Extremity Movement Research Articles

Estimation of the knee joint load using plantar pressure data measured by smart socks: A feasibility study.

Unsupervised sports activities could cause traumas, about 70% of them are those of the low extremities. To avoid traumas, the athlete should be aware of dangerous forces acting within low extremity joints. Research in gait analysis indicated that plantar pressure alteration rate correlates with the gait pace. Thus, the changes in plantar pressure should correlate with the accelerations of extremities, and with the forces, acting in the joints. Smart socks provide a budget solution for the measurement of plantar pressure. To estimate the correlation between the plantar pressure, measured using smart socks, and forces, acting in the joints of the lower extremities. The research is case study based. The volunteer performed a set of squats. The arbitrary plantar pressure-related data were obtained using originally developed smart socks with embedded knitted pressure sensors. Simultaneously, the lower extremity motion data were recorded using two inertial measurement units, attached to the tight and the ankle, from which the forces acted in the knee joint were estimated. The simplest possible model of knee joint mechanics was used to estimate force. The estimates of the plantar pressure and knee joint forces demonstrate a strong correlation (r= 0.75, P< 0.001). The established linear regression equation enables the calculation of the knee joint force with an uncertainty of 22% using the plantar pressure estimate. The accuracy of the classification of the joint force as excessive, i.e., being more than 90% of the maximal force, was 82%. The results demonstrate the feasibility of the smart socks for the estimation of the forces in the knee joints. Smart socks therefore could be used to develop excessive joint force alert devices, that could replace less convenient inertial sensors.

Terminal organization of the corticospinal projection from the arm/hand region of the rostral primary motor cortex (M1r or old M1) to the cervical enlargement (C5-T1) in rhesus monkey.

High-resolution anterograde tracers and stereology were used to study the terminal organization of the corticospinal projection (CSP) from the rostral portion of the primary motor cortex (M1r) to spinal levels C5-T1. Most of this projection (90%) terminated contralaterally within laminae V-IX, with the densest distribution in lamina VII. Moderate bouton numbers occurred in laminae VI, VIII, and IX with few in lamina V. Within lamina VII, labeling occurred over the distal-related dorsolateral subsectors and proximal-related ventromedial subsectors. Within motoneuron lamina IX, most terminations occurred in the proximal-related dorsomedial quadrant, followed by the distal-related dorsolateral quadrant. Segmentally, the contralateral lamina VII CSP gradually declined from C5-T1 but was consistently distributed at C5-C7 in lamina IX. The ipsilateral CSP ended in axial-related lamina VIII and adjacent ventromedial region of lamina VII. These findings demonstrate the M1r CSP influences distal and proximal/axial-related spinal targets. Thus, the M1r CSP represents a transitional CSP, positioned between the caudal M1 (M1c) CSP, which is 98% contralateral and optimally organized to mediate distal upper extremity movements (Morecraft etal., 2013), and dorsolateral premotor (LPMCd) CSP being 79% contralateral and optimally organized to mediate proximal/axial movements (Morecraft etal., 2019). This distal to proximal CSP gradient corresponds to the clinical deficits accompanying caudal to rostral motor cortex injury. The lamina IX CSP is considered in the light of anatomical and neurophysiological evidence which suggests M1c gives rise to the major proportion of the cortico-motoneuronal (CM) projection, while there is a limited M1r CM projection.

Abstract 254: Patients With Signs of Life on Hospital Arrival Have a Higher Chance of Survival and Favorable Neurological Outcomes Following Traumatic Cardiac Arrest

Introduction: The clinical impact of signs of life (SOL) in traumatic cardiac arrest (TCA) remain to be elucidated. A previous study compared TCA patients with pulseless electrical activity (PEA) to those with asystole, but survival was not significantly different between the groups. Other obvious SOL (i.e., fine extremity/eye movement, light reflection, agonal respiration) have not yet been examined in TCA. Hypothesis: We hypothesized that TCA patients with SOL on hospital arrival have a higher chance of survival and good neurological outcomes. Aim: To examine survival and neurological outcomes in TCA patients with or without SOL. Methods: Retrospective review of data from the Japan Trauma Data Bank (2019-2021). The inclusion criteria were patients with TCA on arrival. The exclusion criteria were patients with burns, abbreviated injury scale score&gt; 6 in any region, and missing survival or SOL data. SOL was defined as follows: extremity or eye movement, light reflex, gasping, pulseless electrical activity with electrical heart activity &gt; 40 beats per minute. The primary outcome was survival at discharge. The secondary outcome was favorable neurological outcome (Glasgow Outcome Scale score of 4 or 5) at hospital discharge. Patients with and without SOL were compared using univariable analysis. Results were described with odds ratio (ORs) and 95% confidence intervals (CI). Results: A total of 2,136 patients (121 with SOL and 2,015 without SOL) were included. The characteristics of patients with or without SOL were as follows: age (median age 60.5 years old [interquartile range: 42-80 years] vs. 55.2 [38-75]), gender (male: 83/121 (68.6%) vs. 1,321/2,015 (65.9%), Injury Severity Score (32.9 [22-43] vs. 33.7 [22-41]), blunt trauma (97/121 (82.2%) vs. 1,711/2,015 (84.9%)), and transportation time (15.1 min [7-18] vs. 13.3 [7-16]). The patients with SOL showed higher survival compared with the patients without SOL (11/121 (8.5%) vs. 24/2015 (1.2%), OR 1.9 [CI 1.38-2.85]). A similar trend was observed for favorable neurological outcomes (5/95 (5.3%) vs. 7/1,440 (0.5%), OR 2.41 [CI 1.26-3.60]). Conclusions: TCA patients with SOL at arrival showed higher survival and favorable neurological outcomes at hospital discharge compared with TCA patients without SOL.

Abstract 105: Limb Shaking Transient Ischemic Attack: A Rare Presentation of Internal Carotid Artery Occlusion

Introduction Limb‐shaking transient ischemic attack (LS‐TIA) is a rare disorder characterized by brief, irregular, involuntary movements of the extremities with or without loss of consciousness. Associated paroxysmal hyperkinetic extremity movements often described by patients as “shaking,” “tremors,” or “twitching” are an uncommon and under‐reported presentation of cerebral hypoperfusion. Vascular etiology must remain on the differential as these transient but hemodynamically significant episodes are associated with severe carotid steno‐occlusive disease and carry an elevated risk for stroke. Methods The patient was evaluated in routine clinical practice. Results A man in his 50s with medical history of chronic right internal carotid artery (ICA) occlusion, coronary artery disease and tobacco use disorder presented with two months of intermittent, progressive worsening of left extremity tremors associated with ipsilateral weakness and mild confusion during the spells. These involuntary paroxysmal spells—precipitated by standing up, exertion and neck hyperextension—initially occurred 4 to 5 times per week in left upper extremity but progressed to 4 to 5 times per day with prolonged durations reaching 20 minutes and involving the left lower extremity. The initial event involved loss of consciousness, but no further syncopal episodes were noted. While ipsilateral hemiparesis and mild confusion occurred during the spells, spontaneous resolution and immediate return to baseline were reported afterward. On presentation, the National Institutes of Health Stroke Scale (NIHSS) was zero. Computed tomography (CT) head did not show acute intracranial process. CT angiography (CTA) re‐demonstrated right ICA occlusion at its origin. A load of Clopidogrel 300 mg and Aspirin 325 mg was administered. Orthostatic blood pressure measurements were normal. CT perfusion of brain demonstrated a perfusion decrease within the right frontoparietal lobes in the right middle cerebral artery (MCA) region. Routine EEG was performed, and it did not show interictal discharges. Brain MRI did not show acute infarcts. Catheter cerebral angiogram was then pursued, confirming right ICA occlusion at its origin and additionally showed mild atherosclerosis of the left ICA without flow‐limiting stenosis. After thorough evaluation, these events of unilateral extremity shaking and hemiparesis were deemed to be LS‐TIA. Neurosurgery was consulted and offered extracranial‐intracranial (EC‐IC)/ superficial temporal artery‐MCA bypass surgery. He was discharged in stable condition to continue DAPT and high‐dose statin while pending surgical intervention. Conclusion This case not only provides a descriptive narration of the presentation of LS‐TIA along with the steps in management undertaken but also encourages the consideration of vascular etiology as a potential cause for acute onset paroxysmal hyperkinetic movements. Early diagnosis and appropriate treatment are crucial to reduce burden of poor outcomes and prevention of stroke.

Investigating the Immediate Effect of Feedback on the Performance of People With Abnormal Lower Extremity Movement Patterns: A Review

Background and Aims Faulty movement patterns can lead to dysfunctional and uncoordinated mobility. A proper pattern can cause better movement. In fact, an efficient movement provides more energy for endurance and power with less effort and more mobility and agility. Many studies have reported the effect of feedback on improving faulty movement patterns as a risk factor for anterior cruciate ligament injury. This study aims to investigate whether feedback can affect the performance of people with abnormal lower extremity movement patterns or not. Methods This is a systematic review study. Related articles published from 2000 to 2020 were found by searching in international (Google Scholar, PubMed, ScienceDirect) and national (MagIran, IranDoc) databases using the keyword videotape augmented feedback, augmented feedback, feedback, jump-landing, immediate effect. Results Out of 10 reviewed studies, two were systematic review studies, one was a systematic meta-analysis study, and seven were interventional studies. In all studies, feedback methods had a positive effect on the biomechanics of the lower limb. Three studies examined the impact of feedback on performance, of which two studies stated that feedback caused a decrease in performance, while one study stated that feedback did not affect performance. Conclusion In many studies, feedback methods improved movement patterns, but further studies are needed to understand the effect of feedback on the performance of people with abnormal lower extremity movement patterns.

A case of sacrococcygeal teratoma associated with antenatally acquired urethrovaginal fistula and hydrocolpos

BackgroundSacrococcygeal teratomas (SCTs) are known to cause urological complications, but urethrovaginal (UV) fistula as a complication of SCT is rare. We herein report a case of SCT with UV fistula and hydrocolpos.Case presentationA 1-day-old female neonate presented to our department with prominent swelling in the sacrococcygeal region. She was born at 37 gestational weeks via spontaneous vaginal delivery from a 39-year-old woman. The weight of the baby was 2965 g, and her Apgar scores were 4/10 (at 1 and 5 min). An MRI examination confirmed an 11 × 11 cm Altman classification typeII SCT associated with hydrocolpos, a dilated urinary bladder, and bilateral hydronephrosis. When she was 5 days, the SCT was excised totally and a coccygectomy was performed. After the operation, as her urinary output appeared unstable, a cystoscopic examination was performed on the third postoperative day. This revealed that the UV fistula was located approximately 1 cm from the urethral opening. In addition, the proximal urethra was unobstructed and connected to the bladder. The cystoscope allowed for the passage of a urinary catheter through the urethra. After 1 month of catheter placement, she was discharged from the hospital at 57 days of age. Follow-up was uneventful, with neither urinary infection nor retention.ConclusionsSCTs are associated with not only trouble with rectal function and lower extremity movement but also urinary complications. The pathogenesis of this UV fistula is thought to be the rapid growth of the SCT that developed in the fetal period, resulting in obstruction of the urethra by the tumor and the pubic bone, which in turn caused urinary retention and the formation of a fistula as an escape route for the pressure. Because SCTs can cause a variety of complications depending on the course of the disease, careful examination and follow-up are necessary.

Recovery of Shoulder, Elbow, and Forearm Movement After Nerve Reconstruction for Neonatal Brachial Plexus Palsy.

There is a relative dearth of published data with respect to recovery of upper extremity movement after nerve reconstruction for neonatal brachial plexus palsy (NBPP). This study aimed to demonstrate long-term recovery of active range of motion (AROM) at the shoulder, elbow, and forearm after nerve reconstruction for NBPP and to compare that with patients managed nonoperatively. We interrogated a prospectively collected database of all patients evaluated for NBPP at a single institution from 2005 to 2020. AROM measurements for shoulder, elbow, and forearm movements were collected at every visit up to 5 years of follow-up and normalized between 0 and 1. We used generalized estimated equations to predict AROM for each movement within local age windows over 5 years and compared the operative and nonoperative cohorts at each age interval. In total, >13 000 collected datapoints representing 425 conservatively and 99 operatively managed children were included for analysis. At 5 years, absolute recovery of AROM after nerve reconstruction was ∼50% for shoulder abduction and forward flexion, ∼65% for shoulder external rotation, and ∼75% for elbow flexion and forearm supination, with ∼20% loss of elbow extension AROM. Despite more limited AROM on presentation for the operative cohort, at 5 years, there was no significant difference between the groups in AROM for shoulder external rotation, elbow extension, or forearm supination, and, in Narakas grade 1-2 injury, shoulder abduction and forward flexion. We demonstrate recovery of upper extremity AROM after nerve surgery for NBPP. Despite more severe presenting injury, operative patients had similar recovery of AROM when compared with nonoperative patients for shoulder external rotation, elbow extension, forearm supination, and, for Narakas grade 1-2 injury, shoulder abduction and forward flexion.

Computer simulation on the cueing movements in cue sports: a validation study.

Simulation models have been applied to analyze daily living activities and some sports movements. However, it is unknown whether the current upper extremity musculoskeletal models can be utilized for investigating cue sports movements to generate corresponding kinematic and muscle activation profiles. This study aimed to test the feasibility of applying simulation models to investigate cue sports players' cueing movements with OpenSim. Preliminary muscle forces would be calculated once the model is validated. A previously customized and validated unimanual upper extremity musculoskeletal model with six degrees of freedom at the scapula, shoulder, elbow, and wrist, as well as muscles was used in this study. Two types of cueing movements were simulated: (1) the back spin shot, and (2) 9-ball break shot. Firstly, kinematic data of the upper extremity joints were collected with a 3D motion capture system. Using the experimental marker trajectories of the back spin shot on 10 male cue sports players, the simulation on the cueing movements was executed. The model was then validated by comparing the model-generated joint angles against the experimental results using statistical parametric mapping (SPM1D) to examine the entire angle-time waveform as well as t-tests to compare the discrete variables (e.g., joint range of motion). Secondly, simulation of the break shot was run with the experimental marker trajectories and electromyographic (EMG) data of two male cue sports players as the model inputs. A model-estimated muscle activation calculation was performed accordingly for the upper extremity muscles. The OpenSim-generated joint angles for the back spin shot corresponded well with the experimental results for the elbow, while the model outputs of the shoulder deviated from the experimental data. The discrepancy in shoulder joint angles could be due to the insufficient kinematic inputs for the shoulder joint. In the break shot simulation, the preliminary findings suggested that great shoulder muscle forces could primarily contribute to the forward swing in a break shot. This suggests that strengthening the shoulder muscles may be a viable strategy to improve the break shot performance. It is feasible to cater simulation modeling in OpenSim for biomechanical investigations of the upper extremity movements in cue sports. Model outputs can help better understand the contributions of individual muscle forces when performing cueing movements.

Flights to safe assets in bond markets: Evidence from emerging market economies

This paper investigates cross-border flights to safety (FTS) in sovereign bond markets from the perspective of emerging market economies (EMEs). Accurate identification of such events provides a detailed picture of sharp changes in prices of international assets and potential sources of EMEs' financial fragility. We construct new measures of the FTS occurrence and magnitude by focusing on extreme movements in long-term bond markets vis-à-vis the US for a diverse group of 21 EMEs. An adaptable time-series anomaly detection algorithm is used to recognize patterns in daily data on bond returns from 2002 to 2021. The paper shows that the FTS episodes in the entire sample of EMEs turn out to be short-lived and map well into periods of international financial and economic downturns. The results from panel-data models indicate that country-specific factors, in particular economic fundamentals, matter more for the FTS magnitude than for their mere occurrence. This supports the notion that flights from bond markets are usually triggered by shocks originating outside of EMEs, but the magnitude of these events may materially depend on their domestic conditions, including macroeconomic stability and policy factors. Moreover, the country-specific factors are more important when FTS episodes are driven by external financial risk and US monetary policy rather than shifts in global economic activity.

Reaction of Indian Stock Market to Outbreak of COVID-19: An Empirical Analysis of Extreme Inter-day Movements

The contagious COVID-19 pandemic has been considered a massive global crisis since World War II and has disturbed business and economic activities across the globe. The current study examined the reaction of the stock market’s to the outbreak of COVID-19, considering the extreme inter-day movements in the Indian stock market. The extreme inter-day movements in S&amp;P CNX Nifty-50 have been identified during the study period from January 2020 to December 2021 and further classified into decline and gain events based on positive and negative announcements related to COVID-19. The study utilized an event study approach and panel regression for empirical investigation. The results of the event study analysis illustrate that the significant abnormal loss ranges from 12.86% to 2.47% for the major decline events and significant abnormal return from 8.43% to 3.23% for the gain events. The regression analysis results showed that real return and Central Bank Policy rate have a considerable impact on the abnormal returns during COVID-19. The study’s findings are helpful to policy implications that identified the need to focus on financial education and strengthen the health and finance-related policies to deal with such pandemics in the future.

Assessing jump and cojumps in financial asset returns with applications in futures markets

Price jumps and extreme dependence in financial asset prices are both very important issues in Finance since both would distort the decisions in asset allocation and risk management. Cojumps, as joint occurrence of extreme price movements, share even relevant financial implications about systematic risk. This paper aims to unravel the empirical relationship between cojumps and tail dependence. We first propose a simple approach for identifying jumps and co-jumps in asset prices utilizing the recent realized measures of variation in high frequency finance. The framework is informative in testing the existence of jumps, dating jump days, and quantifying jump contributions to price variations. Our identification approach improves the over-alarm detection of jumps from previous formal tests. Applying the idea to test the presence of cojumps in realized covariances allows us to disentangle the nature of cojumps and the real source of extreme tail dependence. For the empirically investigated S&P 500 spot and futures indices, we find asymmetries in both the frequencies and magnitudes among those downward or upward abrupt comovements. Perhaps surprisingly, we find that it is covolatility instead of cojumps in asset prices that counter-intuitively contributes to the observed extreme tail dependence. However, when the tests are applied in the Taiwanese TAIEX futures and spot indices, a completely different picture emerged. We found evidence of prevailing cojumps, and moreover, it is these cojumps that triggered the marginal jumps within each index returns and contributed to the extreme returns. When further examined cross-sectionally with Taiwanese and Chinese future indices, we documented a pattern of cojump induced tail dependence in futures returns across the Taiwan straits.

Quantifying Patient-Initiated Upper Extremity Movement After Surgical Reconstruction for Adult Pan-Brachial Plexus Injury.

Determining functional recovery in adult patients with traumatic pan-brachial plexus injury (pBPI) is hampered by the fact that most outcome measures are collected in the clinical setting and may not reflect arm use in the real world. This study's objectives were to demonstrate the feasibility of using wearable motion sensor technology to quantify spontaneous arm movement in adult patients with pBPI after surgical reconstruction and report the time and intensity with which the affected arm was used. Twenty-nine patients with pBPI who underwent surgical reconstruction at least 2 years prior were included in this study. Study participants wore an accelerometer on bilateral arms for 7 days. The vector time (VT) and magnitude with which each arm moved were collected and divided by the same values collected from the uninjured arm to generate a ratio (VT and vector magnitude [VM], respectively) to quantify differences between the arms. Correlations between VT, VM, and patient demographic and physician-elicited clinical measures were calculated. Patients were enrolled at Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan, and data analysis was performed at the University of Michigan. Twelve patients had pan-avulsion injuries, and 17 patients had C5 rupture with C6-T1 avulsion injuries. All underwent nerve reconstruction with contralateral C7 or ipsilateral C5 nerve roots as donors. At mean 7.3 years after surgery, the mean VT ratio was 0.54 ± 0.13 and the mean VM ratio was 0.30 ± 0.13. Both VT and VM ratios were significantly correlated with patient employment and movements at the elbow and forearm. Wearable motion detection technology can capture spontaneous, real-world movements of the arm in patients who have undergone surgical reconstruction for pBPI. Despite severe injuries, these patients are able to use their affected arm 50% of the time and with 30% of the intensity of their unaffected arm, which is positively correlated with return to work after injury. These data support the use of surgical reconstruction for pBPI.

The nexus between herding behavior and spillover: evidence from G7 and BRICS

PurposeThis study aims at exploring the nexus between herding behavior and the spillover effect in G7 and BRICS stock markets.Design/methodology/approachThe authors used the dynamic connectedness approach TVP-VAR model of Antonakakis et al. (2019) to capture the spillovers across different markets. Moreover, to explore herding behavior, the authors used a modified version of the CSAD measure of Chang et al. (2000) including extreme market movements. Finally, to study the link between these two phenomena, the authors estimated a DCC-GARCH model.FindingsThe results show that herding behavior exists in the American market and some BRICS markets. Furthermore, spillover between G7 and BRICS increases in times of crisis. Moreover, the authors find a dynamic conditional correlation between herding behavior and spillovers both in the short and long run. The authors conclude that in times of crisis, the transmission of shocks between markets is more frequent, fuelling uncertainty and pushing investors to suppress their own beliefs and follow the general market trends.Originality/valueThis paper uses the TVP-VAR model to explore the spillover effect and the DCC-GARCH model to explore the connectedness between herding behavior and the spillover effect in G7 and BRICS countries in both the short and long run.

Anatomy-aware computed tomography-to-ultrasound spine registration.

Ultrasound (US) has demonstrated to be an effective guidance technique for lumbar spine injections, enabling precise needle placement without exposing the surgeon or the patient to ionizing radiation. However, noise and acoustic shadowing artifacts make US data interpretation challenging. To mitigate these problems, many authors suggested using computed tomography (CT)-to-US registration to align the spine in pre-operative CT to intra-operative US data, thus providing localization of spinallandmarks. In this paper, we propose a deep learning (DL) pipeline for CT-to-US registration and address the problem of a need for annotated medical data for network training. Firstly, we design a data generation method to generate paired CT-US data where the spine is deformed in a physically consistent manner. Secondly, we train a point cloud (PC) registration network using anatomy-aware losses to enforce anatomically consistentpredictions. Our proposed pipeline relies on training the network on realistic generated data. In our data generation method, we model the properties of the joints and disks between vertebrae based on biomechanical measurements in previous studies. We simulate the supine and prone position deformation by applying forces on the spine models. We choose the spine models from 35 patients in VerSe dataset. Each spine is deformed 10 times to create a noise-free data with ground-truth segmentation at hand. In our experiments, we use one-leave-out cross-validation strategy to measure the performance and the stability of the proposed method. For each experiment, we choose generated PCs from three spines as the test set. From the remaining, data from 3 spines act as the validation set and we use the rest of the data for training thealgorithm. To train our network, we introduce anatomy-aware losses and constraints on the movement to match the physics of the spine, namely, rigidity loss and bio-mechanical loss. We define rigidity loss based on the fact that each vertebra can only transform rigidly while the disks and the surrounding tissue are deformable. Second, by using bio-mechanical loss we stop the network from inferring extreme movements by penalizing the force needed to get to a certainpose. To validate the effectiveness of our fully automated data generation pipeline, we qualitatively assess the fidelity of the generated data. This assessment involves verifying the realism of the spinal deformation and subsequently confirming the plausibility of the simulated ultrasound images. Next, we demonstrate that the introduction of the anatomy-aware losses brings us closer to state-of-the-art (SOTA) and yields a reduction of 0.25 mm in terms of target registration error (TRE) compared to using only mean squared error (MSE) loss on the generated dataset. Furthermore, by using the proposed losses, the rigidity loss in inference decreases which shows that the inferred deformation respects the rigidity of the vertebrae and only introduces deformations in the soft tissue area to compensate the difference to the target PC. We also show that our results are close to the SOTA for the simulated US dataset with TRE of 3.89 mm and 3.63 mm for the proposed method and SOTA respectively. In addition, we show that our method is more robust against errors in the initialization in comparison to SOTA and significantly achieves better results (TRE of 4.88 mm compared to 5.66 mm) in this experiment. In conclusion, we present a pipeline for spine CT-to-US registration and explore the potential benefits of utilizing anatomy-aware losses to enhance registration results. Additionally, we propose a fully automatic method to synthesize paired CT-US data with physically consistent deformations, which offers the opportunity to generate extensive datasets for network training. The generated dataset and the source code for data generation and registration pipeline can be accessed via https://github.com/mfazampour/medphys_ct_us_registration.

Determination of various etiological factors for diagnosis of non traumatic scapulo costal syndrome

Background: Scapulocostal syndrome, also known as "snapping scapula," is an under-recognized problem involving overhead or throwing motion of the upper extremities. It is often described as a snapping or grinding sensation accompanied with pain as the scapula touches the chest wall and an audible or palpable click near the anteromedial scapula. Method: A prospective observational study was performed at one of the biggest tertiary care centres of central India from September 2021 to March 2023. A total of 50 patients were included in this study. Patient were evaluated clinically in OPD for pain in Scapulothoracic region. All the suspected patients underwent various investigations like X-ray, ultrasonography, electromyography, nerve conduction velocity study, magnetic resonance imaging (MRI) depending on the condition to reach a diagnosis. The data was recorded and evaluated. Results: A total of 50 patients were included in the study, 30 were females and 20 males, 50 % of our patients were diagnosed with supraspinatus tendinosis, 8 patients were found to have bicipital tendinitis, 3 patients had acromioclavicular joint arthritis, 2 patients developed pain because of glenohumeral joint arthropathy, subscapularis tendinitis. There were some other conditions as well diagnosed in few patients with the help of various investigations. Conclusions: It was found that there were various reasons for pain in patients diagnosed clinically with scapulocostal syndrome. Dominant hand affection was more common. The clinical investigations play a major role in diagnosing these conditions and planning the treatment.

Effects of a Passive Back-Support Exosuit on Erector Spinae and Abdominal Muscle Activity During Short-Duration, Asymmetric Trunk Posture Maintenance Tasks.

To examine the effects of asymmetry and lower extremity mobility restrictions on the effectiveness of a passive back-support exosuit in short-duration, static trunk flexion postures. The effectiveness of trunk exoskeletons/suits for sagittally symmetric trunk posture maintenance has been investigated, but there has been limited study of the effects of asymmetric trunk postures or lower extremity motion restriction. Sixteen participants held trunk flexion postures involving trunk flexion (20°, 40°, 60°), asymmetry (0°, 30°), and lower extremity mobility (Free, Restricted) for 3s. Participants held these postures with and without an exosuit while erector spinae and abdominal muscle activities were collected. There were no significant interactions between exosuit and asymmetry or exosuit and lower extremity motion restrictions, indicating no significant effects of these factors on the effectiveness of the exosuit at reducing trunk muscle activity. The exosuit was found to be effective at reducing erector spinae muscle activity regardless of asymmetry of posture or lower extremity restrictions (average 21%, from 11.2% MVC to 8.8% MVC). The magnitude of the erector spinae activity at 60° of trunk flexion with the exosuit was similar to that seen at 20° without the exosuit. The exosuit consistently provided biomechanical benefit through reduced activation of the erector spinae muscles and neither asymmetry of trunk posture nor lower extremity restriction influenced this effectiveness. Trunk exoskeletons/suits can reduce trunk muscle activation and understanding how characteristics of the trunk postures assumed impact these responses may help target tasks wherein these devices may be effective.

Real-Life Wheelchair Mobility Metrics from IMUs.

Daily wheelchair ambulation is seen as a risk factor for shoulder problems, which are prevalent in manual wheelchair users. To examine the long-term effect of shoulder load from daily wheelchair ambulation on shoulder problems, quantification is required in real-life settings. In this study, we describe and validate a comprehensive and unobtrusive methodology to derive clinically relevant wheelchair mobility metrics (WCMMs) from inertial measurement systems (IMUs) placed on the wheelchair frame and wheel in real-life settings. The set of WCMMs includes distance covered by the wheelchair, linear velocity of the wheelchair, number and duration of pushes, number and magnitude of turns and inclination of the wheelchair when on a slope. Data are collected from ten able-bodied participants, trained in wheelchair-related activities, who followed a 40 min course over the campus. The IMU-derived WCMMs are validated against accepted reference methods such as Smartwheel and video analysis. Intraclass correlation (ICC) is applied to test the reliability of the IMU method. IMU-derived push duration appeared to be less comparable with Smartwheel estimates, as it measures the effect of all energy applied to the wheelchair (including thorax and upper extremity movements), whereas the Smartwheel only measures forces and torques applied by the hand at the rim. All other WCMMs can be reliably estimated from real-life IMU data, with small errors and high ICCs, which opens the way to further examine real-life behavior in wheelchair ambulation with respect to shoulder loading. Moreover, WCMMs can be applied to other applications, including health tracking for individual interest or in therapy settings.

Venous thoracic outlet syndrome, as a pitfall for cardiac implantable electronic device implantations.

The subclavian vein is typically used in cardiovascular implantable electronic device (CIED) implantations. External stress on the subclavian vein can lead to lead-related complications. There are several causes of this stress, such as frequent upper extremity movements or external injury. Venous thoracic outlet syndrome (TOS) can also become the cause of external lead stress. However, the diagnosis of venous TOS can be challenging because subclavian venography can appear normal at first glance. We present a unique case of a device infection in a patient with venous TOS. A careful observation of the imaging studies is vital for diagnosing venous TOS and a leadless pacemaker implantation could be an alternative therapeutic option.

Human upper extremity motor cortex activity shows distinct oscillatory signatures for stereotyped arm and leg movements.

Stepping and arm swing are stereotyped movements that require coordination across multiple muscle groups. It is not known whether the encoding of these stereotyped movements in the human primary motor cortex is confined to the limbs' respective somatotopy. We recorded subdural electrocorticography activities from the hand/arm area in the primary motor cortex of 6 subjects undergoing deep brain stimulation surgery for essential tremor and Parkinson's disease who performed stepping (all patients) and arm swing (n = 3 patients) tasks. We show stepping-related low frequency oscillations over the arm area. Furthermore, we show that this oscillatory activity is separable, both in frequency and spatial domains, from gamma band activity changes that occur during arm swing. Our study contributes to the growing body of evidence that lower extremity movement may be more broadly represented in the motor cortex, and suggest that it may represent a way to coordinate stereotyped movements across the upper and lower extremities.

Objective Clinical Measurement Tools for Functional Evaluation of the Surgical Patient.

Following knee surgery, clinicians have traditionally used visually rated or time-based assessments of lower extremity movement quality to measure surgical outcomes, plan rehabilitation interventions, and measure success. These methods of assessment are prone to error and do not fully capture a patient's inefficient movement patterns post surgery. Further, currently available systems which objectively measure kinematics during these tasks are expensive and unidimensional. For these reasons, recent research has called for the development of objective and low-cost precision rehabilitation tools to improve clinical measurement of movement tasks. The purpose of this article is to highlight two such tools and their applications to knee surgery. The systems highlighted within this article are the Mizzou Point-of-Care Assessment System (MPASS) and the Mizzou Knee Arthrometer Testing System (MKATS). MPASS has demonstrated high levels of agreement with the gold-standard Vicon system in measuring kinematics during sit-to-stand (R > 0.71), lateral step-down (intraclass correlation coefficient [ICC] > 0.55, apart from ankle flexion), and drop vertical jump tasks (ICC > 0.62), as well as gait (R > 0.87). MKATS has been used to quantify differences in tibiofemoral motion between groups during lateral step-down, step-up-and-over, and step-up/step-down tasks. Objective measurement of clinical tasks using portable and inexpensive instruments, such as the MPASS and MKATS, can help clinicians identify inefficient movement patterns and asymmetries which may damage and wear down supporting structures within the knee and throughout the kinetic chain causing pain and discomfort. Identifying these issues can help clinicians to plan interventions and measure their progress at a lower cost than currently available systems. The MPASS and MKATS are useful tools which have many applications to knee surgery.