Extremity Active Range Of Motion Research Articles

Reachable workspace analysis is a potential measurement for impairment of the upper extremity in neuralgic amyotrophy.

Introduction/AimsNeuralgic amyotrophy (NA) is a multifocal neuropathy involving the nerves of the upper extremity, limiting functional capability and reducing range of motion. The reachable workspace (RWS) is a computerized three‐dimensinal analysis system that evaluates the relative surface area (RSA) of an individual's arm reachability and has shown utility in several neuromuscular disorders. The aims of this study were to examine the ability of the RWS to quantitatively detect limitations in upper extremity active range of motion in patients with NA, and correlate these with other upper extremity functional outcome measures.MethodsForty‐seven patients with NA and 25 healthy age‐ and sex‐matched controls were measured with the RWS. Study participants’ RSAs were correlated with scores on the Shoulder Rating Questionnaire (SRQ), the Disabilities of Arm Shoulder and Hand (DASH) questionnaire, and upper extremity strength measurements using hand‐held dynamometry.ResultsPatients with NA showed significantly lower values in the affected arm for all quadrants (except for the ipsilateral lower quadrant) and total RSA compared with controls (P < 0.001). We found moderate correlations between the reachable workspace, the DASH questionnaire result (r = −0.415), and serratus anterior muscle strength (r = 0.414).DiscussionRWS is able to detect limitations in active range of motion of the affected arm in patients with NA, and is moderately correlated with upper extremity functional measures. RWS can demonstrate impairment of the affected upper extremity in NA and it has potential as a clinical outcome measure.

Reliability and concurrent validity of Iphone®level application for measuring lower limb active flexion and extension range of motions in physical education students

Background and Study Aim. The aim of this study was to analyse reliability and validity of accelerometer-based Iphone® Level application for measuring lower extremity active flexion and extension joint range of motion. Material and Methods. Thirty physically healthy students enrolled in sport sciences (11 males, 19 females, 21.2±1.5 years, Body mass 64.4±10.0 kg, Height 1.68±0.8 m, Fat percentage 21.2±7.8 %, 22.5±2.6 kg/m2) participated in the measurements of hip, knee, and ankle joint range of motion twice through Universal goniometer and Iphone® Level applications. The same experienced measurer carried out blind study of plantarflexion, dorsiflexion and knee flexion/extension, hip flexion/extension joint range of motion three times for each measurement methods and the other researcher recorded the results. For simultaneous validity analysis Pearson coefficient of correlation was used to decide the level of adaptation between the two intraclass correlation coefficient and Cronbach’s alpha values. Bland-Altman graphics were utilized for level of agreement between these two different methods. Results. The results of Pearson coefficient of correlation analysis revealed a positive correlation between the measurement values of joint range of motion performed through Universal goniometer and Level App (r2 = 0.44-0.94, p &lt;0.05). Bland-Altman graphics showed a good agreement among Cronbach Alpha values and intraclass correlation coefficient in the confidence range of %95, and universal goniometers and Level App application. Conclusions. The results of this study revealed that goniometric measurements using Iphone® Level App is a good reliable method for measuring lower extremity active range of motion compared to universal goniometer.

Evaluation of admittance control as an alternative to passive arm supports to increase upper extremity function for individuals with Duchenne muscular dystrophy.

The degree of upper extremity active range of motion provided by an admittance control robot compared with a commercially available passive arm support for individuals with DMD who have limited arm function was investigated in this study. The reachable workspace evaluation was used to assess active range of motion provided by both devices. A visual analog scale was also used to secure participant-reported outcome measures. The admittance control robot significantly increased reachable surface area scores compared with the passive arm support for the dominant arm (Wilcoxon T = 5, P = .022, r2 = 0.263) and for the nondominant arm (paired-samples t test, t(9) = 4.66, P = .001, r2 = 0.71). The admittance control robot also significantly decreased participant-reported exertion compared with the passive arm support. Results of this study substantiated the benefits of admittance control for individuals with DMD compared with a commercially available passive arm support.

Usefulness of Kinect sensor-based reachable workspace system for assessing upper extremity dysfunction in breast cancer patients.

Recently, the utility of the Kinect sensor-based reachable workspace analysis system for measuring upper extremity outcomes of neuromuscular and musculoskeletal diseases has been demonstrated. Here, we investigated its usefulness for assessing upper extremity dysfunction in breast cancer patients. Twenty unilateral breast cancer patients were enrolled. Upper extremity active range of motion was captured by the Kinect sensor, and reachable workspace relative surface areas (RSAs) were obtained. The QuickDASH was completed to assess upper extremity disability. General and breast cancer-specific quality of life (QOL) were assessed by the EORTC QLQ-C30 and EORTC QLQ-BR23. The total RSA ratio of the affected and unaffected sides ranges from 0.64 to 1.11. Total RSA was significantly reduced on the affected versus unaffected side (0.659 ± 0.105 vs. 0.762 ± 0.065; p = 0.001). Quadrant 1 and 3 RSAs were significantly reduced (0.135 ± 0.039 vs. 0.183 ± 0.040, p < 0.001; 0.172 ± 0.058 vs. 0.217 ± 0.031, p = 0.006). Total RSA of the affected side was strongly correlated with the numeric pain rating scale during movement (r = - 0.812, p < 0.001) and moderately with the QuickDASH (r = - 0.494, p = 0.027). Further, quadrant 3 RSA was correlated with EORTC QLQ-C30 role functioning (r = 0.576, p = 0.008) and EORTC QLQ-BR23 arm symptoms (r = - 0.588, p = 0.006) scales. The Kinect sensor-based reachable workspace analysis system was effectively applied to assess upper extremity dysfunction in breast cancer patients. This system could potentially serve as a quick and simple outcome measure that provides quantitative data for breast cancer patients.

Relationships between lower-extremity flexibility, asymmetries, and the Y balance test.

Joint flexibility, bilateral asymmetries in flexibility, and bilateral asymmetries in performance of the Y Balance Test have been associated with injuries. However, relationships among these attributes are unclear. The goal of this investigation was to examine how flexibility and flexibility asymmetries relate to the Y Balance Test. Twenty healthy active young adults (9 men and 11 women; mean ± SD: age = 21.9 ± 2.6 years; height = 171 ± 8.8 cm; mass = 67.2 ± 1.9 kg) performed 9 different lower extremity active range of motion (AROM) tests and the Y Balance Test in a single visit. Significant correlations (p ≤ 0.05) existed between bilateral average AROM measures and bilateral average Y Balance Test scores at the ankle and hip. Specifically, ankle dorsiflexion AROM at 0° knee flexion significantly correlated with Anterior, Posterolateral, and Composite directional scores of the Y Balance Test (r = 0.497-0.736). Significant correlations in ankle dorsiflexion AROM at 90° knee flexion also existed with Anterior, Posterolateral, Posteromedial, and Composite directional scores (r = 0.472-0.795). Hip flexion AROM was significantly correlated with Posterolateral, Posteromedial, and Composite directional scores (r = 0.457-0.583). Significant correlations between asymmetries in AROM and asymmetries in the Y Balance Test existed only in ankle plantarflexion with Anterior, Posterolateral, and Composite directional scores of the Y Balance Test (r = 0.520-0.636). Results suggest that when used with recreationally active healthy adults, the Y Balance Test may help identify lower-extremity flexibility deficits and flexibility asymmetries in the ankle and hip regions but may need to be used in conjunction with additional tests to understand a broader picture of functional movement and injury risk.

Management of Bilateral Complex Regional Pain Syndrome in a Pediatric Patient

To describe the physical therapy management of a pediatric patient with bilateral lower extremity complex regional pain syndrome (CRPS). The participant was a 13-year-old adolescent girl who was admitted to an inpatient rehabilitation unit with bilateral lower extremity CRPS-I. Examination included assessment of lower extremity active range of motion, transfers, mobility, and completion of the Functional Independence Measure for Children (WeeFIM). Intervention consisted of gradual desensitization techniques, progressive weight bearing and mobility, functional transfer training, progressive strengthening, and cardiovascular exercises-all conducted using a modified pain exposure therapy approach. WeeFIM scores increased to modified independence or independent in all areas. The severity of the patient's CRPS necessitated a progressive and function-based approach to physical therapy management. Motivation, a pain exposure-based approach, and a multidisciplinary team approach appeared to affect the participant's recovery of function and reintegration into school and leisure activities.

Novel Kinect-Based Method to Assess 3D Reachable Workspace in Musculoskeletal Shoulder Dysfunctions: Case Reports

Objective: To demonstrate the feasibility and usefulness of applying Kinect sensor-based 3D reachable workspace assessment in four cases of musculoskeletal shoulder dysfunction. Methods: Reachable workspace assessments were performed using a Kinect sensor on 4 individuals with various shoulder dysfunctions (shoulder impingement syndrome, frozen shoulder, chronic shoulder dislocation, and post-surgical repair of supraspinatus tear). Upper extremity active range of motion was captured by the Kinect sensor and reconstructed to provide an intuitive graphical representation of each individual’s 3D reachable workspace. For tracking each individual’s progress during rehabilitation, both total and quadrant reachable workspace relative surface areas (RSA) were serially monitored over varying follow-up periods spanning 92 to 197 days. Results: The newly-developed Kinect sensor-based reachable workspace assessment was capable of measuring changes in ROM of individual’s with musculoskeletal shoulder dysfunctions over time, reflecting improvement in 3 out of 4 presented cases. Conclusion: The demonstration cases indicate that the newly-developed sensor-based 3D reachable workspace analysis could be beneficial in clinical evaluation and during rehabilitation of various upper extremity musculoskeletal conditions. The 3D reachable workspace analysis provides a more intuitive and useful quantitative global upper extremity functional outcome measure and a means to better engage the patients through visualization of individualized reachable workspace to track their progress during rehabilitation.

Upper extremity strength and range of motion and their relationship to function in breast cancer survivors

The impact upper extremity impairments (UE) have on UE function in breast cancer survivors (BCS) is unclear. The purpose of this study was to evaluate the associations between upper extremity active range of motion (AROM), passive range of motion (PROM), and strength with self-reported function in BCS. BCS (n = 24) completed the Disabilities of Arm, Shoulder and Hand (DASH) and the Pennsylvania Shoulder Score (PSS). AROM and PROM of shoulder flexion, extension, external rotation (ER) at 0° and 90° of abduction, and internal rotation (IR) at 90° of abduction were measured using a digital inclinometer. Strength was measured using a hand-held dynamometer for scapular abduction and upward rotation, scapular depression and adduction, flexion, IR, ER, scaption, and horizontal adduction. All constructs of AROM, PROM, and strength were correlated with the DASH and PSS. DASH was moderately to highly correlated with 2 of 5 AROM, 2 of 5 PROM, and 6 of 7 shoulder strength measures. PSS was moderately to highly correlated with 2 of 5 AROM, 2 of 5 PROM, and 4 of 7 shoulder strength measures. Regression analysis showed that AROM explained 40% of the DASH scores and strength explained 20% of scores on the PSS. This study characterizes the impact that shoulder motion, flexibility, and strength losses have on shoulder function in BCS. Deficits in AROM and shoulder strength explained the greatest proportion of shoulder disability. Future clinical trials should consider incorporating AROM and strengthening techniques to improve shoulder use after breast cancer treatments.

Outcomes Measure Reliability in Non Ambulatory Boys and Men with Duchenne Muscular Dystrophy (DMD): Results from the Muscular Dystrophy Association DMD Clinical Research Network (P04.085)

Objective: To establish optimal and reliable assessments in non-ambulatory boys and men with DMD. Background Therapeutic trials in DMD most often exclude non-ambulatory individuals and consensus has not been reached regarding which measures are most reliable and feasible. Design/Methods: Clinical evaluators(CEs) from the five MDA-DMD CRN sites were trained in all assessments. Ninety-three non-ambulatory boys/men with DMD who were not on continuous ventilation (mean age 16.8±3.6 years) were assessed twice(AM/PM) on one day with a battery of assessments. Reliability using intra-class correlation coefficients(ICCs) was determined by comparing AM and PM measures. Feasibility was determined by the percentage that could perform the task. Results: Forced Vital Capacity(FVC)(100% of subjects) showed mean FVC 47±23% predicted with an ICC of 0.97. Manual muscle testing was performed for shoulder abduction (88% of subjects; ICC=0.95), elbow flexion (96.8% of subjects; ICC=0.98), wrist flexion (70% of subjects; ICC=0.92) and wrist extension (96% of subjects; ICC=0.89). Hand Held myometrywas performed for supine elbow flexion (71% of subjects; ICC=0.93), supine elbow extension (70% of subjects; ICC=0.94), grip (97% of subject; 0.92), pinch grip(95% of subjects; ICC=0.84), and key grip (99% of subjects; ICC=0.93). Upper extremity active range of motion(ROM) ICCs ranged from 0.89-0.99 and passive ROM ranged from 0.71 to 0.97. Nine-hole peg was performed in 77% of subjects with ICC ranging from 0.96-0.97 for dominant and non-dominant hands. Brooke upper extremity scale was performed on 100% of subjects with an ICC=0.99. Egen Klassifikation(EK) scale was performed in 100% of subjects with ICCs on individual questions ranging from 0.93 to 0.99. Jebsen-Taylor Hand Function test was performed in 84% of subjects with ICCs of individual tasks ranging from 0.64 to 0.98. Conclusions: This study demonstrates excellent reliability across most measures with well-trained CEs from five centers. Ongoing studies will test sensitivity to change across time. Supported by: Muscular Dystrophy Association. Disclosure: Dr. Florence has received personal compensation for activities with GlaxoSmithKline, Inc./Prosena and DART Therapeutics as a consultant. Dr. Connolly has received personal compensation for activities with Halo Therapeutics. Dr. Connolly has received research support from PTC Therapeutics. Dr. Miller has nothing to disclose. Dr. Malkus has nothing to disclose. Dr. Schierbecker has nothing to disclose. Dr. Siener has nothing to disclose. Dr. Wulf has nothing to disclose. Dr. Anand has nothing to disclose. Dr. McDonald has received personal compensation for activities with AVI BioPharma, and PTC Therapeutics. Dr. Goude has nothing to disclose. Dr. Johnson has nothing to disclose. Dr. Nicorici has nothing to disclose. Dr. Day has nothing to disclose. Dr. Karachunski has nothing to disclose. Dr. Dalton has nothing to disclose. Dr. Kelecic has nothing to disclose. Dr. Paulson has nothing to disclose. Dr. Naughton has nothing to disclose. Dr. Lowes has nothing to disclose. Dr. Alfano has nothing to disclose. Dr. Viollet has nothing to disclose. Dr. Flanigan has received personal compensaiton for activities with AVI Therapeutics, Prosensa Therapeutics, and PTC, Inc. Dr. Flanigan has received research support from PTC Therapeutics. Dr. Mendell has received research support from AVI BioPharmaceuticals Inc. Dr. Darras has received personal compensation for activities with UpToDate, Inc., Isis Pharmaceuticals, Inc, and Athena Diagnostics as a consultant.Dr. Darras has received research support from PTC Therapeutics, Inc. Dr. Quigley has nothing to disclose. Dr. Pasternak has nothing to disclose. Dr. Shriber has nothing to disclose. Dr. Parad has nothing to disclose. Dr. Cwik has nothing to disclose.

Active range of motion predicts upper extremity function 3 months after stroke.

After stroke, 80% of patients experience acute paresis of the upper extremity and only approximately one-third achieve full functional recovery. Predicting functional recovery for these patients is highly important to provide focused, cost-effective rehabilitation. Our purpose was to examine if early measures of upper extremity active range of motion (AROM) could predict recovery of upper extremity function, and to describe the trajectory of upper extremity AROM recovery over time. Thirty-three subjects were tested at 1 month and then at 3 months after stroke. Upper extremity function was measured with 6 standardized clinical tests that were synthesized into a single, sensitive score for upper extremity function using principal component analysis. The ability to move each segment (AROM) was measured using a 3-dimensional electromagnetic tracking system. Stepwise multiple regression revealed that AROM of the shoulder and middle finger segments taken at 1 month could predict 71% of the variance in upper extremity function at 3 months. All segments of the upper extremity recover similarly and no evidence of a proximal to distal gradient in motor deficits appeared over time. Simple AROM measurements of the upper extremity taken within 1 month after stroke can be used to predict upper extremity function at 3 months. This information is important for determining the prognosis of upper extremity functional recovery.

The effects of electronic music‐making as a therapeutic activity for improving upper extremity active range of motion

AbstractThe use of occupation to enhance function has been the major principle of the occupational therapy profession. Literature shows that added‐purpose occupations elicit better sensorimotor performance than single‐purpose and rote exercise conditions. Added‐purpose conditions also enhance the motivation and the participation level of individuals. This study examined music‐making activity as a form of occupational embedded exercise to evaluate its effect on improving active shoulder flexion and elbow extension in individuals with hemiplegia. A pre‐test–post‐test control group design involving 10 participants each in experimental and control groups was used. Results showed no statistically significant improvements in shoulder flexion and elbow extension between the experimental and control groups. However, the intervention showed clinical significance in the form of a considerable increase in active shoulder and elbow range in the experimental group. The small sample size and lack of data on control group participants' degree of immobility and other activities might have influenced the study results. Further studies evaluating activities of daily living, work and leisure occupations and their effect on various sensorimotor components are recommended. Also, a larger sample could reduce the probability of a type II error. The results of this study support the occupational therapy principle of preventing disability, improving human performance and maintaining health through meaningful occupation. It also adds accountability to our services by way of showing the efficacy of our treatment. Copyright © 1998 Whurr Publishers Ltd.

Limited joint mobility in adults with diabetes mellitus.

Limited joint mobility (LJM) has been identified as a manifestation of diabetes in some children; this study assessed whether LJM is a phenomenon that also affects persons with adult-onset diabetes mellitus (DM). For the purpose of this study, I defined LJM as limitation in at least two anatomical areas of the right upper extremity. I studied 19 right-handed men (10 without DM, 9 with adult-onset DM) aged 53 to 70 years. The right upper extremity active range of motion of eight motions was evaluated, as was the ability to flatten the hand fully. Intrarater reliability of the results of testing the ROM of six subjects on three occasions was calculated to have an average intraclass correlation coefficient of .98. Student's t-test results showed that the patients with DM had significantly less (p less than .05) ROM in their fingers and in shoulder abduction than the age-matched controls, suggesting that some adults with DM do have LJM. If the limitations are major, progressive, or symptomatic, physical therapy would be indicated to maintain ROM, to minimize pain, and to help the patient to be functionally independent. The results of this study suggest that physical therapists should be aware of the need to address LJM when treating patients with DM. For prophylactic treatment, patients with DM could be instructed routinely in ROM exercises.