Effects of virtual reality training with modified constraint-induced movement therapy on upper extremity function in acute stage stroke: a preliminary study.

PubMed

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.

Effects of ergonomic intervention on work-related upper extremity musculoskeletal disorders among computer workers: a randomized controlled trial.

PubMed

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.

Application of RFID technology-upper extremity rehabilitation training.

PubMed

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

2016-01-01

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

Perceptions of Emergency Medicine Residency and Hand Surgery Fellowship Program Directors in the Appropriate Disposition of Upper Extremity Emergencies.

PubMed

Drolet, Brian C; Lifchez, Scott D; Jacoby, Sidney M; Varone, Andrew; Regan, Linda A; Baren, Jill M; Akelman, Edward; Osterman, A Lee; Levin, L Scott

2015-12-01

To survey emergency medicine (EM) residency and hand surgery fellowship program directors (PDs) to identify consensus in their perceptions of appropriate emergency care of upper extremity emergencies. We created a framework to group common upper extremity emergency diagnoses and surveyed PDs to evaluate the training background--EM, general orthopedic or plastic surgery, or hand fellowship--most appropriate to provide acute, point-of-care management for each of these diagnostic groupings. Responses were pooled and consensus was established with greater than 75% agreement between groups. We received 79 responses from hand fellowship PDs (90% response rate) and 151 responses from EM PDs (49% response rate). We identified consensus for the training background that PDs in both specialties felt was appropriate to care for 17 of 21 diagnostic groupings in the framework. There was a high level of consensus between EM and hand surgery PDs regarding diagnoses that acutely require training in hand surgery versus those that can be managed by an EM physician. Our diagnostic framework may help reduce unnecessary hand surgery consultation and may help to identify patients who do not require more specialized acute care and thus decrease unnecessary transfers. Economic and Decision Analyses IV. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

A Comparison of Whole-Body Vibration and Resistance Training on Total Work in the Rotator Cuff

PubMed Central

Hand, Jason; Verscheure, Susan; Osternig, Louis

2009-01-01

Abstract Context: Whole-body vibration machines are a relatively new technology being implemented in the athletic setting. Numerous authors have examined the proposed physiologic mechanisms of vibration therapy and performance outcomes. Changes have mainly been observed in the lower extremity after individual exercises, with minimal attention to the upper extremity and resistance training programs. Objective: To examine the effects of a novel vibration intervention directed at the upper extremity as a precursor to a supervised, multijoint dynamic resistance training program. Design: Randomized controlled trial. Setting: National Collegiate Athletic Association Division IA institution. Patients or Other Participants: Thirteen female student-athletes were divided into the following 2 treatment groups: (1) whole-body vibration and resistance training or (2) resistance training only. Intervention(s): Participants in the vibration and resistance training group used an experimental vibration protocol of 2 × 60 seconds at 4 mm and 50 Hz, in a modified push-up position, 3 times per week for 10 weeks, just before their supervised resistance training session. Main Outcome Measure(s): Isokinetic total work measurements of the rotator cuff were collected at baseline and at week 5 and week 10. Results: No differences were found between the treatment groups (P > .05). However, rotator cuff output across time increased in both groups (P < .05). Conclusions: Although findings did not differ between the groups, the use of whole-body vibration as a precursor to multijoint exercises warrants further investigation because of the current lack of literature on the topic. Our results indicate that indirectly strengthening the rotator cuff using a multijoint dynamic resistance training program is possible. PMID:19771284

The responsiveness and correlation between Fugl-Meyer Assessment, Motor Status Scale, and the Action Research Arm Test in chronic stroke with upper-extremity rehabilitation robotic training.

PubMed

Wei, Xi-Jun; Tong, Kai-Yu; Hu, Xiao-Ling

2011-12-01

Responsiveness of clinical assessments is an important element in the report of clinical effectiveness after rehabilitation. The correlation could reflect the validity of assessments as an indication of clinical performance before and after interventions. This study investigated the correlation and responsiveness of Fugl-Meyer Assessment (FMA), Motor Status Scale (MSS), Action Research Arm Test (ARAT) and the Modified Ashworth Scale (MAS), which are used frequently in effectiveness studies of robotic upper-extremity training in stroke rehabilitation. Twenty-seven chronic stroke patients were recruited for a 20-session upper-extremity rehabilitation robotic training program. This was a rater-blinded randomized controlled trial. All participants were evaluated with FMA, MSS, ARAT, MAS, and Functional Independent Measure before and after robotic training. Spearman's rank correlation coefficient was applied for the analysis of correlation. The standardized response mean (SRM) and Guyatt's responsiveness index (GRI) were used to analyze responsiveness. Spearman's correlation coefficient showed a significantly high correlation (ρ=0.91-0.96) among FMA, MSS, and ARAT and a fair-to-moderate correlation (ρ=0.40-0.62) between MAS and the other assessments. FMA, MSS, and MAS on the wrist showed higher responsiveness (SRM=0.85-0.98, GRI=1.59-3.62), whereas ARAT showed relatively less responsiveness (SRM=0.22, GRI=0.81). The results showed that FMA or MSS would be the best choice for evaluating the functional improvement in stroke studies on robotic upper-extremity training with high responsiveness and good correlation with ARAT. MAS could be used separately to evaluate the spasticity changes after intervention in terms of high responsiveness.

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

PubMed

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

2016-12-01

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

The influence of a constraint and bimanual training program using a variety of modalities on endurance and on the cardiac autonomic regulation system of children with unilateral cerebral palsy: A self-control clinical trial.

PubMed

Cohen-Holzer, Marilyn; Sorek, Gilad; Schweizer, Maayan; Katz-Leurer, Michal

2017-01-01

An intensive hybrid program, combining constraint with bimanual training, improves upper extremity function as well as walking endurance of children with unilateral cerebral palsy (UCP). Endurance improvement may be associated with the cardiac autonomic regulation system (CARS) adaptation, known to be impaired among these children. To examine the influence of an intensive hybrid program on CARS, walking endurance and the correlation with upper extremity function of children with UCP. Twenty-four children aged 6-10 years with UCP participated in a hybrid program, 10 days, 6 hours per day. Data were collected pre-, post- and 3-months post-intervention. Main outcome measures included the Polar RS800CX for heart rate (HR) and heart rate variability (HRV) data, the 6-Minute Walk Test (6MWT) for endurance, and the Assisting Hand Assessment (AHA) and Jebsen-Taylor Test of Hand Function (JTTHF) for bimanual and unimanual function. A significant reduction in HR and an increase in HRV at post- and 3-month post-intervention was noted (χ22= 8.3, p = 0.016) along with a significant increase in 6MWT with a median increase of 81 meters (χ22= 11.0, p = 0.004) at the same interval. A significant improvement was noted in unimanual and bimanual performance following the intervention. An intensive hybrid program effectively improved CARS function as well as walking endurance and upper extremity function in children with UCP (213).

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

PubMed Central

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

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

PubMed

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

2013-01-01

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

Effects of a sitting boxing program on upper limb function, balance, gait, and quality of life in stroke patients.

PubMed

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.

Body System Effects of a Multi-Modal Training Program Targeting Chronic, Motor Complete Thoracic Spinal Cord Injury.

PubMed

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.

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

PubMed

Jeong, In Cheol; Finkelstein, Joseph

2012-01-01

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

Robots integrated with virtual reality simulations for customized motor training in a person with upper extremity hemiparesis: a case report

PubMed Central

Fluet, Gerard G.; Merians, Alma S.; Qiu, Qinyin; Lafond, Ian; Saleh, Soha; Ruano, Viviana; Delmonico, Andrea R.; Adamovich, Sergei V.

2014-01-01

Background and Purpose A majority of studies examining repetitive task practice facilitated by robots for the treatment of upper extremity paresis utilize standardized protocols applied to large groups. Others utilize interventions tailored to patients but don't describe the clinical decision making process utilized to develop and modify interventions. This case report will describe a robot-based intervention customized to match the goals and clinical presentation of a gentleman with upper extremity hemiparesis secondary to stroke. Methods PM is an 85 year-old man with left hemiparesis secondary to an intracerebral hemorrhage five years prior to examination. Outcomes were measured before and after a one month period of home therapy and after a one month robotic intervention. The intervention was designed to address specific impairments identified during his PT examination. When necessary, activities were modified based on the patient's response to his first week of treatment. Outcomes PM trained twelve sessions using six virtually simulated activities. Modifications to original configurations of these activities resulted in performance improvements in five of these activities. PM demonstrated a 35 second improvement in Jebsen Test of Hand Function time and a 44 second improvement in Wolf Motor Function Test time subsequent to the robotic training intervention. Reaching kinematics, 24 hour activity measurement and the Hand and Activities of Daily Living scales of the Stroke Impact Scale all improved as well. Discussion A customized program of robotically facilitated rehabilitation resulted in large short-term improvements in several measurements of upper extremity function in a patient with chronic hemiparesis. PMID:22592063

Rehabilitation robotics for the upper extremity: review with new directions for orthopaedic disorders.

PubMed

Hakim, Renée M; Tunis, Brandon G; Ross, Michael D

2017-11-01

The focus of research using technological innovations such as robotic devices has been on interventions to improve upper extremity function in neurologic populations, particularly patients with stroke. There is a growing body of evidence describing rehabilitation programs using various types of supportive/assistive and/or resistive robotic and virtual reality-enhanced devices to improve outcomes for patients with neurologic disorders. The most promising approaches are task-oriented, based on current concepts of motor control/learning and practice-induced neuroplasticity. Based on this evidence, we describe application and feasibility of virtual reality-enhanced robotics integrated with current concepts in orthopaedic rehabilitation shifting from an impairment-based focus to inclusion of more intense, task-specific training for patients with upper extremity disorders, specifically emphasizing the wrist and hand. The purpose of this paper is to describe virtual reality-enhanced rehabilitation robotic devices, review evidence of application in patients with upper extremity deficits related to neurologic disorders, and suggest how this technology and task-oriented rehabilitation approach can also benefit patients with orthopaedic disorders of the wrist and hand. We will also discuss areas for further research and development using a task-oriented approach and a commercially available haptic robotic device to focus on training of grasp and manipulation tasks. Implications for Rehabilitation There is a growing body of evidence describing rehabilitation programs using various types of supportive/assistive and/or resistive robotic and virtual reality-enhanced devices to improve outcomes for patients with neurologic disorders. The most promising approaches using rehabilitation robotics are task-oriented, based on current concepts of motor control/learning and practice-induced neuroplasticity. Based on the evidence in neurologic populations, virtual reality-enhanced robotics may be integrated with current concepts in orthopaedic rehabilitation shifting from an impairment-based focus to inclusion of more intense, task-specific training for patients with UE disorders, specifically emphasizing the wrist and hand. Clinical application of a task-oriented approach may be accomplished using commercially available haptic robotic device to focus on training of grasp and manipulation tasks.

Rehab-let: touchscreen tablet for self-training impaired dexterity post stroke: study protocol for a pilot randomized controlled trial.

PubMed

Rand, Debbie; Zeilig, Gabi; Kizony, Rachel

2015-06-18

Impaired dexterity of the weaker upper extremity is common post stroke and it is recommended that these individuals practice many repetitions of movement to regain function. However, stroke rehabilitation methods do not achieve the required intensity to be effective. Touchscreen tablet technology may be used as a motivating tool for self-training impaired dexterity of the weaker upper extremity post stroke. Rehab-let is a self-training protocol utilizing game apps on a touchscreen for practicing movement of the weaker upper extremity. We will conduct a pilot randomized controlled trial to assess Rehab-let compared to traditional self-training to improve dexterity of the weaker hand, and to increase self-training time and satisfaction in individuals with subacute stroke. Forty individuals with stroke undergoing subacute rehabilitation will be randomly allocated to Rehab-let or a traditional self-training program using therapeutic aids such as balls, blocks and pegs. All participants will be requested to perform self-training for 60 minutes a day, 5 times a week for 4 weeks. Dexterity assessed by The Nine Hole Peg Test is the main outcome measure. Assessments will be administered pre and post the self-training intervention by assessors blind to the group allocation. The outcomes of this study will inform the design of a fully powered randomized controlled trial to evaluate the effectiveness of Rehab-let. If found to be effective, Rehab-let can be used during subacute rehabilitation to increase treatment intensity and improve dexterity. Potentially, Rehab-let can also be used after discharge and might be ideal for individuals with mild stroke who are often not referred to formal rehabilitation. Current Controlled Trials NCT02136433 registered on 17 September 2014.

Impact of a joint labor-management ergonomics program on upper extremity musculoskeletal symptoms among garment workers.

PubMed

Herbert, R; Dropkin, J; Warren, N; Sivin, D; Doucette, J; Kellogg, L; Bardin, J; Kass, D; Zoloth, S

2001-10-01

This study evaluated the effect of an ergonomics intervention program on the prevalence and intensity of symptoms of upper extremity work-related musculoskeletal disorders among 36 garment workers performing an operation called spooling. Adjustable chairs were introduced and workers were trained in their use. Symptom surveys were administered prior to and 6 months after introduction of adjustable chairs. Quantitative pre- and post-intervention measurement of joint position was performed utilizing videotapes among a subgroup of nineteen. Eighty nine percent of the cohort reported pain in either the neck or at least one upper extremity anatomic site prior to the adjustable chair intervention. Among subjects reporting pain at baseline, there were significantly decreased pain levels in 10 of 11 anatomic sites after the intervention. Among all subjects, the proportion reporting pain decreased for each anatomic site following the intervention, with statistically significant decreases in 3 sites. However, there were only modest declines in awkward posture among the videotaped subgroup. This study suggests that introduction of an ergonomics program focused on education and introduction of an adjustable chair may diminish musculoskeletal symptomatology in apparel manufacturing workers.

Increasing upper limb training intensity in chronic stroke using embodied virtual reality: a pilot study.

PubMed

Perez-Marcos, Daniel; Chevalley, Odile; Schmidlin, Thomas; Garipelli, Gangadhar; Serino, Andrea; Vuadens, Philippe; Tadi, Tej; Blanke, Olaf; Millán, José D R

2017-11-17

Technology-mediated neurorehabilitation is suggested to enhance training intensity and therefore functional gains. Here, we used a novel virtual reality (VR) system for task-specific upper extremity training after stroke. The system offers interactive exercises integrating motor priming techniques and embodied visuomotor feedback. In this pilot study, we examined (i) rehabilitation dose and training intensity, (ii) functional improvements, and (iii) safety and tolerance when exposed to intensive VR rehabilitation. Ten outpatient stroke survivors with chronic (>6 months) upper extremity paresis participated in a ten-session VR-based upper limb rehabilitation program (2 sessions/week). All participants completed all sessions of the treatment. In total, they received a median of 403 min of upper limb therapy, with 290 min of effective training. Within that time, participants performed a median of 4713 goal-directed movements. Importantly, training intensity increased progressively across sessions from 13.2 to 17.3 movements per minute. Clinical measures show that despite being in the chronic phase, where recovery potential is thought to be limited, participants showed a median improvement rate of 5.3% in motor function (Fugl-Meyer Assessment for Upper Extremity; FMA-UE) post intervention compared to baseline, and of 15.4% at one-month follow-up. For three of them, this improvement was clinically significant. A significant improvement in shoulder active range of motion (AROM) was also observed at follow-up. Participants reported very low levels of pain, stress and fatigue following each session of training, indicating that the intensive VR intervention was well tolerated. No severe adverse events were reported. All participants expressed their interest in continuing the intervention at the hospital or even at home, suggesting high levels of adherence and motivation for the provided intervention. This pilot study showed how a dedicated VR system could deliver high rehabilitation doses and, importantly, intensive training in chronic stroke survivors. FMA-UE and AROM results suggest that task-specific VR training may be beneficial for further functional recovery both in the chronic stage of stroke. Longitudinal studies with higher doses and sample sizes are required to confirm the therapy effectiveness. This trial was retrospectively registered at ClinicalTrials.gov database (registration number NCT03094650 ) on 14 March 2017.

A Comparison of Motor Adaptations to Robotically Facilitated Upper Extremity Task Practice Demonstrated by Children with Cerebral Palsy and Adults with Stroke

PubMed Central

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

Effect of Robot-Assisted Game Training on Upper Extremity Function in Stroke Patients

PubMed Central

2017-01-01

Objective To determine the effects of combining robot-assisted game training with conventional upper extremity rehabilitation training (RCT) on motor and daily functions in comparison with conventional upper extremity rehabilitation training (OCT) in stroke patients. Methods Subjects were eligible if they were able to perform the robot-assisted game training and were divided randomly into a RCT and an OCT group. The RCT group performed one daily session of 30 minutes of robot-assisted game training with a rehabilitation robot, plus one daily session of 30 minutes of conventional rehabilitation training, 5 days a week for 2 weeks. The OCT group performed two daily sessions of 30 minutes of conventional rehabilitation training. The effects of training were measured by a Manual Function Test (MFT), Manual Muscle Test (MMT), Korean version of the Modified Barthel Index (K-MBI) and a questionnaire about satisfaction with training. These measurements were taken before and after the 2-week training. Results Both groups contained 25 subjects. After training, both groups showed significant improvements in motor and daily functions measured by MFT, MMT, and K-MBI compared to the baseline. Both groups demonstrated similar training effects, except motor power of wrist flexion. Patients in the RCT group were more satisfied than those in the OCT group. Conclusion There were no significant differences in changes in most of the motor and daily functions between the two types of training. However, patients in the RCT group were more satisfied than those in the OCT group. Therefore, RCT could be a useful upper extremity rehabilitation training method. PMID:28971037

Effect of a Task-Oriented Rehabilitation Program on Upper Extremity Recovery Following Motor Stroke: The ICARE Randomized Clinical Trial.

PubMed

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

2016-02-09

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

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

PubMed Central

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

2016-01-01

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

Neurophysiological substrates of stroke patients with motor imagery-based Brain-Computer Interface training.

PubMed

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.

Meaningful task-specific training (MTST) for stroke rehabilitation: a randomized controlled trial.

PubMed

Arya, Kamal Narayan; Verma, Rajesh; Garg, R K; Sharma, V P; Agarwal, Monika; Aggarwal, G G

2012-01-01

The upper extremity motor deficit is one of the functional challenges in post stroke patients. The objective of the present study was to evaluate the effectiveness of the meaningful task-specific training (MTST) on the upper extremity motor recovery during the subacute phase after a stroke. This was a randomized, controlled, double-blinded trial in the neurology department of a university hospital and occupational therapy unit of a rehabilitation institute. A convenience sample of 103 people, 4 to 24 weeks (mean, 12.15 weeks) after the stroke, was randomized into 2 groups (MTST, 51; standard training group, 52). Subjects in the Brunnstrom stage of arm recovery of 2 to 5 were included in the study. Ninety-five participants completed the 8-week follow-up. Participants were assigned to receive either the MTST or dose-matched standard training program based on the Brunnstrom stage and Bobath neurodevelopmental technique, 4 to 5 days a week for 4 weeks. Fugl-Meyer assessment (FMA), Action Research Arm Test (ARAT), Graded Wolf Motor Function Test (GWMFT), and Motor Activity Log (MAL) were outcome measures The MTST group showed a positive improvement in the mean scores on the outcome measures at post and follow-up assessments in comparison to the control group. Further, statistically significant differences were observed in changes between the groups at post and follow-up assessment for FMA, ARAT, GWMFT, and MAL. The MTST produced statistically significant and clinically relevant improvements in the upper extremity motor recovery of the patients who had a subacute stroke.

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

PubMed

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

2011-05-16

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

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

PubMed Central

2011-01-01

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

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

PubMed

Melhorn, J M

1996-12-01

Occupational diseases affect 15 to 20% of all Americans. Cumulative trauma disorders (CTDs) account for 56% of all occupational injuries. The recognition and control of occupational injuries has become a major concern of employees, employers, medicine, and the federal government because of health risk and related costs. Upper-extremity CTDs are identified by the National Institute for Occupational Safety and Health as one of the ten most significant occupational health problems in the United States. It is estimated by the year 2000 that 50 cents on the dollar will be spent on CTDs. Although enlightened aircraft employers have developed primary prevention strategies, primary prevention can never be expected to eliminate 100% of the cases. To evaluate several preventive activities, a CTD risk-assessment program was developed and implemented in cooperation with a major aircraft manufacturer employing over 8000 workers. This program was focused on objectively identifying the relationship of work and other activities to an individual worker experiencing CTDs. Early identification has been linked, when applicable, to intervention algorithms for medical care, job task modification, workplace accommodation, and training. A prospective study group of 212 workers who used rivet guns was placed into a four-way experimental design for ergonomic posture training, exercise training, and rivet-gun type (primary factors). A statistical model was developed for the level of CTD risk and evaluated using the SAS software program (SAS Institute, Inc, Carry, NC). Statistical analysis of the primary factors without regard to associated variables (covariates) demonstrated that only posture training had a beneficial risk reduction for the individual. The impact (beneficial or detrimental) for exercise training and for vibration-dampening rivet guns was probably obscured because of the large variability of the responses regarding the associated variables (covariates). When the covariates were analyzed in conjunction with the four experimental groups, a positive benefit from ergonomic posture training and exercise training was demonstrated for the following groups: the dominant han, time spend in an awkward position, number of standard rivets bucked, number of parts routed, number of parts ground, number of vibration-dampening rivets bucked, and newly hired individuals. A negative effect (increase in individual risk level) for current employees using a vibration-dampening rivet gun was demonstrated. This prospective study helps to identify the possible benefit of education and training for controlling CTDs and demonstrates the usefulness of being able to evaluate materials, methods, machines, and environments as they relate to the individual's risk level for the development of upper-extremity CTDs.

Effects of interactive metronome training on postural stability and upper extremity function in Parkinson's disease: a case study.

PubMed

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.

Effects of interactive metronome training on postural stability and upper extremity function in Parkinson’s disease: a case study

PubMed Central

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

Cortical changes after mental imagery training combined with electromyography-triggered electrical stimulation in patients with chronic stroke.

PubMed

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.

The home stroke rehabilitation and monitoring system trial: a randomized controlled trial.

PubMed

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.

Incorporating robotic-assisted telerehabilitation in a home program to improve arm function following stroke.

PubMed

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.

A review of bilateral training for upper extremity hemiparesis.

PubMed

Stoykov, Mary Ellen; Corcos, Daniel M

2009-01-01

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

Survey of upper extremity injuries among martial arts participants.

PubMed

Diesselhorst, Matthew M; Rayan, Ghazi M; Pasque, Charles B; Peyton Holder, R

2013-01-01

To survey participants at various experience levels of different martial arts (MA) about upper extremity injuries sustained during training and fighting. A 21-s question survey was designed and utilised. The survey was divided into four groups (Demographics, Injury Description, Injury Mechanism, and Miscellaneous information) to gain knowledge about upper extremity injuries sustained during martial arts participation. Chi-square testing was utilised to assess for significant associations. Males comprised 81% of respondents. Involvement in multiple forms of MA was the most prevalent (38%). The hand/wrist was the most common area injured (53%), followed by the shoulder/upper arm (27%) and the forearm/elbow (19%). Joint sprains/muscle strains were the most frequent injuries reported overall (47%), followed by abrasions/bruises (26%). Dislocations of the upper extremity were reported by 47% of participants while fractures occurred in 39%. Surgeries were required for 30% of participants. Females were less likely to require surgery and more likely to have shoulder and elbow injuries. Males were more likely to have hand injuries. Participants of Karate and Tae Kwon Do were more likely to have injuries to their hands, while participants of multiple forms were more likely to sustain injuries to their shoulders/upper arms and more likely to develop chronic upper extremity symptoms. With advanced level of training the likelihood of developing chronic upper extremity symptoms increases, and multiple surgeries were required. Hand protection was associated with a lower risk of hand injuries. Martial arts can be associated with substantial upper extremity injuries that may require surgery and extended time away from participation. Injuries may result in chronic upper extremity symptoms. Hand protection is important for reducing injuries to the hand and wrist.

Effects of interactive metronome training on upper extremity function, ADL and QOL in stroke patients.

PubMed

Yu, Ga-Hui; Lee, Jae-Shin; Kim, Su-Kyoung; Cha, Tae-Hyun

2017-01-01

Rhythm and timing training is stimulation that substitutes for a damaged function controls muscular movement or temporal element, which has positive impacts on the neurological aspect and movement of the brain. This study is to assess the changes caused by rhythm and timing training using an interactive metronome (IM) on upper extremity function, ADL and QOL in stroke patients. In order to assess the effects of IM training, a group experiment was conducted on 30 stroke patients. Twelve sessions of IM training were provided for the experimental group three times a week for four weeks, while the control group was trained with a Bilateral arm Self-Exercise (BSE) for the same period. Both groups were evaluated by pre- and post-tests through MFT, MAL, K-MBI and SS-QOL. There were more statistically significant differences (<0.05) in the total score of MFT and the finger control item in the IM Group than in the BSE Group. With respect to ADL, there were more statistically significant differences (<0.05) in the total score of K-MBI and the dressing item in the IM Group than in the BSE Group. The study proposes that IM training can be applied as an occupational therapy program in patients with various diseases who need to adjust the time for performing movements as well as stroke patients.

Muscle activity of leg muscles during unipedal stance on therapy devices with different stability properties.

PubMed

Wolburg, Thomas; Rapp, Walter; Rieger, Jochen; Horstmann, Thomas

2016-01-01

To test the hypotheses that less stable therapy devices require greater muscle activity and that lower leg muscles will have greater increases in muscle activity with less stable therapy devices than upper leg muscles. Cross-sectional laboratory study. Laboratory setting. Twenty-five healthy subjects. Electromyographic activity of four lower (gastrocnemius medialis, soleus, tibialis anterior, peroneus longus) and four upper leg muscles (vastus medialis and lateralis, biceps femoris, semitendinosus) during unipedal quiet barefoot stance on the dominant leg on a flat rigid surface and on five therapy devices with varying stability properties. Muscle activity during unipedal stance differed significantly between therapy devices (P < 0.001). The order from lowest to highest relative muscle activity matched the order from most to least stable therapy device. There was no significant interaction between muscle location (lower versus upper leg) and therapy device (P = 0.985). Magnitudes of additional relative muscle activity for the respective therapy devices differed substantially among lower extremity muscles. The therapy devices offer a progressive increase in training intensity, and thus may be useful for incremental training programs in physiotherapeutic practice and sports training programs. Copyright © 2015 Elsevier Ltd. All rights reserved.

The effects of Nintendo Wii(TM)-based balance and upper extremity training on activities of daily living and quality of life in patients with sub-acute stroke: a randomized controlled study.

PubMed

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.

The effects of 6-week training programs on throwing accuracy, proprioception, and core endurance in baseball.

PubMed

Lust, Kathleen R; Sandrey, Michelle A; Bulger, Sean M; Wilder, Nathan

2009-08-01

With a limited number of outcomes-based studies, only recommendations for strength-training and rehabilitation programs can be made. To determine the extent to which throwing accuracy, core stability, and proprioception improved after completion of a 6-week training program that included open kinetic chain (OKC), closed kinetic chain (CKC), and/or core-stability exercises. A 2 x 3 factorial design. Division III college. 19 healthy baseball athletes with a control group of 15. Two 6-week programs including OKC, CKC, and core-stabilization exercises that were progressed each week. Functional throwing-performance index, closed kinetic chain upper extremity stability test, back-extensor test, 45 degrees abdominal-fatigue test, and right- and left-side bridging test. There was no significant difference between groups. An increase was evident in all pretest-to-posttest results, with improvement ranging from 1.36% to 140%. Both of the 6-week training programs could be used to increase throwing accuracy, core stability, and proprioception in baseball.

Interdisciplinary Comprehensive Arm Rehabilitation Evaluation (ICARE): a randomized controlled trial protocol.

PubMed

Winstein, Carolee J; Wolf, Steven L; Dromerick, Alexander W; Lane, Christianne J; Nelsen, Monica A; Lewthwaite, Rebecca; Blanton, Sarah; Scott, Charro; Reiss, Aimee; Cen, Steven Yong; Holley, Rahsaan; Azen, Stanley P

2013-01-11

Residual disability after stroke is substantial; 65% of patients at 6 months are unable to incorporate the impaired upper extremity into daily activities. Task-oriented training programs are rapidly being adopted into clinical practice. In the absence of any consensus on the essential elements or dose of task-specific training, an urgent need exists for a well-designed trial to determine the effectiveness of a specific multidimensional task-based program governed by a comprehensive set of evidence-based principles. The Interdisciplinary Comprehensive Arm Rehabilitation Evaluation (ICARE) Stroke Initiative is a parallel group, three-arm, single blind, superiority randomized controlled trial of a theoretically-defensible, upper extremity rehabilitation program provided in the outpatient setting.The primary objective of ICARE is to determine if there is a greater improvement in arm and hand recovery one year after randomization in participants receiving a structured training program termed Accelerated Skill Acquisition Program (ASAP), compared to participants receiving usual and customary therapy of an equivalent dose (DEUCC). Two secondary objectives are to compare ASAP to a true (active monitoring only) usual and customary (UCC) therapy group and to compare DEUCC and UCC. Following baseline assessment, participants are randomized by site, stratified for stroke duration and motor severity. 360 adults will be randomized, 14 to 106 days following ischemic or hemorrhagic stroke onset, with mild to moderate upper extremity impairment, recruited at sites in Atlanta, Los Angeles and Washington, D.C. The Wolf Motor Function Test (WMFT) time score is the primary outcome at 1 year post-randomization. The Stroke Impact Scale (SIS) hand domain is a secondary outcome measure.The design includes concealed allocation during recruitment, screening and baseline, blinded outcome assessment and intention to treat analyses. Our primary hypothesis is that the improvement in log-transformed WMFT time will be greater for the ASAP than the DEUCC group. This pre-planned hypothesis will be tested at a significance level of 0.05. ICARE will test whether ASAP is superior to the same number of hours of usual therapy. Pre-specified secondary analyses will test whether 30 hours of usual therapy is superior to current usual and customary therapy not controlled for dose. www.ClinicalTrials.gov Identifier: NCT00871715

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

PubMed

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

2016-06-07

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.

Home-based resistance training improves femoral bone mineral density in women on hormone therapy.

PubMed

Judge, James Oat; Kleppinger, Alison; Kenny, Anne; Smith, Jo-Anne; Biskup, Brad; Marcella, Glenn

2005-09-01

This study tested whether moderate resistance training would improve femoral bone mineral density (BMD) in long-term users of hormone therapy with low BMD. The study was a 2-year randomized, controlled, trial (RCT) of moderate resistance training of either the lower extremity or the upper extremity. Eighty-five women participated in a 6-month observation period. The setting was center-based and home-based training. The participants were 189 women aged 59-78 years, with total femur T-scores from -0.8 to -2.8 and on hormone therapy (HT) for a minimum of 2 years (mean 11.8 years); 153 completed the trial. Lower extremity training used weight belts (mean 7.8 kg) in step-ups and chair rises; upper extremity training used elastic bands and dumbbells. Measurements were BMD and body composition [dual-energy X-ray absorptiometry (DXA)], bone turnover markers. Total femoral BMD showed a downward trend during the observation period: 0.35%+/-0.18% (P=0.14). The response to training was similar in the upper and lower groups in the primary outcomes. At 2 years, total femoral BMD increased 1.5% (95% CI 0.8%-2.2%) in the lower group and 1.8% (95% CI 1.1%-2.5%) in the upper group. Trochanter BMD increased 2.4% (95% CI 1.3%-3.5%) in the lower group and 2.5% (95% CI 1.4%-3.6%) in the upper group (for both analyses time effect P<0.001). At 1 year, a bone resorption marker (C-telopeptide) decreased 9% (P=0.04). Bone formation markers, bone-specific alkaline phosphatase, decreased 5% (P<0.001), and N-terminal type I procollagen peptide decreased 7% (P=0.01). Body composition (percent lean and percent body fat) was maintained in both groups. We concluded that long-term moderate resistance training reversed bone loss, decreased bone turnover, increased femur BMD, and maintained body composition. The similarity of response in upper and lower groups supports a systemic response rather than a site-specific response to moderate resistance training.

Mirror Therapy and Task-Oriented Training for People With a Paretic Upper Extremity.

PubMed

Bondoc, Salvador; Booth, Julie; Budde, Grace; Caruso, Katelyn; DeSousa, Michelle; Earl, Brittany; Hammerton, Kaitlynn; Humphreys, Jill

This study investigates the effect of mirror therapy and task-oriented training on the paretic upper extremity function and occupational performance of people with stroke. This study used a repeated-measures, case-series design in which 4 participants completed a 4-wk intervention consisting of mirror therapy and task-specific training. The intervention was conducted 2×/wk in the clinic and 4×/wk at home. All participants displayed clinically meaningful improvements in self-identified goals at the end of the intervention and at follow-up. Three participants showed clinically meaningful changes in motor function. Although only 1 participant improved in his reported amount of use, all participants showed clinically meaningful improvements in perceived movement quality at varying points of assessment. Mirror therapy, when used as priming for task-oriented training, can produce clinical improvements in upper extremity function and occupational performance in people with hemiparesis. Copyright © 2018 by the American Occupational Therapy Association, Inc.

A six-week neuromuscular training program for competitive junior tennis players.

PubMed

Barber-Westin, Sue D; Hermeto, Alex A; Noyes, Frank R

2010-09-01

This study evaluated the effectiveness of a tennis-specific training program on improving neuromuscular indices in competitive junior players. Tennis is a demanding sport because it requires speed, agility, explosive power, and aerobic conditioning along with the ability to react and anticipate quickly, and there are limited studies that evaluate these indices in young players after a multiweek training program. The program designed for this study implemented the essential components of a previously published neuromuscular training program and also included exercises designed to improve dynamic balance, agility, speed, and strength. Fifteen junior tennis players (10 girls, 5 boys; mean age, 13.0 +/- 1.5 years) who routinely participated in local tournaments and high-school teams participated in the 6-week supervised program. Training was conducted 3 times a week, with sessions lasting 1.5 hours that included a dynamic warm-up, plyometric and jump training, strength training (lower extremity, upper extremity, core), tennis-specific drills, and flexibility. After training, statistically significant improvements and large-to-moderate effect sizes were found in the single-leg triple crossover hop for both legs (p < 0.05), the baseline forehand (p = 0.006) and backhand (p = 0.0008) tests, the service line (p = 0.0009) test, the 1-court suicide (p < 0.0001), the 2-court suicide (p = 0.02), and the abdominal endurance test (p = 0.01). Mean improvements between pretrain and posttrain test sessions were 15% for the single-leg triple crossover hop, 10-11% for the baseline tests, 18% for the service line test, 21% for the 1-court suicide, 10% for the 2-court suicide, and 76% for the abdominal endurance test. No athlete sustained an injury or developed an overuse syndrome as a result of the training program. The results demonstrate that this program is feasible, low in cost, and appears to be effective in improving the majority of neuromuscular indices tested. We accomplished our goal of developing training and testing procedures that could all be performed on the tennis court.

Implementation of specific strength training among industrial laboratory technicians: long-term effects on back, neck and upper extremity pain.

PubMed

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.

Functional electrical stimulation enhancement of upper extremity functional recovery during stroke rehabilitation: a pilot study.

PubMed

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.

Feasibility of task-specific brain-machine interface training for upper-extremity paralysis in patients with chronic hemiparetic stroke.

PubMed

Nishimoto, Atsuko; Kawakami, Michiyuki; Fujiwara, Toshiyuki; Hiramoto, Miho; Honaga, Kaoru; Abe, Kaoru; Mizuno, Katsuhiro; Ushiba, Junichi; Liu, Meigen

2018-01-10

Brain-machine interface training was developed for upper-extremity rehabilitation for patients with severe hemiparesis. Its clinical application, however, has been limited because of its lack of feasibility in real-world rehabilitation settings. We developed a new compact task-specific brain-machine interface system that enables task-specific training, including reach-and-grasp tasks, and studied its clinical feasibility and effectiveness for upper-extremity motor paralysis in patients with stroke. Prospective beforeâ€"after study. Twenty-six patients with severe chronic hemiparetic stroke. Participants were trained with the brain-machine interface system to pick up and release pegs during 40-min sessions and 40 min of standard occupational therapy per day for 10 days. Fugl-Meyer upper-extremity motor (FMA) and Motor Activity Log-14 amount of use (MAL-AOU) scores were assessed before and after the intervention. To test its feasibility, 4 occupational therapists who operated the system for the first time assessed it with the Quebec User Evaluation of Satisfaction with assistive Technology (QUEST) 2.0. FMA and MAL-AOU scores improved significantly after brain-machine interface training, with the effect sizes being medium and large, respectively (p<0.01, d=0.55; p<0.01, d=0.88). QUEST effectiveness and safety scores showed feasibility and satisfaction in the clinical setting. Our newly developed compact brain-machine interface system is feasible for use in real-world clinical settings.

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

PubMed Central

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

2016-01-01

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

Robot-assisted upper extremity rehabilitation for cervical spinal cord injuries: a systematic scoping review.

PubMed

Singh, Hardeep; Unger, Janelle; Zariffa, José; Pakosh, Maureen; Jaglal, Susan; Craven, B Catharine; Musselman, Kristin E

2018-01-15

Abstact Purpose: To provide an overview of the feasibility and outcomes of robotic-assisted upper extremity training for individuals with cervical spinal cord injury (SCI), and to identify gaps in current research and articulate future research directions. A systematic search was conducted using Medline, Embase, PsycINFO, CCTR, CDSR, CINAHL and PubMed on June 7, 2017. Search terms included 3 themes: (1) robotics; (2) SCI; (3) upper extremity. Studies using robots for upper extremity rehabilitation among individuals with cervical SCI were included. Identified articles were independently reviewed by two researchers and compared to pre-specified criteria. Disagreements regarding article inclusion were resolved through discussion. The modified Downs and Black checklist was used to assess article quality. Participant characteristics, study and intervention details, training outcomes, robot features, study limitations and recommendations for future studies were abstracted from included articles. Twelve articles (one randomized clinical trial, six case series, five case studies) met the inclusion criteria. Five robots were exoskeletons and three were end-effectors. Sample sizes ranged from 1 to 17 subjects. Articles had variable quality, with quality scores ranging from 8 to 20. Studies had a low internal validity primarily from lack of blinding or a control group. Individuals with mild-moderate impairments showed the greatest improvements on body structure/function and performance-level measures. This review is limited by the small number of articles, low-sample sizes and the diversity of devices and their associated training protocols, and outcome measures. Preliminary evidence suggests robot-assisted interventions are safe, feasible and can reduce active assistance provided by therapists. Implications for rehabilitation Robot-assisted upper extremity training for individuals with cervical spinal cord injury is safe, feasible and can reduce hands-on assistance provided by therapists. Future research in robotics rehabilitation with individuals with spinal cord injury is needed to determine the optimal device and training protocol as well as effectiveness.

Effectiveness of participatory training for prevention of musculoskeletal disorders: a randomized controlled trial.

PubMed

Yu, Wenzhou; Yu, Ignatius T S; Wang, Xiaorong; Li, Zhimin; Wan, Sabrina; Qiu, Hong; Lin, Hui; Xie, Shaohua; Sun, Trevor

2013-05-01

Health and safety training program has been applied to prevent work-related musculoskeletal disorders (MSDs) in workplace. We evaluated the effectiveness of participatory training and didactic training programs on MSD prevention among frontline workers in Shenzhen, China. The authors randomly assigned 918 workers from intervention factories to receive participatory training (intervention group), and 907 workers from intervention factories and 1,654 workers from control factories to receive didactic training (control_1 group, control_2 group, respectively) from June 1, 2008 to November 30, 2009. Participants were asked to report experience of ache, pain or discomfort in 10 body parts at baseline and 1 year after training. Data were analyzed to compare the MSD prevalence 1 year before and 1 year after training in different groups from 2009 to 2010. The follow-up rate was 61 % (2,120/3,479) at 1 year after training. In the year after training, there were no statistically significant changes in the proportion of workers who reported MSD in any body part. MSD prevalence rates in the intervention group reduced from 16.8 to 9.9 % for lower extremities (χ(2) = 13.102, p < 0.001) and from 12.9 to 8.3 % (χ(2) = 9.433, p = 0.002) for wrist and finger at 1 year after training. However, the rates did not change significantly for upper back, lower back, neck, shoulder and elbow in the intervention group and for all 10 body parts in two control groups. Overall, the training programs did not seem to prevent the occurrence of MSD among frontline workers. However, participatory training might be effective to reduce MSD in the lower extremities and wrist and finger.

Rehabilitation of arm function after stroke. Literature review.

PubMed

Oujamaa, L; Relave, I; Froger, J; Mottet, D; Pelissier, J-Y

2009-04-01

In the recent literature we can find many articles dealing with upper extremity rehabilitation in stroke patients. New techniques, still under evaluation, are becoming the practical applications for the concept of post-stroke brain plasticity. This literature review focuses on controlled randomized studies, reviews and meta-analyses published in the English language from 2004 to 2008. The research was conducted in MEDLINE with the following keywords: "upper limb", "stroke", "rehabilitation". We reviewed 66 studies. The main therapeutic strategies are: activation of the ipsilesional motor cortex, inhibition of the contralesional motor cortex and modulation of the sensory afferents. Keeping a cortical representation of the upper limb distal extremity could prevent the learned non-use phenomenon. The modulation of sensory afferents is then proposed: distal cutaneous electrostimulation, anesthesia of the healthy limb, mirror therapy, virtual reality. Intensifying the rehabilitation care means increasing the total hours of rehabilitation dedicated to the paretic limb (proprioceptive stimulation and repetitive movements). This specific rehabilitation is facilitated by robot-aided therapy in the active-assisted mode, neuromuscular electrostimulation and bilateral task training. Intensifying the rehabilitation training program significantly improves the arm function outcome when performed during subacute stroke rehabilitation (< six months). Ipsilesional neurostimulation as well as mental practice optimize the effect of repetitive gestures for slight motor impairments. Contralesional neurostimulation or anesthesia of the healthy hand both improve the paretic hand's dexterity via a decrease of the transcallosal inhibition. This pathophysiological mechanism could also explain the positive impact of constraint-induced movement therapy (CI therapy) in an environmental setting for chronic stroke patients. To ensure a positive functional outcome, stroke rehabilitation programs are based on task-oriented repetitive training. This literature review shows that exercising the hemiparetic hand and wrist is essential in all stages of a stroke rehabilitation program. New data stemming from neurosciences suggest that ipsilesional corticospinal excitability should be a priority.

[Injuries and damage caused by excess stress in body building and power lifting].

PubMed

Goertzen, M; Schöppe, K; Lange, G; Schulitz, K P

1989-03-01

A questionnaire, designed to elict information about training programs, experience and injury profile, was administered to 358 bodybuilders and 60 powerlifters. This was followed by a clinical orthopedic and radiological examination. The upper extremity, particulary the shoulder and elbow joint, showed the highest injury rate. More than 40% of all injuries occurred in this area. The low back region and the knee were other sites of elevated injury occurrences. Muscular injuries (muscle pulls, tendonitis, sprains) were perceived to account for 83.6% of all injury types. Powerlifting showed a twice as high injury rate as bodybuilding, probably of grounds of a more uniform training program. Weight-training should be associated with a sports-related medical care and supervised by knowledgeable people, who can instruct the athletes in proper lifting techniques and protect them from injury which can result from incorrect weight-training.

Motor skill changes and neurophysiologic adaptation to recovery-oriented virtual rehabilitation of hand function in a person with subacute stroke: a case study.

PubMed

Fluet, Gerard G; Patel, Jigna; Qiu, Qinyin; Yarossi, Matthew; Massood, Supriya; Adamovich, Sergei V; Tunik, Eugene; Merians, Alma S

2017-07-01

The complexity of upper extremity (UE) behavior requires recovery of near normal neuromuscular function to minimize residual disability following a stroke. This requirement places a premium on spontaneous recovery and neuroplastic adaptation to rehabilitation by the lesioned hemisphere. Motor skill learning is frequently cited as a requirement for neuroplasticity. Studies examining the links between training, motor learning, neuroplasticity, and improvements in hand motor function are indicated. This case study describes a patient with slow recovering hand and finger movement (Total Upper Extremity Fugl-Meyer examination score = 25/66, Wrist and Hand items = 2/24 on poststroke day 37) following a stroke. The patient received an intensive eight-session intervention utilizing simulated activities that focused on the recovery of finger extension, finger individuation, and pinch-grasp force modulation. Over the eight sessions, the patient demonstrated improvements on untrained transfer tasks, which suggest that motor learning had occurred, as well a dramatic increase in hand function and corresponding expansion of the cortical motor map area representing several key muscles of the paretic hand. Recovery of hand function and motor map expansion continued after discharge through the three-month retention testing. This case study describes a neuroplasticity based intervention for UE hemiparesis and a model for examining the relationship between training, motor skill acquisition, neuroplasticity, and motor function changes. Implications for rehabilitation Intensive hand and finger rehabilitation activities can be added to an in-patient rehabilitation program for persons with subacute stroke. Targeted training of the thumb may have an impact on activity level function in persons with upper extremity hemiparesis. Untrained transfer tasks can be utilized to confirm that training tasks have elicited motor learning. Changes in cortical motor maps can be used to document changes in brain function which can be used to evaluate changes in motor behavior persons with subacute stroke.

Effect of task-based mirror therapy on motor recovery of the upper extremity in chronic stroke patients: a pilot study.

PubMed

Arya, Kamal Narayan; Pandian, Shanta

2013-01-01

Mirror therapy (MT) is an alternative therapeutic intervention that uses the interaction of visuomotor-proprioception inputs to enhance movement performance of the impaired limb. Despite strong evidence for task-specific training in stroke, MT has been investigated using nontask movements. The aim of this pilot study was to assess the effectiveness of task-based MT on motor recovery of the upper extremity in chronic stroke patients. In a pretest-posttest single-group design, a convenience sample of 13 chronic stroke patients at an occupational therapy department of a rehabilitation institute was assessed on a task-based MT intervention. Participants received a task-based MT program, performing various tasks by the less affected upper extremity and observing in the mirror box along with conventional management, 4 days per week for 4 weeks. Fugl-Meyer Assessment (FMA), which includes subsection upper extremity (FMA-UE) and subpart upper arm (FMA-UA) and hand (FMA-WH), was used as an outcome measure. Participants showed no significant improvement for FMA-UE and FMA-UA at postassessment. FMA-UE changed from 43% to 51%. Post FMA-UA score showed only 2% improvement. However, there was statistically significant improvement on mean scores of FMA-WH at postassessment (16.21 ± 3.06) as compared with the prescores (12.29 ± 3.1; P < .05). FMA-WH improved from 41% to 54%. The preliminary findings suggest that task-based MT is effective in improving wrist and hand motor recovery in chronic stroke patients. Further studies in the form of randomized trials are needed to validate its effectiveness.

A comparison of hemisphere-specific training pattern in Inter-limb Learning Transfer (ILT) for stroke patients with hemiparesis.

PubMed

Yoo, In-gyu; Jung, Min-ye; Yoo, Eun-young; Park, Ji-hyuk; Kang, Dae-hyuk; Lee, Jin

2014-01-01

Stroke patients have major problems with impaired upper-extremity function. Unfortunately, many patients do not experience a full recovery from movement deficits in the upper extremities. The purpose of this study was to compare the effectiveness of inter-limb learning transfer (ILT) to the contralateral upper limb after both hemisphere-specific and -unspecific ipsilateral upper limb training for stroke patients with hemiparesis. Twenty-four stroke patients with hemiparesis participated. The hemisphere-specific training group performed reaching movements in a customized training setting in which non-dominant limb training participants began from a single starting location and proceeded to one of three target locations (1S3T condition); the dominant limb training participants started from one of three starting locations and proceeded to a single target location (3S1T condition). The hemisphere-unspecific training group performed these movements starting under reverse-start and target conditions. The non-dominant to dominant limb transfer, the hemisphere-specific training group performance time decreased significantly as compared with the pre-training session (p < 0.05). Also, the isolation contraction ratio was decreased significantly from that of the pre-training session in the biceps brachii muscles and increased significantly in the upper trapezius muscles (p < 0.05). And, dominant to non-dominant limb transfer in the hemisphere-specific training group significantly increased RMS amplitudes from the pre-training session in the biceps brachii and triceps muscles (p < 0.05). Also, the isolation contraction ratio was increased significantly from that of the pre-training session in the biceps brachii muscles and decreased significantly in the upper trapezius muscles (p < 0.05). However, the hemisphere-unspecific training group showed no significant differences in inter-limb learning transfer (ILT). The transfer of hemisphere-specific training from one arm to the other had a more positive influence on functional recovery than did hemisphere-unspecific training for patients with stroke and hemiparesis.

Effects of Computer-Aided Interlimb Force Coupling Training on Paretic Hand and Arm Motor Control following Chronic Stroke: A Randomized Controlled Trial

PubMed Central

Lin, Chueh-Ho; Chou, Li-Wei; Luo, Hong-Ji; Tsai, Po-Yi; Lieu, Fu-Kong; Chiang, Shang-Lin; Sung, Wen-Hsu

2015-01-01

Objective We investigated the training effects of interlimb force coupling training on paretic upper extremity outcomes in patients with chronic stroke and analyzed the relationship between motor recovery of the paretic hand, arm and functional performances on paretic upper limb. Design A randomized controlled trial with outcome assessment at baseline and after 4 weeks of intervention. Setting Taipei Veterans General Hospital, National Yang-Ming University. Participants Thirty-three subjects with chronic stroke were recruited and randomly assigned to training (n = 16) and control groups (n = 17). Interventions The computer-aided interlimb force coupling training task with visual feedback included different grip force generation methods on both hands. Main Outcome Measures The Barthel Index (BI), the upper extremity motor control Fugl-Meyer Assessment (FMA-UE), the Motor Assessment Score (MAS), and the Wolf Motor Function Test (WMFT). All assessments were executed by a blinded evaluator, and data management and statistical analysis were also conducted by a blinded researcher. Results The training group demonstrated greater improvement on the FMA-UE (p<.001), WMFT (p<.001), MAS (p = .004) and BI (p = .037) than the control group after 4 weeks of intervention. In addition, a moderate correlation was found between the improvement of scores for hand scales of the FMA and other portions of the FMA UE (r = .528, p = .018) or MAS (r = .596, p = .015) in the training group. Conclusion Computer-aided interlimb force coupling training improves the motor recovery of a paretic hand, and facilitates motor control and enhances functional performance in the paretic upper extremity of people with chronic stroke. Trial Registration ClinicalTrials.gov NCT02247674. PMID:26193492

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

PubMed

Kim, Jung Hee; Lee, Byoung-Hee

2015-06-01

The objective of this study was to evaluate the effects of mirror therapy in combination with biofeedback functional electrical stimulation (BF-FES) on motor recovery of the upper extremities after stroke. Twenty-nine patients who suffered a stroke > 6 months prior participated in this study and were randomly allocated to three groups. The BF-FES + mirror therapy and FES + mirror therapy groups practiced training for 5 × 30 min sessions over a 4-week period. The control group received a conventional physical therapy program. The following clinical tools were used to assess motor recovery of the upper extremities: electrical muscle tester, electrogoniometer, dual-inclinometer, electrodynamometer, the Box and Block Test (BBT) and Jabsen Taylor Hand Function Test (JHFT), the Functional Independence Measure, the Modified Ashworth Scale, and the Stroke Specific Quality of Life (SSQOL) assessment. The BF-FES + mirror therapy group showed significant improvement in wrist extension as revealed by the Manual Muscle Test and Range of Motion (p < 0.05). The BF-FES + mirror therapy group showed significant improvement in the BBT, JTHT, and SSQOL compared with the FES + mirror therapy group and control group (p < 0.05). We found that BF-FES + mirror therapy induced motor recovery and improved quality of life. These results suggest that mirror therapy, in combination with BF-FES, is feasible and effective for motor recovery of the upper extremities after stroke. Copyright © 2014 John Wiley & Sons, Ltd.

Trunk restraint to promote upper extremity recovery in stroke patients: a systematic review and meta-analysis.

PubMed

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.

Characteristics of upper extremity's muscle strength in Turkish national wheelchair basketball players team.

PubMed

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.

A low-cost video game applied for training of upper extremity function in children with cerebral palsy: a pilot study.

PubMed

Jannink, Michiel J A; van der Wilden, Gelske J; Navis, Dorine W; Visser, Gerben; Gussinklo, Jeanine; Ijzerman, Maarten

2008-02-01

The aim of the present study was to determine the user satisfaction of the EyeToy for the training of the upper limb in children with cerebral palsy (CP). User satisfaction was measured in 12 children with CP, using a postexperience questionnaire, primarily based on a presence questionnaire. In general, children with CP were satisfied with and motivated by the EyeToy training. In addition, a first evaluation study was performed to determine the effect of this training method on the upper limb function. Ten children with CP were randomly assigned to the intervention (mean age 11 years, 9 months; SD 2,3) and the control group (mean age 12 years, 3 months; SD 3,2). After a treatment period of 6 weeks, the intervention group completed a user satisfaction questionnaire. Functional outcome was measured using the Melbourne Assessment scores. Percentage scores of the Melbourne Assessment of 7 of the 10 children were the same or changed only 1% to 2% from baseline to followup. However, in the experimental group, two children improved more, 9% and 13% respectively. In conclusion, it can be said that the EyeToy is a motivational training tool for the training of children with CP and has the potential to improve upper extremity function.

Motor learning characterizes habilitation of children with hemiplegic cerebral palsy.

PubMed

Krebs, Hermano I; Fasoli, Susan E; Dipietro, Laura; Fragala-Pinkham, Maria; Hughes, Richard; Stein, Joel; Hogan, Neville

2012-09-01

This study tested in children with cerebral palsy (CP) whether motor habilitation resembles motor learning. Twelve children with hemiplegic CP ages 5 to 12 years with moderate to severe motor impairments underwent a 16-session robot-mediated planar therapy program to improve upper limb reach, with a focus on shoulder and elbow movements. Participants were trained to execute point-to-point movements (with robot assistance) with the affected arm and were evaluated (without robot assistance) in trained (point-to-point) and untrained (circle-drawing) conditions. Outcomes were measured at baseline, midpoint, immediately after the program, and 1 month postcompletion. Outcome measures were the Fugl-Meyer (FM), Quality of Upper Extremity Skills Test (QUEST), and Modified Ashworth Scale (MAS) scores; parent questionnaire; and robot-based kinematic metrics. To assess whether learning best characterizes motor habilitation in CP, the authors quantified (a) improvement on trained tasks at completion of training (acquisition) and 1 month following completion (retention) and (b) quantified generalization of improvement to untrained tasks. After robotic intervention, the authors found significant gains in the FM, QUEST, and parent questionnaire. Robot-based evaluations demonstrated significant improvement in trained movements and that improvement was sustained at follow-up. Furthermore, children improved their performance in untrained movements indicating generalization. Motor habilitation in CP exhibits some traits of motor learning. Optimal treatment may not require an extensive repertoire of tasks but rather a select set to promote generalization.

Exploring the impact of visual and movement based priming on a motor intervention in the acute phase post-stroke in persons with severe hemiparesis of the upper extremity.

PubMed

Patel, Jigna; Qiu, Qinyin; Yarossi, Mathew; Merians, Alma; Massood, Supriya; Tunik, Eugene; Adamovich, Sergei; Fluet, Gerard

2017-07-01

Explore the potential benefits of using priming methods prior to an active hand task in the acute phase post-stroke in persons with severe upper extremity hemiparesis. Five individuals were trained using priming techniques including virtual reality (VR) based visual mirror feedback and contralaterally controlled passive movement strategies prior to training with an active pinch force modulation task. Clinical, kinetic, and neurophysiological measurements were taken pre and post the training period. Clinical measures were taken at six months post training. The two priming simulations and active training were well tolerated early after stroke. Priming effects were suggested by increased maximal pinch force immediately after visual and movement based priming. Despite having no clinically observable movement distally, the subjects were able to volitionally coordinate isometric force and muscle activity (EMG) in a pinch tracing task. The Root Mean Square Error (RMSE) of force during the pinch trace task gradually decreased over the training period suggesting learning may have occurred. Changes in motor cortical neurophysiology were seen in the unaffected hemisphere using Transcranial Magnetic Stimulation (TMS) mapping. Significant improvements in motor recovery as measured by the Action Research Arm Test (ARAT) and the Upper Extremity Fugl Meyer Assessment (UEFMA) were demonstrated at six months post training by three of the five subjects. This study suggests that an early hand-based intervention using visual and movement based priming activities and a scaled motor task allows participation by persons without the motor control required for traditionally presented rehabilitation and testing. Implications for Rehabilitation Rehabilitation of individuals with severely paretic upper extremities after stroke is challenging due to limited movement capacity and few options for therapeutic training. Long-term functional recovery of the arm after stroke depends on early return of active hand control, establishing a need for acute training methods focused distally. This study demonstrates the feasibility of an early hand-based intervention using virtual reality based priming and scaled motor activities which can allow for participation by persons without the motor control required for traditionally presented rehabilitation and testing.

Case management services for work related upper extremity disorders. Integrating workplace accommodation and problem solving.

PubMed

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

2001-08-01

A case manager's ability to obtain worksite accommodations and engage workers in active problem solving may improve health and return to work outcomes for clients with work related upper extremity disorders (WRUEDs). This study examines the feasibility of a 2 day training seminar to help nurse case managers identify ergonomic risk factors, provide accommodation, and conduct problem solving skills training with workers' compensation claimants recovering from WRUEDs. Eight procedural steps to this case management approach were identified, translated into a training workshop format, and conveyed to 65 randomly selected case managers. Results indicate moderate to high self ratings of confidence to perform ergonomic assessments (mean = 7.5 of 10) and to provide problem solving skills training (mean = 7.2 of 10) after the seminar. This training format was suitable to experienced case managers and generated a moderate to high level of confidence to use this case management approach.

Prevalence and psychosocial risk factors of upper extremity musculoskeletal pain in industries of Taiwan: a nationwide study.

PubMed

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.

Vibration training improves disability status in multiple sclerosis: A pretest-posttest pilot study.

PubMed

Yang, Feng; Estrada, Edson F; Sanchez, Maria C

2016-10-15

The purpose of this study was to examine the effects of an 8-week vibration training program on changing the disability level in people with multiple sclerosis (MS). Twenty-five adults with clinically-confirmed MS underwent an 8-week vibration training on a side-alternating vibration platform. The vibration frequency and peak-to-peak displacement were set at 20Hz and 2.6mm, respectively. Prior to and following the training course, the disability status was assessed for all participants characterized by the Patient Determined Disability Steps (PDDS) and MS Functional Composite (MSFC) scores. The training program significantly improved the PDDS (3.66±1.88 vs. 3.05±1.99, p=0.009) and the MSFC scores (0.00±0.62 vs 0.36±0.68, p<0.0001). All three MSFC components were improved: lower extremity function (9.37±4.92 vs. 8.13±4.08s, p=0.011), upper extremity function (dominant hand: 27.81±5.96 vs. 26.20±5.82s, p=0.053; non-dominant hand: 28.47±7.40 vs. 27.43±8.33s, p=0.059), and cognitive function (30.55±13.54 vs. 36.95±15.07 points, p=0.004). Our findings suggested that vibration training could be a promising alternative modality to reduce the disability level among people with MS. Copyright © 2016 Elsevier B.V. All rights reserved.

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

PubMed Central

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

2015-01-01

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

Home programs for upper extremity recovery post-stroke: a survey of occupational therapy practitioners.

PubMed

Donoso Brown, Elena V; Fichter, Renae

2017-12-01

Upper extremity hemiparesis is an impairment post-stroke that impacts quality of life. Home programs are an intervention strategy used by many occupational therapists to support continued motor recovery post-stroke, yet little is known about how these programs are designed and implemented. The purpose of this study was to describe how occupational therapy practitioners approach this task and specifically what strategies they use to support adherence and what types of technology are most commonly used. An on-line survey methodology was used. Participants were recruited through multiple sources including state associations and occupational therapy educational program directors. A total of 73 occupational therapy practitioners submitted complete surveys. It was found that majority of occupational therapy practitioners in the sample (n = 53) reported creating home programs focused on upper extremity motor recovery more than 80% of the time. Range of motion and strengthening were reported as being in the top three most commonly used interventions by more than half the sample, however incorporating clients' goals and interests were reported most often as strategies to create meaning in the home program. Respondents also reported limited incorporation of technology and strategies to support adherence. Personal motivation was reported by occupational therapy practitioners to be a key moderator of adherence to a home program. Occupational therapy practitioners often provide home programs for individuals post-stroke focusing on upper extremity function. Future research that aims to understand stakeholders' perspectives on home programs and determine effective strategies for ensuring adherence is needed.

Infusing Training into the Documentation and Culture of Ares I Upper Stage Design and Manufacturing

NASA Technical Reports Server (NTRS)

Scott, David W.

2009-01-01

In roughly two years time, Marshall Space Flight Center's (MSFC) Mission Operations Laboratory (MOL) has incubated a personnel training and certification program for about 1000 learners and multiple phases of the Ares I Upper Stage (US) project. Previous MOL-developed training programs focused on about 100 learners with a focus on operations, and had enough full-time training staff to develop courseware and provide training administration. This paper discusses 1) how creation of a broad, structured training program unfolded as feedback from more narrowly defined tasks, 2) how training philosophy, development methods, and administration are being simplified and tailored so that many Upper Stage organizations can grow their own training yet maintain consistency, accountability, and traceability across the project, and 3) possibilities for interfacing with the production contractor's training system and staff.

Growing a Training System and Culture for the Ares I Upper Stage Project

NASA Technical Reports Server (NTRS)

Scott, David W.

2009-01-01

In roughly two years time, Marshall Space Flight Center s (MSFC) Mission Operations Laboratory (MOL) has incubated a personnel training and certification program for about 1000 learners and multiple phases of the Ares I Upper Stage (US) project. Previous MOL-developed training programs focused on about 100 learners with a focus on operations, and had enough full-time training staff to develop courseware and provide training administration. This paper discusses 1) the basics of MOL's training philosophy, 2) how creation of a broad, structured training program unfolded as feedback from more narrowly defined tasks, 3) how training philosophy, development methods, and administration are being simplified and tailored so that many Upper Stage organizations can "grow their own" training yet maintain consistency, accountability, and traceability across the project, 4) interfacing with the production contractor's training system and staff, and 5) reaping training value from existing materials and events.

Improved motor performance in chronic spinal cord injury following upper-limb robotic training.

PubMed

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.

Exercise prescription after fragility fracture in older adults: a scoping review

PubMed Central

Feehan, Lynne M.; Beck, Charlotte A.; Harris, Susan R.; MacIntyre, Donna L.; Li, Linda C.

2017-01-01

Purpose To identify and chart research literature on safety, efficacy or effectiveness of exercise prescription following fracture in older adults. Methods We conducted a systematic, research-user-informed, scoping review. The population of interest was adults aged ≥ 45 years with any fracture. ‘Exercise prescription’ included post-fracture therapeutic exercise, physical activity or rehabilitation interventions. Eligible designs included knowledge synthesis studies, primary interventional studies and observational studies. Trained reviewers independently evaluated citations for inclusion. Results A total of 9415 citations were reviewed with 134 citations (119 unique studies) identified: 13 knowledge syntheses, 95 randomized or controlled clinical trials, and 11 ‘other’ designs, representing 74 articles on lower extremity fractures, 34 on upper extremity, eight on vertebral, and three on mixed body region fractures. Exercise prescription characteristics were often missing or poorly described. Six general categories emerged describing exercise prescription characteristics: timing post-fracture, person prescribing, program design, functional focus, exercise script parameters and co-interventions. Upper extremity and ankle fracture studies focused on fracture healing or structural impairment outcomes, whereas hip fracture studies focused more on activity limitation outcomes. The variety of different outcome measures used made pooling or comparison of outcomes difficult. Conclusions There was insufficient information to identify evidence-informed parameters for safe and effective exercise prescription for older adults following fracture. Key gaps in the literature include limited numbers of studies on exercise prescription following vertebral fracture, poor delineation of effectiveness of different strategies for early post-fracture mobilization following upper extremity fracture, and inconsistent details of exercise prescription characteristics after lower extremity fracture. PMID:20967425

Motor Learning Characterizes Habilitation of Children With Hemiplegic Cerebral Palsy

PubMed Central

Krebs, Hermano I.; Fasoli, Susan E.; Dipietro, Laura; Fragala-Pinkham, Maria; Hughes, Richard; Stein, Joel; Hogan, Neville

2015-01-01

Background This study tested in children with cerebral palsy (CP) whether motor habilitation resembles motor learning. Methods Twelve children with hemiplegic CP ages 5 to 12 years with moderate to severe motor impairments underwent a 16-session robot-mediated planar therapy program to improve upper limb reach, with a focus on shoulder and elbow movements. Participants were trained to execute point-to-point movements (with robot assistance) with the affected arm and were evaluated (without robot assistance) in trained (point-to-point) and untrained (circle-drawing) conditions. Outcomes were measured at baseline, midpoint, immediately after the program, and 1 month postcompletion. Outcome measures were the Fugl-Meyer (FM), Quality of Upper Extremity Skills Test (QUEST), and Modified Ashworth Scale (MAS) scores; parent questionnaire; and robot-based kinematic metrics. To assess whether learning best characterizes motor habilitation in CP, the authors quantified (a) improvement on trained tasks at completion of training (acquisition) and 1 month following completion (retention) and (b) quantified generalization of improvement to untrained tasks. Results After robotic intervention, the authors found significant gains in the FM, QUEST, and parent questionnaire. Robot-based evaluations demonstrated significant improvement in trained movements and that improvement was sustained at follow-up. Furthermore, children improved their performance in untrained movements indicating generalization. Conclusions Motor habilitation in CP exhibits some traits of motor learning. Optimal treatment may not require an extensive repertoire of tasks but rather a select set to promote generalization. PMID:22331211

The effectiveness of a clinical and home-based physical activity program and simple lymphatic drainage in the prevention of breast cancer-related lymphedema: A prospective randomized controlled study.

PubMed

Dönmez, Ayşe Arıkan; Kapucu, Sevgisun

2017-12-01

To investigate the effectiveness of a clinical and home-based, nurse-led physical activity program (PAP) and simple lymphatic drainage (SLD) in the prevention of breast cancer-related lymphedema. A total of 52 breast cancer patients were randomized to either a PAP and SLD program (n = 25) or a control group (n = 27). Patients in both groups were also provided training for lymphedema. The PAP and SLD were administered through home visits by the investigators, twice a week for six weeks, in the intervention group. The control group did not undergo intervention. The circumference of the upper extremity, symptom severity, and physical function were measured in both groups. The upper extremity circumference increased by about two times from the baseline, in the control group, especially in the sixth week (p < 0.05). Lymphedema-related symptom severity scores were found to decrease significantly in the intervention group, compared to those at the baseline (p < 0.05). It was recommended that PAP and SLD, with a follow-up program, be used for patients who planned to undergo breast cancer surgery, starting from before surgery and continuing until after, to prevent breast cancer-related lymphedema. Copyright © 2017 Elsevier Ltd. All rights reserved.

Effects of two-handed task training on upper limb function of chronic hemiplegic patients after stroke

PubMed Central

Yang, Byung Il; Song, Bo Kyoung; Joung, Sang Mi

2017-01-01

[Purpose] The purpose of this study was to determine whether two-handed task training is effective on motor learning of injured cerebral cortex activation and upper extremity function recovery after stroke. [Subjects and Methods] Two hemiplegic subjects participated in this study: one patient was affected on the dominant side of the body and the other was affected on the non-dominant side of the body, and both scored in the range of 58–66 in the Fugl-Meyer assessment. The excitability of the corticospinal tract and Manual Function Test were examined. [Results] The excitability of the corticospinal tract and the Manual Function Test showed significant differences in the activation of both sides of the cerebral cortex and in the variation in learning effect of upper extremity motor function recovery in patients with hemiplegic non-dominant hand (left). [Conclusion] The results suggested that two-handed task training had a different influence on dominant hand (right) and non-dominant hand (left) motor recovery. PMID:28210051

Injuries in an Extreme Conditioning Program.

PubMed

Aune, Kyle T; Powers, Joseph M

2016-10-19

Extreme conditioning programs (ECPs) are fitness training regimens relying on aerobic, plyometric, and resistance training exercises, often with high levels of intensity for a short duration of time. These programs have grown rapidly in popularity in recent years, but science describing the safety profile of these programs is lacking. The rate of injury in the extreme conditioning program is greater than the injury rate of weightlifting and the majority of injuries occur to the shoulder and back. Cross-sectional study. Level 4. This is a retrospective survey of injuries reported by athletes participating in an ECP. An injury survey was sent to 1100 members of Iron Tribe Fitness, a gym franchise with 5 locations across Birmingham, Alabama, that employs exercises consistent with an ECP in this study. An injury was defined as a physical condition resulting from ECP participation that caused the athlete to either seek medical treatment, take time off from exercising, or make modifications to his or her technique to continue. A total of 247 athletes (22%) completed the survey. The majority (57%) of athletes were male (n = 139), and 94% of athletes were white (n = 227). The mean age of athletes was 38.9 years (±8.9 years). Athletes reported participation in the ECP for, on average, 3.6 hours per week (± 1.2 hours). Eighty-five athletes (34%) reported that they had sustained an injury while participating in the ECP. A total of 132 injuries were recorded, yielding an estimated incidence of 2.71 per 1000 hours. The shoulder or upper arm was the most commonly injured body site, accounting for 38 injuries (15% of athletes). Athletes with a previous shoulder injury were 8.1 times as likely to injure their shoulder in the ECP compared with athletes with healthy shoulders. The trunk, back, head, or neck (n = 29, 12%) and the leg or knee (n = 29, 12%) were the second most commonly injured sites. The injury incidence rate among athletes with < 6 months of experience in the ECP was 2.5 times greater than that of more experienced athletes (≥6 months of experience). Of the 132 injuries, 23 (17%) required surgical intervention. Squat cleans, ring dips, overhead squats, and push presses were more likely to cause injury. Athletes reported that 35% of injuries were due to overexertion and 20% were due to improper technique. The estimated injury rate among athletes participating in this ECP was similar to the rate of injury in weightlifting and most other recreational activities. The shoulder or upper arm was the most commonly injured area, and previous shoulder injury predisposed to new shoulder injury. New athletes are at considerable risk of injury compared with more experienced athletes. Extreme conditioning programs are growing in popularity, and there is disagreement between science and anecdotal reports from athletes, coaches, and physicians about their relative safety. This study estimates the incidence of injury in extreme conditioning programs which appears to be similar to other weight-training programs. © 2016 The Author(s).

Injuries in an Extreme Conditioning Program

PubMed Central

Aune, Kyle T.; Powers, Joseph M.

2016-01-01

Background: Extreme conditioning programs (ECPs) are fitness training regimens relying on aerobic, plyometric, and resistance training exercises, often with high levels of intensity for a short duration of time. These programs have grown rapidly in popularity in recent years, but science describing the safety profile of these programs is lacking. Hypothesis: The rate of injury in the extreme conditioning program is greater than the injury rate of weightlifting and the majority of injuries occur to the shoulder and back. Study Design: Cross-sectional study. Level of Evidence: Level 4. Methods: This is a retrospective survey of injuries reported by athletes participating in an ECP. An injury survey was sent to 1100 members of Iron Tribe Fitness, a gym franchise with 5 locations across Birmingham, Alabama, that employs exercises consistent with an ECP in this study. An injury was defined as a physical condition resulting from ECP participation that caused the athlete to either seek medical treatment, take time off from exercising, or make modifications to his or her technique to continue. Results: A total of 247 athletes (22%) completed the survey. The majority (57%) of athletes were male (n = 139), and 94% of athletes were white (n = 227). The mean age of athletes was 38.9 years (±8.9 years). Athletes reported participation in the ECP for, on average, 3.6 hours per week (± 1.2 hours). Eighty-five athletes (34%) reported that they had sustained an injury while participating in the ECP. A total of 132 injuries were recorded, yielding an estimated incidence of 2.71 per 1000 hours. The shoulder or upper arm was the most commonly injured body site, accounting for 38 injuries (15% of athletes). Athletes with a previous shoulder injury were 8.1 times as likely to injure their shoulder in the ECP compared with athletes with healthy shoulders. The trunk, back, head, or neck (n = 29, 12%) and the leg or knee (n = 29, 12%) were the second most commonly injured sites. The injury incidence rate among athletes with <6 months of experience in the ECP was 2.5 times greater than that of more experienced athletes (≥6 months of experience). Of the 132 injuries, 23 (17%) required surgical intervention. Squat cleans, ring dips, overhead squats, and push presses were more likely to cause injury. Athletes reported that 35% of injuries were due to overexertion and 20% were due to improper technique. Conclusion: The estimated injury rate among athletes participating in this ECP was similar to the rate of injury in weightlifting and most other recreational activities. The shoulder or upper arm was the most commonly injured area, and previous shoulder injury predisposed to new shoulder injury. New athletes are at considerable risk of injury compared with more experienced athletes. Clinical Relevance: Extreme conditioning programs are growing in popularity, and there is disagreement between science and anecdotal reports from athletes, coaches, and physicians about their relative safety. This study estimates the incidence of injury in extreme conditioning programs, which appears to be similar to other weight-training programs. PMID:27760844

Scapular resting position, shoulder pain and function in disabled athletes.

PubMed

Aytar, Aydan; Zeybek, Aslican; Pekyavas, Nihan Ozunlu; Tigli, Ayca Aytar; Ergun, Nevin

2015-10-01

Despite the fact that the number of disabled individuals participating in sports is increasing, there are only sparse reports in the literature concerning overuse injuries. The purpose of this study was to compare scapular resting position, shoulder pain, and function in wheelchair basketball, amputee soccer, and disabled table tennis players. Descriptive study. A total of 63 disabled players from amputee soccer, wheelchair basketball, and disabled table tennis participated in our study. Scapular resting position was taken as primary outcome; pain and function were taken as secondary outcome measurements. Scapular resting position was evaluated with Lateral Scapular Slide Test. Visual Analog Scale was used for evaluating shoulder pain intensity. Quick disabilities of the arm, shoulder, and hand questionnaire were used to assess upper extremity function. There was a significant difference in shoulder pain, function, and scapular resting position in all groups (p < 0.05). Paired comparisons between amputee soccer and wheelchair basketball players and also amputee soccer and disabled table tennis showed difference for all measurement parameters (p < 0.05). When the results are evaluated, it may be stated that amputee soccer players have better scapular resting position than other sports. Crutch usage may not negatively affect scapular resting position and perceived function as much as wheelchair usage. Exercise techniques for shoulder and resting position could be included in training programs of disabled athletes. Wheelchair/crutch usage is a risk, and special exercise techniques for shoulder and dyskinesis could be included in training programs to prevent injury. However, it may not just be important for wheelchair athletes, it may also be important for amputee soccer players. In particular, total upper extremity evaluations and exercises could be added within exercise programs. © The International Society for Prosthetics and Orthotics 2014.

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

PubMed

Kim, TaeHoon; Kim, SeongSik; Lee, ByoungHee

2016-03-01

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

Core stability training: applications to sports conditioning programs.

PubMed

Willardson, Jeffrey M

2007-08-01

In recent years, fitness practitioners have increasingly recommended core stability exercises in sports conditioning programs. Greater core stability may benefit sports performance by providing a foundation for greater force production in the upper and lower extremities. Traditional resistance exercises have been modified to emphasize core stability. Such modifications have included performing exercises on unstable rather than stable surfaces, performing exercises while standing rather than seated, performing exercises with free weights rather than machines, and performing exercises unilaterally rather than bilaterally. Despite the popularity of core stability training, relatively little scientific research has been conducted to demonstrate the benefits for healthy athletes. Therefore, the purpose of this review was to critically examine core stability training and other issues related to this topic to determine useful applications for sports conditioning programs. Based on the current literature, prescription of core stability exercises should vary based on the phase of training and the health status of the athlete. During preseason and in-season mesocycles, free weight exercises performed while standing on a stable surface are recommended for increases in core strength and power. Free weight exercises performed in this manner are specific to the core stability requirements of sports-related skills due to moderate levels of instability and high levels of force production. Conversely, during postseason and off-season mesocycles, Swiss ball exercises involving isometric muscle actions, small loads, and long tension times are recommended for increases in core endurance. Furthermore, balance board and stability disc exercises, performed in conjunction with plyometric exercises, are recommended to improve proprioceptive and reactive capabilities, which may reduce the likelihood of lower extremity injuries.

Exploring the impact of visual and movement based priming on a motor intervention in the acute phase post-stroke in persons with severe hemiparesis of the upper extremity

PubMed Central

Patel, Jigna; Qiu, Qinyin; Yarossi, Mathew; Merians, Alma; Massood, Supriya; Tunik, Eugene; Adamovich, Sergei; Fluet, Gerard

2016-01-01

Purpose Explore the potential benefits of using priming methods prior to an active hand task in the acute phase post-stroke in persons with severe upper extremity hemiparesis. Methods Five individuals were trained using priming techniques including virtual reality (VR) based visual mirror feedback and contralaterally controlled passive movement strategies prior to training with an active pinch force modulation task. Clinical, kinetic, and neurophysiological measurements were taken pre and post the training period. Clinical measures were taken at six months post training. Results The two priming simulations and active training were well tolerated early after stroke. Priming effects were suggested by increased maximal pinch force immediately after visual and movement based priming. Despite having no clinically observable movement distally, the subjects were able to volitionally coordinate isometric force and muscle activity (EMG) in a pinch tracing task. The Root Mean Square Error (RMSE) of force during the pinch trace task gradually decreased over the training period suggesting learning may have occurred. Changes in motor cortical neurophysiology were seen in the unaffected hemisphere using Transcranial Magnetic Stimulation (TMS) mapping. Significant improvements in motor recovery as measured by the Action Research Arm Test (ARAT) and the Upper Extremity Fugl Meyer Assessment (UEFMA) were demonstrated at six months post training by three of the five subjects. Conclusion This study suggests that an early hand-based intervention using visual and movement based priming activities and a scaled motor task allows participation by persons without the motor control required for traditionally presented rehabilitation and testing. PMID:27636200

Treatment for the service member: a description of innovative interventions.

PubMed

Yancosek, Katie; Daugherty, Stephanie E; Cancio, Leonard

2008-01-01

This article describes advances to the rehabilitation programs at major military medical centers since the onset of operations in Iraq and Afghanistan. The demands on military health care in times of war produce advances in the various rehabilitation professions. This article describes two programs that use new technologies for the care of military patients with devastating injuries to the upper extremity. One project relates to the application of voice-sensitive technology. The other project describes the utilization of virtual reality technology through a Firearm Training System. The article also explains an adaptive sports program and how recreation is part of a robust community reintegration program. Lastly, this article discusses the Center for the Intrepid, which is one of two new amputee care centers built to support the advanced rehabilitation of war-wounded amputees.

[Remote intelligent Brunnstrom assessment system for upper limb rehabilitation for post-stroke based on extreme learning machine].

PubMed

Wang, Yue; Yu, Lei; Fu, Jianming; Fang, Qiang

2014-04-01

In order to realize an individualized and specialized rehabilitation assessment of remoteness and intelligence, we set up a remote intelligent assessment system of upper limb movement function of post-stroke patients during rehabilitation. By using the remote rehabilitation training sensors and client data sampling software, we collected and uploaded the gesture data from a patient's forearm and upper arm during rehabilitation training to database of the server. Then a remote intelligent assessment system, which had been developed based on the extreme learning machine (ELM) algorithm and Brunnstrom stage assessment standard, was used to evaluate the gesture data. To evaluate the reliability of the proposed method, a group of 23 stroke patients, whose upper limb movement functions were in different recovery stages, and 4 healthy people, whose upper limb movement functions were normal, were recruited to finish the same training task. The results showed that, compared to that of the experienced rehabilitation expert who used the Brunnstrom stage standard table, the accuracy of the proposed remote Brunnstrom intelligent assessment system can reach a higher level, as 92.1%. The practical effects of surgery have proved that the proposed system could realize the intelligent assessment of upper limb movement function of post-stroke patients remotely, and it could also make the rehabilitation of the post-stroke patients at home or in a community care center possible.

Body composition influenced by progressive elastic band resistance exercise of sarcopenic obesity elderly women: a pilot randomized controlled trial.

PubMed

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.

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

PubMed Central

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

2012-01-01

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

Upper extremity sensory feedback therapy in chronic cerebrovascular accident patients with impaired expressive aphasia and auditory comprehension.

PubMed

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.

Incidence and prevalence of complaints of the neck and upper extremity in general practice

PubMed Central

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

A sensorimotor stimulation program for rehabilitation of chronic stroke patients.

PubMed

de Diego, Cristina; Puig, Silvia; Navarro, Xavier

2013-01-01

The hypothesis of this study is that intensive therapy by means of a sensory and motor stimulation program of the upper limb in patients with chronic hemiparesis and severe disability due to stroke increases mobility and sensibility, and improves the use of the affected limb in activities of daily living (ADL). The program consists of 16 sessions of sensory stimulation and functional activity training in the rehabilitation center, and daily sessions of tactile stimulation, mental imaginery and practice of ADL at home, during 8 weeks. An experimental group (EG) of 12 patients followed this program, compared with a control group (CG) of 9 patients under standard rehabilitation. The efficacy of the program was evaluated by Fugl Meyer Assessment (FMA), Motor Activity Log (MAL) and Stroke Impact Scale-16 (SIS-16) scores, and a battery of sensory tests. The results show that in both groups, the motor FMA and the SIS-16 improved during the 8 weeks, this improvement being higher in the EG. Significant improvements were observed for the sensory tests in the EG. The intensive sensorimotor stimulation program for the upper extremity may be an efficacious method for improving function and use of the affected limb in ADL in chronic stroke patients.

Effects of strength training on body composition, physical functioning, and quality of life in prostate cancer patients during androgen deprivation therapy.

PubMed

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.

Virtual reality for upper extremity rehabilitation in early stroke: a pilot randomized controlled trial.

PubMed

Yin, Chan Wai; Sien, Ng Yee; Ying, Low Ai; Chung, Stephanie Fook-Chong Man; Tan May Leng, Dawn

2014-11-01

To investigate the effect of virtual reality (VR) rehabilitation on upper extremity motor performance of patients with early stroke. Pilot randomized controlled trial. Rehabilitation wards. Twenty three adults with stroke (mean age (SD) = 58.35 (13.45) years and mean time since stroke (SD) = 16.30 (7.44) days). Participants were randomly assigned to VR group (n=11) or control group (n=12). VR group received nine 30 minutes upper extremity VR therapy in standing (five weekdays in two weeks) plus conventional therapy, which included physical and occupational therapy. Control group received only conventional therapy, which was comparable to total training time received by VR group (mean training hours (SD):VR = 17.07 (2.86); control = 15.50 (2.79)). The main outcome measure was the Fugl-Meyer Assessment (FMA). Secondary outcomes included Action Research Arm Test, Motor Activity Log and Functional Independence Measure. Results were taken at baseline, post intervention and 1-month post intervention. Participants' feedback and adverse effects were recorded. All participants improved in FMA scores (mean change (SD) = 11.65 (8.56), P<.001). These effects were sustained at one month after intervention (mean (SD) change from baseline = 18.67 (13.26), P<.001). All other outcome measures showed similar patterns. There were no significant differences in improvement between both groups. Majority of the participants found VR training useful and enjoyable, with no serious adverse effects reported. Although additional VR training was not superior to conventional therapy alone, this study demonstrates the feasibility of VR training in early stroke. © The Author(s) 2014.

Transfer of training between distinct motor tasks after stroke: implications for task-specific approaches to upper-extremity neurorehabilitation.

PubMed

Schaefer, Sydney Y; Patterson, Chavelle B; Lang, Catherine E

2013-09-01

Although task-specific training is emerging as a viable approach for recovering motor function after stroke, there is little evidence for whether the effects of such training transfer to other functional motor tasks not directly practiced in therapy. The purpose of the current study was to test whether training on one motor task in individuals with chronic hemiparesis poststroke would transfer to untrained tasks that were either spatiotemporally similar or different. In all, 11 participants with chronic mild to moderate hemiparesis following stroke completed 5 days of supervised massed practice of a feeding task with their affected side. Performance on the feeding task, along with 2 other untrained functional upper-extremity motor tasks (sorting, dressing) was assessed before and after training. Performance of all 3 tasks improved significantly after training exclusively on 1 motor task. The amount of improvement in the untrained tasks was comparable and was not dependent on the degree of similarity to the trained task. Because the number and type of tasks that can be practiced are often limited within standard stroke rehabilitation, results from this study will be useful for designing task-specific training plans to maximize therapy benefits.

Transfer of Motor Learning Is More Pronounced in Proximal Compared to Distal Effectors in Upper Extremities

PubMed Central

Aune, Tore K.; Aune, Morten A.; Ingvaldsen, Rolf P.; Vereijken, Beatrix

2017-01-01

The current experiment investigated generalizability of motor learning in proximal versus distal effectors in upper extremities. Twenty-eight participants were divided into three groups: training proximal effectors, training distal effectors, and no training control group (CG). Performance was tested pre- and post-training for specific learning and three learning transfer conditions: (1) bilateral learning transfer between homologous effectors, (2) lateral learning transfer between non-homologous effectors, and (3) bilateral learning transfer between non-homologous effectors. With respect to specific learning, both training groups showed significant, similar improvement for the trained proximal and distal effectors, respectively. In addition, there was significant learning transfer to all three transfer conditions, except for bilateral learning transfer between non-homologous effectors for the distal training group. Interestingly, the proximal training group showed significantly larger learning transfer to other effectors compared to the distal training group. The CG did not show significant improvements from pre- to post-test. These results show that learning is partly effector independent and generalizable to different effectors, even though transfer is suboptimal compared to specific learning. Furthermore, there is a proximal-distal gradient in generalizability, in that learning transfer from trained proximal effectors is larger than from trained distal effectors, which is consistent with neuroanatomical differences in activation of proximal and distal muscles. PMID:28943857

Web Based Information System for Job Training Activities Using Personal Extreme Programming (PXP)

NASA Astrophysics Data System (ADS)

Asri, S. A.; Sunaya, I. G. A. M.; Rudiastari, E.; Setiawan, W.

2018-01-01

Job training is one of the subjects in university or polytechnic that involves many users and reporting activities. Time and distance became problems for users to reporting and to do obligations tasks during job training due to the location where the job training took place. This research tried to develop a web based information system of job training to overcome the problems. This system was developed using Personal Extreme Programming (PXP). PXP is one of the agile methods is combination of Extreme Programming (XP) and Personal Software Process (PSP). The information system that has developed and tested which are 24% of users are strongly agree, 74% are agree, 1% disagree and 0% strongly disagree about system functionality.

Development of rehabilitation training support system for occupational therapy of upper limb motor function

NASA Astrophysics Data System (ADS)

Morita, Yoshifumi; Hirose, Akinori; Uno, Takashi; Uchid, Masaki; Ukai, Hiroyuki; Matsui, Nobuyuki

2007-12-01

In this paper we propose a new rehabilitation training support system for upper limbs. The proposed system enables therapists to quantitatively evaluate the therapeutic effect of upper limb motor function during training, to easily change the load of resistance of training and to easily develop a new training program suitable for the subjects. For this purpose we develop control algorithms of training programs in the 3D force display robot. The 3D force display robot has parallel link mechanism with three motors. The control algorithm simulating sanding training is developed for the 3D force display robot. Moreover the teaching/training function algorithm is developed. It enables the therapists to easily make training trajectory suitable for subject's condition. The effectiveness of the developed control algorithms is verified by experiments.

Retrospective Analysis of an Ongoing Group-Based Modified Constraint-Induced Movement Therapy Program for Children with Acquired Brain Injury.

PubMed

Komar, Alyssa; Ashley, Kelsey; Hanna, Kelly; Lavallee, Julia; Woodhouse, Janet; Bernstein, Janet; Andres, Matthew; Reed, Nick

2016-01-01

A pretest-posttest retrospective design was used to evaluate the impact of a group-based modified constraint-induced movement therapy (mCIMT) program on upper extremity function and occupational performance. 20 children ages 3 to 18 years with hemiplegia following an acquired brain injury participated in a 2-week group mCIMT program. Upper extremity function was measured with the Assisting Hand Assessment (AHA) and subtests from the Quality of Upper Extremity Skills Test (QUEST). Occupational performance and satisfaction were assessed using the Canadian Occupational Performance Measure (COPM). Data were analyzed using a Wilcoxon signed-ranks test. Group-based analysis revealed upper extremity function and occupational performance attained statistically significant improvements from pre- to postintervention on all outcome measures (AHA: Z = -3.63, p = <.001; QUEST Grasps: Z = -3.10, p = .002; QUEST Dissociated Movement: Z = -2.51, p = .012; COPM Performance: Z = -3.64, p = <.001; COPM Satisfaction: Z = -3.64, p = <.001). Across individuals, clinically significant improvements were found in 65% of participants' AHA scores. 80% of COPM Performance scores and 70% of COPM Satisfaction scores demonstrated clinically significant improvements in at least one identified goal. This study is an initial step in evaluating and providing preliminary evidence supporting the effectiveness of a group-based mCIMT program for children with hemiplegia following an acquired brain injury.

Maintenance of exercise training benefits is associated with adequate milk and dairy products intake in elderly hypertensive subjects following detraining.

PubMed

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.

Home-based nerve stimulation to enhance effects of motor training in patients in the chronic phase after stroke: a proof-of-principle study.

PubMed

Dos Santos-Fontes, Renata Laurenti; Ferreiro de Andrade, Karina Nocelo; Sterr, Annette; Conforto, Adriana Bastos

2013-01-01

Somatosensory stimulation in the form of repetitive peripheral nerve stimulation (RPSS) is a promising strategy to improve motor function of the upper limb in chronic stroke. Home-based RPSS may be an alternative to hospital-based RPSS. To investigate the feasibility and safety of an innovative program of home-based RPSS combined with motor training and to collect preliminary data on the efficacy of this program to enhance hand motor function in patients in the chronic phase after stroke. Twenty patients were randomized to either active or sham RPSS associated with daily motor training performed at home over 4 consecutive weeks. All the patients were able to perform tasks of the Jebsen-Taylor Test (JTT). The primary outcome measures were feasibility, evaluated by self-reported compliance with the intervention, and safety (adverse events). Secondary outcomes comprised improvements in hand function in the JTT after end of treatment and after a 4-month follow-up period. There were no relevant adverse events. Compliance with RPSS and motor training was significantly greater in the active group than in the sham group. Upper extremity performance improved significantly more in the active group compared with the sham group at the end of treatment. This difference remained significant 4 months later, even when differences in compliance with motor training were considered. Home-based active RPSS associated with motor training was feasible, was safe, and led to long-lasting enhancement of paretic arm performance in the chronic phase after stroke for those who can perform the JTT. These results point to the need for an efficacy trial.

Electromyography-controlled exoskeletal upper-limb-powered orthosis for exercise training after stroke.

PubMed

Stein, Joel; Narendran, Kailas; McBean, John; Krebs, Kathryn; Hughes, Richard

2007-04-01

Robot-assisted exercise shows promise as a means of providing exercise therapy for weakness that results from stroke or other neurological conditions. Exoskeletal or "wearable" robots can, in principle, provide therapeutic exercise and/or function as powered orthoses to help compensate for chronic weakness. We describe a novel electromyography (EMG)-controlled exoskeletal robotic brace for the elbow (the active joint brace) and the results of a pilot study conducted using this brace for exercise training in individuals with chronic hemiparesis after stroke. Eight stroke survivors with severe chronic hemiparesis were enrolled in this pilot study. One subject withdrew from the study because of scheduling conflicts. A second subject was unable to participate in the training protocol because of insufficient surface EMG activity to control the active joint brace. The six remaining subjects each underwent 18 hrs of exercise training using the device for a period of 6 wks. Outcome measures included the upper-extremity component of the Fugl-Meyer scale and the modified Ashworth scale of muscle hypertonicity. Analysis revealed that the mean upper-extremity component of the Fugl-Meyer scale increased from 15.5 (SD 3.88) to 19 (SD 3.95) (P = 0.04) at the conclusion of training for the six subjects who completed training. Combined (summated) modified Ashworth scale for the elbow flexors and extensors improved from 4.67 (+/-1.2 SD) to 2.33 (+/-0.653 SD) (P = 0.009) and improved for the entire upper limb as well. All subjects tolerated the device, and no complications occurred. EMG-controlled powered elbow orthoses can be successfully controlled by severely impaired hemiparetic stroke survivors. This technique shows promise as a new modality for assisted exercise training after stroke.

Shoulder Muscle Activation of Novice and Resistance Trained Women during Variations of Dumbbell Press Exercises

PubMed Central

Luczak, Joshua; Bosak, Andy; Riemann, Bryan L.

2013-01-01

Previous research has compared the effects of trunk inclination angle on muscle activation using barbells and Smith machines in men. Whether similar effects occur with the use of dumbbells or in women remains unknown. The purpose was to compare upper extremity surface electromyographical (EMG) activity between dumbbell bench, incline, and shoulder presses. Dominate arm EMG data were recorded for collegiate-aged female resistance trained individuals (n = 12) and novice female resistance trained exercisers (n = 12) from which average EMG amplitude for each repetition phase (concentric, eccentric) was computed. No significant differences were found between experienced and novice resistance trained individuals. For the upper trapezius and anterior deltoid muscles, shoulder press activation was significantly greater than incline press which in turn was significantly greater than bench press across both phases. The bench and incline presses promoted significantly greater pectoralis major sternal activation compared to the shoulder press (both phases). While pectoralis major clavicular activation during the incline press eccentric phase was significantly greater than both the bench and shoulder presses, activation during the bench press concentric phase promoted significantly greater activation than the incline press which in turn was significantly greater than the shoulder press. These results provide evidence for selecting exercises in resistance and rehabilitation programs. PMID:26464884

Training Persons with Spinal Cord Injury to Ambulate Using a Powered Exoskeleton

PubMed Central

Asselin, Pierre K.; Avedissian, Manuel; Knezevic, Steven; Kornfeld, Stephen; Spungen, Ann M.

2016-01-01

Powered exoskeletons have become available for overground ambulation in persons with paralyses due to spinal cord injury (SCI) who have intact upper extremity function and are able to maintain upright balance using forearm crutches. To ambulate in an exoskeleton, the user must acquire the ability to maintain balance while standing, sitting and appropriate weight shifting with each step. This can be a challenging task for those with deficits in sensation and proprioception in their lower extremities. This manuscript describes screening criteria and a training program developed at the James J. Peters VA Medical Center, Bronx, NY to teach users the skills needed to utilize these devices in institutional, home or community environments. Before training can begin, potential users are screened for appropriate range of motion of the hip, knee and ankle joints. Persons with SCI are at an increased risk of sustaining lower extremity fractures, even with minimal strain or trauma, therefore a bone mineral density assessment is performed to reduce the risk of fracture. Also, as part of screening, a physical examination is performed in order to identify additional health-related contraindications. Once the person has successfully passed all screening requirements, they are cleared to begin the training program. The device is properly adjusted to fit the user. A series of static and dynamic balance tasks are taught and performed by the user before learning to walk. The person is taught to ambulate in various environments ranging from indoor level surfaces to outdoors over uneven or changing surfaces. Once skilled enough to be a candidate for home use with the exoskeleton, the user is then required to designate a companion-walker who will train alongside them. Together, the pair must demonstrate the ability to perform various advanced tasks in order to be permitted to use the exoskeleton in their home/community environment. PMID:27340808

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

PubMed Central

2013-01-01

Background Repetitive task practice is argued to drive neural plasticity following stroke. However, current evidence reveals that hemiparetic weakness impairs the capacity to perform, and practice, movements appropriately. Here we investigated how power training (i.e., high-intensity, dynamic resistance training) affects recovery of upper-extremity motor function post-stroke. We hypothesized that power training, as a component of upper-extremity rehabilitation, would promote greater functional gains than functional task practice without deleterious consequences. Method Nineteen chronic hemiparetic individuals were studied using a crossover design. All participants received both functional task practice (FTP) and HYBRID (combined FTP and power training) in random order. Blinded evaluations performed at baseline, following each intervention block and 6-months post-intervention included: Wolf Motor Function Test (WMFT-FAS, Primary Outcome), upper-extremity Fugl-Meyer Motor Assessment, Ashworth Scale, and Functional Independence Measure. Neuromechanical function was evaluated using isometric and dynamic joint torques and concurrent agonist EMG. Biceps stretch reflex responses were evaluated using passive elbow stretches ranging from 60 to 180º/s and determining: EMG onset position threshold, burst duration, burst intensity and passive torque at each speed. Results Primary outcome: Improvements in WMFT-FAS were significantly greater following HYBRID vs. FTP (p = .049), regardless of treatment order. These functional improvements were retained 6-months post-intervention (p = .03). Secondary outcomes: A greater proportion of participants achieved minimally important differences (MID) following HYBRID vs. FTP (p = .03). MIDs were retained 6-months post-intervention. Ashworth scores were unchanged (p > .05). Increased maximal isometric joint torque, agonist EMG and peak power were significantly greater following HYBRID vs. FTP (p < .05) and effects were retained 6-months post-intervention (p’s < .05). EMG position threshold and burst duration were significantly reduced at fast speeds (≥120º/s) (p’s < 0.05) and passive torque was reduced post-washout (p < .05) following HYBRID. Conclusions Functional and neuromechanical gains were greater following HYBRID vs. FPT. Improved stretch reflex modulation and increased neuromuscular activation indicate potent neural adaptations. Importantly, no deleterious consequences, including exacerbation of spasticity or musculoskeletal complaints, were associated with HYBRID. These results contribute to an evolving body of contemporary evidence regarding the efficacy of high-intensity training in neurorehabilitation and the physiological mechanisms that mediate neural recovery. PMID:23336711

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

PubMed

Patten, Carolynn; Condliffe, Elizabeth G; Dairaghi, Christine A; Lum, Peter S

2013-01-21

Repetitive task practice is argued to drive neural plasticity following stroke. However, current evidence reveals that hemiparetic weakness impairs the capacity to perform, and practice, movements appropriately. Here we investigated how power training (i.e., high-intensity, dynamic resistance training) affects recovery of upper-extremity motor function post-stroke. We hypothesized that power training, as a component of upper-extremity rehabilitation, would promote greater functional gains than functional task practice without deleterious consequences. Nineteen chronic hemiparetic individuals were studied using a crossover design. All participants received both functional task practice (FTP) and HYBRID (combined FTP and power training) in random order. Blinded evaluations performed at baseline, following each intervention block and 6-months post-intervention included: Wolf Motor Function Test (WMFT-FAS, Primary Outcome), upper-extremity Fugl-Meyer Motor Assessment, Ashworth Scale, and Functional Independence Measure. Neuromechanical function was evaluated using isometric and dynamic joint torques and concurrent agonist EMG. Biceps stretch reflex responses were evaluated using passive elbow stretches ranging from 60 to 180º/s and determining: EMG onset position threshold, burst duration, burst intensity and passive torque at each speed. Improvements in WMFT-FAS were significantly greater following HYBRID vs. FTP (p = .049), regardless of treatment order. These functional improvements were retained 6-months post-intervention (p = .03). A greater proportion of participants achieved minimally important differences (MID) following HYBRID vs. FTP (p = .03). MIDs were retained 6-months post-intervention. Ashworth scores were unchanged (p > .05). Increased maximal isometric joint torque, agonist EMG and peak power were significantly greater following HYBRID vs. FTP (p < .05) and effects were retained 6-months post-intervention (p's < .05). EMG position threshold and burst duration were significantly reduced at fast speeds (≥120º/s) (p's < 0.05) and passive torque was reduced post-washout (p < .05) following HYBRID. Functional and neuromechanical gains were greater following HYBRID vs. FPT. Improved stretch reflex modulation and increased neuromuscular activation indicate potent neural adaptations. Importantly, no deleterious consequences, including exacerbation of spasticity or musculoskeletal complaints, were associated with HYBRID. These results contribute to an evolving body of contemporary evidence regarding the efficacy of high-intensity training in neurorehabilitation and the physiological mechanisms that mediate neural recovery.

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

PubMed Central

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

2016-01-01

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

Learning in a Virtual Environment Using Haptic Systems for Movement Re-Education: Can This Medium Be Used for Remodeling Other Behaviors and Actions?

PubMed Central

Merians, Alma S; Fluet, Gerard G; Qiu, Qinyin; Lafond, Ian; Adamovich, Sergei V

2011-01-01

Robotic systems that are interfaced with virtual reality gaming and task simulations are increasingly being developed to provide repetitive intensive practice to promote increased compliance and facilitate better outcomes in rehabilitation post-stroke. A major development in the use of virtual environments (VEs) has been to incorporate tactile information and interaction forces into what was previously an essentially visual experience. Robots of varying complexity are being interfaced with more traditional virtual presentations to provide haptic feedback that enriches the sensory experience and adds physical task parameters. This provides forces that produce biomechanical and neuromuscular interactions with the VE that approximate real-world movement more accurately than visual-only VEs, simulating the weight and force found in upper extremity tasks. The purpose of this article is to present an overview of several systems that are commercially available for ambulation training and for training movement of the upper extremity. We will also report on the system that we have developed (NJIT-RAVR system) that incorporates motivating and challenging haptic feedback effects into VE simulations to facilitate motor recovery of the upper extremity post-stroke. The NJIT-RAVR system trains both the upper arm and the hand. The robotic arm acts as an interface between the participants and the VEs, enabling multiplanar movements against gravity in a three-dimensional workspace. The ultimate question is whether this medium can provide a motivating, challenging, gaming experience with dramatically decreased physical difficulty levels, which would allow for participation by an obese person and facilitate greater adherence to exercise regimes. PMID:21527097

Gravity compensation of an upper extremity exoskeleton.

PubMed

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

2010-01-01

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

Task-oriented rehabilitation robotics.

PubMed

Schweighofer, Nicolas; Choi, Younggeun; Winstein, Carolee; Gordon, James

2012-11-01

Task-oriented training is emerging as the dominant and most effective approach to motor rehabilitation of upper extremity function after stroke. Here, the authors propose that the task-oriented training framework provides an evidence-based blueprint for the design of task-oriented robots for the rehabilitation of upper extremity function in the form of three design principles: skill acquisition of functional tasks, active participation training, and individualized adaptive training. The previous robotic systems that incorporate elements of task-oriented trainings are then reviewed. Finally, the authors critically analyze their own attempt to design and test the feasibility of a TOR robot, ADAPT (Adaptive and Automatic Presentation of Tasks), which incorporates the three design principles. Because of its task-oriented training-based design, ADAPT departs from most other current rehabilitation robotic systems: it presents realistic functional tasks in which the task goal is constantly adapted, so that the individual actively performs doable but challenging tasks without physical assistance. To maximize efficacy for a large clinical population, the authors propose that future task-oriented robots need to incorporate yet-to-be developed adaptive task presentation algorithms that emphasize acquisition of fine motor coordination skills while minimizing compensatory movements.

Developing Home-Based Virtual Reality Therapy Interventions.

PubMed

Lin, Janice; Kelleher, Caitlin L; Engsberg, Jack R

2013-02-01

Stroke is one of the leading causes of serious long-term disability. However, home exercise programs given at rehabilitation often lack in motivational aspects. The purposes of this pilot study were (1) create individualized virtual reality (VR) games and (2) determine the effectiveness of VR games for improving movement in upper extremities in a 6-week home therapy intervention for persons with stroke. Participants were two individuals with upper extremity hemiparesis following a stroke. VR games were created using the Looking Glass programming language and modified based on personal interests, goals, and abilities. Participants were asked to play 1 hour each day for 6 weeks. Assessments measured upper extremity movement (range of motion and Action Research Arm Test [ARAT]) and performance in functional skills (Canadian Occupational Performance Measure [COPM] and Motor Activity Log [MAL]). Three VR games were created by a supervised occupational therapist student. The participants played approximately four to six times a week and performed over 100 repetitions of movements each day. Participants showed improvement in upper extremity movement and participation in functional tasks based on results from the COPM, ARAT, and MAL. Further development in the programming environment is needed to be plausible in a rehabilitation setting. Suggestions include graded-level support and continuation of creating a natural programming language, which will increase the ability to use the program in a rehabilitation setting. However, the VR games were shown to be effective as a home therapy intervention for persons with stroke. VR has the potential to advance therapy services by creating a more motivating home-based therapy service.

Improved Training Program for Fall Prevention of Warfighters with Lower Extremity Trauma

DTIC Science & Technology

2016-10-01

productive, active civilian life. The training program utilizes a microprocessor -controlled treadmill designed to deliver task- specific training...National Military Medical Center (WRNMMC), and Mayo. The fall prevention training program utilizes a microprocessor -controlled treadmill to deliver

Transfer of training between distinct motor tasks after stroke: Implications for task- specific approaches to upper extremity neurorehabilitation

PubMed Central

Schaefer, Sydney Y.; Patterson, Chavelle B.; Lang, Catherine E.

2013-01-01

Background Although task-specific training is emerging as a viable approach for recovering motor function after stroke, there is little evidence for whether the effects of such training transfer to other functional motor tasks not directly practiced in therapy. Objective The purpose of the current study was to test whether training on one motor task would transfer to untrained tasks that were either spatiotemporally similar or different in individuals with chronic hemiparesis post-stroke. Methods Eleven participants with chronic mild-to-moderate hemiparesis following stroke completed five days of supervised massed practice of a feeding task with their affected side. Performance on the feeding task, along with two other untrained functional upper extremity motor tasks (sorting, dressing) was assessed before and after training. Results Performance of all three tasks improved significantly after training exclusively on one motor task. The amount of improvement in the untrained tasks was comparable, and was not dependent on the degree of similarity to the trained task. Conclusions Because the number and type of tasks that can be practiced are often limited within standard stroke rehabilitation, results from this study will be useful for designing task-specific training plans to maximize therapy benefits. PMID:23549521

Upper extremities flexibility comparisons of collegiate "soft" martial art practitioners with other athletes.

PubMed

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.

Injury Surveillance Among NASA Astronauts Using the Barell Injury Diagnosis Matrix

NASA Technical Reports Server (NTRS)

Murray, J. D.; Laughlin, M. S.; Eudy, D. L.; Wear, M. L.; VanBaalen, M. G.

2014-01-01

Astronauts perform physically demanding tasks and risk incurring musculoskeletal injuries during both groundbased training and missions. Increased injury rates throughout the history of the U.S. space program have been attributed to numerous factors, including an aging astronaut corps, increased Weightless Environment Training Facility (WETF) and Neutral Buoyancy Laboratory (NBL) training to construct the International Space Station, and improved clinical operations that promote injury prevention and reporting. With NASA program changes through the years (including retirement of the Shuttle program) and an improved training environment (including a new astronaut gym), there is no surveillance program to systematically track injury rates. A limited number of research projects have been conducted over the past 20 years to evaluate musculoskeletal injuries: (1) to evaluate orthopedic injuries from 1987 to 1995, (2) to describe upper extremity injuries, (3) to evaluate EVA spacesuit training related injuries, and (4) to evaluate in-flight musculoskeletal injuries. Nevertheless, there has been no consistently performed comprehensive assessment of musculoskeletal injuries among astronauts. The Barell Injury Diagnosis Matrix was introduced at the 2001 meeting of the International Collaborative Effort (ICE) on Injury Statistics. The Matrix proposes a standardized method of classifying body region by nature of injury. Diagnoses are coded using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) coding system. The purpose of this study is to assess the usefulness and complexity of the Barell Injury Diagnosis Matrix to classify and track musculoskeletal injuries among NASA astronauts.

Effects of exercise training using resistance bands on glycaemic control and strength in type 2 diabetes mellitus: a meta-analysis of randomised controlled trials.

PubMed

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.

Anterior glenohumeral laxity and stiffness after a shoulder-strengthening program in collegiate cheerleaders.

PubMed

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.

Use of multiple-site performance-contingent SEMG reward programming in pediatric rehabilitation: a retrospective review.

PubMed

Bolek, Jeffrey E

2006-09-01

We completed a retrospective review of the effectiveness of multi-site, performance-contingent reward programming on functional change in motor performance of 16 treatment resistant children. Patients were previously treated in physical or occupational therapy for head control, standing balance training, sitting and upper extremity use (brachial plexus injury). They then participated in a program that utilized multiple surface electromyography sites the use of which was rewarded with videos for performing the correct constellation of recruitment pattern (e.g., contracting some muscles while relaxing others). Onset of reward was calibrated for each patient and transfer of skill to outside the clinic was encouraged by linking a verbal cue to the correct motor plan. Fourteen of the 16 patients improved. The implications of the use of this technique in the treatment of motor dysfunction is discussed.

A treatment for a chronic stroke patient with a plegic hand combining CI therapy with conventional rehabilitation procedures: case report.

PubMed

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.

A randomized trial of training the non-dominant upper extremity to enhance laparoscopic performance.

PubMed

Nieboer, Theodoor E; Sari, Vicdan; Kluivers, Kirsten B; Weinans, Martin J N; Vierhout, Mark E; Stegeman, Dick F

2012-07-01

In laparoscopy, the surgeon's dominant arm will execute difficult tasks with less effort compared to the non-dominant arm. This leads to a relative overuse of muscles on this side. We hypothesized that training the non-dominant arm would improve laparoscopic skills. At baseline, all participants performed three validated tasks on a virtual reality simulator. After randomization, subjects in the intervention group were assigned training tasks. All these tasks had to be performed with the non-dominant hand. Within a week after a three-week study period, participants performed the same three tasks as before. Twenty-six participants were included, 13 in each group. At baseline, there were no differences between groups on all tested parameters. Compliance to training tasks was good. At the end of three weeks, subjects in both groups showed similar improvement of skills on the non-dominant side. On the dominant side, however, subjects in the training group showed significant better improvement of skills on four out of eight parameters. Specific training of the non-dominant upper extremity appears to lead to improvement of skills on the dominant side, a phenomenon known in literature as intermanual transfer of skill learning. To improve laparoscopic skills, bimanual training is recommended.

''Playstation eyetoy games'' improve upper extremity-related motor functioning in subacute stroke: a randomized controlled clinical trial.

PubMed

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.

Effect of virtual reality-based rehabilitation on upper-extremity function in patients with brain tumor: controlled trial.

PubMed

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.

Inter-rater reliability of PATH observations for assessment of ergonomic risk factors in hospital work.

PubMed

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.

Learning in a virtual environment using haptic systems for movement re-education: can this medium be used for remodeling other behaviors and actions?

PubMed

Merians, Alma S; Fluet, Gerard G; Qiu, Qinyin; Lafond, Ian; Adamovich, Sergei V

2011-03-01

Robotic systems that are interfaced with virtual reality gaming and task simulations are increasingly being developed to provide repetitive intensive practice to promote increased compliance and facilitate better outcomes in rehabilitation post-stroke. A major development in the use of virtual environments (VEs) has been to incorporate tactile information and interaction forces into what was previously an essentially visual experience. Robots of varying complexity are being interfaced with more traditional virtual presentations to provide haptic feedback that enriches the sensory experience and adds physical task parameters. This provides forces that produce biomechanical and neuromuscular interactions with the VE that approximate real-world movement more accurately than visual-only VEs, simulating the weight and force found in upper extremity tasks. The purpose of this article is to present an overview of several systems that are commercially available for ambulation training and for training movement of the upper extremity. We will also report on the system that we have developed (NJIT-RAVR system) that incorporates motivating and challenging haptic feedback effects into VE simulations to facilitate motor recovery of the upper extremity post-stroke. The NJIT-RAVR system trains both the upper arm and the hand. The robotic arm acts as an interface between the participants and the VEs, enabling multiplanar movements against gravity in a three-dimensional workspace. The ultimate question is whether this medium can provide a motivating, challenging, gaming experience with dramatically decreased physical difficulty levels, which would allow for participation by an obese person and facilitate greater adherence to exercise regimes. © 2011 Diabetes Technology Society.

Asymmetric training using virtual reality reflection equipment and the enhancement of upper limb function in stroke patients: a randomized controlled trial.

PubMed

Lee, DongJin; Lee, MyungMo; Lee, KyoungJin; Song, ChangHo

2014-07-01

Asymmetric movements with both hands contributed to the improvement of spatially coupled motion. Thus, the aim of this study was to investigate the effects of an asymmetric training program using virtual reality reflection equipment on upper limb function in stroke patients. Twenty-four stroke patients were randomly allocated to an experimental group (n=12) or a control group (n=12). Both groups participated in conventional physical therapy for 2×30 min/d, 5 d/wk, for 4 weeks. The experimental group also participated in an asymmetric training program using virtual reality reflection equipment, and the control group participated in a symmetric training program. Both asymmetric and symmetric programs were conducted for 30 min/d, 5 d/wk, for 4 weeks. To compare upper limb function before and after intervention, the Fugl-Meyer Assessment (FMA), the Box and Block Test (BBT), grip strength, range of motion (ROM), and spasticity were assessed. Both groups showed significant increases in upper limb function, excepting spasticity, after intervention (P<.05, 1-way repeated-measures analysis of variance [ANOVA]). A significant group-time interaction was demonstrated only for shoulder/elbow/wrist items of FMA, BBT, grip strength, and ROM of wrist flexion, extension, and ulnar deviation (P<.05, 2-way repeated-measures ANOVA). This study confirms that the asymmetric training program using virtual reality reflection equipment is an effective intervention method for improving upper limb function in stroke patients. We consider that an additional study based on a program using virtual reflection, which is more functional than performing simple tasks, and consisting of tasks relevant to the activities of daily living be conducted. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Upper extremity weightlifting injuries: Diagnosis and management.

PubMed

Golshani, Kayvon; Cinque, Mark E; O'Halloran, Peter; Softness, Kenneth; Keeling, Laura; Macdonell, J Ryan

2018-03-01

Common upper extremity injuries in resistance training athletes include muscle strains, ligament sprains, pectoralis major tendon ruptures, distal biceps tendon ruptures, and chronic shoulder pain and capsulolabral injuries. While each injury is unique in its specific anatomic location and mechanism, each is preventable with proper exercise technique, safety and maintenance of muscle balance. Conservative treatment is the therapeutic modality of choice and these injuries generally resolve with workout modification, appropriate recovery, anti-inflammatory medication, and physical therapy. If conservative treatment fails, surgical intervention is often successful and can return the weightlifter to a level of performance near their pre-injury level.

Effect of sensory training of the posterior thigh on trunk control and upper extremity functions in stroke patients.

PubMed

Dogru Huzmeli, Esra; Yildirim, Sibel Aksu; Kilinc, Muhammed

2017-04-01

Some studies show that sensorial rehabilitation is effective on functionality. The aim of this study is to investigate the effect of sensory training of the posterior thigh on the functionality of upper extremity and trunk control in stroke patients. Thirteen subjects (53.23 ± 6.82 years) were included in the intervention group and 13 subjects (58.69 ± 5.94 years) in the control group. The control and intervention groups were treated for ten sessions. The control group was treated only with neurodevelopmental treatment, and the intervention group was treated with sensorial training on the posterior thigh in addition to the neurodevelopmental treatment. Subjects were evaluated three times, pre- and post-treatment and 10 days after finishing the treatment. Trunk control was assessed by the Trunk Impairment Scale, reaching function by the Functional Reach Test, balance by the Berg Balance Test, upper extremity symptom and disability severity by the Disabilities of the Arm, Shoulder, Hand and Minnesota, independence level in daily living activities by the Barthel Index, and sensory function of the posterior thigh by sensorial tests. In the post-treatment assessment, it was found that the intervention group was better than the control group in the parameter of functional reach while sitting (p < 0.005). In the third assessment, reaching while sitting and independence level were better in the intervention group than the control group (p < 0.005). There was no difference in sensorial assessment between the groups. Sensory training of the posterior thigh should be included in the rehabilitation programme of stroke patients.

Effect of functional electrical stimulation with mirror therapy on upper extremity motor function in poststroke patients.

PubMed

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.

Does assist-as-needed upper limb robotic therapy promote participation in repetitive activity-based motor training in sub-acute stroke patients with severe paresis?

PubMed

Grosmaire, Anne-Gaëlle; Duret, Christophe

2017-01-01

Repetitive, active movement-based training promotes brain plasticity and motor recovery after stroke. Robotic therapy provides highly repetitive therapy that reduces motor impairment. However, the effect of assist-as-needed algorithms on patient participation and movement quality is not known. To analyze patient participation and motor performance during highly repetitive assist-as-needed upper limb robotic therapy in a retrospective study. Sixteen patients with sub-acute stroke carried out a 16-session upper limb robotic training program combined with usual care. The Fugl-Meyer Assessment (FMA) score was evaluated pre and post training. Robotic assistance parameters and Performance measures were compared within and across sessions. Robotic assistance did not change within-session and decreased between sessions during the training program. Motor performance did not decrease within-session and improved between sessions. Velocity-related assistance parameters improved more quickly than accuracy-related parameters. An assist-as-needed-based upper limb robotic training provided intense and repetitive rehabilitation and promoted patient participation and motor performance, facilitating motor recovery.

School sports accidents: analysis of causes, modes, and frequencies.

PubMed

Kelm, J; Ahlhelm, F; Pape, D; Pitsch, W; Engel, C

2001-01-01

About 5% of all school children are seriously injured during physical education every year. Because of its influence on children's attitude toward sports and the economic aspects, an evaluation of causes and medical consequences is necessary. In this study, 213 school sports accidents were investigated. Besides diagnosis, the localization of injuries, as well as the duration of the sick leave were documented. Average age of injured students was 13 years. Most of the injured students blamed themselves for the accident. The most common injuries were sprains, contusions, and fractures. Main reasons for the accidents were faults in basic motion training. Playing soccer and basketball were the most frequent reasons for injuries. The upper extremity was more frequently involved than the lower extremity. Sports physicians and teachers should work out a program outlining the individual needs and capabilities of the injured students to reintegrate them into physical education.

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

PubMed Central

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

2010-01-01

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

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.

Effect of mirror therapy on upper extremity motor function in stroke patients: a randomized controlled trial.

PubMed

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.

Effect of mirror therapy on upper extremity motor function in stroke patients: a randomized controlled trial

PubMed Central

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

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

PubMed

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

2015-11-01

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

Dissemination and Implementation Strategies of Lower Extremity Preventive Training Programs in Youth: A Clinical Review.

PubMed

DiStefano, Lindsay J; Frank, Barnett S; Root, Hayley J; Padua, Darin A

Neuromuscular preventive training programs effectively reduce injury and improve performance in youth athletes. However, program effectiveness is directly linked to program compliance, fidelity, and dosage. Preventive training programs are not widely adopted by youth sport coaches. One way to promote widespread dissemination and compliance is to identify implementation strategies that influence program adoption and maintenance. It is unknown how previously published programs have followed the elements of an implementation framework. The objective of this review was to evaluate how elements of the 7 steps of implementation, developed by Padua et al, have been performed in the evidence of lower extremity preventive training programs. A systematic review of the literature from 1996 through September 2016 was conducted using electronic databases. Investigations that documented implementation of a sport team-based neuromuscular preventive training program in youth athletes and measured lower extremity injury rates were included. Clinical review. Level 4. A total of 12 studies met the inclusion criteria and were reviewed. Information regarding the completion of any of the 7 steps within the implementation framework developed by Padua et al was extracted. None of the 12 articles documented completion of all 7 steps. While each study addressed some of the 7 steps, no study addressed maintenance or an exit strategy for youth athletes. Program implementation appears limited in obtaining administrative support, utilizing an interdisciplinary implementation team, and monitoring or promoting fidelity of the intervention. Despite strong evidence supporting the effectiveness of preventive training programs in youth athletes, there is a gap between short-term improvements and long-term implementation strategies. Future interventions should include all 7 steps of the implementation framework to promote transparent dissemination of preventive training programs.

Locomotor training using an overground robotic exoskeleton in long-term manual wheelchair users with a chronic spinal cord injury living in the community: Lessons learned from a feasibility study in terms of recruitment, attendance, learnability, performance and safety.

PubMed

Gagnon, Dany H; Escalona, Manuel J; Vermette, Martin; Carvalho, Lívia P; Karelis, Antony D; Duclos, Cyril; Aubertin-Leheudre, Mylène

2018-03-01

For individuals who sustain a complete motor spinal cord injury (SCI) and rely on a wheelchair as their primary mode of locomotion, overground robotic exoskeletons represent a promising solution to stand and walk again. Although overground robotic exoskeletons have gained tremendous attention over the past decade and are now being transferred from laboratories to clinical settings, their effects remain unclear given the paucity of scientific evidence and the absence of large-scale clinical trials. This study aims to examine the feasibility of a locomotor training program with an overground robotic exoskeleton in terms of recruitment, attendance, and drop-out rates as well as walking performance, learnability, and safety. Individuals with a SCI were invited to participate in a 6 to 8-week locomotor training program with a robotic exoskeleton encompassing 18 sessions. Selected participants underwent a comprehensive screening process and completed two familiarization sessions with the robotic exoskeleton. The outcome measures were the rate of recruitment of potential participants, the rate of attendance at training sessions, the rate of drop-outs, the ability to walk with the exoskeleton, and its progression over the program as well as the adverse events. Out of 49 individuals who expressed their interest in participating in the study, only 14 initiated the program (recruitment rate = 28.6%). Of these, 13 individuals completed the program (drop-out rate = 7.1%) and attended 17.6 ± 1.1 sessions (attendance rate = 97.9%). Their greatest standing time, walking time, and number of steps taken during a session were 64.5 ± 10.2 min, 47.2 ± 11.3 min, and 1843 ± 577 steps, respectively. During the training program, these last three parameters increased by 45.3%, 102.1%, and 248.7%, respectively. At the end of the program, when walking with the exoskeleton, most participants required one therapist (85.7%), needed stand-by or contact-guard assistance (57.1%), used forearm crutches (71.4%), and reached a walking speed of 0.25 ± 0.05 m/s. Five participants reported training-related pain or stiffness in the upper extremities during the program. One participant sustained bilateral calcaneal fractures and stopped the program. This study confirms that larger clinical trials investigating the effects of a locomotor training program with an overground robotic exoskeleton are feasible and relatively safe in individuals with complete motor SCI. Moreover, to optimize the recruitment rate and safety in future trials, this study now highlights the need of developing pre-training rehabilitation programs to increase passive lower extremity range of motion and standing tolerance. This study also calls for the development of clinical practice guidelines targeting fragility fracture risk assessment linked to the use of overground robotic exoskeletons.

Effect of Gravity on Robot-Assisted Motor Training After Chronic Stroke: A Randomized Trial

PubMed Central

Conroy, Susan S.; Whitall, Jill; Dipietro, Laura; Jones-Lush, Lauren M.; Zhan, Min; Finley, Margaret A.; Wittenberg, George F.; Krebs, Hermano I.; Bever, Christopher T.

2015-01-01

Objectives To determine the efficacy of 2 distinct 6-week robot-assisted reaching programs compared with an intensive conventional arm exercise program (ICAE) for chronic, stroke-related upper-extremity (UE) impairment. To examine whether the addition of robot-assisted training out of the horizontal plane leads to improved outcomes. Design Randomized controlled trial, single-blinded, with 12-week follow-up. Setting Research setting in a large medical center. Participants Adults (N=62) with chronic, stroke-related arm weakness stratified by impairment severity using baseline UE motor assessments. Interventions Sixty minutes, 3 times a week for 6 weeks of robot-assisted planar reaching (gravity compensated), combined planar with vertical robot-assisted reaching, or intensive conventional arm exercise program. Main Outcome Measure UE Fugl-Meyer Assessment (FMA) mean change from baseline to final training. Results All groups showed modest gains in the FMA from baseline to final with no significant between group differences. Most change occurred in the planar robot group (mean change ± SD, 2.94± 0.77; 95% confidence interval [CI], 1.40 – 4.47). Participants with greater motor impairment (n=41) demonstrated a larger difference in response (mean change ± SD, 2.29±0.72; 95% CI, 0.85–3.72) for planar robot-assisted exercise compared with the intensive conventional arm exercise program (mean change ± SD, 0.43±0.72; 95% CI, −1.00 to 1.86). Conclusions Chronic UE deficits because of stroke are responsive to intensive motor task training. However, training outside the horizontal plane in a gravity present environment using a combination of vertical with planar robots was not superior to training with the planar robot alone. PMID:21849168

Anterior Glenohumeral Laxity and Stiffness After a Shoulder-Strengthening Program in Collegiate Cheerleaders

PubMed Central

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

Design of a complex virtual reality simulation to train finger motion for persons with hemiparesis: a proof of concept study.

PubMed

Adamovich, Sergei V; Fluet, Gerard G; Mathai, Abraham; Qiu, Qinyin; Lewis, Jeffrey; Merians, Alma S

2009-07-17

Current neuroscience has identified rehabilitation approaches with the potential to stimulate adaptive changes in the brains of persons with hemiparesis. These approaches include, intensive task-oriented training, bimanual activities and balancing proximal and distal upper extremity interventions to reduce competition between these segments for neural territory. This paper describes the design and feasibility testing of a robotic/virtual environment system designed to train the hand and arm of persons with hemiparesis. The system employs a simulated piano that presents visual, auditory and tactile feedback comparable to an actual piano. Arm tracking allows patients to train both the arm and hand as a coordinated unit, emphasizing the integration of both transport and manipulation phases. The piano trainer includes songs and scales that can be performed with one or both hands. Adaptable haptic assistance is available for more involved subjects. An algorithm adjusts task difficulty in proportion to subject performance. A proof of concept study was performed on four subjects with upper extremity hemiparesis secondary to chronic stroke to establish: a) the safety and feasibility of this system and b) the concurrent validity of robotically measured kinematic and performance measures to behavioral measures of upper extremity function. None of the subjects experienced adverse events or responses during or after training. As a group, the subjects improved in both performance time and key press accuracy. Three of the four subjects demonstrated improvements in fractionation, the ability to move each finger individually. Two subjects improved their aggregate time on the Jebsen Test of Hand Function and three of the four subjects improved in Wolf Motor Function Test aggregate time. The system designed in this paper has proven to be safe and feasible for the training of hand function for persons with hemiparesis. It features a flexible design that allows for the use and further study of adjustments in point of view, bilateral and unimanual treatment modes, adaptive training algorithms and haptically rendered collisions in the context of rehabilitation of the hemiparetic hand.

Design of a complex virtual reality simulation to train finger motion for persons with hemiparesis: a proof of concept study

PubMed Central

Adamovich, Sergei V; Fluet, Gerard G; Mathai, Abraham; Qiu, Qinyin; Lewis, Jeffrey; Merians, Alma S

2009-01-01

Background Current neuroscience has identified rehabilitation approaches with the potential to stimulate adaptive changes in the brains of persons with hemiparesis. These approaches include, intensive task-oriented training, bimanual activities and balancing proximal and distal upper extremity interventions to reduce competition between these segments for neural territory. Methods This paper describes the design and feasibility testing of a robotic/virtual environment system designed to train the hand and arm of persons with hemiparesis. The system employs a simulated piano that presents visual, auditory and tactile feedback comparable to an actual piano. Arm tracking allows patients to train both the arm and hand as a coordinated unit, emphasizing the integration of both transport and manipulation phases. The piano trainer includes songs and scales that can be performed with one or both hands. Adaptable haptic assistance is available for more involved subjects. An algorithm adjusts task difficulty in proportion to subject performance. A proof of concept study was performed on four subjects with upper extremity hemiparesis secondary to chronic stroke to establish: a) the safety and feasibility of this system and b) the concurrent validity of robotically measured kinematic and performance measures to behavioral measures of upper extremity function. Results None of the subjects experienced adverse events or responses during or after training. As a group, the subjects improved in both performance time and key press accuracy. Three of the four subjects demonstrated improvements in fractionation, the ability to move each finger individually. Two subjects improved their aggregate time on the Jebsen Test of Hand Function and three of the four subjects improved in Wolf Motor Function Test aggregate time. Conclusion The system designed in this paper has proven to be safe and feasible for the training of hand function for persons with hemiparesis. It features a flexible design that allows for the use and further study of adjustments in point of view, bilateral and unimanual treatment modes, adaptive training algorithms and haptically rendered collisions in the context of rehabilitation of the hemiparetic hand. PMID:19615045

Effect of compensatory acceleration training in combination with accommodating resistance on upper body strength in collegiate athletes

PubMed Central

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

Moderate Intensity Cycling Exercise after Upper Extremity Resistance Training Interferes Response to Muscle Hypertrophy but Not Strength Gains

PubMed Central

Tomiya, Shigeto; Kikuchi, Naoki; Nakazato, Koichi

2017-01-01

The purpose of the present study was to examine the effect of 30-min moderate intensity cycling exercise immediately after upper-body resistance training on the muscle hypertrophy and strength gain. Fourteen subjects were randomly divided between two groups. One group performed moderate intensity (55% of maximum oxygen consumption [VO2max], 30 min) cycle training immediately after arm resistance training as concurrent training (CT; n = 7, age: 21.8 ± 0.7 years, height: 1.68 ± 0.06 m, weight: 60.3 ± 7.4 kg); the second group performed the same endurance and arm RT on separate days as control group (SEP; n=7, age: 22.1 ± 0.7 years, height: 1.76 ± 0.05 m, weight: 63.8 ± 3.6 kg). The supervised progressive RT program was designed to induce muscular hypertrophy (3-5 sets of 10 repetitions) with bilateral arm-curl exercise using 75% of the one repetition maximum (1RM) with 2-min rest intervals. The RT program was performed for 8 weeks, twice per week. Muscle cross-sectional area (CSA), 1RM, and VO2max were measured pre- and post-training. Significant increases in muscle CSA from pre- to post-training were observed in both the SEP (p = 0.001, effect size [ES] = 0.84) and the CT groups (p = 0.004, ES = 0.45). A significant increase in 1RM from pre- to post-training was observed in the SEP (p = 0.025, ES = 0.91) and CT groups (p = 0.001, ES = 2.38). There were no interaction effects (time × group) for CSA, 1RM, or VO2max. A significantly higher percentage change of CSA was observed in the SEP group (12.1 ± 4.9%) compared to the CT group (5.0 ± 2.7%, p = 0.029), but no significant difference was observed in the 1RM (SEP: 19.8 ± 16.8%, CT: 24.3 ± 11.1%). The data suggest that significant improvement of CSA and strength can be expected with progressive resistance training with subsequent endurance exercise performed immediately or on a different day. Changes in CSA might be affected by subsequent cycling exercise after 8 weeks of training. Key points Moderate intensity cycling exercise immediately after upper-body resistance training influences the magnitude of muscle hypertrophy and relative value of CSA changes. There was no statistically significant difference in the % change in 1RM between groups after concurrent strength training and moderate intensity endurance training. Timing of endurance training could alter the degree of muscular growth induced by resistance training. PMID:28912657

Effect of a Lower Extremity Preventive Training Program on Physical Performance Scores in Military Recruits.

PubMed

Peck, Karen Y; DiStefano, Lindsay J; Marshall, Stephen W; Padua, Darin A; Beutler, Anthony I; de la Motte, Sarah J; Frank, Barnett S; Martinez, Jessica C; Cameron, Kenneth L

2017-11-01

Peck, KY, DiStefano, LJ, Marshall, SW, Padua, DA, Beutler, AI, de la Motte, SJ, Frank, BS, Martinez, JC, and Cameron, KL. Effect of a lower extremity preventive training program on physical performance scores in military recruits. J Strength Cond Res 31(11): 3146-3157, 2017-Exercise-based preventive training programs are designed to improve movement patterns associated with lower extremity injury risk; however, the impact of these programs on general physical fitness has not been evaluated. The purpose of this study was to compare fitness scores between participants in a preventive training program and a control group. One thousand sixty-eight freshmen from a U.S. Service Academy were cluster-randomized into either the intervention or control group during 6 weeks of summer training. The intervention group performed a preventive training program, specifically the Dynamic Integrated Movement Enhancement (DIME), which is designed to improve lower extremity movement patterns. The control group performed the Army Preparation Drill (PD), a warm-up designed to prepare soldiers for training. Main outcome measures were the Army Physical Fitness Test (APFT) raw and scaled (for age and sex) scores. Independent t tests were used to assess between-group differences. Multivariable logistic regression models were used to control for the influence of confounding variables. Dynamic Integrated Movement Enhancement group participants completed the APFT 2-mile run 20 seconds faster compared with the PD group (p < 0.001), which corresponded with significantly higher scaled scores (p < 0.001). Army Physical Fitness Test push-up scores were significantly higher in the DIME group (p = 0.041), but there were no significant differences in APFT sit-up scores. The DIME group had significantly higher total APFT scores compared with the PD group (p < 0.001). Similar results were observed in multivariable models after controlling for sex and body mass index (BMI). Committing time to the implementation of a preventive training program does not appear to negatively affect fitness test scores.

Comparison of integrated and isolated training on performance measures and neuromuscular control.

PubMed

Distefano, Lindsay J; Distefano, Michael J; Frank, Barnett S; Clark, Micheal A; Padua, Darin A

2013-04-01

Traditional weight training programs use an exercise prescription strategy that emphasizes improving muscle strength through resistance exercises. Other factors, such as stability, endurance, movement quality, power, flexibility, speed, and agility are also essential elements to improving overall functional performance. Therefore, exercises that incorporate these additional elements may be beneficial additions to traditional resistance training programs. The purpose of the study was to compare the effects of an isolated resistance training program (ISO) and an integrated training program (INT) on movement quality, vertical jump height, agility, muscle strength and endurance, and flexibility. The ISO program consisted of primarily upper and lower extremity progressive resistance exercises. The INT program involved progressive resistance exercises, and core stability, power, and agility exercises. Thirty subjects were cluster randomized to either the ISO (n = 15) or INT (n = 15) training program. Each training group performed their respective programs 2 times per week for 8 weeks. The subjects were assessed before (pretest) and after (posttest) the intervention period using the following assessments: a jump-landing task graded using the Landing Error Scoring System (LESS), vertical jump height, T-test time, push-up and sit-up performance, and the sit-and-reach test. The INT group performed better on the LESS test (pretest: 3.90 ± 1.02, posttest: 3.03 ± 1.02; p = 0.02), faster on the T-test (pretest: 10.35 ± 1.20 seconds, posttest: 9.58 ± 1.02 seconds; p = 0.01), and completed more sit-ups (pretest: 40.20 ± 15.01, posttest: 46.73 ± 14.03; p = 0.045) and push-ups (pretest: 40.67 ± 13.85, posttest: 48.93 ± 15.17; p = 0.05) at posttest compared with pretest, and compared with the ISO group at posttest. Both groups performed more push-ups (p = 0.002), jumped higher (p < 0.001), and reached further (p = 0.008) at posttest compared with that at pretest. Performance enhancement programs should use an integrated approach to exercise selection to optimize performance and movement technique benefits.

Evidence-based therapies for upper extremity dysfunction.

PubMed

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.

Effect of virtual reality versus conventional physiotherapy on upper extremity function in children with obstetric brachial plexus injury

PubMed Central

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

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

PubMed

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

2005-01-01

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

The effect of position on the percentage of body mass supported during traditional and modified push-up variants.

PubMed

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.

Safety and improvement of movement function after stroke with atomoxetine: A pilot randomized trial

PubMed Central

Ward, Andrea; Carrico, Cheryl; Powell, Elizabeth; Westgate, Philip M.; Nichols, Laurie; Fleischer, Anne; Sawaki, Lumy

2016-01-01

Background: Intensive, task-oriented motor training has been associated with neuroplastic reorganization and improved upper extremity movement function after stroke. However, to optimize such training for people with moderate-to-severe movement impairment, pharmacological modulation of neuroplasticity may be needed as an adjuvant intervention. Objective: Evaluate safety, as well as improvement in movement function, associated with motor training paired with a drug to upregulate neuroplasticity after stroke. Methods: In this double-blind, randomized, placebo-controlled study, 12 subjects with chronic stroke received either atomoxetine or placebo paired with motor training. Safety was assessed using vital signs. Upper extremity movement function was assessed using Fugl-Meyer Assessment, Wolf Motor Function Test, and Action Research Arm Test at baseline, post-intervention, and 1-month follow-up. Results: No significant between-groups differences were found in mean heart rate (95% CI, –12.4–22.6; p = 0.23), mean systolic blood pressure (95% CI, –1.7–29.6; p = 0.21), or mean diastolic blood pressure (95% CI, –10.4–13.3; p = 0.08). A statistically significant between-groups difference on Fugl-Meyer at post-intervention favored the atomoxetine group (95% CI, 1.6–12.7; p = 0.016). Conclusion: Atomoxetine combined with motor training appears safe and may optimize motor training outcomes after stroke. PMID:27858723

Tobacco Dependence Treatment Training Programs: An International Survey

PubMed Central

Rigotti, Nancy A.; Raw, Martin; McNeill, Ann; Murray, Rachael; Piné-Abata, Hembadoon; Bitton, Asaf; McEwen, Andy

2016-01-01

Abstract Introduction: In line with Article 14 guidelines for the WHO Framework Convention on Tobacco Control, we aimed to assess the progress in training individuals to deliver tobacco cessation treatment. Methods: Cross-sectional web-based survey in May–September 2013 among 122 experts in tobacco control and training from 84 countries (73% response rate among 115 countries surveyed). We measured training program prevalence, participants, and challenges faced. Results: Overall, 21% ( n = 18/84) of countries, mostly low and middle-income countries (LMICs; P = .002), reported no training program. Among 66 countries reporting at least one training program, most (84%) trained healthcare professionals but 54% also trained other individuals including community health workers, teachers, and religious leaders. Most programs (54%) cited funding challenges, although stability of funding varied by income level. Government funding was more commonly reported in higher income countries (high 56%, upper middle 50%, lower middle 27%, low 25%; P = .03) while programs in LMICs relied more on nongovernmental organizations (high 11%, upper middle 37%, lower middle 27%, low 38%; P = .02). Conclusions: One in five countries reported having no tobacco treatment training program representing little progress in terms of training individuals to deliver tobacco treatment in LMICs. Without more trained tobacco treatment providers, one of the tenets of Article 14 is not yet being met and health inequalities are likely to widen. More effort and resources are needed to ensure that healthcare worker educational programs include training to assess tobacco use and deliver brief advice and that training is available for individuals outside the healthcare system in areas with limited healthcare access. PMID:26117835

Sequencing bilateral and unilateral task-oriented training versus task oriented training alone to improve arm function in individuals with chronic stroke.

PubMed

McCombe Waller, Sandy; Whitall, Jill; Jenkins, Toye; Magder, Laurence S; Hanley, Daniel F; Goldberg, Andrew; Luft, Andreas R

2014-12-14

Recovering useful hand function after stroke is a major scientific challenge for patients with limited motor recovery. We hypothesized that sequential training beginning with proximal bilateral followed by unilateral task oriented training is superior to time-matched unilateral training alone. Proximal bilateral training could optimally prepare the motor system to respond to the more challenging task-oriented training. Twenty-six participants with moderate severity hemiparesis Intervention: PARTICIPANTS received either 6-weeks of bilateral proximal training followed sequentially by 6-weeks unilateral task-oriented training (COMBO) or 12-weeks of unilateral task-oriented training alone (SAEBO). A subset of 8 COMB0 and 9 SAEBO participants underwent three functional magnetic resonance imaging (fMRI) scans of hand and elbow movement every 6 weeks. Fugl-Meyer Upper extremity scale, Modified Wolf Motor Function Test, University of Maryland Arm Questionnaire for Stroke, Motor cortex activation (fMRI). The COMBO group demonstrated significantly greater gains between baseline and 12-weeks over all outcome measures (p = .018 based on a MANOVA test) and specifically in the Modified Wolf Motor Function test (time). Both groups demonstrated within-group gains on the Fugl-Meyer Upper Extremity test (impairment) and University of Maryland Arm Questionnaire for Stroke (functional use). fMRI subset analyses showed motor cortex (primary and premotor) activation during hand movement was significantly increased by sequential combination training but not by task-oriented training alone. Sequentially combining a proximal bilateral before a unilateral task-oriented training may be an effective way to facilitate gains in arm and hand function in those with moderate to severe paresis post-stroke compared to unilateral task oriented training alone.

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.

Effects of off-axis elliptical training on reducing pain and improving knee function in individuals with patellofemoral pain

PubMed Central

Tsai, Liang-Ching; Lee, Song Joo; Yang, Aaron J.; Ren, Yupeng; Press, Joel M.; Zhang, Li-Qun

2014-01-01

Objective To examine whether an off-axis elliptical training program reduces pain and improves knee function in individuals with patellofemoral pain (PFP). Design Controlled laboratory study, pre-test-post-test. Setting University rehabilitation center. Participants Twelve adult subjects with PFP. Interventions Subjects with PFP completed an exercise program consisting of 18 sessions of lower extremity off-axis training using a custom-made elliptical trainer that allows frontal-plane sliding and transverse-plane pivoting of the footplates. Main Outcome Measures Changes in knee pain and function post-training and 6 weeks following training were evaluated using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and International Knee Documentation Committee (IKDC) scores. Lower extremity off-axis control was assessed by pivoting and sliding instability, calculated as the root mean square (RMS) of the footplate pivoting angle and sliding distance during elliptical exercise. Subjects’ single-leg hop distance and proprioception in detecting lower extremity pivoting motion were also evaluated. Results Subjects reported significantly greater KOOS and IKDC scores (increased by 12–18 points) and hop distance (increased by 0.2 m) following training. A significant decrease in the pivoting and sliding RMS was also observed following training. Additionally, subjects with PFP demonstrated improved pivoting proprioception when tested under a minimum-weight-bearing position. Conclusions An off-axis elliptical training program was effective in enhancing lower extremity neuromuscular control on the frontal and transverse planes, reducing pain and improving knee function in persons with PFP. PMID:25591131

Body-Machine Interfaces after Spinal Cord Injury: Rehabilitation and Brain Plasticity.

PubMed

Seáñez-González, Ismael; Pierella, Camilla; Farshchiansadegh, Ali; Thorp, Elias B; Wang, Xue; Parrish, Todd; Mussa-Ivaldi, Ferdinando A

2016-12-19

The purpose of this study was to identify rehabilitative effects and changes in white matter microstructure in people with high-level spinal cord injury following bilateral upper-extremity motor skill training. Five subjects with high-level (C5-C6) spinal cord injury (SCI) performed five visuo-spatial motor training tasks over 12 sessions (2-3 sessions per week). Subjects controlled a two-dimensional cursor with bilateral simultaneous movements of the shoulders using a non-invasive inertial measurement unit-based body-machine interface. Subjects' upper-body ability was evaluated before the start, in the middle and a day after the completion of training. MR imaging data were acquired before the start and within two days of the completion of training. Subjects learned to use upper-body movements that survived the injury to control the body-machine interface and improved their performance with practice. Motor training increased Manual Muscle Test scores and the isometric force of subjects' shoulders and upper arms. Moreover, motor training increased fractional anisotropy (FA) values in the cingulum of the left hemisphere by 6.02% on average, indicating localized white matter microstructure changes induced by activity-dependent modulation of axon diameter, myelin thickness or axon number. This body-machine interface may serve as a platform to develop a new generation of assistive-rehabilitative devices that promote the use of, and that re-strengthen, the motor and sensory functions that survived the injury.

Mechanisms of Short-Term Training-Induced Reaching Improvement in Severely Hemiparetic Stroke Patients: A TMS Study

PubMed Central

Harris-Love, Michelle L.; Morton, Susanne M.; Perez, Monica A.; Cohen, Leonardo G.

2011-01-01

Background The neurophysiological mechanisms underlying improved upper-extremity motor skills have been partially investigated in patients with good motor recovery but are poorly understood in more impaired individuals, the majority of stroke survivors. Objective The authors studied changes in primary motor cortex (M1) excitability (motor evoked potentials [MEPs], contralateral and ipsilateral silent periods [CSPs and ISPs] using transcranial magnetic stimulation [TMS]) associated with training-induced reaching improvement in stroke patients with severe arm paresis (n = 11; Upper-Extremity Fugl-Meyer score (F-M) = 27 ± 6). Methods All patients underwent a single session of reaching training focused on moving the affected hand from a resting site to a target placed at 80% of maximum forward reaching amplitude in response to a visual “GO” cue. Triceps contribute primarily as agonist and biceps primarily as antagonist to the trained forward reaching movement. Response times were recorded for each reaching movement. Results Preceding training (baseline), greater interhemispheric inhibition (measured by ISP) in the affected triceps muscle, reflecting inhibition from the nonlesioned to the lesioned M1, was observed in patients with lower F-M scores (more severe motor impairment). Training-induced improvements in reaching were greater in patients with slower response times at baseline. Increased MEP amplitudes and decreased ISPs and CSPs were observed in the affected triceps but not in the biceps muscle after training. Conclusion These results indicate that along with training-induced motor improvements, training-specific modulation of intrahemispheric and interhemispheric mechanisms occurs after reaching practice in chronic stroke patients with substantial arm impairment. PMID:21343522

Capture, Learning, and Classification of Upper Extremity Movement Primitives in Healthy Controls and Stroke Patients

PubMed Central

Guerra, Jorge; Uddin, Jasim; Nilsen, Dawn; Mclnerney, James; Fadoo, Ammarah; Omofuma, Isirame B.; Hughes, Shatif; Agrawal, Sunil; Allen, Peter; Schambra, Heidi M.

2017-01-01

There currently exist no practical tools to identify functional movements in the upper extremities (UEs). This absence has limited the precise therapeutic dosing of patients recovering from stroke. In this proof-of-principle study, we aimed to develop an accurate approach for classifying UE functional movement primitives, which comprise functional movements. Data were generated from inertial measurement units (IMUs) placed on upper body segments of older healthy individuals and chronic stroke patients. Subjects performed activities commonly trained during rehabilitation after stroke. Data processing involved the use of a sliding window to obtain statistical descriptors, and resulting features were processed by a Hidden Markov Model (HMM). The likelihoods of the states, resulting from the HMM, were segmented by a second sliding window and their averages were calculated. The final predictions were mapped to human functional movement primitives using a Logistic Regression algorithm. Algorithm performance was assessed with a leave-one-out analysis, which determined its sensitivity, specificity, and positive and negative predictive values for all classified primitives. In healthy control and stroke participants, our approach identified functional movement primitives embedded in training activities with, on average, 80% precision. This approach may support functional movement dosing in stroke rehabilitation. PMID:28813877

The effects of pilates on balance, mobility and strength in patients with multiple sclerosis.

PubMed

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.

Quantifying C-17 Aircrew Training Priorities

DTIC Science & Technology

2015-06-19

mentally process the situation. Skill-Probability-Risk (SPR) Score Once the data from the SS, SP, and SR has been calculated, an SPR Score can...discrepancies between the SPR Rank-Score and the Vol 1 Rank-Score. Figure 4.8 illustrates the differences in scores between the two processes . Ideally, the...tables. The extreme lower left and extreme upper right of the chart are areas of major discrepancy between the two processes and potentially provide the

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

PubMed

Slijper, Angelique; Svensson, Karin E; Backlund, Per; Engström, Henrik; Sunnerhagen, Katharina Stibrant

2014-03-13

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

Comparison of In-Season-Specific Resistance vs. A Regular Throwing Training Program on Throwing Velocity, Anthropometry, and Power Performance in Elite Handball Players.

PubMed

Hermassi, Souhail; van den Tillaar, Roland; Khlifa, Riadh; Chelly, Mohamed Souhaiel; Chamari, Karim

2015-08-01

The purpose of this study was to compare the effect of a specific resistance training program (throwing movement with a medicine ball) with that of regular training (throwing with regular balls) on ball velocity, anthropometry, maximal upper-body strength, and power. Thirty-four elite male team handball players (age: 18 ± 0.5 years, body mass: 80.6 ± 5.5 kg, height: 1.80 ± 5.1 m, body fat: 13.4 ± 0.6%) were randomly assigned to 1 of the 3 groups: control (n = 10), resistance training group (n = 12), or regular throwing training group (n = 12). Over the 8-week in season, the athletes performed 3 times per week according to an assigned training program alongside their normal team handball training. One repetition maximum (1RM) bench press and 1RM pullover scores assessed maximal arm strength. Anthropometry was assessed by body mass, fat percentage, and muscle volumes of upper body. Handball throwing velocity was measured by a standing throw, a throw with run, and a jump throw. Power was measured by measuring total distance thrown by a 3-kg medicine ball overhead throw. Throwing ball velocity, maximal strength, power, and muscle volume increases for the specific resistance training group after the 8 weeks of training, whereas only maximal strength, muscle volume and power and in the jump throw increases were found for the regular throwing training group. No significant changes for the control group were found. The current findings suggest that elite male handball players can improve ball velocity, anthropometrics, maximal upper-body strength, and power during the competition season by implementing a medicine ball throwing program.

Advances in upper extremity prosthetics.

PubMed

Zlotolow, Dan A; Kozin, Scott H

2012-11-01

Until recently, upper extremity prostheses had changed little since World War II. In 2006, the Defense Advanced Research Projects Agency responded to an increasing number of military amputees with the Revolutionizing Prosthetics program. The program has yielded several breakthroughs both in the engineering of new prosthetic arms and in the control of those arms. Direct brain-wave control of a limb with 22° of freedom may be within reach. In the meantime, advances such as individually powered digits have opened the door to multifunctional full and partial hand prostheses. Restoring sensation to the prosthetic limb remains a major challenge to full integration of the limb into a patient's self-image. Copyright © 2012 Elsevier Inc. All rights reserved.

Innovative strength training-induced neuroplasticity and increased muscle size and strength in children with spastic cerebral palsy: an experimenter-blind case study--three-month follow-up.

PubMed

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.

Incorporating haptic effects into three-dimensional virtual environments to train the hemiparetic upper extremity

PubMed Central

Adamovich, Sergei; Fluet, Gerard G.; Merians, Alma S.; Mathai, Abraham; Qiu, Qinyin

2010-01-01

Current neuroscience has identified several constructs to increase the effectiveness of upper extremity rehabilitation. One is the use of progressive, skill acquisition-oriented training. Another approach emphasizes the use of bilateral activities. Building on these principles, this paper describes the design and feasibility testing of a robotic / virtual environment system designed to train the arm of persons who have had strokes. The system provides a variety of assistance modes, scalable workspaces and hand-robot interfaces allowing persons with strokes to train multiple joints in three dimensions. The simulations utilize assistance algorithms that adjust task difficulty both online and offline in relation to subject performance. Several distinctive haptic effects have been incorporated into the simulations. An adaptive master-slave relationship between the unimpaired and impaired arm encourages active movement of the subject's hemiparetic arm during a bimanual task. Adaptive anti-gravity support and damping stabilize the arm during virtual reaching and placement tasks. An adaptive virtual spring provides assistance to complete the movement if the subject is unable to complete the task in time. Finally, haptically rendered virtual objects help to shape the movement trajectory during a virtual placement task. A proof of concept study demonstrated this system to be safe, feasible and worthy of further study. PMID:19666345

Sliding Mode Tracking Control of a Wire-Driven Upper-Limb Rehabilitation Robot with Nonlinear Disturbance Observer.

PubMed

Niu, Jie; Yang, Qianqian; Wang, Xiaoyun; Song, Rong

2017-01-01

Robot-aided rehabilitation has become an important technology to restore and reinforce motor functions of patients with extremity impairment, whereas it can be extremely challenging to achieve satisfactory tracking performance due to uncertainties and disturbances during rehabilitation training. In this paper, a wire-driven rehabilitation robot that can work over a three-dimensional space is designed for upper-limb rehabilitation, and sliding mode control with nonlinear disturbance observer is designed for the robot to deal with the problem of unpredictable disturbances during robot-assisted training. Then, simulation and experiments of trajectory tracking are carried out to evaluate the performance of the system, the position errors, and the output forces of the designed control scheme are compared with those of the traditional sliding mode control (SMC) scheme. The results show that the designed control scheme can effectively reduce the tracking errors and chattering of the output forces as compared with the traditional SMC scheme, which indicates that the nonlinear disturbance observer can reduce the effect of unpredictable disturbances. The designed control scheme for the wire-driven rehabilitation robot has potential to assist patients with stroke in performing repetitive rehabilitation training.

Effects of a virtual reality-based exercise program on functional recovery in stroke patients: part 1

PubMed Central

Lee, Kyoung-Hee

2015-01-01

This study aimed to determine the effects of a virtual reality exercise program using the Interactive Rehabilitation and Exercise System (IREX) on the recovery of motor and cognitive function and the performance of activities of daily living in stroke patients. [Subjects] The study enrolled 10 patients diagnosed with stroke who received occupational therapy at the Department of Rehabilitation Medicine of Hospital A between January and March 2014. [Methods] The patients took part in the virtual reality exercise program for 30 minutes each day, three times per week, for 4 weeks. Then, the patients were re-evaluated to determine changes in upper extremity function, cognitive function, and performance of activities of daily living 4 weeks after the baseline assessment. [Results] In the experimental group, there were significant differences in the Korea-Mini Mental Status Evaluation, Korean version of the modified Barthel index, and Fugl-Meyer assessment scores between the baseline and endpoint. [Conclusion] The virtual reality exercise program was effective for restoring function in stroke patients. Further studies should develop systematic protocols for rehabilitation training with a virtual reality exercise program. PMID:26180287

Effects of a virtual reality-based exercise program on functional recovery in stroke patients: part 1.

PubMed

Lee, Kyoung-Hee

2015-06-01

This study aimed to determine the effects of a virtual reality exercise program using the Interactive Rehabilitation and Exercise System (IREX) on the recovery of motor and cognitive function and the performance of activities of daily living in stroke patients. [Subjects] The study enrolled 10 patients diagnosed with stroke who received occupational therapy at the Department of Rehabilitation Medicine of Hospital A between January and March 2014. [Methods] The patients took part in the virtual reality exercise program for 30 minutes each day, three times per week, for 4 weeks. Then, the patients were re-evaluated to determine changes in upper extremity function, cognitive function, and performance of activities of daily living 4 weeks after the baseline assessment. [Results] In the experimental group, there were significant differences in the Korea-Mini Mental Status Evaluation, Korean version of the modified Barthel index, and Fugl-Meyer assessment scores between the baseline and endpoint. [Conclusion] The virtual reality exercise program was effective for restoring function in stroke patients. Further studies should develop systematic protocols for rehabilitation training with a virtual reality exercise program.

Rehabilitation of Motor Function after Stroke: A Multiple Systematic Review Focused on Techniques to Stimulate Upper Extremity Recovery

PubMed Central

Hatem, Samar M.; Saussez, Geoffroy; della Faille, Margaux; Prist, Vincent; Zhang, Xue; Dispa, Delphine; Bleyenheuft, Yannick

2016-01-01

Stroke is one of the leading causes for disability worldwide. Motor function deficits due to stroke affect the patients' mobility, their limitation in daily life activities, their participation in society and their odds of returning to professional activities. All of these factors contribute to a low overall quality of life. Rehabilitation training is the most effective way to reduce motor impairments in stroke patients. This multiple systematic review focuses both on standard treatment methods and on innovating rehabilitation techniques used to promote upper extremity motor function in stroke patients. A total number of 5712 publications on stroke rehabilitation was systematically reviewed for relevance and quality with regards to upper extremity motor outcome. This procedure yielded 270 publications corresponding to the inclusion criteria of the systematic review. Recent technology-based interventions in stroke rehabilitation including non-invasive brain stimulation, robot-assisted training, and virtual reality immersion are addressed. Finally, a decisional tree based on evidence from the literature and characteristics of stroke patients is proposed. At present, the stroke rehabilitation field faces the challenge to tailor evidence-based treatment strategies to the needs of the individual stroke patient. Interventions can be combined in order to achieve the maximal motor function recovery for each patient. Though the efficacy of some interventions may be under debate, motor skill learning, and some new technological approaches give promising outcome prognosis in stroke motor rehabilitation. PMID:27679565

From Freshman Student to Upper-Secondary School Teacher in Chemistry: A New Approach with Projects and Group Work.

ERIC Educational Resources Information Center

Josephsen, Jens

1985-01-01

A special five and one-half year program for training upper secondary school chemistry teachers has been developed and tested over the past decade at Roskilde University near Copenhagen. The program (which emphasizes project work) and a student project on epoxy glue are described. Program graduates are generally problem-oriented and…

Development and evaluation of a new telerehabilitation system based on VR technology using multisensory feedback for patients with stroke

PubMed Central

Kato, Norio; Tanaka, Toshiaki; Sugihara, Syunichi; Shimizu, Koichi

2015-01-01

[Purpose] The purpose of this study was to develop a new telerehabilitation system based on VR technology for training of paralyzed upper and lower extremities and poor balance in patients with stroke. Moreover, the effectiveness of the system was verified by analysis of the recovery of these patients. [Subjects] Five healthy persons and five people with motor paralysis, caused by cerebrovascular disease, participated. [Methods] The features of our system are as follows: (1) Our system can train upper and lower limbs and balancing with 3D images. (2) A Kinect® is used for user posture detection. (3) A vibrator is used for feedback to a sensory receptor in order to promote the learning effect of motion. Upper limb and balance training were conducted in this study. [Results] The time necessary for the upper limb and balance training tasks was shortened for the participants with disabilities. The joint angle for the participants with disabilities tended to equate to that of the healthy participants over time. Moreover, our system had no side effects. [Conclusion] These points suggest that our system is effective and safe. The user interface and assessment of the conditions of patients from a distance should be studied in the future. PMID:26644671

Rehabilitation of the elbow following sports injury.

PubMed

Ellenbecker, Todd S; Pieczynski, Tad E; Davies, George J

2010-01-01

Evaluation of the athlete with an elbow injury involves a complete upper extremity approach and a corresponding treatment approach that addresses the identified deficiencies to restore normal function. A significant focus should be placed on the proximal aspect of the upper extremity in addition to the obvious distal injury. A detailed review of the available treatment modalities fails to identify any clear definitive choice to address pain levels; however, a combination of modalities and appropriate exercise can be used in the early rehabilitation phases. The use of a total arm strengthening program along with evaluation of the athlete's sport mechanics is required to successfully return the patient back to their preinjury level of function. A supervised interval sport return program is also a necessary component of the complete rehabilitation program for the athlete with an elbow injury.

Canoe game-based virtual reality training to improve trunk postural stability, balance, and upper limb motor function in subacute stroke patients: a randomized controlled pilot study.

PubMed

Lee, Myung-Mo; Shin, Doo-Chul; Song, Chang-Ho

2016-07-01

[Purpose] This study was aimed at investigating the preliminary therapeutic efficacy and usefulness of canoe game-based virtual reality training for stroke patients. [Subjects and Methods] Ten stroke patients were randomly assigned to an experimental group (EG; n=5) or a control group (CG; n=5). Patients in both groups participated in a conventional rehabilitation program, but those in the EG additionally participated in a 30-min canoe game-based virtual reality training program 3 days a week for 4 weeks. Therapeutic efficacy was assessed based on trunk postural stability, balance, and upper limb motor function. In addition, the usefulness of canoe game-based virtual reality training was assessed in the EG and therapist group (TG; n=20), which consisted of physical and occupational therapists, by using the System Usability Scale (SUS). [Results] Improvements in trunk postural stability, balance, and upper limb motor function were observed in the EG and CG, but were greater in the EG. The mean SUS scores in the EG and TG were 71 ± 5.2 and 74.2 ± 4.8, respectively. [Conclusion] Canoe game-based virtual reality training is an acceptable and effective intervention for improving trunk postural stability, balance, and upper limb motor function in stroke patients.

Innovative STRoke Interactive Virtual thErapy (STRIVE) online platform for community-dwelling stroke survivors: a randomised controlled trial protocol.

PubMed

Johnson, Liam; Bird, Marie-Louise; Muthalib, Makii; Teo, Wei-Peng

2018-01-09

The STRoke Interactive Virtual thErapy (STRIVE) intervention provides community-dwelling stroke survivors access to individualised, remotely supervised progressive exercise training via an online platform. This trial aims to determine the clinical efficacy of the STRIVE intervention and its effect on brain activity in community-dwelling stroke survivors. In a multisite, assessor-blinded randomised controlled trial, 60 stroke survivors >3 months poststroke with mild-to-moderate upper extremity impairment will be recruited and equally randomised by location (Melbourne, Victoria or Launceston, Tasmania) to receive 8 weeks of virtual therapy (VT) at a local exercise training facility or usual care. Participants allocated to VT will perform 3-5 upper limb exercises individualised to their impairment severity and preference, while participants allocated to usual care will be asked to maintain their usual daily activities. The primary outcome measures will be upper limb motor function and impairment, which will be assessed using the Action Research Arm Test and Upper Extremity Fugl-Meyer, respectively. Secondary outcome measures include upper extremity function and spasticity, as measured by the box and block test and Modified AshworthScale, respectively, and task-related changes in bilateral sensorimotor cortex haemodynamics during hand reaching and wrist extension movements as measured by functional near-infrared spectroscopy. Quality of life will be measured using the Euro-Quality of Life-5 Dimension-5 Level Scale, and the Motor Activity Log-28 will be used to measure use of the hemiparetic arm. All measures will be assessed at baseline and immediately postintervention. The study was approved by the Deakin University Human Research Ethics Committee in May 2017 (No. 2017-087). The results will be disseminated in peer-reviewed journals and presented at major international stroke meetings. ACTRN12617000745347; Pre-results. © 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.

Innovative STRoke Interactive Virtual thErapy (STRIVE) online platform for community-dwelling stroke survivors: a randomised controlled trial protocol

PubMed Central

Bird, Marie-Louise; Muthalib, Makii

2018-01-01

Introduction The STRoke Interactive Virtual thErapy (STRIVE) intervention provides community-dwelling stroke survivors access to individualised, remotely supervised progressive exercise training via an online platform. This trial aims to determine the clinical efficacy of the STRIVE intervention and its effect on brain activity in community-dwelling stroke survivors. Methods and analysis In a multisite, assessor-blinded randomised controlled trial, 60 stroke survivors >3 months poststroke with mild-to-moderate upper extremity impairment will be recruited and equally randomised by location (Melbourne, Victoria or Launceston, Tasmania) to receive 8 weeks of virtual therapy (VT) at a local exercise training facility or usual care. Participants allocated to VT will perform 3–5 upper limb exercises individualised to their impairment severity and preference, while participants allocated to usual care will be asked to maintain their usual daily activities. The primary outcome measures will be upper limb motor function and impairment, which will be assessed using the Action Research Arm Test and Upper Extremity Fugl-Meyer, respectively. Secondary outcome measures include upper extremity function and spasticity, as measured by the box and block test and Modified AshworthScale, respectively, and task-related changes in bilateral sensorimotor cortex haemodynamics during hand reaching and wrist extension movements as measured by functional near-infrared spectroscopy. Quality of life will be measured using the Euro-Quality of Life-5 Dimension-5 Level Scale, and the Motor Activity Log-28 will be used to measure use of the hemiparetic arm. All measures will be assessed at baseline and immediately postintervention. Ethics and dissemination The study was approved by the Deakin University Human Research Ethics Committee in May 2017 (No. 2017–087). The results will be disseminated in peer-reviewed journals and presented at major international stroke meetings. Trial registration number ACTRN12617000745347; Pre-results. PMID:29317414

Movement Repetitions in Physical and Occupational Therapy during Spinal Cord Injury Rehabilitation

PubMed Central

Zbogar, Dominik; Eng, Janice J; Miller, William C; Krassioukov, Andrei V; Verrier, Molly C

2016-01-01

Study Design Longitudinal observational study. Objective To quantify the amount of upper and lower extremity movement repetitions (i.e., voluntary movements as part of a functional task or specific motion) occurring during inpatient spinal cord injury (SCI) physical (PT) and occupational therapy (OT), and examine changes over the inpatient rehabilitation stay. Setting Two stand-alone inpatient SCI rehabilitation centres. Methods Participants 103 patients were recruited through consecutive admissions to SCI rehabilitation. Interventions Trained assistants observed therapy sessions and obtained clinical outcome measures in the second week following admission and in the second to last week prior to discharge. Main Outcome Measures PT and OT time, upper and lower extremity repetitions, and changes in these outcomes over the rehabilitation stay. Results We observed 561 PT and 347 OT sessions. Therapeutic time comprised two-thirds of total therapy time. Summed over PT and OT, median upper extremity repetitions in patients with paraplegia were 7 repetitions and in patients with tetraplegia, 42 repetitions. Lower extremity repetitions and steps primarily occurred in ambulatory patients and amounted to 218 and 115, respectively (summed over PT and OT sessions at discharge). Wilcoxon signed rank tests revealed that most repetition variables did not change significantly over the inpatient rehabilitation stay. In contrast, clinical outcomes for the arm and leg improved over this time period. Conclusions Repetitions of upper and lower extremity movement are markedly low during PT and OT sessions. Despite improvements in clinical outcomes, there was no significant increase in movement repetitions over the inpatient rehabilitation stay. PMID:27752057

Epidemiology of Figure Skating Injuries: A Review of the Literature.

PubMed

Han, Julie S; Geminiani, Ellen T; Micheli, Lyle J

2018-05-01

As the popularity and technical demands of figure skating increase, so will the number of athletes presenting with sport-related problems. Searches were performed across PubMed from 1980 to 2017. The keywords searched were skating, skaters, incidence, and injuries. The search was limited to English-language articles and human participants. Relevant articles were cross-referenced. Clinical review. Level 5. Previous studies suggest an increase in incidence of figure skating injuries from 1982 to 2003. When combining all disciplines of figure skating, there is a similar proportion of acute and overuse injuries. Within disciplines, overuse injuries appear to be more common in singles skating, while acute injuries are more common in pairs skating, ice dancing, and synchronized skating. Lower extremity injuries are more common than upper extremity injuries in all disciplines, and pairs skating accounts for the majority of upper extremity injuries. Ankle sprains are the most common skating injury, and patellar tendinitis is the most common overuse injury across all disciplines. Stress fractures are the most common overuse injury in female singles skaters. The predominance of overuse injuries in singles disciplines reflects their increasing technical difficulty, with more difficult jumps and longer training hours. Partner disciplines are more likely to involve acute injuries and upper extremity injuries due to high-risk throws and lifts. Emphasis should be placed on properly fitting skating boots, intrinsic foot and ankle strengthening, and lower extremity flexibility, which may prevent many of the common lower extremity and back injuries in figure skating.

Responsiveness of outcome measures for upper limb prosthetic rehabilitation.

PubMed

Resnik, Linda; Borgia, Matthew

2016-02-01

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

Comparison of athletic training professional preparation to the prevalence of injury occurrence in the collegiate setting

NASA Astrophysics Data System (ADS)

Westerman, Beverly Jean

1999-10-01

This study investigated the relationship between the frequency of injuries that occur to certain body areas in National Collegiate Athletic Association (NCAA) athletes and the percentage of time teaching about the same subject areas in Athletic Training Education Programs (ATEP). Directors of Commission of Accreditation of Allied Health Education Programs (CAAHEP) accredited and National Athletic Trainers' Association (NATA) approved programs were surveyed. Randomly selected ATEP directors were interviewed by telephone to collect information on estimated teaching time, the strengths and weaknesses of their programs, and preferred teaching methods. Data were collected from the NCAA Injury Surveillance System to calculate the frequency of injury. Chi-square 'goodness-of-fit' tests were used to determine if a 'good fit' existed between injury frequency and teaching time in two categories: general body areas (head and face, upper extremity, lower extremity, spine, and abdomen and thorax) and specific body areas (head, face, upper arm and shoulder, elbow and forearm, wrist and hand, hip and pelvis, thigh, knee, lower leg, ankle and foot, cervical spine, thoracic spine, lumbar spine, abdomen, and thorax). Standardized residuals were used to assist in determining the location of statistical significance within the same two categories. The chi-square values calculated for both the general and specific body areas were greater than the critical value set at a significance level of .05 with 4 and 14 degrees of freedom respectively. Therefore, it was found that a 'good fit' does not exist between injury frequency and teaching time. The standardized residuals were calculated for each variable within the categories. One out of five general body areas and 10 out of 15 specific body areas were less than 2.00 in absolute value and were found not to contribute to the high chi-square value. Although the chi-square values showed a lack of fit between injury frequency and teaching time in the general and specific body areas, the standardized residuals indicated a relationship exists between some variables (body areas) within each category. In other words, the percentage of teaching time may correspond with injury frequency in some general and specific body areas. The responses from the program directors indicated they thought their academic programs were spending the appropriate amount of time teaching about the general and specific body areas. However, the percentages of teaching time reported for each of the body areas varied greatly among the responders. Further study is indicated to examine the relationship between teaching time/content and injury frequency.

Mirror Electromyografic Activity in the Upper and Lower Extremity: A Comparison between Endurance Athletes and Non-Athletes.

PubMed

Maudrich, Tom; Kenville, Rouven; Lepsien, Jöran; Villringer, Arno; Ragert, Patrick; Steele, Christopher J

2017-01-01

During unimanual motor tasks, muscle activity may not be restricted to the contracting muscle, but rather occurs involuntarily in the contralateral resting limb, even in healthy individuals. This phenomenon has been referred to as mirror electromyographic activity (MEMG). To date, the physiological (non-pathological) form of MEMG has been observed predominately in upper extremities (UE), while remaining sparsely described in lower extremities (LE). Accordingly, evidence regarding the underlying mechanisms and modulation capability of MEMG, i.e., the extent of MEMG in dependency of exerted force during unilateral isometric contractions are insufficiently investigated in terms of LE. Furthermore, it still remains elusive if and how MEMG is affected by long-term exercise training. Here, we provide novel quantitative evidence for physiological MEMG in homologous muscles of LE (tibialis anterior (TA), rectus femoris (RF)) during submaximal unilateral dorsiflexion in healthy young adults. Furthermore, endurance athletes (EA, n = 11) show a higher extent of MEMG in LE compared to non-athletes (NA, n = 11) at high force demands (80% MVC, maximum voluntary contraction). While the underlying neurophysiological mechanisms of MEMG still remain elusive, our study indicates, at least indirectly, that sport-related long-term training might affect the amount of MEMG during strong isometric contractions specifically in trained limbs. To support this assumption of exercise-induced limb-specific MEMG modulation, future studies including different sports disciplines with contrasting movement patterns and parameters should additionally be performed.

Mirror Electromyografic Activity in the Upper and Lower Extremity: A Comparison between Endurance Athletes and Non-Athletes

PubMed Central

Maudrich, Tom; Kenville, Rouven; Lepsien, Jöran; Villringer, Arno; Ragert, Patrick; Steele, Christopher J.

2017-01-01

During unimanual motor tasks, muscle activity may not be restricted to the contracting muscle, but rather occurs involuntarily in the contralateral resting limb, even in healthy individuals. This phenomenon has been referred to as mirror electromyographic activity (MEMG). To date, the physiological (non-pathological) form of MEMG has been observed predominately in upper extremities (UE), while remaining sparsely described in lower extremities (LE). Accordingly, evidence regarding the underlying mechanisms and modulation capability of MEMG, i.e., the extent of MEMG in dependency of exerted force during unilateral isometric contractions are insufficiently investigated in terms of LE. Furthermore, it still remains elusive if and how MEMG is affected by long-term exercise training. Here, we provide novel quantitative evidence for physiological MEMG in homologous muscles of LE (tibialis anterior (TA), rectus femoris (RF)) during submaximal unilateral dorsiflexion in healthy young adults. Furthermore, endurance athletes (EA, n = 11) show a higher extent of MEMG in LE compared to non-athletes (NA, n = 11) at high force demands (80% MVC, maximum voluntary contraction). While the underlying neurophysiological mechanisms of MEMG still remain elusive, our study indicates, at least indirectly, that sport-related long-term training might affect the amount of MEMG during strong isometric contractions specifically in trained limbs. To support this assumption of exercise-induced limb-specific MEMG modulation, future studies including different sports disciplines with contrasting movement patterns and parameters should additionally be performed. PMID:29085288

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

PubMed

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

2014-11-01

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

Efficacy of Mirror Therapy Containing Functional Tasks in Poststroke Patients

PubMed Central

2016-01-01

Objective To investigate the effect of mirror therapy containing functional tasks on upper extremity function and activities of daily living in patients with subacute stroke. Methods The subjects were randomly divided into two groups: the mirror therapy group (30 patients) and the sham therapy group (30 patients). The mirror therapy group underwent a mirror therapy program together with conventional therapy for 20 minutes per day on 5 days per week for 4 weeks. The control group received a sham conventional therapy program under the same schedule as the mirror therapy group. The Fugl-Meyer Motor Function Assessment (FMA), Brunnstrom motor recovery stage, and Modified Barthel Index (MBI) were evaluated 4 weeks after the treatment. Results The upper extremity function on the affected side and ability to perform daily life activities after the intervention were significantly improved in both groups. After 4 weeks of intervention, improvements in the FMA (p=0.027) and MBI (p=0.041) were significantly greater in the mirror therapy group than the sham therapy group. Conclusion In this study, we found that the mirror therapy containing functional task was effective in terms of improving the upper extremity functions and activities of daily living in patients with subacute stroke. PMID:27606269

Efficacy of Mirror Therapy Containing Functional Tasks in Poststroke Patients.

PubMed

Lim, Kil-Byung; Lee, Hong-Jae; Yoo, Jeehyun; Yun, Hyun-Ju; Hwang, Hye-Jung

2016-08-01

To investigate the effect of mirror therapy containing functional tasks on upper extremity function and activities of daily living in patients with subacute stroke. The subjects were randomly divided into two groups: the mirror therapy group (30 patients) and the sham therapy group (30 patients). The mirror therapy group underwent a mirror therapy program together with conventional therapy for 20 minutes per day on 5 days per week for 4 weeks. The control group received a sham conventional therapy program under the same schedule as the mirror therapy group. The Fugl-Meyer Motor Function Assessment (FMA), Brunnstrom motor recovery stage, and Modified Barthel Index (MBI) were evaluated 4 weeks after the treatment. The upper extremity function on the affected side and ability to perform daily life activities after the intervention were significantly improved in both groups. After 4 weeks of intervention, improvements in the FMA (p=0.027) and MBI (p=0.041) were significantly greater in the mirror therapy group than the sham therapy group. In this study, we found that the mirror therapy containing functional task was effective in terms of improving the upper extremity functions and activities of daily living in patients with subacute stroke.

Use of quadrupedal step training to re-engage spinal interneuronal networks and improve locomotor function after spinal cord injury.

PubMed

Shah, Prithvi K; Garcia-Alias, Guillermo; Choe, Jaehoon; Gad, Parag; Gerasimenko, Yury; Tillakaratne, Niranjala; Zhong, Hui; Roy, Roland R; Edgerton, V Reggie

2013-11-01

Can lower limb motor function be improved after a spinal cord lesion by re-engaging functional activity of the upper limbs? We addressed this issue by training the forelimbs in conjunction with the hindlimbs after a thoracic spinal cord hemisection in adult rats. The spinal circuitries were more excitable, and behavioural and electrophysiological analyses showed improved hindlimb function when the forelimbs were engaged simultaneously with the hindlimbs during treadmill step-training as opposed to training only the hindlimbs. Neuronal retrograde labelling demonstrated a greater number of propriospinal labelled neurons above and below the thoracic lesion site in quadrupedally versus bipedally trained rats. The results provide strong evidence that actively engaging the forelimbs improves hindlimb function and that one likely mechanism underlying these effects is the reorganization and re-engagement of rostrocaudal spinal interneuronal networks. For the first time, we provide evidence that the spinal interneuronal networks linking the forelimbs and hindlimbs are amenable to a rehabilitation training paradigm. Identification of this phenomenon provides a strong rationale for proceeding toward preclinical studies for determining whether training paradigms involving upper arm training in concert with lower extremity training can enhance locomotor recovery after neurological damage.

Assessment of the ability of wheelchair subjects with spinal cord injury to perform a specific protocol of shoulder training: a pilot study.

PubMed

Merolla, Giovanni; Dellabiancia, Fabio; Filippi, Maria Vittoria; De Santis, Elisa; Alpi, Daniele; Magrini, Paola; Porcellini, Giuseppe

2014-04-01

a regular program of exercises in subjects with spinal cord injury (SCI) can contribute to reduce the risk of upper extremities injuries. in this prospective laboratory study we tested the hypothesis that a training machine developed for able-body users is suitable for a shoulder training protocol in 11 paraplegic subjects with SCI. Overall subjects were assessed with the SCIM III, CS, DASH and standard shoulder examination. We set a protocol of shoulder exercises performed with a training machine. Overall subjects were able to perform the protocol but 2 did not complete the exercises n° 6 and 7. The position of the wheelchair during each exercise was recorded. Wheelchair position/loading level were significantly correlated with the protocol n° 2, 3 and 5 as well as BMI/loading level for the exercises n° 5 and 9 and age/loading level for the exercise n° 7. Clinical scores were neither correlated with loading nor with anthropometric data. FROM THE ANALYSIS OF DATA COLLECTED IN THIS STUDY ARISED THAT: 1) the training machine needs some adjustments for paraplegic subjects, 2) the training protocol was appropriate except for the exercises needing a torso-rotation and 3) the template for wheelchair position may be a valid guide for an optimal paraplegic shoulder training.

High School Weight Training: A Comprehensive Program.

ERIC Educational Resources Information Center

Viscounte, Roger; Long, Ken

1989-01-01

Describes a weight training program, suitable for the general student population and the student-athlete, which is designed to produce improvement in specific, measurable areas including bench press (upper body), leg press (lower body), vertical jump (explosiveness); and 40-yard dash (speed). Two detailed charts are included, with notes on their…

Effects of resistance training on muscle strength, exercise capacity, and mobility in middle-aged and elderly patients with coronary artery disease: A meta-analysis.

PubMed

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.

Effects of Ving Tsun Chinese Martial Art Training on Upper Extremity Muscle Strength and Eye-Hand Coordination in Community-Dwelling Middle-Aged and Older Adults: A Pilot Study.

PubMed

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.

Effects of Ving Tsun Chinese Martial Art Training on Upper Extremity Muscle Strength and Eye-Hand Coordination in Community-Dwelling Middle-Aged and Older Adults: A Pilot Study

PubMed Central

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

Identifying barriers to recovery from work related upper extremity disorders: use of a collaborative problem solving technique.

PubMed

Shaw, William S; Feuerstein, Michael; Miller, Virginia I; Wood, Patricia M

2003-08-01

Improving health and work outcomes for individuals with work related upper extremity disorders (WRUEDs) may require a broad assessment of potential return to work barriers by engaging workers in collaborative problem solving. In this study, half of all nurse case managers from a large workers' compensation system were randomly selected and invited to participate in a randomized, controlled trial of an integrated case management (ICM) approach for WRUEDs. The focus of ICM was problem solving skills training and workplace accommodation. Volunteer nurses attended a 2 day ICM training workshop including instruction in a 6 step process to engage clients in problem solving to overcome barriers to recovery. A chart review of WRUED case management reports (n = 70) during the following 2 years was conducted to extract case managers' reports of barriers to recovery and return to work. Case managers documented from 0 to 21 barriers per case (M = 6.24, SD = 4.02) within 5 domains: signs and symptoms (36%), work environment (27%), medical care (13%), functional limitations (12%), and coping (12%). Compared with case managers who did not receive the training (n = 67), workshop participants identified more barriers related to signs and symptoms, work environment, functional limitations, and coping (p < .05), but not to medical care. Problem solving skills training may help focus case management services on the most salient recovery factors affecting return to work.

Back and upper extremity disorders among enlisted U.S. Marines: burden and individual risk factors.

PubMed

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.

Feasibility, Safety, and Preliminary Effectiveness of a Home-Based Self-Managed High-Intensity Interval Training Program Offered to Long-Term Manual Wheelchair Users.

PubMed

Gauthier, Cindy; Brosseau, Rachel; Hicks, Audrey L; Gagnon, Dany H

2018-01-01

To investigate and compare the feasibility, safety, and preliminary effectiveness of home-based self-managed manual wheelchair high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) programs. Eleven manual wheelchair users were randomly assigned to the HIIT ( n = 6) or the MICT group ( n = 5). Both six-week programs consisted of three 40-minute propulsion training sessions per week. The HIIT group alternated between 30 s high-intensity intervals and 60 s low-intensity intervals, whereas the MICT group maintained a constant moderate intensity. Cardiorespiratory fitness, upper limb strength, and shoulder pain were measured before and after the programs. Participants completed a questionnaire on the programs that explored general areas of feasibility. The answers to the questionnaire demonstrated that both training programs were feasible in the community. No severe adverse events occurred, although some participants experienced increased shoulder pain during HIIT. Neither program yielded a significant change in cardiorespiratory fitness or upper limb strength. However, both groups reported moderate to significant subjective improvement. Home-based wheelchair HIIT appears feasible and safe although potential development of shoulder pain remains a concern and should be addressed with a future preventive shoulder exercise program. Some recommendations have been proposed for a larger study aiming to strengthen evidence regarding the feasibility, safety, and effectiveness of HIIT.

Transcranial direct current stimulation combined with upper limb functional training in children with spastic, hemiparetic cerebral palsy: study protocol for a randomized controlled trial.

PubMed

Moura, Renata Calhes Franco; Santos, Cibele Almeida; Grecco, Luanda André Collange; Lazzari, Roberta Delasta; Dumont, Arislander Jonathan Lopes; Duarte, Natalia Carvalho de Almeida; Braun, Luiz Alfredo; Lopes, Jamile Benite Palma; Santos, Ligia Abram Dos; Rodrigues, Eliane Lopes Souza; Albertini, Giorgio; Cimolin, Veronica; Galli, Manuela; Oliveira, Claudia Santos

2016-08-17

The aim of the proposed study is to perform a comparative analysis of functional training effects for the paretic upper limb with and without transcranial direct current stimulation over the primary motor cortex in children with spastic hemiparetic cerebral palsy. The sample will comprise 34 individuals with spastic hemiparetic cerebral palsy, 6 to 16 years old, classified at level I, II, or III of the Manual Ability Classification System. Participants will be randomly allocated to two groups: (1) functional training of the paretic upper limb combined with anodic transcranial stimulation; (2) functional training of the paretic upper limb combined with sham transcranial stimulation. Evaluation will involve three-dimensional movement analysis and electromyography using the SMART-D 140® system (BTS Engineering) and the FREEEMG® system (BTS Engineering), the Quality of Upper Extremity Skills Test, to assess functional mobility, the Portable Device and Ashworth Scale, to measure movement resistance and spasticity, and the Pediatric Evaluation of Disability Inventory, to evaluate performance. Functional reach training of the paretic upper limb will include a range of manual activities using educational toys associated with an induced constraint of the non-paretic limb during the training. Training will be performed in five weekly 20-minute sessions for two weeks. Transcranial stimulation over the primary motor cortex will be performed during the training sessions at an intensity of 1 mA. Findings will be analyzed statistically considering a 5 % significance level (P ≤ 0.05). This paper presents a detailed description of a prospective, randomized, controlled, double-blind, clinical trial designed to demonstrate the effects of combining transcranial direct current stimulation over the primary motor cortex and functional training of the paretic limb in children with cerebral palsy classified at level I, II, or III of the Manual Ability Classification System. The results will be published and evidence found may contribute to the use of transcranial stimulation for this population. ReBEC RBR-6V4Y3K . Registered on 11 February 2015.

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

PubMed Central

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

2017-01-01

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

Intensive exercise program after spinal cord injury ("Full-On"): study protocol for a randomized controlled trial.

PubMed

Galea, Mary P; Dunlop, Sarah A; Davis, Glen M; Nunn, Andrew; Geraghty, Timothy; Hsueh, Ya-seng Arthur; Churilov, Leonid

2013-09-11

Rehabilitation after spinal cord injury (SCI) has traditionally involved teaching compensatory strategies for identified impairments and deficits in order to improve functional independence. There is some evidence that regular and intensive activity-based therapies, directed at activation of the paralyzed extremities, promotes neurological improvement. The aim of this study is to compare the effects of a 12-week intensive activity-based therapy program for the whole body with a program of upper body exercise. A multicenter, parallel group, assessor-blinded randomized controlled trial will be conducted. One hundred eighty-eight participants with spinal cord injury, who have completed their primary rehabilitation at least 6 months prior, will be recruited from five SCI units in Australia and New Zealand. Participants will be randomized to an experimental or control group. Experimental participants will receive a 12-week program of intensive exercise for the whole body, including locomotor training, trunk exercises and functional electrical stimulation-assisted cycling. Control participants will receive a 12-week intensive upper body exercise program. The primary outcome is the American Spinal Injuries Association (ASIA) Motor Score. Secondary outcomes include measurements of sensation, function, pain, psychological measures, quality of life and cost effectiveness. All outcomes will be measured at baseline, 12 weeks, 6 months and 12 months by blinded assessors. Recruitment commenced in January 2011. The results of this trial will determine the effectiveness of a 12-week program of intensive exercise for the whole body in improving neurological recovery after spinal cord injury. NCT01236976 (10 November 2010), ACTRN12610000498099 (17 June 2010).

Descriptive Epidemiology of Musculoskeletal Injuries in Naval Special Warfare Sea, Air, and Land Operators.

PubMed

Lovalekar, Mita; Abt, John P; Sell, Timothy C; Wood, Dallas E; Lephart, Scott M

2016-01-01

The purpose of this analysis was to describe medical chart reviewed musculoskeletal injuries among Naval Special Warfare Sea, Air, and Land Operators. 210 Operators volunteered (age: 28.1 ± 6.0 years, height: 1.8 ± 0.1 m, weight: 85.4 ± 9.3 kg). Musculoskeletal injury data were extracted from subjects' medical charts, and injuries that occurred during 1 year were described. Anatomic location of injury, cause of injury, activity when injury occurred, and injury type were described. The frequency of injuries was 0.025 per Operator per month. Most injuries involved the upper extremity (38.1% of injuries). Frequent anatomic sublocations for injuries were the shoulder (23.8%) and lumbopelvic region of the spine (12.7%). Lifting was the cause of 7.9% of injuries. Subjects were participating in training when 38.1% of injuries occurred and recreational activity/sports when 12.7% of injuries occurred. Frequent injury types were strain (20.6%), pain/spasm/ache (19.0%), fracture (11.1%), and sprain (11.1%). The results of this analysis underscore the need to investigate the risk factors, especially of upper extremity and physical activity related injuries, in this population of Operators. There is a scope for development of a focused, customized injury prevention program, targeting the unique injury profile of this population. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

Neither got a good bill of musculoskeletal health: a comparative study among medical and dental students.

PubMed

Coskun Benlidayi, Ilke; Al-Bayati, Zainb; Guzel, Rengin; Sarpel, Tunay

2018-06-06

It has been well established that musculoskeletal complaints are common among dentistry students. However, data regarding the comparison of overall musculoskeletal health between dental and medical students is scarce. The objective of the current study was to compare musculoskeletal health between medical and dental students. The population of the current study was comprised of fourth- and fifth-year students from medical and dental faculties of the same university who were at least three months in clinical training. Self-administered multi-item questionnaires regarding the musculoskeletal complaints were distributed to these students. A comparative analysis was carried out on the responses derived from the medical and dental students. A total of 219 students completed the questionnaire, yielding a response rate of 81.1%. Almost four fifth (80.4%) of the students reported musculoskeletal pain, with frequencies of 85.9 and 75.8% in dental and medical students, respectively (p > 0.05). Total, upper extremity and neck VAS scores were significantly higher in dental students than those in medical students (p < 0.01, p < 0.001 and p < 0.05, respectively). The rate of mild-severe pain sufferers in the upper extremity was also higher among dental students (p < 0.001). Musculoskeletal pain is frequent in both medical and dental students. However, the intensity of pain - particularly for the upper extremity and neck - is higher among dental students. The findings of the current study might be attributed to the fact that dental education requires more physical burden during routine clinical training than medical education.

White matter microstructure changes induced by motor skill learning utilizing a body machine interface.

PubMed

Wang, Xue; Casadio, Maura; Weber, Kenneth A; Mussa-Ivaldi, Ferdinando A; Parrish, Todd B

2014-03-01

The purpose of this study is to identify white matter microstructure changes following bilateral upper extremity motor skill training to increase our understanding of learning-induced structural plasticity and enhance clinical strategies in physical rehabilitation. Eleven healthy subjects performed two visuo-spatial motor training tasks over 9 sessions (2-3 sessions per week). Subjects controlled a cursor with bilateral simultaneous movements of the shoulders and upper arms using a body machine interface. Before the start and within 2days of the completion of training, whole brain diffusion tensor MR imaging data were acquired. Motor training increased fractional anisotropy (FA) values in the posterior and anterior limbs of the internal capsule, the corona radiata, and the body of the corpus callosum by 4.19% on average indicating white matter microstructure changes induced by activity-dependent modulation of axon number, axon diameter, or myelin thickness. These changes may underlie the functional reorganization associated with motor skill learning. Copyright © 2013 Elsevier Inc. All rights reserved.

Implementation of a Surface Electromyography-Based Upper Extremity Exoskeleton Controller Using Learning from Demonstration.

PubMed

Siu, Ho Chit; Arenas, Ana M; Sun, Tingxiao; Stirling, Leia A

2018-02-05

Upper-extremity exoskeletons have demonstrated potential as augmentative, assistive, and rehabilitative devices. Typical control of upper-extremity exoskeletons have relied on switches, force/torque sensors, and surface electromyography (sEMG), but these systems are usually reactionary, and/or rely on entirely hand-tuned parameters. sEMG-based systems may be able to provide anticipatory control, since they interface directly with muscle signals, but typically require expert placement of sensors on muscle bodies. We present an implementation of an adaptive sEMG-based exoskeleton controller that learns a mapping between muscle activation and the desired system state during interaction with a user, generating a personalized sEMG feature classifier to allow for anticipatory control. This system is robust to novice placement of sEMG sensors, as well as subdermal muscle shifts. We validate this method with 18 subjects using a thumb exoskeleton to complete a book-placement task. This learning-from-demonstration system for exoskeleton control allows for very short training times, as well as the potential for improvement in intent recognition over time, and adaptation to physiological changes in the user, such as those due to fatigue.

Development of an instrument for assessing workstyle in checkout cashier work (BAsIK).

PubMed

Kjellberg, Katarina; Palm, Peter; Josephson, Malin

2012-01-01

Checkout cashier work consists of handling a large number of items during a work shift, which implies repetitive movements of the shoulders, arms and hands/wrists, and a high work rate. The work is associated with a high prevalence of disorders in the neck and upper extremity. The concept of workstyle explains how ergonomic and psychosocial factors interact in the development of work-related upper extremity disorders. The aim of the project was to develop an instrument for the occupational health services to be used in the efforts to prevent upper extremity disorders in checkout cashier work. The instrument is based on the workstyle concept and is intended to be used as a tool to identify high-risk workstyle and needs for interventions, such as training and education. The instrument, BAsIK, consists of four parts; a questionnaire about workstyle, an observation protocol for work technique, a checklist about the design of the checkout and a questionnaire about work organization. The instrument was developed by selecting workstyle items developed for office work and adapting them to checkout cashier work, discussions with researchers and ergonomists, focus-group interviews with cashiers, observations of video recordings of cashiers, and studies of existing guidelines and checklists.

Impact of whole-body rehabilitation in patients receiving chronic mechanical ventilation.

PubMed

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.

Implementation of a Surface Electromyography-Based Upper Extremity Exoskeleton Controller Using Learning from Demonstration

PubMed Central

Arenas, Ana M.; Sun, Tingxiao

2018-01-01

Upper-extremity exoskeletons have demonstrated potential as augmentative, assistive, and rehabilitative devices. Typical control of upper-extremity exoskeletons have relied on switches, force/torque sensors, and surface electromyography (sEMG), but these systems are usually reactionary, and/or rely on entirely hand-tuned parameters. sEMG-based systems may be able to provide anticipatory control, since they interface directly with muscle signals, but typically require expert placement of sensors on muscle bodies. We present an implementation of an adaptive sEMG-based exoskeleton controller that learns a mapping between muscle activation and the desired system state during interaction with a user, generating a personalized sEMG feature classifier to allow for anticipatory control. This system is robust to novice placement of sEMG sensors, as well as subdermal muscle shifts. We validate this method with 18 subjects using a thumb exoskeleton to complete a book-placement task. This learning-from-demonstration system for exoskeleton control allows for very short training times, as well as the potential for improvement in intent recognition over time, and adaptation to physiological changes in the user, such as those due to fatigue. PMID:29401754

Technology-assisted stroke rehabilitation in Mexico: a pilot randomized trial comparing traditional therapy to circuit training in a Robot/technology-assisted therapy gym.

PubMed

Bustamante Valles, Karla; Montes, Sandra; Madrigal, Maria de Jesus; Burciaga, Adan; Martínez, María Elena; Johnson, Michelle J

2016-09-15

Stroke rehabilitation in low- and middle-income countries, such as Mexico, is often hampered by lack of clinical resources and funding. To provide a cost-effective solution for comprehensive post-stroke rehabilitation that can alleviate the need for one-on-one physical or occupational therapy, in lower and upper extremities, we proposed and implemented a technology-assisted rehabilitation gymnasium in Chihuahua, Mexico. The Gymnasium for Robotic Rehabilitation (Robot Gym) consisted of low- and high-tech systems for upper and lower limb rehabilitation. Our hypothesis is that the Robot Gym can provide a cost- and labor-efficient alternative for post-stroke rehabilitation, while being more or as effective as traditional physical and occupational therapy approaches. A typical group of stroke patients was randomly allocated to an intervention (n = 10) or a control group (n = 10). The intervention group received rehabilitation using the devices in the Robot Gym, whereas the control group (n = 10) received time-matched standard care. All of the study subjects were subjected to 24 two-hour therapy sessions over a period of 6 to 8 weeks. Several clinical assessments tests for upper and lower extremities were used to evaluate motor function pre- and post-intervention. A cost analysis was done to compare the cost effectiveness for both therapies. No significant differences were observed when comparing the results of the pre-intervention Mini-mental, Brunnstrom Test, and Geriatric Depression Scale Test, showing that both groups were functionally similar prior to the intervention. Although, both training groups were functionally equivalent, they had a significant age difference. The results of all of the upper extremity tests showed an improvement in function in both groups with no statistically significant differences between the groups. The Fugl-Meyer and the 10 Meters Walk lower extremity tests showed greater improvement in the intervention group compared to the control group. On the Time Up and Go Test, no statistically significant differences were observed pre- and post-intervention when comparing the control and the intervention groups. For the 6 Minute Walk Test, both groups presented a statistically significant difference pre- and post-intervention, showing progress in their performance. The robot gym therapy was more cost-effective than the traditional one-to-one therapy used during this study in that it enabled therapist to train up to 1.5 to 6 times more patients for the approximately same cost in the long term. The results of this study showed that the patients that received therapy using the Robot Gym had enhanced functionality in the upper extremity tests similar to patients in the control group. In the lower extremity tests, the intervention patients showed more improvement than those subjected to traditional therapy. These results support that the Robot Gym can be as effective as traditional therapy for stroke patients, presenting a more cost- and labor-efficient option for countries with scarce clinical resources and funding. ISRCTN98578807 .

Fine finger motor skill training with exoskeleton robotic hand in chronic stroke: stroke rehabilitation.

PubMed

Ockenfeld, Corinna; Tong, Raymond K Y; Susanto, Evan A; Ho, Sze-Kit; Hu, Xiao-ling

2013-06-01

Background and Purpose. Stroke survivors often show a limited recovery in the hand function to perform delicate motions, such as full hand grasping, finger pinching and individual finger movement. The purpose of this study is to describe the implementation of an exoskeleton robotic hand together with fine finger motor skill training on 2 chronic stroke patients. Case Descriptions. Two post-stroke patients participated in a 20-session training program by integrating 10 minutes physical therapy, 20 minutes robotic hand training and 15 minutes functional training tasks with delicate objects(card, pen and coin). These two patients (A and B) had cerebrovascular accident at 6 months and 11 months respectively when enrolled in this study. Outcomes. The results showed that both patients had improvements in Fugl-Meyer assessment (FM), Action Research Arm Test (ARAT). Patients had better isolation of the individual finger flexion and extension based on the reduced muscle co-contraction from the electromyographic(EMG) signals and finger extension force after 20 sessions of training. Discussion. This preliminary study showed that by focusing on the fine finger motor skills together with the exoskeleton robotic hand, it could improve the motor recovery of the upper extremity in the fingers and hand function, which were showed in the ARAT. Future randomized controlled trials are needed to evaluate the clinical effectiveness.

Upper Respiratory Tract Diseases in Athletes in Different Sports Disciplines.

PubMed

Gałązka-Franta, Anna; Jura-Szołtys, Edyta; Smółka, Wojciech; Gawlik, Radosław

2016-12-01

Upper respiratory tract diseases in athletes are a very common medical problem. Training conditions in different sports disciplines increase the risk of upper respiratory disease. Epidemiological evidence suggests that heavy acute or chronic exercise is related to an increased incidence of upper respiratory tract infections in athletes. Regular physical exercise at high intensity may lead to transient immunosuppression due to high prevalence of allergic diseases in athletes. Regardless of the cause they can exclude athletes from the training program and significantly impair their performance. In the present work, the most common upper respiratory tract diseases in athletes taking into account the disciplines in which they most often occur were presented. The focus was laid on symptoms, diagnostic methods and pharmacotherapy. Moreover, preventive procedures which can help reduce the occurrence of upper respiratory tract disease in athletes were presented. Management according to anti-doping rules, criteria for return to training and competition as an important issues of athlete's health were discussed.

The utility of the KJOC score in professional baseball in the United States.

PubMed

Franz, Justin O; McCulloch, Patrick C; Kneip, Chris J; Noble, Philip C; Lintner, David M

2013-09-01

The Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow questionnaire has been shown by previous studies to be more sensitive than other validated subjective measurement tools in the detection of upper extremity dysfunction in overhead-throwing athletes. The primary objective was to establish normative data for KJOC scores in professional baseball players in the United States. The secondary objectives were to evaluate the effect of player age, playing position, professional competition level, history of injury, history of surgery, and time point of administration on the KJOC score. Cross-sectional study; Level of evidence, 3. From 2011 to 2012, a total of 203 major league and minor league baseball players within the Houston Astros professional baseball organization completed the KJOC questionnaire. The questionnaire was administered at 3 time points: spring training 2011, end of season 2011, and spring training 2012. The KJOC scores were analyzed for significant differences based on player age, injury history, surgery history, fielding position, competition level, self-reported playing status, and time point of KJOC administration. The average KJOC score among healthy players with no history of injury was 97.1 for major league players and 96.8 for minor league players. The time point of administration did not significantly affect the final KJOC score (P = .224), and KJOC outcomes did not vary with player age (r = -0.012; P = .867). Significantly lower average KJOC scores were reported by players with a history of upper extremity injury (86.7; P < .001) and upper extremity surgery (75.4; P < .0001). The KJOC results did vary with playing position (P = .0313), with the lowest average scores being reported by pitchers (90.9) and infielders (91.3). This study establishes a quantitative baseline for the future evaluation of professional baseball players with the KJOC score. Age and time of administration had no significant effect on the outcome of the KJOC score. Missed practices or games within the previous year because of injury were the most significant demographic predictors of lower KJOC scores. The KJOC score was shown to be a sensitive measurement tool for detecting subtle changes in the upper extremity performance of the professional baseball population studied.

The effect of sensory-motor training on hand and upper extremity sensory and motor function in patients with idiopathic Parkinson disease.

PubMed

Taghizadeh, Ghorban; Azad, Akram; Kashefi, Sepiede; Fallah, Soheila; Daneshjoo, Fatemeh

2017-11-14

Blinded randomized controlled trial. Patients with Parkinson disease (PD) have sensory problems, but there is still no accurate understanding of the effects of sensory-motor interventions on PD. To investigate the effects of sensory-motor training (SMT) on hand and upper extremity sensory and motor function in patients with PD. Forty patients with PD were allocated to the SMT group or the control group (CG) (mean ages ± standard deviation: SMT, 61.05 ± 13.9 years; CG, 59.15 ± 11.26 years). The CG received the common rehabilitation therapies, whereas the SMT group received SMT. The SMT included discrimination of temperatures, weights, textures, shapes, and objects and was performed 5 times each week for 2 weeks. Significantly reducing the error rates in the haptic object recognition test (dominant hand [DH]: F = 15.36, P = .001, and effect size [ES] = 0.29; nondominant hand [NDH]: F = 9.33, P = .004, and ES = 0.21) and the error means in the wrist proprioception sensation test (DH: F = 9.11, P = .005, and ES = 0.19; NDH: F = 13.04, P = .001, and ES = 0.26) and increasing matched objects in the hand active sensation test (DH: F = 12.15, P = .001, and ES = 0.24; NDH: F = 5.03, P = .03, and ES = 0.12) founded in the SMT. Also, the DH (F = 6.65, P = .01, and ES = 0.15), both hands (F = 7.61, P = .009, and ES = 0.17), and assembly (F = 7.02, P = .01, and ES = 0.15) subtests of fine motor performance, as well as DH (F = 10.1, P = .003, and ES = 0.21) and NDH (F = 8.37, P = .006, and ES = 0.18) in upper extremity functional performance, were improved in the SMT. SMT improved hand and upper extremity sensory-motor function in patients with PD. The SMT group showed improved sensory and motor function. But these results were limited to levels 1 to 3 of the Hoehn and Yahr Scale. Copyright © 2017 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

Modified constraint-induced movement therapy for clients with chronic stroke: interrupted time series (ITS) design.

PubMed

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.

An evaluation of combat application tourniquets on training military personnel: changes in application times and success rates in three successive phases.

PubMed

Unlu, Aytekin; Kaya, E; Guvenc, I; Kaymak, S; Cetinkaya, R A; Lapsekili, E O; Ozer, M T; Guler, A; Yildiz, R; Petrone, P; Harlak, A; Kilic, S

2015-12-01

Haemorrhage from the injured extremity is a significant cause of preventable death in military settings. This study evaluated the effect of training on the efficacy of the combat application tourniquet (CAT) and to define standards for military personnel. Participants from a training tank battalion were randomised. Data collected included age, body mass index, mean arterial pressure, hand dominance, femoral artery diameter and skin thickness. The study involved tourniquet application times (AT) and application success rates in basic, after-training and eyes-closed phases. Doppler ultrasound was used to identify the presence or absence of popliteal, radial and ulnar artery pulses. A total of 102 trainees participated. In the after-training phase, the left and right upper extremity ATs were 35 ± 13.1 s, and 34.8 ± 13.5 s and the right and left lower extremity ATs were 20.6 ± 6.0 s and 20.5 ± 5.5 s, respectively. The overall tourniquet success rates in three successive study phases were 69.6%, 82.4% and 91.2%, respectively. A negative significant relationship was found between extremity circumference and tourniquet success. The results show that the efficacy of CAT application increases with training. Further studies are required to investigate the reasons underlying application failures. This single group prospective randomised study involves level of evidence 4. 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/

High-Speed Cycling Intervention Improves Rate-Dependent Mobility in Older Adults

PubMed Central

Bellumori, Maria; Uygur, Mehmet; Knight, Christopher A.

2016-01-01

PURPOSE The aim was to determine the feasibility of a six-week speed-based exercise program that could be used to initiate new exercise behaviors and improve rapid movement in older adults approaching frailty. METHODS The intervention group included 14 older adults (3 males, 11 females, mean (SD) age: 70 (7.6) years, height: 1.6 (.11) m, mass: 76.8 (12.0) kg, BMI: 27.7(4.7)). The control group included 12 older adults (6 males, 6 females, mean (SD) age: 69.2 (6.9) years, height: 1.7 (.09) m, mass: 78.2 (10.9) kg, BMI: 25.3 (2.7)). Subjects included active older adults, including regular exercisers, but none were engaged in sports or exercises with an emphasis on speed (e.g. cycling spin classes or tennis). Stationary recumbent cycling was selected to minimize fall risk and low pedaling resistance reduced musculoskeletal and cardiovascular load. Two weekly 30-minute exercise sessions consisted of interval training in which subjects pedaled at preferred cadence and performed ten 20-s fast cadence intervals separated by 40-s of active recovery at preferred cadence. RESULTS Significant Group by Time interactions (p<.05) supported a 2-s improvement in the timed up and go test and a 34% improvement in rapid isometric knee extension contractions in the exercise group but not in controls. Central neural adaptations are suggested because this lower extremity exercise program also elicited significant improvements in the untrained upper extremities of the exercise group (elbow extension RFD-SF and 9-Hole Peg Test, p<.05). CONCLUSION These results demonstrate that a relatively low dose of speed-based exercise can improve neuromuscular function and tests of mobility in older adults. Such a program serves as a sensible precursor to subsequent, more vigorous training or as an adjunct to a program where a velocity emphasis is lacking. PMID:27501360

Sequences of upper and lower extremity motions in javelin throwing.

PubMed

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.

A new therapeutic application of brain-machine interface (BMI) training followed by hybrid assistive neuromuscular dynamic stimulation (HANDS) therapy for patients with severe hemiparetic stroke: A proof of concept study.

PubMed

Kawakami, Michiyuki; Fujiwara, Toshiyuki; Ushiba, Junichi; Nishimoto, Atsuko; Abe, Kaoru; Honaga, Kaoru; Nishimura, Atsuko; Mizuno, Katsuhiro; Kodama, Mitsuhiko; Masakado, Yoshihisa; Liu, Meigen

2016-09-21

Hybrid assistive neuromuscular dynamic stimulation (HANDS) therapy improved paretic upper extremity motor function in patients with severe to moderate hemiparesis. We hypothesized that brain machine interface (BMI) training would be able to increase paretic finger muscle activity enough to apply HANDS therapy in patients with severe hemiparesis, whose finger extensor was absent. The aim of this study was to assess the efficacy of BMI training followed by HANDS therapy in patients with severe hemiparesis. Twenty-nine patients with chronic stroke who could not extend their paretic fingers were participated this study. We applied BMI training for 10 days at 40 min per day. The BMI detected the patients' motor imagery of paretic finger extension with event-related desynchronization (ERD) over the affected primary sensorimotor cortex, recorded with electroencephalography. Patients wore a motor-driven orthosis, which extended their paretic fingers and was triggered with ERD. When muscle activity in their paretic fingers was detected with surface electrodes after 10 days of BMI training, we applied HANDS therapy for the following 3 weeks. In HANDS therapy, participants received closed-loop, electromyogram-controlled, neuromuscular electrical stimulation (NMES) combined with a wrist-hand splint for 3 weeks at 8 hours a day. Before BMI training, after BMI training, after HANDS therapy and 3month after HANDS therapy, we assessed Fugl-Meyer Assessment upper extremity motor score (FMA) and the Motor Activity Log14-Amount of Use (MAL-AOU) score. After 10 days of BMI training, finger extensor activity had appeared in 21 patients. Eighteen of 21 patients then participated in 3 weeks of HANDS therapy. We found a statistically significant improvement in the FMA and the MAL-AOU scores after the BMI training, and further improvement was seen after the HANDS therapy. Combining BMI training with HANDS therapy could be an effective therapeutic strategy for severe UE paralysis after stroke.

Injuries and medical issues in softball.

PubMed

Briskin, Susannah M

2012-01-01

Softball is enjoyed by millions of female and male athletes of all ages and competitive levels. Windmill pitchers are at risk for developing overuse injuries in the throwing arm. Improper mechanics and lack of pitch counts may increase the risk for developing a pitching-related injury. Softball-related overuse injuries include proximal biceps tendinitis, upper extremity stress fractures, and ulnar neuritis. Acute injuries commonly occur in the lower extremity and include both fractures and ligamentous injuries. Sliding injuries account for a significant number of these lower extremity injuries. The addition of breakaway bases and mandatory use of protective headgear by defensive players may decrease acute injuries commonly seen in softball. Off-season programs should stress proper throwing and sliding mechanics, core conditioning, and a lower extremity neuromuscular education program.

Duplex sonography for detection of deep vein thrombosis of upper extremities: a 13-year experience.

PubMed

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.

The Effect of Self-directed Exercise Using a Task Board on Pain and Function in the Upper Extremities of Stroke Patients

PubMed Central

Lee, Han Suk; Kim, Jin Ung

2013-01-01

[Purpose] We evaluated the effect of self-directed exercise using a task board on function and pain in the upper extremities of stroke patients [Subjects and Methods] We used the one group pre-post test design. Seven stroke patients who were selected based on the inclusion criteria participated in the program once a week for 10 weeks. The self-directed exercise comprised 5 stages that were divided according to the level of difficulty. The exercise was performed for 60 minutes using a special task board that we designed. The FMA (Fugl-Meyer Motor Assessment), VAS (Visual Analogue Scale), and speed of stacking were assessed to evaluate the amount of use of the affected arm at before and after intervention. [Results] The scores of the VAS and FMA, but not that of the speed of stacking cups, were improved. There was no significant correlation between the changes in VAS, FMA, and the speed of stacking cups. [Conclusion] The findings suggest that self-directed exercise with the task board could improve the levels of function and pain in the upper extremities. We suggest that self-directed exercise can be utilized as a clinical rehabilitation program and improve therapeutic effects. PMID:24259894

Effects of physiotherapy combined with sirolimus in a patient with vascular malformation: A case report.

PubMed

Akbayrak, Türkan; Orhan, Ceren; Baran, Emine; Kaya, Serap; Coskun, Gürsoy; Varan, Ali

2016-01-01

The aim of the present case report was to investigate the effects of a physiotherapy program combined with sirolimus in a child patient with upper extremity edema and joint limitation due to low-flow vascular malformation. This case report included an 11-year-old male patient (26 kg, 130 cm) diagnosed with congenital lymphovascular malformation on the left and right chest. The patient, who had edema on the upper left extremity and experienced joint limitations, was administered complete decongestive therapy (CDT) and manual therapy in combination with sirolimus. Physiotherapy included a total of 24 sessions, 3 sessions a week for 8 weeks. Following the physiotherapy, the patient was assigned to a home therapy program, and then the maintenance phase of the CDT was initiated. Evaluations were carried out at baseline, at the end of week 8, and after 12 months. Following the physiotherapy program combined with sirolimus, a decrease in extremity volume, an increase in joint movement range, and an improvement in disease-related complaints were observed. Physiotherapy methods combined with sirolimus may be an effective treatment method in patients with vascular malformations. However, further studies with larger sample size are warranted.

Virtual rehabilitation in an activity centre for community-dwelling persons with stroke. The possibilities of 3-dimensional computer games.

PubMed

Broeren, Jurgen; Claesson, Lisbeth; Goude, Daniel; Rydmark, Martin; Sunnerhagen, Katharina S

2008-01-01

The main purpose of this study was to place a virtual reality (VR) system, designed to assess and to promote motor performance in the affected upper extremity in subjects after stroke, in a nonhospital environment. We also wanted to investigate if playing computer games resulted in improved motor function in persons with prior stroke. The intervention involved 11 patients after stroke who received extra rehabilitation by training on a computer 3 times a week during a 4-week period. The control group involved 11 patients after stroke who continued their previous rehabilitation (no extra computer training) during this period. The mean age of all was 68 years (range = 47-85) and the average time after stroke 66 months (range = 15-140). The VR training consisted of challenging games, which provided a range of difficulty levels that allow practice to be fun and motivating. An additional group of 11 right-handed aged matched individuals without history of neurological or psychiatric illnesses served as reference subjects. All the participants reported that they were novel computer game players. After an initial introduction they learned to use the VR system quickly. The treatment group demonstrated improvements in motor outcome for the trained upper extremity, but this was not detected in real-life activities. The results of this research suggest the usefulness of computer games in training motor performance. VR can be used beneficially not only by younger participants but also by older persons to enhance their motor performance after stroke. Copyright 2008 S. Karger AG, Basel.

Innovative approaches to the rehabilitation of upper extremity hemiparesis using virtual environments

PubMed Central

MERIANS, A. S.; TUNIK, E.; FLUET, G. G.; QIU, Q.; ADAMOVICH, S. V.

2017-01-01

Aim Upper-extremity interventions for hemiparesis are a challenging aspect of stroke rehabilitation. Purpose of this paper is to report the feasibility of using virtual environments (VEs) in combination with robotics to assist recovery of hand-arm function and to present preliminary data demonstrating the potential of using sensory manipulations in VE to drive activation in targeted neural regions. Methods We trained 8 subjects for 8 three hour sessions using a library of complex VE’s integrated with robots, comparing training arm and hand separately to training arm and hand together. Instrumented gloves and hand exoskeleton were used for hand tracking and haptic effects. Haptic Master robotic arm was used for arm tracking and generating three-dimensional haptic VEs. To investigate the use of manipulations in VE to drive neural activations, we created a “virtual mirror” that subjects used while performing a unimanual task. Cortical activation was measured with functional MRI (fMRI) and transcranial magnetic stimulation. Results Both groups showed improvement in kinematics and measures of real-world function. The group trained using their arm and hand together showed greater improvement. In a stroke subject, fMRI data suggested virtual mirror feedback could activate the sensorimotor cortex contralateral to the reflected hand (ipsilateral to the moving hand) thus recruiting the lesioned hemisphere. Conclusion Gaming simulations interfaced with robotic devices provide a training medium that can modify movement patterns. In addition to showing that our VE therapies can optimize behavioral performance, we show preliminary evidence to support the potential of using specific sensory manipulations to selectively recruit targeted neural circuits. PMID:19158659

Effects of Mirror Therapy in Stroke Patients With Complex Regional Pain Syndrome Type 1: A Randomized Controlled Study.

PubMed

Pervane Vural, Secil; Nakipoglu Yuzer, Guldal Funda; Sezgin Ozcan, Didem; Demir Ozbudak, Sibel; Ozgirgin, Nese

2016-04-01

To investigate the effects of mirror therapy on upper limb motor functions, spasticity, and pain intensity in patients with hemiplegia accompanied by complex regional pain syndrome type 1. Randomized controlled trial. Training and research hospital. Adult patients with first-time stroke and simultaneous complex regional pain syndrome type 1 of the upper extremity at the dystrophic stage (N=30). Both groups received a patient-specific conventional stroke rehabilitation program for 4 weeks, 5 d/wk, for 2 to 4 h/d. The mirror therapy group received an additional mirror therapy program for 30 min/d. We evaluated the scores of the Brunnstrom recovery stages of the arm and hand for motor recovery, wrist and hand subsections of the Fugl-Meyer Assessment (FMA) and motor items of the FIM-motor for functional status, Modified Ashworth Scale (MAS) for spasticity, and visual analog scale (VAS) for pain severity. After 4 weeks of rehabilitation, both groups had significant improvements in the FIM-motor and VAS scores compared with baseline scores. However, the scores improved more in the mirror therapy group than the control group (P<.001 and P=.03, respectively). Besides, the patients in the mirror therapy arm showed significant improvement in the Brunnstrom recovery stages and FMA scores (P<.05). No significant difference was found for MAS scores. In patients with stroke and simultaneous complex regional pain syndrome type 1, addition of mirror therapy to a conventional stroke rehabilitation program provides more improvement in motor functions of the upper limb and pain perception than conventional therapy without mirror therapy. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Upper Extremity Deep Vein Thromboses: The Bowler and the Barista.

PubMed

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.

Upper Extremity Deep Vein Thromboses: The Bowler and the Barista

PubMed Central

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

Dynamic trunk stabilization: a conceptual back injury prevention program for volleyball athletes.

PubMed

Smith, Chad E; Nyland, John; Caudill, Paul; Brosky, Joseph; Caborn, David N M

2008-11-01

The sport of volleyball creates considerable dynamic trunk stability demands. Back injury occurs all too frequently in volleyball, particularly among female athletes. The purpose of this clinical commentary is to review functional anatomy, muscle coactivation strategies, assessment of trunk muscle performance, and the characteristics of effective exercises for the trunk or core. From this information, a conceptual progressive 3-phase volleyball-specific training program is presented to improve dynamic trunk stability and to potentially reduce the incidence of back injury among volleyball athletes. Phase 1 addresses low-velocity motor control, kinesthetic awareness, and endurance, with the clinician providing cues to teach achievement of biomechanically neutral spine alignment. Phase 2 focuses on progressively higher velocity dynamic multiplanar endurance, coordination, and strength-power challenges integrating upper and lower extremity movements, while maintaining neutral spine alignment. Phase 3 integrates volleyball-specific skill simulations by breaking down composite movement patterns into their component parts, with differing dynamic trunk stability requirements, while maintaining neutral spine alignment. Prospective research is needed to validate the efficacy of this program.

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

PubMed

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

2006-12-01

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

Retention of movement pattern changes after a lower extremity injury prevention program is affected by program duration.

PubMed

Padua, Darin A; DiStefano, Lindsay J; Marshall, Stephen W; Beutler, Anthony I; de la Motte, Sarah J; DiStefano, Michael J

2012-02-01

Changes in movement patterns have been repeatedly observed immediately after completing a lower extremity injury prevention program. However, it is not known if movement pattern changes are maintained after discontinuing the training program. The ability to maintain movement pattern changes after training has ceased may be influenced by the program's duration. The authors hypothesized that among individuals who completed either a 3-month or 9-month training program and who demonstrated immediate movement pattern changes, only those who completed the 9-month training program would maintain movement pattern changes after a 3-month period of no longer performing the exercises. Cohort study; Level of evidence, 2. A total of 140 youth soccer athletes from 15 separate teams volunteered to participate. Athletes' movement patterns were assessed using the Landing Error Scoring System (LESS) at pretest, posttest, and 3 months after ceasing the program (retention test). Eighty-four of the original 140 participants demonstrated improvements in their LESS scores between pretest and posttest (change in LESS score >0) and were included in the final analyses for this study (n = 84; 20 boys and 64 girls; mean age, 14 ± 2 years; age range, 11-17 years). Teams performed 3-month (short-duration group) and 9-month (extended-duration group) injury prevention programs. The exercises performed were identical for both groups. Teams performed the programs as part of their normal warm-up routine. Although both groups improved their total LESS scores from pretest to posttest, only the extended-duration training group retained their improvements 3 months after ceasing the injury prevention program (F(2,137) = 3.38; P = .04). Results suggest that training duration may be an important factor to consider when designing injury prevention programs that facilitate long-term changes in movement control.

Physical and psychological benefits of a 24-week traditional dance program in breast cancer survivors.

PubMed

Kaltsatou, Antonia; Mameletzi, Dimitra; Douka, Stella

2011-04-01

The purpose of the present study was to evaluate the influence of a mixed exercise program, including Greek traditional dances and upper body training, in physical function, strength and psychological condition of breast cancer survivors. Twenty-seven women (N = 27), who had been diagnosed and surgically treated for breast cancer, volunteered to participate in this study. The experimental group consisted of 14 women with mean age 56.6 (4.2) years. They attended supervised Greek traditional dance courses and upper body training (1 h, 3 sessions/week) for 24 weeks. The control group consisted of 13 sedentary women with mean age 57.1 (4.1) years. Blood pressure, heart rate, physical function (6-min walking test), handgrip strength, arm volume and psychological condition (Life Satisfaction Inventory and Beck Depression Inventory) were evaluated before and after the exercise program. The results showed significant increases of 19.9% for physical function, 24.3% for right handgrip strength, 26.1% for left handgrip strength, 36.3% for life satisfaction and also a decrease of 35% for depressive symptoms in the experimental group after the training program. Significant reductions of 9% for left hand and 13.7% for right hand arm volume were also found in the experimental group. Consequently, aerobic exercise with Greek traditional dances and upper body training could be an alternative choice of physical activity for breast cancer survivors, thus promoting benefits in physical function, strength and psychological condition. Copyright © 2010 Elsevier Ltd. All rights reserved.

Muscle activation patterns of the upper and lower extremity during the windmill softball pitch.

PubMed

Oliver, Gretchen D; Plummer, Hillary A; Keeley, David W

2011-06-01

Fast-pitch softball has become an increasingly popular sport for female athletes. There has been little research examining the windmill softball pitch in the literature. The purpose of this study was to describe the muscle activation patterns of 3 upper extremity muscles (biceps, triceps, and rhomboids [scapular stabilizers]) and 2 lower extremity muscles (gluteus maximus and medius) during the 5 phases of the windmill softball pitch. Data describing muscle activation were collected on 7 postpubescent softball pitchers (age 17.7 ± 2.6 years; height 169 ± 5.4 cm; mass 69.1 ± 5.4 kg). Surface electromyographic data were collected using a Myopac Jr 10-channel amplifier (RUN Technologies Scientific Systems, Laguna Hills, CA, USA) synchronized with The MotionMonitor™ motion capture system (Innovative Sports Training Inc, Chicago IL, USA) and presented as a percent of maximum voluntary isometric contraction. Gluteus maximus activity reached (196.3% maximum voluntary isometric contraction [MVIC]), whereas gluteus medius activity was consistent during the single leg support of phase 3 (101.2% MVIC). Biceps brachii activity was greatest during phase 4 of the pitching motion. Triceps brachii activation was consistently >150% MVIC throughout the entire pitching motion, whereas the scapular stabilizers were most active during phase 2 (170.1% MVIC). The results of this study indicate the extent to which muscles are activated during the windmill softball pitch, and this knowledge can lead to the development of proper preventative and rehabilitative muscle strengthening programs. In addition, clinicians will be able to incorporate strengthening exercises that mimic the timing of maximal muscle activation most used during the windmill pitching phases.

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

PubMed Central

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

2009-01-01

SUMMARY Objective The study aimed to assess the relative importance of personal and occupational risk factors for upper-extremity musculoskeletal disorders (UEMSDs) in the working population. Methods A total of 3,710 workers (58% of men) participating in a surveillance program of MSDs in a French region in 2002–2005 were included. UEMSDs were diagnosed by 83 trained occupational physicians performing a standardized physical examination. Personal factors and work exposure were assessed by a self-administered questionnaire. Statistical associations between MSDs, personal and occupational factors were analyzed using logistic regression modeling. Results A total of 472 workers suffered from at least one UEMSD. The risk of UEMSDs increased with age for both genders (P<0.001) (O.R. up to 4.9 in men and 5.0 and in women) and in cases of prior history of UEMSDs (OR 3.1 and 5.0, P<0.001). In men, UEMSDs were associated with obesity (OR 2.2, P=0.014), high level of physical demand (OR 2.0, P<0.001), high repetitiveness of the task (OR 1.5, P=0.027), postures with the arms at or above shoulder level (OR 1.7, P=0.009) or with full elbow flexion (OR 1.6, P=0.006), and high psychological demand (O.R. 1.5, P=0.005). In women, UEMSDs were associated with diabetes mellitus (O.R. 4.9, P=0.001), postures with extreme wrist bending (OR 2.0, P<0.001), use of vibrating hand tools (O.R. 2.2, P=0.025) and low level of decision authority (OR 1.4, P=0.042). Conclusion The study showed that personal and work-related physical and psychosocial factors were strongly associated with clinically-diagnosed UEMSDs. PMID:19790112

Closed-Loop Neuroprosthesis for Reach-to-Grasp Assistance: Combining Adaptive Multi-channel Neuromuscular Stimulation with a Multi-joint Arm Exoskeleton.

PubMed

Grimm, Florian; Gharabaghi, Alireza

2016-01-01

Stroke patients with severe motor deficits cannot execute task-oriented rehabilitation exercises with their affected upper extremity. Advanced rehabilitation technology may support them in performing such reach-to-grasp movements. The challenge is, however, to provide assistance as needed, while maintaining the participants' commitment during the exercises. In this feasibility study, we introduced a closed-loop neuroprosthesis for reach-to-grasp assistance which combines adaptive multi-channel neuromuscular stimulation with a multi-joint arm exoskeleton. Eighteen severely affected chronic stroke patients were assisted by a gravity-compensating, seven-degree-of-freedom exoskeleton which was attached to the paretic arm for performing reach-to-grasp exercises resembling activities of daily living in a virtual environment. During the exercises, adaptive electrical stimulation was applied to seven different muscles of the upper extremity in a performance-dependent way to enhance the task-oriented movement trajectory. The stimulation intensity was individualized for each targeted muscle and remained subthreshold, i.e., induced no overt support. Closed-loop neuromuscular stimulation could be well integrated into the exoskeleton-based training, and increased the task-related range of motion (p = 0.0004) and movement velocity (p = 0.015), while preserving accuracy. The highest relative stimulation intensity was required to facilitate the grasping function. The facilitated range of motion correlated with the upper extremity Fugl-Meyer Assessment score of the patients (p = 0.028). Combining adaptive multi-channel neuromuscular stimulation with antigravity assistance amplifies the residual motor capabilities of severely affected stroke patients during rehabilitation exercises and may thus provide a customized training environment for patient-tailored support while preserving the participants' engagement.

Closed-Loop Neuroprosthesis for Reach-to-Grasp Assistance: Combining Adaptive Multi-channel Neuromuscular Stimulation with a Multi-joint Arm Exoskeleton

PubMed Central

Grimm, Florian; Gharabaghi, Alireza

2016-01-01

Stroke patients with severe motor deficits cannot execute task-oriented rehabilitation exercises with their affected upper extremity. Advanced rehabilitation technology may support them in performing such reach-to-grasp movements. The challenge is, however, to provide assistance as needed, while maintaining the participants' commitment during the exercises. In this feasibility study, we introduced a closed-loop neuroprosthesis for reach-to-grasp assistance which combines adaptive multi-channel neuromuscular stimulation with a multi-joint arm exoskeleton. Eighteen severely affected chronic stroke patients were assisted by a gravity-compensating, seven-degree-of-freedom exoskeleton which was attached to the paretic arm for performing reach-to-grasp exercises resembling activities of daily living in a virtual environment. During the exercises, adaptive electrical stimulation was applied to seven different muscles of the upper extremity in a performance-dependent way to enhance the task-oriented movement trajectory. The stimulation intensity was individualized for each targeted muscle and remained subthreshold, i.e., induced no overt support. Closed-loop neuromuscular stimulation could be well integrated into the exoskeleton-based training, and increased the task-related range of motion (p = 0.0004) and movement velocity (p = 0.015), while preserving accuracy. The highest relative stimulation intensity was required to facilitate the grasping function. The facilitated range of motion correlated with the upper extremity Fugl-Meyer Assessment score of the patients (p = 0.028). Combining adaptive multi-channel neuromuscular stimulation with antigravity assistance amplifies the residual motor capabilities of severely affected stroke patients during rehabilitation exercises and may thus provide a customized training environment for patient-tailored support while preserving the participants' engagement. PMID:27445658

Description of a multifaceted rehabilitation program including overground gait training for a child with cerebral palsy: A case report.

PubMed

Farrell, Elizabeth; Naber, Erin; Geigle, Paula

2010-01-01

This case describes the outcomes of a multifaceted rehabilitation program including body weight-supported overground gait training (BWSOGT) in a nonambulatory child with cerebral palsy (CP) and the impact of this treatment on the child's functional mobility. The patient is a nonambulatory 10-year-old female with CP who during an inpatient rehabilitation stay participated in direct, physical therapy 6 days per week for 5 weeks. Physical therapy interventions included stretching of her bilateral lower extremities, transfer training, bed mobility training, balance training, kinesiotaping, supported standing in a prone stander, two trials of partial weight-supported treadmill training, and for 4 weeks, three to five times per week, engaged in 30 minutes of BWSOGT using the Up n' go gait trainer, Lite Gait Walkable, and Rifton Pacer gait trainer. Following the multifaceted rehabilitation program, the patient demonstrated increased step initiation, increased weight bearing through bilateral lower extremities, improved bed mobility, and increased participation in transfers. The child's Gross Motor Functional Measure (GMFM) scores increased across four dimensions and her Physical Abilities and Mobility Scale (PAMS) increased significantly. This case report illustrates that a multifaceted rehabilitation program including BWSOGT was an effective intervention strategy to improve functional mobility in this nonambulatory child with CP.

Intensive exercise program after spinal cord injury (“Full-On”): study protocol for a randomized controlled trial

PubMed Central

2013-01-01

Background Rehabilitation after spinal cord injury (SCI) has traditionally involved teaching compensatory strategies for identified impairments and deficits in order to improve functional independence. There is some evidence that regular and intensive activity-based therapies, directed at activation of the paralyzed extremities, promotes neurological improvement. The aim of this study is to compare the effects of a 12-week intensive activity-based therapy program for the whole body with a program of upper body exercise. Methods/Design A multicenter, parallel group, assessor-blinded randomized controlled trial will be conducted. One hundred eighty-eight participants with spinal cord injury, who have completed their primary rehabilitation at least 6 months prior, will be recruited from five SCI units in Australia and New Zealand. Participants will be randomized to an experimental or control group. Experimental participants will receive a 12-week program of intensive exercise for the whole body, including locomotor training, trunk exercises and functional electrical stimulation-assisted cycling. Control participants will receive a 12-week intensive upper body exercise program. The primary outcome is the American Spinal Injuries Association (ASIA) Motor Score. Secondary outcomes include measurements of sensation, function, pain, psychological measures, quality of life and cost effectiveness. All outcomes will be measured at baseline, 12 weeks, 6 months and 12 months by blinded assessors. Recruitment commenced in January 2011. Discussion The results of this trial will determine the effectiveness of a 12-week program of intensive exercise for the whole body in improving neurological recovery after spinal cord injury. Trial registration NCT01236976 (10 November 2010), ACTRN12610000498099 (17 June 2010). PMID:24025260

A prehabilitation program for physically frail community-living older persons.

PubMed

Gill, Thomas M; Baker, Dorothy I; Gottschalk, Margaret; Gahbauer, Evelyne A; Charpentier, Peter A; de Regt, Paul T; Wallace, Sarah J

2003-03-01

To describe the development and implementation of a preventive, home-based physical therapy program (PREHAB) and to provide evidence for the safety and interrater reliability of the PREHAB protocol. Demonstration study. General community. Ninety-four physically frail, community-living persons, aged 75 years or older, who were randomized to the PREHAB program in a clinical trial. The PREHAB program built on the physical therapy component of 2 previous home-based protocols. A total of 223 assessment items were linked to 28 possible interventions, including progressive balance and conditioning exercises, by using detailed algorithms and decisions rules that were automated on notebook computers. The percentages of participants who were eligible for and who completed each intervention, the extent of progress noted in the balance and conditioning exercises, adherence to the training program, and adverse events. Participants who completed the PREHAB program and those who ended it prematurely received an average of 9.7 and 7.2 interventions during an average of 14.9 and 9.5 home visits, respectively. With few exceptions, the completion rate and interrater reliability for the specific interventions were high. Despite high self-reported adherence to the training program, the majority of participants did not advance beyond the initial Thera-Band level for the upper- and lower-extremity conditioning exercises, and only about a third advanced to the highest 2 levels of the balance exercises. Adverse events were no more common in the PREHAB group than in the educational control group. Our results support the feasibility and safety of the PREHAB program, but also show the special challenges and pitfalls of such a strategy when it is implemented among persons of advanced age and physical frailty. Copyright 2003 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Military Education: Improved Oversight and Management Needed for DOD's Fellowship and Training-with-Industry Programs. Report to Congressional Committees. GAO-12-367

ERIC Educational Resources Information Center

Farrell, Brenda S.

2012-01-01

The Department of Defense (DOD), which includes the military services, selects mid- to upper-career-level military officers to participate in fellowship and training-with-industry programs conducted at non-DOD organizations such as universities, think tanks, private corporations, federal agencies, and Congress. For some fellowships, the military…

The effects of Nordic Walking training on selected upper-body muscle groups in female-office workers: A randomized trial.

PubMed

Kocur, Piotr; Pospieszna, Barbara; Choszczewski, Daniel; Michalowski, Lukasz; Wiernicka, Marzena; Lewandowski, Jacek

2017-01-01

Regular Nordic Walking training could improve fitness and reduce tenderness in selected muscle groups in office workers. An assessment of the effects of a 12-week Nordic Walking training program on the perceived pain threshold (PPT) and the flexibility of selected upper-body muscle groups in postmenopausal female office workers. 39 office workers were selected at random for the treatment group (NWg, n = 20) and the control group (Cg, n = 19). The persons from the NW group completed a 12-week Nordic Walking training program (3 times a week/1 hour). PPTs measurements in selected muscles and functional tests evaluating upper-body flexibility (Back Scratch - BS) were carried out twice in every participant of the study: before and after the training program. A significant increase in PPT (kg/cm2) was observed in the following muscles in the NW group only: upper trapezius (from 1,32 kg/cm2 to 1,99 kg/cm2), mid trapezius (from 2,92 kg/cm2 to 3,30 kg/cm2), latissimus dorsi (from 1,66 kg/cm2 to 2,21 kg/cm2) and infraspinatus (from 1,63 kg/cm2 to 2,93 kg/cm2). Moreover, a significant improvement in the BS test was noted in the NW group compared with the control group (from -1,16±5,7 cm to 2,18±5,1 cm in the NW group vs from -2,52±6,1 to -2,92±6,2 in the control group). A 12-week Nordic Walking training routine improves shoulder mobility and reduces tenderness in the following muscles: trapezius pars descendens and middle trapezius, infraspinatus and latissimus dorsi, in female office workers.

Adaptations to a new physical training program in the combat controller training pipeline.

PubMed

Walker, Thomas B; Lennemann, Lynette M; Anderson, Vint; Lyons, William; Zupan, Michael F

2011-01-01

The United States Air Force combat controller (CCT) training pipeline is extremely arduous and historically has a high attrition rate of 70 to 80%. The primary objective of this study was to evaluate the impact of incorporating a 711 Human Performance Wing (HPW) / Biobehavior, Bioassessment, and Biosurveillance Branch (RHPF)-developed physical fitness-training program into the combat controller (CCT) 5-level training physical fitness program. One-hundred-nine CCT trainees were tested and trained during their initial eight weeks at the 720th Special Tactics Training Squadron (STTS) at Hurlburt Field. Modifications to their physical training program were principally aimed at reducing overtraining and overuse injury, educating trainees and cadre on how to train smarter, and transitioning from traditional to "functional" PT. A battery of physiological measurements and a psychological test were administered prior to and immediately after trainees undertook an 8-week modified physical fitness training program designed to reduce overtraining and injury and improve performance. We performed multiple physical tests for cardiovascular endurance (VO₂max and running economy), "anaerobic" capacity (Wingate power and loaded running tests), body composition (skinfolds), power (Wingate and vertical jump), and reaction time (Makoto eye-hand test). We used the Mental Toughness Questionnaire 48 (MTQ-48) for the psychological test. We observed several significant improvements in physical and physiological performance over the eight weeks of training. Body composition improved by 16.2% (p < 0.05). VO₂max, time-to-exhaustion, and ventilatory threshold were all significantly higher after implementation of the new program than before it. We observed strong trends towards improvement in work accomplished during loaded running (p = 0.07) and in average power per body mass during lower body Wingate (p = 0.08). Other measures of lower body power did not change significantly over the training period, but did show mild trends towards improvement. Upper body average and peak power per kilogram of body mass both improved significantly by 5.8% and 8.1%, respectively. Reaction time was significantly better posttraining as demonstrated by a 7% improvement during the reactive test. Reactive accuracy also improved significantly with the post test accuracy percentage jumping from 61% to 76%. Furthermore, overuse injuries, a major source of attrition fell by a dramatic 67%. The modifications resulted in significant improvement in trainees? graduation rate. In the eight classes prior to implementation of these changes, average CCT graduating class size was nine trainees. For the eight classes following the changes, average CCT graduating class rose to 16.5 trainees, an increase of 83%. Due to its success, STTS leadership expanded the modifications from the eight weeks prior to CDS to include the entire second year of the pipeline. 2011.

[Effect of disease severity on upper extremity muscle strength, exercise capacity, and activities of daily living in individuals with pulmonary arterial hypertension].

PubMed

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.

Reducing musculoskeletal disorders among computer operators: comparison between ergonomics interventions at the workplace.

PubMed

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

2012-01-01

Typing is associated with musculoskeletal disorders (MSDs) caused by multiple risk factors. This control study aimed to evaluate the efficacy of a workplace intervention for reducing MSDs among computer workers. Sixty-six subjects with and without MSD were assigned consecutively to one of three groups: ergonomics intervention (work site and body posture adjustments, muscle activity training and exercises) accompanied with biofeedback training, the same ergonomics intervention without biofeedback and a control group. Evaluation of MSDs, body posture, psychosocial status, upper extremity (UE) kinematics and muscle surface electromyography were carried out before and after the intervention in the workplace and the motion lab. Our main hypothesis that significant differences in the reduction of MSDs will exist between subjects in the study groups and controls was confirmed (χ(2) = 13.3; p = 0.001). Significant changes were found in UE kinematics and posture as well. Both ergonomics interventions effectively reduced MSD and improved body posture. This study aimed to test the efficacy of an individual workplace intervention programme among computer workers by evaluating musculoskeletal disorders (MSDs), body posture, upper extremity kinematics, muscle activity and psychosocial factors were tested. The proposed ergonomics interventions effectively reduced MSDs and improved body posture.

Pilot study of a targeted dance class for physical rehabilitation in children with cerebral palsy.

PubMed

López-Ortiz, Citlali; Egan, Tara; Gaebler-Spira, Deborah J

2016-01-01

This pilot study evaluates the effects of a targeted dance class utilizing classical ballet principles for rehabilitation of children with cerebral palsy on balance and upper extremity control. Twelve children with cerebral palsy (ages 7-15 years) with Gross Motor Function Classification scores II-IV participated in this study and were assigned to either a control group or targeted dance class group. Targeted dance class group participated in 1-h classes three times per week in a 4-week period. The Pediatric Balance Scale and the Quality of Upper Extremity Skills Test were administered before, after, and 1 month after the targeted dance class. Improvements in the Pediatric Balance Scale were present in the targeted dance class group in before versus after and before versus 1 month follow-up comparisons (p-value = 0.0088 and p-value = 0.019, respectively). The Pediatric Balance Scale changes were not significant in the control group. The Quality of Upper Extremity Skills Test did not reach statistical differences in either group. Classical ballet as an art form involves physical training, musical accompaniment, social interactions, and emotional expression that could serve as adjunct to traditional physical therapy. This pilot study demonstrated improvements in balance control. A larger study with a more homogeneous sample is warranted.

Clinical management practices adopted by physiotherapists in India for chronic obstructive pulmonary disease: A national survey.

PubMed

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.

Soccer-Specific Warm-Up and Lower Extremity Injury Rates in Collegiate Male Soccer Players

PubMed Central

Grooms, Dustin R.; Palmer, Thomas; Onate, James A.; Myer, Gregory D.; Grindstaff, Terry

2013-01-01

Context: A number of comprehensive injury-prevention programs have demonstrated injury risk-reduction effects but have had limited adoption across athletic settings. This may be due to program noncompliance, minimal exercise supervision, lack of exercise progression, and sport specificity. A soccer-specific program described as the F-MARC 11+ was developed by an expert group in association with the Federation Internationale de Football Association (FIFA) Medical Assessment and Research Centre (F-MARC) to require minimal equipment and implementation as part of regular soccer training. The F-MARC 11+ has been shown to reduce injury risk in youth female soccer players but has not been evaluated in an American male collegiate population. Objective: To investigate the effects of a soccer-specific warm-up program (F-MARC 11+) on lower extremity injury incidence in male collegiate soccer players. Design: Cohort study. Setting: One American collegiate soccer team followed for 2 seasons. Patients or Other Participants: Forty-one male collegiate athletes aged 18–25 years. Intervention(s): The F-MARC 11+ program is a comprehensive warm-up program targeting muscular strength, body kinesthetic awareness, and neuromuscular control during static and dynamic movements. Training sessions and program progression were monitored by a certified athletic trainer. Main Outcome Measure(s): Lower extremity injury risk and time lost to lower extremity injury. Results: The injury rate in the referent season was 8.1 injuries per 1000 exposures with 291 days lost and 2.2 injuries per 1000 exposures and 52 days lost in the intervention season. The intervention season had reductions in the relative risk (RR) of lower extremity injury of 72% (RR = 0.28, 95% confidence interval = 0.09, 0.85) and time lost to lower extremity injury (P < .01). Conclusions: This F-MARC 11+ program reduced overall risk and severity of lower extremity injury compared with controls in collegiate-aged male soccer athletes. PMID:23848519

New control strategies for neuroprosthetic systems.

PubMed

Crago, P E; Lan, N; Veltink, P H; Abbas, J J; Kantor, C

1996-04-01

The availability of techniques to artificially excite paralyzed muscles opens enormous potential for restoring both upper and lower extremity movements with neuroprostheses. Neuroprostheses must stimulate muscle, and control and regulate the artificial movements produced. Control methods to accomplish these tasks include feedforward (open-loop), feedback, and adaptive control. Feedforward control requires a great deal of information about the biomechanical behavior of the limb. For the upper extremity, an artificial motor program was developed to provide such movement program input to a neuroprosthesis. In lower extremity control, one group achieved their best results by attempting to meet naturally perceived gait objectives rather than to follow an exact joint angle trajectory. Adaptive feedforward control, as implemented in the cycle-to-cycle controller, gave good compensation for the gradual decrease in performance observed with open-loop control. A neural network controller was able to control its system to customize stimulation parameters in order to generate a desired output trajectory in a given individual and to maintain tracking performance in the presence of muscle fatigue. The authors believe that practical FNS control systems must exhibit many of these features of neurophysiological systems.

[Effects of an inpatient pulmonary rehabilitation program on dyspnea, exercise capacity, and health related quality of life for patients with chronic lung disease].

PubMed

Lee, Chang Kwan

2007-04-01

The purpose of this study was to examine the effects of an inpatient pulmonary rehabilitation program on dyspnea, exercise capacity, and health related quality of life in inpatients with chronic lung disease. This quasi experimental study was designed with a nonequivalent control group pre-post test time series. Twenty three patients were assigned to the experimental group and nineteen to the control group. The inpatient pulmonary rehabilitation program was composed of upper and lower extremity exercise, breathing retraining, inspiratory muscle training, education, relaxation and telephone contacts. This program consisted of 4 sessions with inpatients and 4 weeks at home after discharge. The control group was given a home based pulmonary rehabilitation program at the time of discharge. The outcomes were measured by the Borg score, 6MWD and the Chronic Respiratory Disease Questionnaire(CRQ). There was a statistically significant difference in dyspnea between the experimental group and control group, but not among time sequence, or interaction between groups and time sequence. Also significant improvements in exercise capacity and health related quality of life were found only in the experimental group. An Inpatient pulmonary rehabilitation program may be a useful intervention to reduce dyspnea, and increase exercise capacity and health related quality of life for chronic lung disease patients.

Effectiveness of an upper extremity exercise device integrated with computer gaming for aerobic training in adolescents with spinal cord dysfunction.

PubMed

Widman, Lana M; McDonald, Craig M; Abresch, R Ted

2006-01-01

To determine whether a new upper extremity exercise device integrated with a video game (GameCycle) requires sufficient metabolic demand and effort to induce an aerobic training effect and to explore the feasibility of using this system as an exercise modality in an exercise intervention. Pre-post intervention. University-based research facility. SUBJECT POPULATION: A referred sample of 8 adolescent subjects with spina bifida (4 girls, 15.5 +/- 0.6 years; 4 boys, 17.5 +/- 0.9 years) was recruited to participate in the project. All subjects had some level of mobility impairment that did not allow them to participate in mainstream sports available to their nondisabled peers. Five subjects used a wheelchair full time, one used a wheelchair occasionally, but walked with forearm crutches, and 2 were fully ambulatory, but had impaired gait. Peak oxygen uptake, maximum work output, aerobic endurance, peak heart rate, rating of perceived exertion, and user satisfaction. Six of the 8 subjects were able to reach a Vo2 of at least 50% of their Vo2 reserve while using the GameCycle. Seven of the 8 subjects reached a heart rate of at least 50% of their heart rate reserve. One subject did not reach either 50% of Vo2 reserve or 50% of heart rate reserve. Seven of the 8 subjects increased their maximum work capability after training with the GameCycle at least 3 times per week for 16 weeks. The data suggest that the GameCycle seems to be adequate as an exercise device to improve oxygen uptake and maximum work capability in adolescents with lower extremity disability caused by spinal cord dysfunction. The subjects in this study reported that the video game component was enjoyable and provided a motivation to exercise.

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

PubMed

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

2015-02-01

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

Effects of a Strength Training Session After an Exercise Inducing Muscle Damage on Recovery Kinetics.

PubMed

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.

Operative Treatment of Lymphedema Using Suction-Assisted Lipectomy.

PubMed

Greene, Arin K; Maclellan, Reid A

2016-09-01

Surgical management of lymphedema includes removal of affected tissues (excisional procedures), or operations that create new lymphatic connections (physiologic procedures). The purpose of this study was to determine the efficacy of one type of excisional procedure, suction-assisted lipectomy, for extremity lymphedema. Patients treated in our Lymphedema Program between 2007 and 2015 with liposuction that had postoperative follow-up were reviewed. The diagnosis of lymphedema was made by history/physical examination and confirmed with lymphoscintigraphy. Patient sex, age, type of lymphedema (primary or secondary), location of disease, infection history, volume of lipoaspirate, and reduction of extremity volume were recorded. Fifteen patients were included, mean age was 45 years (range, 17-71). Six patients had secondary upper extremity lymphedema, and 9 patients had lower limb disease. Eight patients had a history of repeated cellulitis involving the lymphedematous extremity. Mean lipoaspirate volume was 1612 mL (range, 1200-2800) for the upper extremity and 2902 mL (range, 2000-4800) for the lower limb. Postoperative follow-up averaged 3.1 years. The mean reduction in excess extremity volume was 73% (range, 48% to 94%), and patients reported improvement in their quality of life. Suction-assisted lipectomy is an effective technique to reduce extremity volume for patients with lymphedema.

Physician decision-making in the management of work related upper extremity injuries.

PubMed

Szekeres, Mike; Macdermid, Joy C; Katchky, Adam; Grewal, Ruby

2018-05-22

Physicians working in a tertiary care injured worker clinic are faced with clinical decision-making that must balance the needs of patients and society in managing complex clinical problems that are complicated by the work-workplace context. The purpose of this study is to describe and characterize the decision-making process of upper extremity specialized surgeons when managing injured workers within a specialized worker's compensation clinic. Surgeons were interviewed in a semi-structured manner. Following each interview, the surgeon was also observed in a clinic visit during a new patient assessment, allowing observation of the interactional patterns between surgeon and patient, and comparison of the process described in the interview to what actually occurred during clinic visits. The primary central theme emerging from the surgeon interviews and the clinical observation was the focus on the importance of comprehensive assessment to make the first critical decision: an accurate diagnosis. Two subthemes were also found. The first of these involved the decision whether to proceed to management strategies or to continue with further investigation if the correct diagnosis is uncertain. Once the central theme of diagnosis was achieved, a second subtheme was highlighted; selecting appropriate management options, given the complexities of managing the injured worker, the workplace, and the compensation board. This study illustrates that upper extremity surgeons rely on their training and experience with upper extremity conditions to follow a sequential but iterative decision-making process to provide a more definitive diagnosis and treatment plan for workers with injuries that are often complex. The surgeons are challenged by the context which takes them out of their familiar zone of typical clinical practice to deal with the interactions between the injury, worker, work, workplace and insurer.

Effects of Subsonic Aircraft on Aerosols and Cloudiness in the Upper Troposphere and Lower Stratosphere

NASA Technical Reports Server (NTRS)

Detwiler, Andrew G.

1997-01-01

This work was accomplished primarily by Allison G. Wozniak, a graduate research assistant who has completed the Master of Science in Meteorology program at the South Dakota School of Mines and Technology. Ms. Wozniak was guided and assisted in her work by L. R. Johnson and the principal investigator. Invaluable guidance was supplied by Dr. James Holdeman, NASA Lewis, the manager of the Global Atmospheric Sampling Program (GASP). Dr. Gregory Nastrom, St. Cloud (Minnesota) State University, who has used the GASP data set to provide unique views of the distribution of ozone, clouds, and atmospheric waves and turbulence, in the upper troposphere/lower stratosphere region, was also extremely helpful. Finally, Dr. Terry Deshler, University of Wyoming, supplied observations from the university's upper atmospheric monitoring program for comparison to GASP data.

Elbow joint fatigue and bench-press training.

PubMed

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.

Mirror therapy enhances upper extremity motor recovery in stroke patients.

PubMed

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

2015-12-01

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

The recovery of running ability in an adolescent male after traumatic brain injury: a case study.

PubMed

Moriello, Gabriele; Frear, Matthew; Seaburg, Kristin

2009-06-01

The purpose of this case study was to document outcomes after a rehabilitation program in an adolescent male after traumatic brain injury. Three years after sustaining an injury in a skiing accident, a 17-year-old boy participated in a rehabilitation program with the goal of acquiring the ability to run one mile with his peers. On initial evaluation, the individual had significant left lower extremity weakness, impaired standing balance, limited endurance, and running limitations. He was able to run 10 m wearing a plastic ankle-foot orthosis on the left side but required supervision for safety. The intervention included strength training once weekly for 17 weeks, body weight-supported, treadmill-based locomotor training once weekly for 15 weeks followed by a combination of overground locomotor training and strengthening exercise once weekly for six weeks. After the intervention, muscle strength of the lower extremities increased and the individual was able to run one mile independently. The quality of his running improved, with better mechanics to absorb forces at impact during the absorption phase and increased lower extremity extension during the propulsion phase. A rehabilitation program consisting of strengthening and locomotor training improved running speed, quality, and endurance in an adolescent male after traumatic brain injury. He was able to progress to a less restrictive carbon fiber brace as a result of gains in lower extremity strength. This change in ability allowed him to participate in physical education by running on a track and playing softball with his peers.

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

PubMed

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

1993-04-01

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

Summary of comprehensive systematic review: Rehabilitation in multiple sclerosis

PubMed Central

Haselkorn, Jodie K.; Hughes, Christina; Rae-Grant, Alex; Henson, Lily Jung; Bever, Christopher T.; Lo, Albert C.; Brown, Theodore R.; Kraft, George H.; Getchius, Thomas; Gronseth, Gary; Armstrong, Melissa J.; Narayanaswami, Pushpa

2015-01-01

Objective: To systematically review the evidence regarding rehabilitation treatments in multiple sclerosis (MS). Methods: We systematically searched the literature (1970–2013) and classified articles using 2004 American Academy of Neurology criteria. Results: This systematic review highlights the paucity of well-designed studies, which are needed to evaluate the available MS rehabilitative therapies. Weekly home/outpatient physical therapy (8 weeks) probably is effective for improving balance, disability, and gait (MS type unspecified, participants able to walk ≥5 meters) but probably is ineffective for improving upper extremity dexterity (1 Class I). Inpatient exercises (3 weeks) followed by home exercises (15 weeks) possibly are effective for improving disability (relapsing-remitting MS [RRMS], primary progressive MS [PPMS], secondary progressive MS [SPMS], Expanded Disability Status Scale [EDSS] 3.0–6.5) (1 Class II). Six weeks' worth of comprehensive multidisciplinary outpatient rehabilitation possibly is effective for improving disability/function (PPMS, SPMS, EDSS 4.0–8.0) (1 Class II). Motor and sensory balance training or motor balance training (3 weeks) possibly is effective for improving static and dynamic balance, and motor balance training (3 weeks) possibly is effective for improving static balance (RRMS, SPMS, PPMS) (1 Class II). Breathing-enhanced upper extremity exercises (6 weeks) possibly are effective for improving timed gait and forced expiratory volume in 1 second (RRMS, SPMS, PPMS, mean EDSS 4.5); this change is of unclear clinical significance. This technique possibly is ineffective for improving disability (1 Class II). Inspiratory muscle training (10 weeks) possibly improves maximal inspiratory pressure (RRMS, SPMS, PPMS, EDSS 2–6.5) (1 Class II). PMID:26598432

Effects of combined endurance and strength training on muscle strength, power and hypertrophy in 40-67-year-old men.

PubMed

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.

The Responsiveness and Correlation between Fugl-Meyer Assessment, Motor Status Scale, and the Action Research Arm Test in Chronic Stroke with Upper-Extremity Rehabilitation Robotic Training

ERIC Educational Resources Information Center

Wei, Xi-Jun; Tong, Kai-yu; Hu, Xiao-ling

2011-01-01

Responsiveness of clinical assessments is an important element in the report of clinical effectiveness after rehabilitation. The correlation could reflect the validity of assessments as an indication of clinical performance before and after interventions. This study investigated the correlation and responsiveness of Fugl-Meyer Assessment (FMA),…

Effect of duration of upper- and lower-extremity rehabilitation sessions and walking speed on recovery of interlimb coordination in hemiplegic gait.

PubMed

Kwakkel, Gert; Wagenaar, Robert C

2002-05-01

The effects of different durations of rehabilitation sessions for the upper extremities (UEs) and lower extremities (LEs) on the recovery of interlimb coordination in hemiplegic gait in patients who have had a stroke were investigated. Fifty-three subjects who had strokes involving their middle cerebral arteries were assigned to rehabilitation programs with (1) an emphasis on the LEs, (2) an emphasis on the paretic UE, or (3) a condition in which the paretic arm (UE) and leg (LE) were immobilized with an inflatable pressure splint (control treatment). The 3 treatment regimens were applied for 30 minutes, 5 days a week, during the first 20 weeks after onset of stroke. All subjects also participated in a rehabilitation program 5 days a week that consisted of 15 minutes of UE exercises and 15 minutes of LE exercises in addition to a weekly 11/2-hour session of training in activities of daily living. A repeated-measures design was used. Differences among the 3 treatment regimens were evaluated in terms of comfortable and maximal walking speeds. In addition, mean continuous relative phase (CRP) between paretic arm and leg (PAL) movements and nonparetic arm and leg (NAL) movements and standard deviations of CRP of both limb pairs as a measurement of stability (variability) were evaluated. Comfortable walking speed improved in the group that received interventions involving the LEs compared with the group that received interventions involving the UEs and the group that received the control treatment. No differences among the 3 treatment conditions were found for the mean CRP of NAL and PAL as well as the standard deviation of CRP of both limb pairs. With the exception of an improved comfortable walking speed as a result of a longer duration of rehabilitation sessions, no differential effects of duration of rehabilitation sessions for the LEs and UEs on the variable we measured related to hemiplegic gait were found. Increasing walking speed, however, resulted in a larger mean CRP for both limb pairs, with increased stability and asymmetry of walking, indicating that walking speed influences interlimb coordination in hemiplegic gait.

Continuous and interval training programs using deep water running improves functional fitness and blood pressure in the older adults.

PubMed

Reichert, Thaís; Kanitz, Ana Carolina; Delevatti, Rodrigo Sudatti; Bagatini, Natália Carvalho; Barroso, Bruna Machado; Kruel, Luiz Fernando Martins

2016-02-01

This study aimed to investigate the effects of two periodized training programs of deep water running on functional fitness and blood pressure in the older adults. Thirty-six individuals were divided into continuous group (CONT) and interval group (INT). Both groups were trained for 28 weeks (twice weekly). Measures were performed before the training period, after 12 weeks and training period. Two-way ANOVA and post hoc of Bonferroni were used (α = 0.05). There were no differences between groups in functional tests, with the exception of the flexibility of the upper limbs, in which the INT group showed the highest values. There was a significant improvement in both groups of foot up-and-go test (CONT 6.45 to 5.67; INT 6.59 to 5.78, in seconds), flexibility of lower limbs (CONT -4.76 to -0.61; INT 0.54 to 4.63, in centimeters), strength of upper (CONT 18.76 to 27.69; INT 18.66 to 26.58, in repetitions) and lower limbs (CONT 14.46 to 21.23; INT 14.40 to 21.58, in repetitions), and 6-min walk (CONT 567.50 to 591.16; INT 521.41 to 582.77, in meters). No differences were shown between groups for systolic blood pressure; however, diastolic blood pressure remained higher in CONT during all training. The blood pressure decreased significantly in both groups after the training (CONT 142 ± 16/88 ± 3 to 125 ± 14/77 ± 7 mmHg; INT 133 ± 15/75 ± 7 to 123 ± 17 and 69 ± 11 mmHg). Both programs of deep water running training promoted improvements of similar magnitude in all parameters of functional fitness, with the exception of flexibility of upper limbs, and decreased blood pressure in the older individuals.

A training platform for many-dimensional prosthetic devices using a virtual reality environment

PubMed Central

Putrino, David; Wong, Yan T.; Weiss, Adam; Pesaran, Bijan

2014-01-01

Brain machine interfaces (BMIs) have the potential to assist in the rehabilitation of millions of patients worldwide. Despite recent advancements in BMI technology for the restoration of lost motor function, a training environment to restore full control of the anatomical segments of an upper limb extremity has not yet been presented. Here, we develop a virtual upper limb prosthesis with 27 independent dimensions, the anatomical dimensions of the human arm and hand, and deploy the virtual prosthesis as an avatar in a virtual reality environment (VRE) that can be controlled in real-time. The prosthesis avatar accepts kinematic control inputs that can be captured from movements of the arm and hand as well as neural control inputs derived from processed neural signals. We characterize the system performance under kinematic control using a commercially available motion capture system. We also present the performance under kinematic control achieved by two non-human primates (Macaca Mulatta) trained to use the prosthetic avatar to perform reaching and grasping tasks. This is the first virtual prosthetic device that is capable of emulating all the anatomical movements of a healthy upper limb in real-time. Since the system accepts both neural and kinematic inputs for a variety of many-dimensional skeletons, we propose it provides a customizable training platform for the acquisition of many-dimensional neural prosthetic control. PMID:24726625

Effects of robot-assisted training on upper limb functional recovery during the rehabilitation of poststroke patients.

PubMed

Daunoraviciene, Kristina; Adomaviciene, Ausra; Grigonyte, Agne; Griškevičius, Julius; Juocevicius, Alvydas

2018-05-18

The study aims to determine the effectiveness of robot-assisted training in the recovery of stroke-affected arms using an exoskeleton robot Armeo Spring. To identify the effect of robot training on functional recovery of the arm. A total of 34 stroke patients were divided into either an experimental group (EG; n= 17) or a control group (n= 17). EG was also trained to use the Armeo Spring during occupational therapy. Both groups were clinically assessed before and after treatment. Statistical comparison methods (i.e. one-tailed t-tests for differences between two independent means and the simplest test) were conducted to compare motor recovery using robot-assisted training or conventional therapy. Patients assigned to the EG showed a statistically significant improvement in upper extremity motor function when compared to the CG by FIM (P< 0.05) and ACER (P< 0.05). The calculated treatment effect in the EG and CG was meaningful for shoulder and elbow kinematic parameters. The findings show the benefits of robot therapy in two areas of functional recovery. Task-oriented robotic training in rehabilitation setting facilitates recovery not only of the motor function of the paretic arm but also of the cognitive abilities in stroke patients.

Haptically facilitated bimanual training combined with augmented visual feedback in moderate to severe hemiplegia.

PubMed

Boos, Amy; Qiu, Qinyin; Fluet, Gerard G; Adamovich, Sergei V

2011-01-01

This study describes the design and feasibility testing of a hand rehabilitation system that provides haptic assistance for hand opening in moderate to severe hemiplegia while subjects attempt to perform bilateral hand movements. A cable-actuated exoskeleton robot assists the subjects in performing impaired finger movements but is controlled by movement of the unimpaired hand. In an attempt to combine the neurophysiological stimuli of bilateral movement and action observation during training, visual feedback of the impaired hand is replaced by feedback of the unimpaired hand, either by using a sagittaly oriented mirror or a virtual reality setup with a pair of virtual hands presented on a flat screen controlled with movement of the unimpaired hand, providing a visual image of their paretic hand moving normally. Joint angles for both hands are measured using data gloves. The system is programmed to maintain a symmetrical relationship between the two hands as they respond to commands to open and close simultaneously. Three persons with moderate to severe hemiplegia secondary to stroke trained with the system for eight, 30 to 60 minute sessions without adverse events. Each demonstrated positive motor adaptations to training. The system was well tolerated by persons with moderate to severe upper extremity hemiplegia. Further testing of its effects on motor ability with a broader range of clinical presentations is indicated.

The effects of adding single-joint exercises to a multi-joint exercise resistance training program on upper body muscle strength and size in trained men.

PubMed

de França, Henrique Silvestre; Branco, Paulo Alexandre Nordeste; Guedes Junior, Dilmar Pinto; Gentil, Paulo; Steele, James; Teixeira, Cauê Vazquez La Scala

2015-08-01

The aim of this study was compare changes in upper body muscle strength and size in trained men performing resistance training (RT) programs involving multi-joint plus single-joint (MJ+SJ) or only multi-joint (MJ) exercises. Twenty young men with at least 2 years of experience in RT were randomized in 2 groups: MJ+SJ (n = 10; age, 27.7 ± 6.6 years) and MJ (n = 10; age, 29.4 ± 4.6 years). Both groups trained for 8 weeks following a linear periodization model. Measures of elbow flexors and extensors 1-repetition maximum (1RM), flexed arm circumference (FAC), and arm muscle circumference (AMC) were taken pre- and post-training period. Both groups significantly increased 1RM for elbow flexion (4.99% and 6.42% for MJ and MJ+SJ, respectively), extension (10.60% vs 9.79%, for MJ and MJ+SJ, respectively), FAC (1.72% vs 1.45%, for MJ and MJ+SJ, respectively), and AMC (1.33% vs 3.17% for MJ and MJ+SJ, respectively). Comparison between groups revealed no significant difference in any variable. In conclusion, 8 weeks of RT involving MJ or MJ+SJ resulted in similar alterations in muscle strength and size in trained participants. Therefore, the addition of SJ exercises to a RT program involving MJ exercises does not seem to promote additional benefits to trained men, suggesting MJ-only RT to be a time-efficient approach.

Association Between Brain-Derived Neurotrophic Factor Genotype and Upper Extremity Motor Outcome After Stroke.

PubMed

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.

The GRONORUN 2 study: effectiveness of a preconditioning program on preventing running related injuries in novice runners. The design of a randomized controlled trial.

PubMed

Bredeweg, Steef W; Zijlstra, Sjouke; Buist, Ida

2010-09-01

Distance running is a popular recreational exercise. It is a beneficial activity for health and well being. However, running may also cause injuries, especially of the lower extremities. In literature there is no agreement what intrinsic and extrinsic factors cause running related injuries (RRIs). In theory, most RRIs are elicited by training errors, this too much, too soon. In a preconditioning program runners can adapt more gradually to the high mechanical loads of running and will be less susceptible to RRIs. In this study the effectiveness of a 4-week preconditioning program on the incidence of RRIs in novice runners prior to a training program will be studied. The GRONORUN 2 (Groningen Novice Running) study is a two arm randomized controlled trial studying the effect of a 4-week preconditioning (PRECON) program in a group of novice runners. All participants wanted to train for the recreational Groningen 4-Mile running event. The PRECON group started a 4-week preconditioning program with walking and hopping exercises 4 weeks before the start of the training program. The control (CON) and PRECON group started a frequently used 9-week training program in preparation for the Groningen 4-Mile running event.During the follow up period participants registered their running exposure, other sporting activities and running related injuries in an Internet based running log. The primary outcome measure was the number of RRIs. RRI was defined as a musculoskeletal ailment or complaint of the lower extremities or back causing a restriction on running for at least three training sessions. The GRONORUN 2 study will add important information to the existing running science. The concept of preconditioning is easy to implement in existing training programs and will hopefully prevent RRIs especially in novice runners. The Netherlands National Trial Register NTR1906. The NTR is part of the WHO Primary Registries.

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

PubMed

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

2011-01-01

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

Prevalence of injuries among young adults in sport centers: relation to the type and pattern of activity.

PubMed

Lubetzky-Vilnai, A; Carmeli, E; Katz-Leurer, M

2009-12-01

The rate of injuries resulting from physical exercise in sport centers as well as related factors has not yet been described. The aims of this study were to describe the prevalence of self-reported activity-specific injuries, to identify the relations between injury profile and different types and patterns of physical activity and to assess whether gender is a modifying variable in that connection. Four hundred and fifty-seven men and women aged 20-35 years participated in this cross-sectional study. A questionnaire was used to evaluate the types and patterns of physical activity performed in the 12 months preceding the study and sports injuries sustained during that time. One hundred and ninety of the 457 subjects reported an injury as a result of exercising (41.6%). A relationship was found between weight training and injuries of the upper extremity (UE) for men and between spinning classes and knee injuries for women. Among those who participated in weight-training exercises, more frequent and longer duration exercise was associated with UE injury, and among those who participated in spinning classes more frequent exercise was associated with knee injury. Future injury prevention programs in sport centers should pay special attention to men who participate in weight training and to women who participate in spinning classes.

Pediatric dermatology training survey of United States dermatology residency programs.

PubMed

Nijhawan, Rajiv I; Mazza, Joni M; Silverberg, Nanette B

2014-01-01

Variability exists in pediatric dermatology education for dermatology residents. We sought to formally assess the pediatric dermatology curriculum and experience in a dermatology residency program. Three unique surveys were developed for dermatology residents, residency program directors, and pediatric dermatology fellowship program directors. The surveys consisted of questions pertaining to residency program characteristics. Sixty-three graduating third-year residents, 51 residency program directors, and 18 pediatric dermatology fellowship program directors responded. Residents in programs with one or more full-time pediatric dermatologist were more likely to feel very competent treating children and were more likely to be somewhat or extremely satisfied with their pediatric curriculums than residents in programs with no full-time pediatric dermatologist (50.0% vs 5.9%, p = 0.002, and 85.3% vs 52.9%, p < 0.001, respectively). Residents in programs with no full-time pediatric dermatologist were the only residents who were somewhat or extremely dissatisfied with their pediatric training. Residency program directors were more satisfied with their curriculums when there was one or more pediatric dermatologist on staff (p < 0.01). Residents in programs with pediatric dermatology fellowships were much more likely to report being extremely satisfied than residents in programs without a pediatric dermatology fellowship (83.3% vs 21.2%; p < 0.001). The results of this survey support the need for dermatology residency programs to continue to strengthen their pediatric dermatology curriculums, especially through the recruitment of full-time pediatric dermatologists. © 2013 Wiley Periodicals, Inc.

Integrating Advanced Physical Training Programs into the Marine Corps

DTIC Science & Technology

2009-02-20

all of which are available to the public for use. However, the most popular training program amongst Marines is CrossFit6. While CrossFit is a...the CrossFit program and consequently a fee is required to participate in the CrossFit 3 P90X, Extreme Body Workout, (unknown... CrossFit : Forging Elite Fitness, (unknown, CrossFit : Forging Elite Fitness n.d.), CrossFit , as advertised on its website, is a principal strength and

An advanced rehabilitation robotic system for augmenting healthcare.

PubMed

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.

Compensatory strategies during manual wheelchair propulsion in response to weakness in individual muscle groups: A simulation study.

PubMed

Slowik, Jonathan S; McNitt-Gray, Jill L; Requejo, Philip S; Mulroy, Sara J; Neptune, Richard R

2016-03-01

The considerable physical demand placed on the upper extremity during manual wheelchair propulsion is distributed among individual muscles. The strategy used to distribute the workload is likely influenced by the relative force-generating capacities of individual muscles, and some strategies may be associated with a higher injury risk than others. The objective of this study was to use forward dynamics simulations of manual wheelchair propulsion to identify compensatory strategies that can be used to overcome weakness in individual muscle groups and identify specific strategies that may increase injury risk. Identifying these strategies can provide rationale for the design of targeted rehabilitation programs aimed at preventing the development of pain and injury in manual wheelchair users. Muscle-actuated forward dynamics simulations of manual wheelchair propulsion were analyzed to identify compensatory strategies in response to individual muscle group weakness using individual muscle mechanical power and stress as measures of upper extremity demand. The simulation analyses found the upper extremity to be robust to weakness in any single muscle group as the remaining groups were able to compensate and restore normal propulsion mechanics. The rotator cuff muscles experienced relatively high muscle stress levels and exhibited compensatory relationships with the deltoid muscles. These results underline the importance of strengthening the rotator cuff muscles and supporting muscles whose contributions do not increase the potential for impingement (i.e., the thoracohumeral depressors) and minimize the risk of upper extremity injury in manual wheelchair users. Copyright © 2016 Elsevier Ltd. All rights reserved.

Compensatory Strategies during Manual Wheelchair Propulsion in Response to Weakness in Individual Muscle Groups: A Simulation Study

PubMed Central

Slowik, Jonathan S.; McNitt-Gray, Jill L.; Requejo, Philip S.; Mulroy, Sara J.; Neptune, Richard R.

2016-01-01

Background The considerable physical demand placed on the upper extremity during manual wheelchair propulsion is distributed among the individual muscles. The strategy used to distribute the workload is likely influenced by the relative force-generating capacities of individual muscles, and some strategies may be associated with a higher injury risk than others. The objective of this study was to use forward dynamics simulations of manual wheelchair propulsion to identify compensatory strategies that can be used to overcome weakness in individual muscle groups and identify specific strategies that may increase injury risk. Identifying these strategies can provide rationale for the design of targeted rehabilitation programs aimed at preventing the development of pain and injury in manual wheelchair users. Methods Muscle-actuated forward dynamics simulations of manual wheelchair propulsion were analyzed to identify compensatory strategies in response to individual muscle group weakness, using individual muscle mechanical power and stress as measures of upper extremity demand. Findings The simulation analyses found the upper extremity to be robust to weakness in any single muscle group as the remaining groups were able to compensate and restore normal propulsion mechanics. The rotator cuff muscles experienced relatively high muscle stress levels and exhibited compensatory relationships with the deltoid muscles. Interpretation These results underline the importance of strengthening the rotator cuff muscles and supporting muscles whose contributions do not increase the potential for impingement (i.e., the thoracohumeral depressors) and minimize the risk of upper extremity injury in manual wheelchair users. PMID:26945719

Know How to Teach Me… Evaluating the Effects of an In-Service Training Program for Regular School Teachers toward Inclusive Education

ERIC Educational Resources Information Center

Srivastava, Meenakshi; de Boer, Anke A.; Pijl, Sip Jan

2015-01-01

Teachers are seen as key players in implementing inclusive education. However, extremely little attention has been paid to teacher preparation, particularly in India. The aim of the current study was to implement a teacher training program and evaluate its effects and appropriateness. This focused on increasing teachers' (a) attitudes, (b)…

Resistance Training Reduces Force Tremor and Improves Manual Dexterity in Older Individuals With Essential Tremor.

PubMed

Kavanagh, Justin J; Wedderburn-Bisshop, Jacob; Keogh, Justin W L

2016-01-01

Although symptoms of Essential Tremor (ET) are typically controlled with medication, it is of interest to explore additional therapies to assist with functionality. The purpose of this study was to determine if a generalized upper limb resistance training (RT) program improves manual dexterity and reduces force tremor in older individuals with ET. Ten Essential Tremor and 9 controls were recruited into a dual group, pretest-posttest intervention study. Participants performed 6 weeks of upper-limb RT, and battery of manual dexterity and isometric force tremor assessments were performed before and after the RT to determine the benefits of the program. The six-week, high-load, RT program produced strength increases in each limb for the ET and healthy older group. These changes in strength aligned with improvements in manual dexterity and tremor-most notably for the ET group. The least affected limb and the most affected limb exhibited similar improvements in functional assessments of manual dexterity, whereas reductions in force tremor amplitude following the RT program were restricted to the most affected limb of the ET group. These findings suggest that generalized upper limb RT program has the potential to improve aspects of manual dexterity and reduce force tremor in older ET patients.

Upper-extremity and mobility subdomains from the Patient-Reported Outcomes Measurement Information System (PROMIS) adult physical functioning item bank.

PubMed

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.

Effectiveness of physical therapy interventions for children with cerebral palsy: A systematic review

PubMed Central

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

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

PubMed

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

2015-01-01

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

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

PubMed Central

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

2015-01-01

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

[Rhabdomyolysis in a well-trained woman after unusually intense exercise].

PubMed

Larsen, Christian; Jensen, Mogens Pfeiffer

2014-06-16

A 35-year-old woman was acutely hospitalized with oedema of the upper limbs, reduced force, severe movement reduction and muscle pain in both upper extremities. Her symptoms started after three days of intense exercise doing kayaking and a lot of pull-ups in crossfit. Rhabdomyolysis is a syndrome, characterized by muscle necrosis. Usually there is a marked elevation of creatine kinase (CK) concentration with symptoms as described and myoglobinuria (dark coloured urine). After hard muscular work there will often be asymptomatic, but significant elevations in CK concentration, and in rare cases life-threatening rhabdomyolysis with electrolyte imbalances and acute kidney failure.

Predictors of Upper-Extremity Physical Function in Older Adults.

PubMed

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.

Adaptive mixed reality rehabilitation improves quality of reaching movements more than traditional reaching therapy following stroke.

PubMed

Duff, Margaret; Chen, Yinpeng; Cheng, Long; Liu, Sheng-Min; Blake, Paul; Wolf, Steven L; Rikakis, Thanassis

2013-05-01

Adaptive mixed reality rehabilitation (AMRR) is a novel integration of motion capture technology and high-level media computing that provides precise kinematic measurements and engaging multimodal feedback for self-assessment during a therapeutic task. We describe the first proof-of-concept study to compare outcomes of AMRR and traditional upper-extremity physical therapy. Two groups of participants with chronic stroke received either a month of AMRR therapy (n = 11) or matched dosing of traditional repetitive task therapy (n = 10). Participants were right handed, between 35 and 85 years old, and could independently reach to and at least partially grasp an object in front of them. Upper-extremity clinical scale scores and kinematic performances were measured before and after treatment. Both groups showed increased function after therapy, demonstrated by statistically significant improvements in Wolf Motor Function Test and upper-extremity Fugl-Meyer Assessment (FMA) scores, with the traditional therapy group improving significantly more on the FMA. However, only participants who received AMRR therapy showed a consistent improvement in kinematic measurements, both for the trained task of reaching to grasp a cone and the untrained task of reaching to push a lighted button. AMRR may be useful in improving both functionality and the kinematics of reaching. Further study is needed to determine if AMRR therapy induces long-term changes in movement quality that foster better functional recovery.

Pilot study of a targeted dance class for physical rehabilitation in children with cerebral palsy

PubMed Central

López-Ortiz, Citlali; Egan, Tara; Gaebler-Spira, Deborah J

2016-01-01

Introduction: This pilot study evaluates the effects of a targeted dance class utilizing classical ballet principles for rehabilitation of children with cerebral palsy on balance and upper extremity control. Methods: Twelve children with cerebral palsy (ages 7–15 years) with Gross Motor Function Classification scores II–IV participated in this study and were assigned to either a control group or targeted dance class group. Targeted dance class group participated in 1-h classes three times per week in a 4-week period. The Pediatric Balance Scale and the Quality of Upper Extremity Skills Test were administered before, after, and 1 month after the targeted dance class. Results: Improvements in the Pediatric Balance Scale were present in the targeted dance class group in before versus after and before versus 1 month follow-up comparisons (p-value = 0.0088 and p-value = 0.019, respectively). The Pediatric Balance Scale changes were not significant in the control group. The Quality of Upper Extremity Skills Test did not reach statistical differences in either group. Conclusion: Classical ballet as an art form involves physical training, musical accompaniment, social interactions, and emotional expression that could serve as adjunct to traditional physical therapy. This pilot study demonstrated improvements in balance control. A larger study with a more homogeneous sample is warranted. PMID:27721977

Circuit Weight Training--An Answer to Achieving Physical Fitness?

ERIC Educational Resources Information Center

Cobleigh, Bruce; Kaufer, Irwin J.

1992-01-01

Describes a high school circuit weight training (CWT) program which promotes physical fitness and helps students understand relationships between health and physical activity. It consists of upper- and lower-body weight lifts and cardiorespiratory exercises. Research indicates that CWT improves even difficult to improve health-related components.…

Preparing Postbaccalaureates for Entry and Success in Biomedical PhD Programs

PubMed Central

Hall, Joshua D.; Harrell, Jessica R.; Cohen, Kimberley W.; Miller, Virginia L.; Phelps, Patricia V.; Cook, Jeanette G.

2016-01-01

Certain racial and ethnic groups, individuals with disabilities, and those from low socioeconomic backgrounds remain underrepresented (UR) in the biomedical sciences. This underrepresentation becomes more extreme at each higher education stage. To support UR scholars during the critical transition from baccalaureate to PhD, we established an intensive, 1-yr postbaccalaureate training program. We hypothesized that this intervention would strengthen each participant’s competitiveness for leading PhD programs and build a foundation of skills and self-efficacy important for success during and after graduate school. Scholar critical analysis skills, lab technique knowledge, and Graduate Record Examination scores all improved significantly during the program. Scholars reported significant confidence growth in 21 of 24 categories related to success in research careers. In 5 yr, 91% (41/45) of scholars transitioned directly into PhD programs. Importantly, 40% (18/45) of participating postbaccalaureate scholars had previously been declined acceptance into graduate school; however, 17/18 of these scholars directly entered competitive PhD programs following our training program. Alumni reported they were “extremely well” prepared for graduate school, and 95% (39/41) are currently making progress to graduation with a PhD. In conclusion, we report a model for postbaccalaureate training that could be replicated to increase participation and success among UR scholars in the biomedical sciences. PMID:27496358

Development of Korean Academy of Medical Sciences Guideline for rating physical disability of upper extremity.

PubMed

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.

Integrated versus isolated training of the hemiparetic upper extremity in haptically rendered virtual environments.

PubMed

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

2010-01-01

This paper describes the preliminary results of an ongoing study of the effects of two training approaches on motor function and learning in persons with hemi paresis due to cerebrovascular accidents. Eighteen subjects with chronic stroke performed eight, three-hour sessions of sensorimotor training in haptically renedered environments. Eleven subjects performed training activities that integrated hand and arm movement while another seven subjects performed activities that trained the hand and arm with separately. As a whole, the eighteen subjects made statistically significant improvements in motor function as evidenced by robust improvements in Wolf Motor Function Test times and corresponding improvements in Jebsen Test of Hand Function times. There were no significant between group effects for these tests. However, the two training approaches elicited different patterns and magnitudes of performance improvement that suggest that they may elicit different types of change in motor learning and or control.

Moving toward New Horizons for Marketing Education: Designing a Marketing Training for the Poor in Developing and Emerging Markets

ERIC Educational Resources Information Center

Teklehaimanot, Mebrahtu L.; Ingenbleek, Paul T. M.; Tessema, Workneh K.; van Trijp, Hans C. M.

2017-01-01

In recent years, marketing education has broadened to poor people in developing and emerging countries. In this article, the authors use four empirical studies that apply well-established training design procedures to design a marketing training program for Ethiopian pastoralists. Because pastoralists operate in extremely remote, traditional, and…

Constraint-induced movement therapy for children with hemiplegia after traumatic brain injury: a quantitative study.

PubMed

Cimolin, Veronica; Beretta, Elena; Piccinini, Luigi; Turconi, Anna Carla; Locatelli, Federica; Galli, Manuela; Strazzer, Sandra

2012-01-01

The aims of this study are to quantify the movement limitation of upper limbs in hemiplegic children with traumatic brain injury (TBI) by using a clinical-functional scale and upper limb kinematics and to evaluate the effectiveness of constraint-induced movement therapy (CIMT) on upper limbs. Pre-post study. Clinical rehabilitation research laboratory. Ten children with TBI. The participants were evaluated by clinical examinations (Gross Motor Function Measure, Besta scale, Quality of Upper Extremities Skills Test, and Manual Ability Classification System) and 3D kinematic movement analysis of the upper limb before the CIMT program (pretest: 0.7 years after the injury) and at the end of the program (posttest: 10 weeks later). After the CIMT, most of the clinical measures improved significantly. Some significant improvements were present in terms of kinematics, in particular, in the movement duration and the velocity of movement execution of both tasks; the index of curvature and the average jerk improved, respectively, during reaching and hand-to-mouth task, while the adjusting sway parameter decreased during the 2 movements. Significant improvements were found in upper limb joint excursion after the rehabilitative programme too. Our results suggest that the CIMT program can improve movement efficiency and upper limb function in children after TBI. The integration of the clinical outcomes and upper limb kinematics revealed to be crucial in detecting the effects of the CIMT programme.

Clinical concepts for treatment of the elbow in the adolescent overhead athlete.

PubMed

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.

Optimal bounds and extremal trajectories for time averages in nonlinear dynamical systems

NASA Astrophysics Data System (ADS)

Tobasco, Ian; Goluskin, David; Doering, Charles R.

2018-02-01

For any quantity of interest in a system governed by ordinary differential equations, it is natural to seek the largest (or smallest) long-time average among solution trajectories, as well as the extremal trajectories themselves. Upper bounds on time averages can be proved a priori using auxiliary functions, the optimal choice of which is a convex optimization problem. We prove that the problems of finding maximal trajectories and minimal auxiliary functions are strongly dual. Thus, auxiliary functions provide arbitrarily sharp upper bounds on time averages. Moreover, any nearly minimal auxiliary function provides phase space volumes in which all nearly maximal trajectories are guaranteed to lie. For polynomial equations, auxiliary functions can be constructed by semidefinite programming, which we illustrate using the Lorenz system.

Effects of hand cycle training on physical capacity in individuals with tetraplegia: a clinical trial.

PubMed

Valent, Linda J M; Dallmeijer, Annet J; Houdijk, Han; Slootman, Hans J; Janssen, Thomas W; Post, Marcel W M; van der Woude, Lucas H

2009-10-01

Regular physical activity is important for people with tetraplegia to maintain fitness but may not always be easily integrated into daily life. In many countries, hand cycling has become a serious option for daily mobility in people with tetraplegia. However, little information exists regarding the suitability of this exercise mode for this population. The purpose of this study was to evaluate the effects of a structured hand cycle training program in individuals with chronic tetraplegia. Pretraining and posttraining outcome measurements of physical capacity were compared. Structured hand cycle interval training was conducted at home or in a rehabilitation center in the Netherlands. Twenty-two patients with tetraplegia (American Spinal Injury Association Impairment Scale classification A-D) at least 2 years since injury participated. The intervention was an 8- to 12-week hand cycle interval training program. Primary outcomes of physical capacity were: peak power output (POpeak) and peak oxygen uptake (Vo(2)peak), as determined in hand cycle peak exercise tests on a motor-driven treadmill. Secondary outcome measures were: peak muscle strength (force-generating capacity) of the upper extremities (as assessed by handheld dynamometry), respiratory function (forced vital capacity and peak expiratory flow) and participant-reported shoulder pain. Significant improvements following a mean of 19 (SD=3) sessions of hand cycle training were found in POpeak (from 42.5 W [SD=21.9] to 50.8 W [SD=25.4]), Vo(2)peak (from 1.32 L.min(-1) [SD=0.40] to 1.43 L.min(-1) [SD=0.43]), and mechanical efficiency, as reflected by a decrease in submaximal oxygen uptake. Except for shoulder abduction strength, no significant effects were found on the secondary outcomes. Common health complications, such as urinary tract infections, bowel problems, and pressure sores, led to dropout and nonadherence. Patients with tetraplegia were able to improve their physical capacity through regular hand cycle interval training, without participant-reported shoulder-arm pain or discomfort.

A 15-year review of the Stanford Internal Medicine Residency Program: predictors of resident satisfaction and dissatisfaction.

PubMed

Kahn, James S; Witteles, Ronald M; Mahaffey, Kenneth W; Desai, Sumbul A; Ozdalga, Errol; Heidenreich, Paul A

2017-01-01

Satisfaction with training and with educational experiences represents important internal medicine (IM) programmatic goals. Graduates from IM residency programs are uniquely poised to provide insights into their educational and training experiences and to assess whether these experiences were satisfactory and relevant to their current employment. We surveyed former IM residents from the training program held during the years 2000-2015 at the Department of Medicine, Stanford University. The first part of the survey reviewed the IM residency program and the second part sought identifying data regarding gender, race, ethnicity, work, relationships, and financial matters. The primary outcome was satisfaction with the residency experience. Of the 405 individuals who completed the Stanford IM residency program in the study period, we identified 384 (95%) former residents with a known email address. Two hundred and one (52%) former residents responded to the first part and 185 (48%) answered both the parts of the survey. The mean age of the respondents was 36.9 years; 44% were female and the mean time from IM residency was 6.1 (±4.3) years. Fifty-eight percent reported extreme satisfaction with their IM residency experience. Predictors associated with being less than extremely satisfied included insufficient outpatient experience, insufficient international experience, insufficient clinical research experience, and insufficient time spent with family and peers. The residents expressed an overall high satisfaction rate with their IM training. The survey results provided insights for improving satisfaction with IM residency training that includes diversifying and broadening IM training experiences.

A 15-year review of the Stanford Internal Medicine Residency Program: predictors of resident satisfaction and dissatisfaction

PubMed Central

Kahn, James S; Witteles, Ronald M; Mahaffey, Kenneth W; Desai, Sumbul A; Ozdalga, Errol; Heidenreich, Paul A

2017-01-01

Introduction Satisfaction with training and with educational experiences represents important internal medicine (IM) programmatic goals. Graduates from IM residency programs are uniquely poised to provide insights into their educational and training experiences and to assess whether these experiences were satisfactory and relevant to their current employment. Methods We surveyed former IM residents from the training program held during the years 2000–2015 at the Department of Medicine, Stanford University. The first part of the survey reviewed the IM residency program and the second part sought identifying data regarding gender, race, ethnicity, work, relationships, and financial matters. The primary outcome was satisfaction with the residency experience. Results Of the 405 individuals who completed the Stanford IM residency program in the study period, we identified 384 (95%) former residents with a known email address. Two hundred and one (52%) former residents responded to the first part and 185 (48%) answered both the parts of the survey. The mean age of the respondents was 36.9 years; 44% were female and the mean time from IM residency was 6.1 (±4.3) years. Fifty-eight percent reported extreme satisfaction with their IM residency experience. Predictors associated with being less than extremely satisfied included insufficient outpatient experience, insufficient international experience, insufficient clinical research experience, and insufficient time spent with family and peers. Conclusion The residents expressed an overall high satisfaction rate with their IM training. The survey results provided insights for improving satisfaction with IM residency training that includes diversifying and broadening IM training experiences. PMID:28814910

Bipolar Latissimus Dorsi Transfer for Restoration of Pectoralis Major Function in Poland Syndrome.

PubMed

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.

Upcoming Paralympic summer games in Rio: what did the German medical team learn from the London Games?

PubMed

Kubosch, Eva J; Kosel, Jürgen; Steffen, Kathrin; Konstantinidis, Lukas; Kubosch, David; Südkamp, Norbert P; Hirschmüller, Anja

2017-11-01

Musculoskeletal complaints are frequently diagnosed in Paralympic athletes. Despite the increased professionalism in Paralympic Sports, the documentation of injuries and other health complaints during high-level competition is sparse. With respect to the upcoming Paralympic Summer Games in Rio de Janeiro, the aim of this study was the analysis of all musculoskeletal complaints within the German Paralympic Athletes during the London 2012 Paralympic Games. All musculoskeletal complaints (MSC) of the 150 German athletes seeking medical attention, hereby defined as "injury", were recorded during the in-competition period of the London Paralympics Games (22 days), regardless of their severity and consequences. Standardized documentation included the onset of symptoms, the medical diagnoses, the therapeutic measures taken as well as consecutive restrictions in training and competition. Incidence rates and localizations were analyzed by sports discipline. A total of 201 musculoskeletal complaints were recorded for 140 athletes (93.3%), corresponding to 1.4 musculoskeletal complaints per "injured" athlete. The incidence of musculoskeletal complaints in German athletes was 62.9±15.4/1000 athlete-days. High incidence rates (IR) were observed in wheelchair basketball (IR 72/1000 athlete-days, 1.6 injuries per athlete) and equestrian events (IR 72.7, 1.6). Musculoskeletal complaints were mainly located in the upper extremities (37.6%) and the spine (37.6%). The most frequent diagnoses were myalgia (N.=105, 52%). We noted a high rate of musculoskeletal complaints among German Paralympic athletes across sports and body parts, highlighting the need for prevention programs that focus on the upper extremities and spine.

Short-Term Effects of Whole-Body Vibration Combined with Task-Related Training on Upper Extremity Function, Spasticity, and Grip Strength in Subjects with Poststroke Hemiplegia: A Pilot Randomized Controlled Trial.

PubMed

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.

Evaluation of pediatric upper extremity peripheral nerve injuries.

PubMed

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.

Extreme Conditioning Programs: Potential Benefits and Potential Risks.

PubMed

Knapik, Joseph J

2015-01-01

CrossFit, Insanity, Gym Jones, and P90X are examples of extreme conditioning programs (ECPs). ECPs typically involve high-volume and high-intensity physical activities with short rest periods between movements and use of multiple joint exercises. Data on changes in fitness with ECPs are limited to CrossFit investigations that demonstrated improvements in muscle strength, muscular endurance, aerobic fitness, and body composition. However, no study has directly compared CrossFit or other ECPs to other more traditional forms of aerobic and resistance training within the same investigation. These direct comparisons are needed to more adequately evaluate the effectiveness of ECPs. Until these studies emerge, the comparisons with available literature suggest that improvements in CrossFit, in terms of muscular endurance (push-ups, sit-ups), strength, and aerobic capacity, appear to be similar to those seen in more traditional training programs. Investigations of injuries in ECPs are limited to two observational studies that suggest that the overall injury rate is similar to that seen in other exercise programs. Several cases of rhabdomyolysis and cervical carotid artery dissections have been reported during CrossFit training. The symptoms, diagnosis, and treatment of these are reviewed here. Until more data on ECPs emerge, physical training should be aligned with US Army doctrine. If ECPs are included in exercise programs, trainers should (1) have appropriate training certifications, (2) inspect exercise equipment regularly to assure safety, (3) introduce ECPs to new participants, (4) ensure medical clearance of Soldiers with special health problems before participation in ECPs, (4) tailor ECPs to the individual Soldier, (5) adjust rest periods to optimize recovery and reduce fatigue, (6) monitor Soldiers for signs of overtraining, rhabdomyolysis, and other problems, and (7) coordinate exercise programs with other unit training activities to eliminate redundant activities and minimize the risk of overuse injuries. 2015.

Introduction to the Transference of High Technology Systems. An Intercultural Approach.

ERIC Educational Resources Information Center

Norton, Kent; And Others

A training program for upper-middle to upper-level managers of a company in Iran uses the lecture/seminar approach. The goals of the course are to develop insights into problem areas connected with the development of a pragmatic intercultural management model, and to introduce approaches and prerequisites for modern management. The 10 lectures…

Summary of comprehensive systematic review: Rehabilitation in multiple sclerosis: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology.

PubMed

Haselkorn, Jodie K; Hughes, Christina; Rae-Grant, Alex; Henson, Lily Jung; Bever, Christopher T; Lo, Albert C; Brown, Theodore R; Kraft, George H; Getchius, Thomas; Gronseth, Gary; Armstrong, Melissa J; Narayanaswami, Pushpa

2015-11-24

To systematically review the evidence regarding rehabilitation treatments in multiple sclerosis (MS). We systematically searched the literature (1970-2013) and classified articles using 2004 American Academy of Neurology criteria. This systematic review highlights the paucity of well-designed studies, which are needed to evaluate the available MS rehabilitative therapies. Weekly home/outpatient physical therapy (8 weeks) probably is effective for improving balance, disability, and gait (MS type unspecified, participants able to walk ≥5 meters) but probably is ineffective for improving upper extremity dexterity (1 Class I). Inpatient exercises (3 weeks) followed by home exercises (15 weeks) possibly are effective for improving disability (relapsing-remitting MS [RRMS], primary progressive MS [PPMS], secondary progressive MS [SPMS], Expanded Disability Status Scale [EDSS] 3.0-6.5) (1 Class II). Six weeks' worth of comprehensive multidisciplinary outpatient rehabilitation possibly is effective for improving disability/function (PPMS, SPMS, EDSS 4.0-8.0) (1 Class II). Motor and sensory balance training or motor balance training (3 weeks) possibly is effective for improving static and dynamic balance, and motor balance training (3 weeks) possibly is effective for improving static balance (RRMS, SPMS, PPMS) (1 Class II). Breathing-enhanced upper extremity exercises (6 weeks) possibly are effective for improving timed gait and forced expiratory volume in 1 second (RRMS, SPMS, PPMS, mean EDSS 4.5); this change is of unclear clinical significance. This technique possibly is ineffective for improving disability (1 Class II). Inspiratory muscle training (10 weeks) possibly improves maximal inspiratory pressure (RRMS, SPMS, PPMS, EDSS 2-6.5) (1 Class II). © 2015 American Academy of Neurology.

Falling Down on the Job: Evaluation and Treatment of Fall Risk Among Older Adults With Upper Extremity Fragility Fractures.

PubMed

McDonough, Christine M; Colla, Carrie H; Carmichael, Donald; Tosteson, Anna N A; Tosteson, Tor D; Bell, John-Erik; Cantu, Robert V; Lurie, Jonathan D; Bynum, Julie P W

2017-03-01

Clinical practice guidelines recommend fall risk assessment and intervention for older adults who sustain a fall-related injury to prevent future injury and mobility decline. The aim of this study was to describe how often Medicare beneficiaries with upper extremity fracture receive evaluation and treatment for fall risk. Observational cohort. Participants were fee-for-service beneficiaries age 66 to 99 treated as outpatients for proximal humerus or distal radius/ulna ("wrist") fragility fractures. -Participants were studied using Carrier and Outpatient Hospital files. The proportion of patients evaluated or treated for fall risk up to 6 months after proximal humerus or wrist fracture from 2007-2009 was examined based on evaluation, treatment, and diagnosis codes. Time to evaluation and number of treatment sessions were calculated. Logistic regression was used to analyze patient characteristics that predicted receiving evaluation or treatment. Narrow (gait training) and broad (gait training or therapeutic exercise) definitions of service were used. There were 309,947 beneficiaries who sustained proximal humerus (32%) or wrist fracture (68%); 10.7% received evaluation or treatment for fall risk or gait issues (humerus: 14.2%; wrist: 9.0%). Using the broader definition, the percentage increased to 18.5% (humerus: 23.4%; wrist: 16.3%). Factors associated with higher likelihood of services after fracture were: evaluation or treatment for falls or gait prior to fracture, more comorbidities, prior nursing home stay, older age, humerus fracture (vs wrist), female sex, and white race. Claims analysis may underestimate physician and physical therapist fall assessments, but it is not likely to qualitatively change the results. A small proportion of older adults with upper extremity fracture received fall risk assessment and treatment. Providers and health systems must advance efforts to provide timely evidence-based management of fall risk in this population. © 2017 American Physical Therapy Association

Falling Down on the Job: Evaluation and Treatment of Fall Risk Among Older Adults With Upper Extremity Fragility Fractures

PubMed Central

Colla, Carrie H.; Carmichael, Donald; Tosteson, Anna N. A.; Tosteson, Tor D.; Bell, John-Erik; Cantu, Robert V.; Lurie, Jonathan D.; Bynum, Julie P. W.

2017-01-01

Abstract Background: Clinical practice guidelines recommend fall risk assessment and intervention for older adults who sustain a fall-related injury to prevent future injury and mobility decline. Objective: The aim of this study was to describe how often Medicare beneficiaries with upper extremity fracture receive evaluation and treatment for fall risk. Design: Observational cohort. Methods: Participants were fee-for-service beneficiaries age 66 to 99 treated as outpatients for proximal humerus or distal radius/ulna (“wrist”) fragility fractures. -Participants were studied using Carrier and Outpatient Hospital files. The proportion of patients evaluated or treated for fall risk up to 6 months after proximal humerus or wrist fracture from 2007–2009 was examined based on evaluation, treatment, and diagnosis codes. Time to evaluation and number of treatment sessions were calculated. Logistic regression was used to analyze patient characteristics that predicted receiving evaluation or treatment. Narrow (gait training) and broad (gait training or therapeutic exercise) definitions of service were used. Results: There were 309,947 beneficiaries who sustained proximal humerus (32%) or wrist fracture (68%); 10.7% received evaluation or treatment for fall risk or gait issues (humerus: 14.2%; wrist: 9.0%). Using the broader definition, the percentage increased to 18.5% (humerus: 23.4%; wrist: 16.3%). Factors associated with higher likelihood of services after fracture were: evaluation or treatment for falls or gait prior to fracture, more comorbidities, prior nursing home stay, older age, humerus fracture (vs wrist), female sex, and white race. Limitations: Claims analysis may underestimate physician and physical therapist fall assessments, but it is not likely to qualitatively change the results. Conclusions: A small proportion of older adults with upper extremity fracture received fall risk assessment and treatment. Providers and health systems must advance efforts to provide timely evidence-based management of fall risk in this population. PMID:28340130

Physical examination of upper extremity compressive neuropathies.

PubMed

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.

The Highly-Automated Airplane: Its Impact on Aviation Safety and an Analysis of Training Philosophy.

DTIC Science & Technology

1997-06-01

equipment. This means more than just knowing how to program the device and being familiar with the functions of varying modes (Patrick, 1996:18). 33...the function that I wanted to use or modify in a flight plan." "Initially it is extremely difficult to figure out exactly how to program or pull up...commented: "Getting used to the EFIS display was the hardest. Initially it is extremely difficult to figure out exactly how to program or pull up the

Ability of Ultrasonography in Detection of Different Extremity Bone Fractures; a Case Series Study

PubMed Central

Bozorgi, Farzad; Shayesteh Azar, Massoud; Montazer, Seyed Hossein; Chabra, Aroona; Heidari, Seyed Farshad; Khalilian, Alireza

2017-01-01

Introduction: Despite radiography being the gold standard in evaluation of orthopedic injuries, using bedside ultrasonography has several potential supremacies such as avoiding exposure to ionizing radiation, availability in pre-hospital settings, being extensively accessible, and ability to be used on the bedside. The aim of the present study is to evaluate the diagnostic accuracy of ultrasonography in detection of extremity bone fractures. Methods: This study is a case series study, which was prospectively conducted on multiple blunt trauma patients, who were 18 years old or older, had stable hemodynamic, Glasgow coma scale 15, and signs or symptoms of a possible extremity bone fracture. After initial assessment, ultrasonography of suspected bones was performed by a trained emergency medicine resident and prevalence of true positive and false negative findings were calculated compared to plain radiology. Results: 108 patients with the mean age of 44.6 ± 20.4 years were studied (67.6% male). Analysis was done on 158 sites of fracture, which were confirmed with plain radiography. 91 (57.6%) cases were suspected to have upper extremity fracture(s) and 67 (42.4%) to have lower ones. The most frequent site of injuries were forearm (36.7%) in upper limbs and leg (27.8%) in lower limbs. Prevalence of true positive and false negative cases for fractures detected by ultrasonography were 59 (64.8%) and 32 (35.52%) for upper and 49 (73.1%) and 18 (26.9%) for lower extremities, respectively. In addition, prevalence of true positive and false negative detected cases for intra-articular fractures were 24 (48%) and 26 (52%), respectively. Conclusion The present study shows the moderate sensitivity (68.3%) of ultrasonography in detection of different extremity bone fractures. Ultrasonography showed the best sensitivity in detection of femur (100%) and humerus (76.2%) fractures, respectively. It had low sensitivity in detection of in intra-articular fractures. PMID:28286822

Ability of Ultrasonography in Detection of Different Extremity Bone Fractures; a Case Series Study.

PubMed

Bozorgi, Farzad; Shayesteh Azar, Massoud; Montazer, Seyed Hossein; Chabra, Aroona; Heidari, Seyed Farshad; Khalilian, Alireza

2017-01-01

Despite radiography being the gold standard in evaluation of orthopedic injuries, using bedside ultrasonography has several potential supremacies such as avoiding exposure to ionizing radiation, availability in pre-hospital settings, being extensively accessible, and ability to be used on the bedside. The aim of the present study is to evaluate the diagnostic accuracy of ultrasonography in detection of extremity bone fractures. This study is a case series study, which was prospectively conducted on multiple blunt trauma patients, who were 18 years old or older, had stable hemodynamic, Glasgow coma scale 15, and signs or symptoms of a possible extremity bone fracture. After initial assessment, ultrasonography of suspected bones was performed by a trained emergency medicine resident and prevalence of true positive and false negative findings were calculated compared to plain radiology. 108 patients with the mean age of 44.6 ± 20.4 years were studied (67.6% male). Analysis was done on 158 sites of fracture, which were confirmed with plain radiography. 91 (57.6%) cases were suspected to have upper extremity fracture(s) and 67 (42.4%) to have lower ones. The most frequent site of injuries were forearm (36.7%) in upper limbs and leg (27.8%) in lower limbs. Prevalence of true positive and false negative cases for fractures detected by ultrasonography were 59 (64.8%) and 32 (35.52%) for upper and 49 (73.1%) and 18 (26.9%) for lower extremities, respectively. In addition, prevalence of true positive and false negative detected cases for intra-articular fractures were 24 (48%) and 26 (52%), respectively. The present study shows the moderate sensitivity (68.3%) of ultrasonography in detection of different extremity bone fractures. Ultrasonography showed the best sensitivity in detection of femur (100%) and humerus (76.2%) fractures, respectively. It had low sensitivity in detection of in intra-articular fractures.

Workplace-Based Rehabilitation of Upper Limb Conditions: A Systematic Review.

PubMed

Hoosain, Munira; de Klerk, Susan; Burger, Marlette

2018-05-23

Purpose The objective of this systematic review was to identify, collate and analyse the current available evidence on the effectiveness of workplace-based rehabilitative interventions in workers with upper limb conditions on work performance, pain, absenteeism, productivity and other outcomes. Methods We searched Medline, Cochrane Library, Scopus, Web of Science, Academic Search Premier, Africa-Wide Information, CINAHL, OTSeeker and PEDro with search terms in four broad areas: upper limb, intervention, workplace and clinical trial (no date limits). Studies including neck pain only or musculoskeletal pain in other areas were not included. Results Initial search located 1071 articles, of which 80 were full text reviewed. Twenty-eight articles were included, reporting on various outcomes relating to a total of seventeen studies. Nine studies were of high methodological quality, seven of medium quality, and one of low quality. Studies were sorted into intervention categories: Ergonomic controls (n = 3), ergonomic training and workstation adjustments (n = 4), exercise and resistance training (n = 6), clinic-based versus workplace-based work hardening (n = 1), nurse case manager training (n = 1), physiotherapy versus Feldenkrais (n = 1), and ambulant myofeedback training (n = 1). The largest body of evidence supported workplace exercise programs, with positive effects for ergonomic training and workstation adjustments, and mixed effects for ergonomic controls. Ambulant myofeedback training had no effect. The remaining three categories had positive effects in the single study on each intervention. Conclusion While there is substantial evidence for workplace exercise programs, other workplace-based interventions require further high quality research. Systematic review registration PROSPERO CRD42017059708.

Rationale and design of the ARCUS: Effects of trAnsRadial perCUtaneouS coronary intervention on upper extremity function.

PubMed

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.

Intra-seasonal Characteristics of Wintertime Extreme Cold Events over South Korea

NASA Astrophysics Data System (ADS)

Park, Taewon; Jeong, Jeehoon; Choi, Jahyun

2017-04-01

The present study reveals the changes in the characteristics of extreme cold events over South Korea for boreal winter (November to March) in terms of the intra-seasonal variability of frequency, duration, and atmospheric circulation pattern. Influences of large-scale variabilities such as the Siberian High activity, the Arctic Oscillation (AO), and the Madden-Julian Oscillation (MJO) on extreme cold events are also investigated. In the early and the late of the winter during November and March, the upper-tropospheric wave-train for a life-cycle of the extreme cold events tends to pass quickly over East Asia. In addition, compared with the other months, the intensity of the Siberian High is weaker and the occurrences of strong negative AO are less frequent. It lead to events with weak amplitude and short duration. On the other hand, the amplified Siberian High and the strong negative AO occur more frequently in the mid of the winter from December to February. The extreme cold events are mainly characterized by a well-organized anticyclonic blocking around the Ural Mountain and the Subarctic. These large-scale circulation makes the extreme cold events for the midwinter last long with strong amplitude. The MJO phases 2-3 which provide a suitable condition for the amplification of extreme cold events occur frequently for November to January when the frequencies are more than twice those for February and March. While the extreme cold events during March have the least frequency, the weakest amplitude, and the shortest duration due to weak impacts of the abovementioned factors, the strong activities of the factors for January force the extreme cold events to be the most frequent, the strongest, and the longest among the boreal winter. Keywords extreme cold event, wave-train, blocking, Siberian High, AO, MJO

Are temporal characteristics of fast repetitive oscillating movement invariant?

PubMed

Gutnik, B J; Nicholson, J; Go, W; Gale, D; Nash, D

2003-06-01

Validation of the proportional duration model was attempted using very fast single-joint repetitive horizontal abductive-adductive movements of the stretched upper extremity with minimal cognitive input. Participants drew oscillating horizontal lines during 20 sec. over relatively short distances as quickly as possible without visual feedback. Spatial, temporal, and kinetic parameters were analysed. The amplitude and the time spent accelerating, decelerating, and reversing in both directions of each experimental line were recorded and related to the centre of gravity of the upper extremity. The accelerations of the centre of mass of the upper extremity were calculated and used to calculate the forces involved. The ratios of durations were compared and intercorrelated for the two fastest, two average, and two slowest cycles from each participant. Results exhibited significant standard deviations and variability of temporal and kinetic parameters within individual trials. The number of significant coefficients of correlation within individual trials was small despite the controlling influence of the same generalised motor program. The proportional duration model did not hold for our data. Peripheral factors (probably the length-tension relationship rule for skeletal muscles and viscosity of muscle) may be important in this type of action.

Training Tomorrow's Environmental Journalists: Assessing the Extent of Environmental-Themed Training in College-Level Journalism Programs

ERIC Educational Resources Information Center

Schmidt, Hans C.

2017-01-01

While the scale of the environmental problems facing the planet mean that effective environmental journalism is now more important than ever, the environmental beat can be extremely challenging for journalists. One way to address this is by providing specialized training for future journalists. This study involves an investigation of the extent to…

Combined Cognitive-Strategy and Task-Specific Training Affects Cognition and Upper-Extremity Function in Subacute Stroke: An Exploratory Randomized Controlled Trial

PubMed Central

Polatajko, Helene; Baum, Carolyn; Rios, Jorge; Cirone, Dianne; Doherty, Meghan; McEwen, Sara

2016-01-01

The purpose of this study was to estimate the effect of Cognitive Orientation to Daily Occupational Performance (CO–OP) compared with usual occupational therapy on upper-extremity movement, cognitive flexibility, and stroke impact in people less than 3 mo after stroke. An exploratory, single-blind randomized controlled trial was conducted with people referred to outpatient occupational therapy services at two rehabilitation centers. Arm movement was measured with the Action Research Arm Test, cognitive flexibility with the Delis–Kaplan Executive Function System Trail Making subtest, and stroke impact with subscales of the Stroke Impact Scale. A total of 35 participants were randomized, and 26 completed the intervention. CO–OP demonstrated measurable effects over usual care on all measures. These data provide early support for the use of CO–OP to improve performance and remediate cognitive and arm movement impairments after stroke over usual care; however, future study is warranted to confirm the effects observed in this trial. PMID:26943113

Injuries in karate: systematic review.

PubMed

Thomas, Roger E; Ornstein, Jodie

2018-05-22

to identify all studies of Karate injuries and assess injury rates, types, location, and causes. Six electronic and four grey literature databases were searched. Two reviewers independently assessed titles/abstracts, abstracted data and assessed risk-of-bias with the Newcastle-Ottawa scale. Average injury rates/1000AE (AE = athletic-encounter) and/1000minutesAE, injury location and type weighted by study size were calculated. In competitions rates of injury/1000AE and/1000 minutesAE were similar for males (111.4/1000AE, 75.4/1000 minAE) and females (105.8/1000AE, 72.8/1000 minAE). Location of injury rates/1000AE for males were 44.0 for head/neck, 11.9 lower extremities, 8.1 torso and 5.4 upper extremities and were similar for females: 41.2 head/neck, 12.4 lower extremities, 9.1 torso and 6.3 upper extremities. Injury rates varied widely by study. Rates/1000AE for type of injury were contusions/abrasions/lacerations/bruises/tooth avulsion for males (68.1) and females (30.4); hematomas/bleeding/epistaxis males (11.4) and females (12.1); strains/sprains males (3.5) and females (0.1); dislocations males (2.9) and females (0.9); concussions males (2.5) and females (3.9); and fractures males (2.9) and females (1.4). Punches were a more common mechanism of injury for males (59.8) than females (40.8) and kicks similar (males 19.7, females 21.7). Weighted averages were not calculated for weight class or belt colour because there were too few studies. Nineteen injury surveys reported annual injury rates from 30% to rates ten times higher but used different reporting methods. Studies provided no data to explain wide rate ranges. Studies need to adopt one injury definition, one data-collection form, and collect comprehensive data for each study for both training and competitions. More data are needed to measure the effect of weight, age and experience on injuries, rates and types of injury during training, and for competitors with high injury rates. RCTs are needed of interventions such as training and feedback of performance data to reduce injury rates.

Virtual Reality Training With Three-Dimensional Video Games Improves Postural Balance and Lower Extremity Strength in Community-Dwelling Older Adults.

PubMed

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.

Multicenter Randomized Trial of Robot-Assisted Rehabilitation for Chronic Stroke: Methods and Entry Characteristics for VA ROBOTICS

PubMed Central

Lo, Albert C.; Guarino, Peter; Krebs, Hermano I.; Volpe, Bruce T.; Bever, Christopher T.; Duncan, Pamela W.; Ringer, Robert J.; Wagner, Todd H.; Richards, Lorie G.; Bravata, Dawn M.; Haselkorn, Jodie K.; Wittenberg, George F.; Federman, Daniel G.; Corn, Barbara H.; Maffucci, Alysia D.; Peduzzi, Peter

2017-01-01

Background Chronic upper extremity impairment due to stroke has significant medical, psychosocial, and financial consequences, but few studies have examined the effectiveness of rehabilitation therapy during the chronic stroke period. Objective To test the safety and efficacy of the MIT-Manus robotic device for chronic upper extremity impairment following stroke. Methods The VA Cooperative Studies Program initiated a multicenter, randomized, controlled trial in November 2006 (VA ROBOTICS). Participants with upper extremity impairment ≥6 months poststroke were randomized to robot-assisted therapy (RT), intensive comparison therapy (ICT), or usual care (UC). RT and ICT consisted of three 1-hour treatment sessions per week for 12 weeks. The primary outcome was change in the Fugl-Meyer Assessment upper extremity motor function score at 12 weeks relative to baseline. Secondary outcomes included the Wolf Motor Function Test and the Stroke Impact Scale. Results A total of 127 participants were randomized: 49 to RT, 50 to ICT, and 28 to UC. The majority of participants were male (96%), with a mean age of 65 years. The primary stroke type was ischemic (85%), and 58% of strokes occurred in the anterior circulation. Twenty percent of the participants reported a stroke in addition to their index stroke. The average time from the index stroke to enrollment was 56 months (range, 6 months to 24 years). The mean Fugl-Meyer score at entry was 18.9. Conclusions VA ROBOTICS demonstrates the feasibility of conducting multicenter clinical trials to rigorously test new rehabilitative devices before their introduction to clinical practice. The results are expected in early 2010. PMID:19541917

The HAAPI (Home Arm Assistance Progression Initiative) Trial: - A Novel Robotics Delivery Approach in Stroke Rehabilitation

PubMed Central

Wolf, Steven L.; Sahu, Komal; Bay, R. Curtis; Buchanan, Sharon; Reiss, Aimee; Linder, Susan; Rosenfeldt, Anson; Alberts, Jay

2015-01-01

Background Geographical location, socioeconomic status and logistics surrounding transportation impede access of post-stroke individuals to comprehensive rehabilitative services. Robotic therapy may enhance telerehabilitation by delivering consistent and state-of-the art therapy while allowing for the remote monitoring and adjusting therapy for underserved populations. The Hand Mentor Pro (HMP), was incorporated within a home exercise program (HEP) to improve upper extremity functional capabilities post-stroke. Objective To determine the efficacy of a home-based telemonitored robotic-assisted therapy as part of a HEP compared with a dose-matched HEP-only intervention among individuals less than 6 months post-stroke and characterized as underserved. Methods In this prospective, single-blinded, multisite, randomized controlled trial, 99 hemiparetic participants with limited access to upper extremity rehabilitation were randomized to the: 1) experimental group which received combined HEP and HMP for 3 hrs/day x 5 days x 8 weeks; or 2) control group which received HEP only at an identical dosage. Weekly communication between the supervising therapist and participant promoted compliance and progression of the HEP and HMP prescription. The Action Research Arm Test and Wolf Motor Function Test along with the Fugl Meyer Assessment (upper extremity) were primary and secondary outcome measures respectively, undertaken before and after the interventions. Results Both groups demonstrated improvement across all upper extremity outcomes. Conclusions Robotic+HEP and HEP only were both effectively delivered remotely. There was no difference between groups in change in motor function over time, additional research is necessary to determine appropriate dosage of HMP and HEP. PMID:25782693

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

PubMed

Kang, Youn Joo; Park, Hae Kyung; Kim, Hyun Jung; Lim, Taeo; Ku, Jeonghun; Cho, Sangwoo; Kim, Sun I; Park, Eun Sook

2012-10-04

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

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

PubMed Central

2012-01-01

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

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

PubMed

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

2007-09-01

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

The Academic I-BEST: A Model for Precollege Student Success in College Transfer Programs

ERIC Educational Resources Information Center

Emory, Doug; Raymond, Linda; Lee, Karen; Twohy, Sean

2016-01-01

Beginning in 2011, Lake Washington Institute of Technology initiated an I-BEST (Integrated Basic Education and Skills Training) program designed to allow upper-level basic education students to directly enter academic courses required by college transfer degrees. This program, the Academic I-BEST, represents one of the earliest examples of the…

Enhanced left-finger deftness following dominant upper- and lower-limb amputation.

PubMed

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.

Appling Andragogy Theory in Photoshop Training Programs

ERIC Educational Resources Information Center

Alajlan, Abdulrahman Saad

2015-01-01

Andragogy is a strategy for teaching adults that can be applied to Photoshop training. Photoshop workshops are frequented by adult learners, and thus andragogical models for instruction would be extremely helpful for prospective trainers looking to improve their classroom designs. Adult learners are much different than child learners, given the…

Effects of feedback-based balance and core resistance training vs. Pilates training on balance and muscle function in older women: a randomized-controlled trial.

PubMed

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.

Intensive Sensorimotor Arm Training Mediated by Therapist or Robot Improves Hemiparesis in Patients With Chronic Stroke

PubMed Central

Volpe, Bruce T.; Lynch, Daniel; Rykman-Berland, Avrielle; Ferraro, Mark; Galgano, Michael; Hogan, Neville; Krebs, Hermano I.

2016-01-01

Investigators have demonstrated that a variety of intensive movement training protocols for persistent upper limb paralysis in patients with chronic stroke (6 months or more after stroke) improve motor outcome. This randomized controlled study determined in patients with upper limb motor impairment after chronic stroke whether movement therapy delivered by a robot or by a therapist using an intensive training protocol was superior. Robotic training (n = 11) and an intensive movement protocol (n = 10) improved the impairment measures of motor outcome significantly and comparably; there were no significant changes in disability measures. Motor gains were maintained at the 3-month evaluation after training. These data contribute to the growing awareness that persistent impairments in those with chronic stroke may not reflect exhausted capacity for improvement. These new protocols, rendered by either therapist or robot, can be standardized, tested, and replicated, and potentially will contribute to rational activity-based programs. PMID:18184932

EMG-Torque correction on Human Upper extremity using Evolutionary Computation

NASA Astrophysics Data System (ADS)

JL, Veronica; Parasuraman, S.; Khan, M. K. A. Ahamed; Jeba DSingh, Kingsly

2016-09-01

There have been many studies indicating that control system of rehabilitative robot plays an important role in determining the outcome of the therapy process. Existing works have done the prediction of feedback signal in the controller based on the kinematics parameters and EMG readings of upper limb's skeletal system. Kinematics and kinetics based control signal system is developed by reading the output of the sensors such as position sensor, orientation sensor and F/T (Force/Torque) sensor and there readings are to be compared with the preceding measurement to decide on the amount of assistive force. There are also other works that incorporated the kinematics parameters to calculate the kinetics parameters via formulation and pre-defined assumptions. Nevertheless, these types of control signals analyze the movement of the upper limb only based on the movement of the upper joints. They do not anticipate the possibility of muscle plasticity. The focus of the paper is to make use of the kinematics parameters and EMG readings of skeletal system to predict the individual torque of upper extremity's joints. The surface EMG signals are fed into different mathematical models so that these data can be trained through Genetic Algorithm (GA) to find the best correlation between EMG signals and torques acting on the upper limb's joints. The estimated torque attained from the mathematical models is called simulated output. The simulated output will then be compared with the actual individual joint which is calculated based on the real time kinematics parameters of the upper movement of the skeleton when the muscle cells are activated. The findings from this contribution are extended into the development of the active control signal based controller for rehabilitation robot.

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

PubMed Central

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

2018-01-01

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

Gait parameters associated with responsiveness to treadmill training with body-weight support after stroke: an exploratory study.

PubMed

Mulroy, Sara J; Klassen, Tara; Gronley, JoAnne K; Eberly, Valerie J; Brown, David A; Sullivan, Katherine J

2010-02-01

Task-specific training programs after stroke improve walking function, but it is not clear which biomechanical parameters of gait are most associated with improved walking speed. The purpose of this study was to identify gait parameters associated with improved walking speed after a locomotor training program that included body-weight-supported treadmill training (BWSTT). A prospective, between-subjects design was used. Fifteen people, ranging from approximately 9 months to 5 years after stroke, completed 1 of 3 different 6-week training regimens. These regimens consisted of 12 sessions of BWSTT alternated with 12 sessions of: lower-extremity resistive cycling; lower-extremity progressive, resistive strengthening; or a sham condition of arm ergometry. Gait analysis was conducted before and after the 6-week intervention program. Kinematics, kinetics, and electromyographic (EMG) activity were recorded from the hemiparetic lower extremity while participants walked at a self-selected pace. Changes in gait parameters were compared in participants who showed an increase in self-selected walking speed of greater than 0.08 m/s (high-response group) and in those with less improvement (low-response group). Compared with participants in the low-response group, those in the high-response group displayed greater increases in terminal stance hip extension angle and hip flexion power (product of net joint moment and angular velocity) after the intervention. The intensity of soleus muscle EMG activity during walking also was significantly higher in participants in the high-response group after the intervention. Only sagittal-plane parameters were assessed, and the sample size was small. Task-specific locomotor training alternated with strength training resulted in kinematic, kinetic, and muscle activation adaptations that were strongly associated with improved walking speed. Changes in both hip and ankle biomechanics during late stance were associated with greater increases in gait speed.

A 3-Month Jump-Landing Training Program: A Feasibility Study Using the RE-AIM Framework

PubMed Central

Aerts, Inne; Cumps, Elke; Verhagen, Evert; Mathieu, Niels; Van Schuerbeeck, Sander; Meeusen, Romain

2013-01-01

Context: Evaluating the translatability and feasibility of an intervention program has become as important as determining the effectiveness of the intervention. Objective: To evaluate the applicability of a 3-month jump-landing training program in basketball players, using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework. Design: Randomized controlled trial. Setting: National and regional basketball teams. Patients or Other Participants: Twenty-four teams of the second highest national division and regional basketball divisions in Flanders, Belgium, were randomly assigned (1:1) to a control group and intervention group. A total of 243 athletes (control group = 129, intervention group = 114), ages 15 to 41 years, volunteered. Intervention(s): All exercises in the intervention program followed a progressive development, emphasizing lower extremity alignment during jump-landing activities. Main Outcome Measure(s): The results of the process evaluation of the intervention program were based on the 5 dimensions of the RE-AIM framework. The injury incidence density, hazard ratios, and 95% confidence intervals were determined. Results: The participation rate of the total sample was 100% (reach). The hazard ratio was different between the intervention group and the control group (0.40 [95% confidence interval = 0.16, 0.99]; effectiveness). Of the 12 teams in the intervention group, 8 teams (66.7%) agreed to participate in the study (adoption). Eight of the participating coaches (66.7%) felt positively about the intervention program and stated that they had implemented the training sessions of the program as intended (implementation). All coaches except 1 (87.5%) intended to continue the intervention program the next season (maintenance). Conclusions: Compliance of the coaches in this coach-supervised jump-landing training program was high. In addition, the program was effective in preventing lower extremity injuries. PMID:23675788

A 3-month jump-landing training program: a feasibility study using the RE-AIM framework.

PubMed

Aerts, Inne; Cumps, Elke; Verhagen, Evert; Mathieu, Niels; Van Schuerbeeck, Sander; Meeusen, Romain

2013-01-01

Evaluating the translatability and feasibility of an intervention program has become as important as determining the effectiveness of the intervention. To evaluate the applicability of a 3-month jump-landing training program in basketball players, using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework. Randomized controlled trial. National and regional basketball teams. Twenty-four teams of the second highest national division and regional basketball divisions in Flanders, Belgium, were randomly assigned (1:1) to a control group and intervention group. A total of 243 athletes (control group = 129, intervention group = 114), ages 15 to 41 years, volunteered. All exercises in the intervention program followed a progressive development, emphasizing lower extremity alignment during jump-landing activities. The results of the process evaluation of the intervention program were based on the 5 dimensions of the RE-AIM framework. The injury incidence density, hazard ratios, and 95% confidence intervals were determined. The participation rate of the total sample was 100% (reach). The hazard ratio was different between the intervention group and the control group (0.40 [95% confidence interval = 0.16, 0.99]; effectiveness). Of the 12 teams in the intervention group, 8 teams (66.7%) agreed to participate in the study (adoption). Eight of the participating coaches (66.7%) felt positively about the intervention program and stated that they had implemented the training sessions of the program as intended (implementation). All coaches except 1 (87.5%) intended to continue the intervention program the next season (maintenance). Compliance of the coaches in this coach-supervised jump-landing training program was high. In addition, the program was effective in preventing lower extremity injuries.

Functional Multijoint Position Reproduction Acuity in Overhead-Throwing Athletes

PubMed Central

Tripp, Brady L; Uhl, Timothy L; Mattacola, Carl G; Srinivasan, Cidambi; Shapiro, Robert

2006-01-01

Context: Baseball players rely on the sensorimotor system to uphold the balance between upper extremity stability and mobility while maintaining athletic performance. However, few researchers have studied functional multijoint measures of sensorimotor acuity in overhead-throwing athletes. Objective: To compare sensorimotor acuity between 2 high-demand functional positions and among planes of motion within individual joints and to describe a novel method of measuring sensorimotor function. Design: Single-session, repeated-measures design. Setting: University musculoskeletal research laboratory. Patients or Other Participants: Twenty-one National Collegiate Athletic Association Division I baseball players (age = 20.8 ± 1.5 years, height = 181.3 ± 5.1 cm, mass = 87.8 ± 9.1 kg) with no history of upper extremity injury or central nervous system disorder. Main Outcome Measure(s): We measured active multijoint position reproduction acuity in multiple planes using an electromagnetic tracking device. Subjects reproduced 2 positions: arm cock and ball release. We calculated absolute and variable error for individual motions at the scapulothoracic, glenohumeral, elbow, and wrist joints and calculated overall joint acuity with 3-dimensional variable error. Results: Acuity was significantly better in the arm-cock position compared with ball release at the scapulothoracic and glenohumeral joints. We observed significant differences among planes of motion within the scapulothoracic and glenohumeral joints at ball release. Scapulothoracic internal rotation and glenohumeral horizontal abduction and rotation displayed less acuity than other motions. Conclusions: We established the reliability of a functional measure of upper extremity sensorimotor system acuity in baseball players. Using this technique, we observed differences in acuity between 2 test positions and among planes of motion within the glenohumeral and scapulothoracic joints. Clinicians may consider these differences when designing and implementing sensorimotor system training. Our error scores are similar in magnitude to those reported using single-joint and single-plane measures. However, 3-dimensional, multijoint measures allow practical, unconstrained test positions and offer additional insight into the upper extremity as a functional unit. PMID:16791298

Portable upper extremity robotics is as efficacious as upper extremity rehabilitative therapy: a randomized controlled pilot trial.

PubMed

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.

Effectiveness of an Upper Extremity Exercise Device Integrated With Computer Gaming for Aerobic Training in Adolescents With Spinal Cord Dysfunction

PubMed Central

Widman, Lana M; McDonald, Craig M; Abresch, R. Ted

2006-01-01

Background/Objective: To determine whether a new upper extremity exercise device integrated with a video game (GameCycle) requires sufficient metabolic demand and effort to induce an aerobic training effect and to explore the feasibility of using this system as an exercise modality in an exercise intervention. Design: Pre-post intervention. Setting: University-based research facility. Subject Population: A referred sample of 8 adolescent subjects with spina bifida (4 girls, 15.5 ± 0.6 years; 4 boys, 17.5 ± 0.9 years) was recruited to participate in the project. All subjects had some level of mobility impairment that did not allow them to participate in mainstream sports available to their nondisabled peers. Five subjects used a wheelchair full time, one used a wheelchair occasionally, but walked with forearm crutches, and 2 were fully ambulatory, but had impaired gait. Main Outcome Measures: Peak oxygen uptake, maximum work output, aerobic endurance, peak heart rate, rating of perceived exertion, and user satisfaction. Results: Six of the 8 subjects were able to reach a Vo2 of at least 50% of their Vo2 reserve while using the GameCycle. Seven of the 8 subjects reached a heart rate of at least 50% of their heart rate reserve. One subject did not reach either 50% of Vo2 reserve or 50% of heart rate reserve. Seven of the 8 subjects increased their maximum work capability after training with the GameCycle at least 3 times per week for 16 weeks. Conclusions: The data suggest that the GameCycle seems to be adequate as an exercise device to improve oxygen uptake and maximum work capability in adolescents with lower extremity disability caused by spinal cord dysfunction. The subjects in this study reported that the video game component was enjoyable and provided a motivation to exercise. PMID:17044386

Effects of an Off-Axis Pivoting Elliptical Training Program on Gait Function in Persons With Spastic Cerebral Palsy: A Preliminary Study.

PubMed

Tsai, Liang-Ching; Ren, Yupeng; Gaebler-Spira, Deborah J; Revivo, Gadi A; Zhang, Li-Qun

2017-07-01

This preliminary study examined the effects of off-axis elliptical training on reducing transverse-plane gait deviations and improving gait function in 8 individuals with cerebral palsy (CP) (15.5 ± 4.1 years) who completed an training program using a custom-made elliptical trainer that allows transverse-plane pivoting of the footplates during exercise. Lower-extremity off-axis control during elliptical exercise was evaluated by quantifying the root-mean-square and maximal angular displacement of the footplate pivoting angle. Lower-extremity pivoting strength was assessed. Gait function and balance were evaluated using 10-m walk test, 6-minute-walk test, and Pediatric Balance Scale. Toe-in angles during gait were quantified. Participants with CP demonstrated a significant decrease in the pivoting angle (root mean square and maximal angular displacement; effect size, 1.00-2.00) and increase in the lower-extremity pivoting strength (effect size = 0.91-1.09) after training. Reduced 10-m walk test time (11.9 ± 3.7 seconds vs. 10.8 ± 3.0 seconds; P = 0.004; effect size = 1.46), increased Pediatric Balance Scale score (43.6 ± 12.9 vs. 45.6 ± 10.8; P = 0.042; effect size = 0.79), and decreased toe-in angle (3.7 ± 10.5 degrees vs. 0.7 ± 11.7 degrees; P = 0.011; effect size = 1.22) were observed after training. We present an intervention to challenge lower-extremity off-axis control during a weight-bearing and functional activity for individuals with CP. Our preliminary findings suggest that this intervention was effective in enhancing off-axis control, gait function, and balance and reducing in-toeing gait in persons with CP.

Preparing Elementary Mathematics-Science Teaching Specialists.

ERIC Educational Resources Information Center

Miller, L. Diane

1992-01-01

Describes a professional development program to train math/science specialists for the upper elementary school grades. Using results from an interest survey, 30 teachers were chosen to participate in a 3-year program to become math/science specialists. Presents the teaching model used and the advantages for teachers and students in having subject…

The Relationship Between Anomalous Presummer Extreme Rainfall Over South China and Synoptic Disturbances

NASA Astrophysics Data System (ADS)

Huang, Ling; Luo, Yali; Zhang, Da-Lin

2018-04-01

A spectral analysis of daily rainfall data has been performed to investigate extreme rainfall events in south China during the presummer rainy seasons between 1998 and 2015 (excluding 1999, 2006, 2011, and 2014). The results reveal a dominant frequency mode at the synoptic scale with pronounced positive rainfall anomalies. By analyzing the synoptic-scale bandpass-filtered anomalous circulations, 24 extreme rainfall episodes (defined as those with a daily rainfall amount in the top 5%) are categorized into "cyclone" (15) and "trough" (8) types, with the remaining events as an "anticyclone" type, according to the primary anomalous weather system contributing to each extreme rainfall episode. The 15 cyclone-type episodes are further separated into (11) lower- and (4) upper-tropospheric migratory anomalies. An analysis of their anomalous fields shows that both types could be traced back to the generation of cyclonic anomalies downstream of the Tibetan Plateau, except for two episodes of lower-tropospheric migratory anomalies originating over the South China Sea. However, a lower-tropospheric cyclonic anomaly appears during all phases in the former type, but only in the wettest phase in the latter type, with its peak disturbance occurring immediately beneath an upper-level warm anomaly. The production of extreme rainfall in the trough-type episodes is closely related to a deep trough anomaly extending from an intense cyclonic anomaly over north China, which in turn could be traced back to a midlatitude Rossby wave train passing by the Tibetan Plateau. The results have important implications for understanding the origin, structure, and evolution of synoptic disturbances associated with the presummer extreme rainfall in south China.

Effectiveness of an Orientation and Counseling Program for Adult Evening Students at Drake University.

ERIC Educational Resources Information Center

McCannon, Roger S.

Literature on counseling adult college students is extremely limited; few if any training programs are currently operating with the purpose of preparing counseling specialists in adult education. Moreover, college/university orientation programs for new entering adult part-time evening students are virtually nonexistent. Recognizing the need for…

Effect of mirror therapy and electrical stimulation on upper extremity function in stroke with hemiplegic patient: a pilot study.

PubMed

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.

Training strategy of explosive strength in young female volleyball players.

PubMed

Pereira, Ana; Costa, Aldo M; Santos, Patricia; Figueiredo, Teresa; João, Paulo Vicente

2015-01-01

The aim of this study was to examine the effect of an 8-week combined jump and ball throwing training program in the performance of upper and lower extremities among young female volleyball players of the high school. A total of 20 young female volleyball players playing at Scholar Sport in High School at the district level were divided in two groups: the experimental group (n=10; 14.0±0.0 years; 1.6±0.1 m; 52.0±7.0 kg and 20.7±2.4% body mass) and the control group (n=10; 13.8±0.4 years, 1.6±0.1 m; 53.5±4.7 kg and 20.3±1.7% body mass). The experimental group received additional plyometric and ball throwing exercises besides their normal volleyball practice. The control group underwent only their regular session of training. Strength performance in the experimental group significantly improved (medicine ball and volleyball ball throwing: P=0.00; and counter movement jump: P=0.05), with the improvement ranging from 5.3% to 20.1%. No significant changes in strength performance were observed in the control group (P>0.05). The 8-week combined jump and ball throwing training can significantly improve muscular performance in young female volleyball players. These findings may be useful for all physical education teachers and volleyball coaches. Copyright © 2015 Lithuanian University of Health Sciences. Production and hosting by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

Benefits of music training are widespread and lifelong: a bibliographic review of their non-musical effects.

PubMed

Dawson, William J

2014-06-01

Recent publications indicate that musical training has effects on non-musical activities, some of which are lifelong. This study reviews recent publications collected from the Performing Arts Medicine Association bibliography. Music training, whether instrumental or vocal, produces beneficial and long-lasting changes in brain anatomy and function. Anatomic changes occur in brain areas devoted to hearing, speech, hand movements, and coordination between both sides of the brain. Functional benefits include improved sound processing and motor skills, especially in the upper extremities. Training benefits extend beyond music skills, resulting in higher IQs and school grades, greater specialized sensory and auditory memory/recall, better language memory and processing, heightened bilateral hand motor functioning, and improved integration and synchronization of sensory and motor functions. These changes last long after music training ends and can minimize or prevent age-related loss of brain cells and some mental functions. Early institution of music training and prolonged duration of training both appear to contribute to these positive changes.

Ultrasound-guided supraclavicular block: outcome of 510 consecutive cases.

PubMed

Perlas, Anahi; Lobo, Giovanni; Lo, Nick; Brull, Richard; Chan, Vincent W S; Karkhanis, Reena

2009-01-01

Supraclavicular brachial plexus block provides consistently effective anesthesia to the upper extremity. However, traditional nerve localization techniques may be associated with a high risk of pneumothorax. In the present study, we report block success and clinical outcome data from 510 consecutive patients who received an ultrasound-guided supraclavicular block for upper extremity surgery. After institutional review board approval, the outcome of 510 consecutive patients who received an ultrasound-guided supraclavicular block for upper extremity surgery was reviewed. Real-time ultrasound guidance was used with a high-frequency linear probe. The neurovascular structures were imaged on short axis, and the needle was inserted using an in-plane technique with either a medial-to-lateral or lateral-to-medial orientation. Five hundred ten ultrasound-guided supraclavicular blocks were performed (50 inpatients, 460 outpatients) by 47 different operators at different levels of training over a 24-month period. Successful surgical anesthesia was achieved in 94.6% of patients after a single attempt; 2.8% required local anesthetic supplementation of a single peripheral nerve territory; and 2.6% received an unplanned general anesthetic. No cases of clinically symptomatic pneumothorax developed. Complications included symptomatic hemidiaphragmatic paresis (1%), Horner syndrome (1%), unintended vascular punctures (0.4%), and transient sensory deficits (0.4%). Ultrasound-guided supraclavicular block is associated with a high rate of successful surgical anesthesia and a low rate of complications and thus may be a safe alternative for both inpatients and outpatients. Severe underlying respiratory disease and coagulopathy should remain a contraindication for this brachial plexus approach.

Elbow Joint Fatigue and Bench-Press Training

PubMed Central

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

[Optimization of resistance training using elastic bands].

PubMed

Guex, K

2015-07-15

Resistance training using elastic bands allows to perform a large variety of exercises for upper and lower body. It can be considered as a real alternative to the use of fitness equipment or free weight. After having determined the goal of the resistance training (i.e., maximal strength, hypertrophy, power or local muscular endurance), the acute program variables (i.e., muscle action, loading, volume, exercise selection and order, rest periods and repetition velocity) must be selected regarding the recommendations for strength training. The load is the most important variable in resistance program design. To determine it in an accurate way, when using elastic bands, it is recommended to use the Multiple RM test.

Epidemiology of fishing related upper extremity injuries presenting to the emergency department in the United States.

PubMed

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.

Increasing your HCAHPS scores with Extreme Customer Service.

PubMed

Clouarte, Joe

2016-10-01

Providing great customer service is extremely critical in the healthcare setting, especially when it comes to HCAHBPS (Hospital Consumer Assessment of Health care Providers and Systems) scores, the author says. While there are several service training programs within healthcare, they often require six to eight minutes of interaction with patients or guests. This works well for clinical staff, he says, but when it comes to non-clinical staff, including security officers, many times they only have fifteen or thirty seconds to create positive patient or guest experience. In this article he describes Extreme Customer Service © a program he has developed to fill that customer gap for non-clinical staff.

A Six-Week Resistance Training Program Does Not Change Shear Modulus of the Triceps Brachii.

PubMed

Akagi, Ryota; Shikiba, Tomofumi; Tanaka, Jun; Takahashi, Hideyuki

2016-08-01

We investigated the effect of a 6-week resistance training program on the shear modulus of the triceps brachii (TB). Twenty-three young men were randomly assigned to either the training (n = 13) or control group (n = 10). Before and after conducting the resistance training program, the shear modulus of the long head of the TB was measured at the point 70% along the length of the upper arm from the acromial process of the scapula to the lateral epicondyle of the humerus using shear wave ultrasound elastography. Muscle thickness of the long head of the TB was also determined at the same site by ultrasonography used during both tests. A resistance exercise was performed 3 days a week for 6 weeks using a dumbbell mass-adjusted to 80% of the 1-repetition maximum (1RM). The training effect on the muscle thickness and 1RM was significant. Nevertheless, the muscle shear modulus was not significantly changed after the training program. From the perspective of muscle mechanical properties, the present results indicate that significant adaptation must occur to make the TB more resistant to subsequent damaging bouts during the 6-week training program to target the TB.

Upper extremity access for fenestrated endovascular aortic aneurysm repair is not associated with increased morbidity.

PubMed

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.

Efficacy of neuromuscular electrical stimulation in patients with COPD followed in intensive care unit.

PubMed

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.

Feasibility study of a combined treatment of electromyography-triggered neuromuscular stimulation and mirror therapy in stroke patients: a randomized crossover trial.

PubMed

Kojima, Kosuke; Ikuno, Koki; Morii, Yuta; Tokuhisa, Kentaro; Morimoto, Shigeru; Shomoto, Koji

2014-01-01

Mirror therapy (MT) and electromyography-triggered neuromuscular stimulation (ETMS) are both effective treatments for impaired upper limbs following stroke. A combination of these two treatments (ETMS-MT) may result in greater gain than either treatment alone. The feasibility and possible effects of ETMS-MT upon upper extremity function were investigated in stroke patients. Thirteen post-acute stroke patients were randomly assigned to an immediate ETMS-MT group or a delayed ETMS-MT group and then underwent an 8-week training program. The immediate ETMS-MT group received ETMS-MT in addition to physical and occupational therapy (PT+OT) for 4 weeks. They then received only PT+OT for the next 4 weeks. In the delayed ETMS-MT group, interventions were provided in the reverse order. The main outcome measure was the Fugl-Meyer Assessment (FMA). The immediate ETMS-MT group showed significantly greater gain in FMA in the first 4 weeks. The delayed ETMS-MT group showed significantly greater gain in active range of motion during the latter 4 weeks. No adverse effects were reported following ETMS-MT. ETMS-MT might be as effective as independent MT or ETMS without causing any side effects. Future research should focus upon the direct comparisons between independent and combined interventions.

Upper extremity deep venous thrombosis after port insertion: What are the risk factors?

PubMed

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.

Motor skill changes and neurophysiologic adaptation to recovery-oriented virtual rehabilitation of hand function in a person with subacute stroke: a case study

PubMed Central

Fluet, Gerard G.; Patel, Jigna; Qiu, Qinyin; Yarossi, Matthew; Massood, Supriya; Adamovich, Sergei V.; Tunik, Eugene; Merians, Alma S.

2016-01-01

Purpose The complexity of upper extremity (UE) behavior requires recovery of near normal neuromuscular function to minimize residual disability following a stroke. This requirement places a premium on spontaneous recovery and neuroplastic adaptation to rehabilitation by the lesioned hemisphere. Motor skill learning is frequently cited as a requirement for neuroplasticity. Studies examining the links between training, motor learning, neuroplasticity, and improvements in hand motor function are indicated. Methods This case study describes a patient with slow recovering hand and finger movement (Total Upper Extremity Fugl–Meyer examination score = 25/66, Wrist and Hand items = 2/24 on poststroke day 37) following a stroke. The patient received an intensive eight-session intervention utilizing simulated activities that focused on the recovery of finger extension, finger individuation, and pinch-grasp force modulation. Results Over the eight sessions, the patient demonstrated improvements on untrained transfer tasks, which suggest that motor learning had occurred, as well a dramatic increase in hand function and corresponding expansion of the cortical motor map area representing several key muscles of the paretic hand. Recovery of hand function and motor map expansion continued after discharge through the three-month retention testing. Conclusion This case study describes a neuroplasticity based intervention for UE hemiparesis and a model for examining the relationship between training, motor skill acquisition, neuroplasticity, and motor function changes. PMID:27669997

Portable Upper Extremity Robotics is as Efficacious as Upper Extremity Rehabilitative Therapy: A Randomized Controlled Pilot Trial

PubMed Central

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

Communication Training as a Prevention to Sexual Harassment.

ERIC Educational Resources Information Center

Berryman-Fink, Cynthia

Although illegal, sexual harassment is frequent in the American workplace and extremely disruptive and costly to employees and employers alike. Most organizational responses to the problem have been hard line, short term, after-the-fact measures that inform, threaten, or discipline employees. What is needed, however, is a training program with an…

Exercise effect with the wheelchair aerobic fitness trainer on conditioning and metabolic function in disabled persons: a pilot study.

PubMed

Midha, M; Schmitt, J K; Sclater, M

1999-03-01

To determine the effect of exercise with the wheelchair aerobic fitness trainer (WAFT) on anthropometric indices, conditioning, and endocrine and metabolic parameters in persons with lower extremity disability. Exercise sessions with the WAFT lasted 20 to 30 minutes for two to three sessions. Tertiary-care Veterans Administration medical center. Twelve subjects (3 with quadriplegia, 7 with paraplegia, 1 with cerebrovascular accident, 1 with bilateral above-knee amputation). Anthropometric indices (heart rate, blood pressure, weight, oxygen utilization, body mass index, upper arm and abdominal circumference, arm power) and endocrine and metabolic parameters (fasting serum glucose, lipids, and thyroid function) were determined before and after 10 weeks of exercise with the WAFT. All patients noted improved feelings of well-being after training. Mean resting heart rate, upper arm fat area, and fasting serum cholesterol level decreased significantly. Peak oxygen consumption, midarm circumference, and free thyroxine index increased significantly with training. WAFT improves quality of life, conditioning, and endocrine-metabolic parameters in disabled persons.

Tissue expansion in the treatment of giant congenital melanocytic nevi of the upper extremity

PubMed Central

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

Robot-supported upper limb training in a virtual learning environment : a pilot randomized controlled trial in persons with MS.

PubMed

Feys, Peter; Coninx, Karin; Kerkhofs, Lore; De Weyer, Tom; Truyens, Veronik; Maris, Anneleen; Lamers, Ilse

2015-07-23

Despite the functional impact of upper limb dysfunction in multiple sclerosis (MS), effects of intensive exercise programs and specifically robot-supported training have been rarely investigated in persons with advanced MS. To investigate the effects of additional robot-supported upper limb training in persons with MS compared to conventional treatment only. Seventeen persons with MS (pwMS) (median Expanded Disability Status Scale of 8, range 3.5-8.5) were included in a pilot RCT comparing the effects of additional robot-supported training to conventional treatment only. Additional training consisted of 3 weekly sessions of 30 min interacting with the HapticMaster robot within an individualised virtual learning environment (I-TRAVLE). Clinical measures at body function (Hand grip strength, Motricity Index, Fugl-Meyer) and activity (Action Research Arm test, Motor Activity Log) level were administered before and after an intervention period of 8 weeks. The intervention group were also evaluated on robot-mediated movement tasks in three dimensions, providing active range of motion, movement duration and speed and hand-path ratio as indication of movement efficiency in the spatial domain. Non-parametric statistics were applied. PwMS commented favourably on the robot-supported virtual learning environment and reported functional training effects in daily life. Movement tasks in three dimensions, measured with the robot, were performed in less time and for the transporting and reaching movement tasks more efficiently. There were however no significant changes for any clinical measure in neither intervention nor control group although observational analyses of the included cases indicated large improvements on the Fugl-Meyer in persons with more marked upper limb dysfunction. Robot-supported training lead to more efficient movement execution which was however, on group level, not reflected by significant changes on standard clinical tests. Persons with more marked upper limb dysfunction may benefit most from additional robot-supported training, but larger studies are needed. This trial is registered within the registry Clinical Trials GOV ( NCT02257606 ).

Robot-aided gait training in an individual with chronic spinal cord injury: a case study.

PubMed

Bishop, Lauri; Stein, Joel; Wong, Christopher Kevin

2012-09-01

Traditional physical therapy is beneficial in restoring mobility in individuals who have sustained spinal cord injury (SCI), but residual limitations often persist. Robotic technologies may offer opportunities for further gains. The purpose of this case study was to document the use and practicality of gait training for an individual with chronic, incomplete SCI with asymmetric lower limb motor deficits using a novel robotic knee orthosis (RKO). The participant was a 22-year-old woman who sustained fractures of the odontoid process and C5-C6 vertebrae from a motor vehicle accident resulting in incomplete SCI with asymmetric tetraparesis, right side more severe than left side. She required supervised assistance with gait and balance tasks, minimal assistance to ascend/descend steps using a handrail, and upper extremity assistance for sit-to-stand tasks. The participant underwent 7 one-hour sessions of mobility training, using a novel RKO. Her primary goal was to increase independence and endurance with mobility. Functional measures included the 6-Minute Walk Test, the Berg Balance Scale, the Timed Up & Go Test, and the 10-Meter Walk Test. Outcomes were assessed and recorded at baseline and on completion of 7 hours of training with the device over a 2-week period. No adverse events occurred. The RKO was well received by both the participant and the treating therapist. The participant demonstrated improvements in the 6-Minute Walk Test and Berg Balance Scale after RKO-training intervention. Outcomes suggest that the use of this device during a physical therapy program for an individual with incomplete SCI is practical and this device may be a useful adjunct to standard training.

Effects of mirror therapy combined with motor tasks on upper extremity function and activities daily living of stroke patients.

PubMed

Kim, Kyunghoon; Lee, Sukmin; Kim, Donghoon; Lee, Kyoungbo; Kim, Youlim

2016-01-01

[Purpose] The objective of this study was to investigate the effects of mirror therapy combined with exercise tasks on the function of the upper limbs and activities of daily living. [Subjects and Methods] Twenty-five stroke patients who were receiving physical therapy at K Hospital in Gyeonggi-do, South Korea, were classified into a mirror therapy group (n=12) and a conventional therapy group (n=13). The therapies were applied for 30 minutes per day, five times per week, for a total of four weeks. Upper limb function was measured with the Action Research Arm test, the Fugl-Meyer Assessment, and the Box and Block test, and activities of daily living were measured with the Functional Independence Measure. A paired test was performed to compare the intragroup differences between before training and after four weeks of therapy, and an independent t-test was performed to compare the differences between the two groups before and after four weeks of therapy. [Results] In the intragroup comparison, both groups showed significant differences between measurements taken before and after four weeks of therapy. In the intergroup comparison, the mirror therapy group showed significant improvements compared with the conventional therapy group, both in upper limb function and activities of daily living. [Conclusion] The findings of this study demonstrated that mirror therapy is more effective than conventional therapy for the training of stroke patients to improve their upper limb function and activities of daily living.

A Rasch-validated version of the upper extremity functional index for interval-level measurement of upper extremity function.

PubMed

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.

A Rasch-Validated Version of the Upper Extremity Functional Index for Interval-Level Measurement of Upper Extremity Function

PubMed Central

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

Game Analysis, Validation, and Potential Application of EyeToy Play and Play 2 to Upper-Extremity Rehabilitation

PubMed Central

Caldwell, Michelle; Dickerhoof, Erica; Hall, Anastasia; Odakura, Bryan; Fanchiang, Hsin-Chen

2014-01-01

Objective. To describe and analyze the potential use of games in the commercially available EyeToy Play and EyeToy Play 2 on required/targeted training skills and feedback provided for clinical application. Methods. A summary table including all games was created. Two movement experts naïve to the software validated required/targeted training skills and feedback for 10 randomly selected games. Ten healthy school-aged children played to further validate the required/targeted training skills. Results. All but two (muscular and cardiovascular endurance) had excellent agreement in required/targeted training skills, and there was 100% agreement on feedback. Children's performance in required/targeted training skills (number of unilateral reaches and bilateral reaches, speed, muscular endurance, and cardiovascular endurance) significantly differed between games (P < .05). Conclusion. EyeToy Play games could be used to train children's arm function. However, a careful evaluation of the games is needed since performance might not be consistent between players and therapists' interpretation. PMID:25610652

Effects of Exercise on Bone Mineral Content in Postmenopausal Women.

ERIC Educational Resources Information Center

Rikli, Roberta E.; McManis, Beth G.

1990-01-01

Study tested the effect of exercise programs on bone mineral content (BMC) and BMC/bone width in 31 postmenopausal women. Subjects were placed in groups with aerobic exercise, aerobics plus upper-body weight training, or no exercise. Results indicate that regular exercise programs positively affect bone mineral maintenance in postmenopausal women.…

Effect of forced use of the lower extremity on gait performance and mobility of post-acute stroke patients

PubMed Central

Yu, Wen-Hsiu; Liu, Wen-Yu; Wong, Alice May-Kuen; Wang, Tzu-Chi; Li, Yen-Chen; Lien, Hen-Yu

2015-01-01

[Purpose] The purpose of this study was to investigate the effects of a forced-use training program on gait, mobility and quality of life of post-acute stroke patients. [Subjects] Twenty-one individuals with unilateral stroke participated in this study. All participants had suffered from first-ever stroke with time since onset of at least 3 months. [Methods] A single-blinded, non-equivalent, pre-post controlled design with 1-month follow-up was adopted. Participants received either a forced-use or a conventional physical therapy program for 2 weeks. The main outcomes assessed were preferred and fastest walking velocities, spatial and temporal symmetry indexes of gait, the timed up and go test, the Rivermead Mobility Index, and the Stroke-Specific Quality of Life Scale (Taiwan version). [Results] Forced-use training induced greater improvements in gait and mobility than conventional physical therapy. In addition, compared to pre-training, patients in the conventional physical therapy group walked faster but more asymmetrically after training. However, neither program effectively improved in-hospital quality of life. [Conclusion] The forced-use approach can be successfully applied to the lower extremities of stroke patients to improve mobility, walking speeds and symmetry of gait. PMID:25729182

Multiple sessions of transcranial direct current stimulation and upper extremity rehabilitation in stroke: A review and meta-analysis.

PubMed

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.

Comparison between Steroid Injection and Stretching Exercise on the Scalene of Patients with Upper Extremity Paresthesia: Randomized Cross-Over Study.

PubMed

Kim, Yong Wook; Yoon, Seo Yeon; Park, Yongbum; Chang, Won Hyuk; Lee, Sang Chul

2016-03-01

To compare the therapeutic effects on upper extremity paresthesia of intra-muscular steroid injections into the scalene muscle with those of stretching exercise only. Twenty patients with upper extremity paresthesia who met the criteria were recruited to participate in this single-blind, crossover study. Fourteen of 20 patients were female. The average age was 45.0 ± 10.5 years and duration of symptom was 12.2 ± 8.7 months. Each participant completed one injection and daily exercise program for 2 weeks. After randomization, half of all patients received ultrasound-guided injection of scalene muscles before exercise, while the other was invested for the other patients. After two weeks, there was a significant decrease of the visual analog scale score of treatment effect compared with baseline in both groups (6.90 to 2.85 after injection and 5.65 to 4.05 after stretching exercise, p<0.01). However, injection resulted in greater improvements than stretching exercise (p<0.01). The number of patients with successful treatment, defined as >50% reduction in post-treatment visual analog scale, was 18 of 20 (90.0%) after injection, compared to 5 of 20 (25.0%) after stretching exercise. There were no cases of unintended brachial plexus block after injection. Ultrasound-guided steroid injection or stretching exercise of scalene muscles led to reduced upper extremity paresthesia in patients who present with localized tenderness in the scalene muscle without electrodiagnostic test abnormalities, although injection treatment resulted in more improvements. The results suggest that symptoms relief might result from injection into the muscle alone not related to blockade of the brachial plexus.

Comparison between Steroid Injection and Stretching Exercise on the Scalene of Patients with Upper Extremity Paresthesia: Randomized Cross-Over Study

PubMed Central

Kim, Yong Wook; Yoon, Seo Yeon; Park, Yongbum; Chang, Won Hyuk

2016-01-01

Purpose To compare the therapeutic effects on upper extremity paresthesia of intra-muscular steroid injections into the scalene muscle with those of stretching exercise only. Materials and Methods Twenty patients with upper extremity paresthesia who met the criteria were recruited to participate in this single-blind, crossover study. Fourteen of 20 patients were female. The average age was 45.0±10.5 years and duration of symptom was 12.2±8.7 months. Each participant completed one injection and daily exercise program for 2 weeks. After randomization, half of all patients received ultrasound-guided injection of scalene muscles before exercise, while the other was invested for the other patients. Results After two weeks, there was a significant decrease of the visual analog scale score of treatment effect compared with baseline in both groups (6.90 to 2.85 after injection and 5.65 to 4.05 after stretching exercise, p<0.01). However, injection resulted in greater improvements than stretching exercise (p<0.01). The number of patients with successful treatment, defined as >50% reduction in post-treatment visual analog scale, was 18 of 20 (90.0%) after injection, compared to 5 of 20 (25.0%) after stretching exercise. There were no cases of unintended brachial plexus block after injection. Conclusion Ultrasound-guided steroid injection or stretching exercise of scalene muscles led to reduced upper extremity paresthesia in patients who present with localized tenderness in the scalene muscle without electrodiagnostic test abnormalities, although injection treatment resulted in more improvements. The results suggest that symptoms relief might result from injection into the muscle alone not related to blockade of the brachial plexus. PMID:26847305

Combining levodopa and virtual reality-based therapy for rehabilitation of the upper limb after acute stroke: pilot study Part II

PubMed Central

Samuel, Geoffrey Sithamparapillai; Oey, Nicodemus Edrick; Choo, Min; Ju, Han; Chan, Wai Yin; Kok, Stanley; Ge, Yu; Dongen, Antonius M Van; Ng, Yee Sien

2017-01-01

INTRODUCTION This study aimed to evaluate the safety and efficacy of a combination of levodopa and virtual reality (VR)-based therapy for the enhancement of upper limb recovery following acute stroke. METHODS This was a pilot single-blinded case series of acute stroke patients with upper extremity hemiparesis. Patients were randomised to standard care with concomitant administration of either levodopa alone (control group) or combination therapy consisting of VR-based motivational visuomotor feedback training with levodopa neuromodulation (VR group). Main clinical outcome measures were the Fugl-Meyer Upper Extremity (FM-UE) assessment and Action Research Arm Test (ARAT). Kinematic measurements of affected upper limb movement were evaluated as a secondary measure of improvement. RESULTS Of 42 patients screened, four patients were enrolled in each of the two groups. Two patients dropped out from the control group during the trial. Patients receiving combination therapy had clinically significant improvements in FM-UE assessment scores of 16.5 points compared to a 3.0-point improvement among control patients. Similarly, ARAT scores of VR group patients improved by 15.3 points compared to a 10.0-point improvement in the control group. Corresponding improvements were noted in kinematic measures, including hand-path ratio, demonstrating that the quality of upper limb movement improved in the VR group. CONCLUSION Our results suggest that VR-based therapy and pharmacotherapy may be combined for acute stroke rehabilitation. Bedside acquisition of kinematic measurements allows accurate assessment of the quality of limb movement, offering a sensitive clinical tool for quantifying motor recovery during the rehabilitation process after acute stroke. PMID:27311739

[Trauma surgery in Pacific Small Island Developing States (SIDS)].

PubMed

Oberli, H; Martin, C

2017-10-01

The small developing countries in the Pacific are grouped together as Small Island Development States (SIDS) because they face similar problems which they cannot cope with nationally. They are developing countries, so-called low and lower middle income countries (LMIC), are economically weak and the islands of the different nations are widely scattered. Approximately 80% of the 10 million inhabitants live in rural regions. Over 40% of patients in the surgical departments of hospitals are hospitalized for injuries, and this tendency is increasing. Fractures of the upper extremities are relatively more frequent in the Pacific than in the countries of the North. Long distances, lack of possibilities for treatment and lack of transport often cause complications, such as infected open fractures, pseudarthrosis and posttraumatic malformations. There are too few hospitals with sufficiently competent surgeons, anesthetists and obstetricians (SAO) and appropriate equipment. The PIOA was founded in Honiara, Solomon Islands, and offers surgeons of the Pacific SIDS a comprehensive, structured trauma and orthopedic surgery training in their own countries. It lasts 4 years and leads to an M‑Med (orthopaedic surgery) diploma and to a Fellowship of the International College of Surgeons (FICS), which are both recognized by the participating hospitals. It is free for participants. The AOAF is an independent organization with the only aim to enhance trauma surgery capacity in LMICs. The AOAF supports the PIOA program together with the Wyss Medical Foundation. Currently, 18 trainees from 8 Pacific SIDS are participating in the PIOA training program.

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

ERIC Educational Resources Information Center

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

2011-01-01

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

Rehabilitation after a grade III latissimus dorsi tear of a soccer player: A case report.

PubMed

Fysentzou, Christodoulos

2016-11-21

Latissimus dorsi, grade III tendon tears are an uncommon injury. There are very few cases reported in the literature, but most importantly, no cases could be found that relate to soccer. To present a successful, non-operative rehabilitation program for a professional athlete, after a grade III latissimus dorsi tear. A 37 year old healthy, elite professional soccer goalkeeper was injured during a championship game. The athlete fell on his left side with an outstretched and externally rotated upper extremity in order to catch a ball that was going very close to the left pole of his goal-post. After on-field and off-field clinical examinations, the diagnosis was a left latissimus dorsi tendon tear which was later confirmed by MRI as a grade III tear. During the first two weeks, intervention consisted of anti-inflammatory treatment and light therapeutic exercises. As the pain was subsiding and the strength was returning, the treatment shifted to purely strengthening and functional training. Four weeks after the injury, the athlete presented with pain 0/10 in all functional activities and full ROM in both active and passive movements. Before discharge, the athlete underwent a sport specific training program, without any complains, that cleared him to participate in normal training with the rest of the team. Three months after the injury the strength of the player's left shoulder was 5/5 in all movements. The protocol used yielded an accelerated return to sport (soccer) and function compared with other published research after a grade III latissimus dorsi tendon tear. One year later, the goalkeeper was still playing in the same competitive level without any re-injuries or complains, which means that this treatment protocol withstood the test of time.

Evaluation of the Plastic Surgery In-Service Training Exam: Lower Extremity Questions.

PubMed

Silvestre, Jason; Basta, Marten N; Serletti, Joseph M; Chang, Benjamin

2015-01-01

To facilitate the training of plastic surgery residents, we analyzed a knowledge-based curriculum for plastic and reconstructive surgery of the lower extremity. The Plastic Surgery In-Service Training Exam (PSITE) is a commonly used tool to assess medical knowledge in plastic surgery. We reviewed the lower extremity content on 6 consecutive score keys (2008-2013). Questions were classified by taxonomy, anatomy, and subject. Answer references were quantified by source and relative year of publication. Totally, 107 questions related to the lower extremity (9.1% of all questions) and 14 questions had an associated image (13.1%). Questions required decision making (49%) over interpretation (36%) and direct recall (15%) skills (p < 0.001). Conditions of the leg (42.1%) and thigh (24.3%) constituted most of the questions. Subject matter focused on flap reconstruction (38.3%), nerve injury (8.4%), and congenital deformity (6.5%). Analysis of 263 citations to 66 unique journals showed that Plastic and Reconstructive Surgery (54.9%) was the highest yield primary source. The median year of publication relative to PSITE administration was 6 (range: 1-58) with a mode of 2 years. Plastic Surgery by Mathes et al. was the most referenced textbook (21.9%). These data establish a benchmark for lower extremity training during plastic surgery residency. Study efforts focused on the most common topics and references will enhance trainee preparation for lower extremity PSITE questions. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Proof of concept of the ability of the kinect to quantify upper extremity function in dystrophinopathy.

PubMed

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.

Lower-extremity resistance training on unstable surfaces improves proxies of muscle strength, power and balance in healthy older adults: a randomised control trial.

PubMed

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.

Upper Extremity Amputations and Prosthetics

PubMed Central

Ovadia, Steven A.; Askari, Morad

2015-01-01

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

Imaging of upper extremity stress fractures in the athlete.

PubMed

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.

Diagnostic accuracy of ultrasound in upper and lower extremity long bone fractures of emergency department trauma patients.

PubMed

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.

Closed-Loop Task Difficulty Adaptation during Virtual Reality Reach-to-Grasp Training Assisted with an Exoskeleton for Stroke Rehabilitation

PubMed Central

Grimm, Florian; Naros, Georgios; Gharabaghi, Alireza

2016-01-01

Stroke patients with severe motor deficits of the upper extremity may practice rehabilitation exercises with the assistance of a multi-joint exoskeleton. Although this technology enables intensive task-oriented training, it may also lead to slacking when the assistance is too supportive. Preserving the engagement of the patients while providing “assistance-as-needed” during the exercises, therefore remains an ongoing challenge. We applied a commercially available seven degree-of-freedom arm exoskeleton to provide passive gravity compensation during task-oriented training in a virtual environment. During this 4-week pilot study, five severely affected chronic stroke patients performed reach-to-grasp exercises resembling activities of daily living. The subjects received virtual reality feedback from their three-dimensional movements. The level of difficulty for the exercise was adjusted by a performance-dependent real-time adaptation algorithm. The goal of this algorithm was the automated improvement of the range of motion. In the course of 20 training and feedback sessions, this unsupervised adaptive training concept led to a progressive increase of the virtual training space (p < 0.001) in accordance with the subjects' abilities. This learning curve was paralleled by a concurrent improvement of real world kinematic parameters, i.e., range of motion (p = 0.008), accuracy of movement (p = 0.01), and movement velocity (p < 0.001). Notably, these kinematic gains were paralleled by motor improvements such as increased elbow movement (p = 0.001), grip force (p < 0.001), and upper extremity Fugl-Meyer-Assessment score from 14.3 ± 5 to 16.9 ± 6.1 (p = 0.026). Combining gravity-compensating assistance with adaptive closed-loop feedback in virtual reality provides customized rehabilitation environments for severely affected stroke patients. This approach may facilitate motor learning by progressively challenging the subject in accordance with the individual capacity for functional restoration. It might be necessary to apply concurrent restorative interventions to translate these improvements into relevant functional gains of severely motor impaired patients in activities of daily living. PMID:27895550

Closed-Loop Task Difficulty Adaptation during Virtual Reality Reach-to-Grasp Training Assisted with an Exoskeleton for Stroke Rehabilitation.

PubMed

Grimm, Florian; Naros, Georgios; Gharabaghi, Alireza

2016-01-01

Stroke patients with severe motor deficits of the upper extremity may practice rehabilitation exercises with the assistance of a multi-joint exoskeleton. Although this technology enables intensive task-oriented training, it may also lead to slacking when the assistance is too supportive. Preserving the engagement of the patients while providing "assistance-as-needed" during the exercises, therefore remains an ongoing challenge. We applied a commercially available seven degree-of-freedom arm exoskeleton to provide passive gravity compensation during task-oriented training in a virtual environment. During this 4-week pilot study, five severely affected chronic stroke patients performed reach-to-grasp exercises resembling activities of daily living. The subjects received virtual reality feedback from their three-dimensional movements. The level of difficulty for the exercise was adjusted by a performance-dependent real-time adaptation algorithm. The goal of this algorithm was the automated improvement of the range of motion. In the course of 20 training and feedback sessions, this unsupervised adaptive training concept led to a progressive increase of the virtual training space ( p < 0.001) in accordance with the subjects' abilities. This learning curve was paralleled by a concurrent improvement of real world kinematic parameters, i.e., range of motion ( p = 0.008), accuracy of movement ( p = 0.01), and movement velocity ( p < 0.001). Notably, these kinematic gains were paralleled by motor improvements such as increased elbow movement ( p = 0.001), grip force ( p < 0.001), and upper extremity Fugl-Meyer-Assessment score from 14.3 ± 5 to 16.9 ± 6.1 ( p = 0.026). Combining gravity-compensating assistance with adaptive closed-loop feedback in virtual reality provides customized rehabilitation environments for severely affected stroke patients. This approach may facilitate motor learning by progressively challenging the subject in accordance with the individual capacity for functional restoration. It might be necessary to apply concurrent restorative interventions to translate these improvements into relevant functional gains of severely motor impaired patients in activities of daily living.

Hand Robotic Therapy in Children with Hemiparesis: A Pilot Study.

PubMed

Bishop, Lauri; Gordon, Andrew M; Kim, Heakyung

2017-01-01

The aim of this study was to understand the impact of training with a hand robotic device on hand paresis and function in a population of children with hemiparesis. Twelve children with hemiparesis (mean age, 9 [SD, 3.64] years) completed participation in this prospective, experimental, pilot study. Participants underwent clinical assessments at baseline and again 6 weeks later with instructions to not initiate new therapies. After these assessments, participants received 6 weeks of training with a hand robotic device, consisting of 1-hour sessions, 3 times weekly. Assessments were repeated on completion of training. Results showed significant improvements after training on the Assisting Hand Assessment (mean difference, 2.0 Assisting Hand Assessment units; P = 0.011) and on the upper-extremity component of the Fugl-Meyer scale (raw score mean difference, 4.334; P = 0.001). No significant improvements between pretest and posttest were noted on the Jebsen-Taylor Test of Hand Function, the Quality of Upper Extremity Skills Test, or the Pediatric Evaluation of Disability Inventory after intervention. Total active mobility of digits and grip strength also failed to demonstrate significant changes after training. Participants tolerated training with the hand robotic device, and significant improvements in bimanual hand use, as well as impairment-based scales, were noted. Improvements were carried over into bimanual skills during play. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Understand key components of neuroplasticity; (2) Discuss the benefits of robotic therapy in the recovery of hand function in pediatric patients with hemiplegia; and (3) Appropriately incorporate robotic therapy into the treatment plan of pediatric patients with hemiplegia. Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Extreme-Teaching-2 (XT [superscript]2): Evaluation of an Innovative Semester-Long Intensive GTA Training Program Based on Microteaching

ERIC Educational Resources Information Center

Santandreu Calonge, David; Mark, Kai-Pan; Chiu, P. H. Patrio; Thadani, Dimple R.; Pun, Cecilia F. K.

2013-01-01

Microteaching techniques have been used for teacher training since the mid 1960s. Despite its usefulness, as affirmed by pre-service teachers, in-service teachers, and graduate teaching assistants (GTAs), there are numerous criticisms on the shortcomings of microteaching activities. Specifically, it (a) oversimplifies the classroom learning and…

Effects of a Supervised versus an Unsupervised Combined Balance and Strength Training Program on Balance and Muscle Power in Healthy Older Adults: A Randomized Controlled Trial.

PubMed

Lacroix, André; Kressig, Reto W; Muehlbauer, Thomas; Gschwind, Yves J; Pfenninger, Barbara; Bruegger, Othmar; Granacher, Urs

2016-01-01

Losses in lower extremity muscle strength/power, muscle mass and deficits in static and particularly dynamic balance due to aging are associated with impaired functional performance and an increased fall risk. It has been shown that the combination of balance and strength training (BST) mitigates these age-related deficits. However, it is unresolved whether supervised versus unsupervised BST is equally effective in improving muscle power and balance in older adults. This study examined the impact of a 12-week BST program followed by 12 weeks of detraining on measures of balance and muscle power in healthy older adults enrolled in supervised (SUP) or unsupervised (UNSUP) training. Sixty-six older adults (men: 25, women: 41; age 73 ± 4 years) were randomly assigned to a SUP group (2/week supervised training, 1/week unsupervised training; n = 22), an UNSUP group (3/week unsupervised training; n = 22) or a passive control group (CON; n = 22). Static (i.e., Romberg Test) and dynamic (i.e., 10-meter walk test) steady-state, proactive (i.e., Timed Up and Go Test, Functional Reach Test), and reactive balance (e.g., Push and Release Test), as well as lower extremity muscle power (i.e., Chair Stand Test; Stair Ascent and Descent Test) were tested before and after the active training phase as well as after detraining. Adherence rates to training were 92% for SUP and 97% for UNSUP. BST resulted in significant group × time interactions. Post hoc analyses showed, among others, significant training-related improvements for the Romberg Test, stride velocity, Timed Up and Go Test, and Chair Stand Test in favor of the SUP group. Following detraining, significantly enhanced performances (compared to baseline) were still present in 13 variables for the SUP group and in 10 variables for the UNSUP group. Twelve weeks of BST proved to be safe (no training-related injuries) and feasible (high attendance rates of >90%). Deficits of balance and lower extremity muscle power can be mitigated by BST in healthy older adults. Additionally, supervised as compared to unsupervised BST was more effective. Thus, it is recommended to counteract intrinsic fall risk factors by applying supervised BST programs for older adults. © 2015 The Author(s) Published by S. Karger AG, Basel.

Effects of a Short-Term Plyometric and Resistance Training Program on Fitness Performance in Boys Age 12 to 15 Years

PubMed Central

Faigenbaum, Avery D.; McFarland, James E.; Keiper, Fred B.; Tevlin, William; Ratamess, Nicholas A.; Kang, Jie; Hoffman, Jay R.

2007-01-01

The purpose of this study was to compare the effects of a six week training period of combined plyometric and resistance training (PRT, n = 13) or resistance training alone (RT, n = 14) on fitness performance in boys (12-15 yr). The RT group performed static stretching exercises followed by resistance training whereas the PRT group performed plyometric exercises followed by the same resistance training program. The training duration per session for both groups was 90 min. At baseline and after training all participants were tested on the vertical jump, long jump, medicine ball toss, 9.1 m sprint, pro agility shuttle run and flexibility. The PRT group made significantly (p < 0.05) greater improvements than RT in long jump (10.8 cm vs. 2.2 cm), medicine ball toss (39.1 cm vs. 17.7 cm) and pro agility shuttle run time (-0.23 sec vs. -0.02 sec) following training. These findings suggest that the addition of plyometric training to a resistance training program may be more beneficial than resistance training and static stretching for enhancing selected measures of upper and lower body power in boys. Key pointsYouth conditioning programs which include different types of training and different loading schemes (e.g., high velocity plyometrics and resistance training) may be most effective for enhancing power performance.The effects of resistance training and plyometric training may be synergistic in children, with their combined effects being greater that each program performed alone. PMID:24149486

Comparison of upper extremity glenohumeral joint forces in children with cerebral palsy using anterior and posterior walkers - biomed 2009.

PubMed

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.

Accuracy of a disability instrument to identify workers likely to develop upper extremity musculoskeletal disorders.

PubMed

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.

Development and initial psychometric evaluation of an item bank created to measure upper extremity function in persons with stroke.

PubMed

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.

Closed-kinetic chain upper-body training improves throwing performance of NCAA Division I softball players.

PubMed

Prokopy, Max P; Ingersoll, Christopher D; Nordenschild, Edwin; Katch, Frank I; Gaesser, Glenn A; Weltman, Arthur

2008-11-01

Closed-kinetic chain resistance training (CKCRT) of the lower body is superior to open-kinetic chain resistance training (OKCRT) to improve performance parameters (e.g., vertical jump), but the effects of upper-body CKCRT on throwing performance remain unknown. This study compared shoulder strength, power, and throwing velocity changes in athletes training the upper body exclusively with either CKCRT (using a system of ropes and slings) or OKCRT. Fourteen female National Collegiate Athletic Association Division I softball player volunteers were blocked and randomly placed into two groups: CKCRT and OKCRT. Blocking ensured the same number of veteran players and rookies in each training group. Training occurred three times weekly for 12 weeks during the team's supervised off-season program. Olympic, lower-body, core training, and upper-body intensity and volume in OKCRT and CKCRT were equalized between groups. Criterion variables pre- and posttraining included throwing velocity, bench press one-repetition maximum (1RM), dynamic single-leg balance, and isokinetic peak torque and power (PWR) (at 180 degrees x s(-1)) for shoulder flexion, extension, internal rotation, and external rotation (ER). The CKCRT group significantly improved throwing velocity by 2.0 mph (3.4%, p < 0.05), and the OKCRT group improved 0.3 mph (0.5%, NS). A significant interaction was observed (p < 0.05). The CKCRT group improved its 1RM bench press to the same degree (1.9 kg) as the OKCRT group (p < 0.05 within each group). The CKCRT group improved all measures of shoulder strength and power, whereas OKCRT conferred little change in shoulder torque and power scores. Although throwing is an open-chain movement, adaptations from CKCRT may confer benefits to subsequent performance. Strength coaches can incorporate upper-body CKCRT without sacrificing gains in maximal strength or performance criteria associated with an athletic open-chain movement such as throwing.

Variation in the Gross Tumor Volume and Clinical Target Volume for Preoperative Radiotherapy of Primary Large High-Grade Soft Tissue Sarcoma of the Extremity Among RTOG Sarcoma Radiation Oncologists

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

Prevalence of upper extremity symptoms and disorders among dental and dental hygiene students.

PubMed

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.

Effects of robotic-aided rehabilitation on recovery of upper extremity function in chronic stroke: a single case study.

PubMed

Flinn, Nancy A; Smith, Jennifer L; Tripp, Christopher J; White, Matthew W

2009-01-01

The objective of the study was to examine the results of robotic therapy in a single client. A 48-year-old female client 15 months post-stroke, with right hemiparesis, received robotic therapy as an outpatient in a large Midwestern rehabilitation hospital. Robotic therapy was provided three times a week for 6 weeks. Robotic therapy consisted of goal-directed, robotic-aided reaching tasks to exercise the hemiparetic shoulder and elbow. No other therapeutic intervention for the affected upper extremity was provided during the study or 3 months follow-up period. The outcome measures included the Fugl-Meyer, graded Wolf motor function test (GWMFT), motor activity log, active range of motion and Canadian occupational performance measure. The participant made gains in active movement; performance; and satisfaction of functional tasks, GWMFT and functional use. Limitations involved in this study relate to the generalizability of the sample size, effect of medications, expense of robotic technologies and the impact of aphasia. Future research should incorporate functional use training along with robotic therapy.

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

PubMed Central

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

2016-01-01

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

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

PubMed

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

2016-11-01

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

Unilateral and bilateral upper extremity weight-bearing effect on upper extremity impairment and functional performance after brain injury

PubMed Central

REISTETTER, TIMOTHY; ABREU, BEATRIZ C.; BEAR-LEHMAN, JANE; OTTENBACHER, KENNETH J.

2010-01-01

The purpose of the study was to investigate the effect of upper extremity (UE) weight bearing on UE impairment functional performance of persons with acquired brain injury (BI). A quasi-experimental design was used to examine a convenience sample of 99 persons with acquired BI and 22 without BI (WBI) living in a community re-entry centre. A computerized force-sensing array pressure map system was used to determine the UE pressure during unilateral and bilateral conditions. Differences between groups were examined using t-tests. Correlations were computed between UE weight bearing and hand function, and functional performance as measured by the Fugl-Meyer scale and functional independence measure (FIM) scale. The group of people with BI exerted significantly lower UE weight bearing during unilateral conditions as compared with persons WBI [left: t (119) = 2.34, p = 0.021; right: t (119) = 4.79, p = 0.043). UE weight-bearing measures correlated strongly with FIM motor scores with bilateral UE conditions yielded the highest significant correlation (bilateral left r = 0.487, p < 0.001; bilateral right r = 0.469, p < 0.01). The results indicated that UE weight-bearing pressure differs in unilateral and bilateral conditions, between persons with and WBI and between persons with stroke and traumatic brain injury. These findings may have implications for occupational therapists that use unilateral versus bilateral motor training for rehabilitation. There is a need to replicate the study design with a randomized and stratified sample of persons with BI. PMID:19551694

Preliminary trial of postural strategy training using a personal transport assistance robot for patients with central nervous system disorder.

PubMed

Ozaki, Kenichi; Kagaya, Hitoshi; Hirano, Satoshi; Kondo, Izumi; Tanabe, Shigeo; Itoh, Norihide; Saitoh, Eiichi; Fuwa, Toshio; Murakami, Ryo

2013-01-01

To examine the efficacy of postural strategy training using a personal transport assistance robot (PTAR) for patients with central nervous system disorders. Single-group intervention trial. Rehabilitation center at a university hospital. Outpatients (N=8; 5 men, 3 women; mean age, 50±13y) with a gait disturbance (mean time after onset, 34±29mo) as a result of central nervous system disorders were selected from a volunteer sample. Two methods of balance exercise using a PTAR were devised: exercise against perturbation and exercise moving the center of gravity. The exercises were performed twice a week for 4 weeks. Preferred and tandem gait speeds, Functional Reach Test, functional base of support, center of pressure (COP), muscle strength of lower extremities, and grip strength were assessed before and after the completion of the exercise program. After the exercise program, enjoyment of exercise was investigated via a visual analog scale questionnaire. After the program, statistically significant improvements were noted for tandem gait speeds (P=.009), Functional Reach Test (P=.003), functional base of support (P=.014), and lower extremity muscle strength (P<.001-.042). On the other hand, preferred gait speeds (P=.151), COP (P=.446-.714), and grip power (P=.584) did not change. Finally, subjects rated that this exercise was more enjoyable than traditional balance exercises. Dynamic balance and lower extremity muscle strength were significantly improved in response to postural strategy training with the PTAR. These results suggest that postural strategy training with the PTAR may contribute to fall prevention of patients with a balance disorder. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Effects of being a peer-leader in an eating disorder prevention program: can we further reduce eating disorder risk factors?

PubMed

Black Becker, Carolyn; Bull, Stephanie; Smith, Lisa M; Ciao, Anna C

2008-01-01

Studies regarding the effect of peer-leadership on peer-leaders in prevention programs remain extremely limited. In this study, 83 undergraduate sorority members, who previously participated in the program, served as peer-leaders for an eating disorder prevention program. Peer-leaders attended 9 hours of training and then led two 2-hour sessions. Leaders showed decreases (beyond participation in earlier studies) in dietary restraint, bulimic pathology, body dissatisfaction, and thin-ideal internalization from pre-training through 7-week follow up. Results from this exploratory study suggest that peer-leaders who participate in a program and subsequently lead it may experience additional benefits compared to participation in the program alone.

Body Composition Changes in Severely Burned Children During ICU Hospitalization.

PubMed

Cambiaso-Daniel, Janos; Malagaris, Ioannis; Rivas, Eric; Hundeshagen, Gabriel; Voigt, Charles D; Blears, Elizabeth; Mlcak, Ron P; Herndon, David N; Finnerty, Celeste C; Suman, Oscar E

2017-12-01

Prolonged hospitalization due to burn injury results in physical inactivity and muscle weakness. However, how these changes are distributed among body parts is unknown. The aim of this study was to evaluate the degree of body composition changes in different anatomical regions during ICU hospitalization. Retrospective chart review. Children's burn hospital. Twenty-four severely burned children admitted to our institution between 2000 and 2015. All patients underwent a dual-energy x-ray absorptiometry within 2 weeks after injury and 2 weeks before discharge to determine body composition changes. No subject underwent anabolic intervention. We analyzed changes of bone mineral content, bone mineral density, total fat mass, total mass, and total lean mass of the entire body and specifically analyzed the changes between the upper and lower limbs. In the 24 patients, age was 10 ± 5 years, total body surface area burned was 59% ± 17%, time between dual-energy x-ray absorptiometries was 34 ± 21 days, and length of stay was 39 ± 24 days. We found a significant (p < 0.001) average loss of 3% of lean mass in the whole body; this loss was significantly greater (p < 0.001) in the upper extremities (17%) than in the lower extremities (7%). We also observed a remodeling of the fat compartments, with a significant whole-body increase in fat mass (p < 0.001) that was greater in the truncal region (p < 0.0001) and in the lower limbs (p < 0.05). ICU hospitalization is associated with greater lean mass loss in the upper limbs of burned children. Mobilization programs should include early mobilization of upper limbs to restore upper extremity function.

Training in childhood obesity management in the United States: a survey of pediatric, internal medicine-pediatrics and family medicine residency program directors

PubMed Central

2010-01-01

Background Information about the availability and effectiveness of childhood obesity training during residency is limited. Methods We surveyed residency program directors from pediatric, internal medicine-pediatrics (IM-Peds), and family medicine residency programs between September 2007 and January 2008 about childhood obesity training offered in their programs. Results The response rate was 42.2% (299/709) and ranged by specialty from 40.1% to 45.4%. Overall, 52.5% of respondents felt that childhood obesity training in residency was extremely important, and the majority of programs offered training in aspects of childhood obesity management including prevention (N = 240, 80.3%), diagnosis (N = 282, 94.3%), diagnosis of complications (N = 249, 83.3%), and treatment (N = 242, 80.9%). However, only 18.1% (N = 54) of programs had a formal childhood obesity curriculum with variability across specialties. Specifically, 35.5% of IM-Peds programs had a formal curriculum compared to only 22.6% of pediatric and 13.9% of family medicine programs (p < 0.01). Didactic instruction was the most commonly used training method but was rated as only somewhat effective by 67.9% of respondents using this method. The most frequently cited significant barrier to implementing childhood obesity training was competing curricular demands (58.5%). Conclusions While most residents receive training in aspects of childhood obesity management, deficits may exist in training quality with a minority of programs offering a formal childhood obesity curriculum. Given the high prevalence of childhood obesity, a greater emphasis should be placed on development and use of effective training strategies suitable for all specialties training physicians to care for children. PMID:20163732

Training in childhood obesity management in the United States: a survey of pediatric, internal medicine-pediatrics and family medicine residency program directors.

PubMed

Wolff, Margaret S; Rhodes, Erinn T; Ludwig, David S

2010-02-17

Information about the availability and effectiveness of childhood obesity training during residency is limited. We surveyed residency program directors from pediatric, internal medicine-pediatrics (IM-Peds), and family medicine residency programs between September 2007 and January 2008 about childhood obesity training offered in their programs. The response rate was 42.2% (299/709) and ranged by specialty from 40.1% to 45.4%. Overall, 52.5% of respondents felt that childhood obesity training in residency was extremely important, and the majority of programs offered training in aspects of childhood obesity management including prevention (N = 240, 80.3%), diagnosis (N = 282, 94.3%), diagnosis of complications (N = 249, 83.3%), and treatment (N = 242, 80.9%). However, only 18.1% (N = 54) of programs had a formal childhood obesity curriculum with variability across specialties. Specifically, 35.5% of IM-Peds programs had a formal curriculum compared to only 22.6% of pediatric and 13.9% of family medicine programs (p < 0.01). Didactic instruction was the most commonly used training method but was rated as only somewhat effective by 67.9% of respondents using this method. The most frequently cited significant barrier to implementing childhood obesity training was competing curricular demands (58.5%). While most residents receive training in aspects of childhood obesity management, deficits may exist in training quality with a minority of programs offering a formal childhood obesity curriculum. Given the high prevalence of childhood obesity, a greater emphasis should be placed on development and use of effective training strategies suitable for all specialties training physicians to care for children.

The effectiveness of manual therapy for the management of musculoskeletal disorders of the upper and lower extremities: a systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.

PubMed

Southerst, Danielle; Yu, Hainan; Randhawa, Kristi; Côté, Pierre; D'Angelo, Kevin; Shearer, Heather M; Wong, Jessica J; Sutton, Deborah; Varatharajan, Sharanya; Goldgrub, Rachel; Dion, Sarah; Cox, Jocelyn; Menta, Roger; Brown, Courtney K; Stern, Paula J; Stupar, Maja; Carroll, Linda J; Taylor-Vaisey, Anne

2015-01-01

Musculoskeletal disorders (MSDs) of the upper and lower extremities are common in the general population and place a significant burden on the health care system. Manual therapy is recommended by clinical practice guidelines for the management of these injuries; however, there is limited evidence to support its effectiveness. The purpose of our review was to investigate the effectiveness of manual therapy in adults or children with MSDs of the upper or lower extremity. Randomized controlled trials (RCTs), cohort studies, and case-control studies evaluating the effectiveness of manual therapy were eligible. We searched MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Central Register of Controlled Trials from 1990 to 2015. Paired reviewers screened studies for relevance and critically appraised relevant studies using the Scottish Intercollegiate Guidelines Network criteria. Studies with low risk of bias were synthesized following best-evidence synthesis principles. Where available, we computed mean changes between groups, relative risks and 95 % CI. We screened 6047 articles. Seven RCTs were critically appraised and three had low risk of bias. For adults with nonspecific shoulder pain of variable duration, cervicothoracic spinal manipulation and mobilization in addition to usual care may improve self-perceived recovery compared to usual care alone. For adults with subacromial impingement syndrome of variable duration, neck mobilization in addition to a multimodal shoulder program of care provides no added benefit. Finally, for adults with grade I-II ankle sprains of variable duration, lower extremity mobilization in addition to home exercise and advice provides greater short-term improvements in activities and function over home exercise and advice alone. No studies were included that evaluated the effectiveness of manual therapy in children or for the management of other extremity injuries in adults. The current evidence on the effectiveness of manual therapy for MSDs of the upper and lower extremities is limited. The available evidence supports the use of manual therapy for non-specific shoulder pain and ankle sprains, but not for subacromial impingement syndrome in adults. Future research is needed to determine the effectiveness of manual therapy and guide clinical practice. CRD42014009899.

Mirror therapy in children with hemiplegia: a pilot study.

PubMed

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.

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

PubMed

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.

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

PubMed Central

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

2015-01-01

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

Maximal Upper Body Strength and Oxygen Uptake are Associated with Performance in High-Level 200-M Sprint Kayakers.

PubMed

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.

Upper extremity impairments in type 1 diabetes with long duration; common problems with great impact on daily life.

PubMed

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.

Time to adapt exercise training regimens in pulmonary rehabilitation – a review of the literature

PubMed Central

Lee, Annemarie L; Holland, Anne E

2014-01-01

Exercise intolerance, exertional dyspnea, reduced health-related quality of life, and acute exacerbations are features characteristic of chronic obstructive pulmonary disease (COPD). Patients with a primary diagnosis of COPD often report comorbidities and other secondary manifestations, which diversifies the clinical presentation. Pulmonary rehabilitation that includes whole body exercise training is a critical part of management, and core programs involve endurance and resistance training for the upper and lower limbs. Improvement in maximal and submaximal exercise capacity, dyspnea, fatigue, health-related quality of life, and psychological symptoms are outcomes associated with exercise training in pulmonary rehabilitation, irrespective of the clinical state in which it is commenced. There may be benefits for the health care system as well as the individual patient, with fewer exacerbations and subsequent hospitalization reported with exercise training. The varying clinical profile of COPD may direct the need for modification to traditional training strategies for some patients. Interval training, one-legged cycling (partitioning) and non-linear periodized training appear to be equally or more effective than continuous training. Inspiratory muscle training may have a role as an adjunct to whole body training in selected patients. The benefits of balance training are also emerging. Strategies to ensure that health enhancing behaviors are adopted and maintained are essential. These may include training for an extended duration, alternative environments to undertake the initial program, maintenance programs following initial exercise training, program repetition, and incorporation of approaches to address behavioral change. This may be complemented by methods designed to maximize uptake and completion of a pulmonary rehabilitation program. PMID:25419125

Time to adapt exercise training regimens in pulmonary rehabilitation--a review of the literature.

PubMed

Lee, Annemarie L; Holland, Anne E

2014-01-01

Exercise intolerance, exertional dyspnea, reduced health-related quality of life, and acute exacerbations are features characteristic of chronic obstructive pulmonary disease (COPD). Patients with a primary diagnosis of COPD often report comorbidities and other secondary manifestations, which diversifies the clinical presentation. Pulmonary rehabilitation that includes whole body exercise training is a critical part of management, and core programs involve endurance and resistance training for the upper and lower limbs. Improvement in maximal and submaximal exercise capacity, dyspnea, fatigue, health-related quality of life, and psychological symptoms are outcomes associated with exercise training in pulmonary rehabilitation, irrespective of the clinical state in which it is commenced. There may be benefits for the health care system as well as the individual patient, with fewer exacerbations and subsequent hospitalization reported with exercise training. The varying clinical profile of COPD may direct the need for modification to traditional training strategies for some patients. Interval training, one-legged cycling (partitioning) and non-linear periodized training appear to be equally or more effective than continuous training. Inspiratory muscle training may have a role as an adjunct to whole body training in selected patients. The benefits of balance training are also emerging. Strategies to ensure that health enhancing behaviors are adopted and maintained are essential. These may include training for an extended duration, alternative environments to undertake the initial program, maintenance programs following initial exercise training, program repetition, and incorporation of approaches to address behavioral change. This may be complemented by methods designed to maximize uptake and completion of a pulmonary rehabilitation program.

Can physiological engineering/programming increase multi-generational thermal tolerance to extreme temperature events?

PubMed

Sorby, Kris L; Green, Mark P; Dempster, Tim D; Jessop, Tim S

2018-05-29

Organisms increasingly encounter higher frequencies of extreme weather events as a consequence of global climate change. Currently, few strategies are available to mitigate climate change effects on animals arising from acute extreme high temperature events. We tested the capacity of physiological engineering to influence the intra- and multi-generational upper thermal tolerance capacity of a model organism Artemia , subjected to extreme high temperatures. Enhancement of specific physiological regulators during development could affect thermal tolerances or life-history attributes affecting subsequent fitness. Using experimental Artemia populations we exposed F0 individuals to one of four treatments; heat hardening (28°C to 36°C, 1°C per 10 minutes), heat hardening plus serotonin (0.056 µg ml -1 ), heat hardening plus methionine (0.79 mg ml -1 ), and a control treatment. Regulator concentrations were based on previous literature. Serotonin may promote thermotolerance, acting upon metabolism and life-history. Methionine acts as a methylation agent across generations. For all groups, measurements were collected for three performance traits of individual thermal tolerance (upper sublethal thermal limit, lethal limit, and dysregulation range) over two generations. Results showed no treatment increased upper thermal limit during acute thermal stress, although serotonin-treated and methionine-treated individuals outperformed controls across multiple thermal performance traits. Additionally, some effects were evident across generations. Together these results suggest phenotypic engineering provides complex outcomes; and if implemented with heat hardening can further influence performance in multiple thermal tolerance traits, within and across generations. Potentially, such techniques could be up-scaled to provide resilience and stability in populations susceptible to extreme temperature events. © 2018. Published by The Company of Biologists Ltd.

Using Wearable Sensors and Machine Learning Models to Separate Functional Upper Extremity Use From Walking-Associated Arm Movements.

PubMed

McLeod, Adam; Bochniewicz, Elaine M; Lum, Peter S; Holley, Rahsaan J; Emmer, Geoff; Dromerick, Alexander W

2016-02-01

To improve measurement of upper extremity (UE) use in the community by evaluating the feasibility of using body-worn sensor data and machine learning models to distinguish productive prehensile and bimanual UE activity use from extraneous movements associated with walking. Comparison of machine learning classification models with criterion standard of manually scored videos of performance in UE prosthesis users. Rehabilitation hospital training apartment. Convenience sample of UE prosthesis users (n=5) and controls (n=13) similar in age and hand dominance (N=18). Participants were filmed executing a series of functional activities; a trained observer annotated each frame to indicate either UE movement directed at functional activity or walking. Synchronized data from an inertial sensor attached to the dominant wrist were similarly classified as indicating either a functional use or walking. These data were used to train 3 classification models to predict the functional versus walking state given the associated sensor information. Models were trained over 4 trials: on UE amputees and controls and both within subject and across subject. Model performance was also examined with and without preprocessing (centering) in the across-subject trials. Percent correct classification. With the exception of the amputee/across-subject trial, at least 1 model classified >95% of test data correctly for all trial types. The top performer in the amputee/across-subject trial classified 85% of test examples correctly. We have demonstrated that computationally lightweight classification models can use inertial data collected from wrist-worn sensors to reliably distinguish prosthetic UE movements during functional use from walking-associated movement. This approach has promise in objectively measuring real-world UE use of prosthetic limbs and may be helpful in clinical trials and in measuring response to treatment of other UE pathologies. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Incorporating yoga into an intense physical therapy program in someone with Parkinson's disease: a case report.

PubMed

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.

Upper Extremity Proprioception After Stroke: Bridging the Gap Between Neuroscience and Rehabilitation.

PubMed

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.

The cross education of strength and skill following unilateral strength training in the upper and lower limbs.

PubMed

Green, Lara A; Gabriel, David A

2018-04-18

Cross education is the strength gain or skill improvement transferred to the contralateral limb following unilateral training or practice. The present study examined the transfer of both strength and skill following a strength training program. Forty participants (20M, 20F) completed a 6-week unilateral training program of dominant wrist flexion or dorsiflexion. Strength, force variability, and muscle activity were assessed pre-training, post-training, and following 6-weeks of detraining (retention). Analyses of covariance compared the experimental limb (trained or untrained) to the control (dominant or non-dominant). There were no sex differences in the training response. Cross education of strength at post-training was 6% (p<0.01) in the untrained arm and 13% (p<0.01) in the untrained leg. Contralateral strength continued to increase following detraining to 15% in the arm (p<0.01) and 14% in the leg (p<0.01). There was no difference in strength gains between upper and lower limbs (p>0.05). Cross education of skill (force variability) demonstrated greater improvements in the untrained limbs compared to the control limbs during contractions performed without concurrent feedback. Significant increases in V-wave amplitude (p=0.02) and central activation (p<0.01) were highly correlated with contralateral strength gains. There was no change in agonist amplitude or motor unit firing rates in the untrained limbs (p>0.05). The neuromuscular mechanisms mirrored the force increases at post-training and retention supporting central drive adaptations of cross education. The continued strength increases at retention identified the presence of motor learning in cross education, as confirmed by force variability.

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

PubMed

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.

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

PubMed Central

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

2015-01-01

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

Neuromuscular training with injury prevention counselling to decrease the risk of acute musculoskeletal injury in young men during military service: a population-based, randomised study

PubMed Central

2011-01-01

Background The rapidly increasing number of activity-induced musculoskeletal injuries among adolescents and young adults is currently a true public health burden. The objective of this study was to investigate whether a neuromuscular training programme with injury prevention counselling is effective in preventing acute musculoskeletal injuries in young men during military service. Methods The trial design was a population-based, randomised study. Two successive cohorts of male conscripts in four companies of one brigade in the Finnish Defence Forces were first followed prospectively for one 6-month term to determine the baseline incidence of injury. After this period, two new successive cohorts in the same four companies were randomised into two groups and followed prospectively for 6 months. Military service is compulsory for about 90% of 19-year-old Finnish men annually, who comprised the cohort in this study. This randomised, controlled trial included 968 conscripts comprising 501 conscripts in the intervention group and 467 conscripts in the control group. A neuromuscular training programme was used to enhance conscripts' motor skills and body control, and an educational injury prevention programme was used to increase knowledge and awareness of acute musculoskeletal injuries. The main outcome measures were acute injuries of the lower and upper limbs. Results In the intervention groups, the risk for acute ankle injury decreased significantly compared to control groups (adjusted hazards ratio (HR) = 0.34, 95% confidence interval (95% CI) = 0.15 to 0.78, P = 0.011). This risk decline was observed in conscripts with low as well as moderate to high baseline fitness levels. In the latter group of conscripts, the risk of upper-extremity injuries also decreased significantly (adjusted HR = 0.37, 95% CI 0.14 to 0.99, P = 0.047). In addition, the intervention groups tended to have less time loss due to injuries (adjusted HR = 0.55, 95% CI 0.29 to 1.04). Conclusions A neuromuscular training and injury prevention counselling programme was effective in preventing acute ankle and upper-extremity injuries in young male army conscripts. A similar programme could be useful for all young individuals by initiating a regular exercise routine. Trial registration ClinicalTrials.gov identifier number NCT00595816. PMID:21481230

Neuromuscular training with injury prevention counselling to decrease the risk of acute musculoskeletal injury in young men during military service: a population-based, randomised study.

PubMed

Parkkari, Jari; Taanila, Henri; Suni, Jaana; Mattila, Ville M; Ohrankämmen, Olli; Vuorinen, Petteri; Kannus, Pekka; Pihlajamäki, Harri

2011-04-11

The rapidly increasing number of activity-induced musculoskeletal injuries among adolescents and young adults is currently a true public health burden. The objective of this study was to investigate whether a neuromuscular training programme with injury prevention counselling is effective in preventing acute musculoskeletal injuries in young men during military service. The trial design was a population-based, randomised study. Two successive cohorts of male conscripts in four companies of one brigade in the Finnish Defence Forces were first followed prospectively for one 6-month term to determine the baseline incidence of injury. After this period, two new successive cohorts in the same four companies were randomised into two groups and followed prospectively for 6 months. Military service is compulsory for about 90% of 19-year-old Finnish men annually, who comprised the cohort in this study. This randomised, controlled trial included 968 conscripts comprising 501 conscripts in the intervention group and 467 conscripts in the control group. A neuromuscular training programme was used to enhance conscripts' motor skills and body control, and an educational injury prevention programme was used to increase knowledge and awareness of acute musculoskeletal injuries. The main outcome measures were acute injuries of the lower and upper limbs. In the intervention groups, the risk for acute ankle injury decreased significantly compared to control groups (adjusted hazards ratio (HR) = 0.34, 95% confidence interval (95% CI) = 0.15 to 0.78, P = 0.011). This risk decline was observed in conscripts with low as well as moderate to high baseline fitness levels. In the latter group of conscripts, the risk of upper-extremity injuries also decreased significantly (adjusted HR = 0.37, 95% CI 0.14 to 0.99, P = 0.047). In addition, the intervention groups tended to have less time loss due to injuries (adjusted HR = 0.55, 95% CI 0.29 to 1.04). A neuromuscular training and injury prevention counselling programme was effective in preventing acute ankle and upper-extremity injuries in young male army conscripts. A similar programme could be useful for all young individuals by initiating a regular exercise routine. ClinicalTrials.gov identifier number NCT00595816.

Individual muscle contributions to push and recovery subtasks during wheelchair propulsion.

PubMed

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.

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

PubMed

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

2013-01-01

Parkinson Disease (PD) and Huntington Disease (HD) are degenerative neurological diseases, which can result in impairments and activity limitations affecting the upper extremities from early in the disease process. The progressive nature of these diseases poses unique challenges for therapists aiming to effectively maximize physical functioning and minimize participation restrictions in these patient groups. Research is underway in both diseases to develop effective disease-modifying agents and pharmacological interventions, as well as mobility-focused rehabilitation protocols. Rehabilitation, and in particular task-specific interventions, has the potential to influence the upper extremity functional abilities of patients with these degenerative conditions. However to date, investigations of interventions specifically addressing upper extremity function have been limited in both PD, and in particular HD. In this paper, we provide an update of the known pathological features of PD and HD as they relate to upper extremity function. We further review the available literature on the use of outcome measures, and the clinical management of upper extremity function in both conditions. Due to the currently limited evidence base in both diseases, we recommend utilization of a clinical management framework specific for degenerative conditions that can serve as a guideline for disease management. Copyright © 2013. Published by Elsevier Inc.

Placement of Upper Extremity Arteriovenous Access in Patients with Central Venous Occlusions: A Novel Technique.

PubMed

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.

Training modalities in robot-mediated upper limb rehabilitation in stroke: a framework for classification based on a systematic review.

PubMed

Basteris, Angelo; Nijenhuis, Sharon M; Stienen, Arno H A; Buurke, Jaap H; Prange, Gerdienke B; Amirabdollahian, Farshid

2014-07-10

Robot-mediated post-stroke therapy for the upper-extremity dates back to the 1990s. Since then, a number of robotic devices have become commercially available. There is clear evidence that robotic interventions improve upper limb motor scores and strength, but these improvements are often not transferred to performance of activities of daily living. We wish to better understand why. Our systematic review of 74 papers focuses on the targeted stage of recovery, the part of the limb trained, the different modalities used, and the effectiveness of each. The review shows that most of the studies so far focus on training of the proximal arm for chronic stroke patients. About the training modalities, studies typically refer to active, active-assisted and passive interaction. Robot-therapy in active assisted mode was associated with consistent improvements in arm function. More specifically, the use of HRI features stressing active contribution by the patient, such as EMG-modulated forces or a pushing force in combination with spring-damper guidance, may be beneficial.Our work also highlights that current literature frequently lacks information regarding the mechanism about the physical human-robot interaction (HRI). It is often unclear how the different modalities are implemented by different research groups (using different robots and platforms). In order to have a better and more reliable evidence of usefulness for these technologies, it is recommended that the HRI is better described and documented so that work of various teams can be considered in the same group and categories, allowing to infer for more suitable approaches. We propose a framework for categorisation of HRI modalities and features that will allow comparing their therapeutic benefits.

Training modalities in robot-mediated upper limb rehabilitation in stroke: a framework for classification based on a systematic review

PubMed Central

2014-01-01

Robot-mediated post-stroke therapy for the upper-extremity dates back to the 1990s. Since then, a number of robotic devices have become commercially available. There is clear evidence that robotic interventions improve upper limb motor scores and strength, but these improvements are often not transferred to performance of activities of daily living. We wish to better understand why. Our systematic review of 74 papers focuses on the targeted stage of recovery, the part of the limb trained, the different modalities used, and the effectiveness of each. The review shows that most of the studies so far focus on training of the proximal arm for chronic stroke patients. About the training modalities, studies typically refer to active, active-assisted and passive interaction. Robot-therapy in active assisted mode was associated with consistent improvements in arm function. More specifically, the use of HRI features stressing active contribution by the patient, such as EMG-modulated forces or a pushing force in combination with spring-damper guidance, may be beneficial. Our work also highlights that current literature frequently lacks information regarding the mechanism about the physical human-robot interaction (HRI). It is often unclear how the different modalities are implemented by different research groups (using different robots and platforms). In order to have a better and more reliable evidence of usefulness for these technologies, it is recommended that the HRI is better described and documented so that work of various teams can be considered in the same group and categories, allowing to infer for more suitable approaches. We propose a framework for categorisation of HRI modalities and features that will allow comparing their therapeutic benefits. PMID:25012864

Systematic Review of Postgraduate Surgical Education in Low- and Middle-Income Countries.

PubMed

Rickard, Jennifer

2016-06-01

Surgical care is recognized as an important component of public health, however, many low- and middle- income countries (LMICs) are faced with a shortage of trained personnel. In response to this unmet need, many countries have developed local postgraduate training programs in surgery. This study aims to characterize general surgery postgraduate education in LMICs. PubMed, EMBASE, and Global Index Medicus databases were searched for articles related to postgraduate general surgery education in LMICs. Studies in other surgical specialties and those published prior to 1990 were excluded. Data were collected on the characteristics of postgraduate training programs. Sixty-four articles discussed postgraduate surgical education in LMICs. Programs in 34 different countries and 6 different regions were represented. Nine countries were low-income, 12 were low-middle-income, and 13 were upper-middle-income countries. Sixty-four articles described aspects of the local postgraduate training program. Prior to postgraduate training, residents complete an undergraduate medical degree with 19 programs describing a pre-training experience such as internship. Surgical curricula were broad-based to prepare trainees to work in low-resource settings. At the completion of postgraduate training, examination formats varied including oral, written, and clinical exams. Postgraduate general surgery programs ranged from 2.5 to 7 years. Postgraduate surgical education is one mechanism to increase surgical capacity in LMICs. Different strategies have been employed to improve surgical education in LMICs and learning from these programs can optimize surgical education across teaching sites.

A multi-train electrical stimulation protocol facilitates transcranial electrical motor evoked potentials and increases induction rate and reproducibility even in patients with preoperative neurological deficits.

PubMed

Ushio, Shuta; Kawabata, Shigenori; Sumiya, Satoshi; Kato, Tsuyoshi; Yoshii, Toshitaka; Yamada, Tsuyoshi; Enomoto, Mitsuhiro; Okawa, Atsushi

2018-06-01

This study sought to evaluate the facilitation effect of repetitive multi-train transcranial electrical stimulation (mt-TES) at 2 repetition rates on transcranial electrical motor evoked potential (Tc-MEP) monitoring during spinal surgery, and to assess the induction rate in patients with impaired motor function from a compromised spinal cord or spinal nerve. We studied 32 consecutive patients with impaired motor function undergoing cervical or thoracic spinal surgery (470 muscles). A series of 10 TESs with 5 pulse trains were preoperatively delivered at 2 repetition rates (1 and 5 Hz). All peak-topeak amplitudes of the MEPs of the upper and lower extremity muscles elicited by the 10 TESs were measured. The induction rates of the lower extremity muscles were also assessed with muscle and preoperative lower extremity motor function scores. In each of the muscles, MEP amplitudes were augmented by about 2-3 times at 1 Hz and 5-6 times at 5 Hz. Under the 5-Hz condition, all limb muscles showed significant amplification. Also, in all preoperative motor function score groups, the amplitudes and induction rates of the lower extremity muscles were significantly increased. Moreover, the facilitation effects tended to peak in the last half of the series of 10 TESs. In all score groups of patients with preoperative neurological deficits, repetitive mt-TES delivered at a frequency of 5 Hz markedly facilitated the MEPs of all limb muscles and increased the induction rate. We recommend this method to improve the reliability of intraoperative monitoring during spinal surgery.

Effects of low-frequency repetitive transcranial magnetic stimulation and neuromuscular electrical stimulation on upper extremity motor recovery in the early period after stroke: a preliminary study.

PubMed

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.

Diagnostic accuracy of ultrasound in upper and lower extremity long bone fractures of emergency department trauma patients

PubMed Central

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

Ergonomic stressors and upper extremity disorders in vehicle manufacturing: cross sectional exposure-response trends

PubMed Central

Punnett, L.

1998-01-01

OBJECTIVE: To evaluate the association between upper extremity soft tissue disorders and exposure to preventable ergonomic stressors in vehicle manufacturing operations. METHODS: A cross sectional study was conducted in one vehicle stamping plant and one engine assembly plant. A standardised physical examination of the upper extremities was performed on all subjects. An interviewer administered questionnaire obtained data on demographics, work history, musculoskeletal symptoms, non-occupational covariates, and psycho-physical (relative intensity) ratings of ergonomic stressors. The primary exposure score was computed by summing the responses to the psychophysical exposure items. Multivariate regression analysis was used to model the prevalence of disorders of the shoulders or upper arms, wrists or hands, and all upper extremity regions (each defined both by symptoms and by physical examination plus symptoms) as a function of exposure quartile. RESULTS: A total of 1315 workers (85% of the target population) was examined. The prevalence of symptom disorders was 22% for the wrists or hands and 15% for the shoulders or upper arms; cases defined on the basis of a physical examination were about 80% as frequent. Disorders of the upper extremities, shoulders, and wrists or hands all increased markedly with exposure score, after adjustment for plant, acute injury, sex, body mass index, systemic disease, and seniority. CONCLUSIONS: Musculoskeletal disorders of the upper extremities were strongly associated with exposure to combined ergonomic stressors. The exposure- response trend was very similar for symptom cases and for physical examination cases. It is important to evaluate all dimensions of ergonomic exposure in epidemiological studies, as exposures often occur in combination in actual workplaces.   PMID:9764102

Usability of Videogame-Based Dexterity Training in the Early Rehabilitation Phase of Stroke Patients: A Pilot Study.

PubMed

Vanbellingen, Tim; Filius, Suzanne J; Nyffeler, Thomas; van Wegen, Erwin E H

2017-01-01

Approximately 70-80% of stroke survivors have limited activities of daily living, mainly due to dexterous problems. Videogame-based training (VBT) along with virtual reality seems to be beneficial to train upper limb function. To evaluate the usability of VBT using the Leap Motion Controller (LMC) to train fine manual dexterity in the early rehabilitation phase of stroke patients as an add-on to conventional therapy. Additionally, this study aimed to estimate the feasibility and potential efficacy of the VBT. During 3 months, 64 stroke patients were screened for eligibility, 13 stroke patients were included (4 women and 9 men; age range: 24-91 years; mean time post stroke: 28.2 days). Nine sessions of 30 min VBT, three times per week as an add-on to conventional therapy with stroke inpatients. Primary outcome was the usability of the system measured with the System Usability Scale. Secondary outcomes concerning feasibility were the compliance rate calculated from the total time spent on the intervention (TT) compared to planned time, the opinion of participants via open-end questions, and the level of active participation measured with the Pittsburgh Rehabilitation Participation Scale. Regarding the potential efficacy secondary outcomes were: functional dexterity measured with the Nine Hole Peg Test (NHPT), subjective dexterity measured with the Dexterity Questionnaire 24, grip strength measured with the Jamar dynamometer, and motor impairment of the upper limb measured with the Fugl-Meyer Upper Extremity (FM-UE) scale. Primarily, the usability of the system was good to excellent. The patient's perception of usability remained stable over a mean period of 3 weeks of VBT. Secondly, the compliance rate was good, and the level of active participation varied between good and very good. The opinion of the participants revealed that despite individual differences, the overall impression of the therapy and device was good. Patients showed significant improvements in hand dexterity. No changes were found in motor impairment of the upper limb (FM-UE) during intervention. VBT using LMC is a usable rehabilitation tool to train dexterity in the early rehabilitation phase of stroke inpatients.

Changes in skill and physical fitness following training in talent-identified volleyball players.

PubMed

Gabbett, Tim; Georgieff, Boris; Anderson, Steve; Cotton, Brad; Savovic, Darko; Nicholson, Lee

2006-02-01

This study investigated the effect of a skill-based training program on measurements of skill and physical fitness in talent-identified volleyball players. Twenty-six talented junior volleyball players (mean +/- SE age, 15.5 +/- 0.2 years) participated in an 8-week skill-based training program that included 3 skill-based court sessions per week. Skills sessions were designed to develop passing, setting, serving, spiking, and blocking technique and accuracy as well as game tactics and positioning skills. Coaches used a combination of technical and instructional coaching, coupled with skill-based games to facilitate learning. Subjects performed measurements of skill (passing, setting, serving, and spiking technique and accuracy), standard anthropometry (height, standing-reach height, body mass, and sum of 7 skinfolds), lower-body muscular power (vertical jump, spike jump), upper-body muscular power (overhead medicine-ball throw), speed (5- and 10-m sprint), agility (T-test), and maximal aerobic power (multistage fitness test) before and after training. Training induced significant (p < 0.05) improvements in spiking, setting, and passing accuracy and spiking and passing technique. Compared with pretraining, there were significant (p < 0.05) improvements in 5- and 10-m speed and agility. There were no significant differences between pretraining and posttraining for body mass, skinfold thickness, lower-body muscular power, upper-body muscular power, and maximal aerobic power. These findings demonstrate that skill-based volleyball training improves spiking, setting, and passing accuracy and spiking and passing technique, but has little effect on the physiological and anthropometric characteristics of players.

SENSory re-learning of the UPPer limb after stroke (SENSUPP): study protocol for a pilot randomized controlled trial.

PubMed

Carlsson, Håkan; Rosén, Birgitta; Pessah-Rasmussen, Hélène; Björkman, Anders; Brogårdh, Christina

2018-04-17

Many stroke survivors suffer from sensory impairments of their affected upper limb (UL). Although such impairments can affect the ability to use the UL in everyday activities, very little attention is paid to sensory impairments in stroke rehabilitation. The purpose of this trial is to investigate if sensory re-learning in combination with task-specific training may prove to be more effective than task-specific training alone to improve sensory function of the hand, dexterity, the ability to use the hand in daily activities, perceived participation, and life satisfaction. This study is a single-blinded pilot randomized controlled trial (RCT) with two treatment arms. The participants will be randomly assigned either to sensory re-learning in combination with task-specific training (sensory group) or to task-specific training only (control group). The training will consist of 2.5 h of group training per session, 2 times per week for 5 weeks. The primary outcome measures to assess sensory function are as follows: Semmes-Weinstein monofilament, Shape/Texture Identification (STI™) test, Fugl-Meyer Assessment-upper extremity (FMA-UE; sensory section), and tactile object identification test. The secondary outcome measures to assess motor function are as follows: Box and Block Test (BBT), mini Sollerman Hand Function Test (mSHFT), Modified Motor Assessment Scale (M-MAS), and Grippit. To assess the ability to use the hand in daily activities, perceived participation, and life satisfaction, the Motor Activity Log (MAL), Canadian Occupational Performance Measure (COPM), Stroke Impact Scale (SIS) participation domain, and Life Satisfaction checklist will be used. Assessments will be performed pre- and post-training and at 3-month follow-up by independent assessors, who are blinded to the participants' group allocation. At the 3-month follow-up, the participants in the sensory group will also be interviewed about their general experience of the training and how effective they perceived the training. The results from this study can add new knowledge about the effectiveness of sensory re-learning in combination with task-specific training on UL functioning after stroke. If the new training approach proves efficient, the results can provide information on how to design a larger RCT in the future in persons with sensory impairments of the UL after stroke. ClinicalTrials.gov, NCT03336749 . Registered on 8 November 2017.

Integrating Telehealth Emergency Department Follow-up Visits into Residency Training.

PubMed

Papanagnou, Dimitrios; Stone, Danica; Chandra, Shruti; Watts, Phillip; Chang, Anna Marie; Hollander, Judd E

2018-04-05

Introduction Given the rapid expansion of telehealth (TH), there is an emerging need for trained professionals who can effectively deliver TH services. As there is no formal TH training program for residents, the Department of Emergency Medicine (DEM) at Thomas Jefferson University (TJU) developed a pilot training program for senior post-graduate-year three (PGY-3) residents that exposed them to TH practices. The objective of the study was to determine the feasibility of developing a resident-led, post-Emergency-Department (ED) visit TH follow-up program as an educational opportunity to 1) address patient satisfaction; and 2) expose senior residents to TH delivery. Methods During a one-month block in their third-year of training, EM residents were exposed to and educated on TH delivery and utility through on-the-job, just-in-time training. Residents spent four hours per week evaluating patients previously seen in the ED within the last 5-7 days in the form of TH follow-up visits. ED patients were screened to identify which patient chief complaints and presentations were appropriate for a follow-up visit, given a specific day and time for their TH encounter, facilitated by a resident, and supervised by a faculty member trained in TH. Demographic patient and visit data were collected. Residents then completed a brief survey at the end of the rotation to capture their educational experiences and recommendations for subsequent training improvement. Results Over 12 months, 197 TH follow-up visits were performed by 12 residents. One hundred twenty-six patients (64%) were female. Top chief complaints included extremity pain (11.2%); abdominal pain (8.1%); upper respiratory infections (8.1%); lacerations (7.6%), and motor vehicle accidents (7.6%). The average number of days between the ED visit and the TH follow-up call was 5.1 days (IQR 3-6). 44.7% of patients were compliant with their discharge instructions and medications. On a Likert scale low (1) to high (10)], average patient helpfulness rating was 8.2 (IQR 7.8-10) and the average patient likelihood to recommend a TH follow-up visit was 8.5 (IQR 8-10). Ten residents completed the follow-up survey on the educational experience of the rotation (response rate 83%), of which seven described there is value to have a TH rotation in the curriculum. Thematic analysis of open-ended responses yielded constructive feedback for programmatic improvement. Conclusion The authors propose a feasible TH training opportunity integrated into EM residency training to assist them with meeting a rapidly-growing demand for TH and prepare them for diverse job opportunities.

Does a web-based feedback training program result in improved reliability in clinicians' ratings of the Global Assessment of Functioning (GAF) Scale?

PubMed

Støre-Valen, Jakob; Ryum, Truls; Pedersen, Geir A F; Pripp, Are H; Jose, Paul E; Karterud, Sigmund

2015-09-01

The Global Assessment of Functioning (GAF) Scale is used in routine clinical practice and research to estimate symptom and functional severity and longitudinal change. Concerns about poor interrater reliability have been raised, and the present study evaluated the effect of a Web-based GAF training program designed to improve interrater reliability in routine clinical practice. Clinicians rated up to 20 vignettes online, and received deviation scores as immediate feedback (i.e., own scores compared with expert raters) after each rating. Growth curves of absolute SD scores across the vignettes were modeled. A linear mixed effects model, using the clinician's deviation scores from expert raters as the dependent variable, indicated an improvement in reliability during training. Moderation by content of scale (symptoms; functioning), scale range (average; extreme), previous experience with GAF rating, profession, and postgraduate training were assessed. Training reduced deviation scores for inexperienced GAF raters, for individuals in clinical professions other than nursing and medicine, and for individuals with no postgraduate specialization. In addition, training was most beneficial for cases with average severity of symptoms compared with cases with extreme severity. The results support the use of Web-based training with feedback routines as a means to improve the reliability of GAF ratings performed by clinicians in mental health practice. These results especially pertain to clinicians in mental health practice who do not have a masters or doctoral degree. (c) 2015 APA, all rights reserved.

Self-Estimation of Blood Alcohol Concentration: A Review

PubMed Central

Aston, Elizabeth R.; Liguori, Anthony

2013-01-01

This article reviews the history of blood alcohol concentration (BAC) estimation training, which trains drinkers to discriminate distinct BAC levels and thus avoid excessive alcohol consumption. BAC estimation training typically combines education concerning alcohol metabolism with attention to subjective internal cues associated with specific concentrations. Estimation training was originally conceived as a component of controlled drinking programs. However, dependent drinkers were unsuccessful in BAC estimation, likely due to extreme tolerance. In contrast, moderate drinkers successfully acquired this ability. A subsequent line of research translated laboratory estimation studies to naturalistic settings by studying large samples of drinkers in their preferred drinking environments. Thus far, naturalistic studies have provided mixed results regarding the most effective form of BAC feedback. BAC estimation training is important because it imparts an ability to perceive individualized impairment that may be present below the legal limit for driving. Consequently, the training can be a useful component for moderate drinkers in drunk driving prevention programs. PMID:23380489

AExaCTT - Aerobic Exercise and Consecutive Task-specific Training for the upper limb after stroke: Protocol for a randomised controlled pilot study.

PubMed

Valkenborghs, Sarah R; Visser, Milanka M; Dunn, Ashlee; Erickson, Kirk I; Nilsson, Michael; Callister, Robin; van Vliet, Paulette

2017-09-01

Motor function may be enhanced if aerobic exercise is paired with motor training. One potential mechanism is that aerobic exercise increases levels of brain-derived neurotrophic factor (BDNF), which is important in neuroplasticity and involved in motor learning and motor memory consolidation. This study will examine the feasibility of a parallel-group assessor-blinded randomised controlled trial investigating whether task-specific training preceded by aerobic exercise improves upper limb function more than task-specific training alone, and determine the effect size of changes in primary outcome measures. People with upper limb motor dysfunction after stroke will be allocated to either task-specific training or aerobic exercise and consecutive task-specific training. Both groups will perform 60 hours of task-specific training over 10 weeks, comprised of 3 × 1 hour sessions per week with a therapist and 3 × 1 hours of home-based self-practice per week. The combined intervention group will also perform 30 minutes of aerobic exercise (70-85%HR max ) immediately prior to the 1 hour of task-specific training with the therapist. Recruitment, adherence, retention, participant acceptability, and adverse events will be recorded. Clinical outcome measures will be performed pre-randomisation at baseline, at completion of the training program, and at 1 and 6 months follow-up. Primary clinical outcome measures will be the Action Research Arm Test (ARAT) and the Wolf Motor Function Test (WMFT). If aerobic exercise prior to task-specific training is acceptable, and a future phase 3 randomised controlled trial seems feasible, it should be pursued to determine the efficacy of this combined intervention for people after stroke.

Comparison of two techniques of robot-aided upper limb exercise training after stroke.

PubMed

Stein, Joel; Krebs, Hermano Igo; Frontera, Walter R; Fasoli, Susan E; Hughes, Richard; Hogan, Neville

2004-09-01

This study examined whether incorporating progressive resistive training into robot-aided exercise training provides incremental benefits over active-assisted robot-aided exercise for the upper limb after stroke. A total of 47 individuals at least 1 yr poststroke were enrolled in this 6-wk training protocol. Paretic upper limb motor abilities were evaluated using clinical measures and a robot-based assessment to determine eligibility for robot-aided progressive resistive training at study entry. Subjects capable of participating in resistance training were randomized to receive either active-assisted robot-aided exercises or robot-aided progressive resistance training. Subjects who were incapable of participating in resistance training underwent active-assisted robotic therapy and were again screened for eligibility after 3 wks of robotic therapy. Those subjects capable of participating in resistance training at 3 wks were then randomized to receive either robot-aided resistance training or to continue with robot-aided active-assisted training. One subject withdrew due to unrelated medical issues, and data for the remaining 46 subjects were analyzed. Subjects in all groups showed improvement in measures of motor control (mean increase in Fugl-Meyer of 3.3; 95% confidence interval, 2.2-4.4) and maximal force (mean increase in maximal force of 3.5 N, P = 0.027) over the course of robot-aided exercise training. No differences in outcome measures were observed between the resistance training groups and the matched active-assisted training groups. Subjects' ability to perform the robotic task at the time of group assignment predicted the magnitude of the gain in motor control. The incorporation of robot-aided progressive resistance exercises into a program of robot-aided exercise did not favorably or negatively affect the gains in motor control or strength associated with this training, though interpretation of these results is limited by sample size. Individuals with better motor control at baseline experienced greater increases in motor control with robotic training.

Upper-body strength gains from different modes of resistance training in women who are underweight and women who are obese.

PubMed

Mayhew, Jerry L; Smith, Abbie E; Arabas, Jana L; Roberts, B Scott

2010-10-01

The purpose of this study was to determine the degree of upper-body strength gained by college women who are underweight and those who are obese using different modes of resistance training. Women who were underweight (UWW, n = 93, weight = 49.3 ± 4.5 kg) and women who were obese (OBW, n = 73, weight = 94.0 ± 15.1 kg) were selected from a larger cohort based on body mass index (UWW ≤ 18.5 kg·m⁻²; OBW ≥ 30 kg·m⁻²). Subjects elected to train with either free weights (FW, n = 38), supine vertical bench press machine (n = 52) or seated horizontal bench press machine (n = 76) using similar linear periodization resistance training programs 3× per week for 12 weeks. Each participant was assessed for upper-body strength using FWs (general) and machine weight (specific) 1 repetition maximum bench press before and after training. Increases in general and mode-specific strength were significantly greater for OBW (5.2 ± 5.1 and 9.6 ± 5.1 kg, respectively) than for UWW (3.5 ± 4.1 and 7.2 ± 5.2 kg, respectively). General strength gains were not significantly different among the training modes. Mode-specific gains were significantly greater (p < 0.05) than general strength gains for all groups. In conclusion, various resistance training modes may produce comparable increases in general strength but will register greater gains if measured using the specific mode employed for training, regardless of the weight category of the individual.

The New Jersey Institute of Technology Robot-Assisted Virtual Rehabilitation (NJIT-RAVR) system for children with cerebral palsy: a feasibility study.

PubMed

Qiu, Qinyin; Ramirez, Diego A; Saleh, Soha; Fluet, Gerard G; Parikh, Heta D; Kelly, Donna; Adamovich, Sergei V

2009-11-16

We hypothesize that the integration of virtual reality (VR) with robot assisted rehabilitation could be successful if applied to children with hemiparetic CP. The combined benefits of increased attention provided by VR and the larger training stimulus afforded by adaptive robotics may increase the beneficial effects of these two approaches synergistically. This paper will describe the NJIT-RAVR system, which combines adaptive robotics with complex VR simulations for the rehabilitation of upper extremity impairments and function in children with CP and examine the feasibility of this system in the context of a two subject training study. The NJIT-RAVR system consists of the Haptic Master, a 6 degrees of freedom, admittance controlled robot and a suite of rehabilitation simulations that provide adaptive algorithms for the Haptic Master, allowing the user to interact with rich virtual environments. Two children, a ten year old boy and a seven year old girl, both with spastic hemiplegia secondary to Cerebral Palsy were recruited from the outpatient center of a comprehensive pediatric rehabilitation facility. Subjects performed a battery of clinical testing and kinematic measurements of reaching collected by the NJIT-RAVR system. Subjects trained with the NJIT-RAVR System for one hour, 3 days a week for three weeks. The subjects played a combination of four or five simulations depending on their therapeutic goals, tolerances and preferences. Games were modified to increase difficulty in order to challenge the subjects as their performance improved. The testing battery was repeated following the training period. Both participants completed 9 hours of training in 3 weeks. No untoward events occurred and no adverse responses to treatment or complaints of cyber sickness were reported. One participant showed improvements in overall performance on the functional aspects of the testing battery. The second subject made improvements in upper extremity active range of motion and in kinematic measures of reaching movements. We feel that this study establishes the feasibility of integrating robotics and rich virtual environments to address functional limitations and decreased motor performance in children with mild to moderate cerebral palsy.

Preventing running injuries. Practical approach for family doctors.

PubMed Central

Johnston, C. A. M.; Taunton, J. E.; Lloyd-Smith, D. R.; McKenzie, D. C.

2003-01-01

OBJECTIVE: To present a practical approach for preventing running injuries. QUALITY OF EVIDENCE: Much of the research on running injuries is in the form of expert opinion and comparison trials. Recent systematic reviews have summarized research in orthotics, stretching before running, and interventions to prevent soft tissue injuries. MAIN MESSAGE: The most common factors implicated in running injuries are errors in training methods, inappropriate training surfaces and running shoes, malalignment of the leg, and muscle weakness and inflexibility. Runners can reduce risk of injury by using established training programs that gradually increase distance or time of running and provide appropriate rest. Orthoses and heel lifts can correct malalignments of the leg. Running shoes appropriate for runners' foot types should be selected. Lower-extremity strength and flexibility programs should be added to training. Select appropriate surfaces for training and introduce changes gradually. CONCLUSION: Prevention addresses factors proven to cause running injuries. Unfortunately, injury is often the first sign of fault in running programs, so patients should be taught to recognize early symptoms of injury. PMID:14526862

UAF Space Systems Engineering Program: Engaging Students through an Apprenticeship Model

NASA Astrophysics Data System (ADS)

Thorsen, D.

2017-12-01

Learning by doing has been the mantra of engineering education for decades, however, the constraints of semester length courses limits the types and size of experiences that can be offered to students. The Space Systems Engineering Program (SSEP) at the University of Alaska Fairbanks provides interdisciplinary engineering and science students with hands-on experience in all aspects of space systems engineering through a design, build, launch paradigm applied to balloon and rocket payloads and small satellites. The program is structured using an apprenticeship model such that students, freshmen through graduate, can participate in multi-year projects thereby gaining experiences appropriate to their level in college. Students enter the lab in a trainee position and receive training on lab processes and design software. Depending on the student's interests they learn how to use specific lab equipment and software design tools. Trainees provide support engineering under guidance of an upper classman. As the students' progress in their degree program and gain more expertise, they typically become part of a specific subsystem team, where they receive additional training in developing design documents and in writing requirements and test documents, and direct their efforts to meeting specific objectives. By the time the student reaches their senior year, they have acquired the leadership role for a specific subsystem and/or a general leadership role in the lab. If students stay to pursue graduate degrees, they assume the responsibility of training and mentoring other undergraduates in their areas of expertise. Throughout the program upper class students mentor the newer students. The Space Systems Engineering Program strives to reinforce a student's degree program through these large scale projects that place engineering in context.

Current Concepts in Examination and Treatment of Elbow Tendon Injury

PubMed Central

Ellenbecker, Todd S.; Nirschl, Robert; Renstrom, Per

2013-01-01

Context: Injuries to the tendons of the elbow occur frequently in the overhead athlete, creating a significant loss of function and dilemma to sports medicine professionals. A detailed review of the anatomy, etiology, and pathophysiology of tendon injury coupled with comprehensive evaluation and treatment information is needed for clinicians to optimally design treatment programs for rehabilitation and prevention. Evidence Acquisitions: The PubMed database was searched in January 2012 for English-language articles pertaining to elbow tendon injury. Results: Detailed information on tendon pathophysiology was found along with incidence of elbow injury in overhead athletes. Several evidence-based reviews were identified, providing a thorough review of the recommended rehabilitation for elbow tendon injury. Conclusions: Humeral epicondylitis is an extra-articular tendon injury that is common in athletes subjected to repetitive upper extremity loading. Research is limited on the identification of treatment modalities that can reduce pain and restore function to the elbow. Eccentric exercise has been studied in several investigations and, when coupled with a complete upper extremity strengthening program, can produce positive results in patients with elbow tendon injury. Further research is needed in high-level study to delineate optimal treatment methods. PMID:24427389

Stress fractures of the ribs and upper extremities: causation, evaluation, and management.

PubMed

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.

Effects of functional stabilization training on pain, function, and lower extremity biomechanics in women with patellofemoral pain: a randomized clinical trial.

PubMed

Baldon, Rodrigo de Marche; Serrão, Fábio Viadanna; Scattone Silva, Rodrigo; Piva, Sara Regina

2014-04-01

Randomized clinical trial. To compare the effects of functional stabilization training (FST) versus standard training on knee pain and function, lower-limb and trunk kinematics, trunk muscle endurance, and eccentric hip and knee muscle strength in women with patellofemoral pain. A combination of hip- and knee-strengthening exercise may be more beneficial than quadriceps strengthening alone to improve pain and function in individuals with patellofemoral pain. However, there is limited evidence of the effectiveness of these exercise programs on the biomechanics of the lower extremity. Thirty-one women were randomized to either the FST group or standard-training group. Patients attended a baseline assessment session, followed by an 8-week intervention, and were reassessed at the end of the intervention and at 3 months after the intervention. Assessment measures were a 10-cm visual analog scale for pain, the Lower Extremity Functional Scale, and the single-leg triple-hop test. A global rating of change scale was used to measure perceived improvement. Kinematics were assessed during the single-leg squat. Outcome measures also included trunk endurance and eccentric hip and knee muscle strength assessment. The patients in the FST group had less pain at the 3-month follow-up and greater global improvement and physical function at the end of the intervention compared to those in the standard-training group. Lesser ipsilateral trunk inclination, pelvis contralateral depression, hip adduction, and knee abduction, along with greater pelvis anteversion and hip flexion movement excursions during the single-leg squat, were only observed in the FST group after the intervention. Only those in the FST group had greater eccentric hip abductor and knee flexor strength, as well as greater endurance of the anterior, posterior, and lateral trunk muscles, after training. An intervention program consisting of hip muscle strengthening and lower-limb and trunk movement control exercises was more beneficial in improving pain, physical function, kinematics, and muscle strength compared to a program of quadriceps-strengthening exercises alone.

DANCE, BALANCE AND CORE MUSCLE PERFORMANCE MEASURES ARE IMPROVED FOLLOWING A 9-WEEK CORE STABILIZATION TRAINING PROGRAM AMONG COMPETITIVE COLLEGIATE Dancers.

PubMed

Watson, Todd; Graning, Jessica; McPherson, Sue; Carter, Elizabeth; Edwards, Joshuah; Melcher, Isaac; Burgess, Taylor

2017-02-01

Dance performance requires not only lower extremity muscle strength and endurance, but also sufficient core stabilization during dynamic dance movements. While previous studies have identified a link between core muscle performance and lower extremity injury risk, what has not been determined is if an extended core stabilization training program will improve specific measures of dance performance. This study examined the impact of a nine-week core stabilization program on indices of dance performance, balance measures, and core muscle performance in competitive collegiate dancers. Within-subject repeated measures design. A convenience sample of 24 female collegiate dance team members (age = 19.7 ± 1.1 years, height = 164.3 ± 5.3 cm, weight 60.3 ± 6.2 kg, BMI = 22.5 ± 3.0) participated. The intervention consisted of a supervised and non-supervised core (trunk musculature) exercise training program designed specifically for dance team participants performed three days/week for nine weeks in addition to routine dance practice. Prior to the program implementation and following initial testing, transversus abdominis (TrA) activation training was completed using the abdominal draw-in maneuver (ADIM) including ultrasound imaging (USI) verification and instructor feedback. Paired t tests were conducted regarding the nine-week core stabilization program on dance performance and balance measures (pirouettes, single leg balance in passe' releve position, and star excursion balance test [SEBT]) and on tests of muscle performance. A repeated measures (RM) ANOVA examined four TrA instruction conditions of activation: resting baseline, self-selected activation, immediately following ADIM training and four days after completion of the core stabilization training program. Alpha was set at 0.05 for all analysis. Statistically significant improvements were seen on single leg balance in passe' releve and bilateral anterior reach for the SEBT (both p ≤ 0.01), number of pirouettes (p = 0.011), and all measures of strength (p ≤ 0.05) except single leg heel raise. The RM ANOVA on mean percentage of change in TrA was significant; post hoc paired t tests demonstrated significant improvements in dancers' TrA activations across the four instruction conditions. This core stabilization training program improves pirouette ability, balance (static and dynamic), and measures of muscle performance. Additionally, ADIM training resulted in immediate and short-term (nine-week) improvements in TrA activation in a functional dance position. 2b.

DANCE, BALANCE AND CORE MUSCLE PERFORMANCE MEASURES ARE IMPROVED FOLLOWING A 9-WEEK CORE STABILIZATION TRAINING PROGRAM AMONG COMPETITIVE COLLEGIATE Dancers

PubMed Central

Graning, Jessica; McPherson, Sue; Carter, Elizabeth; Edwards, Joshuah; Melcher, Isaac; Burgess, Taylor

2017-01-01

Background Dance performance requires not only lower extremity muscle strength and endurance, but also sufficient core stabilization during dynamic dance movements. While previous studies have identified a link between core muscle performance and lower extremity injury risk, what has not been determined is if an extended core stabilization training program will improve specific measures of dance performance. Hypothesis/Purpose This study examined the impact of a nine-week core stabilization program on indices of dance performance, balance measures, and core muscle performance in competitive collegiate dancers. Study Design Within-subject repeated measures design. Methods A convenience sample of 24 female collegiate dance team members (age = 19.7 ± 1.1 years, height = 164.3 ± 5.3 cm, weight 60.3 ± 6.2 kg, BMI = 22.5 ± 3.0) participated. The intervention consisted of a supervised and non-supervised core (trunk musculature) exercise training program designed specifically for dance team participants performed three days/week for nine weeks in addition to routine dance practice. Prior to the program implementation and following initial testing, transversus abdominis (TrA) activation training was completed using the abdominal draw-in maneuver (ADIM) including ultrasound imaging (USI) verification and instructor feedback. Paired t tests were conducted regarding the nine-week core stabilization program on dance performance and balance measures (pirouettes, single leg balance in passe’ releve position, and star excursion balance test [SEBT]) and on tests of muscle performance. A repeated measures (RM) ANOVA examined four TrA instruction conditions of activation: resting baseline, self-selected activation, immediately following ADIM training and four days after completion of the core stabilization training program. Alpha was set at 0.05 for all analysis. Results Statistically significant improvements were seen on single leg balance in passe’ releve and bilateral anterior reach for the SEBT (both p ≤ 0.01), number of pirouettes (p = 0.011), and all measures of strength (p ≤ 0.05) except single leg heel raise. The RM ANOVA on mean percentage of change in TrA was significant; post hoc paired t tests demonstrated significant improvements in dancers’ TrA activations across the four instruction conditions Conclusion This core stabilization training program improves pirouette ability, balance (static and dynamic), and measures of muscle performance. Additionally, ADIM training resulted in immediate and short-term (nine-week) improvements in TrA activation in a functional dance position. Level of Evidence 2b PMID:28217414

Upper extremity sensorimotor control among collegiate football players.

PubMed

Laudner, Kevin G

2012-03-01

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

Black breast cancer survivors experience greater upper extremity disability.

PubMed

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

2015-11-01

Over one-third of breast cancer survivors experience upper extremity disability. Black women present with factors associated with greater upper extremity disability, including: increased body mass index (BMI), more advanced disease stage at diagnosis, and varying treatment type compared with Whites. No prior research has evaluated the relationship between race and upper extremity disability using validated tools and controlling for these factors. Data were drawn from a survey study among 610 women with stage I-III hormone receptor positive breast cancer. The disabilities of the arm, shoulder and hand (QuickDASH) is an 11-item self-administered questionnaire that has been validated for breast cancer survivors to assess global upper extremity function over the past 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.

Effect of Upper Limb Rehabilitation Compared to No Upper Limb Rehabilitation in Lung Transplant Recipients: A Randomized Controlled Trial.

PubMed

Fuller, Louise M; El-Ansary, Doa; Button, Brenda M; Corbett, Monique; Snell, Greg; Marasco, Silvana; Holland, Anne E

2017-10-16

To investigate the effect of a supervised upper limb (UL) program (SULP) compared to no supervised UL program (NULP) after lung transplantation (LTx). Randomized controlled trial. Physiotherapy gym. Participants (N=80; mean age, 56±11y; 37 [46%] men) were recruited after LTx. All participants underwent lower limb strength thrice weekly and endurance training. Participants randomized to SULP completed progressive UL strength training program using handheld weights and adjustable pulley equipment. Overall bodily pain was rated on the visual analog scale. Shoulder flexion and abduction muscle strength were measured on a hand held dynamometer. Health related quality of life was measured with Medical Outcomes Study 36-item Short Form health Survey and the Quick Dash. Measurements were made at baseline, 6 weeks, 12 weeks, and 6 months by blinded assessors. After 6 weeks of training, participants in the SULP (n=41) had less overall bodily pain on the visual analog scale than did participants in the NULP (n=36) (mean VAS bodily pain score, 2.1±1.3cm vs 3.8±1.7cm; P<.001) as well as greater UL strength than did participants in the NULP (mean peak force, 8.4±4.0Nm vs 6.7±2.8Nm; P=.037). At 12 weeks, participants in the SULP better quality of life related to bodily pain (76±17 vs 66±26; P=.05), but at 6 months there were no differences between the groups in any outcome measures. No serious adverse events were reported. UL rehabilitation results in short-term improvements in pain and muscle strength after LTx, but no longer-term effects were evident. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

Effects of interactive visual feedback training on post-stroke pusher syndrome: a pilot randomized controlled study.

PubMed

Yang, Yea-Ru; Chen, Yi-Hua; Chang, Heng-Chih; Chan, Rai-Chi; Wei, Shun-Hwa; Wang, Ray-Yau

2015-10-01

We investigated the effects of a computer-generated interactive visual feedback training program on the recovery from pusher syndrome in stroke patients. Assessor-blinded, pilot randomized controlled study. A total of 12 stroke patients with pusher syndrome were randomly assigned to either the experimental group (N = 7, computer-generated interactive visual feedback training) or control group (N = 5, mirror visual feedback training). The scale for contraversive pushing for severity of pusher syndrome, the Berg Balance Scale for balance performance, and the Fugl-Meyer assessment scale for motor control were the outcome measures. Patients were assessed pre- and posttraining. A comparison of pre- and posttraining assessment results revealed that both training programs led to the following significant changes: decreased severity of pusher syndrome scores (decreases of 4.0 ± 1.1 and 1.4 ± 1.0 in the experimental and control groups, respectively); improved balance scores (increases of 14.7 ± 4.3 and 7.2 ± 1.6 in the experimental and control groups, respectively); and higher scores for lower extremity motor control (increases of 8.4 ± 2.2 and 5.6 ± 3.3 in the experimental and control groups, respectively). Furthermore, the computer-generated interactive visual feedback training program produced significantly better outcomes in the improvement of pusher syndrome (p < 0.01) and balance (p < 0.05) compared with the mirror visual feedback training program. Although both training programs were beneficial, the computer-generated interactive visual feedback training program more effectively aided recovery from pusher syndrome compared with mirror visual feedback training. © The Author(s) 2014.

Impact of an implanted neuroprosthesis on community ambulation in incomplete SCI.

PubMed

Lombardo, Lisa M; Kobetic, Rudolf; Pinault, Gilles; Foglyano, Kevin M; Bailey, Stephanie N; Selkirk, Stephen; Triolo, Ronald J

2018-03-01

Test the effect of a multi-joint control with implanted electrical stimulation on walking after spinal cord injury (SCI). Single subject research design with repeated measures. Hospital-based biomechanics laboratory and user assessment of community use. Female with C6 AIS C SCI 30 years post injury. Lower extremity muscle activation with an implanted pulse generator and gait training. Walking speed, maximum distance, oxygen consumption, upper extremity (UE) forces, kinematics and self-assessment of technology. Short distance walking speed at one-year follow up with or without stimulation was not significantly different from baseline. However, average walking speed was significantly faster (0.22 m/s) with stimulation over longer distances than volitional walking (0.12 m/s). In addition, there was a 413% increase in walking distance from 95 m volitionally to 488 m with stimulation while oxygen consumption and maximum upper extremity forces decreased by 22 and 16%, respectively. Stimulation also produced significant (P ≤ 0.001) improvements in peak hip and knee flexion, ankle angle at foot off and at mid-swing. An implanted neuroprosthesis enabled a subject with incomplete SCI to walk longer distances with improved hip and knee flexion and ankle dorsiflexion resulting in decreased oxygen consumption and UE support. Further research is required to determine the robustness, generalizability and functional implications of implanted neuroprostheses for community ambulation after incomplete SCI.

Profiles of musculoskeletal development in limbs of college Olympic weightlifters and wrestlers.

PubMed

Kanehisa, H; Fukunaga, T

1999-04-01

To investigate the event-related profiles of musculoskeletal development in weight-categorized athletes, we measured the cross-sectional areas (CSA) of bone and muscle in the forearm, upper arm, lower leg and thigh, using a B-mode ultrasound apparatus, in college Olympic weightlifters (OWL, n = 19) and wrestlers (WR, n = 17) and untrained men (UM, n = 24), whose body masses were within the range from 55 kg to 78 kg. Both bone and muscle CSA at all sites were significantly correlated to the two-thirds power of fat-free mass (FFM(2/3)) with correlation coefficients of 0.430-40.741 (P < 0.05) and 0.608-0.718 (P < 0.05), respectively. Moreover, there were significant correlations between bone and muscle CSA at all sites (r = 0.664-0.829, P < 0.05). Even when bone and muscle CSA were expressed relative value to FFM(2/3), both OWL and WR showed significantly greater values than UM at all sites except for the lower leg. Furthermore, the comparison of the lean (bone + muscle) CSA ratio from site to site indicated a higher distribution of lean tissues in the upper extremities in OWL and WR compared to UM. While there was no significant difference between the two athlete groups in FFM(2/3), OWL showed significantly larger values than WR in the bone CSA of the upper arm and thigh and in the muscle CSA of the lower leg and thigh. However, lean CSA ratios of the upper extremities to the lower ones were significantly higher in WR than in OWL. Thus, the present results indicated that, compared to UM, OWL and WR had a greater lean tissue CSA in limbs, especially in the upper extremities, even when the difference in FFM was normalized. Moreover, the relative distribution of lean tissues in limbs differed between the two weight-categorized athletes in spite of there being no difference in FFM, which may be attributable to their own training regimens and/or competition style.

Robotics in shoulder rehabilitation

PubMed Central

Sicuri, Chiara; Porcellini, Giuseppe; Merolla, Giovanni

2014-01-01

Summary In the last few decades, several researches have been conducted in the field of robotic rehabilitation to meet the intensive, repetitive and task-oriented training, with the goal to recover the motor function. Up to now, robotic rehabilitation studies of the upper extremity have generally focused on stroke survivors leaving less explored the field of orthopaedic shoulder rehabilitation. In this review we analyse the present status of robotic technologies, in order to understand which are the current indications and which may be the future perspective for their application in both neurological and orthopaedic shoulder rehabilitation. PMID:25332937

New possibilities of improving the function of the hand of patients with spastic hemiplegia.

PubMed

Kiwerski, J

1984-01-01

The report presents a therapeutic proposal aiming at the improvement of the functions of the paretic hand in spastic hemiplegics. To achieve this aim the author suggests a combination of phenolization of the medial and ulnar nerves and the stimulation training of the wrist and fingers extensors. An implanted stimulator is used; the stimulator electrodes are fixed to the radial nerve. The strengthening of the extensors during the period of increased muscular tension of the flexors makes it possible to improve the functions of the paretic upper extremity.

Investigation of hand function among children diagnosed with autism spectrum disorder with upper extremity trauma history.

PubMed

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.

Interdisciplinary rehabilitation for a patient with incomplete cervical spinal cord injury and multimorbidity: A case report.

PubMed

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.

Exercise prescription for overhead athletes with shoulder pathology: a systematic review with best evidence synthesis.

PubMed

Wright, Alexis A; Hegedus, Eric J; Tarara, Daniel T; Ray, Samantha C; Dischiavi, Steven L

2018-02-01

To produce a best evidence synthesis of exercise prescription used when treating shoulder pathology in the overhead athlete. A systematic review of exercises used in overhead athletes including case studies and clinical commentaries. MEDLINE, PubMed, SPORTDiscus and CINAHL from database inception through July 8, 2016. We examined data from randomised controlled trials and prospective cohort (level I-IV evidence) studies that addressed exercise intervention in the rehabilitation of the overhead athlete with shoulder pathology. Case studies and clinical commentaries (level V evidence) were examined to account for expert opinion-based research. Data were combined using best evidence synthesis and graded (A-F) recommendations (Centre for Evidence-Based Medicine). There were 33 unique exercises in six level I-IV studies that met our inclusion criteria. Most exercises were single-plane, upper extremity exercises performed below 90 o of elevation. There were 102 unique exercises in 33 level V studies that met our inclusion criteria. These exercises emphasised plyometrics, kinetic chain and sport-specific training. Overall, evidence for exercise interventions in overhead athletes with shoulder pathology is dominated by expert opinion (grade D). There is great variability between exercise approaches suggested by experts and those investigated in research studies and the overall level of evidence is low. The strongest available evidence (level B) supports the use of single-plane, open chain upper extremity exercises performed below 90° of elevation and closed chain upper extremity exercises. Clinical expert pieces support a more advanced, global treatment approach consistent with the complex, multidimensional nature of sport. © 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.

Emotion regulation strategies mediate the associations of positive and negative affect to upper extremity physical function.

PubMed

Talaei-Khoei, Mojtaba; Nemati-Rezvani, Hora; Fischerauer, Stefan F; Ring, David; Chen, Neal; Vranceanu, Ana-Maria

2017-05-01

The Gross process model of emotion regulation holds that emotion-eliciting situations (e.g. musculoskeletal illness) can be strategically regulated to determine the final emotional and behavioral response. Also, there is some evidence that innate emotional traits may predispose an individual to a particular regulating coping style. We enrolled 107 patients with upper extremity musculoskeletal illness in this cross-sectional study. They completed self-report measures of positive and negative affect, emotion regulation strategies (cognitive reappraisal and expressive suppression), upper extremity physical function, pain intensity, and demographics. We used Preacher and Hayes' bootstrapping approach to process analysis to infer the direct effect of positive and negative affect on physical function as well as their indirect effects through activation of emotion regulation strategies. Negative affect was associated with decreased physical function. The association was partly mediated by expressive suppression (b (SE)=-.10 (.05), 95% BCa CI [-.21, -.02]). Positive affect was associated with increased physical function. Cognitive reappraisal partially mediated this association (b (SE)=.11 (.05), 95% BCa CI [.03, .24]). After controlling for pain intensity, the ratio of the mediated effect to total effect grew even larger in controlled model comparing to uncontrolled model (33% vs. 26% for expressive suppression and 32% vs. 30% for cognitive reappraisal). The relationships between affect, emotion regulation strategies and physical function appear to be more dependent on the emotional response to an orthopedic condition rather than the intensity of the nociceptive stimulation of the pain. Findings support integration of emotion regulation training in skill-based psychotherapy in this population to mitigate the effect of negative affect and enhance the influence of positive affect on physical function. Copyright © 2017 Elsevier Inc. All rights reserved.

The influence of an arduous military training program on immune function and upper respiratory tract infection incidence.

PubMed

Whitham, Martin; Laing, Stewart J; Dorrington, Melanie; Walters, Robert; Dunklin, Steve; Bland, Duncan; Bilzon, James L J; Walsh, Neil P

2006-08-01

The effects of the first 19 weeks of U.K. Parachute Regiment (PARA) training on upper respiratory tract infection (URTI) incidence and immune function (circulating leukocyte counts, lymphocyte subsets, lipopolysaccharide-stimulated neutrophil degranulation, and salivary immunoglobulin A concentrations) were investigated for 14 PARA recruits and 12 control subjects. No significant differences were reported between groups for the number or duration of URTIs, lymphocyte subsets, or salivary immunoglobulin A concentrations during training. URTI incidence was greater in the PARA group at weeks 2 and 3 (p < 0.05), coinciding with a decrease in circulating leukocyte and lymphocyte counts (p < 0.05). Neutrophil degranulation was similar in the PARA and control groups at weeks 0 and 19. Decreases in saliva flow rate occurred in the PARA group at week 15 and weeks 18 to 20 (p < 0.05). These results show a limited effect of PARA training on URTI incidence and immune function. The progressive decrease in saliva flow rate during PARA training may indicate an ensuing state of hypohydration.

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

NASA Astrophysics Data System (ADS)

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

2005-12-01

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

Comparison of upper extremity kinematics in children with spastic diplegic cerebral palsy using anterior and posterior walkers.

PubMed

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.

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

PubMed

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

2015-09-01

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

Aerobic Exercise Training in Post-Polio Syndrome: Process Evaluation of a Randomized Controlled Trial.

PubMed

Voorn, Eric L; Koopman, Fieke S; Brehm, Merel A; Beelen, Anita; de Haan, Arnold; Gerrits, Karin H L; Nollet, Frans

2016-01-01

To explore reasons for the lack of efficacy of a high intensity aerobic exercise program in post-polio syndrome (PPS) on cardiorespiratory fitness by evaluating adherence to the training program and effects on muscle function. A process evaluation using data from an RCT. Forty-four severely fatigued individuals with PPS were randomized to exercise therapy (n = 22) or usual care (n = 22). Participants in the exercise group were instructed to exercise 3 times weekly for 4 months on a bicycle ergometer (60-70% heart rate reserve). The attendance rate was high (median 89%). None of the participants trained within the target heart rate range during >75% of the designated time. Instead, participants exercised at lower intensities, though still around the anaerobic threshold (AT) most of the time. Muscle function did not improve in the exercise group. Our results suggest that severely fatigued individuals with PPS cannot adhere to a high intensity aerobic exercise program on a cycle ergometer. Despite exercise intensities around the AT, lower extremity muscle function nor cardiorespiratory fitness improved. Improving the aerobic capacity in PPS is difficult through exercise primarily focusing on the lower extremities, and may require a more individualized approach, including the use of other large muscle groups instead. Netherlands National Trial Register NTR1371.

Efficacy of a 3 month training program on the jump-landing technique in jump-landing sports. Design of a cluster randomized controlled trial

PubMed Central

2010-01-01

Background With the relatively high rate of injuries to the lower extremity due to jump-landing movement patterns and the accompanied high costs, there is need for determining potential preventive programs. A program on the intervention of jump-landing technique is possibly an important preventative measure since it appeared to reduce the incidence of lower extremity injuries. In real life situations, amateur sports lack the infrastructure and funds to have a sports physician or therapist permanently supervising such a program. Therefore the current prevention program is designed so that it could be implemented by coaches alone. Objective The objective of this randomized controlled trial is to evaluate the effect of a coach supervised intervention program targeting jump-landing technique on the incidence of lower extremity injuries. Methods Of the 110 Flemish teams of the elite division, 24 teams are included and equally randomized to two study groups. An equal selection of female and male teams with allocation to intervention and control group is obtained. The program is a modification of other prevention programs previously proven to be effective. All exercises in the current program are adjusted so that a more progressive development in the exercise is presented. Both the control and intervention group continue with their normal training routine, while the intervention group carries out the program on jump-landing technique. The full intervention program has a duration of three months and is performed 2 times a week during warm-up (5-10 min). Injuries are registered during the entire season. Discussion The results of this study can give valuable information on the effect of a coach supervised intervention program on jump-landing technique and injury occurrence. Results will become available in 2011. Trial registration Trial registration number: NTR2560 PMID:21144030

Lichen elemental content bioindicators for air quality in upper Midwest, USA: A model for large-scale monitoring

Treesearch

Susan Will-Wolf; Sarah Jovan; Michael C. Amacher

2017-01-01

Our development of lichen elemental bioindicators for a United States of America (USA) national monitoring program is a useful model for other large-scale programs. Concentrations of 20 elements were measured, validated, and analyzed for 203 samples of five common lichen species. Collections were made by trained non-specialists near 75 permanent plots and an expert...

Upper extremity pain and computer use among engineering graduate students.

PubMed

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.

Shoulder injuries from alpine skiing and snowboarding. Aetiology, treatment and prevention.

PubMed

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.

Effects of a Brief Team Training Program on Surgical Teams' Nontechnical Skills: An Interrupted Time-Series Study.

PubMed

Gillespie, Brigid M; Harbeck, Emma; Kang, Evelyn; Steel, Catherine; Fairweather, Nicole; Panuwatwanich, Kriengsak; Chaboyer, Wendy

2017-04-27

Up to 60% of adverse events in surgery are the result of poor communication and teamwork. Nontechnical skills in surgery (NOTSS) are critical to the success of surgery and patient safety. The study aim was to evaluate the effect of a brief team training intervention on teams' observed NOTSS. Pretest-posttest interrupted time-series design with statistical process control analysis was used to detect longitudinal changes in teams' NOTSS. We evaluated NOTSS using the revised NOTECHS weekly for 20 to 25 weeks before and after implementation of a team training program. We observed 179 surgical procedures with cardiac, vascular, upper gastrointestinal, and hepatobiliary teams. Mean posttest NOTECHS scores increased across teams, showing special cause variation. There were also significant before and after improvements in NOTECHS scores in respect to professional role and in the use of the Surgical Safety Checklist. Our results suggest associated improvements in teams' NOTSS after implementation of the team training program.

[EFFECTS IN BODY COMPOSITION AND BONE MINERAL DENSITY OF SIMULATE ALTITUDE PROGRAM IN TRIATHLETES].

PubMed

Ramos-Campo, Domingo Jesús; Rubio Arias, Jacobo Ángel; Jiménez Diaz, José Fernando

2015-09-01

body composition is an important factor to improve athletic performance. Futhermore, bone mineral density informs about the bone stiffness of the skeletal system. the aim of the present research was to analyze modifications on body composition and bone mineral density parameters after a seven week intermittent hypoxia training (IHT) program. eighteen male trained triathletes were divided in two groups: an intermittent hypoxia training group (GIHT: n: 9; 26.0 ± 6.7 years; 173.3 ± 5.9 cm; 66.4 ± 5.9 kg; VO2 max: 59.5 ± 5.0 ml/kg/min) that conducted a normoxic training plus an IHT and a control group (GC: n: 9; 29.3 ± 6.8 years; 174.9 ± 4.6 cm; 59.7 ± 6.8 kg; VO2 max: 58.9 ± 4.5 ml/kg/min) that performed only a normoxic training. Training process was standardized across the two groups. The IHT program consisted on two 60 minutes sessions per week at intensities over the anaerobic threshold and atmospheric conditions between 14.5 and 15% FiO2. Before and after the seven week training, body composition and bone mineral density were analyzed. After this training program, the GIHT showed lower values in free fat mass in upper limbs and fat mass in lower limbs (p < 0.05) than before the program. In terms of bone mineral density variables, between the two groups no changes were found. the addition of an IHT program to normoxic training caused an improvement in body composition parameters compared to similar training under normoxic conditions. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

The Effects of Individualized Resistance Strength Programs on Knee Muscular Imbalances in Junior Elite Soccer Players

PubMed Central

Śliwowski, Robert; Jadczak, Łukasz; Hejna, Rafał; Wieczorek, Andrzej

2015-01-01

The purpose of this study was to investigate the effects of a resistance training program on the muscular strength of soccer players’ knees that initially presented unilateral and bilateral differences. For this study, a team of 24 male well-trained junior soccer players was divided into two strength program training groups: a Resistance Training Control Group (RTCG) composed of 10 players that did not have muscular imbalances and a Resistance Training Experimental Group (RTEG) composed of 14 players that had muscular imbalances. All players followed a resistance training program for six weeks, two times per week, during the transition period. The program of individualized strength training consisted of two parts. The first part, which was identical in terms of the choice of training loads, was intended for both training groups and contained two series of exercises including upper and lower body exercises. The second part of the program was intended only for RTEG and consisted of two additional series for the groups of muscles that had identified unilateral and bilateral differences. The applied program showed various directions in the isokinetic profile of changes. In the case of RTCG, the adaptations related mainly to the quadriceps muscle (the peak torque (PT) change for the dominant leg was statistically significant (p < 0.05)). There were statistically significant changes in RTEG (p < 0.05) related to PT for the hamstrings in both legs, which in turn resulted in an increase in the conventional hamstring/quadriceps ratio (H/Q). It is interesting that the statistically significant (p < 0.05) changes were noted only for the dominant leg. No statistically significant changes in bilateral differences (BD) were noted in either group. These results indicate that individualized resistance training programs could provide additional benefits to traditional strength training protocols to improve muscular imbalances in post-adolescent soccer players. PMID:26630271

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

PubMed Central

2012-01-01

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

Web-Based 3D Technology for Scenario Authoring and Visualization: The Savage Project

DTIC Science & Technology

2001-01-01

T. M., & Sadhu, P. (2001). XML How to Program . Upper Saddle River, New Jersey: Prentice Hall. Foley, J. D., van Dam, A., Feiner, S. K., & Hughes...Following graduation from NPS in September 2001, Major Nicklaus will be assigned to the Marine Air-Ground Task Force (MAGTF) Staff Training Program ...goal is to accelerate the worldwide demand for products based on these standards through the sponsorship of market and user education programs . The

Improving the Teaching Skills of Residents in a Surgical Training Program: Results of the Pilot Year of a Curricular Initiative in an Ophthalmology Residency Program.

PubMed

Chee, Yewlin E; Newman, Lori R; Loewenstein, John I; Kloek, Carolyn E

2015-01-01

To design and implement a teaching skills curriculum that addressed the needs of an ophthalmology residency training program, to assess the effect of the curriculum, and to present important lessons learned. A teaching skills curriculum was designed for the Harvard Medical School (HMS) Residency Training Program in Ophthalmology. Results of a needs assessment survey were used to guide curriculum objectives. Overall, 3 teaching workshops were conducted between October 2012 and March 2013 that addressed areas of need, including procedural teaching. A postcurriculum survey was used to assess the effect of the curriculum. Massachusetts Eye and Ear Infirmary, a tertiary care institution in Boston, MA. Overall, 24 residents in the HMS Residency Training Program in Ophthalmology were included. The needs assessment survey demonstrated that although most residents anticipated that teaching would be important in their future career, only one-third had prior formal training in teaching. All residents reported they found the teaching workshops to be either very or extremely useful. All residents reported they would like further training in teaching, with most residents requesting additional training in best procedural teaching practices for future sessions. The pilot year of the resident-as-teacher curriculum for the HMS Residency Training Program in Ophthalmology demonstrated a need for this curriculum and was perceived as beneficial by the residents, who reported increased comfort in their teaching skills after attending the workshops. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

An eight-week golf-specific exercise program improves physical characteristics, swing mechanics, and golf performance in recreational golfers.

PubMed

Lephart, Scott M; Smoliga, James M; Myers, Joseph B; Sell, Timothy C; Tsai, Yung-Shen

2007-08-01

The purpose of this study was to determine the effects of an 8-week golf-specific exercise program on physical characteristics, swing mechanics, and golf performance. Fifteen trained male golfers (47.2 +/- 11.4 years, 178.8 +/- 5.8 cm, 86.7 +/- 9.0 kg, and 12.1 +/- 6.4 U.S. Golf Association handicap) were recruited. Trained golfers was defined operationally as golfers who play a round of golf at least 2-3 times per week and practice at the driving range at least 2-3 times per week during the regular golf season. Subjects performed a golf-specific conditioning program 3-4 times per week for 8 weeks during the off-season in order to enhance physical characteristics. Pre- and posttraining testing of participants included assessments of strength (torso, shoulder, and hip), flexibility, balance, swing mechanics, and golf performance. Following training, torso rotational strength and hip abduction strength were improved significantly (p < 0.05). Torso, shoulder, and hip flexibility improved significantly in all flexibility measurements taken (p < 0.05). Balance was improved significantly in 3 of 12 measurements, with the remainder of the variables demonstrating a nonsignificant trend for improvement. The magnitude of upper-torso axial rotation was decreased at the acceleration (p = 0.015) and impact points (p =0.043), and the magnitude of pelvis axial rotation was decreased at the top (p = 0.031) and acceleration points (p = 0.036). Upper-torso axial rotational velocity was increased significantly at the acceleration point of the golf swing (p = 0.009). Subjects increased average club velocity (p = 0.001), ball velocity (p = 0.001), carry distance (p = 0.001), and total distance (p = 0.001). These results indicate that a golf-specific exercise program improves strength, flexibility, and balance in golfers. These improvements result in increased upper-torso axial rotational velocity, which results in increased club head velocity, ball velocity, and driving distance.

Dose-Response Relationship of Neuromuscular Training for Injury Prevention in Youth Athletes: A Meta-Analysis

PubMed Central

Steib, Simon; Rahlf, Anna L.; Pfeifer, Klaus; Zech, Astrid

2017-01-01

Background: Youth athletes with intensive sports participation are at an increased risk of sustaining injuries. Neuromuscular training programs reduce sports-related injury risk in this population, however, the dose-response relationship is largely unknown. Thus, the aim of this meta-analysis was to identify the optimal frequency, volume, duration, and period of neuromuscular training to prevent injuries in youth athletes. Methods: Computerized database searches (PubMed, Scopus, SPORTDiscus, The Cochrane Library, PEDro) were conducted in January 2017, with search terms related to youth sports, neuromuscular training, and injury prevention. Eligible trials (i) evaluated a neuromuscular training program; (ii) included youth athletes of 21 years or younger; (iii) had an analytical design (RCTs, quasi-experimental, cohort studies); (iv) contained original data; (v) and provided injury data. Two reviewers independently extracted data and assessed quality of eligible studies. Injury rate ratios (IRRs) for lower extremity injuries were pooled meta-analytically, and moderator analyses examined the effect of training frequency, duration, volume, and period. Results: Data from 16 trials yielded an overall risk reduction of 42% with neuromuscular training (IRR = 0.58, 95%CI 0.47–0.72). Training frequencies of two (IRR = 0.50; 95%CI 0.29–0.86) or three times (IRR = 0.40; 95%CI 0.31–0.53) per week revealed the largest risk reduction, and a weekly training volume of more than 30 min tended to be more effective compared to lower volumes. Programs with 10–15 min (IRR = 0.55; 95%CI 0.42–0.72) session duration produced effects comparable to those with longer session duration (IRR = 0.60; 95%CI 0.46–0.76). Interventions lasting more than 6 months were not superior to shorter programs. Conclusion: This meta-analysis revealed that NMT performed in short bouts of 10–15 min, two to three times per week, with a weekly training volume of 30–60 min had the largest preventive effect for lower extremity injuries in youth athletes. These effects can be achieved within 20–60 sessions and training periods of <6 months. The present results are derived from a relatively small number of studies with heterogeneous methodological quality and should be treated with caution. The study was a priori registered at PROSPERO (CRD42016053473). PMID:29184511

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

PubMed

Slavens, Brooke A; Harris, Gerald F

2008-01-01

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

Incidental Learning and Explicit Recall in Upper Extremity Prosthesis Use: Insights Into Functional Rehabilitation Challenges.

PubMed

Hughey, Laura; Wheaton, Lewis A

2016-01-01

Loss of an upper extremity and the resulting rehabilitation often requires individuals to learn how to use a prosthetic device for activities of daily living. It remains unclear how prostheses affect motor learning outcomes. The authors' aim was to evaluate whether incidental motor learning and explicit recall is affected in intact persons either using prostheses (n = 10) or the sound limb (n = 10), and a chronic amputee on a modified serial reaction time task. Latency and accuracy of task completion were recorded over six blocks, with a distractor task between blocks 5 and 6. Participants were also asked to recall the sequence immediately following the study and at a 24-hr follow-up. Prosthesis users demonstrate patterns consistent with implicit learning, with sustained error patterns with the distal terminal device. More intact individuals were able to explicitly recall the sequence initially, however there was no significant difference 24 hr following the study. Acute incidental motor learning does not appear to diminish task related error patterns or accompany with explicit recall in prosthesis users, which could present limitations for acute training of prosthesis use in amputees. This suggests differing mechanisms of visuospatial sequential learning and motor control with prostheses.

Impaired Voluntary Movement Control and Its Rehabilitation in Cerebral Palsy.

PubMed

Gordon, Andrew M

2016-01-01

Cerebral palsy is caused by early damage to the developing brain, as the most common pediatric neurological disorder. Hemiplegia (unilateral spastic cerebral palsy) is the most common subtype, and the resulting impairments, lateralized to one body side, especially affect the upper extremity, limiting daily function. This chapter first describes the pathophysiology and mechanisms underlying impaired upper extremity control of cerebral palsy. It will be shown that the severity of impaired hand function closely relates to the integrity of the corticospinal tract innervating the affected hand. It will also shown that the developing corticospinal tract can reorganize its connectivity depending on the timing and location of CNS injury, which also has implications for the severity of hand impairments and rehabilitation. The mechanisms underlying impaired motor function will be highlighted, including deficits in movement execution and planning and sensorimotor integration. It will be shown that despite having unimanual hand impairments, bimanual movement control deficits and mirror movements also impact function. Evidence for motor learning-based therapies including Constraint-Induced Movement Therapy and Bimanual Training, and the possible pathophysiological predictors of treatment outcome and plasticity will be described. Finally, future directions for rehabilitations will be presented.

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

PubMed

Cordeiro d'Ornellas, Marcos; Cargnin, Diego João; Cervi Prado, Ana Lúcia

2015-01-01

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

College students and computers: assessment of usage patterns and musculoskeletal discomfort.

PubMed

Noack-Cooper, Karen L; Sommerich, Carolyn M; Mirka, Gary A

2009-01-01

A limited number of studies have focused on computer-use-related MSDs in college students, though risk factor exposure may be similar to that of workers who use computers. This study examined computer use patterns of college students, and made comparisons to a group of previously studied computer-using professionals. 234 students completed a web-based questionnaire concerning computer use habits and physical discomfort respondents specifically associated with computer use. As a group, students reported their computer use to be at least 'Somewhat likely' 18 out of 24 h/day, compared to 12 h for the professionals. Students reported more uninterrupted work behaviours than the professionals. Younger graduate students reported 33.7 average weekly computing hours, similar to hours reported by younger professionals. Students generally reported more frequent upper extremity discomfort than the professionals. Frequent assumption of awkward postures was associated with frequent discomfort. The findings signal a need for intervention, including, training and education, prior to entry into the workforce. Students are future workers, and so it is important to determine whether their increasing exposure to computers, prior to entering the workforce, may make it so they enter already injured or do not enter their chosen profession due to upper extremity MSDs.

Relative incidence of phlebitis associated with peripheral intravenous catheters in the lower versus upper extremities.

PubMed

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.

Neuromuscular training improves performance and lower-extremity biomechanics in female athletes.

PubMed

Myer, Gregory D; Ford, Kevin R; Palumbo, Joseph P; Hewett, Timothy E

2005-02-01

The purpose of this study was to examine the effects of a comprehensive neuromuscular training program on measures of performance and lower-extremity movement biomechanics in female athletes. The hypothesis was that significant improvements in measures of performance would be demonstrated concomitant with improved biomechanical measures related to anterior cruciate ligament injury risk. Forty-one female basketball, soccer, and volleyball players (age, 15.3 +/- 0.9 years; weight, 64.8 +/- 9.96 kg; height, 171.2 +/- 7.21 cm) underwent 6 weeks of training that included 4 main components (plyometric and movement, core strengthening and balance, resistance training, and speed training). Twelve age-, height-, and weight-matched controls underwent the same testing protocol twice 6 weeks apart. Trained athletes demonstrated increased predicted 1 repetition maximum squat (92%) and bench press (20%). Right and left single-leg hop distance increased 10.39 cm and 8.53 cm, respectively, and vertical jump also increased from 39.9 +/- 0.9 cm to 43.2 +/- 1.1 cm with training. Speed in a 9.1-m sprint improved from 1.80 +/- 0.02 seconds to 1.73 +/- 0.01 seconds. Pre- and posttest 3-dimensional motion analysis demonstrated increased knee flexion-extension range of motion during the landing phase of a vertical jump (right, 71.9 +/- 1.4 degrees to 76.9 +/- 1.4 degrees ; left, 71.3 +/- 1.5 degrees to 77.3 +/- 1.4 degrees ). Training decreased knee valgus (28%) and varus (38%) torques. Control subjects did not demonstrate significant alterations during the 6-week interval. The results of this study support the hypothesis that the combination of multiple-injury prevention-training components into a comprehensive program improves measures of performance and movement biomechanics.

Intracortical inhibition and facilitation with unilateral dominant, unilateral nondominant and bilateral movement tasks in left- and right-handed adults.

PubMed

McCombe Waller, Sandy; Forrester, Larry; Villagra, Federico; Whitall, Jill

2008-06-15

To investigate intracortical inhibition and facilitation in response to unilateral dominant, nondominant and bilateral biceps activation and short-term upper extremity training in right- and left-handed adults. Paired-pulse transcranial magnetic stimulation was used to measure intracortical excitability in motor dominant and nondominant cortices of 26 nondisabled adults. Neural facilitation and inhibition were measured in each hemisphere during unilateral dominant, nondominant and bilateral arm activation and after training in each condition. No differences were seen between right- and left-handed subjects. Intracortical facilitation and decreased inhibition were seen in each hemisphere with unilateral activation/training of contralateral muscles and bilateral muscle activation/training. Persistent intracortical inhibition was seen in each hemisphere with ipsilateral muscle activation/training. Inhibition was greater in the nondominant hemisphere during dominant hemisphere activation (dominant arm contraction). Strongly dominant individuals show no difference in intracortical responses given handedness. Intracortical activity with unilateral and bilateral arm activation and short-term training differs based on hemispheric dominance, with the motor dominant hemisphere exerting a larger inhibitory influence over the nondominant hemisphere. Bilateral activation and training have a disinhibitory effect in both dominant and nondominant hemispheres.

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

PubMed

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

2013-12-01

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

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

PubMed Central

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

2014-01-01

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

Relief of neuropathic pain after spinal cord injury by brain-computer interface training.

PubMed

Yoshida, Naoki; Hashimoto, Yasunari; Shikota, Mio; Ota, Tetsuo

2016-01-01

The aim of this study was to report the effects of brain-computer interface (BCI) training, a neurofeedback rehabilitation technique, on persistent neuropathic pain (NP) after cervical spinal cord injury (SCI). We present the case of a 71-year-old woman with NP in her left upper extremity after SCI (C8). She underwent BCI training as outpatient rehabilitation for 4 months to enhance event-related desynchronization (ERD), which is triggered by the patient's motor intuition. Scalp electroencephalography was recorded to observe the ERD during every BCI training session. The patient's pain was evaluated with the McGill Pain Questionnaire (MPQ) and a visual analog scale (VAS). The MPQ was performed after every BCI training session, and the patient assessed the VAS score on her own, once every few days during the BCI training period. After the BCI training started, the patient's ERD during the BCI training period increased significantly, from 15.6-30.3%. Moreover, her VAS score decreased gradually, from 8 to 5, after the BCI training started, although the MPQ did not change significantly. BCI training has the potential to provide relief for patients with persistent NP via brain plasticity, and to improve their activities of daily living and quality of life.

Effects of a randomized controlled recurrent fall prevention program on risk factors for falls in frail elderly living at home in rural communities.

PubMed

Jeon, Mi Yang; Jeong, HyeonCheol; Petrofsky, Jerrold; Lee, Haneul; Yim, JongEun

2014-11-14

Falling can lead to severe health issues in the elderly and importantly contributes to morbidity, death, immobility, hospitalization, and early entry to long-term care facilities. The aim of this study was to devise a recurrent fall prevention program for elderly women in rural areas. This study adopted an assessor-blinded, randomized, controlled trial methodology. Subjects were enrolled in a 12-week recurrent fall prevention program, which comprised strength training, balance training, and patient education. Muscle strength and endurance of the ankles and the lower extremities, static balance, dynamic balance, depression, compliance with preventive behavior related to falls, fear of falling, and fall self-efficacy at baseline and immediately after the program were assessed. Sixty-two subjects (mean age 69.2±4.3 years old) completed the program--31 subjects in the experimental group and 31 subjects in the control group. When the results of the program in the 2 groups were compared, significant differences were found in ankle heel rise test, lower extremity heel rise test, dynamic balance, depression, compliance with fall preventative behavior, fear of falling, and fall self-efficacy (p<0.05), but no significant difference was found in static balance. This study shows that the fall prevention program described effectively improves muscle strength and endurance, balance, and psychological aspects in elderly women with a fall history.

Nerve Injuries of the Upper Extremity

MedlinePlus

... 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 ...

Congenital Differences of the Upper Extremity: Classification and Treatment Principles

PubMed Central

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

Innovations in prosthetic interfaces for the upper extremity.

PubMed

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

2013-12-01

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

The influence of nontraditional training modalities on physical performance: review of the literature.

PubMed

O'Hara, Reginald B; Serres, Jennifer; Traver, Kyle L; Wright, Bruce; Vojta, Chris; Eveland, Ed

2012-10-01

The primary purpose of this effort was to review several forms of nontraditional (NT) training programs, including heavy lower extremity strength training, CrossFit training, kettlebell training, and agility training, and discuss the effects of these exercise regimens on physical performance. The secondary purpose was to evaluate NT fitness training programs for evidence that they may provide beneficial options to help airmen improve their fitness scores. A search of the literature for 1980-2010 was performed using the Franzello Aeromedical Library, Public Medicine, and Air Force Institute of Technology search engines. There were 50 articles located and the authors selected 29 articles that specifically addressed the primary and secondary purposes of this literature review. This review indicates that an NT training approach is warranted in the general Air Force population. Heavy leg strength training and agility training show promise in enhancing aerobic fitness and improving fitness scores, particularly among members who have difficulty passing a physical fitness test. Most of the nontraditional forms of physical training are not supported in the scientific literature, with the exception of heavy leg strength training and agility training. However, even these NT forms of training require further investigation.

Case Report on the Use of a Custom Myoelectric Elbow-Wrist-Hand Orthosis for the Remediation of Upper Extremity Paresis and Loss of Function in Chronic Stroke.

PubMed

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.

New options for vascularized bone reconstruction in the upper extremity.

PubMed

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.

Rugby injuries.

PubMed

McIntosh, Andrew S

2005-01-01

The purpose of this chapter is to review critically the existing studies on the epidemiology of pediatric rugby injuries and discuss suggestions for injury prevention and further research. Data were sourced from the sports medicine and science literature mainly since 1990, and from a prospective injury surveillance project in rugby undertaken by the University of New South Wales (UNSW) in Sydney during 2002. Literature searches were performed using Medline and SportsDiscus. Reported injury rates were between 7 and 18 injuries per 1,000 hours played, with the rate of injuries resulting in loss of playing or training time measured at 6.5-10.6 per 1,000 hours played. Injury rates increased with age and level of qualification. Head injury and concussion accounted for 10-40% of all injuries. In the UNSW study, concussion accounted for 25% of injuries resulting in loss of playing or training time in the under 13 year age group. Upper and lower extremity injuries were equally apportioned, with musculoskeletal injuries being the main type of injury. Fractures were observed in the upper extremity and ankle, and joint/ligament injuries affected the shoulder, knee and ankle. The tackle was associated with around 50% of all injuries. The scrum produced fewer injuries, but is historically associated with spinal cord injury. Rugby is a contact sport with injury risks related to physical contact, primarily in the tackle. Most injuries affect the musculoskeletal system, with the exception of concussion. Spinal cord injury is rare, but catastrophic. Research is required to understand better injury risks and to reduce the incidence of shoulder, knee and ankle joint injuries, concussion and spinal injury.