Extremity Function In Patients Research Articles

Upper extremity function and its relation with hand sensation and upper extremity strength in patients with multiple sclerosis

The purpose of this study was to investigate the relationships between the upper extremity functions, upper extremity strength and hand sensation in patients with Multiple Sclerosis (MS). Twenty-two patients with MS (mean age: 38.5 ± 8.31 years, median Expanded Disability Status Scale (EDSS): 2) and 10 healthy subjects were included. Upper extremity function was measured with the Nine-hole peg test, upper extremity strength (shoulder flexion-abduction, elbow flexion, pinch and grip) with hand-held dynamometer, hand grip dynamometer and manual pinch meter, threshold of light touch-pressure with Semmes-Weinstein monofilament, duration of vibration with 128-Hz frequency tuning fork, and distance of two-point discrimination with an aesthesiometer. Strength and functional level of the upper extremity, light touch-pressure, two-point discrimination, vibration sensations of the hand were lower in patients with MS compared with healthy controls (p < 0.05). Light touch-pressure sensation of thumb and index fingers, two-point discrimination of index finger and elbow flexion strength were found to be related with upper extremity function in patients with MS (p< 0.05). These results indicate that the hand sensation, upper extremity strength and function were affected in MS patients. Additionally upper extremity functions seem to be related with light touch-pressure and two-point discrimination sensations of the hand and elbow flexion strength. Upper extremity strengthening and sensorial training of the hand may contribute to the upper extremity function in patients with MS.

Effects of peripheral sensory nerve stimulation plus task-oriented training on upper extremity function in patients with subacute stroke: a pilot randomized crossover trial

To investigate the feasibility of peripheral sensory nerve stimulation combined with task-oriented training in patients with stroke during inpatient rehabilitation. A pilot randomized crossover trial. Two rehabilitation hospitals. Twenty-two patients with subacute stroke. Participants were randomly assigned to two groups and underwent two weeks of training in addition to conventional inpatient rehabilitation. The immediate group underwent peripheral sensory nerve stimulation combined with task-oriented training in the first week, followed by another week with task-oriented training alone. The delayed group underwent the same training in reverse order. Outcome measures were the level of fatigue and Wolf Motor Function Test. Patients were assessed at baseline, one and two weeks. All participants completed the study with no adverse events. There was no significant difference in level of fatigue between each treatment. From baseline to one week, the immediate group showed larger improvements than the delayed groups in the Wolf Motor Function Test (decrease in mean time (± SD) from 41.9 ± 16.2 seconds to 30.6 ± 11.4 seconds versus from 46.8 ± 19.4 seconds to 42.9 ± 14.7 seconds, respectively) but the difference did not reach significance after Bonferroni correction (P = 0.041). Within-group comparison showed significant improvements in the Wolf Motor Function Test mean time after the peripheral sensory nerve stimulation combined with task-oriented training periods in each group (P < 0.01). Peripheral sensory nerve stimulation is feasible in clinical settings and may enhance the effects of task-oriented training in patients with subacute stroke.

Postoperative Analysis of Patients Who Received the Universal 2 Total Wrist Implant System

Third-generation total wrist arthroplasty devices have provided joint stability, relief from pain and increased wrist motion for patients suffering from severe arthritis. While reports of clinical follow-up appointments describe improved wrist function, the improvement in overall upper extremity function and patient perception remains a question. Therefore, the purpose of this study was to assess the upper extremity function in patients that received the Universal 2 total implant system. Eight patients participated in the complete protocol, which included testing activities of daily living as well as surveys to assess patient perception. The findings of the current study suggest that although patients exhibit motion that exceeds the needed amount, many still have a perceived disability.

P12 Study of reliability of the box and block test for manual dexterity of upper extremity function in patients with rheumatoid arthritis

Our study contributes to the understanding of key drivers of stunted growth, a factor widely recognized as major impediment to human capital development. Specifically, we examine the effects of sanitation coverage and usage on child height for age in a semi-urban setting in Northern India. Although sanitation – broadly defined as hygienic means of promoting health through prevention of human contact with the hazards of wastes, particularly human waste – has long been acknowledged as an indispensable element of disease prevention and primary health care programmes, a large number of recent impact evaluation studies on sanitation interventions in low income countries fail to find any health improvements. We address endogeneity of sanitation coverage through an instrumental variable approach, exploiting variation in raw material construction prices. Doing so, we find that sanitation coverage plays a significant and positive role in height growth during the first years of life and that this causal relationship holds particularly for girls. Our findings suggest that a policy that aims to increase sanitation coverage in a context such as the one studied here, is not only effective in reducing child stunting but also implicitly targets girls.

A Modified Method for Constraint-induced Movement Therapy: A Supervised Self-training Protocol

Constraint-induced movement therapy (CI therapy) is a rehabilitation treatment that is effective for improving upper extremity function in patients with stroke hemiparesis. In standard protocols, the burdens are great on the patient, therapist, and in terms of health care costs, preventing the wider application of CI therapy. To address this, we developed a protocol based on self-training and examined its effects. Patients with chronic hemiparesis caused by a stroke (intracerebral hemorrhage or cerebral infarct) 180 days after disease onset were included in this study. We performed before and after comparisons after intervention. We assessed motor impairment in the shoulder, elbow, forearm, wrist, and hand with the Fugl-Meyer Assessment (FMA) and determined training tasks, taking into consideration the patient's primary complaint. We established direct supervision by the therapist and self-training to occupy 40% and 60% of the training period, respectively. With this protocol, training was conducted 5 hours per day for 10 consecutive weekdays. We assessed upper extremity function using the FMA, Wolf Motor Function Test (WMFT), and Motricity Index (MI) before and after intervention. There were 40 subjects. Before and after intervention, scores for the FMA upper extremity items, WMFT functional ability scale, WMFT performance times, and MI showed significant improvements, from 49.35 ± 10.1 (mean ± SD) to 52.88 ± 8.0 points, 3.48 ± 0.65 to 3.72 ± 0.67 points, 14.37 ± 13.22 to 10.58 ± 11.97 seconds, and 75.0 ± 12.0 to 77.7 ± 12.0 points, respectively. Our self-training-based CI therapy protocol is likely to be as effective for improving upper extremity function as the standard CI therapy. The method may contribute to the wider use of CI therapy.

편마비 환자의 재활운동치료를 위한 능동형 상지훈련시스템 개발

An active training system has been developed to assist the upper extremity function in patients with spasticity. We also evaluated the performance of the developed assistive system in five normal subjects and one hemiplegic patient. The maximum voluntary contraction (MVC) tests for biceps brachii and triceps brachii were performed and the relationship between linear enveloped EMG signal and the elbow joint torque was found. In order to implement an active training, our system was designed to allow isokinetic movement only when the subject generates elbow joint motion larger than the pre-fixed threshold level. The proposed EMG-feedback control method could provide active exercises, resulting in better rehabilitation protocol for spastic patients.

An Adaptive Automated Robotic Task-Practice System for Rehabilitation of Arm Functions After Stroke

We present a novel robotic task-practice system, i.e., adaptive and automatic presentation of tasks (ADAPT), which is designed to enhance the recovery of upper extremity functions in patients with stroke. We designed ADAPT in accordance with current training guidelines for stroke rehabilitation; ADAPT engages the patient intensively, actively, and adaptively in a variety of realistic functional tasks that require reaching and manipulation. A general-purpose robot simulates the dynamics of the functional tasks and presents these functional tasks to the patient. A novel tool-changing system enables ADAPT to automatically switch between the tools corresponding to the functional tasks. The control architecture of ADAPT is composed of three main components: a high-level task scheduler, a functional task model, and a low-level admittance controller. The high-level task scheduler adaptively selects the task to practice and sets the task difficulty based on the previous performance of the patients. The functional task model generates desired trajectories based on learned models of task dynamics. Tasks dynamics are modeled with receptive field weighted regression (RFWR), such that the feel of the task tools is accurately modeled, and the task difficulty can be easily adjusted. The low-level admittance controller <i xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">,</i> which is also learned with RFWR <i xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">,</i> implements the selected task trajectory for robot-patient interaction. The results of a preliminary experiment with a healthy subject demonstrate the successful operation of ADAPT.

The efficacy analysis of Deanxit in the treatment of post-stroke depression in shoulder-hand syndrome

目的 探讨黛力新治疗脑卒中后肩手综合征并发抑郁的疗效及其对患侧上肢功能恢复的作用.方法 对138例脑卒中后肩手综合征合并抑郁患者随机分为治疗组及对照组,常规治疗相同,治疗组采用黛力新治疗,对照组采用多塞平治疗,治疗前后采用汉密顿抑郁量表(HAMD)、抑郁自评量表(SDS)记录精神状态,用Fugl-Meyer量表和目测类比评分法(VHS)对患者上肢关节被动运动范围、上肢和腕关节的运动功能、疼痛及水肿程度并对比疗效.结果 经治疗28 d后两组对比,HAMD、SDS,评分及减分率比较差异有统计学意义(P＜0.05),抑郁的治疗愈率、显效率及有效以及患者上肢功能的恢复差异均有统计学意义(P＜0.05).结论 黛力新治疗脑卒中合并抑郁患者具有较好的疗效。

Telerehabilitation Using a Virtual Environment Improves Upper Extremity Function in Patients With Stroke

In this paper, we describe our experience in designing a virtual environment-based (VE) telerehabilitation system, and the results of a clinical study of the first 11 subjects with stroke to use the system. Our telerehabilitation system allows a therapist to conduct interactive VE treatment sessions remotely with a patient who is located at home. The system, software architecture, and development experience are described. Results of the clinical study on subjects with stroke showed significant improvements in upper extremity function following 30 1-h VE treatment sessions as measured by three standard clinical tests: Fugl-Meyer test of motor recovery (FM) (p < 0.0001), Wolf motor test (WMT) (p = 0.0097, and shoulder strength (ShS) (p = 0.0027). Grip strength (GS) showed a trend toward improvement (p = 0.025). These changes were maintained, for the most part, at four-months follow-up (FM +7.6, WMT -18.4 s, ShS, +169%, GS, +53%).

Restoration of Active Extension of Fore­arm in Patients with Cervical Spinal Cord Injury at C5-C6 Level

Surgical reconstruction of upper extremity function in patients with high tetraplegia is presented. Five patients with sequelae of cervical spinal cord injury at C5-C6 level were operated on. Seven reconstructive operations were performed. Surgery consists of m. biceps brachii transposition to m. triceps brachii through the medial end of the humerus. First clinical experience is discussed.

Screening for poor performance of lower extremity in primary care: the Camucia Project

Individuals with poor lower extremity performance are prime candidates for disability prevention. The Camucia Project is a collaborative study between geriatricians and primary care physicians (PCPs) testing the hypothesis that PCPs can use a simple performance-based test to identify older persons with poor lower extremity function, without excessive interference with their clinical routine. We also hypothesized that the number needed to screen (NNTS) a positive case would be lower in physicians' clinics than in the general population. 23 PCPs administered the short physical performance battery (SPPB) to 360 consecutive, non-disabled and non-demented, 70- to 79-year-old outpatients. PCPs were asked to: 1) evaluate the feasibility and usefulness of administering the SPPB; 2) ascertain selected diseases according to predefined criteria; 3) identify causes of poor lower extremity function in patients with a SPPB score < or =9. NNTS from this study were compared with those estimated in non-disabled and non-demented, 70- to 79-year-old persons randomly selected from the InCHIANTI study population. The majority of PCPs (20/23) reported that using the SPPB to evaluate older patients was feasible and useful. The NNTS in the outpatient clinics was lower than in the InCHIANTI participants (1.6 vs 4.3). Poor lower extremity performance was attributed to musculo-skeletal diseases in 75%, to more than one cause in 55% (128/234), and to no specific cause in 16.2% (37/234) of the participants with SPPB < or =9. Screening of older persons with poor lower extremity perfomance by PCPs is feasible and efficient.

The intra- and interrater reliability of the action research arm test: A practical test of upper extremity function in patients with stroke

van der Lee JH, de Groot V, Beckerman H, Wagenaar RC, Lankhorst GJ, Bouter LM. The intra- and interrater reliability of the Action Research Arm test: a practical test of upper extremity function in patients with stroke. Arch Phys Med Rehabil 2001;82:14-9. Objectives: To determine the intra- and interrater reliability of the Action Research Arm (ARA) test, to assess its ability to detect a minimal clinically important difference (MCID) of 5.7 points, and to identify less reliable test items. Design: Intrarater reliability of the sum scores and of individual items was assessed by comparing (1) the ratings of the laboratory measurements of 20 patients with the ratings of the same measurements recorded on videotape by the original rater, and (2) the repeated ratings of videotaped measurements by the same rater. Interrater reliability was assessed by comparing the ratings of the videotaped measurements of 2 raters. The resulting limits of agreement were compared with the MCID. Patients: Stratified sample, based on the intake ARA score, of 20 chronic stroke patients (median age, 62yr; median time since stroke onset, 3.6yr; mean intake ARA score, 29.2). Main Outcome Measures: Spearman's rank-order correlation coefficient (Spearman's rho); intraclass correlation coefficient (ICC); mean difference and limits of agreement, based on ARA sum scores; and weighted kappa, based on individual items. Results: All intra- and interrater Spearman's rho and ICC values were higher than.98. The mean difference between ratings was highest for the interrater pair (.75; 95% confidence interval,.02-1.48), suggesting a small systematic difference between raters. Intrarater limits of agreement were −1.66 to 2.26; interrater limits of agreement were −2.35 to 3.85. Median weighted kappas exceeded.92. Conclusion: The high intra- and interrater reliability of the ARA test was confirmed, as was its ability to detect a clinically relevant difference of 5.7 points. © 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

A quantitative test of upper extremity function

An evaluation of upper extremity function in patients with severe hand disabilities in terms of pinch, grasp, grip, elbow flexion and extension, forearm pronation and supination was performed and scored. Scores on this basic test correlated fairly well with scores on a conventional hand activities of daily living test. The test has sufficient reliability and consistency to measure improvement or deterioration in function when performed serially. Application of the test to a large number of nursing home type patients has shown that upper extremity activity is meaningless without knowledge of the patient's overall physical and mental functioning. The hand evaluation can be used in properly selected patients to determine what functions of the upper extremity are impaired and need treatment. It can also be used to measure changes in hand function with advancing disease, surgical or other treatment.