Finger Extension Research Articles

Development of an Electromyography Signal Acquisition Prototype and Statistical Validation Against a Commercial Device

Electromyography (EMG) stands out as an accessible and inexpensive method for identifying muscle contractions on the surface and within deeper muscle tissues. Using specialized electronic circuits for amplification and filtering can help develop simple but effective systems for detecting and analyzing these signals. However, EMG devices developed by research teams frequently lack rigorous methodologies for validating the quality of the signals they record compared to those obtained by commercial systems that have undergone extensive testing and regulatory approval for market release. This underscores the critical need for standardized validation techniques to reliably assess the performance of experimental devices relative to established commercial equipment. Hence, this study introduces a methodology for the development and statistical validation of a laboratory EMG circuit compared with a professional device available on the market. The experiment simultaneously recorded the muscle electrical activity of 18 volunteers using two biosignal acquisition devices—a prototype EMG and a commercial system—both applied in parallel at the same recording site. Volunteers performed a series of finger and wrist extension movements to elicit myoelectric activity in these forearm muscles. To achieve this, it was necessary to develop not only the EMG signal conditioning board, but also two additional interface boards: one for enabling parallel recording on both devices and another for synchronizing the devices with the task programmatically controlled in Python that the volunteers were required to perform. The EMG signals generated during these tasks were recorded simultaneously by both devices. Subsequently, 22 feature indices commonly used for classifying muscular activity patterns were calculated from two-second temporal windows of the recordings to extract detailed temporal and spatial characteristics. Finally, the Mean Absolute Percentage Error (MAPE) was computed to compare the indices from the prototype with those from the commercial device, using this method as a validation system to assess the quality of the signals recorded by the prototype relative to the commercial equipment. A concordance of 87.6% was observed between the feature indices calculated from the recordings of both devices, suggesting high effectiveness and reliability of the EMG signals recorded by the prototype compared to the commercial device. These results validate the efficacy of our EMG prototype device and provide a solid foundation for the future evaluation of similar devices, ensuring their reliability, accuracy, and suitability for research or clinical applications.

Brain and Muscle derived features to discriminate simple hand motor tasks for a rehabilitative BCI: comparative study on healthy and post-stroke individuals.

Brain-Computer Interfaces targeting post-stroke recovery of the upper limb employ mainly electroencephalography to decode movement-related brain activation. Recently hybrid systems including muscular activity were introduced. We compared the motor task discrimination abilities of three different features, namely event-related desynchronization/synchronization (ERD/ERS) and movement-related cortical potential (MRCP) as brain-derived features and cortico-muscular coherence (CMC) as a hybrid brain-muscle derived feature, elicited in 13 healthy subjects and 13 stroke patients during the execution/attempt of two simple hand motor tasks (finger extension and grasping) commonly employed in upper limb rehabilitation protocols. 
Approach. We employed a three-way statistical design to investigate whether their ability to discriminate the two movements follows a specific temporal evolution along the movement execution and is eventually different among the three features and between the two groups. We also investigated the differences in performance at the single-subject level.
Main results. The ERD/ERS and the CMC-based classification showed similar temporal evolutions of the performance with a significant increase in accuracy during the execution phase while MRCP-based accuracy peaked at movement onset. Such temporal dynamics were similar but slower in stroke patients when the movements were attempted with the affected hand. Moreover, CMC outperformed the two brain features in healthy subjects and stroke patients when performing the task with their unaffected hand, whereas a higher variability across subjects was observed in patients performing the tasks with their affected hand. Interestingly, brain features performed better in this latter condition with respect to healthy subjects. 
Significance. Our results provide hints to improve the design of Brain-Computer Interfaces for post-stroke rehabilitation, emphasizing the need for personalized approaches tailored to patients' characteristics and to the intended rehabilitative target.

Leveraging wearable sensors and machine learning for posture-based detection of carpal tunnel syndrome

Abstract Carpal tunnel is associated with long-term use of the wrist and hand for various activities such as typing, welding, or poor working postures. Carpal Tunnel Syndrome (CTS) may cause severe pain and discomfort in the hand and wrist, and in some circumstances, surgery becomes inevitable. The objective of this study is to prevent typing postures, which can be ascertained as predisposing subjects to CTS development. The data used in this study is an array of wrist wearable sensors to capture flexion, extension, and bending of fingers while using a keyboard or mouse. Machine learning is employed on the data in order to identify risk factors indicative of a high probability of CTS. The analyzed models are linear regression, Support Vector Machine, Random Forest, Multilayer Perceptron, Convolution Neural Network, and Long Short Term Memory. The conditions for assessing the performance of the data models include RMS error, coefficients of determination, and mean absolute percentage error. In this research, I conducted an exploratory data analysis (EDA) to gain an initial understanding of the dataset. Following the exploratory phase, I applied feature extraction techniques, specifically Principal Component Analysis (PCA). As put forward for the proposed research, the strategies to prevent risky occupations have broad potential at the present time, especially in the case of CTS when preventing repetitive wrist movements.

Relationship between self-reported impairments and clinical examination of upper extremity in subjects with type 2 diabetes mellitus

BackgroundUpper Extremity Impairments (UEIs) in type 2 DM(Diabetes Mellitus) usually occur after other complications of DM have occurred and can lead to disability and severely impact the quality of life. This study aimed to identify the UEIs by self-reported questionnaire and clinical findings and to investigate whether self-reported impairments conform to clinical findings and whether any vital questions about UEIs can be identified to screen the UEIs quickly in type 2 DM comprehensive assessment. Methods91 medically diagnosed type 2 DM subjects were enlisted at a tertiary care hospital per the inclusion and exclusion criteria to participate in the study. Participants were asked to fill out a self-reported questionnaire regarding UEIs, following which a clinical examination of the upper extremity was performed to identify the UEIs. Results85% of the participants self-reported UEIs. Self-reported shoulder pain was reported by n = 34 (37.3%), stiffness by n = 21(23.1%), and hand weakness by n = 24 (26.4%). Clinical examination of shoulder and hand revealed impairments such as hands against the back in n = 30(33%), lift-off sign in 22(24.1%), decreased finger extension in 11(12.1%), and thenar strength in 9(9.9%). Self-reported shoulder pain and hand stiffness were associated with clinically examined decreased shoulder mobility and rotator cuff (RC) tests (p < 0.05). Grip strength, thenar strength, and Phalen's sign decreased significantly with self-reported hand weakness (p < 0.05). ConclusionSelf-reported shoulder pain and stiffness, hand stiffness, and weakness should be used to identify patients with UEIs needing comprehensive assessment and treatment. Significantly self-reported hand impairments can also be an indication to screen shoulder pathologies.

Therapy for Dupuytren’s Disease: Collagenase Therapy—A Long-Term Follow-Up Study

Background: Dupuytren’s disease (DD) is a systemic connective tissue disorder of the palm. It particularly affects men of Northern European or Caucasian origin over the age of 55. In addition to the classical surgical therapy via limited fasciectomy, Dupuytren’s contracture can also be treated minimally invasively. A relatively new treatment method is the use of collagenase injections (Xiapex) to reduce the contracture of the fingers. The data regarding the long-term success of this therapy are currently limited. Methods: In this monocentric retrospective study, we examined 35 patients who were treated with collagenase (Xiapex) for Dupuytren’s contracture in the long fingers. Following the manufacturer’s recommendations, the injection was administered intralesionally, and the cord was ruptured through the passive extension of the finger under local anesthesia with Mepivacain the following day. The clinical follow-up examination was conducted after an average of 5.7 years. The stages of Dupuytren’s disease were documented using the Tubiana classification. Additionally, parameters of finger extension ability, differentiated by metacarpophalangeal (MCP), and proximal interphalangeal (PIP) joints, as well as patient-specific risk parameters, were evaluated Results: The long-term results of collagenase therapy after an average of 5.7 years showed a significant improvement in the contracture of the affected fingers. In the MCP joints, the flexion contracture decreased from 42° to 17° (p ≤ 0.001), and in the PIP joints, it decreased from 56° to 33° (p ≤ 0.001). The primary recurrence rate was 11% for the MCP joints and 19% for the PIP joints, respectively. The analysis of risk factors showed a significant risk for worse long-term outcomes in patients with diabetes and those with nicotine abuse. Conclusions: Collagenase therapy for Dupuytren’s disease achieved significant long-term improvements in contracture in both MCP and PIP joints. In accordance with general risk factors for DD, patients with diabetes and those with nicotine abuse are at risk of worse long-term outcomes. Overall, it is a time-saving, low-risk, and straightforward technique for treating the disabling contracture component of this disease.

Ultrasound-guided radial nerve release at the arm under WALANT

Radial nerve entrapment at the LIS is an aching pain in the distal, lateral upper arm and leads to weakness in wrist and thumb/index finger extension. Additionally, a positive scratch collapse test and localized pain on pressure at the entrapment site are observed.The described approach uses a minimally invasive percutaneous ultrasound-guided technique under local anesthesia.

THE EFFICACY OF DYNAMIC TAPPING IN PATIENTS WITH TENNIS ELBOW A STUDY OF RANDOMISED CONTROLLED TRIAL

The purpose of the study is to evaluate the efficacy of Dynamic taping in conjunction with conventional physiotherapy compared to conventional physiotherapy alone for tennis elbow. Objectives: To evaluate pain intensity at rest, during forceful wrist extension, during forceful grip, during the Cozen test, at resisted middle finger extension, and during palpation of the affected site, both before and after conventional physiotherapy combined with Dynamic taping, as well as conventional physiotherapy alone, in patients with tennis elbow. Methodology: 70Individuals diagnosed with tennis elbow were directly Selected from the physiotherapy outpatient department at CMJ University, Meghalaya. 60 participants were deemed suitable for the study and were randomly allocated to two groups: Group A and Group B. In Group A (Experimental group), 30 patients received both dynamic taping and conventional physiotherapy, while Group B (Control group) consisted of 30 patients who received only conventional physiotherapy. The Visual Analogue Scale was employed to assess pain severity in various functional positions. An independent t-test was used to compare the results. Results: Following Treatment, the study revealed that the experimental group exhibited a notable enhancement in pain associated with forceful wrist extension (p&lt;0.05), pain during vigorous grip (p&lt;0.05), pain on the Cozen test (p&lt;0.05), pain during forceful middle finger extension (p&lt;0.025), and pain upon palpation (p&lt;0.025). In instances of resting discomfort, a substantial reduction in pain intensity was not observed. Conclusion:This experimental investigation demonstrates that the application of Dynamic taping in conjunction with conventional physiotherapy is more efficacious than conventional physiotherapy alone for patients suffering from tennis elbow.

Whole-Head Noninvasive Brain Signal Measurement System with High Temporal and Spatial Resolution Using Static Magnetic Field Bias to the Brain.

Noninvasive brain signal measurement techniques are crucial for understanding human brain function and brain-machine interface applications. Conventionally, noninvasive brain signal measurement techniques, such as electroencephalography, magnetoencephalography, functional magnetic resonance imaging, and near-infrared spectroscopy, have been developed. However, currently, there is no practical noninvasive technique to measure brain function with high temporal and spatial resolution using one instrument. We developed a novel noninvasive brain signal measurement technique with high temporal and spatial resolution by biasing a static magnetic field emitted from a coil on the head to the brain. In this study, we applied this technique to develop a groundbreaking system for noninvasive whole-head brain function measurement with high spatiotemporal resolution across the entire head. We validated this system by measuring movement-related brain signals evoked by a right index finger extension movement and demonstrated that the proposed system can measure the dynamic activity of brain regions involved in finger movement with high spatiotemporal accuracy over the whole brain.

Targeted Muscle Reinnervation in the Upper Arm: A Functional Anatomical Study

BackgroundThe aim of this study was to accurately locate the neural fascicle controlling hand movement in the upper arm, to enhance expression of motor intention after targeted muscle reinnervation. MethodsThe right sides of the median, ulnar and radial nerves were dissected from distal to proximal in 6 fresh cadaver specimens. The sectional location and diameter of the functional fascicle were measured at 10 and 20 cm below the acromion. The diameter of the main muscle branches of muscle reinnervation target muscles was measured. ResultsThe median nerve branch of finger and wrist flexion was mainly located between the 9 and 12 o’clock positions in the plane 10 and 20 cm below the acromion, where the diameter of the nerve fascicle was 2.07 and 2.04 mm, respectively. The ulnar nerve branch of finger and wrist flexion was mainly located between the 8 and 12 o’clock positions, with a diameter of respectively 1.80 and 1.99 mm. The radial branch of finger and wrist extension was mainly located between the 10 and 2 o’clock positions in the plane 10 cm below the acromion and between 6 and 12 o’clock in the plane 20 cm below the acromion, with a diameter of respectively 2.57 and 3.03 mm. ConclusionsThe nerve fascicles innervating the flexor and extensor fingers were distributed in relatively constant regions of the median, ulnar and radial nerve trunks, and their diameters closely matched the muscle branches of the target muscle.

Soft pneumatic actuators for pushing fingers into extension

BackgroundCompliant pneumatic actuators possess many characteristics that are desirable for wearable robotic systems. These actuators can be lightweight, integrated with clothing, and accommodate uncontrolled degrees of freedom. These attributes are especially desirable for hand exoskeletons, where the soft actuator can conform to the highly variable digit shape. In particular, locating the pneumatic actuator on the palmar side of the digit may have benefits for assisting finger extension and resisting unwanted finger flexion, but this configuration requires suppleness to allow digit flexion while retaining sufficient stiffness to assist extension.MethodsTo meet these needs, we designed an actuator consisting of a hollow chamber long enough to span the joints of each digit while sufficiently narrow not to inhibit finger adduction. We explored the geometrical design parameter space for this chamber in terms of shape, dimensions, and wall thickness. After fabricating an elastomer-based prototype for each actuator design, we measured active extension force and passive resistance to bending for each chamber using a mechanical jig. We also created a finite element model for each chamber to enable estimation of the impact of chamber deformation, caused by joint rotation, on airflow through the chamber. Finally, we created a prototype hand exoskeleton with the chamber parameters yielding the best outcomes.ResultsA rectangular cross-sectional area was preferable to a semi-obround shape for the chamber; wall thickness also impacted performance. Extension joint torque reached 0.33 N-m at a low chamber pressure of 48.3 kPa. The finite element model confirmed that airflow for the rectangular chamber remained high despite deformation resulting from joint rotation. The hand exoskeleton created with the rectangular chambers enabled rapid movement, with a cycle time of 1.1 s for voluntary flexion followed by actuated extension.ConclusionsThe developed soft actuators are feasible for use in promoting finger extension from the palmar side of the hand. This placement utilizes pushing rather than pulling for digit extension, which is more comfortable and safer. The small chamber volumes allow rapid filling and evacuation to facilitate relatively high frequency finger movements.

Quantitative Measurement of Rotation in Phalangeal Fracture Malunion Using Computed Tomography Imaging-"Linkage Simulation".

Malunion of thumb and finger fractures causes problems in the cosmetic and functional aspects of the hand. Malunion of phalangeal fractures usually manifests as a combination of rotational deformities in the coronal, sagittal, and transverse planes, and corrective osteotomy is performed on the planes that cause these problems. Quantification of the deformity is essential for precise osteotomy and is difficult to perform in the transverse plane, even with radiography or computed tomography. Thus, we developed a technique called linkage simulation for the quantitative measurement of rotational deformities for surgical planning. In this procedure, finger extension and flexion can be simulated based on the predicted rotational axis of the joint, which is useful for determining the appropriate correction. Furthermore, by performing a reduction simulation in the software, it is possible to simulate the surgery and predict the postoperative results. This paper reports the details of this technique.

Effectiveness of mixed reality-based rehabilitation on hands and fingers by individual finger-movement tracking in patients with stroke

BackgroundMixed reality (MR) is helpful in hand training for patients with stroke, allowing them to fully submerge in a virtual space while interacting with real objects. The recognition of individual finger movements is required for MR rehabilitation. This study aimed to assess the effectiveness of updated MR-board 2, adding finger training for patients with stroke.MethodsTwenty-one participants with hemiplegic stroke (10 with left hemiplegia and 11 with right hemiplegia; nine female patients; 56.7 ± 14.2 years of age; and onset of stroke 32.7 ± 34.8 months) participated in this study. MR-board 2 comprised a board plate, a depth camera, plastic-shaped objects, a monitor, a palm-worn camera, and seven gamified training programs. All participants performed 20 self-training sessions involving 30-min training using MR-board 2. The outcome measurements for upper extremity function were the Fugl–Meyer assessment (FMA) upper extremity score, repeated number of finger flexion and extension (Repeat-FE), the thumb opposition test (TOT), Box and Block Test score (BBT), Wolf Motor Function Test score (WMFT), and Stroke Impact Scale (SIS). One-way repeated measures analysis of variance and the post hoc test were applied for the measurements. MR-board 2 recorded the fingers’ active range of motion (AROM) and Dunnett’s test was used for pairwise comparisons.ResultsExcept for the FMA-proximal score (p = 0.617) and TOT (p = 0.005), other FMA scores, BBT score, Repeat-FE, WMFT score, and SIS stroke recovery improved significantly (p < 0.001) during MR-board 2 training and were maintained until follow-up. All AROM values of the finger joints changed significantly during training (p < 0.001).ConclusionsMR-board 2 self-training, which includes natural interactions between humans and computers using a tangible user interface and real-time tracking of the fingers, improved upper limb function across impairment, activity, and participation. MR-board 2 could be used as a self-training tool for patients with stroke, improving their quality of life.Trial registration number: This study was registered with the Clinical Research Information Service (CRIS: KCT0004167).

Supinator to posterior interosseous nerve transfer to restore hand opening in brachial plexus and spinal cord injury: a systematic review and individual patient-data meta-analysis.

Cervical spinal cord injury (SCI) and lower trunk brachial plexus injury (BPI) commonly result in hand paralysis. Although restoring hand function is complex and challenging to achieve, regaining volitional hand control drastically enhances functionality for these patients. The authors aimed to systematically review the outcomes of hand-opening function after supinator to posterior interosseous nerve (PIN) transfer. A systematic literature review was performed according to the PRISMA guidelines. A total of 16 studies with 88 patients and 119 supinator to PIN transfers were included (87 transfers for SCI and 32 for BPI). In most studies, the time interval from injury to surgery was 6-12 months. Finger extension and thumb extension (Medical Research Council grade ≥ 3/5) recovered in 86.5% (103/119) and 78.1% (93/119) of cases, respectively, over a median follow-up of 19 months. The rates of recovery were similar for the SCI and BPI populations (finger extension, 87.3% in SCI and 84.3% in BPI; thumb extension, 75.8% in SCI and 84.3% in BPI). Type of injury (OR 1.05, 95% CI 0.17-6.4, p = 0.95), time from injury to surgery (OR 1.01, 95% CI 0.8-1.29, p = 0.88), and age (OR 0.97, 95% CI 0.90-1.06, p = 0.60) were not associated with odds of a successful outcome. Duration of follow-up was significantly associated with successful finger extension (OR 1.15, 95% CI 1.01-1.30, p = 0.026). No donor-associated supinator weakness was reported postoperatively given that patients had an intact bicep muscle preoperatively contributing to supination. Supinator to PIN transfer is a safe and effective procedure that can achieve successful restoration of digital extension in the SCI and BPI population at similar rates. Duration of follow-up was associated with superior outcomes, which was expected.

Prognostic efficiency of diagnostic blockade as a method of modeling the result of selective neurotomy of the motor branches of the median nerve in patients with cerebral palsy

BACKGROUND: A feature of the disease course in patients with spastic cerebral palsy is a combination of motor neurological disorders with contractures in extremity joints. Neurosurgical methods are currently the main treatment for correcting the pathological tone of the “spastic hand.” However, the decreased tone does not affect secondary (fixed) contractures; therefore, the effectiveness of this type of treatment is extremely dependent on the accurate selection of a certain category of patients. Presumably, diagnostic blockade of the median nerve can create a reversible model for planned neurosurgical treatment. The inclusion of this technique as a standard for examining a patient with spastic cerebral palsy before invasive tone-lowering treatment can radically promote treatment effectiveness. AIM: This study aimed to assess the prognostic effectiveness of diagnostic blockade as a method of modeling the result of selective neurotomy of the motor branches of the median nerve in patients with cerebral palsy. MATERIALS AND METHODS: A longitudinal prospective study enrolled 39 children (aged 5–18 years) with spastic cerebral palsy. Before neurosurgical treatment, each patient underwent a diagnostic n. medianus under electrical stimulation and ultrasound control. After a diagnostic blockade, only patients who had a good functional and goniometric response were selected for the study, which served as an indication for selective neurotomy of the median nerve, and orthopedic treatment was performed in children with a negative event. Patients referred for neurotomy underwent a standardized examination before treatment during the diagnostic blockade and after neurosurgical treatment. The examination included the assessment of the amplitude of passive and active movements in the joints of the upper extremities, muscle tone, and functional capabilities of the upper extremities and dynamometry. RESULTS: In comparison with the initial data, a significant increase in the amplitude of passive and active hand extension, passive and active abduction of the first finger, and upper limb functional capabilities according to the MACS classification and the Miller scale was determined both after the diagnostic blockade and after selective neurotomy of the motor branches of the median nerve. CONCLUSIONS: Based on the results of the study, the effect of the diagnostic blockade and neurosurgical treatment outcomes are unidirectional, which allows the use of blockade as a method for modeling the possible result in clinically complex cases of spastic hand. The use of diagnostic blockade in clinical practice makes it possible to adequately assess the severity of fixed contractures and reduce the pathological hypertonicity of the target muscles. Diagnostic blockade allows for the collection of sufficient information to make an objective decision about which type of treatment is most preferable for each patient – neurosurgical, orthopedic, or sequential use of both methods.

Defining the landscape of TIA1 and SQSTM1 digenic myopathy

TIA1/SQSTM1 myopathy is one of the few digenic myopathies. We describe four new French adult male patients carrying the TIA1 p.Asn357Ser and SQSTM1 p.Pro392Leu variant and review the literature to include 20 additional cases to define the spectrum of the disease. These twenty-four patients (75% males) had late-onset (52,6 ± 10,1 years), mainly asymmetric, distal ankle and hand finger extension weakness (75%), mild CK elevation (82.4%) and myopathic EMG. Two of the four French patients had sensorimotor axonal polyneuropathy and an additional one had neurogenic changes in muscle biopsy. Muscle biopsy showed rimmed vacuoles (44.4%), myofibrillar disorganization (16.7%) or both (38.9%), with P62/TDP43 aggregates. The TIA1 p.Asn357Ser variant was present in all patients and the SQSTM1 p.Pro392Leu was the most frequent (71%) of the four reported SQSTM1 variants. We reviewed the distal myopathy gene panels of Pitié-Salpêtrière's hospital cohort finding a prevalence of 11/414=2.7% of the TIA1 p.Asn357Ser variant, with two patients having an alternative diagnosis (TTN and MYH7) with atypical phenotypes, resembling some of the features seen in TIA1/SQSTM1 myopathy. Overall, TIA1/SQSTM1 myopathy has a homogenous phenotype reinforcing the pathogenicity of its digenic variants. We confirm an increased burden of the TIA1 p.Asn357Ser variant in distal myopathy patients which could act as a genetic modifier.

Comparison of Treatment Outcomes of Different Immobilized Finger Positions After Repair of Flexor Tendon Rupture in Zones I and II: A Nonrandomized Controlled Trial With Historical Control Group.

Introduction The position of finger immobilization after flexor tendon rupture repair is changed to the extended position to prevent flexion contracture of the interphalangeal (IP) joint. However, in Strickland's assessment, We believe that a reduction in TAF (total active flexion) affects the outcome and that extension fixation is not necessarily the primary focus.For example, there are management methods that swap the fixed position between day and night. It is assumed that some effect is sought by placing the fingers in the flexed position. That is, the method of fixation is currently selected at individual facilities through twists and turns; however,the indications and criteria for selecting finger fixation positions are ambiguous, and they are apparently subject to the experience of therapists. This study aimed to characterize follow-up outcomes of flexion and extension fixation after zones I and II flexor tendon rupture repair. Methods This nonrandomized controlled trial with historical controls included 25 patients with flexor tendon ruptures of 30 fingers. The flexion fixation group consisted of 12 patients (n=16 fingers) and the extension fixation group consisted of 13 patients (n=14 fingers). The group with flexion fixation comprised patients who slept with their injured fingers in the flexed position (intervention group). The group with extension was retrospectively selected between April 2017 and March 2019, who slept with their injured finger in the extended position (historical control group). Strickland assessments of the range of motion (ROM) of each joint at the conclusion of hand therapy, the ratio of total active motion of the repaired, to the healthy finger (%TAF), and IP joint extension limitation angles were compared using Mann-Whitney U tests. Ratios of excellent and good ratings based on the Strickland assessment were compared using Fisher exact tests. Result The results of the Strickland assessment showed excellent or goodoutcomes for 22(73%) of 30 fingers, which was in line with our previous findings. Strickland ratings of excellent were achieved in seven (44%) of 16 fingers and four (28%) of 14 fingers in the groups with flexion and extension fixation, respectively. The outcomes for two (22%) of 16 fingers and seven (78%) of 14 fingers in the groups with flexion and extension fixation were, respectively, rated asgood. The proportion of patients rated as excellent was significantly higher in the group with flexionthan extension fixation (p=0.040). The %TAF and the active flexion angle of the distal interphalangeal (DIP) joint were higher in the group with flexionthan extension fixation (p=0008 and p=0.025, respectively). Furthermore, the total angle of the IP joint limit of extension did not significantly differ between the groups. Conclusion Flexion fixation after flexor tendon rupture achieved an excellent Strickland rating and was more effective than extension fixation, especially in terms of the active flexion ROM of the DIP joint. Flexion fixation might be an alternative to extension fixation because the range of flexion should be greater and might provide a range of finger extension motion equivalent to that of extension fixation.

Design and testing of fabric-based portable soft exoskeleton glove for hand grasping assistance in daily activity

Hand exoskeleton robots have been developed as rehabilitation robots and assistive devices. Based on the material used, they can be soft or hard exoskeletons. Soft materials such as fabric can be used as a component of the wearable robot to increase comfortability. In this paper, we proposed an affordable soft hand exoskeleton based on fabric and motor-tendon actuation for hand flexion/extension motion assistance in daily activities. On-off control and PI compensator were implemented to regulate finger flexion and extension of the soft exoskeleton. The controllers were embedded into a microcontroller using Simulink software. The input signal command comes from the potentiometer and electromyography (EMG) sensor to drive the flexion/extension movement. Based on the experiments, the proposed controller successfully controlled the exoskeleton hand to facilitate a user in grasping various objects. The proposed soft hand exoskeleton is lightweight, comfortable, portable, and affordable, making it easily manufactured using available hardware and open-source code. The developed soft exoskeleton is a potential assistive device for a person who lost the ability to grasp objects.

Treating Lateral Epicondylopathy With Dry Needling and Exercise: A Case Series.

Lateral epicondylopathy (LE) is a common overuse injury affecting elbow, wrist, and hand function. It is characterized by weakness and pain in the muscles and tendons of the forearm responsible for the extension of your wrist and fingers. Trigger point dry needling is a technique reported to be beneficial in managing pain and dysfunction after LE diagnosis. LE is also commonly treated with conservative treatment, such as joint and soft tissue mobilization, self-care home programs, and anti-inflammatory use. We explored a different dry needling approach consisting of in situ dry needling with electric stimulation combined with targeted therapeutic exercise to treat LE in 3 cases. Three patients were referred for dry needling once a week for 6weeks and home-based exercise therapy for LE. They were clinically evaluated using grip strength, a visual analog scale to assess pain, and Patient-Rated Tennis Elbow Evaluation Test scores. These were measured at 4 time points (weeks 0, 2, 4, and 6). The dry needling intervention incorporated 8 locations in the upper-extremity with 2 electric stimulation channels. The patients had reduced pain as measured by a visual analog scale, increased function as measured by the Patient-Rated Tennis Elbow Evaluation Test, and increased grip strength over 6weeks. This case series illustrates the use of dry needling and a home exercise program to provide a favorable outcome in a patient with LE. Patients had an 80% to 100% reduction in pain and similar improvements in function that were significantly beyond the minimum clinically important difference. This dry needling approach is a safe and effective treatment of LE in the short term.

Retro Oesophageal Transfer of Contralateral C7 in Birth Brachial Plexus Injury - A Retrospective Study.

Background: Presence of available healthy nerve roots on the injured side determines the outcome after nerve reconstruction. Paucity of nerve roots warrants contralateral C7 harvest for optimal results. We aim to study the risks and benefits of retro oesophageal transfer of contralateral C7 root in infants with birth brachial plexus injury. Methods: Study was carried out from 2017 to 2022 in 13 children who have undergone retro oesophageal transfer of contralateral C7 root to affected side. Follow-up period ranged from 8 to 60 months after the surgery. Motor power assessment was done using by active movement scale. Results: Average active movement score for abduction was found to be 6, elbow flexion 5.7, elbow extension 5.8, wrist extension 3, wrist flexion 4, finger flexion 4.8 and finger extension 3.8, respectively. No neurological deficits, limb length anomaly noted in the normal upper limb after contralateral C7 harvest. Conclusions: Retro oesophageal transfer of contralateral C7 is a safe technique in birth brachial plexus injury. The advantage of retro oesophageal transfer is reduction in the length of nerve grafts, thus helping in early neurotisation of distal forearm and hand muscles. The large axonal output from contralateral C7 can be used to reconstruct different nerves without any residual deficits on the normal side. Level of Evidence: Level IV (Therapeutic).

Research and Development of a 3D-Printed Dynamic Finger Flexion Orthosis for Finger Extension Stiffness-A Preliminary Study.

Finger extension stiffness is a common post-traumatic complication that results in the hand's functional impairment. In clinical practice, a dynamic splint enables the patient to stretch the affected finger independently. However, current dynamic splints have drawbacks, such as limited stretching efficacy, and interfere with the hand's functional activities. Therefore, this study aimed to develop a dynamic finger flexion orthosis capable of stretching each finger joint using additive manufacturing (AM) technology, thereby enabling hand functional activity, and analyze the clinical improvement in the range of motion (ROM). One subject with a hand fracture was recruited while undergoing a 7-week home-based rehabilitation program for the orthosis. The outcome measurements included the total active motion (TAM), the tip-to-finger distance (TPD), and the score on the Disability of Arm, Shoulder, and Hand (DASH) questionnaire. The results show that the TAM of the participant's fingers increased by 72.7 degrees on average, the TPD decreased by 3.5 cm on average, and the DASH score decreased to 9.5 points. The 7-week home-based rehabilitation program for the orthosis resulted in a 53.6% increase in the TAM on average. The developed orthosis improved hand function and enabled a more complete ROM in finger flexion.