Extremity Impairment Research Articles

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.

Innovations in Sports: A Key to Enhancing Rehabilitation Outcomes

Introduction and purpose: Traditional rehabilitation methods often have limitations in improving motor function and cognitive abilities. This review aims to provide an updated overview of innovative methods in rehabilitation, focusing on the role of immersive and interactive technologies in enhancing rehabilitation outcomes. The literature suggests that these technologies can improve upper limb mobility, grip strength, and manual dexterity, as well as cognitive function, attention, and spatial awareness. Additionally, innovative balance and gait rehabilitation programs have been shown to improve functional mobility and reduce the risk of falls. The use of these technologies in combination with other rehabilitation modalities, such as electrostimulation and robotic assistance, may lead to even greater improvements in motor function and cognitive abilities. While more research is needed to fully understand the benefits and limitations of these innovative approaches, the existing evidence suggests that they have the potential to revolutionize rehabilitation and improve quality of life for patients. Materials and Methods: A literature review was conducted using PubMed with search phrases immersive and interactive technologies and rehabilitation. Description of the state of knowledge: Traditional rehabilitation methods often have limitations in improving motor function and cognitive abilities.Upper extremity impairment is a common and debilitating consequence of stroke. Summary: imersive and interactive technologies have the potential to improve upper limb mobility, grip strength, and manual dexterity, as well as cognitive function, attention, and spatial awareness. Innovative balance and gait rehabilitation programs have been shown to improve functional mobility and reduce the risk of falls. The use of these technologies in combination with other rehabilitation modalities may lead to even greater improvements in motor function and cognitive abilities.

Differences in motor network reorganization between patients with good and poor upper extremity impairment outcomes after stroke.

Changes in cortical excitability after stroke are closely associated with motor function recovery. This study aimed to clarify the motor network reorganization mechanisms corresponding to the different clinical outcomes of upper limb motor impairment in patients with subacute stroke. Motor function was assessed before rehabilitation (pre), after rehabilitation (post), and at the 1-year follow-up (follow-up) using the Fugl-Meyer assessment upper extremity scale. Further, resting-state functional magnetic resonance imaging (fMRI) data were collected in both pre- and post-conditions. Twenty patients with stroke were categorized into good and poor outcome groups based on motor impairments at the 1-year follow-up. Functional connections between motor-related regions of interest and the rest of the brain were subsequently calculated. Finally, the correlation between motor network reorganization and behavioral improvement at the 1-year follow-up was analyzed. The good outcome group exhibited a positive precondition motor function and continuous improvement, whereas the poor outcome group showed a weak precondition motor function and insignificant improvement. Contralesional hemisphere-related connections were found to be higher in the good outcome group pre-conditioning, with both groups showing minimal change post-conditioning, while no relationship with motor impairment was found. Long interhemispheric connections were decreased and increased in the good and poor outcome groups respectively, and were negatively correlated with motor impairment. Different motor network reorganizations during the subacute phase can influence the varying motor outcomes in the affected upper limb after stroke. These findings may serve as the theoretical basis for future neuromodulatory research.

Clinical and genetic features of CMT2T in Italian patients confirm the importance of MME pathogenic variants in idiopathic, late‐onset axonal neuropathies

AbstractBackground and AimsSince 2016, biallelic mutations in the membrane metalloendopeptidase (MME) gene have been associated with late‐onset recessive CMT2 (CMT2T). More recently, heterozygous mutations have also been identified in familial and sporadic patients with late‐onset axonal neuropathy, ranging from subclinical to severe. This indicates that the heterozygous MME variants may not be fully penetrant, or alternatively, that they may be a potential risk factor for neuropathy. Here, we describe the clinical, neurophysiological, and genetic findings of 32 CM2T Italian patients.MethodsThe patients were recruited from four different Italian referral centers. Following a comprehensive battery of neurological, electrophysiological, and laboratory examinations, the patients' DNA was subjected to sequencing in order to identify any variants in the gene. Bioinformatic and modeling analyses were performed to evaluate the identified variants' effects.ResultsWe observe a relatively mild axonal sensory‐motor neuropathy with a greater impairment of the lower extremities. Biallelic and monoallelic patients exhibit comparable disease severity, with an earlier onset observed in those with biallelic variants. When considering a subgroup with more than 10 years of disease, it becomes evident that biallelic patients exhibit a more severe form of neuropathy. This suggests that they are more prone to quick progression.InterpretationCM2T has been definitively defined as a late‐onset neuropathy, with a typical onset in the fifth to sixth decades of life and a more rapidly progressing worsening for biallelic patients. CMT2T can be included in the neuropathies of the elderly, particularly if MME variants heterozygous patients are included.

Realizing computer vision rehabilitation assessment tests & evaluation applications for mobile devices

Upper extremity impairments are a common consequence of stroke, necessitating thorough rehabilitation monitoring and kinematic assessments to facilitate motor recovery. The Box and Block Test (BBT) and Sollerman Hand Function Test (SHFT) are two widely utilized and recommended tools for objectively measuring upper limb dexterity and evaluating fine motor skill rehabilitation in patients. However, these tests rely on specific equipment and therapist attendance, making the process time-consuming and clinic-dependent. This paper introduces a computer vision-based hand rehabilitation assessment suite specifically designed for mobile devices, such as smartphones and tablets, which serves as a virtual alternative to traditional methods while also incorporating an interactive exergame. Our application faithfully integrates the original tests’ guidelines and procedures into an engaging computer vision experience, utilizing advanced technologies like MediaPipe Hands for precise hand and finger tracking. This innovative solution obviates the need for additional computer peripherals such as smart gloves or VR headsets, as well as physical equipment like wooden boxes and blocks, relying solely on the built-in camera of everyday mobile devices. In addition, we address several technical challenges encountered in our approach and outline future directions for score normalization and feature expansion, ensuring the continued improvement and efficacy of our hand rehabilitation assessment suite.

Osteopathic treatment of a person with Arnold-Chiari malformation and Syringomyelia: A case report

We present the case of a symptomatic patient diagnosed with Arnold Chiari I malformation (ACI) and Syringomyelia (S) who evolves favorably through an initial osteopathic treatment plan lasting 6 months and osteopathic maintenance treatment up to 36 months. The objectives of the treatment were to reduce pain and increase mobility of the shoulders and Scapular waist/Shoulder/Elbow/Wrist with a secondary objective to improve balance and coordination.After the administration of 32 sessions of Osteopathic Manipulative Treatment (OMT) started in August 2020, applying an initial treatment plan of 6 sessions monthly the patient was asymptomatic with remission of pain and increased mobility in the shoulders and cervical spine and a normal neurological examination (including normal gait).The main symptoms and relevant clinical findings were: functional impairment of the upper extremities that limited activities of daily living (ADLs) requiring assistance, headaches, cervical and dorsal spine pain in bilateral belt at T6 level, vertiginous sensation and gait instability. The patient was diagnosed with ACI and Syringomyelia in 2012. She received surgical and pharmacological treatment without clinical improvement and performed relaxation and breathing exercises on her own.We present evidence of the beneficial effect of osteopathic treatment on the associated symptomatology in a case of ACI and Syringomyelia.

Combining Cyproheptadine Hydrochloride With Targeted Muscle Activation Training to Treat Upper Extremity Stroke: A Randomized, Placebo-Controlled Trial

ObjectiveTo examine a treatment for upper extremity impairment in stroke survivors that combines administration of cyproheptadine hydrochloride with repetitive practice focused on control of muscle activation patterns. DesignDouble-blind, randomized controlled trial. SettingsLaboratory within a free-standing rehabilitation hospital. ParticipantsA total of 94 stroke survivors with severe, chronic hand impairment were randomly assigned to 1 of 4 treatment groups. InterventionsParticipants received either a placebo or cyproheptadine hydrochloride in identical pill form. The daily dosage of cyproheptadine/placebo was gradually increased from 8 to 24 mg/d over 3 weeks and then maintained over the next 6 weeks while participants completed 18 therapy sessions. Therapy consisted of either (1) active practice of muscle activation patterns to play “serious” computer games or control a custom hand exoskeleton or (2) passive, cyclical finger stretching imposed by the exoskeleton. Main Outcome MeasuresHand control was evaluated with the primary outcome measure of time to complete the Graded Wolf Motor Function Test (GWMFT) and secondary outcome measures including finger strength and spasticity. ResultsAcross the 88 participants who completed the study, a repeated-measures analysis of variance revealed a significant effect of GroupxEvaluation interaction on GWMFT (F=1.996, P=.026). The 3 groups receiving cyproheptadine and/or actively practicing muscle activation pattern control exhibited significant reduction in mean time to complete the GWMFT tasks; roughly one-third of these participants experienced at least a 10% reduction in completion time. Gains were maintained at the 1-month follow-up evaluation. The group receiving placebo and passive stretching did not show improvement. No significant differences among groups were observed in terms of changes in strength or spasticity. ConclusionsDespite chronic, severe impairment, stroke survivors were able to complete the therapy focused on muscle activations and achieved statistically significant improvement in hand motor control. Cyproheptadine hydrochloride is a potential complementary treatment modality for stroke survivors with hand impairment.

Risk Factors for Upper Extremity Impairment after Mastectomy: A Single Institution Retrospective Review.

Patients with breast cancer treated with mastectomy are more likely to develop upper extremity dysfunction compared with those treated with breast-conserving therapy. This study aimed to identify cancer and treatment characteristics that may be risk factors for development of upper extremity dysfunction in patients treated with mastectomy. The authors performed a retrospective chart review of patients at the University of Chicago who were treated with a unilateral or bilateral mastectomy from 2010 to 2020 and developed upper extremity dysfunction based on International Classification of Disease-10 codes. Patients were analyzed by side of body (left or right). Patient demographics and treatment characteristics were extracted from the electronic medical record. In total, 259 patients met criteria and were included in our study. A total of 396 upper extremities were recorded as experiencing dysfunction and were analyzed. Mean age was 60 years (range = 28-96), and mean body mass index was 28.4 (SD = 7.5). An estimated 54% of patients underwent breast reconstruction. After multivariable analysis, chronic upper extremity pain was found to be associated with ipsilateral radiotherapy (P < 0.001) and ipsilateral in situ cancer (0.041). Limited range of motion was found to be associated with ipsilateral invasive cancer (P = 0.01), any ipsilateral mastectomy surgery (P < 0.001), and ipsilateral radiotherapy (P = 0.03). Musculoskeletal dysfunction was found to be associated with no ipsilateral modified radical mastectomy (P = 0.033). No oncological or treatment characteristics were found to be associated with decreased strength or adhesive capsulitis. Furthermore, breast reconstruction (implant or autologous tissue based) was not associated with upper extremity dysfunction. Breast cancer characteristics and treatment modalities may predispose patients treated with mastectomy to developing types of upper extremity dysfunction.

Non-invasive Transcutaneous Spinal Cord Stimulation Programming Recommendations for the Treatment of Upper Extremity Impairment in Tetraplegia

ObjectivesThis study analyzes the stimulation parameters implemented during two successful trials that used non-invasive transcutaneous spinal cord stimulation (tSCS) to effectively improve upper extremity function after chronic spinal cord injury (SCI). It proposes a framework to guide stimulation programming decisions for the successful translation of these techniques into the clinic. Materials and MethodsProgramming data from 60 participants who completed the Up-LIFT trial and from 17 participants who subsequently completed the LIFT Home trial were analyzed. All observations of stimulation amplitudes, frequencies, waveforms, and electrode configurations were examined. The incidence of adverse events and relatedness to stimulation parameters is reported. A comparison of parameter usage across the American Spinal Injury Association Impairment Scale (AIS) subgroups was conducted to evaluate stimulation strategies across participants with varying degrees of sensorimotor preservation. ResultsActive (cathodal) electrodes were typically placed between the C3/C4 and C6/C7 spinous processes. Most sessions featured return (anodal) electrodes positioned bilaterally over the anterior superior iliac spine, although clavicular placement was frequently used by 12 participants. Stimulation was delivered with a 10-kHz carrier frequency and typically a 30-Hz burst frequency. Biphasic waveforms were used in 83% of sessions. Average stimulation amplitudes were higher for biphasic waveforms. The AIS B subgroup required significantly higher amplitudes than did the AIS C and D subgroups. Device-related adverse events were infrequent, and not correlated with specific waveforms or amplitudes. Within the home setting, participants maintained their current amplitudes within 1% of the preset values. The suggested stimulation programming framework dictates the following hierarchical order of parameter adjustments: current amplitude, waveform type, active/return electrode positioning, and burst frequency, guided by clinical observations as required. ConclusionsThis analysis summarizes effective stimulation parameters from the trials and provides a decision-making framework for clinical implementation of tSCS for upper extremity functional restoration after SCI. The parameters are aligned with existing literature and proved safe and well tolerated by participants.

Feasibility and efficacy of virtual reality rehabilitation compared with conventional physiotherapy for upper extremity impairment due to ischaemic stroke: protocol for a randomised controlled trial

IntroductionApproximately half of all stroke survivors have persistent upper extremity functional impairment, leading to reduced self-care, independence and quality of life. High-intensity, task-oriented virtual reality rehabilitation improves motor recovery. However,...

Effectiveness of Intermittent Theta Burst Stimulation to Enhance Upper Extremity Recovery After Stroke: A Pilot Study

ObjectivesTo first investigate the effectiveness of modified constraint-ınduced movement therapy (mCIMT) in low-functioning patients with stroke (PwS). Second, we aimed to investigate the efficiency of intermittent theta-burst stimulation (iTBS), applied on intermittent days, in addition to the mCIMT in PwS. DesignA randomized, sham-controlled, single-blinded study. SettingOutpatient clinic. ParticipantsFifteen PwS (age [mean±SD]: 66.3±9.2 years; 53% female) who were in the first 1 to 12 months after the incident were included in the study. InterventionsPwS were divided into 3 groups: (1) mCIMT alone; (2) mCIMT + sham iTBS; (3) mCIMT + iTBS. Each group received 15 sessions of mCIMT (1 hour/session, 3 sessions/week). iTBS was applied with 600 pulses on impaired M1 before mCIMT. Main Outcome MeasuresUpper extremity (UE) impairment was assessed with the Fugl-Meyer Test (FMT-UE), whereas the motor function was evaluated with the Wolf-Motor Function Test (WMFT). Motor Activity Log-28 (MAL-28) was used to evaluate the amount of use and how well (How Well Scale) the impaired UE movements. ResultsWith-in-group analysis revealed that all groups had statistically significant improvements based on the FMT-UE and MAL-28 (p<.05). However, the performance time and arm strength variables of WMFT were only increased in the mCIMT + iTBS group (p<.05). The only between-group difference was observed in the intracortical facilitation in favor of the mCIMT + iTBS group (p<.05). The effect size of iTBS was f=0.18. ConclusionsOur findings suggest that mCIMT with and without the application of iTBS has increased the UE motor function in low-functioning PwS. iTBS applied on intermittent days may have additional benefits as an adjunct therapy for facilitating cortical excitability, increasing the speed and strength of the impaired UE as well as decreasing disability.

Gamma oscillations induced by 40-Hz visual-auditory stimulation for the treatment of acute-phase limb motor rehabilitation after stroke: study protocol for a prospective randomized controlled trial

BackgroundThe incidence of hemiparetic limb dysfunction reaches 85% in stroke patients, emerging as a critical factor influencing their daily lives. However, the effectiveness of current rehabilitation treatments is considerably limited, particularly in patients with upper extremity impairment. This study aims to conduct a prospective clinical trial to validate the safety and effectiveness of gamma oscillations induced by 40-Hz visual-auditory stimulation in treating post-stroke upper limb dysfunction and to explore the relevant mechanisms.MethodsThis trial is a prospective, randomized controlled, double-blind study. All enrolled patients were randomly assigned to two groups. The experimental group received intervention through 40-Hz visual-auditory stimulation, while the control group underwent intervention with randomly matched visual-auditory stimulation frequencies. The primary efficacy endpoint is the change in motor function. Secondary efficacy endpoints include motor-evoked potentials, cerebral hemodynamic changes, neural network connectivity, and alterations in synaptic-related genes. Safety evaluation included major adverse events, all-cause mortality, and photosensitive epilepsy. Assessments will be conducted at baseline, after a 14-day treatment period, and during subsequent follow-up visits (at 3 and 6 months) post-treatment. The differences between the two groups will be compared.DiscussionThis study will evaluate the safety and efficacy of gamma oscillations induced by 40-Hz visual-auditory stimulation in treating patients with upper extremity dysfunction after an acute cerebral stroke. Concurrently, we will explore potential mechanisms, including changes in synaptic-related genes and neural network connectivity. This trial is expected to provide evidence for the effectiveness of this new technique in treating upper extremity dysfunction after a stroke and improving patients’ quality of life.Trial registrationThe study protocol has been registered with the Chinese Clinical Trial Registry (ChiCTR) under registration number ChiCTR2300076579 on October 12, 2023.

Effect of Constraint-Induced Movement Therapy (CIMT) on Upper Extremity Function in Stroke Patients

Background: Stroke is a leading cause of disability worldwide, with upper extremity impairments presenting significant rehabilitation challenges. Constraint-Induced Movement Therapy (CIMT) has emerged as a potential intervention for enhancing upper limb functionality, but its efficacy compared to traditional therapy methods requires further exploration. Objective: The study aimed to evaluate the effectiveness of CIMT versus traditional therapy in improving upper extremity function among stroke survivors. Methods: In this quasi-experimental study, 58 stroke patients from Aziz Fatima and Allied Hospital in Faisalabad were recruited and allocated to either the CIMT group (n=29) or the traditional therapy group (n=29). Eligible participants were those aged 30-50 years with ischemic or infarctive stroke and impaired use of their hemiparetic arm. The CIMT group received standard treatment plus CIMT, while the traditional group received only standard treatment, including manual therapy and TENS, for 8 weeks. Pre- and post-treatment assessments utilized the Upper Extremity Motor Activity Log (UEMAL) scales. Data analysis was conducted using SPSS version 25, employing independent t-tests. Results: The CIMT group showed a significant improvement in the UEMAL Amount Scale (pre-treatment: 1.64 ± 0.51, post-treatment: 3.04 ± 0.75; p=0.000) and the UEMAL How Well Scale (pre-treatment: 2.28 ± 0.57, post-treatment: 3.81 ± 0.55; p=0.000). The traditional therapy group also demonstrated gains but to a lesser extent (UEMAL Amount Scale pre-treatment: 1.08 ± 0.24, post-treatment: 1.69 ± 0.33; UEMAL How Well Scale pre-treatment: 1.47 ± 0.30, post-treatment: 2.11 ± 0.40; p=0.000 for both). Conclusion: CIMT provided significant functional improvements in upper extremity motor activity compared to traditional therapy, suggesting that CIMT may be a more effective approach for post-stroke rehabilitation of the upper limb.

Smartwatch-based functional assessment for upper extremity impairment after musculoskeletal injuries: A pilot study.

Wearable sensors are increasingly applied to rehabilitation for arm movement analysis. However, simple and clinically relevant applications are scarce. To investigate the feasibility of single smart watch-based parameters for functional assessment in upper limb rehabilitation for musculoskeletal injuries using a commercial smart watch. Ten patients with unilateral shoulder pain and range-of-motion limitations were enrolled. They wore Galaxy Watch® and performed three sets of upper extremity tasks consisting of gross activities-of-daily-living tasks, Wolf Motor Function Test (WMFT), and Upper Extremity Functional Index (UEFI), and the acceleration and angular velocities were acquired. The motion segment size (MSS), representing motion smoothness from a clinical perspective, and various sensor-based parameters were extracted. The correlation between the parameters and clinical outcome measures were analyzed. The percent relative range (PRR) of the significant parameters was also calculated. For overhead and behind body activity task set, mean MSS for elbow flexion/extension axis significantly correlated with WMFT score (R = 0.784, p = .012). For planar tasks, mean MSS for the forearm supination/pronation (R = 0.815, p = .007) and shoulder rotation (R = 0.870, p = .002) axes significantly correlated with WMFT score. For forearm and fine movement task set, mean MSS of the elbow flexion/extension angle showed significant correlation with WMFT (R = 0.880, p < .001) and UEFI (R = 0.718, p = .019). The total performance time (R = -0.741, p = .014) also showed significant correlation with WMFT score. The PRR for mean MSS in forearm supination (71.5%, planar tasks) and mean MSS in x-direction (49.8%, forearm and fine motor movements) were similar to the PRR of WMFT (58.5%), suggesting sufficient variation range across different degree of impairments. The commercial smart watch-based parameters showed consistent potential for use in clinical functional assessments.

A3C: An Image-Association-Based Computing Device Authentication Framework for People with Upper Extremity Impairments

Current computing device authentication often presents accessibility barriers for people with upper extremity impairments (UEI). In this paper, we present a framework called Accessible image-Association-based Authentication for Computing-devices (A3C) , a novel recognition-based graphical authentication framework specifically designed for people with UEI to authenticate to their computing devices. A3C requires users to provide a set of primary images that the user knows that are recognizable to them and subsequently associate each primary image with a secondary image. To evaluate the efficacy of the A3C framework, we instantiated the framework by implementing a version of A3C called A3C-FA , which uses images of faces of people the user knows as the primary image and animal images as the secondary image. We then performed three studies to evaluate A3C-FA: a shoulder-surfing attack study ( N=319 ), a close-adversary attack study ( N=268 ), and a usability study with people with UEI ( N=14 ). We found that A3C was robust against both shoulder-surfing and close-adversary attacks. We also performed a detailed study to evaluate the accessibility of A3C-FA. Our participants reported that A3C-FA was more usable and more secure than the authentication approaches with which they were familiar. Based on these findings, we suggest four areas of future research to further improve the design of A3C framework.

Tackling Post-COVID-19 Rehabilitation Challenges: A Pilot Clinical Trial Investigating the Role of Robotic-Assisted Hand Rehabilitation.

Background: Prolonged hospitalization in severe COVID-19 cases can lead to substantial muscle loss and functional deterioration. While rehabilitation is essential, conventional approaches face capacity challenges. Therefore, evaluating the effectiveness of robotic-assisted rehabilitation for patients with post-COVID-19 fatigue syndrome to enhance both motor function and overall recovery holds paramount significance. Our objective is to assess the effectiveness of rehabilitation in post-COVID-19 patients with upper extremity impairment through the utilization of a hand exoskeleton-based robotic system. Methods: A total of 13 participants experiencing acute or limited functional or strength impairment in an upper extremity due to COVID-19 were enrolled in the study. A structured intervention consisted of 45 min therapy sessions, conducted four times per week over a six-week period, utilizing a hand exoskeleton. The research employed standardized health assessments, motion analysis, and semi-structured interviews for pre-intervention and follow-up evaluations. Paired sample t-tests were employed to statistically analyze the outcomes. Results: The outcomes showed a reduction in overall dependence levels across participants, positive changes in various quality of life-related measurements, and an average increase of 60.4 ± 25.7% and 28.7 ± 11.2% for passive and active flexion, respectively. Conclusions: Our data suggest that hand exoskeleton-based robotic systems hold promise to optimize the rehabilitation outcomes following severe COVID-19. Trial registration: ID NCT06137716 at ClinicalTrials.gov.

Responsiveness to exoskeleton loading during bimanual reaching is associated with corticospinal tract integrity in stroke.

Device-based rehabilitation of upper extremity impairment following stroke often employs one-sized-fits-all approaches that do not account for individual differences in patient characteristics. Determine if corticospinal tract lesion load could explain individual differences in the responsiveness to exoskeleton loading of the arms in chronic stroke participants. Fourteen stroke participants performed a bimanual shared cursor reaching task in virtual reality while exoskeletons decreased the effective weight of the more-impaired arm and increased the effective weight of the less-impaired arm. We calculated the change in relative displacement between the arms (RC) and the change in relative muscle activity (MC) between the arms from the biceps and deltoids. We calculated corticospinal tract lesion load (wCSTLL) in a subset of 10 participants. Exoskeleton loading did not change RC (p = 0.07) or MC (p = 0.47) at the group level, but significant individual differences emerged. Participants with little overlap between the lesion and corticospinal tract responded to loading by decreasing muscle activity in the more-impaired arm relative to the less-impaired arm. The change in deltoid MC was associated with smaller wCSTLL (R2 = 0.43, p = 0.039); there was no such relationship for biceps MC (R2 < 0.001, p = 0.98). Here we provide evidence that corticospinal tract integrity is a critical feature that determines one's ability to respond to upper extremity exoskeleton loading. Our work contributes to the development of personalized device-based interventions that would allow clinicians and researchers to titrate constraint levels during bimanual activities.

Wearable Sensor to Monitor Quality of Upper Limb Task Practice for Stroke Survivors at Home.

Many stroke survivors experience persistent upper extremity impairment that limits performance in activities of daily living. Upper limb recovery requires high repetitions of task-specific practice. Stroke survivors are often prescribed task practices at home to supplement rehabilitation therapy. A poor quality of task practices, such as the use of compensatory movement patterns, results in maladaptive neuroplasticity and suboptimal motor recovery. There currently lacks a tool for the remote monitoring of movement quality of stroke survivors' task practices at home. The objective of this study was to evaluate the feasibility of classifying movement quality at home using a wearable IMU. Nineteen stroke survivors wore an IMU sensor on the paretic wrist and performed four functional upper limb tasks in the lab and later at home while videorecording themselves. The lab data served as reference data to classify home movement quality using dynamic time warping. Incorrect and correct movement quality was labeled by a therapist. The home task practice movement quality was classified with an accuracy of 92% and F1 score of 0.95 for all tasks combined. Movement types contributing to misclassification were further investigated. The results support the feasibility of a home movement quality monitoring system to assist with upper limb rehabilitation post stroke.

Effects of 1-hour computer use on ulnar and median nerve conduction velocity and muscle activity in office workers.

To compare the effects of 1-hour computer use on ulnar and median nerve conduction velocity and muscle activity in office workers with symptomatic neck pain and asymptomatic office workers. A total of 40 participants, both male and female office workers, with symptomatic neck pain (n = 20) and asymptomatic (n = 20), were recruited. Pain intensity, ulnar nerve conduction velocity, median nerve conduction velocity, and muscle activity were determined before and after 1 hour of computer use. There was a significant increase in pain intensity in the neck area in both groups (P < .001). The symptomatic neck pain group revealed a significant decrease in the sensory nerve conduction velocity of the ulnar nerve (P = .008), whereas there was no difference in the median nerve conduction velocity (P > .05). Comparing before and after computer use, the symptomatic neck pain group had less activity of the semispinalis muscles and higher activity of the anterior scalene muscle than the asymptomatic group (P < .05). The trapezius and wrist extensor muscles showed no significant differences in either group (P > .05). This study found signs of neuromuscular deficit of the ulnar nerve, semispinalis muscle, and anterior scalene muscle after 1hour of computer use among office workers with symptomatic neck pain, which may indicate the risk of neuromuscular impairment of the upper extremities. The recommendation of resting, and encouraging function and flexibility of the neuromuscular system after 1hour of computer use should be considered.

Beyond Traditional Therapy: A Novel Multimodal Regimen for Stroke-Related Hand Dysfunction.

Objective: The study aims to explore the effect of a blended multimodal practice aregimen on enhancing upper extremity function in chronic stroke patients. Specifically, we seek to investigate the potential benefits of incorporating MMP into the existing rehabilitation protocols for stroke survivors and assess its effectiveness in improving motor outcomes. Methods: The study utilized a randomized controlled trial design with chronic stroke patients who experienced upper extremity impairments. The participants were provided multimodal physical practice, multimodal mental practice, and blended multimodal practice regimen for three months. Results: The ANOVA analysis revealed a significant difference among the groups for the MMPG measure, indicating that the Blended Multimodal Practice Group (BMPG) performed significantly better compared to the Multimodal Physical Practice Group (MPPG) and the Multimodal Mental Practice Group (MMPG). Conclusion: The findings of this study suggest that incorporating multimodal mental practice approaches into stroke rehabilitation programs can enhance upper extremity function in chronic stroke patients.