Changes In Upper Limb Function Research Articles

122P A retrospective review of changes in upper limb function following spinal surgery in spinal muscular atrophy

122P A retrospective review of changes in upper limb function following spinal surgery in spinal muscular atrophy

Effects of virtual reality-based robot therapy combined with task-oriented therapy on upper limb function and cerebral cortex activation in patients with stroke.

This study aimed to investigate the effects of virtual reality (VR)-based robot therapy combined with task-oriented therapy on cerebral cortex activation and upper limb function in patients with stroke. This study included 46 patients with hemiplegia within 1 year of stroke onset. Patients were divided into an experimental group (n = 23) and a control group (n = 23) using a computer randomization program. The experimental group received VR-based robot and task-oriented therapies, whereas the control group received only task-oriented therapy. All participants received interventions for 40 minutes per session, 5 times a week, for 8 weeks. For the pre- and post-evaluation of all participants, the Fugl-Meyer Assessment for the upper extremity, manual function test, motor activity log, and Jebsen-Taylor Hand Function Test were used to evaluate changes in upper limb function and motor-evoked potential amplitudes were measured to compare cerebral cortex activation. In comparison to the control group, experimental group demonstrated an improvement in the function of the upper limb (P < .01) and activation of the cerebral cortex (P < .01). The combined intervention of VR-based robot and task-oriented therapies is valuable for improving upper limb function and cerebral cortex activation in patients with stroke.

A deep learning wearable-based solution for continuous at-home monitoring of upper limb goal-directed movements.

Monitoring upper limb function is crucial for tracking progress, assessing treatment effectiveness, and identifying potential problems or complications. Hand goal-directed movements (GDMs) are a crucial aspect of daily life, reflecting planned motor commands with hand trajectories towards specific target locations. Previous studies have shown that GDM tasks can detect early changes in upper limb function in neurodegenerative diseases and can be used to track disease progression over time. In this study, we used accelerometer data from stroke survivor participants and controls doing activities of daily living to develop an automated deep learning approach to detect GDMs. The model performance for detecting GDM or non-GDM from windowed data achieved an AUC of 0.9, accuracy 0.83, sensitivity 0.81, specificity 0.84 and F1 0.82. We further validated the utility of detecting GDM by extracting features from GDM periods and using these features to classify whether the measurements are collected from a stroke survivor or a control participant, and to predict the Fugl-Meyer assessment score from stroke survivors. This study presents a promising and reliable tool for monitoring upper limb function in a real-world setting, and assessing biomarkers related to upper limb health in neurological, neuromuscular and muscles disorders.

Specific versus general exercise programme in adults with subacromial impingement syndrome: a randomised controlled trial

ObjectivesCurrent evidence on the clinical effectiveness about the different types of exercises in the subacromial impingement syndrome (SIS) remains controversial. This study aims to compare the short-term (at 5 weeks)...

How self-help devices made by a 3D printer due to changes in upper limb function promoted the habitual use in daily life of the paralyzed hand of a cerebral infarction patient in the convalescent stage

How self-help devices made by a 3D printer due to changes in upper limb function promoted the habitual use in daily life of the paralyzed hand of a cerebral infarction patient in the convalescent stage

Constraint-Induced Movement Therapy for Infants With or at Risk for Cerebral Palsy: A Scoping Review.

Although research shows that older children with hemiplegic cerebral palsy (CP) benefit from constraint-induced movement therapy (CIMT), the efficacy of CIMT among the infant population is unknown. To explore the existing evidence on CIMT for infants age 24 mo and younger with CP or at risk for CP. PubMed, CINAHL, Cochrane, and ProQuest were searched. Study Selection and Data Collection: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and American Occupational Therapy Association guidelines were used for abstracting data and assessing data quality. Two frameworks guided this scoping review. Studies met the following criteria: infants with hemiplegic CP, published in English between 2000 and 2020, peer reviewed, and addressed changes in upper limb function of the hemiplegic upper limb. Eight articles met the inclusion criteria: 2 randomized controlled trials, 1 retrospective cohort design, 1 pretest-posttest study, 2 single-subject studies, and 2 case studies. In this scoping review, we examined CIMT protocols for an overview of dosage, constraint, administration, parent training and education, and objective outcome measures. Existing literature supports CIMT protocols for infants with CP. However, much variability exists in protocol design and appropriate outcome measures among studies. Higher level research is needed to support the efficacy of CIMT among infants with CP. What This Article Adds: This scoping review summarizes the existing literature on CIMT for infants with hemiplegic CP. This information can help guide therapists to implement CIMT protocols in the clinical setting and to identify additional research to establish practice standards.

Nothing to lose: a phenomenological study of upper limb nerve transfer surgery for individuals with tetraplegia

Purpose For individuals with tetraplegia, regaining upper limb function forms the highest priority for improving quality of life. Use of nerve transfers to reconstruct upper limb function is increasing, however little is known about individual’s decision to have and experience of the surgery and associated rehabilitation outcomes. This qualitative study aimed to understand the experience of surgery on the lives of individuals with tetraplegia 18 months post-surgery. Method In-depth, semi-structured interviews were conducted with five purposively selected individuals who have undergone upper limb nerve transfers at a metropolitan health service, Melbourne, Australia, specializing in spinal cord injury rehabilitation. Collaizi’s phenomenological framework guided data analysis, resulting in an essence statement describing the individuals’ experience. Results An essence statement comprising three themes; Deciding on Surgery, Facing Challenges: Surgery to Recovery and Evaluating Surgical Outcomes, was developed. Conclusion The study suggests that for individuals with tetraplegia, hope to regain lost upper limb function forms a core consideration in the decision to have surgery. For clinicians supporting patient’s decision, balancing hope with the realities of surgery is important. Even small changes in upper limb function had an important influence on participant’s confidence in social situations through enhanced participation in a range of everyday activities. IMPLICATIONS FOR REHABILITATION In making a decision to have surgery, individuals with tetraplegia benefit from two way discussions with the healthcare team and others who have already undergone surgery. Healthcare teams need to help prepare individuals for the challenges of surgery including: expectations of pain, hospital stay, initial loss of independence and the time it may take to see re-innervation of target muscles and subsequent functional changes. Surgery should be routinely considered as individuals’ report that even small changes in upper limb function positively increases participation in everyday tasks and confidence in social situations. When evaluating changes in upper limb function, patient-centered measures should be used.

Biomechanical analysis of users of multi-articulating externally powered prostheses with and without their device.

Loss of the hand results in significant functional deficits and requires adaptation of movement patterns which may result in overuse injuries. An externally powered prosthesis may improve function of the affected limb and reduce the overreliance on the intact side; however, little research has been done in this area. Investigate changes in upper limb function and kinematics in individuals with partial-hand amputations performing a functional assessment by comparing results with and without a multi-articulating hand prosthesis. Cross-sectional. Three-dimensional kinematics of four- and five-digit limb loss participants were collected as they performed the Southampton Hand Assessment Procedure with and without a prothesis. Ten males completed the protocol: five with four-digit loss (thumb intact) and five with five-digit loss. Significantly larger joint motions were seen without the prosthesis than with for all participants, which may be an indicator of higher risk for overuse injury. Significant improvement was seen in Southampton Hand Assessment Procedure scores in the five-digit limb loss participants using the prosthesis compared with not using the device (p < 0.05 for 6/7 Southampton Hand Assessment Procedure score categories). The prosthesis reduced functional deficits and decreased joint range of motion in individuals with partial hand loss. Results showed reduced compensatory motions throughout the upper limb and torso which may reduce the risk of overuse injury. Results of this study indicate that externally powered partial hand prostheses can be effective in improving function and reducing compensation in individuals with partial hand loss.

Pain Reduction and Changes in Upper Limb Function Produced by Different Treatments in Carpal Tunnel Syndrome

Pain Reduction and Changes in Upper Limb Function Produced by Different Treatments in Carpal Tunnel Syndrome

Revised upper limb module for spinal muscular atrophy: 12 month changes.

The aim of the study was to assess 12 month changes in upper limb function in patients affected by spinal muscular atrophy type 2 and 3. Longitudinal 12 month data was collected in 114 patients, 60 type 2 and 54 type 3, using the Revised Upper Limb Module. The 12 month changes ranged between -7 and 9 (mean: -0.41; SD: 2.93). The mean changes were not significantly different between the three spinal muscular atrophy groups (-0.45 in type 2, -0.23 in non-ambulant type 3 and -0.34 in ambulant type 3, p = 0.96) and the relationship between 12 month change and age classes was not significantly different among the three types of SMA patients. Our results confirm that the Module explores a wide range of functional abilities and can be used in ambulant and non-ambulant patients of different ages in conjunction with other functional scales. Muscle Nerve 59:426-430, 2019.

Upper Limb Function of Children with Unilateral Cerebral Palsy After a Magic-Themed HABIT: A Pre-Post-Study with 3- and 6-Month Follow-Up

Aims: To examine changes in upper limb function, and performance in everyday tasks, for children with unilateral cerebral palsy who participated in a magic-themed hand-arm bimanual intensive therapy (HABIT). Methods: Twenty-eight children participated; mean age 10 y 6 mo (SD 2 y 2 mo), n = 15 male and n = 13 female. Using a single group, pre-and post-test design, the magic-themed HABIT was delivered for 60 hours over 10 days. Bimanual and unimanual hand function were measured using the Assisting Hand Assessment (AHA) and Box and Blocks Test (BBT). Occupational performance was rated using the Canadian Occupational Performance Measure (COPM). Two parent questionnaires explored change in bimanual hand use in everyday activities; ABILHAND-Kids and Children’s Hand-use Experience Questionnaire (CHEQ). Assessments were completed pre-, immediately post, 3 months and 6 months after the intervention. Results: Friedman’s ANOVA revealed a significant improvement for COPM and CHEQ grasp subscale. Repeated measures ANOVA revealed a significant improvement in BBT, and ABILHAND-Kids, and no significant change for AHA. Conclusions: Children who participated in the magic-themed HABIT experienced improved occupational performance, unimanual skills, and parent ratings of performance in challenging everyday tasks.

Recovery of upper limb use after stroke and its relationship with upper limb function

A stroke often results in functional impairments of the affected upper limb and in distorted upper limb use of the affected arm in daily life (ULUaff). It is currently unclear how ULUaff recovers after stroke and how it relates to upper limb function (ULF). Therefore, the aims of this study were to explore the recovery of ULUaff post-stroke and its relationship with the recovery of ULF during rehabilitation. In fifteen people after stroke receiving ‘usual care’ in a rehabilitation center, ULUaff and ULF was assessed at 3, 12, and 26 weeks post-stroke. ULUaff was estimated for one week using an activity monitor consisting of three accelerometers: one on the unaffected leg and one on each wrist and was defined as the ratio of the amount of movement of the affected arm divided by the unaffected arm, with 1 expressing equal levels of use. ULF was measured with the Fugl–Meyer Assessment (FMA). Data of 10 participants could be used for analysis. At 3 weeks, ULUaff was on average 0.26 with a large interindividual variability (ranging from 0.14 to 0.62). The average ULUaff increased to 0.37 at 12 weeks and 0.43 at 26 weeks. The recovery patterns also showed a large inter-individual variability ( Fig. 1 ). Changes in ULUaff had no significant correlation with changes in ULF ( r = 0.48, P = 0.18**, Fig. 2 ). At group level the amount of use of the affected arm is strongly affected in the 6-month period after a stroke, but increases over time. However, considerable inter-individual differences were found, in the amount at three time moments post-stroke as well as in the recovery patterns. Recovery of use of the affected arm was not related to recovery of upper limb function.

Upper limb function in Duchenne muscular dystrophy: 24 month longitudinal data.

The aim of the study was to establish 24 month changes in upper limb function using a revised version of the performance of upper limb test (PUL 2.0) in a large cohort of ambulant and non-ambulant boys with Duchenne muscular dystrophy and to identify possible trajectories of progression. Of the 187 patients studied, 87 were ambulant (age range: 7–15.8 years), and 90 non-ambulant (age range: 9.08–24.78). The total scores changed significantly over time (p<0.001). Non-ambulant patients had lower total scores at baseline (mean 19.7) when compared to the ambulant ones (mean 38.4). They also had also a bigger decrease in total scores over 24 months compared to the ambulant boys (4.36 vs 2.07 points). Multivariate model analysis showed that the Performance of Upper Limb changes reflected the entry level and ambulation status, that were independently associated to the slope of Performance of Upper Limb changes. This information will be of help both in clinical practice and at the time of designing clinical trials.

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

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.

No changes in functional connectivity during motor recovery beyond 5 weeks after stroke; A longitudinal resting-state fMRI study.

Spontaneous motor recovery after stroke appears to be associated with structural and functional changes in the motor network. The aim of the current study was to explore time-dependent changes in resting-state (rs) functional connectivity in motor-impaired stroke patients, using rs-functional MRI at 5 weeks and 26 weeks post-stroke onset. For this aim, 13 stroke patients from the EXPLICIT-stroke Trial and age and gender-matched healthy control subjects were included. Patients’ synergistic motor control of the paretic upper-limb was assessed with the upper extremity section of the Fugl-Meyer Assessment (FMA-UE) within 2 weeks, and at 5 and 26 weeks post-stroke onset. Results showed that the ipsilesional rs-functional connectivity between motor areas was lower compared to the contralesional rs-functional connectivity, but this difference did not change significantly over time. No relations were observed between changes in rs-functional connectivity and upper-limb motor recovery, despite changes in upper-limb function as measured with the FMA-UE. Last, overall rs-functional connectivity was comparable for patients and healthy control subjects. To conclude, the current findings did not provide evidence that in moderately impaired stroke patients the lower rs-functional connectivity of the ipsilesional hemisphere changed over time.

THE EFFECTIVENESS OF NURSING INTERVENTIONS TRUNCAL CONTROL EXERCISE AGAINST THE UPPER LIMB FUNCTION, BALANCE, AND GAIT ON THE CLIENT POST STROKE

Introduction: Poststroke clients will have impaired postural body that can have affect to their balance, ability to gait and function of the upper limb. Truncal control exercise can improve and maintain body postural be good. Rehabilitation poststroke still focusing on upper and lower limbs exercise of hemiplegia compared postural body’s repair. Method: This type of research used experimental with quasy control group pretest – postest design. The number of samples obtained with consecutive sampling techniques that appropriate criteria research consists of 20 respondents (n = 10 treatment-and n-control = 10). The independent variable is the truncal control exercise. The dependent variable is the function of the upper limb, balance, and gait. Data were collected by using observation and checklist sheets. Data were analyzed using independent t-test and paired t-test with α = 0,05. Results and analysis: The results of statistical tests performed in the treatment group and the control was obtained p-value of the functional capabilities of the upper limb = 0.270 and p-value of performance of upper limb function = 0.289. The results of statistical tests performed in the treatment group and the control was obtained p-value of balance = 0.017. The results of statistical tests performed in the treatment group and the control was obtained p-value of gait = 0.026. Discussion and conclusion: Nursing interventions truncal control exercise have less effective results to changes in upper limb function, but it is effective to balance and walk clients pascastroke. Nursing interventions truncal control exercise have more effective results to changes in balance than gait on poststroke clients. Nursing interventions truncal control exercise can be continued as a form of collaborative action for medical-surgical nurse with physiotherapy to optimize rehabilitation programs of posstroke clients with balance and gait problems in clinic or home’s client.

Intervensi Keperawatan Truncal Control Exercise terhadap Fungsi Ekstremitas Atas, Keseimbangan, dan Berjalan pada Klien Pascastroke

Introduction: Poststroke clients will have impaired postural body that can have affect to their balance, ability to gait and function of the upper limb. Truncal control exercise can improve and maintain body postural be good. Rehabilitation poststroke still focusing on upper and lower limbs exercise of hemiplegia compared postural body’s repair.Methods: This type of research used experimental with quasy control group pretest – postest design. The number of samples obtained with consecutive sampling techniques that appropriate criteria research consists of 20 respondents (n = 10 treatment-and n-control = 10). The independent variable is the truncal control exercise. The dependent variable is the function of the upper limb, balance, and gait. Data were collected by using observation and checklist sheets. Data were analyzed using independent t-test and paired t-test with α = 0,05.Results: The results of statistical tests performed in the treatment group and the control was obtained p-value of the functional capabilities of the upper limb = 0.270 and p-value of performance of upper limb function = 0.289. The results of statistical tests performed in the treatment group and the control was obtained p-value of balance = 0.017. The results of statistical tests performed in the treatment group and the control was obtained p-value of gait = 0.026.Discussion: Nursing interventions truncal control exercise have less effective results to changes in upper limb function, but it is effective to balance and walk clients pascastroke. Nursing interventions truncal control exercise can be continued as a form of collaborative action for medical-surgical nurse with physiotherapy to optimize rehabilitation programs of posstroke clients with balance and gait problems in clinic or home’s client.

Correlations between arm motor behavior and brain function following bilateral arm training after stroke: a systematic review.

Bilateral training (BT) of the upper limb (UL) might enhance recovery of arm function after stroke. To better understand the therapeutic potential of BT, this study aimed to determine the correlation between arm motor behavior and brain structure/function as a result of bilateral arm training poststroke. A systematic review of quantitative studies of BT evaluating both UL motor behavior and neuroplasticity was conducted. Eleven electronic databases were searched. Two reviewers independently selected studies, extracted data and assessed methodological quality, using the Effective Public Health Practice Project (EPHPP) tool. Eight studies comprising 164 participants met the inclusion criteria. Only two studies rated "strong" on the EPHPP tool. Considerable heterogeneity of participants, BT modes, comparator interventions and measures contraindicated pooled outcome analysis. Modes of BT included: in-phase and anti-phase; functional movements involving objects; and movements only. Movements were mechanically coupled, free, auditory-cued, or self-paced. The Fugl-Meyer Assessment (UL section) was used in six of eight studies, however, different subsections were used by different studies. Neural correlates were measured using fMRI and TMS in three and five studies, respectively, using a wide variety of variables. Associations between changes in UL function and neural plasticity were inconsistent and only two studies reported a statistical correlation following BT. No clear pattern of association between UL motor and neural response to BT was apparent from this review, indicating that the neural correlates of motor behavior response to BT after stroke remain unknown. To understand the full therapeutic potential of BT and its different modes, further investigation is required.

Home-based neurologic music therapy for upper limb rehabilitation with stroke patients at community rehabilitation stage-a feasibility study protocol.

Background: Impairment of upper limb function following stroke is more common than lower limb impairment and is also more resistant to treatment. Several lab-based studies with stroke patients have produced statistically significant gains in upper limb function when using musical instrument playing and techniques where rhythm acts as an external time-keeper for the priming and timing of upper limb movements.Methods: For this feasibility study a small sample size of 14 participants (3–60 months post stroke) has been determined through clinical discussion between the researcher and study host in order to test for management, feasibility and effects, before planning a larger trial determined through power analysis. A cross-over design with five repeated measures will be used, whereby participants will be randomized into either a treatment (n = 7) or wait list control (n = 7) group. Intervention will take place twice weekly over 6 weeks. The ARAT and 9HPT will be used to measure for quantitative gains in arm function and finger dexterity, pre/post treatment interviews will serve to investigate treatment compliance and tolerance. A lab based EEG case comparison study will be undertaken to explore audio-motor coupling, brain connectivity and neural reorganization with this intervention, as evidenced in similar studies.Discussion: Before evaluating the effectiveness of a home-based intervention in a larger scale study, it is important to assess whether implementation of the trial methodology is feasible. This study investigates the feasibility, efficacy and patient experience of a music therapy treatment protocol comprising a chart of 12 different instrumental exercises and variations, which aims at promoting measurable changes in upper limb function in hemiparetic stroke patients. The study proposes to examine several new aspects including home-based treatment and dosage, and will provide data on recruitment, adherence and variability of outcomes.

Primed Physical Therapy Enhances Recovery of Upper Limb Function in Chronic Stroke Patients

Background. Recovery of upper limb function is important for regaining independence after stroke. Objective. To test the effects of priming upper limb physical therapy with intermittent theta burst stimulation (iTBS), a form of noninvasive brain stimulation. Methods. Eighteen adults with first-ever chronic monohemispheric subcortical stroke participated in this randomized, controlled, triple-blinded trial. Intervention consisted of priming with real or sham iTBS to the ipsilesional primary motor cortex immediately before 45 minutes of upper limb physical therapy, daily for 10 days. Changes in upper limb function (Action Research Arm Test [ARAT]), upper limb impairment (Fugl-Meyer Scale), and corticomotor excitability, were assessed before, during, and immediately, 1 month and 3 months after the intervention. Functional magnetic resonance images were acquired before and at one month after the intervention. Results. Improvements in ARAT were observed after the intervention period when therapy was primed with real iTBS, but not sham, and were maintained at 1 month. These improvements were not apparent halfway through the intervention, indicating a dose effect. Improvements in ARAT at 1 month were related to balancing of corticomotor excitability and an increase in ipsilesional premotor cortex activation during paretic hand grip. Conclusions. Two weeks of iTBS-primed therapy improves upper limb function at the chronic stage of stroke, for at least 1 month postintervention, whereas therapy alone may not be sufficient to alter function. This indicates a potential role for iTBS as an adjuvant to therapy delivered at the chronic stage.