therapy with tasks on upper extremity unction and self-care in stroke patients. [Subjects] Thirty participants were randomly assigned to either an experimental group (n=15) or a control group (n=15). [Methods] Subjects in the experimental group received mirror therapy with tasks, and those in the control group received a sham therapy; both therapies were administered, five times per week for six weeks. The main outcome measures were the Manual Function Test for the paralyzed upper limb and the Functional Independence Measure for self-care performance. [Results] The experimental group had more significant gains in change scores compared with the control group after the intervention. [Conclusion] We consider mirror therapy with tasks to be an effective form of intervention for upper extremity function and self-care in stroke patients.
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Imoto, Takayuki; Kida, Akira; Yokochi, Takashi; Iwase, Mitsunori; Kozawa, Kenji
2018-01-01
Objective This study examined the associations of body flexibility with carotid arterial remodelling, including intima–media thickness (IMT) and plaque formation in middle-aged men. Methods The subjects of this cross-sectional study included 1354 Japanese men aged 35–59 years without histories of stroke or cardiac diseases. The arm extensibility test, which can estimate flexibility of the upper extremity (composed of shoulder external rotation and forearm supination), and the sit-and-reach test were performed. Common carotid IMT and plaque formation (≥1.1 mm) were estimated by ultrasound. Results The proportion of subjects who fully completed the arm extensibility test was 55.0%, and who had plaques in the common carotid artery was 37.8%. IMT was associated with poor arm extensibility (β=–0.073, 95% CI –0.02224 to –0.00041, P=0.004), while plaque formation was associated with poor sit-and-reach (OR 0.98579, 95% CI 0.97257 to 0.99919, P=0.038) after adjustment by all covariates. Conclusions This study demonstrated that poor upper extremity and trunk flexibility were associated with characteristics of early onset of atherosclerosis. Furthermore, these associations were independent of covariates such as age, blood pressure, blood lipids glucose levels and abdominal fat accumulation, handgrip strength and lifestyle, including sleeping, drinking, exercise and smoking habits. Poor flexibility may reflect subclinical atherosclerosis in middle-aged men. PMID:29306892
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Obesity-related differences in neural correlates of force control.
Mehta, Ranjana K; Shortz, Ashley E
2014-01-01
Greater body segment mass due to obesity has shown to impair gross and fine motor functions and reduce balance control. While recent studies suggest that obesity may be linked with altered brain functions involved in fine motor tasks, this association is not well investigated. The purpose of this study was to examine the neural correlates of motor performance in non-obese and obese adults during force control of two upper extremity muscles. Nine non-obese and eight obese young adults performed intermittent handgrip and elbow flexion exertions at 30% of their respective muscle strengths for 4 min. Functional near infrared spectroscopy was employed to measure neural activity in the prefrontal cortex bilaterally, joint steadiness was computed using force fluctuations, and ratings of perceived exertions (RPEs) were obtained to assess perceived effort. Obesity was associated with higher force fluctuations and lower prefrontal cortex activation during handgrip exertions, while RPE scores remained similar across both groups. No obesity-related differences in neural activity, force fluctuation, or RPE scores were observed during elbow flexion exertions. The study is one of the first to examine obesity-related differences on prefrontal cortex activation during force control of the upper extremity musculature. The study findings indicate that the neural correlates of motor activity in the obese may be muscle-specific. Future work is warranted to extend the investigation to monitoring multiple motor-function related cortical regions and examining obesity differences with different task parameters (e.g., longer duration, increased precision demands, larger muscles, etc.).
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Lehnhardt, M; Hirche, C; Daigeler, A; Goertz, O; Ring, A; Hirsch, T; Drücke, D; Hauser, J; Steinau, H U
2012-02-01
Soft tissue sarcomas (STS) are a rare entity with reduced prognosis due to their aggressive biology. For an optimal treatment of STS identification of independent prognostic factors is crucial in order to reduce tumor-related mortality and recurrence rates. The surgical oncological concept includes wide excisions with resection safety margins >1 cm which enables acceptable functional results and reduced rates of amputation of the lower extremities. In contrast, individual anatomy of the upper extremities, in particular of the hand, leads to an intentional reduction of resection margins in order to preserve the extremity and its function with the main intention of tumor-free resection margins. In this study, the oncological safety and outcome as well as functional results were validated by a retrospective analysis of survival rate, recurrence rate and potential prognostic factors. A total of 160 patients who had been treated for STS of the upper extremities were retrospectively included. Independent prognostic factors were analyzed (primary versus recurrent tumor, tumor size, resection status, grade of malignancy, additional therapy, localization in the upper extremity). Kaplan-Meier analyses for survival rate and local control were calculated. Further outcome measures were functional results validated by the DASH score and rate of amputation. In 130 patients (81%) wide tumor excision (R0) was performed and in 19 patients (12%) an amputation was necessary. The 5-year overall survival rate was 70% and the 5-year survival rate in primary tumors was 81% whereas in recurrences 55% relapsed locally. The 10-year overall survival rate was 45% and the 5-year recurrence rate was 18% for primary STS and 43% for recurrent STS. Variance analysis revealed primary versus recurrent tumor, tumor size, resection status and grade of malignancy as independent prognostic factors. Analysis of functional results showed a median DASH score of 37 (0-100; 0=contralateral extremity). The 5-year survival and local recurrence rates are comparable to STS wide resections with safety margins >1 cm for the lower extremities and the trunk. Analysis of prognostic factors revealed resection status and the tumor-free resection margins to be the main goals in STS resection of upper extremity.
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Risk factors associated with PICC-related upper extremity venous thrombosis in cancer patients.
Yi, Xiao-lei; Chen, Jie; Li, Jia; Feng, Liang; Wang, Yan; Zhu, Jia-An; Shen, E; Hu, Bing
2014-03-01
To investigate the incidence and risk factors for peripherally inserted central venous catheters-related upper extremity venous thrombosis in patients with cancer. With the widespread use of peripherally inserted central venous catheters, peripherally inserted central venous catheters-related upper extremity venous thrombosis in patients with cancer leads to increasing morbidity and mortality. It is very important to further explore the incidence and risk factors for peripherally inserted central venous catheters-related venous thrombosis. Consecutive patients with cancer who were scheduled to receive peripherally inserted central venous catheters, between September 2009 and May 2012, were prospectively studied in our centre. They were investigated for venous thrombosis by Doppler sonography three times a day within 30 days after catheter insertion. Univariable and multivariable logistic regressions' analyses were performed to identify the risk factors for peripherally inserted central venous catheters-related thrombosis. A total of 89 patients with cancer were studied in our research. Of these, 81 patients were followed up within one month. The mean interval between catheter insertion and the onset of thrombosis was 12.45 ± 6.17 days. The multivariable analyses showed that chemotherapy history, less activities and diabetes were the key risk factors for thrombosis. Peripherally inserted central venous catheters-related upper extremity venous thrombosis had high incidence rate, and most cases had no significant symptoms. The history of chemotherapy, less activities and diabetes were found to be the key risk factors. It should be routinely scanned in high-risk patients every 3-5 days after catheter insertion, which would then find blood clots in time and reduce the incidence of pulmonary embolism. Risk factors associated with peripherally inserted central venous catheters-related upper extremity venous thrombosis are of critical importance in improving the quality of patients' life. It is very important to grasp the indications to reduce the incidence rate of peripherally inserted central venous catheters-related upper extremity venous thrombosis. © 2013 John Wiley & Sons Ltd.
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Situ, Jie; Wu, Jian; Wang, Jing-lin; Zhu, De-xiang; Zhang, Jian-jie; Liu, Wei-wei; Qin, Zhuo-hui
2012-05-01
To study the sympathetic skin response (SSR) to the effects of N-hexane on autonomic nerves function in patients with chronic N-hexane poisoning. The subjects in present study included 30 controls and 37 cases with chronic N-hexane poisoning. Also 37 patients were divided into 3 subgroups (mild, moderate and severe poisoning) according to diagnostic criteria of occupational diseases. All subjects were examined by SSR test and nerve conduction velocity (NCV) test. All patients were reexamined by SSR and NCV every 1 ∼ 2 months. The differences in SSR parameters (latency, amplitude) among groups were observed. In the severe poisoning subgroup, the changes of SSR and NCV parameters (conduction velocity, amplitude) in different poisoning stages were observed. There were significant differences in SSR latency of upper extremity among groups and the significant differences in SSR amplitude of upper and lower extremity among groups (P < 0.05). No significant differences in SSR parameters were found between the adjacent groups (P > 0.05). There were significant differences in SSR latency of upper extremity during different periods and the significant differences in SSR amplitude of upper and lower extremity during different periods among all groups (P < 0.05). The change of SSR parameters consistent with that in NCV. The longest SSR latency of upper extremity and the smallest SSR amplitudes of upper and lower extremity appears 1 - 2 months earlier than that of the smallest action potential amplitude. The damage of autonomic nerves induced by N-hexane increased with poisoning progresses. The damage of autonomic nerves corresponded with the damage of myelin sheath of large myelinated nerves, but which appeared 1 - 2 months earlier than the damage of axon of large myelinated nerves. SSR test may serve as a method to detect the damage of autonomic nerves function in patients with chronic N-hexane poisoning.
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Using Free Internet Videogames in Upper Extremity Motor Training for Children with Cerebral Palsy.
Sevick, Marisa; Eklund, Elizabeth; Mensch, Allison; Foreman, Matthew; Standeven, John; Engsberg, Jack
2016-06-07
Movement therapy is one type of upper extremity intervention for children with cerebral palsy (CP) to improve function. It requires high-intensity, repetitive and task-specific training. Tedium and lack of motivation are substantial barriers to completing the training. An approach to overcome these barriers is to couple the movement therapy with videogames. This investigation: (1) tested the feasibility of delivering a free Internet videogame upper extremity motor intervention to four children with CP (aged 8-17 years) with mild to moderate limitations to upper limb function; and (2) determined the level of intrinsic motivation during the intervention. The intervention used free Internet videogames in conjunction with the Microsoft Kinect motion sensor and the Flexible Action and Articulated Skeleton Toolkit software (FAAST) software. Results indicated that the intervention could be successfully delivered in the laboratory and the home, and pre- and post- impairment, function and performance assessments were possible. Results also indicated a high level of motivation among the participants. It was concluded that the use of inexpensive hardware and software in conjunction with free Internet videogames has the potential to be very motivating in helping to improve the upper extremity abilities of children with CP. Future work should include results from additional participants and from a control group in a randomized controlled trial to establish efficacy.
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Wu, Zhibin; Li, Nianping; Cui, Haijiao; Peng, Jinqing; Chen, Haowen; Liu, Penglong
2017-01-01
Existing thermal comfort field studies are mainly focused on the relationship between the indoor physical environment and the thermal comfort. In numerous chamber experiments, physiological parameters were adopted to assess thermal comfort, but the experiments’ conclusions may not represent a realistic thermal environment due to the highly controlled thermal environment and few occupants. This paper focuses on determining the relationships between upper extremity skin temperatures (i.e., finger, wrist, hand and forearm) and the indoor thermal comfort. Also, the applicability of predicting thermal comfort by using upper extremity skin temperatures was explored. Field studies were performed in office buildings equipped with split air-conditioning (SAC) located in the hot summer and cold winter (HSCW) climate zone of China during the summer of 2016. Psychological responses of occupants were recorded and physical and physiological factors were measured simultaneously. Standard effective temperature (SET*) was used to incorporate the effect of humidity and air velocity on thermal comfort. The results indicate that upper extremity skin temperatures are good indicators for predicting thermal sensation, and could be used to assess the thermal comfort in terms of physiological mechanism. In addition, the neutral temperature was 24.7 °C and the upper limit for 80% acceptability was 28.2 °C in SET*. PMID:28934173
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Wu, Zhibin; Li, Nianping; Cui, Haijiao; Peng, Jinqing; Chen, Haowen; Liu, Penglong
2017-09-21
Existing thermal comfort field studies are mainly focused on the relationship between the indoor physical environment and the thermal comfort. In numerous chamber experiments, physiological parameters were adopted to assess thermal comfort, but the experiments' conclusions may not represent a realistic thermal environment due to the highly controlled thermal environment and few occupants. This paper focuses on determining the relationships between upper extremity skin temperatures (i.e., finger, wrist, hand and forearm) and the indoor thermal comfort. Also, the applicability of predicting thermal comfort by using upper extremity skin temperatures was explored. Field studies were performed in office buildings equipped with split air-conditioning (SAC) located in the hot summer and cold winter (HSCW) climate zone of China during the summer of 2016. Psychological responses of occupants were recorded and physical and physiological factors were measured simultaneously. Standard effective temperature (SET*) was used to incorporate the effect of humidity and air velocity on thermal comfort. The results indicate that upper extremity skin temperatures are good indicators for predicting thermal sensation, and could be used to assess the thermal comfort in terms of physiological mechanism. In addition, the neutral temperature was 24.7 °C and the upper limit for 80% acceptability was 28.2 °C in SET*.
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Song, P.
A model of the solar chromosphere that consists of two fundamentally different regions, a lower region and an upper region, is proposed. The lower region is covered mostly by weak locally closed magnetic field and small network areas of extremely strong, locally open field. The field in the upper region is relatively uniform and locally open, connecting to the corona. The chromosphere is heated by strong collisional damping of Alfvén waves, which are driven by turbulent motions below the photosphere. The heating rate depends on the field strength, wave power from the photosphere, and altitude in the chromosphere. The wavesmore » in the internetwork area are mostly damped in the lower region, supporting radiation in the lower chromosphere. The waves in the network area, carrying more Poynting flux, are only weakly damped in the lower region. They propagate into the upper region. As the thermal pressure decreases with height, the network field expands to form the magnetic canopy where the damping of the waves from the network area supports radiation in the whole upper region. Because of the vertical stratification and horizontally nonuniform distribution of the magnetic field and heating, one circulation cell is formed in each of the upper and lower regions. The two circulation cells distort the magnetic field and reinforce the funnel-canopy-shaped magnetic geometry. The model is based on classical processes and is semi-quantitative. The estimates are constrained according to observational knowledge. No anomalous process is invoked or needed. Overall, the heating mechanism is able to damp 50% of the total wave energy.« less
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Evaluation of impairment of the upper extremity.
Blair, S J; McCormick, E; Bear-Lehman, J; Fess, E E; Rader, E
1987-08-01
Evaluation of impairment of the upper extremity is the product of a team effort by the physician, occupational therapist, physical therapist, and rehabilitation counselor. A careful recording of the anatomic impairment should be made because this is critical in determining the subsequent functional activities of the extremity. The measurement criteria for clinical and functional evaluation includes condition assessment instruments. Some assess the neurovascular system, others assess movements including the monitoring of articular motion and musculotendinous function. Sensibility assessment instruments measure sympathetic response and detect single joint stimulus, discrimination, quantification, and recognition abilities. A detailed description of each assessment is recorded and physical capacity evaluation is only one component of the entire vocational evaluation. This evaluation answers questions regarding the injured worker's ability to return to his previous job. The work simulator is a useful instrument that allows rehabilitation and testing of the injured upper extremity. Job site evaluation includes assessment criteria for work performance, work behavior, and work environment.
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Gauthier, Lynne V; Kane, Chelsea; Borstad, Alexandra; Strahl, Nancy; Uswatte, Gitendra; Taub, Edward; Morris, David; Hall, Alli; Arakelian, Melissa; Mark, Victor
2017-06-08
Constraint-Induced Movement therapy (CI therapy) is shown to reduce disability, increase use of the more affected arm/hand, and promote brain plasticity for individuals with upper extremity hemiparesis post-stroke. Randomized controlled trials consistently demonstrate that CI therapy is superior to other rehabilitation paradigms, yet it is available to only a small minority of the estimated 1.2 million chronic stroke survivors with upper extremity disability. The current study aims to establish the comparative effectiveness of a novel, patient-centered approach to rehabilitation utilizing newly developed, inexpensive, and commercially available gaming technology to disseminate CI therapy to underserved individuals. Video game delivery of CI therapy will be compared against traditional clinic-based CI therapy and standard upper extremity rehabilitation. Additionally, individual factors that differentially influence response to one treatment versus another will be examined. This protocol outlines a multi-site, randomized controlled trial with parallel group design. Two hundred twenty four adults with chronic hemiparesis post-stroke will be recruited at four sites. Participants are randomized to one of four study groups: (1) traditional clinic-based CI therapy, (2) therapist-as-consultant video game CI therapy, (3) therapist-as-consultant video game CI therapy with additional therapist contact via telerehabilitation/video consultation, and (4) standard upper extremity rehabilitation. After 6-month follow-up, individuals assigned to the standard upper extremity rehabilitation condition crossover to stand-alone video game CI therapy preceded by a therapist consultation. All interventions are delivered over a period of three weeks. Primary outcome measures include motor improvement as measured by the Wolf Motor Function Test (WMFT), quality of arm use for daily activities as measured by Motor Activity Log (MAL), and quality of life as measured by the Quality of Life in Neurological Disorders (NeuroQOL). This multi-site RCT is designed to determine comparative effectiveness of in-home technology-based delivery of CI therapy versus standard upper extremity rehabilitation and in-clinic CI therapy. The study design also enables evaluation of the effect of therapist contact time on treatment outcomes within a therapist-as-consultant model of gaming and technology-based rehabilitation. Clinicaltrials.gov, NCT02631850 .
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Respiratory Muscle Strength Predicts Decline in Mobility in Older Persons
Buchman, A.S.; Boyle, P.A.; Wilson, R.S.; Leurgans, S.; Shah, R.C.; Bennett, D.A.
2008-01-01
Objectives To test the hypothesis that respiratory muscle strength is associated with the rate of change in mobility even after controlling for leg strength and physical activity. Methods Prospective study of 890 ambulatory older persons without dementia who underwent annual clinical evaluations to examine change in the rate of mobility over time. Results In a linear mixed-effect model adjusted for age, sex, and education, mobility declined about 0.12 unit/year, and higher levels of respiratory muscle strength were associated with a slower rate of mobility decline (estimate 0.043, SE 0.012, p < 0.001). Respiratory muscle strength remained associated with the rate of change in mobility even after controlling for lower extremity strength (estimate 0.036, SE 0.012, p = 0.004). In a model that included terms for respiratory muscle strength, lower extremity strength and physical activity together, all three were independent predictors of mobility decline in older persons. These associations remained significant even after controlling for body composition, global cognition, the development of dementia, parkinsonian signs, possible pulmonary disease, smoking, joint pain and chronic diseases. Conclusion Respiratory muscle strength is associated with mobility decline in older persons independent of lower extremity strength and physical activity. Clinical interventions to improve respiratory muscle strength may decrease the burden of mobility impairment in the elderly. PMID:18784416
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Peters, Denise M; McPherson, Aaron K; Fletcher, Blake; McClenaghan, Bruce A; Fritz, Stacy L
2013-09-01
The use of video gaming as a therapeutic intervention has increased in popularity; however, the number of repetitions in comparison with traditional therapy methods has yet to be investigated. The primary purpose of this study was to document and compare the number of repetitions performed while playing 1 of 2 video gaming systems for a time frame similar to that of a traditional therapy session in individuals with chronic stroke. Twelve participants with chronic stroke (mean age, 66.8 ± 8.2 years; time poststroke, 19.2 ± 15.4 months) completed video game play sessions, using either the Nintendo Wii or the Playstation 2 EyeToy. A total of 203 sessions were captured on video record; of these, 50 sessions for each gaming system were randomly selected for analysis. For each selected record, active upper and lower extremity repetitions were counted for a 36-minute segment of the recorded session. The Playstation 2 EyeToy group produced an average of 302.5 (228.1) upper extremity active movements and 189.3 (98.3) weight shifts, significantly higher than the Nintendo Wii group, which produced an average of 61.9 (65.7) upper extremity active movements and 109.7 (78.5) weight shifts. No significant differences were found in steps and other lower extremity active movements between the 2 systems. The Playstation 2 EyeToy group produced more upper extremity active movements and weight shifting movements than the Nintendo Wii group; the number and type of repetitions varied across games. Active gaming (specifically Playstation 2 EyeToy) provided more upper extremity repetitions than those reported in the literature by using traditional therapy, suggesting that it may be a modality to promote increased active movements in individuals poststroke.
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Metlapally, Sangeetha; Tong, Jianliang L.; Tahir, Humza J.; Schor, Clifton M.
2014-01-01
It has been proposed that the accommodation system could perform contrast discrimination between the two dioptric extremes of accommodative microfluctuations to extract directional signals for reflex accommodation. Higher-order aberrations (HOAs) may have a significant influence on the strength of these contrast signals. Our goal was to compute the effect HOAs may have on contrast signals for stimuli within the upper defocus limit by comparing computed microcontrast fluctuations with psychophysical contrast increment thresholds (Bradley & Ohzawa, 1986). Wavefront aberrations were measured while subjects viewed a Maltese spoke stimulus monocularly. Computations were performed for accommodation or disaccommodation stimuli from a 3 Diopter (D) baseline. Microfluctuations were estimated from the standard deviation of the wavefronts over time at baseline. Through-focus Modulation Transfer, optical contrast increments (ΔC), and Weber fractions (ΔC/C) were derived from point spread functions computed from the wavefronts at baseline for 2 and 4 cycles per degree (cpd) components, with and without HOAs. The ΔCs thus computed from the wavefronts were compared with psychophysical contrast increment threshold data. Microfluctuations are potentially useful for extracting directional information for defocus values within 3 D, where contrast increments for the 2 or 4 cpd components exceed psychophysical thresholds. HOAs largely reduce contrast signals produced by microfluctuations, depending on the mean focus error, and their magnitude in individual subjects, and they may shrink the effective stimulus range for reflex accommodation. The upper defocus limit could therefore be constrained by discrimination of microcontrast fluctuations. PMID:25342542
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Pulmonary Function, Muscle Strength and Mortality in Old Age
Buchman, A. S.; Boyle, P. A.; Wilson, R.S.; Gu, Liping; Bienias, Julia L.; Bennett, D. A.
2009-01-01
Numerous reports have linked extremity muscle strength with mortality but the mechanism underlying this association is not known. We used data from 960 older persons without dementia participating in the Rush Memory and Aging Project to test two sequential hypotheses: first, that extremity muscle strength is a surrogate for respiratory muscle strength, and second, that the association of respiratory muscle strength with mortality is mediated by pulmonary function. In a series of proportional hazards models, we first demonstrated that the association of extremity muscle strength with mortality was no longer significant after including a term for respiratory muscle strength, controlling for age, sex, education, and body mass index. Next, the association of respiratory muscle strength with mortality was attenuated by more than 50% and no longer significant after including a term for pulmonary function. The findings were unchanged after controlling for cognitive function, parkinsonian signs, physical frailty, balance, physical activity, possible COPD, use of pulmonary medications, vascular risk factors including smoking, chronic vascular diseases, musculoskeletal joint pain, and history of falls. Overall, these findings suggest that pulmonary function may partially account for the association of muscle strength and mortality. PMID:18755207
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Human adaptations for the visual assessment of strength and fighting ability from the body and face
Sell, Aaron; Cosmides, Leda; Tooby, John; Sznycer, Daniel; von Rueden, Christopher; Gurven, Michael
2008-01-01
Selection in species with aggressive social interactions favours the evolution of cognitive mechanisms for assessing physical formidability (fighting ability or resource-holding potential). The ability to accurately assess formidability in conspecifics has been documented in a number of non-human species, but has not been demonstrated in humans. Here, we report tests supporting the hypothesis that the human cognitive architecture includes mechanisms that assess fighting ability—mechanisms that focus on correlates of upper-body strength. Across diverse samples of targets that included US college students, Bolivian horticulturalists and Andean pastoralists, subjects in the US were able to accurately estimate the physical strength of male targets from photos of their bodies and faces. Hierarchical linear modelling shows that subjects were extracting cues of strength that were largely independent of height, weight and age, and that corresponded most strongly to objective measures of upper-body strength—even when the face was all that was available for inspection. Estimates of women's strength were less accurate, but still significant. These studies are the first empirical demonstration that, for humans, judgements of strength and judgements of fighting ability not only track each other, but accurately track actual upper-body strength. PMID:18945661
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Need to Identify Parameters of Concrete in the Weakest Zone of the Industrial Floor
NASA Astrophysics Data System (ADS)
Stawiski, Bohdan; Radzik, Łukasz
2017-10-01
The ways in which industrial floors are exploited leads to the requirement for the highest strength of their upper zone. Physical phenomena occurring during the compaction and hardening of the concrete cause different strength distributions. In the top zone of industrial floors, the strength is significantly lower (over a dozen MPa) than the strength in the bottom zone (several dozen MPa). Standard tests of control samples do not detect this fact. Processes for the application and finishing of embedded mineral-aggregate hardeners (dry shakes) can be regarded as uncontrolled. The effects of the use of dry shakes are not evaluated. In combination with the phenomenon of bleeding, they often fail by delamination. This paper presents the results of industrial floor testing. The ultrasonic pulse velocity method with dry point contact transducers was used. The results show how upper layer strength was reduced, and how dry shakes application affected the strength of the floor. The strength distribution in hardened concrete, which delaminated from the rest of the floor was presented as well. The extension of compulsory control tests of concrete samples was proposed. In the authors’ opinion, particular attention should be paid to 3 centimetres of the upper layer.
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NASA Astrophysics Data System (ADS)
Dérerová, Jana; Kohút, Igor; Radwan, Anwar H.; Bielik, Miroslav
2017-12-01
The temperature model of the lithosphere along profile passing through the Red Sea region has been derived using 2D integrated geophysical modelling method. Using the extrapolation of failure criteria, lithology and calculated temperature distribution, we have constructed the rheological model of the lithosphere in the area. We have calculated the strength distribution in the lithosphere and constructed the strength envelopes for both compressional and extensional regimes. The obtained results indicate that the strength steadily decreases from the Western desert through the Eastern desert towards the Red Sea where it reaches its minimum for both compressional and extensional regime. Maximum strength can be observed in the Western desert where the largest strength reaches values of about 250-300 MPa within the upper crust on the boundary between upper and lower crust. In the Eastern desert we observe slightly decreased strength with max values about 200-250 MPa within upper crust within 15 km with compression being dominant. These results suggest mostly rigid deformation in the region or Western and Eastern desert. In the Red Sea, the strength rapidly decreases to its minimum suggesting ductile processes as a result of higher temperatures.
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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.
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Upper Extremity Artificial Limb Control as an Issue Related to Movement and Mobility in Daily Living
ERIC Educational Resources Information Center
Wallace, Steve; Anderson, David I.; Trujillo, Michael; Weeks, Douglas L.
2005-01-01
The 1992 NIH Research Planning Conference on Prosthetic and Orthotic Research for the 21st Century (Childress, 1992) recognized that the field of prosthetics lacks theoretical understanding and empirical studies on learning to control an upper-extremity prosthesis. We have addressed this problem using a novel approach in which persons without…
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Ulnar nerve injury associated with trampoline injuries.
Maclin, Melvin M; Novak, Christine B; Mackinnon, Susan E
2004-08-01
This study reports three cases of ulnar neuropathy after trampoline injuries in children. A chart review was performed on children who sustained an ulnar nerve injury from a trampoline accident. In all cases, surgical intervention was required. Injuries included upper-extremity fractures in two cases and an upper-extremity laceration in one case. All cases required surgical exploration with internal neurolysis and ulnar nerve transposition. Nerve grafts were used in two cases and an additional nerve transfer was used in one case. All patients had return of intrinsic hand function and sensation after surgery. Children should be followed for evolution of ulnar nerve neuropathy after upper-extremity injury with consideration for electrical studies and surgical exploration if there is no improvement after 3 months.
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Dabaghi-Richerand, A; Haces-García, F; Capdevila-Leonori, R
2015-01-01
The purpose of this study is to determine the prognostic factors of a satisfactory functional outcome in patients using upper extremity prosthetics with a proximal third forearm stump, and above, level of amputation. All patients with longitudinal deficiencies and traumatic amputations of upper extremity with a level of amputation of proximal third forearm and above were included. A total of 49 patients with unilateral upper extremity amputations that had used the prosthetic for a minimum of 2 years were included in the protocol. The Disability arm shoulder hand (DASH) scale was used to determine a good result with a cut-off of less than 40%. The independent variables were the level of amputation, the etiology for its use, initial age of use and number of hours/day using the prosthesis. It was found that patients with a congenital etiology and those that started using the prosthetic before 6 years of age had better functional results. It was found that when adapting a patient with an upper extremity prosthetic, which has a high rejection rate of up to 49%, better functional outcomes are found in those who started using it before 6 years of age, and preferably because of a congenital etiology. It was also found that the number of hours/day strongly correlates with a favorable functional outcome. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.
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Development of novel 3D-printed robotic prosthetic for transradial amputees.
Gretsch, Kendall F; Lather, Henry D; Peddada, Kranti V; Deeken, Corey R; Wall, Lindley B; Goldfarb, Charles A
2016-06-01
Upper extremity myoelectric prostheses are expensive. The Robohand demonstrated that three-dimensional printing reduces the cost of a prosthetic extremity. The goal of this project was to develop a novel, inexpensive three-dimensional printed prosthesis to address limitations of the Robohand. The prosthesis was designed for patients with transradial limb amputation. It is shoulder-controlled and externally powered with an anthropomorphic terminal device. The user can open and close all five fingers, and move the thumb independently. The estimated cost is US$300. After testing on a patient with a traumatic transradial amputation, several advantages were noted. The independent thumb movement facilitated object grasp, the device weighed less than most externally powered prostheses, and the size was easily scalable. Limitations of the new prosthetic include low grip strength and decreased durability compared to passive prosthetics. Most children with a transradial congenital or traumatic amputation do not use a prosthetic. A three-dimensional printed shoulder-controlled robotic prosthesis provides a cost effective, easily sized and highly functional option which has been previously unavailable. © The International Society for Prosthetics and Orthotics 2015.
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Streptococcus intermedius: an unusual cause of spinal epidural abscess
Ramhmdani, Seba
2017-01-01
Spinal epidural abscess (SEA) following dental procedures is a rarely reported entity. Here, we present a unique case of a 74-year-old immunocompetent man who developed severe lower back pain and bilateral lower extremity weakness 4 days following two root canal procedures. Lumbar spine magnetic resonance imaging (MRI) showed several pockets of epidural abscesses extending from L1 through L5. Blood cultures grew Streptococcus intermedius, an anaerobic commensal bacterium of the normal flora of the mouth and upper airways. The patient was treated with IV penicillin for 7 days but his symptoms continued to deteriorate. A repeat MRI showed extension of the epidural abscess to T10–T11 level. The patient was emergently transferred to our hospital where he underwent bilateral decompressive laminectomy of T10 through S1 and abscess evacuation. Pus culture was positive for Streptococcus intermedius, which confirmed the diagnosis and the treatment plan. He was discharged on intravenous (IV) penicillin for 6 weeks. His symptoms improved significantly postoperatively as he retained his baseline strength in his lower extremity. PMID:28744508
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Schmid, Arlene A; Atler, Karen E; Malcolm, Matthew P; Grimm, Laura A; Klinedinst, Tara C; Marchant, David R; Marchant, Tasha P; Portz, Jennifer Dickman
2018-05-01
Assess pre to-post outcomes for people with chronic pain and Type 2 Diabetes Mellitus (T2DM) randomized to an 8-week yoga intervention or usual care. Participants were included if they self-reported: chronic pain; T2DM; >18 years old; no exercise restrictions or consistent yoga; and consented to the study. After yoga, there were significant improvements in: Brief Pain Inventory pain interference (49 ± 15.00 vs. 41.25 ± 19.46, p = .034); Fullerton Advanced Balance scale (14.2 ± 14.1 vs. 20.4 ± 13.5, p = .03); upper extremity strength (7.7 ± 6.3 vs.10.8 ± 6.5, p = .02); lower extremity strength (4.1 ± 3.8 vs. 6.7 ± 4.8, p = .02); and RAND 36-item Health Survey quality of life scores (81.1 ± 7.7 vs. 91.9 ± 8.9, p = .04). Balance scores became significantly worse during the 8 weeks for people randomized to the control (27.1 ± 9.9 vs. 21.7 ± 13.4, = p.01). Data from this small RCT indicates yoga may be therapeutic and may improve multiple outcomes in this seemingly at-risk population. NCT03010878. Copyright © 2018 Elsevier Ltd. All rights reserved.
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Response of upper ocean cooling off northeastern Taiwan to typhoon passages
NASA Astrophysics Data System (ADS)
Zheng, Zhe-Wen; Zheng, Quanan; Gopalakrishnan, Ganesh; Kuo, Yi-Chun; Yeh, Ting-Kuang
2017-07-01
A comprehensive investigation of the typhoon induced upper ocean processes and responses off northeastern Taiwan was conducted. Using the Regional Ocean Modeling System, the upper ocean responses of all typhoons striking Taiwan between 2005 and 2013 were simulated. In addition to Kuroshio intrusion, the present study demonstrates another important mechanism of typhoon induced near-inertial currents over the continental shelf of East China Sea, which can also trigger a distinct cooling (through entrainment mixing) within this region. Results indicate that the processes of typhoon inducing distinct cooling off northeastern Taiwan are conditional phenomena (only ∼12% of typhoons passing Taiwan triggered extreme cooling there). Subsequently, by executing a series of sensitivity experiments and systematic analyses on the behaviors and background conditions of all those typhoon cases, key criteria determining the occurrences of cooling through both mechanisms were elucidated. Occurrences of cooling through the Kuroshio intrusion mechanism are determined mainly by the strength of the local wind over northeastern Taiwan. A distinct cooling triggered by enhanced near-inertial currents is shown to be associated with the process of wind-current resonance. Both processes of Kuroshio intrusion and enhanced near-inertial currents are dominated by wind forcing rather than upper oceanic conditions. Based on the recent findings on the possible dynamic linkage between sea surface temperature near northeast Taiwan and local weather systems, the results elucidated in this study lay the foundation for further improvement in the regional weather prediction surrounding northeast Taiwan.
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Suprascapular neuropathy after intensive progressive resistive exercise: case report.
Agre, J C; Ash, N; Cameron, M C; House, J
1987-04-01
A healthy 30-year-old man developed pain in the posterior shoulder region approximately one month after initiating an intensive weightlifting program to increase upper extremity strength. This program especially emphasized shoulder abduction exercises. The pain intensified as he continued and finally he noted weakness of the involved shoulder, which led him to seek medical advice. Examination was normal except for atrophy of the infraspinatus muscle on the involved side and decreased strength of shoulder abduction and external rotation. Electromyographic examination demonstrated 3+ positive sharp waves in the infraspinatus muscle, delayed conduction to the supraspinatus muscle, and absence of an evoked response to the infraspinatus muscle. Surgical decompression of the suprascapular nerve within the suprascapular notch was then performed. Two weeks after surgery the pain was much less and the conduction velocities had improved. Eight months after surgery the patient was free of pain, the conduction velocities had returned to normal, and electromyography revealed reinnervation of the denervated muscle fibers. Intensive shoulder exercise, especially involving repeated forceful abduction movements, should be considered in the etiology of suprascapular neuropathy.
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Tomita, Yoshihito; Arima, Kazuhiko; Kanagae, Mitsuo; Okabe, Takuhiro; Mizukami, Satoshi; Nishimura, Takayuki; Abe, Yasuyo; Goto, Hisashi; Horiguchi, Itsuko; Aoyagi, Kiyoshi
2015-01-01
Abstract Our aim was to explore the association of physical performance and pain with fear of falling among community-dwelling Japanese women. The subjects were 278 women aged 65 years and over. We collected information on fear of falling, painful joints, comorbidities, falls in the previous year, and cataracts. Walking time (distance of 6 m), chair stand time (5 times), grip strength, the timed up and go test (TUG), and functional reach were measured. The prevalence of fear of falling was 36.3%, and it increased with age, but it was not significant (P = 0.081). Multivariate logistic regression analysis showed that poor physical performance (longer walking time, longer chair stand time, weaker grip strength, and longer TUG) and pain (low back, and upper and lower extremity pain) were significantly associated with fear of falling after adjusting for age, body mass index, comorbidities, falls in the previous year, and cataracts. Maintaining physical functioning and managing pain may be important for elderly women with fear of falling. PMID:26334906
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Tomita, Yoshihito; Arima, Kazuhiko; Kanagae, Mitsuo; Okabe, Takuhiro; Mizukami, Satoshi; Nishimura, Takayuki; Abe, Yasuyo; Goto, Hisashi; Horiguchi, Itsuko; Aoyagi, Kiyoshi
2015-09-01
Our aim was to explore the association of physical performance and pain with fear of falling among community-dwelling Japanese women.The subjects were 278 women aged 65 years and over. We collected information on fear of falling, painful joints, comorbidities, falls in the previous year, and cataracts. Walking time (distance of 6 m), chair stand time (5 times), grip strength, the timed up and go test (TUG), and functional reach were measured.The prevalence of fear of falling was 36.3%, and it increased with age, but it was not significant (P = 0.081). Multivariate logistic regression analysis showed that poor physical performance (longer walking time, longer chair stand time, weaker grip strength, and longer TUG) and pain (low back, and upper and lower extremity pain) were significantly associated with fear of falling after adjusting for age, body mass index, comorbidities, falls in the previous year, and cataracts.Maintaining physical functioning and managing pain may be important for elderly women with fear of falling.
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Systematic review of the effectiveness of mirror therapy in upper extremity function.
Ezendam, Daniëlle; Bongers, Raoul M; Jannink, Michiel J A
2009-01-01
This review gives an overview of the current state of research regarding the effectiveness of mirror therapy in upper extremity function. A systematic literature search was performed to identify studies concerning mirror therapy in upper extremity. The included journal articles were reviewed according to a structured diagram and the methodological quality was assessed. Fifteen studies were identified and reviewed. Five different patient categories were studied: two studies focussed on mirror therapy after an amputation of the upper limb, five studies focussed on mirror therapy after stroke, five studies focussed on mirror therapy with complex regional pain syndrome type 1 (CRPS1) patients, one study on mirror therapy with complex regional pain syndrome type 2 (CRPS2) and two studies focussed on mirror therapy after hand surgery other than amputation. Most of the evidence for mirror therapy is from studies with weak methodological quality. The present review showed a trend that mirror therapy is effective in upper limb treatment of stroke patients and patients with CRPS, whereas the effectiveness in other patient groups has yet to be determined.
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Ray, Juliet J; Alvarez, Angel D; Ulbrich, Sondra L; Lessner-Eisenberg, Sharon; Satahoo, Shevonne S; Meizoso, Jonathan P; Karcutskie, Charles A; Mundra, Leela S; Namias, Nicholas; Pizano, Louis R; Schulman, Carl I
Whole body vibration (WBV) has been shown to improve strength in extremities with healed burn wounds. We hypothesize that WBV reduces pain during rehabilitation compared to standard therapy alone. Patients with ≥1% TBSA burn to one or more extremities from October 2014 to December 2015 were randomized to vibration (VIBE) or control. Each burned extremity was tested separately within the assigned group. Patients underwent one to three therapy sessions (S1, S2, S3) consisting of five upper and/or lower extremity exercises with or without WBV. Pain was assessed pre-, mid-, and postsession on a scale of 1 to 10. Mean pain scores at S1 to S3 were compared between groups with paired samples t-tests. An independent t-test was used to compare differences in pain scores between groups. Continuous variables were compared using a t-test or Mann-Whitney U test, and categorical variables were compared using a χ or Fisher's exact test, as appropriate. Forty-eight randomized test extremities (VIBE = 26, control = 22) were analyzed from a total of 31 subjects. There were no significant differences between groups in age, gender, overall TBSA, TBSA in the test extremity, pain medication use before therapy session, or skin grafting before therapy session. At S1, S2, and S3, there was a statistically significant decrease in mid- and postsession pain compared to presession pain in VIBE vs controls. Exposure to WBV decreased pain during and after physical therapy. This modality may be applicable to a variety of soft tissue injuries and warrants additional investigation.
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Gonzalez, Brian D; Jim, Heather S L; Small, Brent J; Sutton, Steven K; Fishman, Mayer N; Zachariah, Babu; Heysek, Randy V; Jacobsen, Paul B
2016-05-01
The purpose of the study is to examine changes in muscle strength and self-reported physical functioning in men receiving androgen deprivation therapy (ADT) for prostate cancer compared to matched controls. Prostate cancer patients scheduled to begin ADT (n = 62) were assessed within 20 days of starting ADT and 6 and 12 months later. Age and geographically matched prostate cancer controls treated with prostatectomy only (n = 86) were assessed at similar time intervals. Grip strength measured upper body strength, the Chair Rise Test measured lower body strength, and the SF-12 Physical Functioning scale measured self-reported physical functioning. As expected, self-reported physical functioning and upper body muscle strength declined in ADT recipients but remained stable in prostate cancer controls. Contrary to expectations, lower body muscle strength remained stable in ADT recipients but improved in prostate cancer controls. Higher Gleason scores, more medical comorbidities, and less exercise at baseline predicted greater declines in physical functioning in ADT recipients. ADT is associated with declines in self-reported physical functioning and upper body muscle strength as well as worse lower body muscle strength relative to prostate cancer controls. These findings should be included in patient education regarding the risks and benefits of ADT. Findings also underscore the importance of conducting research on ways to prevent or reverse declines in physical functioning in this patient population.
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Isometric Arm Strength and Subjective Rating of Upper Limb Fatigue in Two-Handed Carrying Tasks
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
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Isometric arm strength and subjective rating of upper limb fatigue in two-handed carrying tasks.
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.
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Knoop, J; Steultjens, M P M; Roorda, L D; Lems, W F; van der Esch, M; Thorstensson, C A; Twisk, J W R; Bierma-Zeinstra, S M A; van der Leeden, M; Dekker, J
2015-06-01
Although exercise therapy is effective for reducing pain and activity limitations in patients with knee osteoarthritis (OA), the underlying mechanisms are unclear. This study aimed to evaluate if improvements in neuromuscular factors (i.e. upper leg muscle strength and knee proprioception) underlie the beneficial effects of exercise therapy in patients with knee OA. Secondary analyses from a randomised controlled trial, with measurements at baseline, 6 weeks, 12 weeks and 38 weeks. Rehabilitation centre. One hundred and fifty-nine patients diagnosed with knee OA. Exercise therapy. Changes in pain [numeric rating scale (NRS)] and activity limitations [Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical function subscale and get-up-and-go test] during the study period. Independent variables were changes in upper leg muscle strength and knee joint proprioception (i.e. motion sense) during the study period. Longitudinal regression analyses (generalised estimating equation) were performed to analyse associations between changes in upper leg muscle strength and knee proprioception with changes in pain and activity limitations. Improved muscle strength was significantly associated with reductions in NRS pain {B coefficient -2.5 [95% confidence interval (CI) -3.7 to -1.4], meaning that every change of 1 unit of strength was linked to a change of -2.5 units of pain}, WOMAC physical function (-8.8, 95% CI -13.4 to -4.2) and get-up-and-go test (-1.7, 95% CI -2.4 to -1.0). Improved proprioception was not significantly associated with better outcomes of exercise therapy (P>0.05). Upper leg muscle strengthening is one of the mechanisms underlying the beneficial effects of exercise therapy in patients with knee OA. Copyright © 2014 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.
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Lee, Yongwoo; Choi, Wonjae; Lee, Kyeongjin; Song, Changho; Lee, Seungwon
2017-10-01
Avatar-based three-dimensional technology is a new approach to improve physical function in older adults. The aim of this study was to use three-dimensional video gaming technology in virtual reality training to improve postural balance and lower extremity strength in a population of community-dwelling older adults. The experimental group participated in the virtual reality training program for 60 min, twice a week, for 6 weeks. Both experimental and control groups were given three times for falls prevention education at the first, third, and fifth weeks. The experimental group showed significant improvements not only in static and dynamic postural balance but also lower extremity strength (p < .05). Furthermore, the experimental group was improved to overall parameters compared with the control group (p < .05). Therefore, three-dimensional video gaming technology might be beneficial for improving postural balance and lower extremity strength in community-dwelling older adults.
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Bot, Sandra D M; Terwee, Caroline B; van der Windt, Daniëlle A W M; van der Beek, Allard J; Bouter, Lex M; Dekker, Joost
2007-08-01
To study work-related physical and psychosocial risk factors for sick leave among patients who have visited their general practitioner for neck or upper extremity complaints. Three hundred and forty two patients with neck or upper extremity complaints completed self-report questionnaires at baseline and after 3 months. Cox regression models were used to investigate the association between work-related risk factors and sick leave (i.e., lost days from work due to neck or upper extremity complaints in 3 months). Effect modification by sick leave at baseline, sex, worrying and musculoskeletal co-morbidity was evaluated by adding product terms to the regression models. In the subgroup of patients who scored high on the pain copying scale "worrying" the hazard ratio of sick leave was 1.32 (95% CI 1.07-1.62) per 10% increase in heavy physical work. The subgroup of patients who were sitting for long periods of time had a reduced risk of sick leave as compared to patients who did not spend a lot of time sitting, again only in patients who scored high on the pain coping scale "worrying" (adjusted HR=0.17, 95%-CI 0.04-0.72). Other work-related risk factors were not significantly related to sick leave. Heavy physical work increased the risk of sick leave and prolonged sitting reduced the risk of sick leave in a subgroup of patients who worried much about their pain. Additional large longitudinal studies of sufficiently large size among employees with neck or upper extremity complaints are needed to confirm our results.
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Factors favorable to frequent extreme precipitation in the upper Yangtze River Valley
NASA Astrophysics Data System (ADS)
Tian, Baoqiang; Fan, Ke
2013-08-01
Extreme precipitation events in the upper Yangtze River Valley (YRV) have recently become an increasingly important focus in China because they often cause droughts and floods. Unfortunately, little is known about the climate processes responsible for these events. This paper investigates factors favorable to frequent extreme precipitation events in the upper YRV. Our results reveal that a weakened South China Sea summer monsoon trough, intensified Eurasian-Pacific blocking highs, an intensified South Asian High, a southward subtropical westerly jet and an intensified Western North Pacific Subtropical High (WNPSH) increase atmospheric instability and enhance the convergence of moisture over the upper YRV, which result in more extreme precipitation events. The snow depth over the eastern Tibetan Plateau (TP) in winter and sea surface temperature anomalies (SSTAs) over three key regions in summer are important external forcing factors in the atmospheric circulation anomalies. Deep snow on the Tibetan Plateau in winter can weaken the subsequent East Asian summer monsoon circulation above by increasing the soil moisture content in summer and weakening the land-sea thermal contrast over East Asia. The positive SSTA in the western North Pacific may affect southwestward extension of the WNPSH and the blocking high over northeastern Asia by arousing the East Asian-Pacific pattern. The positive SSTA in the North Atlantic can affect extreme precipitation event frequency in the upper YRV via a wave train pattern along the westerly jet between the North Atlantic and East Asia. A tripolar pattern from west to east over the Indian Ocean can strengthen moisture transport by enhancing Somali cross-equatorial flow.
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Munaretto, Joseph M; McNitt-Gray, Jill L; Flashner, Henryk; Requejo, Philip S
2013-08-01
Repetitive loading during manual wheelchair propulsion (WCP) is associated with overuse injury to the upper extremity (UE). The aim of this study was to determine how RF redirection and load distribution are affected by changes upper extremity kinematic modifications associated with modifications in seat positions during a WCP task. The aim of this study was to determine how RF redirection and load distribution are affected by upper extremity kinematic changes associated with seat position adjustment during a WCP task. Dynamic simulations using an experiment-based multi-link inverse dynamics model were used to generate solutions for redistributing UE mechanical load in different seating positions without decrements in WCP task performance. Experimental RF and kinematic data were collected for one subject propelling at a self-selected speed and used as input into the model. Shoulder/axle distance, wrist angular position, and RF direction were systematically modified to simulate how the mechanical demand imposed on the upper extremity (elbow and shoulder net joint moments (NJMs) and net joint forces) may vary. Load distribution depended on UE orientation relative to the wheel. At peak force, lower shoulder/axle distances and more anterior wrist positions on the pushrim allowed for more extended elbow positions and reduced total NJM load. Simulation results incorporating subject-specific data may provide mechanically based information to guide clinical interventions that aim to maintain WCP performance and redistribute load by modifying RF direction, seat configuration and hand/rim interaction. Copyright © 2012 IPEM. Published by Elsevier Ltd. All rights reserved.
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Gelen, Ertugrul; Dede, Muhittin; Bingul, Bergun Meric; Bulgan, Cigdem; Aydin, Mensure
2012-01-01
The purpose of this study was to compare the acute effects of static stretching; dynamic exercises and high volume upper extremity plyometric activity on tennis serve performance. Twenty-six elite young tennis players (15.1 ± 4.2 years, 167.9 ± 5.8 cm and 61.6 ± 8.1 kg) performed 4 different warm-up (WU) routines in a random order on non-consecutive days. The WU methods consisted of traditional WU (jogging, rally and serve practice) (TRAD); traditional WU and static stretching (TRSS); traditional WU and dynamic exercise (TRDE); and traditional WU and high volume upper extremity plyometric activity (TRPLYP). Following each WU session, subjects were tested on a tennis serve ball speed test. TRAD, TRSS, TRDE and TRPLYO were compared by repeated measurement analyses of variance and post-hoc comparisons. In this study a 1 to 3 percent increase in tennis serve ball speed was recorded in TRDE and TRPLYO when compared to TRAD (p< 0.05). However, no significant change in ball speed performance between TRSS and TRAD. (p> 0.05). ICCs for ball speed showed strong reliability (0.82 to 0.93) for the ball speed measurements.The results of this study indicate that dynamic and high volume upper extremity plyometric WU activities are likely beneficial to serve speed of elite junior tennis players. Key points After the traditional warm up in tennis, static stretching has no effect on serve speed. Tennis players should perform dynamic exercises and/or high volume upper extremity plyometric activities to improve their athletic performance. PMID:24150068
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Jones, Margaret T
2014-01-01
Purpose To determine the impact of inclusion of a band or chain compensatory acceleration training (CAT), in a 5-week training phase, on maximal upper body strength during a 14-week off-season strength and conditioning program for collegiate male athletes. Patients and methods Twenty-four National Collegiate Athletic Association (NCAA) collegiate baseball players, who were familiar with the current strength and conditioning program and had a minimum of 1 year of formal collegiate strength and conditioning experience, participated in this off-season training study. None of the men had participated in CAT before. Subjects were matched following a maximal effort (1-repetition maximum [1-RM]) bench press test in week 1, then were randomly assigned into a band-based CAT group or a chain-based CAT group and participated in a 5-week training phase that included bench pressing twice per week. Upper body strength was measured by 1-RM bench press again at week 6. A 2 × 2 mixed factorial (method × time) analysis of variance was calculated to compare differences across groups. The alpha level was set at P<0.05. Results No difference (F1,22=0.04, P=0.84) existed between the band-based CAT and chain-based CAT groups. A significant difference was observed between pre- and posttests of 1-RM bench (F1,22=88.46, P=0.001). Conclusion A 5-week band CAT or chain CAT training program used in conjunction with an off-season strength and conditioning program can increase maximal upper body strength in collegiate baseball athletes. Using band CAT and/or chain CAT as a training modality in the off-season will vary the training stimulus from the traditional and likely help to maintain the athlete’s interest. PMID:25177154
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Fractures from trampolines: results from a national database, 2002 to 2011.
Loder, Randall T; Schultz, William; Sabatino, Meagan
2014-01-01
No study specifically analyzes trampoline fracture patterns across a large population. The purpose of this study was to determine such patterns. We queried the National Electronic Injury Surveillance System database for trampoline injuries between 2002 and 2011, and the patients were analyzed by age, sex, race, anatomic location of the injury, geographical location of the injury, and disposition from the emergency department (ED). Statistical analyses were performed with SUDAAN 10 software. Estimated expenses were determined using 2010 data. There were an estimated 1,002,735 ED visits for trampoline-related injuries; 288,876 (29.0%) sustained fractures. The average age for those with fractures was 9.5 years; 92.7% were aged 16 years or younger; 51.7% were male, 95.1% occurred at home, and 9.9% were admitted. The fractures were located in the upper extremity (59.9%), lower extremity (35.7%), and axial skeleton (spine, skull/face, rib/sternum) (4.4%-spine 1.0%, skull/face 2.9%, rib/sternum 0.5%). Those in the axial skeleton were older (16.5 y) than the upper extremity (8.7 y) or lower extremity (10.0 y) (P<0.0001) and more frequently male (67.9%). Lower extremity fractures were more frequently female (54.0%) (P<0.0001). The forearm (37%) and elbow (19%) were most common in the upper extremity; elbow fractures were most frequently admitted (20.0%). The tibia/fibula (39.5%) and ankle (31.5%) were most common in the lower extremity; femur fractures were most frequently admitted (57.9%). Cervical (36.4%) and lumbar (24.7%) were most common locations in the spine; cervical fractures were the most frequently admitted (75.6%). The total ED expense for all trampoline injuries over this 10-year period was $1.002 billion and $408 million for fractures. Trampoline fractures most frequently involve the upper extremity followed by the lower extremity, >90% occur in children. The financial burden to society is large. Further efforts for prevention are needed.
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ERIC Educational Resources Information Center
Cintas, Holly Lea; Parks, Rebecca; Don, Sarah; Gerber, Lynn
2011-01-01
Content validity and reliability of the Brief Assessment of Motor Function (BAMF) Upper Extremity Gross Motor Scale (UEGMS) were evaluated in this prospective, descriptive study. The UEGMS is one of five BAMF ordinal scales designed for quick documentation of gross, fine, and oral motor skill levels. Designed to be independent of age and…
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ERIC Educational Resources Information Center
Ringenbach, Shannon D. R; Albert, Andrew R.; Chen, Chih-Chia; Alberts, Jay L.
2014-01-01
The aim of this study was to examine the effectiveness of 2 modes of exercise on cognitive and upper extremity movement functioning in adolescents with Down syndrome (DS). Nine participants randomly completed 3 interventions over 3 consecutive weeks. The interventions were: (a) voluntary cycling (VC), in which participants cycled at their…
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Kim, Arim; Lee, Hye-Sun; Song, Chiang-Soon
2017-01-01
[Purpose] The purpose of this study was to examine the effects of interactive metronome training on the postural stability and upper extremity function of an individual with Parkinson's disease. [Subject and Methods] The participant of this case study was a 75-year-old female with Parkinson's disease diagnosed 7 years prior. This study was a single-subject research with an A-B-A design. She received IM training during the treatment phase (B phase) for 40 minutes per session. She was assessed pretest and posttest using the Berg balance scale and Wolf motor function test, and at baseline and the treatment phase using the measured box-and-block test and a Tetrax system. [Results] After training, the patient's static and dynamic balance, functional activity, and performance time of the upper extremity improved. Interactive metronome therapy improved the manual dexterity of both hands. Interactive metronome therapy also improved the limit of stability of the Parkinson's disease. [Conclusion] Though a case study, the results of this study suggest that IM therapy is effective at restoring the postural stability and upper extremity function of patients with Parkinson's disease.
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Kim, Arim; Lee, Hye-Sun; Song, Chiang-Soon
2017-01-01
[Purpose] The purpose of this study was to examine the effects of interactive metronome training on the postural stability and upper extremity function of an individual with Parkinson’s disease. [Subject and Methods] The participant of this case study was a 75-year-old female with Parkinson’s disease diagnosed 7 years prior. This study was a single-subject research with an A-B-A design. She received IM training during the treatment phase (B phase) for 40 minutes per session. She was assessed pretest and posttest using the Berg balance scale and Wolf motor function test, and at baseline and the treatment phase using the measured box-and-block test and a Tetrax system. [Results] After training, the patient’s static and dynamic balance, functional activity, and performance time of the upper extremity improved. Interactive metronome therapy improved the manual dexterity of both hands. Interactive metronome therapy also improved the limit of stability of the Parkinson’s disease. [Conclusion] Though a case study, the results of this study suggest that IM therapy is effective at restoring the postural stability and upper extremity function of patients with Parkinson’s disease. PMID:28210066
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Li, Mingfen; Liu, Ye; Wu, Yi; Liu, Sirao; Jia, Jie; Zhang, Liqing
2014-06-01
We investigated the efficacy of motor imagery-based Brain Computer Interface (MI-based BCI) training for eight stroke patients with severe upper extremity paralysis using longitudinal clinical assessments. The results were compared with those of a control group (n = 7) that only received FES (Functional Electrical Stimulation) treatment besides conventional therapies. During rehabilitation training, changes in the motor function of the upper extremity and in the neurophysiologic electroencephalographic (EEG) were observed for two groups. After 8 weeks of training, a significant improvement in the motor function of the upper extremity for the BCI group was confirmed (p < 0.05 for ARAT), simultaneously with the activation of bilateral cerebral hemispheres. Additionally, event-related desynchronization (ERD) of the affected sensorimotor cortexes (SMCs) was significantly enhanced when compared to the pretraining course, which was only observed in the BCI group (p < 0.05). Furthermore, the activation of affected SMC and parietal lobe were determined to contribute to motor function recovery (p < 0.05). In brief, our findings demonstrate that MI-based BCI training can enhance the motor function of the upper extremity for stroke patients by inducing the optimal cerebral motor functional reorganization.
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Using Free Internet Videogames in Upper Extremity Motor Training for Children with Cerebral Palsy
Sevick, Marisa; Eklund, Elizabeth; Mensch, Allison; Foreman, Matthew; Standeven, John; Engsberg, Jack
2016-01-01
Movement therapy is one type of upper extremity intervention for children with cerebral palsy (CP) to improve function. It requires high-intensity, repetitive and task-specific training. Tedium and lack of motivation are substantial barriers to completing the training. An approach to overcome these barriers is to couple the movement therapy with videogames. This investigation: (1) tested the feasibility of delivering a free Internet videogame upper extremity motor intervention to four children with CP (aged 8–17 years) with mild to moderate limitations to upper limb function; and (2) determined the level of intrinsic motivation during the intervention. The intervention used free Internet videogames in conjunction with the Microsoft Kinect motion sensor and the Flexible Action and Articulated Skeleton Toolkit software (FAAST) software. Results indicated that the intervention could be successfully delivered in the laboratory and the home, and pre- and post- impairment, function and performance assessments were possible. Results also indicated a high level of motivation among the participants. It was concluded that the use of inexpensive hardware and software in conjunction with free Internet videogames has the potential to be very motivating in helping to improve the upper extremity abilities of children with CP. Future work should include results from additional participants and from a control group in a randomized controlled trial to establish efficacy. PMID:27338485
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A Field Test for Upper Body Strength and Endurance.
ERIC Educational Resources Information Center
Nelson, Jack K.; And Others
1991-01-01
Researchers studied the reliability of the modified push-up test in measuring upper body strength and endurance in elementary through college students. It also examined the accuracy of partner scoring. The test proved much easier to administer than the regular floor push-up. It was valid and reliable for all students and suitable for partner…
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Exogrip: assisted hand strength glove - biomed 2011.
Best, Jade E; Bostick, Nehemiah F; Connelly, John R; Dunn, Michael G; Gelles, Richard A; Norvell, Elizabeth K; Waugaman, William B; Mims, Capt Willie H
2011-01-01
A large number of American troops fighting in Afghanistan and Iraq have received wounds in their upper extremities leading to significant nerve damage and loss of strength. These injuries impair their ability to perform day-to-day tasks such as lifting a cup of coffee or opening a door. Although the cause of some injuries in service-people is often unique to their employment, civilian employees in other industries are also plagued with similar physical damage due to other kinds of injuries. Our goal is to develop a device to augment the strength of injured troops and civilian workers so they can perform everyday tasks despite their physical limitations. The ExoGrip is a glove designed to provide this necessary strength augmentation. The ExoGrip consists primarily of pressure sensors, linear actuators, and a microcontroller to provide a force multiplier based on a persons strength. The goal of the first phase of the project was to conduct research and also produce a working prototype of one finger. This goal was achieved by a group of classmates who started the project a year before. Their research and feasibility analysis ended in the mechanical movement of a single finger when the sensors were activated. The next phase of this project is to design and integrate a working prototype that manipulates all four fingers, while keeping the thumb in a fixed position. This paper describes the integration of new microcontrollers, linear actuators utilizing pulse width modulation technology, and improved pressure sensors needed to manipulate the fingers, as well as laying the foundation for future testing and development of a final product.
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Evaluation of a Shoulder Injury Prevention Program in Wheelchair Basketball.
Wilroy, Jereme; Hibberd, Elizabeth
2017-11-15
Previous literature has theorized that alterations in shoulder physical characteristics are present in wheelchair athletes and contribute to shoulder pain and injury. Limited empirical evidence is present that evaluates the effectiveness of a shoulder injury prevention program focusing on improving these altered characteristics. To evaluate the effectiveness of a 6-week intervention program at improving characteristics that increases the risk of developing pain or shoulder injury. Pre and post-test. Home-based and controlled laboratory. Seven collegiate wheelchair athletes. Shoulder range of motion (ROM) and scapular muscle strength were assessed, and a 5-minute injury prevention program was taught to participants. Participants completed the intervention 3 times per week for 6 weeks. Following completion of the program, a post-intervention screening was performed. Internal/external rotation ROM, retraction strength, and internal/external rotation strength. Participants experienced a significant improvement in dominant limb shoulder internal rotation ROM (t6=3.56,p=0.012) with an average increase of 11.4° of IR ROM, and a significant improvement in dominant limb shoulder external rotation (ER) ROM (t6=2.79,p=0.032) with an average increase of 8.0° of ER ROM. There were no significant increases in shoulder IR or ER strength and scapular retraction strength (p>0.05). Improvements in ROM have previously been linked to decreases in shoulder pain and injury in other upper-extremity dominant sports by improving scapular kinematics. These results provide evidence that a 6-week strengthening and stretching intervention program may decrease risk factors for shoulder injury in wheelchair athletics.
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Boschman, J S; Noor, A; Lundström, R; Nilsson, T; Sluiter, J K; Hagberg, M
2017-08-01
The purpose was to increase job-specific knowledge about individual and work-related factors and their relationship with current and future work ability (WA). We studied cross-sectional relationships between mental demands, physical exertion during work, grip strength, musculoskeletal pain in the upper extremities and WA and the relationships between these variables and WA 11 years later. We used a dataset of a prospective cohort study (1997-2008) among employees of an engineering plant (n = 157). The cohort was surveyed by means of tests and written questions on work demands, musculoskeletal health, WA score (WAS; 0-10), and mental and physical WA. Spearman correlation coefficients and logistic regression analysis were used. Among manual workers, we found weak correlations between grip strength and current and future physical WA. We did not find predictors for future poor WA among the manual workers. Among the office workers, we found that musculoskeletal pain was moderately and negatively related to current WAS and physical WA. More handgrip strength related to better future WAS and physical WA. Musculoskeletal pain (OR 1.67 p < 0.01) and lower handgrip strength (OR 0.91 p < 0.05) predicted future poor WA among office workers. Our results showed cross-sectional and longitudinal relationships between musculoskeletal health and work ability depending on occupation. However, the present implies that predicting work ability in the far future based on health surveillance data is rather difficult. Testing the musculoskeletal system (grip strength) and asking workers' about their musculoskeletal health seems relevant when monitoring work ability.
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Muscle volume, strength, endurance, and exercise loads during 6-month missions in space.
Gopalakrishnan, Raghavan; Genc, Kerim O; Rice, Andrea J; Lee, Stuart M C; Evans, Harlan J; Maender, Christian C; Ilaslan, Hakan; Cavanagh, Peter R
2010-02-01
Decrements in muscular strength during long-duration missions in space could be mission-critical during construction and exploration activities. The purpose of this study was to quantify changes in muscle volume, strength, and endurance of crewmembers on the International Space Station (ISS) in the context of new measurements of loading during exercise countermeasures. Strength and muscle volumes were measured from four male ISS crewmembers (49.5 +/- 4.7 yr, 179.3 +/- 7.1 cm, 85.2 +/- 10.4 kg) before and after long-duration spaceflight (181 +/- 15 d). Preflight and in-flight measurements of forces between foot and shoe allowed comparisons of loading from 1-g exercise and exercise countermeasures on ISS. Muscle volume change was greater in the calf (-10 to 16%) than the thigh (-4% to -7%), but there was no change in the upper arm (+0.4 to -0.8%). Isometric and isokinetic strength changes at the knee (range -10.4 to -24.1%), ankle (range -4 to -22.3%), and elbow (range -7.5 to -16.7%) were observed. Although there was an overall postflight decline in total work (-14%) during the endurance test, an increase in postflight resistance to fatigue was observed. The peak in-shoe forces during running and cycling on ISS were approximately 46% and 50% lower compared to 1-g values. Muscle volume and strength were decreased in the lower extremities of crewmembers during long-duration spaceflight on ISS despite the use of exercise countermeasures. in-flight countermeasures were insufficient to replicate the daily mechanical loading experienced by the crewmembers before flight. Future exercise protocols need careful assessment both in terms of intensity and duration to maximize the "dose" of exercise and to increase loads compared to the measured levels.
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Reactivity, stability, and strength performance capacity in motor sports.
Baur, H; Müller, S; Hirschmüller, A; Huber, G; Mayer, F
2006-11-01
Racing drivers require multifaceted cognitive and physical abilities in a multitasking situation. A knowledge of their physical capacities may help to improve fitness and performance. To compare reaction time, stability performance capacity, and strength performance capacity of élite racing drivers with those of age-matched, physically active controls. Eight élite racing drivers and 10 physically active controls matched for age and weight were tested in a reaction and determination test requiring upper and lower extremity responses to visual and audio cues. Further tests comprised evaluation of one-leg postural stability on a two-dimensional moveable platform, measures of maximum strength performance capacity of the extensors of the leg on a leg press, and a test of force capacity of the arms in a sitting position at a steering wheel. An additional arm endurance test consisted of isometric work at the steering wheel at +30 degrees and -30 degrees where an eccentric threshold load of 30 N.m was applied. Subjects had to hold the end positions above this threshold until exhaustion. Univariate one way analysis of variance (alpha = 0.05) including a Bonferroni adjustment was used to detect group differences between the drivers and controls. The reaction time of the racing drivers was significantly faster than the controls (p = 0.004). The following motor reaction time and reaction times in the multiple determination test did not differ between the groups. No significant differences (p>0.05) were found for postural stability, leg extensor strength, or arm strength and endurance. Racing drivers have faster reaction times than age-matched physically active controls. Further development of motor sport-specific test protocols is suggested. According to the requirements of motor racing, strength and sensorimotor performance capacity can potentially be improved.
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NASA Astrophysics Data System (ADS)
Loikith, Paul C.; Detzer, Judah; Mechoso, Carlos R.; Lee, Huikyo; Barkhordarian, Armineh
2017-10-01
The associations between extreme temperature months and four prominent modes of recurrent climate variability are examined over South America. Associations are computed as the percent of extreme temperature months concurrent with the upper and lower quartiles of the El Niño-Southern Oscillation (ENSO), the Atlantic Niño, the Pacific Decadal Oscillation (PDO), and the Southern Annular Mode (SAM) index distributions, stratified by season. The relationship is strongest for ENSO, with nearly every extreme temperature month concurrent with the upper or lower quartiles of its distribution in portions of northwestern South America during some seasons. The likelihood of extreme warm temperatures is enhanced over parts of northern South America when the Atlantic Niño index is in the upper quartile, while cold extremes are often association with the lowest quartile. Concurrent precipitation anomalies may contribute to these relations. The PDO shows weak associations during December, January, and February, while in June, July, and August its relationship with extreme warm temperatures closely matches that of ENSO. This may be due to the positive relationship between the PDO and ENSO, rather than the PDO acting as an independent physical mechanism. Over Patagonia, the SAM is highly influential during spring and fall, with warm and cold extremes being associated with positive and negative phases of the SAM, respectively. Composites of sea level pressure anomalies for extreme temperature months over Patagonia suggest an important role of local synoptic scale weather variability in addition to a favorable SAM for the occurrence of these extremes.
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Coenen, Pieter; Willenberg, Lisa; Parry, Sharon; Shi, Joyce W; Romero, Lorena; Blackwood, Diana M; Maher, Christopher G; Healy, Genevieve N; Dunstan, David W; Straker, Leon M
2018-02-01
Given the high exposure to occupational standing in specific occupations, and recent initiatives to encourage intermittent standing among white-collar workers, a better understanding of the potential health consequences of occupational standing is required. We aimed to review and quantify the epidemiological evidence on associations of occupational standing with musculoskeletal symptoms. A systematic review was performed. Data from included articles were extracted and described, and meta-analyses conducted when data were sufficiently homogeneous. Electronic databases were systematically searched. Peer-reviewed articles on occupational standing and musculoskeletal symptoms from epidemiological studies were identified. Of the 11 750 articles screened, 50 articles reporting 49 studies were included (45 cross-sectional and 5 longitudinal; n=88 158 participants) describing the associations of occupational standing with musculoskeletal symptoms, including low-back (39 articles), lower extremity (14 articles) and upper extremity (18 articles) symptoms. In the meta-analysis, 'substantial' (>4 hours/workday) occupational standing was associated with the occurrence of low-back symptoms (pooled OR (95% CI) 1.31 (1.10 to 1.56)). Evidence on lower and upper extremity symptoms was too heterogeneous for meta-analyses. The majority of included studies reported statistically significant detrimental associations of occupational standing with lower extremity, but not with upper extremity symptoms. The evidence suggests that substantial occupational standing is associated with the occurrence of low-back and (inconclusively) lower extremity symptoms, but there may not be such an association with upper extremity symptoms. However, these conclusions are tentative as only limited evidence was found from high-quality, longitudinal studies with fully adjusted models using objective measures of standing. 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/.
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Heavy Tail Behavior of Rainfall Extremes across Germany
NASA Astrophysics Data System (ADS)
Castellarin, A.; Kreibich, H.; Vorogushyn, S.; Merz, B.
2017-12-01
Distributions are termed heavy-tailed if extreme values are more likely than would be predicted by probability distributions that have exponential asymptotic behavior. Heavy-tail behavior often leads to surprise, because historical observations can be a poor guide for the future. Heavy-tail behavior seems to be widespread for hydro-meteorological extremes, such as extreme rainfall and flood events. To date there have been only vague hints to explain under which conditions these extremes show heavy-tail behavior. We use an observational data set consisting of 11 climate variables at 1440 stations across Germany. This homogenized, gap-free data set covers 110 years (1901-2010) at daily resolution. We estimate the upper tail behavior, including its uncertainty interval, of daily precipitation extremes for the 1,440 stations at the annual and seasonal time scales. Different tail indicators are tested, including the shape parameter of the Generalized Extreme Value distribution, the upper tail ratio and the obesity index. In a further step, we explore to which extent the tail behavior can be explained by geographical and climate factors. A large number of characteristics is derived, such as station elevation, degree of continentality, aridity, measures for quantifying the variability of humidity and wind velocity, or event-triggering large-scale atmospheric situation. The link between the upper tail behavior and these characteristics is investigated via data mining methods capable of detecting non-linear relationships in large data sets. This exceptionally rich observational data set, in terms of number of stations, length of time series and number of explaining variables, allows insights into the upper tail behavior which is rarely possible given the typical observational data sets available.
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ERIC Educational Resources Information Center
Park, Eun Sook; Sim, Eun Geol; Rha, Dong-wook
2011-01-01
The aims of this study were to investigate the nature and extent of upper limb deformities via the use of various classifications, and to analyze the relationship between upper limb deformities and gross motor or upper limb functionality levels. Upper extremity data were collected from 234 children with spastic cerebral palsy (CP) who were…
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Online Health Information Seeking in Hand and Upper Extremity Surgery.
Özkan, Sezai; Mellema, Jos J; Nazzal, Adam; Lee, Sang-Gil; Ring, David
2016-12-01
Information gathering is a key component of shared decision making and has a measurable effect on treatment decisions. Access to health information might improve quality of care in hand surgery. Our purpose was to identify socio-demographic, condition-related, and psychosocial factors associated with online information-seeking behavior in patients with hand and upper-extremity conditions. From June 2015 to February 2016, we enrolled 134 patients with an upper-extremity condition who presented to an outpatient hand surgery office at an urban level I trauma center in this cross-sectional study. Participants provided socio-demographic information and completed online questionnaires assessing their online information-seeking behavior, pain intensity, symptoms of depression, and pain interference, and an upper extremity-specific, patient-reported outcome measure. A total of 57 patients (43%) sought information regarding their condition online before their visit. Compared with patients with no online information-seeking behavior, patients who sought information online were more educated. Psychosocial and condition-related factors were not associated with online information seeking. In multivariable analysis, education in years and involvement of the dominant upper limb were independently associated with online information-seeking behavior. Education in years and involvement of the dominant upper limb were independently associated with online information-seeking behavior but psychosocial and condition-related factors were not. As health information seeking is becoming an integral part of the modern day clinical experience, efforts to make online information more appealing and useful to people of all education levels are merited. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
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Wei, Jiao; Herrler, Tanja; Gu, Bin; Yang, Mei; Li, Qingfeng; Dai, Chuanchang; Xie, Feng
2018-05-01
The repair of extensive upper limb skin lesions in pediatric patients is extremely challenging due to substantial limitations of flap size and donor-site morbidity. We aimed to create an oversize preexpanded flap based on intercostal artery perforators for large-scale resurfacing of the upper extremity in children. Between March 2013 and August 2016, 11 patients underwent reconstructive treatment for extensive skin lesions in the upper extremity using a preexpanded intercostal artery perforator flap. Preoperatively, 2 to 4 candidate perforators were selected as potential pedicle vessels based on duplex ultrasound examination. After tissue expander implantation in the thoracodorsal area, regular saline injections were performed until the expanded flap was sufficient in size. Then, a pedicled flap was formed to resurface the skin lesion of the upper limb. The pedicles were transected 3 weeks after flap transfer. Flap survival, complications, and long-term outcome were evaluated. The average time of tissue expansion was 133 days with a mean final volume of 1713 mL. The thoracoabdominal flaps were based on 2 to 6 pedicles and used to resurface a mean skin defect area of 238 cm ranging from 180 to 357 cm. In all cases, primary donor-site closure was achieved. Marginal necrosis was seen in 5 cases. The reconstructed limbs showed satisfactory outcome in both aesthetic and functional aspects. The preexpanded intercostal artery perforator flap enables 1-block repair of extensive upper limb skin lesions. Due to limited donor-site morbidity and a pedicled technique, this resurfacing approach represents a useful tool especially in pediatric patients.
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Extremely Painful Multifocal Acquired Predominant Axonal Sensorimotor Neuropathy of the Upper Limb.
Lieba-Samal, Doris; van Eijk, Jeroen J J; van Rosmalen, Marieke H J; van Balken, Irene M F; Verrips, Aad; Mostert, Jop; Pillen, Sigrid; van Alfen, Nens
2018-06-01
The differential diagnosis of upper extremity mononeuritis multiplex includes neuralgic amyotrophy, vasculitic neuropathy, and Lewis-Sumner syndrome. We describe 3 patients initially suspected of neuralgic amyotrophy, who had an extremely painful, protracted, progressive disease course, not fitting one of these established diagnoses. Nerve ultrasonography showed focal caliber changes of the roots, plexus, and limb nerves. Electromyography showed predominant multifocal axonopathy. Ongoing autoimmune neuropathy was suspected. Steroid treatment provided temporary relief, and intravenous immunoglobulin A sustained pain decrease and functional improvement. These patients appear to have extremely painful axonal inflammatory neuropathy, with a good response to immune-modulating treatment. © 2017 by the American Institute of Ultrasound in Medicine.
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Hoga-Miura, Koji; Ae, Michiyoshi; Fujii, Norihisa; Yokozawa, Toshiharu
2016-10-01
This study investigated the function of the upper extremities of elite race walkers during official 20 km races, focusing on the angular momentum about the vertical axis and other parameters of the upper extremities. Sixteen walkers were analysed using the three-dimensional direct linear transformation method during three official men's 20 km walking races. The subjects, included participants at the Olympics and World Championships, who finished without disqualification and had not been disqualified during the two years prior to or following the races analysed in the present study. The angular momenta of the upper and lower body were counterbalanced as in running and normal walking. The momentum of the upper body was mainly generated by the upper extremities. The joint force moment of the right shoulder and the joint torque at the left shoulder just before right toe-off were significantly correlated with the walking speed. These were counterbalanced by other moments and torques to the torso torque, which worked to obtain a large mechanical energy flow from the recovery leg to the support leg in the final phase of the support phase. Therefore, a function of the shoulder torque was to counterbalance the torso torque to gain a fast walking speed with substantial mechanical energy flow.
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Extreme events and event size fluctuations in biased random walks on networks.
Kishore, Vimal; Santhanam, M S; Amritkar, R E
2012-05-01
Random walk on discrete lattice models is important to understand various types of transport processes. The extreme events, defined as exceedences of the flux of walkers above a prescribed threshold, have been studied recently in the context of complex networks. This was motivated by the occurrence of rare events such as traffic jams, floods, and power blackouts which take place on networks. In this work, we study extreme events in a generalized random walk model in which the walk is preferentially biased by the network topology. The walkers preferentially choose to hop toward the hubs or small degree nodes. In this setting, we show that extremely large fluctuations in event sizes are possible on small degree nodes when the walkers are biased toward the hubs. In particular, we obtain the distribution of event sizes on the network. Further, the probability for the occurrence of extreme events on any node in the network depends on its "generalized strength," a measure of the ability of a node to attract walkers. The generalized strength is a function of the degree of the node and that of its nearest neighbors. We obtain analytical and simulation results for the probability of occurrence of extreme events on the nodes of a network using a generalized random walk model. The result reveals that the nodes with a larger value of generalized strength, on average, display lower probability for the occurrence of extreme events compared to the nodes with lower values of generalized strength.
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Revised upper limb module for spinal muscular atrophy: Development of a new module.
Mazzone, Elena S; Mayhew, Anna; Montes, Jacqueline; Ramsey, Danielle; Fanelli, Lavinia; Young, Sally Dunaway; Salazar, Rachel; De Sanctis, Roberto; Pasternak, Amy; Glanzman, Allan; Coratti, Giorgia; Civitello, Matthew; Forcina, Nicola; Gee, Richard; Duong, Tina; Pane, Marika; Scoto, Mariacristina; Pera, Maria Carmela; Messina, Sonia; Tennekoon, Gihan; Day, John W; Darras, Basil T; De Vivo, Darryl C; Finkel, Richard; Muntoni, Francesco; Mercuri, Eugenio
2017-06-01
There is a growing need for a robust clinical measure to assess upper limb motor function in spinal muscular atrophy (SMA), as the available scales lack sensitivity at the extremes of the clinical spectrum. We report the development of the Revised Upper Limb Module (RULM), an assessment specifically designed for upper limb function in SMA patients. An international panel with specific neuromuscular expertise performed a thorough review of scales currently available to assess upper limb function in SMA. This review facilitated a revision of the existing upper limb function scales to make a more robust clinical scale. Multiple revisions of the scale included statistical analysis and captured clinically relevant changes to fulfill requirements by regulators and advocacy groups. The resulting RULM scale shows good reliability and validity, making it a suitable tool to assess upper extremity function in the SMA population for multi-center clinical research. Muscle Nerve 55: 869-874, 2017. © 2016 Wiley Periodicals, Inc.
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Pérez-Cruzado, David; Merchán-Baeza, Jose Antonio; González-Sánchez, Manuel; Cuesta-Vargas, Antonio I
2017-04-01
Stroke is a leading cause of disability in developed countries. One of the most widespread techniques in clinical practice is mirror therapy (MT). To determine the effectiveness of MT over other methods of intervention in the recovery of upper limb function in people who have had a stroke. A systematic review was conducted. The search string was established based on the last systematic review about MT that dated from 2009: "upper extremity" OR "upper limb "AND "mirror therapy" AND stroke. For this search Pubmed, Scopus and SciELO databases were used. Fifteen studies were included in the systematic review. Recovery of the upper limb, upper limb function and gross manual dexterity were frequently measured in these studies. In the primary variables in promoting recovery, MT alone showed better results in acute and chronic stroke patients in upper limb functioning than either conventional rehabilitation (CR) or CR plus MT. PROSPERO registration number: CRD42015026869. © 2016 Occupational Therapy Australia.
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Krucoff, Max O; Cook, Steven; Adogwa, Owoicho; Moreno, Jessica; Yang, Siyun; Xie, Jichun; Firempong, Alexander O; Lad, Nandan; Bagley, Carlos A
2017-01-01
To examine the influence of race, gender, and socioeconomic factors on presentations and outcomes of adult Chiari I malformations. The charts of 638 adult patients with Chiari I malformations were reviewed, and 287 patients were included in the study. Race, gender, insurance status, symptoms, depth of cerebellar tonsillar herniation, and presence of syringomyelia were examined as covariates in multivariate logistic regression models to identify independent predictors of presentation and outcome. Patients with public insurance had a longer stay in the hospital (P = 0.01). A higher proportion of male patients presented with upper extremity weakness (P = 0.01), lower extremity weakness (P = 0.040), and cranial nerve findings (P = 0.02). Men had shorter onset to diagnosis times (P = 0.02), worse tonsillar herniation (P = 0.03), and more severe symptoms (P = 0.05). White patients more frequently presented with back pain (P = 0.03), and African American patients more frequently presented with lower extremity weakness (P = 0.01). African Americans had worse tonsillar herniation (P < 0.01) and were more likely to present with syringomyelia (P = 0.01). Multivariate regression analysis revealed that back pain (P < 0.01), upper extremity weakness (P ≤ 0.01), upper extremity paresthesias (P < 0.01), and upper with lower extremity paresthesias (P = 0.04) were significant predictors of syringomyelia. The only independent predictor of outcome was size of tonsillar herniation (P = 0.03). Significant differences in presentation of Chiari I malformation resulting from gender, race, and insurance status were quantified for the first time. Copyright © 2016 Elsevier Inc. All rights reserved.
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USDA-ARS?s Scientific Manuscript database
This study aimed to statistically and hydrologically assess the performance of four latest and widely used satellite–gauge combined precipitation estimates (SGPEs), namely CRT, BLD, 3B42CDR, and 3B42 for the extreme precipitation and stream'ow scenarios over the upper Yellow river basin (UYRB) in ch...
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Upper Extremity Injuries in Tennis Players: Diagnosis, Treatment, and Management
Chung, Kevin C.; Lark, Meghan E.
2016-01-01
Synopsis Upper extremity tennis injuries are most commonly characterized as overuse injuries to the wrist, elbow and shoulder. The complex anatomy of these structures and their interaction with biomechanical properties of tennis strokes contributes to the diagnostic challenges. A thorough understanding of tennis kinetics, in combination with the current literature surrounding diagnostic and treatment methods, will improve clinical decision-making. PMID:27886833
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Grobet, Cécile; Marks, Miriam; Tecklenburg, Linda; Audigé, Laurent
2018-04-13
The EuroQol-5 Dimension (EQ-5D) is the most widely used generic instrument to measure quality of life (QoL), yet its application in upper extremity orthopaedics as well as its measurement properties remain largely undefined. We implemented a systematic literature review to provide an overview of the application of EQ-5D in patients with upper extremity disorders and analyse its measurement properties. We searched Medline, EMBASE, Cochrane and Scopus databases for clinical studies including orthopaedic patients with surgical interventions of the upper extremity who completed the EQ-5D. For all included studies, the use of EQ-5D and quantitative QoL data were described. Validation studies of EQ-5D were assessed according to COSMIN guidelines and standard measurement properties were examined. Twenty-three studies were included in the review, 19 of which investigated patients with an intervention carried out at the shoulder region. In 15 studies, EQ-5D assessed QoL as the primary outcome. Utility index scores in non-trauma patients generally improved postoperatively, whereas trauma patients did not regain their recalled pre-injury QoL levels. EQ-5D measurement properties were reported in three articles on proximal humerus fractures and carpal tunnel syndrome. Positive ratings were seen for construct validity (Spearman correlation coefficient ≥ 0.70 with the Short Form (SF)-12 or SF-6D health surveys) and reliability (intraclass correlation coefficient ≥ 0.77) with intermediate responsiveness (standardised response means: 0.5-0.9). However, ceiling effects were identified with 16-48% of the patients scoring the maximum QoL. The methodological quality of the three articles varied from fair to good. For surgical interventions of the upper extremity, EQ-5D was mostly applied to assess QoL as a primary outcome in patients with shoulder disorders. Investigations of the measurement properties were rare, but indicate good reliability and validity as well as moderate responsiveness in patients with upper extremity conditions.
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Dilek, Burcu; Ayhan, Cigdem; Yagci, Gozde; Yakut, Yavuz
Single-blinded randomized controlled trial. Pain management is essential in the early stages of the rehabilitation of distal radius fractures (DRFx). Pain intensity at the acute stage is considered important for determining the individual recovery process, given that higher pain intensity and persistent pain duration negatively affect the function and cortical activity of pain response. Graded motor imagery (GMI) and its components are recent pain management strategies, established on a neuroscience basis. To investigate the effectiveness of GMI in hand function in patients with DRFx. Thirty-six participants were randomly allocated to either GMI (n = 17; 52.59 [9.8] years) or control (n = 19; 47.16 [10.5] years) groups. The GMI group received imagery treatment in addition to traditional rehabilitation, and the control group received traditional rehabilitation for 8 weeks. The assessments included pain at rest and during activity using the visual analog scale, wrist and forearm active range of motion (ROM) with universal goniometer, grip strength with the hydraulic dynamometer (Jamar; Bolingbrook, IL), and upper extremity functional status using the Disability of the Arm, Shoulder and Hand Questionnaire, and the Michigan Hand Questionnaire. Assessments were performed twice at baseline and at the end of the eighth week. The GMI group showed greater improvement in pain intensity (during rest, 2.24; activity, 6.18 points), wrist ROM (flexion, -40.59; extension, -45.59; radial deviation, -25.59; and ulnar deviation, -26.77 points) and forearm ROM (supination, -43.82 points), and functional status (Disability of the Arm, Shoulder and Hand Questionnaire, 38.00; Michigan Hand Questionnaire, -32.53 points) when compared with the control group (for all, P < .05). The cortical model of pathological pain suggests new strategies established on a neuroscience basis. These strategies aim to normalize the cortical proprioceptive representation and reduce pain. One of these recent strategies, GMI appears to provide beneficial effects to control pain, improve grip strength, and increase upper extremity functions in patients with DRFx. Copyright © 2017 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.
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Jingar, Aripta; Alaparthi, Gopala Krishna; Vaishali, K; Krishnan, Shyam; Zulfeequer; Unnikrishnan, B
2013-04-01
Evidence supports the use of pulmonary rehabilitation in the treatment of chronic obstructive pulmonary disease (COPD) patients both during acute exacerbation and at later stages. It is used in India; but, to date, there has been no study that has investigated the structure of pulmonary rehabilitation programs for COPD patients in India. The recent study aims to determine the current practice patterns of Indian Physiotherapists for COPD patients admitted in Intensive Care Units (ICUs) and wards in terms of assessment and treatment. A questionnaire-based survey was conducted across India. Questionnaires were distributed to around 800 physiotherapists via E-mail. Physiotherapists with a Master Degree and a specialization in cardiopulmonary science or a minimum of 1 year of experience in treating cardiopulmonary patients were included. The questionnaires addressed assessment measures and treatment techniques given to COPD patients. A total of 342 completed questionnaires were received, yielding a response rate of 43.8%, with a majority of responses from Karnataka, Maharashtra and Gujarat. The assessment and treatment techniques used were almost similar between ICUs and wards. More than 80% of the responders carried out the assessment of certain respiratory impairments in both ICUs and wards. An objective measure of dyspnea was taken by less than 40% of the responders, with little attention given to functional exercise capacity and health-related quality of life. Eighty-five percent of the responders used Dyspnea-relieving strategies and traditional airway clearance techniques in both ICUs and wards. Eighty-three percent of the responders were giving patients in the wards training for upper and lower extremity. Fifty percent were giving strength training in the wards. Whether patients are admitted in ICUs or Wards, the practice pattern adopted by Physiotherapists to treat them vary very little with respect to certain measures taken. Assessment predominantly focused on respiratory impairment measures, followed by dyspnea-quantifying measures, with little attention given to functional exercise capacity and health-related quality of life measures. Treatment techniques given were concentrated on dyspnea-relieving strategies, airway clearance techniques and upper and lower extremity exercises, with little attention given to strength training.
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Effects of acute upper-body vibration on strength and power variables in climbers.
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.
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Liu, Peng-fei; Liu, Jing; Zhu, Hong-hui; Zhang, Xin; Zhang, Ge; Li, You-fang; Su, Yu; Wang, Chen-jia
2016-01-01
Taking four plant species, Caragana korshinskii, Salix psammophila, Hippophae rhamnides and Artemisia sphaerocephala, which were 3-4 years old and in vigorous growth period, as test materials, the anti-fracture forces of lateral-root branches and adjacent upper straight roots were measured with the self-made fixture and the instrument of TY 8000. The lateral-root branches were vital and the diameters were 1-4 mm. The results showed that the anti-fracture force and anti-fracture strength of lateral-root branches were lesser than those of the adjacent upper straight roots even though the average diameter of lateral-root branches was greater. The ratios of anti-fracture strength of lateral-root branches to the adjacent upper straight roots were 71.5% for C. korshinskii, 62.9% for S. psammophila, 45.4% for H. rhamnides and 35.4% for A. sphaerocephala. For the four plants, the anti-fracture force positively correlated with the diameter in a power function, while the anti-fracture strength negatively correlated with diameter in a power function. The anti-fracture strengths of lateral-root branches and adjacent upper straight roots for the four species followed the sequence of C. korshinskii (33.66 and 47.06 MPa) > S. psammophila (17.31 and 27.54 MPa) > H. rhamnides (3.97 and 8.75 MPa) > A. sphaerphala (2.18 and 6.15 MPa).
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Jensen, Jens Christian; Haahr, Jens Peder; Frost, Poul; Andersen, Johan Hviid
2013-10-01
Musculoskeletal pain conditions remain a major cause of care-seeking in general practice. Not all patients with musculoskeletal pain (MP) seek care at their general practitioner (GP), but for those who do, the GP's knowledge of what work-related factors might have influenced the patient's decision to seek care could be important in order to give more well-founded advice to our patients. The objective of this study was to elucidate the effects of workloads on care-seeking for back pain or upper extremity pain during an eighteen-month follow-up period. This is a prospective study with a baseline questionnaire and eighteen-month follow-up. Among the registered patients of 8 GPs, we identified 8,517 persons between 17 and 65 years of age, who all received the questionnaire. A total of 5,068 (59.5 %) persons answered. During the eighteen months of follow-up, we used the International Classification for Primary Care (ICPC) to identify all care-seekers with either back pain or upper extremity pain. Of these, all currently employed persons were included in our analysis, in all 4,325 persons. For analysis, we used Cox proportional hazards regression analysis. Analyses were stratified by gender. High levels of heavy lifting, defined as the upper tertile on a categorical scale, were associated with care-seeking for back pain (HR 1.90 [95 % CI: 1.14-3.15]) and upper extremity pain (HR 2.09 [95 % CI: 1.30-3.38]) among males, but not in a statistically significant way among females. Repetitive work and psychosocial factors did not have any statistically significant impact on care-seeking for neither back pain nor upper extremity pain. Work-related factors such as heavy lifting do, to some extent, contribute to care-seeking with MP. We suggest that asking the patient about physical workloads should be routinely included in consultations dealing with MP.
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Giladi, Aviram M; Shanmugakrishnan, R Raja; Venkatramani, Hari; Raja Sekaran, S; Chung, Kevin C; Sabapathy, S Raja
2017-06-01
At Ganga Hospital in Coimbatore, India, a unique approach is applied to treat massive upper limb injuries. However, long-term outcomes of complex reconstruction performed in the resource-limited setting are not known. This hinders understanding of outcomes and disability from these injuries and prevents systematically addressing care delivery around upper extremity trauma in the developing world. This project aims to analyze the details of the unique Ganga Hospital reconstruction experience and use patient-reported outcome measures for the first time in this patient population to evaluate post-injury recovery and disability . Forty-six patients were evaluated 6 months or more after massive proximal upper extremity reconstruction at Ganga Hospital. Patients completed functional tests, Jebsen-Taylor test (JTT), and patient-reported outcomes (PROs)-Michigan Hand Questionnaire (MHQ), Disability of Arm, Shoulder, and Hand questionnaire (DASH), and Short-Form 36 (SF-36). Correlations between metrics were assessed with Pearson's correlation coefficients. Linear regression modeling evaluated associations between severity, reconstruction, and outcomes. MHQ and DASH results correlated with functional test performance, JTT performance, and SF-36 scores (Pearson's coefficients all ≥0.33, p ≤ 0.05). In this cohort, mean MHQ score was 79 ± 15 and mean DASH score was 13 ± 15, which are not significantly different than scores for long-term outcomes after other complex upper extremity procedures. The following factors predicted PROs and functional performance after reconstruction: extent of soft tissue reconstruction, multi-segmental ulna fractures, median nerve injury, and ability for patients to return to work and maintain their job after injury. Complex proximal upper extremity salvage can be performed in the resource-limited setting with excellent long-term functional and patient-reported outcomes. PRO questionnaires are useful for reporting outcomes that correlate to functional and sensory testing and may be used to assess post-traumatic disability.
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Esmaeilzadeh, Sina; Ozcan, Emel; Capan, Nalan
2014-01-01
The aim of the study was to determine effects of ergonomic intervention on work-related upper extremity musculoskeletal disorders (WUEMSDs) among computer workers. Four hundred computer workers answered a questionnaire on work-related upper extremity musculoskeletal symptoms (WUEMSS). Ninety-four subjects with WUEMSS using computers at least 3 h a day participated in a prospective, randomized controlled 6-month intervention. Body posture and workstation layouts were assessed by the Ergonomic Questionnaire. We used the Visual Analogue Scale to assess the intensity of WUEMSS. The Upper Extremity Function Scale was used to evaluate functional limitations at the neck and upper extremities. Health-related quality of life was assessed with the Short Form-36. After baseline assessment, those in the intervention group participated in a multicomponent ergonomic intervention program including a comprehensive ergonomic training consisting of two interactive sessions, an ergonomic training brochure, and workplace visits with workstation adjustments. Follow-up assessment was conducted after 6 months. In the intervention group, body posture (p < 0.001) and workstation layout (p = 0.002) improved over 6 months; furthermore, intensity (p < 0.001), duration (p < 0.001), and frequency (p = 0.009) of WUEMSS decreased significantly in the intervention group compared with the control group. Additionally, the functional status (p = 0.001), and physical (p < 0.001), and mental (p = 0.035) health-related quality of life improved significantly compared with the controls. There was no improvement of work day loss due to WUEMSS (p > 0.05). Ergonomic intervention programs may be effective in reducing ergonomic risk factors among computer workers and consequently in the secondary prevention of WUEMSDs.
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Understanding neuromotor strategy during functional upper extremity tasks using symbolic dynamics.
Nathan, Dominic E; Guastello, Stephen J; Prost, Robert W; Jeutter, Dean C
2012-01-01
The ability to model and quantify brain activation patterns that pertain to natural neuromotor strategy of the upper extremities during functional task performance is critical to the development of therapeutic interventions such as neuroprosthetic devices. The mechanisms of information flow, activation sequence and patterns, and the interaction between anatomical regions of the brain that are specific to movement planning, intention and execution of voluntary upper extremity motor tasks were investigated here. This paper presents a novel method using symbolic dynamics (orbital decomposition) and nonlinear dynamic tools of entropy, self-organization and chaos to describe the underlying structure of activation shifts in regions of the brain that are involved with the cognitive aspects of functional upper extremity task performance. Several questions were addressed: (a) How is it possible to distinguish deterministic or causal patterns of activity in brain fMRI from those that are really random or non-contributory to the neuromotor control process? (b) Can the complexity of activation patterns over time be quantified? (c) What are the optimal ways of organizing fMRI data to preserve patterns of activation, activation levels, and extract meaningful temporal patterns as they evolve over time? Analysis was performed using data from a custom developed time resolved fMRI paradigm involving human subjects (N=18) who performed functional upper extremity motor tasks with varying time delays between the onset of intention and onset of actual movements. The results indicate that there is structure in the data that can be quantified through entropy and dimensional complexity metrics and statistical inference, and furthermore, orbital decomposition is sensitive in capturing the transition of states that correlate with the cognitive aspects of functional task performance.
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Armijo-Olivo, Susan; Woodhouse, Linda J; Steenstra, Ivan A; Gross, Douglas P
2016-12-01
To determine whether the Disabilities of the Arm, Shoulder, and Hand (DASH) tool added to the predictive ability of established prognostic factors, including patient demographic and clinical outcomes, to predict return to work (RTW) in injured workers with musculoskeletal (MSK) disorders of the upper extremity. A retrospective cohort study using a population-based database from the Workers' Compensation Board of Alberta (WCB-Alberta) that focused on claimants with upper extremity injuries was used. Besides the DASH, potential predictors included demographic, occupational, clinical and health usage variables. Outcome was receipt of compensation benefits after 3 months. To identify RTW predictors, a purposeful logistic modelling strategy was used. A series of receiver operating curve analyses were performed to determine which model provided the best discriminative ability. The sample included 3036 claimants with upper extremity injuries. The final model for predicting RTW included the total DASH score in addition to other established predictors. The area under the curve for this model was 0.77, which is interpreted as fair discrimination. This model was statistically significantly different than the model of established predictors alone (p<0.001). When comparing the DASH total score versus DASH item 23, a non-significant difference was obtained between the models (p=0.34). The DASH tool together with other established predictors significantly helped predict RTW after 3 months in participants with upper extremity MSK disorders. An appealing result for clinicians and busy researchers is that DASH item 23 has equal predictive ability to the total DASH score. 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/.
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Terwee, Caroline B.; van der Windt, Daniëlle A. W. M.; van der Beek, Allard J.; Bouter, Lex M.; Dekker, Joost
2007-01-01
Objectives To study work-related physical and psychosocial risk factors for sick leave among patients who have visited their general practitioner for neck or upper extremity complaints. Methods Three hundred and forty two patients with neck or upper extremity complaints completed self-report questionnaires at baseline and after 3 months. Cox regression models were used to investigate the association between work-related risk factors and sick leave (i.e., lost days from work due to neck or upper extremity complaints in 3 months). Effect modification by sick leave at baseline, sex, worrying and musculoskeletal co-morbidity was evaluated by adding product terms to the regression models. Results In the subgroup of patients who scored high on the pain copying scale “worrying” the hazard ratio of sick leave was 1.32 (95% CI 1.07–1.62) per 10% increase in heavy physical work. The subgroup of patients who were sitting for long periods of time had a reduced risk of sick leave as compared to patients who did not spend a lot of time sitting, again only in patients who scored high on the pain coping scale “worrying” (adjusted HR = 0.17, 95%-CI 0.04–0.72). Other work-related risk factors were not significantly related to sick leave. Conclusions Heavy physical work increased the risk of sick leave and prolonged sitting reduced the risk of sick leave in a subgroup of patients who worried much about their pain. Additional large longitudinal studies of sufficiently large size among employees with neck or upper extremity complaints are needed to confirm our results. PMID:17410376
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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
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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.
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Burkhart, Timothy A; Brydges, Evan; Stefanczyk, Jennifer; Andrews, David M
2017-04-01
The occurrence of distal upper extremity injuries resulting from forward falls (approximately 165,000 per year) has remained relatively constant for over 20years. Previous work has provided valuable insight into fall arrest strategies, but only symmetric falls in body postures that do not represent actual fall scenarios closely have been evaluated. This study quantified the effect of asymmetric loading and body postures on distal upper extremity response to simulated forward falls. Twenty participants were suspended from the Propelled Upper Limb fall ARest Impact System (PULARIS) in different torso and leg postures relative to the ground and to the sagittal plane (0°, 30° and 45°). When released from PULARIS (hands 10cm above surface, velocity 1m/s), participants landed on two force platforms, one for each hand. Right forearm impact response was measured with distal (radial styloid) and proximal (olecranon) tri-axial accelerometers and bipolar EMG from seven muscles. Overall, the relative height of the torso and legs had little effect on the forces, or forearm response variables. Muscle activation patterns consistently increased from the start to the peak activation levels after impact for all muscles, followed by a rapid decline after peak. The impact forces and accelerations suggest that the distal upper extremity is loaded more medial-laterally during asymmetric falls than symmetric falls. Altering the direction of the impact force in this way (volar-dorsal to medial-lateral) may help reduce distal extremity injuries caused when landing occurs symmetrically in the sagittal plane as it has been shown that volar-dorsal forces increase the risk of injury. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Kho, Michelle E; Truong, Alexander D; Zanni, Jennifer M; Ciesla, Nancy D; Brower, Roy G; Palmer, Jeffrey B; Needham, Dale M
2015-02-01
The purpose of the study is to compare neuromuscular electrical stimulation (NMES) vs sham on leg strength at hospital discharge in mechanically ventilated patients. We conducted a randomized pilot study of NMES vs sham applied to 3 bilateral lower extremity muscle groups for 60 minutes daily in the intensive care unit (ICU). Between June 2008 and March 2013, we enrolled adults who were receiving mechanical ventilation within the first week of ICU stay and who could transfer independently from bed to chair before hospital admission. The primary outcome was lower extremity muscle strength at hospital discharge using Medical Research Council score (maximum, 30). Secondary outcomes at hospital discharge included walking distance and change in lower extremity strength from ICU awakening. Clinicaltrials.gov: NCT00709124. We stopped enrollment early after 36 patients due to slow patient accrual and the end of research funding. For NMES vs sham, mean (SD) lower extremity strength was 28 (2) vs 27 (3), P = .072. Among secondary outcomes, NMES vs sham patients had a greater mean (SD) walking distance (514 [389] vs 251 [210] ft, P = .050) and increase in muscle strength (5.7 [5.1] vs 1.8 [2.7], P = .019). In this pilot randomized trial, NMES did not significantly improve leg strength at hospital discharge. Significant improvements in secondary outcomes require investigation in future research. Copyright © 2014 Elsevier Inc. All rights reserved.
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Zečević Luković, Tanja; Ristić, Branko; Jovanović, Zorica; Rančić, Nemanja; Ignjatović Ristić, Dragana; Cuković, Saša
2012-08-01
To evaluate the effects of early started combined therapy in Complex Regional Pain Syndrome-1 (CRPS-1) on the upper extremities. The study included 36 patients in the first stadium of CRPS-1 on the upper extremities The mean age of patients was 42.6±14.6, the majority of them (26 of 36) were females. The right side of the upper extremity was affected much more then the left side. They were treated by combined therapy including analgetics, electrotherapy, magneto therapy and kinesitherapy. The average length of observation was 172.1 days (from 90 to 250 days). The average length of treatment was 91.5±42.16 days. Intensity of pain, swelling of the extremity, the change in skin coloration and cutaneous manifestations were assessed three times, at the beginning of the treatment, after 6 weeks and at the end of the treatment. The pain was registered in all patients at visit 1 (average pain intensity was 5.70 ±1.44 on 100 mm visual analogue scale), and it was progressively decreased during the treatment from 3.60±1.22 at the second visit to 0.34±0.68 at the third visit. Vasodilatation was registered in 30 (83.33%) patients and skin temperature asymmetries was found in 21 (58.33%) patients. The difference of size was detected in 30 (83.33%) patients at the first visit compared to four (11.11%) patients at the end of the treatment. There were six (16.66%) patients without swelling at the beginning compared to 26 (72.22%) at the end of the treatment (p less than 0.000). Complete healing was achieved in 32 patients (88.88%). The carefully chosen physical agents in combination with analgesic and non-steroidal anti-inflammatory drugs may benefit in patients with CRPS-1 on the upper extremity if the treatment starts as soon as possible.
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Wang, Chia-Chi; Lin, Shu-Cheng; Hsu, Shu-Ching; Yang, Ming-Ta; Chan, Kuei-Hui
2017-10-27
Creatine supplementation reduces the impact of muscle fatigue on post-activation potentiation (PAP) of the lower body, but its effects on the upper body remain unknown. This study examined the effects of creatine supplementation on muscle strength, explosive power, and optimal individual PAP time of the upper body during a set of complex training bouts in canoeists. Seventeen male high school canoeists performed a bench row for one repetition at maximum strength and conducted complex training bouts to determine the optimal individual timing of PAP and distance of overhead medicine ball throw before and after the supplementation. Subjects were assigned to a creatine or placebo group, and later consumed 20 g of creatine or carboxymethyl cellulose per day for six days. After supplementation, the maximal strength in the creatine group significantly increased ( p < 0.05). The optimal individual PAP time in the creatine group was significantly earlier than the pre-supplementation times ( p < 0.05). There was no significant change in explosive power for either group. Our findings support the notion that creatine supplementation increases maximal strength and shortens the optimal individual PAP time of the upper body in high school athletes, but has no effect on explosive power. Moreover, it was found that the recovery time between a bench row and an overhead medicine ball throw in a complex training bout is an individual phenomenon.
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Congenital Median Upper Lip Fistula
al Aithan, Bandar
2012-01-01
Congenital median upper lip fistula (MULF) is an extremely rare condition resulting from abnormal fusion of embryologic structures. We present a new case of congenital medial upper lip fistula located in the midline of the philtrum of a 6 year old girl. PMID:22953305
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Hand grips strength effect on motor function in human brain using fMRI: a pilot study
NASA Astrophysics Data System (ADS)
Ismail, S. S.; Mohamad, M.; Syazarina, S. O.; Nafisah, W. Y.
2014-11-01
Several methods of motor tasks for fMRI scanning have been evolving from simple to more complex tasks. Motor tasks on upper extremity were applied in order to excite the increscent of motor activation on contralesional and ipsilateral hemispheres in brain. The main objective of this study is to study the different conditions for motor tasks on upper extremity that affected the brain activation. Ten healthy right handed with normal vision (3 male and 7 female, age range=20-30 years, mean=24.6 years, SD=2.21) participated in this study. Prior to the scanning, participants were trained on hand grip tasks using rubber ball and pressure gauge tool outside the scanner. During fMRI session, a block design with 30-s task blocks and alternating 30-s rest periods was employed while participants viewed a computer screen via a back projection-mirror system and instructed to follow the instruction by gripping their hand with normal and strong grips using a rubber ball. Statistical Parametric mapping (SPM8) software was used to determine the brain activation. Both tasks activated the primary motor (M1), supplementary motor area (SMA), dorsal and ventral of premotor cortex area (PMA) in left hemisphere while in right hemisphere the area of primary motor (M1) somatosensory was activated. However, the comparison between both tasks revealed that the strong hand grip showed the higher activation at M1, PMA and SMA on left hemisphere and also the area of SMA on right hemisphere. Both conditions of motor tasks could provide insights the functional organization on human brain.
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Suwa, Masataka; Imoto, Takayuki; Kida, Akira; Yokochi, Takashi; Iwase, Mitsunori; Kozawa, Kenji
2018-01-05
This study examined the associations of body flexibility with carotid arterial remodelling, including intima-media thickness (IMT) and plaque formation in middle-aged men. The subjects of this cross-sectional study included 1354 Japanese men aged 35-59 years without histories of stroke or cardiac diseases. The arm extensibility test, which can estimate flexibility of the upper extremity (composed of shoulder external rotation and forearm supination), and the sit-and-reach test were performed. Common carotid IMT and plaque formation (≥1.1 mm) were estimated by ultrasound. The proportion of subjects who fully completed the arm extensibility test was 55.0%, and who had plaques in the common carotid artery was 37.8%. IMT was associated with poor arm extensibility (β=-0.073, 95% CI -0.02224 to - 0.00041, P=0.004), while plaque formation was associated with poor sit-and-reach (OR 0.98579, 95% CI 0.97257 to 0.99919, P=0.038) after adjustment by all covariates. This study demonstrated that poor upper extremity and trunk flexibility were associated with characteristics of early onset of atherosclerosis. Furthermore, these associations were independent of covariates such as age, blood pressure, blood lipids glucose levels and abdominal fat accumulation, handgrip strength and lifestyle, including sleeping, drinking, exercise and smoking habits. Poor flexibility may reflect subclinical atherosclerosis in middle-aged men. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
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Dorsi, Michael J; Belzberg, Allan J
2012-01-01
Transverse myelitis (TM) may result in permanent neurologic dysfunction. Nerve transfers have been developed to restore function after peripheral nerve injury. Here, we present a case report of a child with permanent right upper extremity weakness due to TM that underwent nerve transfers. The following procedures were performed: double fascicle transfer from median nerve and ulnar nerve to the brachialis and biceps branches of the musculocutaneous nerve, spinal accessory to suprascapular nerve, and medial cord to axillary nerve end-to-side neurorraphy. At 22 months, the patient demonstrated excellent recovery of elbow flexion with minimal improvement in shoulder abduction. We propose that the treatment of permanent deficits from TM represents a novel indication for nerve transfers in a subset of patients. Copyright © 2011 Wiley Periodicals, Inc.
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Upper extremity paraesthesia: clinical assessment and reasoning.
Muscolino, Joseph E
2008-07-01
The art of clinical assessment involves an accurate determination of the cause(s) of a patient's symptoms. Given that a set of symptoms can be influenced by many contributing factors and features, assessment needs to differentially evaluate these. Accurate and appropriate treatment depends on differential assessment based on sound clinical reasoning. Many conditions derive from multiple causes demanding evaluation of as many etiological features as can be identified. The case review presented here involves a patient presenting with paraesthesia spreading into her right upper extremity. A complex history, involving her neck and contralateral upper extremity was assessed. The patient was found to have at least seven underlying, predisposing, and etiological, conditions capable of initiating, aggravating, or maintaining the presenting symptoms. Weighing the relative contributions of these often interacting features, and correlating this with the history, helped to identify a successful course of treatment.
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[Laterality of upper extremity movements in infancy: observations at 4 and 9 months of age].
Shiotani, Yuka; Matsuzawa, Shigeyuki; Ikeda, Hiroko; Sawada, Akiko; Okada, Masako; Kutsuki, Aya; Tomiwa, Kiyotaka
2010-07-01
This study investigated the process involved in the lateralization of movements during infancy by observing upper extremity movements in a laboratory setting. Reaching for flying rings, balls, mini toy cars, and small round cookies were observed and recorded by videotape at 4 and 9 months of age. The subjects were 202 infants who participated in Japan Children's Study, a cohort study on the development of sociability. Infants reached for objects significantly more frequently at 9 months (98%) than at 4 months (40%) (p<0.001). Though the lateral preference in reaching for balls at 4 months was ambiguous, reaching for toy cars was performed more frequently with the right hand at 9 months (50%) than with the left one (19%) (p<0.01). Lateralization of the upper extremity movements is thought to appear by 9 months.
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Common Injuries in Professional Football Quarterbacks.
Kirsch, Jacob M; Burrus, M Tyrrell; Bedi, Asheesh
2018-03-01
Professional football quarterbacks are at particular risk for upper extremity injuries due to the physical demands of their position coupled with the inherent risks associated with professional football. This review sought to evaluate current clinical literature to better characterize the injury profile unique to this athletic population. Shoulder injuries are the most prevented upper extremity injury among professional football quarterbacks. The quarterback position is disproportionately impacted by shoulder injuries when compared to professional athletes at other positions. Moreover, contrary to other professional throwing athletes, the majority of upper extremity injuries in the professional quarterback result from direct contact as opposed to the throwing motion. The injury profile among professional quarterbacks is unique compared to other positions and other overhead professional throwing athletes. Overall, a paucity of high quality clinical evidence exists to support the management of injuries in this elite population.
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Lang, Catherine E.; Bland, Marghuretta D.; Bailey, Ryan R.; Schaefer, Sydney Y.; Birkenmeier, Rebecca L.
2012-01-01
The purpose of this review is to provide a comprehensive approach for assessing the upper extremity (UE) after stroke. First, common upper extremity impairments and how to assess them are briefly discussed. While multiple UE impairments are typically present after stroke, the severity of one impairment, paresis, is the primary determinant of UE functional loss. Second, UE function is operationally defined and a number of clinical measures are discussed. It is important to consider how impairment and loss of function affect UE activity outside of the clinical environment. Thus, this review also identifies accelerometry as an objective method for assessing UE activity in daily life. Finally, the role that each of these levels of assessment should play in clinical decision making is discussed in order to optimize the provision of stroke rehabilitation services. PMID:22975740
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The effects of short-cycle sprints on power, strength, and salivary hormones in elite rugby players.
Crewther, Blair T; Cook, Christian J; Lowe, Tim E; Weatherby, Robert P; Gill, Nicholas
2011-01-01
This study examined the effects of short-cycle sprints on power, strength, and salivary hormones in elite rugby players. Thirty male rugby players performed an upper-body power and lower-body strength (UPLS) and/or a lower-body power and upper-body strength (LPUS) workout using a crossover design (sprint vs. control). A 40-second upper-body or lower-body cycle sprint was performed before the UPLS and LPUS workouts, respectively, with the control sessions performed without the sprints. Bench throw (BT) power and box squat (BS) 1 repetition maximum (1RM) strength were assessed in the UPLS workout, and squat jump (SJ) power and bench press (BP) 1RM strength were assessed in the LPUS workout. Saliva was collected across each workout and assayed for testosterone (Sal-T) and cortisol (Sal-C). The cycle sprints improved BS (2.6 ± 1.2%) and BP (2.8 ± 1.0%) 1RM but did not affect BT and SJ power. The lower-body cycle sprint produced a favorable environment for the BS by elevating Sal-T concentrations. The upper-body cycle sprint had no hormonal effect, but the workout differences (%) in Sal-T (r = -0.59) and Sal-C (r = 0.42) concentrations correlated to the BP, along with the Sal-T/C ratio (r = -0.49 to -0.66). In conclusion, the cycle sprints improved the BP and BS 1RM strength of elite rugby players but not power output in the current format. The improvements noted may be explained, in part, by the changes in absolute or relative hormone concentrations. These findings have practical implications for prescribing warm-up and training exercises.
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Amaral, Josária F.; Alvim, Felipe C.; Castro, Eliane A.; Doimo, Leonice A.; Silva, Marcus V.; Novo, José M.
2014-01-01
Background Aging is a multifactorial process that leads to changes in the quantity and quality of skeletal muscle and contributes to decreased levels of muscle strength. Objective This study sought to investigate whether the isometric muscle strength, fat-free mass (FFM) and power of the electromyographic (EMG) signal of the upper and lower limbs of women are similarly affected by aging. Method The sample consisted of 63 women, who were subdivided into three groups (young (YO) n=33, 24.7±3.5 years; middle age (MA) n=15, 58.6±4.2 years; and older adults (OA). n=15, 72.0±4.2 years). Isometric strength was recorded simultaneously with the capture of the electrical activity of the flexor muscles of the fingers and the vastus lateralis during handgrip and knee extension tests, respectively. FFM was assessed using dual-energy X-ray absorptiometry. Results The handgrip strength measurements were similar among groups (p=0.523), whereas the FFM of the upper limbs was lower in group OA compared to group YO (p=0.108). The RMSn values of the hand flexors were similar among groups (p=0.754). However, the strength of the knee extensors, the FFM of the lower limbs and the RMSn values of the vastus lateralis were lower in groups MA (p=0.014, p=0.006 and p=0.013, respectively) and OA (p=0.000, p=0.000 and p<0.000, respectively) compared to group YO. Conclusions The results of this study demonstrate that changes in isometric muscle strength in MLG and electromyographic activity of the lower limbs are more pronounced with the aging process of the upper limb. PMID:24676705
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Hang Them High: A Hands-Free Technique for Upper Extremity Limb Holding During Surgical Preparation.
Aneja, Arun; Leung, Patrick; Marquez-Lara, Alejandro
Lifting and holding upper and lower limbs during the "prep and drape" portion of certain orthopaedic procedures exert strong forces on the holder and may lead to musculoskeletal disorders. To address these challenges during upper extremity procedures, this article describes a hand-free elevation and traction technique of the upper limbs during preoperative skin preparation with the use of items readily available within the operating room (OR). This technique is particularly useful for heavy or fractured limbs that may impose a physical challenge to lift and maintain in a stable position. Implementation of this technique reduces the risk to nurses, OR personnel, and caregivers of developing work-related musculoskeletal injuries while lifting and holding limbs in the orthopaedic OR.
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Modifications in Wheelchair Propulsion Technique with Speed.
Russell, Ian M; Raina, Shashank; Requejo, Philip S; Wilcox, Rand R; Mulroy, Sara; McNitt-Gray, Jill L
2015-01-01
Repetitive loading of the upper limb joints during manual wheelchair (WC) propulsion (WCP) has been identified as a factor that contributes to shoulder pain, leading to loss of independence and decreased quality of life. The purpose of this study was to determine how individual manual WC users with paraplegia modify propulsion mechanics to accommodate expected increases in reaction forces (RFs) generated at the pushrim with self-selected increases in WCP speed. Upper extremity kinematics and pushrim RFs were measured for 40 experienced manual WC users with paraplegia while propelling on a stationary ergometer at self-selected free and fast propulsion speeds. Upper extremity kinematics and kinetics were compared within subject between propulsion speeds. Between group and within-subject differences were determined (α = 0.05). Increased propulsion speed was accompanied by increases in RF magnitude (22 of 40, >10 N) and shoulder net joint moment (NJM, 15 of 40, >10 Nm) and decreases in pushrim contact duration. Within-subject comparison indicated that 27% of participants modified their WCP mechanics with increases in speed by regulating RF orientation relative to the upper extremity segments. Reorientation of the RF relative to the upper extremity segments can be used as an effective strategy for mitigating rotational demands (NJM) imposed on the shoulder at increased propulsion speeds. Identification of propulsion strategies that individuals can use to effectively accommodate for increases in RFs is an important step toward preserving musculoskeletal health of the shoulder and improving health-related quality of life.
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Survey of Hand and Upper Extremity Injuries Among Rock Climbers.
Nelson, Clayton E; Rayan, Ghazi M; Judd, Dustin I; Ding, Kai; Stoner, Julie A
2017-07-01
Rock climbing first evolved as a sport in the late 18th century. With its growing popularity, the number of rock climbing-related injuries has potential to increase, spurring a rise in the number of articles associated with it. Despite the available literature, there remains a paucity of information about upper extremity injuries sustained by rock climbers, and no studies to date have focused on gender-specific injuries. A 24-question online survey was distributed to rock climbers about upper extremity injuries sustained during rock climbing. Statistical analysis was used to study association between participants' demographics and injuries. A total of 397 participants responded to the survey. Mean age was 32.5 years with males comprising 85%. No significant differences in demographics or climbing behaviors were found between males and females. Ninety percent of participants reported sustaining an upper extremity injury. Fingers were the most common injury followed by shoulder/arm and elbow/forearm. Our study found females to be more likely to report a rock climbing-related injury, and more likely to undergo surgery for it. Female rock climbers were significantly more likely to report a shoulder/upper arm injury and were also more likely to report undergoing surgery compared with males, where these differences were not due to age or climbing behaviors. Further investigation is warranted into the association between shoulder injuries and female athletes to determine how the gender differences relate to extent of injury as well as health service utilization behaviors.
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ERIC Educational Resources Information Center
Thorley, Megan; Lannin, Natasha; Cusick, Anne; Novak, Iona; Boyd, Roslyn
2012-01-01
Aim: To investigate reliability of the Quality of Upper Extremity Skills Test (QUEST) scores for children with cerebral palsy (CP) aged 2-12 years. Method: Thirty-one QUESTs from 24 children with CP were rated once by two raters and twice by one rater. Internal consistency of total scores, inter- and intra-rater reliability findings for total,…
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Upper Extremity Injuries in Tennis Players: Diagnosis, Treatment, and Management.
Chung, Kevin C; Lark, Meghan E
2017-02-01
Upper extremity tennis injuries are most commonly characterized as overuse injuries to the wrist, elbow, and shoulder. The complex anatomy of these structures and their interaction with biomechanical properties of tennis strokes contributes to the diagnostic challenges. A thorough understanding of tennis kinetics, in combination with the current literature surrounding diagnostic and treatment methods, will improve clinical decision-making. Copyright © 2016 Elsevier Inc. All rights reserved.
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ERIC Educational Resources Information Center
Kawamura, Anne; Campbell, Kent; Lam-Damji, Sophie; Fehlings, Darcy
2007-01-01
This study compared the effects of low and high doses of botulinum toxin A (BTX-A) to improve upper extremity function. Thirty-nine children (22 males, 17 females) with a mean age of 6 years 2 months (SD 2y 9mo) diagnosed with spastic hemiplegia or triplegia were enrolled into this double-blind, randomized controlled trial. The high-dose group…
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Park, JuHyung; Lee, NaYun; Cho, YongHo; Yang, YeongAe
2015-03-01
[Purpose] The purpose of this study was to investigate the impact that modified constraint-induced movement therapy has on upper extremity function and the daily life of chronic stroke patients. [Subjects and Methods] Modified constraint-induced movement therapy was conduct for 2 stroke patients with hemiplegia. It was performed 5 days a week for 2 weeks, and the participants performed their daily living activities wearing mittens for 6 hours a day, including the 2 hours of the therapy program. The assessment was conducted 5 times in 3 weeks before and after intervention. The upper extremity function was measured using the box and block test and a dynamometer, and performance daily of living activities was assessed using the modified Barthel index. The results were analyzed using a scatterplot and linear regression. [Results] All the upper extremity functions of the participants all improved after the modified constraint-induced movement therapy. Performance of daily living activities by participant 1 showed no change, but the results of participant 2 had improved after the intervention. [Conclusion] Through the results of this research, it was identified that modified constraint-induced movement therapy is effective at improving the upper extremity functions and the performance of daily living activities of chronic stroke patients.
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Banks, Kevin P; Ly, Justin Q; Beall, Douglas P; Grayson, David E; Bancroft, Laura W; Tall, Michael A
2005-01-01
Overuse injuries are a very common cause of pain in athletes, accounting for a significant loss of training time and missed competitions. Magnetic resonance imaging (MRI) is playing an increasing role in facilitating the expeditious and safe return of these individuals to their preinjury level of physical performance by allowing accurate diagnosis. Sports physicians are increasingly relying on the exquisite anatomic detail afforded by this technique to formulate diagnoses that assist with the optimal management of these athletic injuries. Some upper extremity overuse entities are well recognized; two examples are medial epicondylitis, classically appearing in baseball pitchers, and lateral epicondylitis, in tennis players. Other less well-known injuries of the upper extremity, such as intersection syndrome in rowers and distal clavicular stress fractures in weightlifters, are frequent occurrences in certain circles of athletes. The following article is a pictorial review of the MRI findings of upper extremity overuse injuries encountered in the competitive athlete, with an emphasis on the sports scenarios in which they occur. We will depict mechanisms of injury and applicable anatomy and show characteristic imaging findings. A wide range of entities are addressed, including but not limited to overuse injuries occurring in baseball, swimming, gymnastics, weightlifting, bowling, and cycling.
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Playing piano can improve upper extremity function after stroke: case studies.
Villeneuve, Myriam; Lamontagne, Anouk
2013-01-01
Music-supported therapy (MST) is an innovative approach that was shown to improve manual dexterity in acute stroke survivors. The feasibility of such intervention in chronic stroke survivors and its longer-term benefits, however, remain unknown. The objective of this pilot study was to estimate the short- and long-term effects of a 3-week piano training program on upper extremity function in persons with chronic stroke. A multiple pre-post sequential design was used, with measurements taken at baseline (week0, week3), prior to (week6) and after the intervention (week9), and at 3-week follow-up (week12). Three persons with stroke participated in the 3-week piano training program that combined structured piano lessons to home practice program. The songs, played on an electronic keyboard, involved all 5 digits of the affected hand and were displayed using a user-friendly MIDI program. After intervention, all the three participants showed improvements in their fine (nine hole peg test) and gross (box and block test) manual dexterity, as well as in the functional use of the upper extremity (Jebsen hand function test). Improvements were maintained at follow-up. These preliminary results support the feasibility of using an MST approach that combines structured lessons to home practice to improve upper extremity function in chronic stroke.
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Use of computer games as an intervention for stroke.
Proffitt, Rachel M; Alankus, Gazihan; Kelleher, Caitlin L; Engsberg, Jack R
2011-01-01
Current rehabilitation for persons with hemiparesis after stroke requires high numbers of repetitions to be in accordance with contemporary motor learning principles. The motivational characteristics of computer games can be harnessed to create engaging interventions for persons with hemiparesis after stroke that incorporate this high number of repetitions. The purpose of this case report was to test the feasibility of using computer games as a 6-week home therapy intervention to improve upper extremity function for a person with stroke. One person with left upper extremity hemiparesis after stroke participated in a 6-week home therapy computer game intervention. The games were customized to her preferences and abilities and modified weekly. Her performance was tracked and analyzed. Data from pre-, mid-, and postintervention testing using standard upper extremity measures and the Reaching Performance Scale (RPS) were analyzed. After 3 weeks, the participant demonstrated increased upper extremity range of motion at the shoulder and decreased compensatory trunk movements during reaching tasks. After 6 weeks, she showed functional gains in activities of daily living (ADLs) and instrumental ADLs despite no further improvements on the RPS. Results indicate that computer games have the potential to be a useful intervention for people with stroke. Future work will add additional support to quantify the effectiveness of the games as a home therapy intervention for persons with stroke.
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Aoyagi, Yoichiro; Tsubahara, Akio
2004-01-01
Upper extremity hemiplegia after stroke is common and disabling. Apart from conventional physical and occupational therapy, a number of additional approaches that use devices such as orthoses, prostheses, electrical stimulation, and robots have been introduced. The purpose of this review was to assess the clinical efficacy of such devices used for the affected upper extremities of acute, subacute, and chronic stroke patients. Assessments of their effectiveness and recommendations were based on the weight of published scientific evidence. The amount of evidence with respect to hand splints and shoulder slings is limited. Further study with a well-designed randomized controlled trial (RCT) is required to investigate accurately their short- and long-term efficacy. A number of studies suggested that the use of electrical stimulation for reducing shoulder subluxation or improving the function of wrist and finger extensors is effective during or shortly after the daily treatment period. The robotic approach to hemiplegic upper extremities appears to be a novel therapeutic strategy that may help improve hand and arm function. However, the longer term effectiveness after discontinuation as well as the motor recovery mechanism of electrical stimulation or robotic devices remains unclear. More research is needed to determine the evidence-based effectiveness of electrical stimulation or other devices for stroke survivors.
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Fujiwara, Toshiyuki; Kawakami, Michiyuki; Honaga, Kaoru; Tochikura, Michi; Abe, Kaoru
2017-01-01
Hybrid Assistive Neuromuscular Dynamic Stimulation (HANDS) therapy is one of the neurorehabilitation therapeutic approaches that facilitates the use of the paretic upper extremity (UE) in daily life by combining closed-loop electromyography- (EMG-) controlled neuromuscular electrical stimulation (NMES) with a wrist-hand splint. This closed-loop EMG-controlled NMES can change its stimulation intensity in direct proportion to the changes in voluntary generated EMG amplitudes recorded with surface electrodes placed on the target muscle. The stimulation was applied to the paretic finger extensors. Patients wore a wrist-hand splint and carried a portable stimulator in an arm holder for 8 hours during the daytime. The system was active for 8 hours, and patients were instructed to use their paretic hand as much as possible. HANDS therapy was conducted for 3 weeks. The patients were also instructed to practice bimanual activities in their daily lives. Paretic upper extremity motor function improved after 3 weeks of HANDS therapy. Functional improvement of upper extremity motor function and spasticity with HANDS therapy is based on the disinhibition of the affected hemisphere and modulation of reciprocal inhibition. HANDS therapy may offer a promising option for the management of the paretic UE in patients with stroke.
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Perceived psychological stress and upper extremity cumulative trauma disorders.
Strasser, P B; Lusk, S L; Franzblau, A; Armstrong, T J
1999-01-01
This report presents data exploring the relationship between perceived psychological stress and several variables implicated in the etiology of upper extremity cumulative trauma disorders (UECTDs). The sample was 354 workers from three different manufacturing companies. The primary job exposure for the subjects was that they were engaged in jobs that involved repetitious movements of the upper extremities, primarily of the hands and arms. Data collection included a detailed health history, a comprehensive physical examination of the upper extremities, limited electrodiagnostic testing, Cohen's Perceived Stress Scale, Karasek's Job Content Questionnaire, demographic information, and a measurement of repetition. Descriptive analyses, analysis of variance, correlational analyses, and multiple linear regression were used to examine the data. Perceived stress, as measured in this study, was only weakly associated with repetition, job dissatisfaction, and subjective complaints related to UECTDs. In addition, factors generally accepted as related to UECTDs (e.g., repetition, female gender, hormonal influences, and existing medical conditions) were not robust predictors of perceived stress. The major limitation is related to the measurement of perceived psychological stress. Like most psychosocial phenomena, perceived stress is a complex construct, one that is difficult to measure and correlate with health outcomes. Further research is necessary to examine what role, if any, perceived stress may have in the etiology of UECTDs.
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Gurbuz, Nigar; Afsar, Sevgi Ikbali; Ayaş, Sehri; Cosar, Sacide Nur Saracgil
2016-09-01
[Purpose] This study aimed to evaluate the effectiveness of mirror therapy combined with a conventional rehabilitation program on upper extremity motor and functional recovery in stroke patients. [Subjects and Methods] Thirty-one hemiplegic patients were included. The patients were randomly assigned to a mirror (n=16) or conventional group (n=15). The patients in both groups underwent conventional therapy for 4 weeks (60-120 minutes/day, 5 days/week). The mirror group received mirror therapy, consisting of periodic flexion and extension movements of the wrist and fingers on the non-paralyzed side. The patients in the conventional group performed the same exercises against the non-reflecting face of the mirror. The patients were evaluated at the beginning and end of the treatment by a blinded assessor using the Brunnstrom stage, Fugl-Meyer Assessment (FMA) upper extremity score, and the Functional Independence Measure (FIM) self-care score. [Results] There was an improvement in Brunnstrom stage and the FIM self-care score in both groups, but the post-treatment FMA score was significantly higher in the mirror therapy group than in the conventional treatment group. [Conclusion] Mirror therapy in addition to a conventional rehabilitation program was found to provide additional benefit in motor recovery of the upper extremity in stroke patients.
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Gurbuz, Nigar; Afsar, Sevgi Ikbali; Ayaş, Sehri; Cosar, Sacide Nur Saracgil
2016-01-01
[Purpose] This study aimed to evaluate the effectiveness of mirror therapy combined with a conventional rehabilitation program on upper extremity motor and functional recovery in stroke patients. [Subjects and Methods] Thirty-one hemiplegic patients were included. The patients were randomly assigned to a mirror (n=16) or conventional group (n=15). The patients in both groups underwent conventional therapy for 4 weeks (60–120 minutes/day, 5 days/week). The mirror group received mirror therapy, consisting of periodic flexion and extension movements of the wrist and fingers on the non-paralyzed side. The patients in the conventional group performed the same exercises against the non-reflecting face of the mirror. The patients were evaluated at the beginning and end of the treatment by a blinded assessor using the Brunnstrom stage, Fugl-Meyer Assessment (FMA) upper extremity score, and the Functional Independence Measure (FIM) self-care score. [Results] There was an improvement in Brunnstrom stage and the FIM self-care score in both groups, but the post-treatment FMA score was significantly higher in the mirror therapy group than in the conventional treatment group. [Conclusion] Mirror therapy in addition to a conventional rehabilitation program was found to provide additional benefit in motor recovery of the upper extremity in stroke patients. PMID:27799679
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Playing Piano Can Improve Upper Extremity Function after Stroke: Case Studies
Villeneuve, Myriam; Lamontagne, Anouk
2013-01-01
Music-supported therapy (MST) is an innovative approach that was shown to improve manual dexterity in acute stroke survivors. The feasibility of such intervention in chronic stroke survivors and its longer-term benefits, however, remain unknown. The objective of this pilot study was to estimate the short- and long-term effects of a 3-week piano training program on upper extremity function in persons with chronic stroke. A multiple pre-post sequential design was used, with measurements taken at baseline (week0, week3), prior to (week6) and after the intervention (week9), and at 3-week follow-up (week12). Three persons with stroke participated in the 3-week piano training program that combined structured piano lessons to home practice program. The songs, played on an electronic keyboard, involved all 5 digits of the affected hand and were displayed using a user-friendly MIDI program. After intervention, all the three participants showed improvements in their fine (nine hole peg test) and gross (box and block test) manual dexterity, as well as in the functional use of the upper extremity (Jebsen hand function test). Improvements were maintained at follow-up. These preliminary results support the feasibility of using an MST approach that combines structured lessons to home practice to improve upper extremity function in chronic stroke. PMID:23533954
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Professional musicians with craniomandibular dysfunctions treated with oral splints.
Steinmetz, Anke; Ridder, Paul H; Methfessel, Götz; Muche, Burkhard
2009-10-01
Craniomandibular dysfunction (CMD) symptoms occur frequently in violin/viola and wind players and can be associated with pain in the neck, shoulders and arm. In the current study, the effect of oral splint treatment of CMD on reducing pain and symptoms especially in these areas was investigated. Thirty (30) musicians undergoing CMD treatment with oral splints participated in this study. They completed a questionnaire that addressed CMD symptoms, localization of pain, and subjective changes in symptoms. Pain in the shoulder and/or upper extremity was the most frequent symptom reported by 83% of subjects, followed by neck pain (80%) and pain in the teeth/TMJ regions (63%). Treatment with oral splints contributed to a significant decrease in neck pain in 91%, teeth/TMJ pain in 83%, and shoulder and upper extremity pain in 76% of the musicians. Eighty percent (80%) of the patients reported improvement of their predominant symptoms. CMD can be a potential cause for pain in the neck, shoulders, and upper extremities of musicians. It is paramount that musicians with musculoskeletal problems be examined for CMD symptoms. Treatment with oral splints seems to be valuable. Further prospective, randomized controlled studies are necessary to confirm efficacy of oral splint treatment in CMD-associated pain and problems in the neck, shoulder, and the upper extremities in musicians.
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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.
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Jung, Hungu; Yamasaki, Masahiro
2016-12-08
Reduced lower extremity range of motion (ROM) and muscle strength are related to functional disability in older adults who cannot perform one or more activities of daily living (ADL) independently. The purpose of this study was to determine which factors of seven lower extremity ROMs and two muscle strengths play dominant roles in the physical performance of community-dwelling older women. Ninety-five community-dwelling older women (mean age ± SD, 70.7 ± 4.7 years; age range, 65-83 years) were enrolled in this study. Seven lower extremity ROMs (hip flexion, hip extension, knee flexion, internal and external hip rotation, ankle dorsiflexion, and ankle plantar flexion) and two muscle strengths (knee extension and flexion) were measured. Physical performance tests, including functional reach test (FRT), 5 m gait test, four square step test (FSST), timed up and go test (TUGT), and five times sit-to-stand test (FTSST) were performed. Stepwise regression models for each of the physical performance tests revealed that hip extension ROM and knee flexion strength were important explanatory variables for FRT, FSST, and FTSST. Furthermore, ankle plantar flexion ROM and knee extension strength were significant explanatory variables for the 5 m gait test and TUGT. However, ankle dorsiflexion ROM was a significant explanatory variable for FRT alone. The amount of variance on stepwise multiple regression for the five physical performance tests ranged from 25 (FSST) to 47% (TUGT). Hip extension, ankle dorsiflexion, and ankle plantar flexion ROMs, as well as knee extension and flexion strengths may play primary roles in the physical performance of community-dwelling older women. Further studies should assess whether specific intervention programs targeting older women may achieve improvements in lower extremity ROM and muscle strength, and thereby play an important role in the prevention of dependence on daily activities and loss of physical function, particularly focusing on hip extension, ankle dorsiflexion, and ankle plantar flexion ROMs as well as knee extension and flexion strength.
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Salvage of mangled upper extremity using the Masquelet technique in a child: A case report.
Alassaf, Nabil; Alhoukail, Amro; Alsahli, Abdullah; Althubaiti, Ghazi
2017-01-01
To report our experience with the Masquelet concept in a pediatric upper extremity following an open injury to the elbow. A case report and literature review. An 11-year-old boy was transferred to our institution after a motor vehicle collision. There was a primary loss of the ulnohumeral articulation and the surrounding soft tissues as well as the ulnar nerve. Reconstruction used the Masquelet-induced membrane technique and a soft tissue flap. At the 30-month follow-up, the extremity was pain free and functional. This case highlights the value of the Masquelet technique in pediatric extremity injuries, where there is a loss of a major articular segment, as well as significant soft tissue compromise.
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Evaluating Upper-Body Strength and Power From a Single Test: The Ballistic Push-up.
Wang, Ran; Hoffman, Jay R; Sadres, Eliahu; Bartolomei, Sandro; Muddle, Tyler W D; Fukuda, David H; Stout, Jeffrey R
2017-05-01
Wang, R, Hoffman, JR, Sadres, E, Bartolomei, S, Muddle, TWD, Fukuda, DH, and Stout, JR. Evaluating upper-body strength and power from a single test: the ballistic push-up. J Strength Cond Res 31(5): 1338-1345, 2017-The purpose of this study was to examine the reliability of the ballistic push-up (BPU) exercise and to develop a prediction model for both maximal strength (1 repetition maximum [1RM]) in the bench press exercise and upper-body power. Sixty recreationally active men completed a 1RM bench press and 2 BPU assessments in 3 separate testing sessions. Peak and mean force, peak and mean rate of force development, net impulse, peak velocity, flight time, and peak and mean power were determined. Intraclass correlation coefficients were used to examine the reliability of the BPU. Stepwise linear regression was used to develop 1RM bench press and power prediction equations. Intraclass correlation coefficient's ranged from 0.849 to 0.971 for the BPU measurements. Multiple regression analysis provided the following 1RM bench press prediction equation: 1RM = 0.31 × Mean Force - 1.64 × Body Mass + 0.70 (R = 0.837, standard error of the estimate [SEE] = 11 kg); time-based power prediction equation: Peak Power = 11.0 × Body Mass + 2012.3 × Flight Time - 338.0 (R = 0.658, SEE = 150 W), Mean Power = 6.7 × Body Mass + 1004.4 × Flight Time - 224.6 (R = 0.664, SEE = 82 W); and velocity-based power prediction equation: Peak Power = 8.1 × Body Mass + 818.6 × Peak Velocity - 762.0 (R = 0.797, SEE = 115 W); Mean Power = 5.2 × Body Mass + 435.9 × Peak Velocity - 467.7 (R = 0.838, SEE = 57 W). The BPU is a reliable test for both upper-body strength and power. Results indicate that the mean force generated from the BPU can be used to predict 1RM bench press, whereas peak velocity and flight time measured during the BPU can be used to predict upper-body power. These findings support the potential use of the BPU as a valid method to evaluate upper-body strength and power.
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Hwang, Ui-Jae; Kwon, Oh-Yun; Yi, Chung-Hwi; Jeon, Hye-Seon; Weon, Jong-Hyuck; Ha, Sung-Min
2017-06-01
Shoulder pain occurs commonly in food service workers (FSWs) who repetitively perform motions of the upper limbs. Myofascial trigger points (MTrPs) on the upper trapezius (UT) are among the most common musculoskeletal shoulder pain syndromes. This study determined the psychological, posture, mobility, and strength factors associated with pain severity in FSWs with UT pain due to MTrPs.In this cross-sectional study, we measured 17 variables in 163 FSWs with UT pain due to MTrPs: a visual analog scale (VAS) pain score, age, sex, Borg rating of perceived exertion (BRPE) scale, beck depression inventory, forward head posture angle, rounded shoulder angle (RSA), shoulder slope angle, scapular downward rotation ratio, cervical lateral-bending side difference angle, cervical rotation side difference angle, glenohumeral internal rotation angle, shoulder horizontal adduction angle, serratus anterior (SA) strength, lower trapezius (LT) strength, bicep strength, and glenohumeral external rotator strength, in 163 FSWs with UT pain due to MTrPs.The model for factors influencing UT pain with MTrPs included SA strength, age, BRPE, LT strength, and RSA as predictor variables that accounted for 68.7% of the variance in VAS (P < .001) in multiple regression models with a stepwise selection procedure. The following were independent variables influencing the VAS in the order of standardized coefficients: SA strength (β = -0.380), age (β = 0.287), BRPE (β = 0.239), LT strength (β = -0.195), and RSA (β = 0.125).SA strength, age, BRPE, LT strength, and RSA variables should be considered when evaluating and intervening in UT pain with MTrPs in FSWs.
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Predictors of upper trapezius pain with myofascial trigger points in food service workers
Hwang, Ui-Jae; Kwon, Oh-Yun; Yi, Chung-Hwi; Jeon, Hye-Seon; Weon, Jong-Hyuck; Ha, Sung-Min
2017-01-01
Abstract Shoulder pain occurs commonly in food service workers (FSWs) who repetitively perform motions of the upper limbs. Myofascial trigger points (MTrPs) on the upper trapezius (UT) are among the most common musculoskeletal shoulder pain syndromes. This study determined the psychological, posture, mobility, and strength factors associated with pain severity in FSWs with UT pain due to MTrPs. In this cross-sectional study, we measured 17 variables in 163 FSWs with UT pain due to MTrPs: a visual analog scale (VAS) pain score, age, sex, Borg rating of perceived exertion (BRPE) scale, beck depression inventory, forward head posture angle, rounded shoulder angle (RSA), shoulder slope angle, scapular downward rotation ratio, cervical lateral-bending side difference angle, cervical rotation side difference angle, glenohumeral internal rotation angle, shoulder horizontal adduction angle, serratus anterior (SA) strength, lower trapezius (LT) strength, bicep strength, and glenohumeral external rotator strength, in 163 FSWs with UT pain due to MTrPs. The model for factors influencing UT pain with MTrPs included SA strength, age, BRPE, LT strength, and RSA as predictor variables that accounted for 68.7% of the variance in VAS (P < .001) in multiple regression models with a stepwise selection procedure. The following were independent variables influencing the VAS in the order of standardized coefficients: SA strength (β = −0.380), age (β = 0.287), BRPE (β = 0.239), LT strength (β = −0.195), and RSA (β = 0.125). SA strength, age, BRPE, LT strength, and RSA variables should be considered when evaluating and intervening in UT pain with MTrPs in FSWs. PMID:28658117
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Baker, Daniel G
2013-02-01
The purpose of this investigation was to observe changes in maximal upper body strength and power across a 10-year period in professional athletes who were experienced resistance trainers. Six professional rugby league players were observed with test data reported according to 2 important training stages in their professional careers. The first stage (1996-1998) monitored the changes as the subjects strived to establish themselves as elite professionals in their sport. The remaining test data are from the latter stage (2000-2006), which is characterized by a longer competition schedule and shorter periods devoted to improving physical preparation. The changes in upper body strength, assessed by the 1 repetition maximum bench press and mean maximum power during bench press throws with various barbell resistances of 40-80 kg, were assessed by effect size (ES) and smallest worthwhile change (SWC) statistics. Large increases in strength and power of approximately 22-23% were reported across the 10-year period, however, only small changes (as determined by ES) in strength or power occurred after year 2000 till 2006. This result of only small changes in strength or power despite 6 years of intense resistance training was attributed to 3 main factors. Key among them are the possible existence of a "strength ceiling" for experienced resistance trainers, the Long-term Athlete Development model, and possibly an inappropriate volume of strength-endurance training from 2004 to 2005. The fact that an SWC in strength and power occurred in the year after the cessation of strength-endurance training suggests that training program manipulation is still an influencing factor in continuing strength and power gains in experienced resistance trainers.
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Reed, Casey A; Ford, Kevin R; Myer, Gregory D; Hewett, Timothy E
2012-08-01
Core stability training, operationally defined as training focused to improve trunk and hip control, is an integral part of athletic development, yet little is known about its direct relation to athletic performance. This systematic review focuses on identification of the association between core stability and sports-related performance measures. A secondary objective was to identify difficulties encountered when trying to train core stability with the goal of improving athletic performance. A systematic search was employed to capture all articles related to athletic performance and core stability training that were identified using the electronic databases MEDLINE, CINAHL and SPORTDiscus™ (1982-June 2011). A systematic approach was used to evaluate 179 articles identified for initial review. Studies that performed an intervention targeted toward the core and measured an outcome related to athletic or sport performances were included, while studies with a participant population aged 65 years or older were excluded. Twenty-four in total met the inclusionary criteria for review. Studies were evaluated using the Physical Therapy Evidence Database (PEDro) scale. The 24 articles were separated into three groups, general performance (n = 8), lower extremity (n = 10) and upper extremity (n = 6), for ease of discussion. In the majority of studies, core stability training was utilized in conjunction with more comprehensive exercise programmes. As such, many studies saw improvements in skills of general strengths such as maximum squat load and vertical leap. Surprisingly, not all studies reported measurable increases in specific core strength and stability measures following training. Additionally, investigations that targeted the core as the primary goal for improved outcome of training had mixed results. Core stability is rarely the sole component of an athletic development programme, making it difficult to directly isolate its affect on athletic performance. The population biases of some studies of athletic performance also confound the results. Targeted core stability training provides marginal benefits to athletic performance. Conflicting findings and the lack of a standardization for measurement of outcomes and training focused to improve core strength and stability pose difficulties. Because of this, further research targeted to determine this relationship is necessary to better understand how core strength and stability affect athletic performance.
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Yu, Chang Ho; Seo, Shin Bae; Kang, Seung Rok; Kim, Kyung; Kwon, Tae Kyu
2015-01-01
This study shows the improvement of muscle activity and muscle strength imbalance in the lower extremities through independent exercise loads in vibration platform. Twenty females of age 20 participated in this study. The subjects were divided into WBV group, with more than 10% of muscle strength imbalance between left and right the lower extremities, and control group, with less than 10% of muscle strength imbalance between left and right the lower extremities. As the prior experiment showed, different exercise postures provide different muscular activities. As a result, the highest muscular activity was found to be in the low squat posture. Therefore, the LS posture was selected for the exercise in this experiment. Vibration intensities were applied to dominant muscle and non-dominant muscle, and the vibration frequency was fixed at 25Hz for the WBV group. The control group was asked to perform the same exercise as the WBV group, without stimulated vibration. This exercise was conducted for a total of 4 weeks. As a result, the WBV group which showed an average deviation of 16% before the experiment, tended to decrease approximately to 5%. In this study, vibration exercise using load deviation is shown to be effective in improving the muscle strength imbalance.
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Snyder, Kelli R; Earl, Jennifer E; O'Connor, Kristian M; Ebersole, Kyle T
2009-01-01
Movement and muscle activity of the hip have been shown to affect movement of the lower extremity, and been related to injury. The purpose of this study was to determine if increased hip strength affects lower extremity mechanics during running. Within subject, repeated measures design. Fifteen healthy women volunteered. Hip abduction and external rotation strength were measured using a hand-held dynamometer. Three-dimensional biomechanical data of the lower extremity were collected during running using a high-speed motion capture system. Measurements were made before, at the mid-point, and after a 6-week strengthening program using closed-chain hip rotation exercises. Joint range of motion (rearfoot eversion, knee abduction, hip adduction, and internal rotation), eversion velocity, eversion angle at heel strike, and peak joint moments (rearfoot inversion, knee abduction, hip abduction, and external rotation) were analyzed using repeated measures analysis of variance (P
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Bullock, Garrett S; Brookreson, Nate; Knab, Amy M; Butler, Robert J
2017-06-01
Abnormal fundamental movement patterns and upper-quarter dynamic balance are proposed mechanisms affecting athletic performance and injury risk. There are few studies investigating functional movement and closed-chain upper-extremity dynamic stability in swimmers. The purpose of this study was to determine differences in fundamental movement competency and closed-chain upper-extremity dynamic balance, using the Functional Movement Screen (FMS) and Upper-Quarter Y Balance Test (YBT-UQ), of high school (HS; n = 70) and collegiate (COL; n = 70) swimmers. Variables included the individual movement tests on the FMS and the average normalized reach (percent limb length [%LL]) for each direction, with the YBT-UQ. Statistical analysis was completed using a chi square for the independent test scores on the FMS while independent samples t-test to examine performance on the YBT-UQ (p ≤ 0.05). HS swimmers exhibited a statistically significant greater percentage of below average performance (score of 0 or 1) on the following FMS tests: lunge (HS: 22.9%, COL: 4.3%), hurdle step (HS: 31.4%, COL: 7.1%), and push-up (HS: 61.4%, COL: 31.4%). Furthermore, COL males performed worse in the lunge (male: 9%, female: 0%), whereas COL females had poorer efficiency in the push-up (male: 17.6%, female: 44%). Significant effects of competition level and sex were observed in YBT-UQ medial reach (HS: female 92.06, male 101.63; COL: female 101.3, male 101.5% LL). Individual fundamental movement patterns that involved lumbopelvic neuromuscular control differed between HS and COL swimmers. General upper-extremity dynamic balance differed between competition levels. These data may be helpful in understanding injury and performance-based normative data for participation and return to swimming.
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Bieler, Theresa; Magnusson, Stig Peter; Christensen, Helle Elisabeth; Kjaer, Michael; Beyer, Nina
2017-07-01
To investigate between-leg differences in hip and thigh muscle strength and leg extensor power in patients with unilateral hip osteoarthritis. Further, to compare between-leg differences in knee extensor strength and leg extensor power between patients and healthy peers. Seventy-two patients (60-87 years) with radiographic and symptomatic hip osteoarthritis not awaiting hip replacement and 35 healthy peers (63-82 years) were included. Hip and thigh muscle strength and leg extensor power were measured in patients and knee extensor strength and leg extensor power in healthy. The symptomatic extremity in patients was significantly (p < 0.05, paired t-test) weaker compared with the non-symptomatic extremity for five hip muscles (8-17%), knee extensors (11%) and leg extensor power (19%). Healthy older adults had asymmetry in knee extensor strength (6%, p < 0.05) comparable to that found in patients, but had no asymmetry in leg extensor power. Patients had generalized weakening of the affected lower extremity and numerically the largest asymmetry was evident for leg extensor power. In contrast, healthy peers had no asymmetry in leg extensor power. These results indicate that exercise interventions focusing on improving leg extensor power of the symptomatic lower extremity and reducing asymmetry may be beneficial for patients with hip osteoarthritis. Implications for Rehabilitation Even in patients with mild symptoms not awaiting hip replacement a generalized muscle weakening of the symptomatic lower extremity seems to be present. Between-leg differences in leg extensor power (force × velocity) appears to be relatively large (19%) in patients with unilateral hip osteoarthritis in contrast to healthy peers who show no asymmetry. Compared to muscle strength the relationship between functional performance and leg extensor power seems to be stronger, and more strongly related to power of the symptomatic lower extremity. Our results indicate that exercise interventions focusing on improving leg extensor power of the symptomatic lower extremity and reducing asymmetry may be beneficial for patients with mild symptoms not awaiting hip replacement.
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Upper limb robot-assisted therapy in cerebral palsy: a single-blind randomized controlled trial.
Gilliaux, Maxime; Renders, Anne; Dispa, Delphine; Holvoet, Dominique; Sapin, Julien; Dehez, Bruno; Detrembleur, Christine; Lejeune, Thierry M; Stoquart, Gaëtan
2015-02-01
Several pilot studies have evoked interest in robot-assisted therapy (RAT) in children with cerebral palsy (CP). To assess the effectiveness of RAT in children with CP through a single-blind randomized controlled trial. Sixteen children with CP were randomized into 2 groups. Eight children performed 5 conventional therapy sessions per week over 8 weeks (control group). Eight children completed 3 conventional therapy sessions and 2 robot-assisted sessions per week over 8 weeks (robotic group). For both groups, each therapy session lasted 45 minutes. Throughout each RAT session, the patient attempted to reach several targets consecutively with the REAPlan. The REAPlan is a distal effector robot that allows for displacements of the upper limb in the horizontal plane. A blinded assessment was performed before and after the intervention with respect to the International Classification of Functioning framework: body structure and function (upper limb kinematics, Box and Block test, Quality of Upper Extremity Skills Test, strength, and spasticity), activities (Abilhand-Kids, Pediatric Evaluation of Disability Inventory), and participation (Life Habits). During each RAT session, patients performed 744 movements on average with the REAPlan. Among the variables assessed, the smoothness of movement (P < .01) and manual dexterity assessed by the Box and Block test (P = .04) improved significantly more in the robotic group than in the control group. This single-blind randomized controlled trial provides the first evidence that RAT is effective in children with CP. Future studies should investigate the long-term effects of this therapy. © The Author(s) 2014.
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Dipla, Konstantina; Makri, Maria; Zafeiridis, Andreas; Soulas, Dimitrios; Tsalouhidou, Sofia; Mougios, Vassilis; Kellis, Spyros
2008-08-01
Resistance exercise is recommended to individuals following high-protein diets in order to augment changes in body composition. However, alterations in macronutrient composition may compromise physical performance. The present study investigated the effects of an isoenergetic high-protein diet on upper and lower limb strength and fatigue during high-intensity resistance exercise. Ten recreationally active women, aged 25-40 years, followed a control diet (55, 15 and 30 % of energy from carbohydrate, protein and fat, respectively) and a high-protein diet (respective values, 30, 40 and 30) for 7 d each in a random counterbalanced design. Each participant underwent strength testing of upper limb (isometric handgrip strength and endurance) and lower limb (four sets of sixteen maximal knee flexions and extensions on an isokinetic dynamometer) before and after applying each diet. Body weight, body fat and RER were significantly reduced following the high-protein diet (P < 0.05). No differences were found between diets in any of the strength performance parameters (handgrip strength, handgrip endurance, peak torque, total work and fatigue) or the responses of heart rate, systolic and diastolic arterial pressure, blood lactate and blood glucose to exercise. Women on a short-term isoenergetic high-protein, moderate-fat diet maintained muscular strength and endurance of upper and lower limbs during high-intensity resistance exercise without experiencing fatigue earlier compared with a control diet.
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Ortiz, Alexis; Tirado, Maribel; Hughes, Daniel C; Gonzalez, Velda; Song, JaeJoon; Mama, Scherezade K; Basen-Engquist, Karen
2018-10-01
To report baseline data from a physical activity (PA) intervention for Latina breast cancer survivors, and assess the relationship between PA, fitness, and disability. Eighty-nine Latina breast cancer survivors from San Juan, PR and Houston, TX (age: 55.4 ± 9.9 years; BMI: 29.87 ± 5.62 kg/m 2 ; ≥ 3 months post-treatment) participated in this study. At baseline participants completed fitness testing (six-minute walk test [6MWT], 30-second sit-stand; grip strength, lower and upper extremity and low back strength, shoulder range of motion, balance testing), and assessment of physical activity (PA) and disability. PA was assessed using the International Physical Activity Questionnaire (IPAQ). A subsample (n = 27) received an accelerometer to compare objective versus self-reported PA. Participants exhibited low PA (M = 76.5 MET·minutes/week; SD = 183.4), poor fitness (6MWT M = 436.4 meters, SD = 99.1; 30s sit-stand, M = 11.6 stands, SD = 3.1), and no detectable disability. In an adjusted model lower extremity fitness was associated with PA, with a one repetition increase in sit-to-stand associated with 49 additional minutes of self-reported PA plus walking per week. The correlation between IPAQ moderate-vigorous PA and accelerometer was 0.38 (p = 0.047). Latina breast cancer survivors have low physical activity and fitness levels that increase their risk of disability, cardiometabolic comorbidities, and potential cancer recurrence.
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Hong, Il Ki; Choi, Jong Bae; Lee, Jong Ha
2012-09-01
Paresis of the upper extremity after stroke is not effectively solved by existing therapies. We investigated whether mental imagery training combined with electromyogram-triggered electric stimulation improved motor function of the paretic upper extremity in patients with chronic stroke and induced cortical changes. Fourteen subjects with chronic stroke (≥12 months) were randomly allocated to receive mental imagery training combined with electromyogram-triggered electric stimulation (n=7) or generalized functional electric stimulation (n=7) on the forearm extensor muscles of the paretic extremity in 2 20-minute daily sessions 5 days a week for 4 weeks. The upper extremity component of the Fugl-Meyer Motor Assessment, the Motor Activity Log, the modified Barthel Index, and (18)F-fluorodeoxyglucose brain positron emission tomography were measured before and after the intervention. The group receiving mental imagery training combined with electromyogram-triggered electric stimulation exhibited significant improvements in the upper extremity component of the Fugl-Meyer Motor Assessment after intervention (median, 7; interquartile range, 5-8; P<0.05), but the group receiving functional electric stimulation did not (median, 0; interquartile range, 0-3). Differences in score changes between the 2 groups were significant. The mental imagery training combined with electromyogram-triggered electric stimulation group showed significantly increased metabolism in the contralesional supplementary motor, precentral, and postcentral gyri (P(uncorrected)<0.001) after the intervention, but the functional electric stimulation group showed no significant differences. Mental imagery training combined with electromyogram-triggered electric stimulation improved motor function of the paretic extremity in patients with chronic stroke. The intervention increased metabolism in the contralesional motor-sensory cortex. Clinical Trial Registration- URL: https://e-irb.khmccri.or.kr/eirb/receipt/index.html?code=02&status=5. Unique identifier: KHUHMDIRB 1008-02.
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Validation and Reliability of a Novel Test of Upper Body Isometric Strength.
Bellar, David; Marcus, Lena; Judge, Lawrence W
2015-09-29
The purpose of the present investigation was to examine the association of a novel test of upper body isometric strength against a 1RM bench press measurement. Forty college age adults (n = 20 female, n = 20 male; age 22.8 ± 2.8 years; body height 171.6 ± 10.8 cm; body mass 73.5 ± 16.3 kg; body fat 23.1 ± 5.4%) volunteered for the present investigation. The participants reported to the lab on three occasions. The first visit included anthropometric measurements and familiarization with both the upper body isometric test and bench press exercise. The final visits were conducted in a randomized order, with one being a 1RM assessment on the bench press and the other consisting of three trials of the upper body isometric assessment. For the isometric test, participants were positioned in a "push-up" style position while tethered (stainless steel chain) to a load cell (high frequency) anchored to the ground. The peak isometric force was consistent across all three trials (ICC = 0.98) suggesting good reliability. Multiple regression analysis was completed with the predictors: peak isometric force, gender, against the outcome variable 1RM bench press. The analysis resulted in a significant model (r2 = 0.861, p≤0.001) with all predictor variables attaining significance in the model (p<0.05). Isometric peak strength had the greatest effect on the model (Beta = 5.19, p≤0.001). Results from this study suggest that the described isometric upper body strength assessment is likely a valid and reliable tool to determine strength. Further research is warranted to gather a larger pool of data in regard to this assessment.
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Validation and Reliability of a Novel Test of Upper Body Isometric Strength
Bellar, David; Marcus, Lena; Judge, Lawrence W.
2015-01-01
The purpose of the present investigation was to examine the association of a novel test of upper body isometric strength against a 1RM bench press measurement. Forty college age adults (n = 20 female, n = 20 male; age 22.8 ± 2.8 years; body height 171.6 ± 10.8 cm; body mass 73.5 ± 16.3 kg; body fat 23.1 ± 5.4%) volunteered for the present investigation. The participants reported to the lab on three occasions. The first visit included anthropometric measurements and familiarization with both the upper body isometric test and bench press exercise. The final visits were conducted in a randomized order, with one being a 1RM assessment on the bench press and the other consisting of three trials of the upper body isometric assessment. For the isometric test, participants were positioned in a “push-up” style position while tethered (stainless steel chain) to a load cell (high frequency) anchored to the ground. The peak isometric force was consistent across all three trials (ICC = 0.98) suggesting good reliability. Multiple regression analysis was completed with the predictors: peak isometric force, gender, against the outcome variable 1RM bench press. The analysis resulted in a significant model (r2 = 0.861, p≤0.001) with all predictor variables attaining significance in the model (p<0.05). Isometric peak strength had the greatest effect on the model (Beta = 5.19, p≤0.001). Results from this study suggest that the described isometric upper body strength assessment is likely a valid and reliable tool to determine strength. Further research is warranted to gather a larger pool of data in regard to this assessment. PMID:26557203
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Hertzog, Maxime; Rumpf, Michael Clemens; Hader, Karim
2017-08-26
Soccer is classified as a contact/collision sport with many player-to-player duels. Winning these duels, shielding the ball or fending off an opponent requires upper-body strength and power. Therefore this study aimed, a) to examine the time-related effect of an upper-body RT on maximal strength and power changes in highly trained soccer players, b) to investigate if the resistance-training (RT) status influences these changes throughout a competitive season. Twenty-eight soccer players participated in this study and were divided into an untrained (UG) and a trained (TG) group, according to their RT status. Both groups performed the same upper-body RT once a week, over 30 weeks. Maximal strength (1RM) and maximal power (MP) were assessed before, during and after the competitive season. Both groups significantly improved 1RM and MP over the entire competitive season, with a moderate (TG, 13%) to very large (UG, 21%) magnitude in 1RM and with a small (TG, 8%) to moderate (UG, 13%) magnitude in MP. After the initial 10 weeks of RT, UG presented significant and slightly (1RM) to moderately (MP) greater improvements than TG. For all other time intervals, the between-groups changes in 1RM were rated as similar. For the last 20 weeks of the RT, the change in MP was significantly lower for UG compared to TG. One upper-body RT-session per week will provide sufficient stimulus to enable an almost certain improvement in strength and power throughout a competitive season for all players disregarding their initial RT status.
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Inadequate Loading Stimulus on ISS Results in Bone and Muscle Loss
NASA Technical Reports Server (NTRS)
Rice, A. J.; Genc, K. O.; Maender, C. C.; Gopalakrishnan, R.; Kuklis, M. M.; Cavanagh, P. R.
2011-01-01
INTRODUCTION Exercise has been the primary countermeasure to combat musculoskeletal changes during International Space Station (ISS) missions. However, these countermeasures have not been successful in preventing loss of bone mineral density (BMD) or muscle volume in crew members. METHODS We examined lower extremity loading during typical days on-orbit and on Earth for four ISS crew members. In-shoe forces were monitored using force-measuring insoles placed inside the shoes. BMD (by DXA), muscle volumes (by MRI), and strength were measured before and after long-duration spaceflight (181 +/- 15 days). RESULTS The peak forces measured during ISS activity were significantly less than those measured in 1g for the same activities. Typical single-leg loads on-orbit during walking and running were 0.89 +/- 0.17 body weights (BW) and 1.28 +/- 0.18 BW compared to 1.18 +/- 0.11 BW and 2.36 +/- .22 BW in 1g, respectively [2]. Crew members were only loaded for an average of 43.17 +/- 14.96 min a day while performing exercise on-orbit even though 146.8 min were assigned for exercise each day. Areal BMD decreased in the femoral neck and total hip by 0.71 +/- 0.34% and 0.81 +/- 0.21% per month, respectively. Changes in muscle volume were observed in the lower extremity (-10 to -16% calf; -4 to -7% thigh) but there were no changes in the upper extremity (+0.4 to -0.8%). Decrements in isometric and isokinetic strength at the knee (range: -10.4 to -24.1%), ankle (range: -4 to -22.3%), and elbow (range: -7.5 to - 16.7%) were also observed. Knee extension endurance tests showed an overall decline in total work (-14%) but an increased resistance to fatigue post-flight. DISCUSSION AND CONCLUSIONS Our findings support the conclusion that the measured exercise durations and/or loading stimuli were insufficient to protect bone and muscle health.
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A hybrid joint based controller for an upper extremity exoskeleton
NASA Astrophysics Data System (ADS)
Mohd Khairuddin, Ismail; Taha, Zahari; Majeed, Anwar P. P. Abdul; Hakeem Deboucha, Abdel; Azraai Mohd Razman, Mohd; Aziz Jaafar, Abdul; Mohamed, Zulkifli
2016-02-01
This paper presents the modelling and control of a two degree of freedom upper extremity exoskeleton. The Euler-Lagrange formulation was used in deriving the dynamic modelling of both the human upper limb as well as the exoskeleton that consists of the upper arm and the forearm. The human model is based on anthropometrical measurements of the upper limb. The proportional-derivative (PD) computed torque control (CTC) architecture is employed in this study to investigate its efficacy performing joint-space control objectives specifically in rehabilitating the elbow and shoulder joints along the sagittal plane. An active force control (AFC) algorithm is also incorporated into the PD-CTC to investigate the effectiveness of this hybrid system in compensating disturbances. It was found that the AFC- PD-CTC performs well against the disturbances introduced into the system whilst achieving acceptable trajectory tracking as compared to the conventional PD-CTC control architecture.
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Upper extremity transplantation: current concepts and challenges in an emerging field.
Elliott, River M; Tintle, Scott M; Levin, L Scott
2014-03-01
Loss of an isolated upper limb is an emotionally and physically devastating event that results in significant impairment. Patients who lose both upper extremities experience profound disability that affects nearly every aspect of their lives. While prosthetics and surgery can eventually provide the single limb amputee with a suitable assisting hand, limited utility, minimal haptic feedback, weight, and discomfort are persistent problems with these techniques that contribute to high rates of prosthetic rejection. Moreover, despite ongoing advances in prosthetic technology, bilateral amputees continue to experience high levels of dependency, disability, and distress. Hand and upper extremity transplantation holds several advantages over prosthetic rehabilitation. The missing limb is replaced with one of similar skin color and size. Sensibility, voluntary motor control, and proprioception are restored to a greater degree, and afford better dexterity and function than prosthetics. The main shortcomings of transplantation include the hazards of immunosuppression, the complications of rejection and its treatment, and high cost. Hand and upper limb transplantation represents the most commonly performed surgery in the growing field of Vascularized Composite Allotransplantation (VCA). As upper limb transplantation and VCA have become more widespread, several important challenges and controversies have emerged. These include: refining indications for transplantation, optimizing immunosuppression, establishing reliable criteria for monitoring, diagnosing, and treating rejection, and standardizing outcome measures. This article will summarize the historical background of hand transplantation and review the current literature and concepts surrounding it.
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Physical and mental workload in single-incision laparoscopic surgery and conventional laparoscopy.
Koca, Dilek; Yıldız, Sedat; Soyupek, Feray; Günyeli, İlker; Erdemoglu, Ebru; Soyupek, Sedat; Erdemoglu, Evrim
2015-06-01
The aim of the present study is to evaluate mental workload and fatigue in fingers, hand, arm, shoulder in single-incision laparoscopic surgery (SILS) and multiport laparoscopy. Volunteers performed chosen tasks by standard laparoscopy and SILS. Time to complete tasks and finger and hand strength were evaluated. Lateral, tripod, and pulp pinch strengths were measured. Hand dexterity was determined by pegboard. Electromyography recordings were taken from biceps and deltoid muscles of both extremities. The main outcome measurement was median frequency (MF) slope. NASA-TLX was used for mental workload. Time to complete laparoscopic tasks were longer in the SILS group (P < .05). Decrease of strength in fingers and hand were similar in SILS and standard laparoscopy. Pegboard time was increased in both hands after SILS (P < .05). MF slope of biceps muscle and deltoid muscle in SILS was far away from the reference slope. MF slope of biceps muscle and deltoid muscle in standard laparoscopy was close to reference slope, indicating there was more fatigue in biceps and deltoid muscles of both upper extremities in SILS group. NASA-TLX score was 73 ± 13.3 and 42 ± 19.5 in SILS and multiport laparoscopy, respectively (P < .01). Mental demand, physical demand, temporal demand, performance, effort, and frustration were, respectively, scored 10.7 ± 3.8, 11.7 ± 3.5, 12.2 ± 2.7, 11 ± 3, 13.6 ± 2.7, and 13.5 ± 2.8 in SILS and 6.3 ± 3.1, 6.6 ± 3.3, 7.3 ± 3.3, 7.1 ± 4.1, 7.9 ± 3.9, and 6.6 ± 3.8 in standard laparoscopy (P < .01). SILS is mentally and physically demanding, particularly on arms and shoulders. Fatigue of big muscles, effort, and frustration were major challenges of SILS. Ergonomic intervention of instruments are needed to decrease mental and physical workload. © The Author(s) 2014.
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NASA Technical Reports Server (NTRS)
Clements, L. L.; Lee, P. R.
1980-01-01
Tension tests on graphite/epoxy composites were performed to determine the influence of various quality control variables on failure strength as a function of moisture and moderate temperatures. The extremely high and low moisture contents investigated were found to have less effect upon properties than did temperature or the quality control variables of specimen flaws and prepreg batch to batch variations. In particular, specimen flaws were found to drastically reduce the predicted strength of the composite, whereas specimens from different batches of prepreg displayed differences in strength as a function of temperature and extreme moisture exposure. The findings illustrate the need for careful specimen preparation, studies of flaw sensitivity, and careful quality control in any study of composite materials.
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Texting on mobile phones and musculoskeletal disorders in young adults: A five-year cohort study.
Gustafsson, Ewa; Thomée, Sara; Grimby-Ekman, Anna; Hagberg, Mats
2017-01-01
The aim was to examine whether texting on a mobile phone is a risk factor for musculoskeletal disorders in the neck and upper extremities in a population of young adults. In a longitudinal population-based cohort study with Swedish young adults (aged 20-24 years) data were collected via a web-based questionnaire at baseline (n = 7092) and after one and five years. Cross-sectional associations were found between text messaging and reported ongoing symptoms in neck and upper extremities (odds ratios, ORs 1.3-2.0). Among symptom-free at baseline prospective associations were only found between text messaging and new cases of reported symptoms in the hand/fingers (OR 2.0) at one year follow up. Among those with symptoms at baseline prospective associations were found between text messaging and maintained pain in neck/upper back (OR 1.6). The results imply mostly short-term effects, and to a lesser extent, long-term effects on musculoskeletal disorders in neck and upper extremities. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.
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Quantification of human upper extremity nerves and fascicular anatomy.
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.
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Preliminary research of a novel center-driven robot for upper extremity rehabilitation.
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.
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Rhabdomyolysis After Performing Blood Flow Restriction Training: A Case Report.
Tabata, Shogo; Suzuki, Yukio; Azuma, Koichiro; Matsumoto, Hideo
2016-07-01
Tabata, S, Suzuki, Y, Azuma, K, and Matsumoto, H. Rhabdomyolysis after performing blood flow restriction training: a case report. J Strength Cond Res 30(7): 2064-2068, 2016-Rhabdomyolysis is a serious and potentially life-threatening condition related to resistance training. Despite numerous reports of low-intensity blood flow restriction (BFR) training inducing muscle hypertrophy and increasing strength, few reports of rhabdomyolysis related to BFR training have been published. Here, we report a 30-year-old obese Japanese man admitted to our hospital the day after his first BFR training session with complaints of severe muscle pain in his upper and lower extremities, high fever, and pharyngeal pain. He was diagnosed with acute rhabdomyolysis based on a serum creatine phosphokinase level of 56,475 U·L and a urine myoglobin level of >3,000 ng·ml, and with acute tonsillitis based on a white blood cell count of 17,390 and C-reactive protein level of 10.43 mg·dl. A number of factors are suspected to be related to the onset and exacerbation of rhabdomyolysis, including excessive muscular training with BFR, bacterial infection, and medication. After 10 days of hospitalization with intravenous fluids and antibacterial drugs, he recovered without complications. This case indicates that BFR training should be conducted with careful consideration of the physical condition and strength of the individual to prevent serious complications, such as rhabdomyolysis.
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Orysiak, Joanna; Mazur-Rozycka, Joanna; Fitzgerald, John; Starczewski, Michal; Malczewska-Lenczowska, Jadwiga
2018-01-01
Objectives The aim was to examine the association between serum vitamin D concentration and isometric strength of various muscle groups, vertical jump performance, and repeated sprint ability in young ice hockey players. The secondary aim was to determine the association between vitamin D deficiency and indices of iron status. Methods Fifty male ice hockey players (17.2±0.9 years) participated in this cross-sectional study. Exercise performance was evaluated using isometric strength measures of upper and lower extremities, vertical jump performance and repeated sprint ability (RSA). Blood samples were collected for the determination of serum 25-hydroxyvitamin D (25(OH)D) and multiple indicies of iron status. Results The mean serum 25(OH)D concentration was 30.4 ng·ml-1 and ranged from 12.5 to 91.4 ng·ml-1. Eleven participants (22%) had vitamin D deficiency and 20 athletes (40%) had vitamin D insufficiency. Serum 25(OH)D concentration was not positively correlated with isometric muscle strength, vertical jump performance, or RSA after adjusting for age, training experience, fat mass, fat free mass and height. Serum 25(OH)D concentration was not associated with indices of iron status. Conclusion Vitamin D insufficiency is highly prevalent in ice hockey players, but 25(OH)D concentration but it is not associated with exercise performance or indices of iron status. PMID:29630669
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An evolutionary perspective on the history of flap reconstruction in the upper extremity.
Fang, Frank; Chung, Kevin C
2014-05-01
Examining the evolution of flap reconstruction of the upper extremity is similar to studying the evolution of biological species. This analogy provides a perspective to appreciate the contributing factors that led to the development of the current arsenal of techniques. It shows the trajectory for the future and provides a glimpse of the factors that that will be influential in the future. Copyright © 2014 Elsevier Inc. All rights reserved.
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Aki, Esra; Atasavun, Songül; Kayihan, Holya
2008-06-01
Kinesthetic sense plays an important role in writing. Children with low vision lack sensory input from the environment given their loss of vision. This study assessed the effect of upper extremity kinesthetic sense on writing function in two groups, one of students with low vision (9 girls and 11 boys, 9.4 +/- 1.9 yr. of age) and one of sighted students (10 girls and 10 boys, 10.1 +/- 1.3 yr. of age). All participants were given the Kinesthesia Test and Jebsen Hand Function Test-Writing subtest. Students with low vision scored lower on kinesthetic perception and writing performance than sighted peers. The correlation between scores for writing performance and upper extremity kinesthetic sense in the two groups was significant (r = -.34). The probability of deficiencies in kinesthetic information in students with low vision must be remembered.
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Vitse, J; Bekara, F; Bertheuil, N; Sinna, R; Chaput, B; Herlin, C
2017-02-01
Current data on upper extremity propeller flaps are poor and do not allow the assessment of the safety of this technique. A systematic literature review was conducted searching PubMed, EMBASE, and the Cochrane Library electronic databases, and the selection process was adapted from the preferred reporting items for systematic reviews and meta-analysis statement. The final analysis included ten relevant articles involving 117 flaps. The majority of flaps were used for the hand, distal wrist, and elbow. The radial artery perforator and ulnar artery perforator were the most frequently used flaps. The were 7% flaps with venous congestion and 3% with complete necrosis. No difference in complications rate was found for different flaps sites. Perforator-based propeller flaps appear to be an interesting procedure for covering soft tissue defects involving the upper extremities, even for large defects, but the procedure requires experience and close monitoring. II.
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Bone Lengthening in the Pediatric Upper Extremity.
Farr, Sebastian; Mindler, Gabriel; Ganger, Rudolf; Girsch, Werner
2016-09-07
➤Bone lengthening has been used successfully for several congenital and acquired conditions in the pediatric clavicle, humerus, radius, ulna, and phalanges.➤Common indications for bone lengthening include achondroplasia, radial longitudinal deficiency, multiple hereditary exostosis, brachymetacarpia, symbrachydactyly, and posttraumatic and postinfectious growth arrest.➤Most authors prefer distraction rates of <1 mm/day for each bone in the upper extremity except the humerus, which can safely be lengthened by 1 mm/day.➤Most authors define success by the amount of radiographic bone lengthening, joint motion after lengthening, and subjective patient satisfaction rather than validated patient-related outcome measures.➤Bone lengthening of the upper extremity is associated with a high complication rate, with complications including pin-track infections, fixation device failure, nerve lesions, nonunion, fracture of regenerate bone, and joint dislocations. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.
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Park, Jung-Keun; Boyer, Jon; Tessler, Jamie; Casey, Jeffrey; Schemm, Linda; Gore, Rebecca; Punnett, Laura
2009-07-01
This study examined the inter-rater reliability of expert observations of ergonomic risk factors by four analysts. Ten jobs were observed at a hospital using a newly expanded version of the PATH method (Buchholz et al. 1996), to which selected upper extremity exposures had been added. Two of the four raters simultaneously observed each worker onsite for a total of 443 observation pairs containing 18 categorical exposure items each. For most exposure items, kappa coefficients were 0.4 or higher. For some items, agreement was higher both for the jobs with less rapid hand activity and for the analysts with a higher level of ergonomic job analysis experience. These upper extremity exposures could be characterised reliably with real-time observation, given adequate experience and training of the observers. The revised version of PATH is applicable to the analysis of jobs where upper extremity musculoskeletal strain is of concern.
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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
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Markovic, Goran; Sarabon, Nejc; Greblo, Zrinka; Krizanic, Valerija
2015-01-01
Aging is associated with decline in physical function that could result in the development of physical impairment and disability. Hence, interventions that simultaneously challenge balance ability, trunk (core) and extremity strength of older adults could be particularly effective in preserving and enhancing these physical functions. The purpose of this study was to compare the effects of feedback-based balance and core resistance training utilizing the a special computer-controlled device (Huber®) with the conventional Pilates training on balance ability, neuromuscular function and body composition of healthy older women. Thirty-four older women (age: 70±4 years) were randomly assigned to a Huber group (n=17) or Pilates group (n=17). Both groups trained for 8 weeks, 3 times a week. Maximal isometric strength of the trunk flexors, extensors, and lateral flexors, leg power, upper-body strength, single- and dual-task static balance, and body composition were measured before and after the intervention programs. Significant group×time interactions and main effects of time (p<0.05) were found for body composition, balance ability in standard and dual-task conditions, all trunk muscle strength variables, and leg power in favor of the Huber group. The observed improvements in balance ability under both standard and dual-task conditions in the Huber group were mainly the result of enhanced postural control in medial-lateral direction (p<0.05). Feedback-based balance and core resistance training proved to be more effective in improving single- and dual-task balance ability, trunk muscle strength, leg power, and body composition of healthy older women than the traditional Pilates training. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
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Lin, Shu-Fen; Sung, Huei-Chuan; Li, Tzai-Li; Hsieh, Tsung-Cheng; Lan, Hsiao-Chin; Perng, Shoa-Jen; Smith, Graeme D
2015-05-01
The aim of this study was to investigate the effects of Tai-Chi in conjunction with thera-band resistance exercise on functional fitness and muscle strength in community-based older people. Tai-Chi is known to improve functional fitness in older people. Tai-Chi is usually performed with free hands without resistance training and usually focuses on training lower limbs. To date, no study has examined the use of Tai-Chi in conjunction with thera-band resistance exercise in this population. Cluster randomised trial design. Older people at six senior day care centres in Taiwan were assigned to thera-band resistance exercise or control group using a cluster randomisation. The thera-band resistance exercise group (n = 48) received sixty minute thera-band resistance exercise twice weekly for a period of 16 weeks. The control group (n = 47) underwent routine activities in the day care centre, receiving no Tai-Chi or resistance exercise. After receiving the thera-band resistance exercise, intervention participants displayed a significant increase in muscle strength of upper and lower extremities. Significant improvements were recorded on most measures of the Senior Fitness Test, with the exception of the chair-stand and back-scratch test. Thera-band resistance exercise has the potential to improve functional fitness and muscle strength in community-based older people. Thera-band resistance exercise potentially offers a safe and appropriate form of physical activity that nursing staff can easily incorporate into the daily routine of older people in day care centres, potentially improving functional performance and muscle strength. © 2015 John Wiley & Sons Ltd.
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Chen, Hsi-Chung; Hsu, Nai-Wei; Chou, Pesus
2017-04-01
Different pathomechanisms may underlie the age-related decline in muscle mass and muscle power in older adults. This study aimed to examine the independent relationship between sleep duration and muscle power. Older adults, aged 65 years and older, were randomly selected to participate in a community-based survey in Yilan city, Taiwan. Data on self-reported sleep duration, sociodemographic information, lifestyle, chronic medical and mental health conditions, sleep-related parameters, and anthropometric measurements were collected. Participants who slept ≤4 hr, 5 hr, 6-7 hr, 8 hr, and ≥9 hr were defined as shortest, short, mid-range, long, and longest sleepers, respectively. Muscle power was estimated using hand grip strength. A total of 1081 individuals participated. Their average age was 76.3 ± 6.1 years, and 59.4% were female. After controlling for covariates, including muscle mass of the upper extremities, both long (estimated mean [95% confidence interval, CI]: 19.2 [18.2-20.2], p = .03) and longest sleepers (estimated mean [95% CI]: 17.8 [16.4-19.2], p = .001) had weaker hand grip strength than mid-range sleepers (estimated mean [95% CI]: 20.9 [20.3-21.4]). When stratified by sex, the association between longest sleep duration and weaker hand grip strength was noted among men only. Older adults with long sleep duration had weaker hand grip strength irrespective of muscle mass. This finding suggests that decreased muscle power may mediate or confound the relationship between long sleep duration and adverse health outcomes. © Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.
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Long-term functional, subjective and psychological results after single digit replantation.
Chen, Jing; Zhang, Ai Xian; Chen, Qing Zhong; Mu, Shuai; Tan, Jun
2018-03-01
The aim of this study was to analyse the long-term functional, subjective, and psychological results after single-digit replantation. Thirty cases of digital replantation (14 thumbs, 12 index fingers, 2 middle fingers, 1 ring finger, and 1 little finger) in 30 patients (7 females and 23 males) with a mean age of 44.2 years (20-65 years) were evaluated at the end of a mean follow-up time of 36 months (19-50 months). The active range of motion of joints, grip and pinch strength, cutaneous sensibility, upper-extremity functioning, and subjective satisfaction were determined using the Disability of Arm, Shoulder, and Hand (DASH) questionnaire and the Michigan Hand Outcomes questionnaire (MHQ). Psychological sequelae, including depression, anxiety, and posttraumatic stress disorder (PTSD), were assessed. A correlation analysis among variables was also performed. The mean score for the DASH questionnaire was 6.6 (range: 0-39.2). The symptom of cold intolerance occurred in 53% of the patients. Two patients were diagnosed with depression, and only one patient exhibited PTSD. The DASH score had a good statistical correlation with total grip strength, pinch grip strength, and static two-point discrimination (S-2PD) (P < 0.05). Several aspects of the MHQ were also statistically relevant to some or all of the three objective results. Furthermore, the grip strength showed significant correlation with DASH and most aspects of the MHQ in multivariate logistic regression analysis (P < 0.05). Total grip strength is the most important factor positively related to subjective outcomes. The incidence rates of psychological symptoms after digit replantation are very low at long-term follow-up. Level IV, therapeutic study. Copyright © 2017 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.
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Tectonic stresses in the lithosphere: constraints provided by the experimental deformation of rocks.
Kirby, S.H.
1980-01-01
The strengths of rocks clearly place an upper limit on the stress that can be sustained by the upper half of the lithosphere. Laboratory data on rock rheology are generally lacking at intermediate temperatures and pressures on the important rock types expected in the lithosphere, so a definitive accounting of the strength distribution with depth in the upper lithosphere is presently unattainable. Analogies are drawn between the fragmentary strength data on slicates at intermediate temperature and the more extensive experimental data on marble and limestone, and several tentative conclusions are drawn: First, brittle processes, such as faulting and cataclasis, are expected to control rock strength at low pressures and temperatures. The strengths associated with these brittle mechanisms increase rapidly with increasing effective pressure and are relatively insensitive to temperature and strain rate. Second, the transitions between brittle and ductile processes occur at critical values of the least principal stress sigma3. I suggest that the concept of the deformation mechanism map of Ashby (1972) be extended to brittle-ductile transitions by normalizing the applied differential stress sigma by sigma3, i.e., the transitions occur at critical values of sigma/sigma3. -from Author
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ERIC Educational Resources Information Center
Hobayan, Kalani; Patterson, Debra; Sherman, Clay; Wiersma, Lenny
2014-01-01
In a society in which obesity levels have tripled in the past 30 years, the importance of increased fitness levels within the academic setting has become even more critical. The purpose of this study was to investigate the validity of alternative Fitnessgram upper body tests of muscular strength and endurance among seventh and eighth grade males…
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Necrotizing Fasciitis of the Upper Extremity, Case Report and Review of the Literature
Nazerani, Shahram; Maghari, Ahmad; Kalantar Motamedi, Mohammad Hosein; Vahedian Ardakani, Jalal; Rashidian, Nikdokht; Nazerani, Tina
2012-01-01
ABSTRACT Necrotizing fasciitis is a rare, life-threatening infection most commonly seen in patients with diabetes mellitus, intravenous drug abuse, and immunocompromised conditions. The extremities are the primary sites of involvement in as many as two thirds of the cases. In a significant proportion of patients, the extremities are involved as a result of trauma, needle puncture or extravasation of drugs. The infection is usually polymicrobial. Treatment involves broad-spectrum antibiotics and multiple surgical debridements or amputation. We present a patient with necrotizing fasciitis of the upper limb and present our experience with this often lethal condition. PMID:24350113
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Eidson, Christopher A; Jenkins, Gavin R; Yuen, Hon K; Abernathy, Anne M; Brannon, Mary Beth; Pung, Anna R; Ward, Kiara D; Weaver, Tara E
2017-01-01
To identify physical measures that predict maximal handgrip strength (MHGS) and provide evidence for identifying lack of sincerity of effort when assessing upper extremity weakness. This study investigated anthropometric measurements associated with MHGS of healthy young adults. A convenience sample of 150 healthy adults ages 19 to 34 years old completed the MHGS assessment, which was measured using a Jamar dynamometer according to the protocol of the American Society of Hand Therapists, for both dominant and non-dominant hands. Several anthropometric data were collected, which included height, body weight, forearm length, forearm circumference, hand length, and hand width. Multivariable linear regression analysis indicated gender and hand width were uniquely and significantly associated with participants' MHGS for dominant and non-dominant hand and accounted for more than 60% of the variance, with R2 = 0.60, P < 0.001 for the dominant hand model and R2 = 0.64, P < 0.001 for the non-dominant hand model. Among the forearm and hand anthropometric measures, hand width is the best predictor of MHGS in both the non-dominant and dominant hands for healthy young adults.
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Necessary and sufficient criterion for extremal quantum correlations in the simplest Bell scenario
NASA Astrophysics Data System (ADS)
Ishizaka, Satoshi
2018-05-01
In the study of quantum nonlocality, one obstacle is that the analytical criterion for identifying the boundaries between quantum and postquantum correlations has not yet been given, even in the simplest Bell scenario. We propose a plausible, analytical, necessary and sufficient condition ensuring that a nonlocal quantum correlation in the simplest scenario is an extremal boundary point. Our extremality condition amounts to certifying an information-theoretical quantity; the probability of guessing a measurement outcome of a distant party optimized using any quantum instrument. We show that this quantity can be upper and lower bounded from any correlation in a device-independent way, and we use numerical calculations to confirm that coincidence of the upper and lower bounds appears to be necessary and sufficient for the extremality.
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NASA Astrophysics Data System (ADS)
Priya, P.; Krishnan, R.; Mujumdar, Milind; Houze, Robert A.
2017-10-01
Historical rainfall records reveal that the frequency and intensity of extreme precipitation events, during the summer monsoon (June-September) season, have significantly risen over the Western Himalayas (WH) and adjoining upper Indus basin since 1950s. Using multiple datasets, the present study investigates the possible coincidences between an increasing trend of precipitation extremes over WH and changes in background flow climatology. The present findings suggest that the combined effects of a weakened southwest monsoon circulation, increased activity of transient upper-air westerly troughs over the WH region, enhanced moisture supply by southerly winds from the Arabian Sea into the Indus basin have likely provided favorable conditions for an increased frequency of certain types of extreme precipitation events over the WH region in recent decades.
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Salvage of mangled upper extremity using the Masquelet technique in a child: A case report
Alassaf, Nabil; Alhoukail, Amro; Alsahli, Abdullah; Althubaiti, Ghazi
2017-01-01
Aim: To report our experience with the Masquelet concept in a pediatric upper extremity following an open injury to the elbow. Methods: A case report and literature review. Results: An 11-year-old boy was transferred to our institution after a motor vehicle collision. There was a primary loss of the ulnohumeral articulation and the surrounding soft tissues as well as the ulnar nerve. Reconstruction used the Masquelet-induced membrane technique and a soft tissue flap. At the 30-month follow-up, the extremity was pain free and functional. Conclusion: This case highlights the value of the Masquelet technique in pediatric extremity injuries, where there is a loss of a major articular segment, as well as significant soft tissue compromise. PMID:29201370
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Duma, Stefan M; Hansen, Gail A; Kennedy, Eric A; Rath, Amber L; McNally, Craig; Kemper, Andrew R; Smith, Eric P; Brolinson, P Gunnar; Stitzel, Joel D; Davis, Martin B; Bass, Cameron R; Brozoski, Frederick T; McEntire, B Joseph; Alem, Nabih M; Crowley, John S
2004-11-01
This paper describes a three part analysis to characterize the interaction between the female upper extremity and a helicopter cockpit side airbag system and to develop dynamic hyperextension injury criteria for the female elbow joint. Part I involved a series of 10 experiments with an original Army Black Hawk helicopter side airbag. A 5(th) percentile female Hybrid III instrumented upper extremity was used to demonstrate side airbag upper extremity loading. Two out of the 10 tests resulted in high elbow bending moments of 128 Nm and 144 Nm. Part II included dynamic hyperextension tests on 24 female cadaver elbow joints. The energy source was a drop tower utilizing a three-point bending configuration to apply elbow bending moments matching the previously conducted side airbag tests. Post-test necropsy showed that 16 of the 24 elbow joint tests resulted in injuries. Injury severity ranged from minor cartilage damage to more moderate joint dislocations and severe transverse fractures of the distal humerus. Peak elbow bending moments ranged from 42.4 Nm to 146.3 Nm. Peak bending moment proved to be a significant indicator of any elbow injury (p = 0.02) as well as elbow joint dislocation (p = 0.01). Logistic regression analyses were used to develop single and multiple variate injury risk functions. Using peak moment data for the entire test population, a 50% risk of obtaining any elbow injury was found at 56 Nm while a 50% risk of sustaining an elbow joint dislocation was found at 93 Nm for the female population. These results indicate that the peak elbow bending moments achieved in Part I are associated with a greater than 90% risk for elbow injury. Subsequently, the airbag was re-designed in an effort to mitigate this as well as the other upper extremity injury risks. Part III assessed the redesigned side airbag module to ensure injury risks had been reduced prior to implementing the new system. To facilitate this, 12 redesigned side airbag deployments were conducted using the same procedures as Part I. Results indicate that the re-designed side airbag has effectively mitigated elbow injury risks induced by the original side airbag design. It is anticipated that this study will provide researchers with additional injury criteria for assessing upper extremity injury risk caused by both military and automotive side airbag deployments.
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The PROMIS physical function correlates with the QuickDASH in patients with upper extremity illness.
Overbeek, Celeste L; Nota, Sjoerd P F T; Jayakumar, Prakash; Hageman, Michiel G; Ring, David
2015-01-01
To assess disability more efficiently with less burden on the patient, the National Institutes of Health has developed the Patient Reported Outcomes Measurement Information System (PROMIS) Physical Function-an instrument based on item response theory and using computer adaptive testing (CAT). Initially, upper and lower extremity disabilities were not separated and we were curious if the PROMIS Physical Function CAT could measure upper extremity disability and the Quick Disability of Arm, Shoulder and Hand (QuickDASH). We aimed to find correlation between the PROMIS Physical Function and the QuickDASH questionnaires in patients with upper extremity illness. Secondarily, we addressed whether the PROMIS Physical Function and QuickDASH correlate with the PROMIS Depression CAT and PROMIS Pain Interference CAT instruments. Finally, we assessed factors associated with QuickDASH and PROMIS Physical Function in multivariable analysis. A cohort of 93 outpatients with upper extremity illnesses completed the QuickDASH and three PROMIS CAT questionnaires: Physical Function, Pain Interference, and Depression. Pain intensity was measured with an 11-point ordinal measure (0-10 numeric rating scale). Correlation between PROMIS Physical Function and the QuickDASH was assessed. Factors that correlated with the PROMIS Physical Function and QuickDASH were assessed in multivariable regression analysis after initial bivariate analysis. There was a moderate correlation between the PROMIS Physical Function and the QuickDASH questionnaire (r=-0.55, p<0.001). Greater disability as measured with the PROMIS and QuickDASH correlated most strongly with PROMIS Depression (r=-0.35, p<0.001 and r=0.34, p<0.001 respectively) and Pain Interference (r=-0.51, p<0.001 and r=0.74, p<0.001 respectively). The factors accounting for the variability in PROMIS scores are comparable to those for the QuickDASH except that the PROMIS Physical Function is influenced by other pain conditions while the QuickDASH is not. The PROMIS Physical Function instrument may be used as an upper extremity disability measure, as it correlates with the QuickDASH questionnaire, and both instruments are influenced most strongly by the degree to which pain interferes with achieving goals. Level III, diagnostic study. See the Instructions for Authors for a complete description of levels of evidence.
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Kim, Seong-Gil
2018-01-01
Background The purpose of this study was to investigate the effect of ankle ROM and lower-extremity muscle strength on static balance control ability in young adults. Material/Methods This study was conducted with 65 young adults, but 10 young adults dropped out during the measurement, so 55 young adults (male: 19, female: 36) completed the study. Postural sway (length and velocity) was measured with eyes open and closed, and ankle ROM (AROM and PROM of dorsiflexion and plantarflexion) and lower-extremity muscle strength (flexor and extensor of hip, knee, and ankle joint) were measured. Pearson correlation coefficient was used to examine the correlation between variables and static balance ability. Simple linear regression analysis and multiple linear regression analysis were used to examine the effect of variables on static balance ability. Results In correlation analysis, plantarflexion ROM (AROM and PROM) and lower-extremity muscle strength (except hip extensor) were significantly correlated with postural sway (p<0.05). In simple correlation analysis, all variables that passed the correlation analysis procedure had significant influence (p<0.05). In multiple linear regression analysis, plantar flexion PROM with eyes open significantly influenced sway length (B=0.681) and sway velocity (B=0.011). Conclusions Lower-extremity muscle strength and ankle plantarflexion ROM influenced static balance control ability, with ankle plantarflexion PROM showing the greatest influence. Therefore, both contractile structures and non-contractile structures should be of interest when considering static balance control ability improvement. PMID:29760375
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Kim, Seong-Gil; Kim, Wan-Soo
2018-05-15
BACKGROUND The purpose of this study was to investigate the effect of ankle ROM and lower-extremity muscle strength on static balance control ability in young adults. MATERIAL AND METHODS This study was conducted with 65 young adults, but 10 young adults dropped out during the measurement, so 55 young adults (male: 19, female: 36) completed the study. Postural sway (length and velocity) was measured with eyes open and closed, and ankle ROM (AROM and PROM of dorsiflexion and plantarflexion) and lower-extremity muscle strength (flexor and extensor of hip, knee, and ankle joint) were measured. Pearson correlation coefficient was used to examine the correlation between variables and static balance ability. Simple linear regression analysis and multiple linear regression analysis were used to examine the effect of variables on static balance ability. RESULTS In correlation analysis, plantarflexion ROM (AROM and PROM) and lower-extremity muscle strength (except hip extensor) were significantly correlated with postural sway (p<0.05). In simple correlation analysis, all variables that passed the correlation analysis procedure had significant influence (p<0.05). In multiple linear regression analysis, plantar flexion PROM with eyes open significantly influenced sway length (B=0.681) and sway velocity (B=0.011). CONCLUSIONS Lower-extremity muscle strength and ankle plantarflexion ROM influenced static balance control ability, with ankle plantarflexion PROM showing the greatest influence. Therefore, both contractile structures and non-contractile structures should be of interest when considering static balance control ability improvement.
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Eckardt, Nils
2016-11-24
It is well documented that both balance and resistance training have the potential to mitigate intrinsic fall risk factors in older adults. However, knowledge about the effects of simultaneously executed balance and resistance training (i.e., resistance training conducted on unstable surfaces [URT]) on lower-extremity muscle strength, power and balance in older adults is insufficient. The objective of the present study was to compare the effects of machine-based stable resistance training (M-SRT) and two types of URT, i.e., machine-based (M-URT) and free-weight URT (F-URT), on measures of lower-extremity muscle strength, power and balance in older adults. Seventy-five healthy community-dwelling older adults aged 65-80 years, were assigned to three intervention groups: M-SRT, M-URT and F-URT. Over a period of ten weeks, all participants exercised two times per week with each session lasting ~60 min. Tests included assessment of leg muscle strength (e.g., maximal isometric leg extension strength), power (e.g., chair rise test) and balance (e.g., functional reach test), carried out before and after the training period. Furthermore, maximal training load of the squat-movement was assessed during the last training week. Maximal training load of the squat-movement was significantly lower in F-URT in comparison to M-SRT and M-URT. However, lower-extremity resistance training conducted on even and uneven surfaces meaningfully improved proxies of strength, power and balance in all groups. M-URT produced the greatest improvements in leg extension strength and F-URT in the chair rise test and functional reach test. Aside from two interaction effects, overall improvements in measures of lower-extremity muscle strength, power and balance were similar across training groups. Importantly, F-URT produced similar results with considerably lower training load as compared to M-SRT and M-URT. Concluding, F-URT seems an effective and safe alternative training program to mitigate intrinsic fall risk factors in older adults. This trial has been registered with clinicaltrials.gov ( NCT02555033 ) on 09/18/2015.
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Population-based utilities for upper extremity functions in the setting of tetraplegia.
Ram, Ashwin N; Curtin, Catherine M; Chung, Kevin C
2009-11-01
People with tetraplegia face substantial physical and financial hardships. Although upper extremity reconstruction has been advocated for people with tetraplegia, these procedures are markedly underused in the United States. Population-based preference evaluation of upper extremity reconstruction is important to quantify the value of these reconstructive procedures. This study sought to establish the preferences for 3 health states: tetraplegia, tetraplegia with corrected pinch function, and tetraplegia with corrected elbow extension function. A computer-based, time trade-off survey was administered to a cohort of 81 able-bodied second-year medical students who served as a surrogate for the general public. This survey instrument has undergone pilot testing and has established face validity to evaluate the 3 health states of interest. Utilities were calculated based on an estimated 20 years of remaining life. The mean utility for the tetraplegic health state was low. On average, respondents gave up 10.8 +/- 5.0 out of a hypothetical 20 years for perfect health, for a utility of tetraplegia equal to 0.46. For recovery of pinch function, respondents gave up an average of 6.5 +/- 4.3 years, with a corresponding health utility of 0.68. For recovery of elbow extension function, respondents gave up an average of 7.6 +/- 4.5 years, with a corresponding health utility of 0.74. This study established the preferences for 2 upper extremity surgical interventions: tetraplegia with pinch and tetraplegia with elbow extension. The findings from this study place a high value on upper-limb reconstructive procedures with tetraplegia.
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Qin, Jin; Trudeau, Matthieu; Katz, Jeffrey N; Buchholz, Bryan; Dennerlein, Jack T
2011-08-01
Musculoskeletal disorders associated with computer use span the joints of the upper extremity. Computing typically involves tapping in multiple directions. Thus, we sought to describe the loading on the finger, wrist, elbow and shoulder joints in terms of kinematic and kinetic difference across single key switch tapping to directional tapping on multiple keys. An experiment with repeated measures design was conducted. Six subjects tapped with their right index finger on a stand-alone number keypad placed horizontally in three conditions: (1) on single key switch (the number key 5); (2) left and right on number key 4 and 6; (3) top and bottom on number key 8 and 2. A force-torque transducer underneath the keypad measured the fingertip force. An active-marker infrared motion analysis system measured the kinematics of the fingertip, hand, forearm, upper arm and torso. Joint moments for the metacarpophalangeal, wrist, elbow, and shoulder joints were estimated using inverse dynamics. Tapping in the top-bottom orientation introduced the largest biomechanical loading on the upper extremity especially for the proximal joint, followed by tapping in the left-right orientation, and the lowest loading was observed during single key switch tapping. Directional tapping on average increased the fingertip force, joint excursion, and peak-to-peak joint torque by 45%, 190% and 55%, respectively. Identifying the biomechanical loading patterns associated with these fundamental movements of keying improves the understanding of the risks of upper extremity musculoskeletal disorders for computer keyboard users. Copyright © 2010 Elsevier Ltd. All rights reserved.