Hand Performance Research Articles

Rewiring Cortico-Muscular Control in the Healthy and Poststroke Human Brain with Proprioceptive β-Band Neurofeedback.

In severely affected stroke survivors, cortico-muscular control is disturbed and volitional upper limb movements often absent. Mental rehearsal of the impaired movement in conjunction with sensory feedback provision are suggested as promising rehabilitation exercises. Knowledge about the underlying neural processes, however, remains vague. In male and female chronic stroke patients with hand paralysis, a brain-computer interface controlled a robotic orthosis and turned sensorimotor β-band desynchronization during motor imagery (MI) of finger extension into contingent hand opening. Healthy control subjects performed the same task and received the same proprioceptive feedback with a robotic orthosis or visual feedback only. Only when proprioceptive feedback was provided, cortico-muscular coherence (CMC) increased with a predominant information flow from the sensorimotor cortex to the finger extensors. This effect (1) was specific to the β frequency band, (2) transferred to a motor task (MT), (3) was proportional to subsequent corticospinal excitability (CSE) and correlated with behavioral changes in the (4) healthy and (5) poststroke condition; notably, MI-related enhancement of β-band CMC in the ipsilesional premotor cortex correlated with motor improvements after the intervention. In the healthy and injured human nervous system, synchronized activation of motor-related cortical and spinal neural pools facilitates, in accordance with the communication-through-coherence hypothesis, cortico-spinal communication and may, thereby, be therapeutically relevant for functional restoration after stroke, when voluntary movements are no longer possible.SIGNIFICANCE STATEMENT This study provides insights into the neural processes that transfer effects of brain-computer interface neurofeedback to subsequent motor behavior. Specifically, volitional control of cortical oscillations and proprioceptive feedback enhances both cortical activity and behaviorally relevant connectivity to the periphery in a topographically circumscribed and frequency-specific way. This enhanced cortico-muscular control can be induced in the healthy and poststroke brain. Thereby, activating the motor cortex with mental rehearsal of the impaired movement and closing the loop by robot-assisted feedback synchronizes ipsilesional premotor cortex and spinal neural pools in the β frequency band. This facilitates, in accordance with the communication-through-coherence hypothesis, cortico-spinal communication and may, thereby, be therapeutically relevant for functional restoration after stroke, when voluntary movements are no longer possible.

Spontaneous Motor Recovery after Cervical Spinal Cord Injury: Issues for Nerve Transfer Surgery Decision Making.

Retrospective cohort study. To quantify spontaneous upper extremity motor recovery between 6 and 12 months after spinal cord injury (SCI) to help guide timing of nerve transfer surgery to improve upper limb function in cervical SCI. Nineteen European SCI rehabilitation centers. Data was extracted from the European Multicenter Study of SCI database for individuals with mid-level cervical SCI (N = 268). Muscle function grades at 6 and 12 months post-SCI were categorized for analysis. From 6 to 12 months after SCI, spontaneous surgically-relevant recovery was limited. Of all limbs (N = 263) with grade 0-2 elbow extension at 6 months, 4% regained grade 4-5 and 11% regained grade 3 muscle function at 12 months. Of all limbs (N = 380) with grade 0-2 finger flexion at 6 months, 3% regained grade 4-5 and 5% regained grade 3 muscle function at 12 months. This information supports early (6 month) post-injury surgical consultation and evaluation. With this information, individuals with SCI can more fully engage in preference-based decision-making about surgical intervention versus continued rehabilitation and spontaneous recovery to gain elbow extension and/or hand opening and closing.

Accurate Continuous Prediction of 14 Degrees of Freedom of the Hand from Myoelectrical Signals through Convolutive Deep Learning.

Natural control of assistive devices requires continuous positional encoding and decoding of the user's volition. Human movement is encoded by recruitment and rate coding of spinal motor units. Surface electromyography provides some information on the neural code of movement and is usually decoded into finger joint angles. However, the current approaches to mapping the electrical signal into joint angles are unsatisfactory. There are no methods that allow precise estimation of joint angles during natural hand movements within the large numbers of degrees of freedom of the hand. We propose a framework to train a neural network from digital cameras and high-density surface electromyography from the extrinsic (forearm and wrist) hand muscles. Furthermore, we show that our 3D convolutional neural network optimally predicted 14 functional flexion/extension joints of the hand. We found in our experiments (4 subjects; mean age of 26±2.12 years) that our model can predict individual sinusoidal finger movement at different speeds (0.5 and 1.5 Hz), as well as two and three finger pinching, and hand opening and closing, covering 14 degrees of freedom of the hand. Our deep learning method shows a mean absolute error of 2.78±0.28 degrees with a mean correlation coefficient between predicted and expected joint angles of 0.94, 95% confidence interval (CI) [0.81, 0.98] with simulated real-time inference times lower than 30 milliseconds. These results demonstrate that our approach is capable of predicting the user's volition similar to digital cameras through a non-invasive wearable neural interface. Clinical relevance- This method establishes a viable interface that can be used for both immersive virtual reality medical simulations environments and assistive devices such as exoskeleton and prosthetics.

The effect of institutional quality on income distribution in institutionally developed countries

The research aims to measure the impact of institutional quality on income distribution in institutionally developed countries. The panel data method has been used for the period (2002-2018), for a group of countries that are characterized by the development of their institutions. Fixed effects model (FEM) was adopted to estimate the models included in the research. The regression of the three income shares (the richest 10%, middle 40%, and the poorest 40%) was performed as dependent variables within three models. The explanatory variables were represented by the indicators of institutions issued by the World Bank (political stability, control of corruption, government effectiveness, regulatory quality, rule of law, voice and accountability). The effect of other explanatory variables has been taken into consideration, such as government expenditure as a percent of gross domestic product, unemployment rate, and trade openness. The results showed that the response of the income distribution to institutional variables was weak, as all the calculated elasticities were less than one. However, it was found that institutional variables play a more important distributional role than economic variables. Also, it was found that the only institutional variable influencing the distribution of income in favor of the rich class is the control of corruption. While institutional variables that have a distributional effect in favor of the poor are government effectiveness, political stability, and the quality of regulations. The variables affecting the distribution of income in favor of the middle class were the effectiveness of the government, regulatory quality, and the rule of law. On the other hand, unemployment rate and trade openness had a negative impact on the income share of the poor, while the government expenditure rate, unemployment rate, and trade openness had a positive effect on the middle-class share; unemployment rate had a positive effect on the share of the rich class.

Classification of Electromyography Signal with Machine Learning

The problem of classifying electromyography signals in each gesture occurs due to the use of a constant level of signal amplitude. This research presents an efficiency enhancement of electromyography signal classification in each gesture with machine learning. The performance efficiency of 5 models: SVM, RF, MLP, KNN, and Deep Leaning was compared. The signals were recorded by a low-cost signal sensor. Fist clenching and hand opening gestures were alternately performed every 5 second for 5 times each. Therefore, the total was 4,767 records divided into 3,274 records of hand opening gesture, 1,492 records of fist clenching gesture and 4,833 records of wrist rotating gesture. The results showed that the MLP model was found to have the highest accuracy at 81.45% for fist clenching and hand opening gestures. The Deep Learning model was found to have the highest accuracy at 89.03% for wrist rotating and hand opening gestures.

Dual-task interference in action programming and action planning — Evidence from the end-state comfort effect

In the present study, we examined the extent of interference between a cognitive task (auditory n-back task) and different aspects of motor performance. Specifically, we wanted to find out whether such interference is more pronounced for aspects of planning as compared to programming. Here, motor planning is represented by a phenomenon called the “end-state comfort effect”, the fact that we tolerate uncomfortable initial postures in favour of a more comfortable final posture. We asked participants to grasp differently sized cylindrical objects and to place them on target platforms of varying height (grasp-and-place task), So, participants were required to (1) adjust their hand opening to the object width (action programming) and (2) to plan whether to grasp the object higher or lower in order to be able to place it comfortably onto the low or high target platform. We found that participants demonstrated the end-state comfort effect by anticipating the final posture und planning the movement accordingly with a higher object-grasp for low end-target position and lower object-grasp height for high end-target position, respectively. The auditory task was negatively affected by having to perform a visuomotor task in parallel, suggesting that the two tasks share cognitive and attentional resources. No significant impact from the auditory task on the motor tasks was found. Accordingly, it was not possible to determine which of the two motor aspects (programming or planning) contributed more towards the interference observed in the auditory task. To address this question, we carried out a second experiment. For this second experiment we focussed on the interference effects found in the auditory task and contrasted two versions of the grasp-and-place task. In the first version of the task, the height of the target-shelf varied from trial-to-trial but the width of the target object remained the same. We assumed that this version had high planning demands and low programming demands. In the second version the width of the target object varied and the target-shelf height remained constant. Presumably this increased programming demands but reduced planning demands. Significant interference with the auditory task was only found for the first version, supporting the hypothesis that motor planning requires more cognitive resources and thus creates higher multitasking costs.

Remote assessment of myotonic dystrophy type 1: A feasibility study.

Remote study visits (RSVs) are emerging as important tools for clinical research. We tested the feasibility of using RSVs to evaluate patients with myotonic dystrophy type 1 (DM1), including remote quantitative assessment of muscle function, and we assessed correlations of remote assessments with patient-reported function. Twenty three subjects with DM1 were consented remotely. Toolkits containing a tablet computer, grip dynamometer, and spirometer were shipped to participants. The tablets were loaded with software for video-conferencing and questionnaires about functional impairment, patient experience with technology, and willingness to participate in future remote studies. Grip strength, forced vital capacity, peak cough flow, timed-up-and-go (TUG), and grip myotonia (hand opening time) were determined during RSVs. We assessed correlations of remote assessments with patient-reported outcomes of muscle function and with CTG repeat size. All 23 subjects completed RSVs. 95% of participants were able to complete all components of the remote study. All toolkit components were returned upon completion. Grip strength and TUG demonstrated moderate to strong correlations with self-reported inventories of upper and lower extremity impairment, respectively (ρ=0.7 and ρ=-0.52). A total of 91% of subjects expressed interest in participating in future RSVs. Results of this study support the feasibility of using portable devices and video-conferencing for remote collection of patient-reported outcomes and quantitative assessment of muscle function in DM1.

Neuromotor prosthetic to treat stroke-related paresis: N-of-1 trial

BackgroundFunctional recovery of arm movement typically plateaus following a stroke, leaving chronic motor deficits. Brain-computer interfaces (BCI) may be a potential treatment for post-stroke deficitsMethodsIn this n-of-1 trial (NCT03913286), a person with chronic subcortical stroke with upper-limb motor impairment used a powered elbow-wrist-hand orthosis that opened and closed the affected hand using cortical activity, recorded from a percutaneous BCI comprised of four microelectrode arrays implanted in the ipsilesional precentral gyrus, based on decoding of spiking patterns and high frequency field potentials generated by imagined hand movements. The system was evaluated in a home setting for 12 weeksResultsRobust single unit activity, modulating with attempted or imagined movement, was present throughout the precentral gyrus. The participant acquired voluntary control over a hand-orthosis, achieving 10 points on the Action Research Arm Test using the BCI, compared to 0 without any device, and 5 using myoelectric control. Strength, spasticity, the Fugl-Meyer scores improved.ConclusionsWe demonstrate in a human being that ensembles of individual neurons in the cortex overlying a chronic supratentorial, subcortical stroke remain active and engaged in motor representation and planning and can be used to electrically bypass the stroke and promote limb function. The participant’s ability to rapidly acquire control over otherwise paralyzed hand opening, more than 18 months after a stroke, may justify development of a fully implanted movement restoration system to expand the utility of fully implantable BCI to a clinical population that numbers in the tens of millions worldwide.

Early exploration of one's own body, exploration of objects, and motor, language, and cognitive development relate dynamically across the first two years of life.

Early exploratory behaviors have been proposed to facilitate children's learning, impacting motor, cognitive, language, and social development. This study related the performance of behaviors used to explore oneself to behaviors used to explore objects, and then related both types of exploratory behaviors to motor, language, and cognitive measures longitudinally from 3 through 24 months of age via secondary analysis of an existing dataset. Participants were 52 children (23 full-term, 29 preterm). Previously published results from this dataset documented delays for preterm relative to full-term infants in each assessment. The current results related performance among the assessments throughout the first 2 years of life. They showed that the developmental trajectories of behaviors children used for self-exploration closely related to the trajectories of behaviors they employed to explore objects. The trajectories of both self and object exploration behaviors significantly related to trajectories of children's motor, language, and cognitive development. Specifically, significant relations to global development were observed for self-exploratory head lifting, midline head and hand positioning, hand opening, and behavioral variability, as well as for object-oriented bimanual holding, mouthing, looking, banging, manipulating, transferring of objects, and behavioral intensity and variability. These results demonstrate continuity among the early exploratory behaviors infants perform with their bodies alone, exploratory behaviors with portable objects, and global development. The findings identify specific self- and object-exploration behaviors that may serve as early indicators of developmental delay and could be targeted by interventions to advance motor, language, and cognitive outcomes for infants at risk for delay. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A Novel Respiratory Control and Actuation System for Upper-Limb Prosthesis Users: Clinical Evaluation Study

The most widely-used active upper-limb (UL) prostheses worldwide are body-powered (BP), which is a two-centuries-old technology. Despite their affordability and functional benefits to users, these devices are prone to poor outcomes for many patients. Additionally, BP devices have witnessed limited improvements compared to their externally-powered counterparts. Literature indicates a strong need for appropriate prosthetic solutions for children and adolescents. Our previous work introduced a first-of-its-kind breathing-powered UL prosthesis (“Airbender”) that can overcome several limitations of the current BP systems (e.g., restricted operation space, user discomfort caused by the harness to which the cables are attached). Users can regulate their breathing, and this controllable airflow is subsequently used to power a small (purpose-built and optimised) Tesla turbine that can accurately control the opening and closing of the prosthetic hand. The current work explores device usability in children and adolescents with a UL difference (n = 15). Further, we gathered feedback, suggestions and satisfaction levels from the study participants and their parents on breathing as a modality of controlling a prosthetic device. The collected responses and study observations were subjected to qualitative and statistical analysis. This study showcases real-world testing of a breathing-powered prosthesis and proves that UL-deficient children and adolescents can indeed operate the device (i.e., volitionally open or close) with their breathing input. The perceived level of difficulty in opening or closing the device tended to be on the ‘easy’ side. We report generally favourable feedback obtained from participants and their parents. Additionally, design suggestions and satisfaction levels concerning different device attributes help us involve the key stakeholders in co-creating and proactively developing a robust product development roadmap. This work is aligned with creating a step-change in the potential BP prosthetics options for patients in the future, propelled by a need-led approach.

Personalized protocol and scoring scale for functional electrical stimulation of the hand: A pilot feasibility study.

Complex personalized Functional Electrical Stimulation (FES) protocols for calibrating parameters and electrode positioning have been proposed, most being time-consuming or technically cumbersome for clinical settings. Therefore, there is a need for new personalized FES protocols that generate comfortable, functional hand movements, while being feasible for clinical translation. To develop a personalized FES protocol, comprising electrode placement and parameter selection, to generate hand opening (HO), power grasp (PW) and precision grip (PG) movements, and compare in a pilot feasibility study its performance to a non-personalized protocol based on standard FES guidelines. Two FES protocols, one personalized (P1) and one non-personalized (P2), were used to produce hand movements in twenty-three healthy participants. FES-induced movements were assessed with a new scoring scale which comprises items for selectivity, functionality, and comfort. Higher FES-HSS scores were obtained with P1 for all movements: HO (p= 0.00013), PW (p= 0.00007), PG (p= 0.00460). Electrode placement time was significantly shorter for P2 (p= 0.00003). Comfort scores were similar for both protocols. The personalized protocol for electrode placement and parameter selection enabled functional FES-induced hand movements and presented advantages over a non-personalized protocol. This protocol warrants further investigation to confirm its suitability for developing upper-limb rehabilitation interventions with clinical translational potential.

Intrafascicular peripheral nerve stimulation produces fine functional hand movements in primates.

Restoring dexterous hand control is critical for people with paralysis. Approaches based on surface or intramuscular stimulation provide limited finger control, generate insufficient force to recover functional movements, and require numerous electrodes. Here, we show that intrafascicular peripheral electrodes could produce functional grasps and sustained forces in three monkeys. We designed an intrafascicular implantable electrode targeting the motor fibers of the median and radial nerves. Our interface selectively and reliably activated extrinsic and intrinsic hand muscles, generating multiple functional grips, hand opening, and sustained contraction forces for up to 2 months. We extended those results to a behaving monkey with transient hand paralysis and used intracortical signals to control simple stimulation protocols that enabled this animal to perform a functional grasping task. Our findings show that just two intrafascicular electrodes can generate a rich portfolio of dexterous and functional hand movements with important implications for clinical applicability.

The Anatomy of Nerve Transfers Used in Tetraplegic Hand Reconstruction

To evaluate the anatomy of nerve transfers used to reconstruct wrist extension, hand opening, and hand closing in tetraplegic patients. Nerve transfers were completed on 18 paired cadaveric upper limbs. The overlap of donor and recipient nerves was measured, as well as the distance to the target muscle. Axons were counted in each nerve and branch, with the axon percentage calculated by dividing the donor nerve count by that of the recipient. Transfers with overlap of the donor and recipient nerve were from the radial nerve branch to extensor carpi radialis brevis to anterior interosseous nerve (AIN) and from the branch(es) to supinator to posterior interosseous nerve. The extensor carpi radialis brevis to AIN had the shortest distance to the target, with the branch to brachialis to AIN being the longest. The nerve transfers for wrist extension had the highest axon percentage. Of the transfers for hand closing, the brachialis to AIN had the highest axon percentage, and the branch to brachioradialis to AIN had the lowest. The anatomical features of nerve transfers used in tetraplegic hand reconstruction are variable. Differences may help explain clinical outcomes. This study demonstrates which nerve transfers may be anatomically favorable for restoring hand function in tetraplegic patients.

The neural correlates of intermanual transfer

Intermanual transfer of motor learning is a form of learning generalization that leads to behavioral advantages in various tasks of daily life. It might also be useful for rehabilitation of patients with unilateral motor deficits. Little is known about neural structures and cognitive processes that mediate intermanual transfer. Previous studies have suggested a role for primary motor cortex (M1) and the supplementary motor area (SMA). Here, we investigated the functional neuroanatomy of intermanual transfer with a special emphasis on functional connectivity within the motor network and between motor regions and attentional networks, including the fronto-parietal executive control network and visual attention networks. We designed a finger tapping task, in which young, heathy subjects trained the non-dominant left hand in the MRI scanner. Behaviorally, transfer of sequence learning was observed in most cases, independently of the trained hand's performance. Pre- and post-training functional connectivity patterns of cortical motor seeds were investigated using generalized psychophysiological interaction analyses. Transfer was correlated with the strength of connectivity between the left premotor cortex and structures within the dorsal attention network (superior parietal cortex, left middle temporal gyrus) and executive control network (right prefrontal regions) during pre-training, relative to post-training. Changes in connectivity within the motor network, and more particularly between trained and untrained M1, as well as between the SMA and untrained M1, correlated with transfer after training. Together, these results suggest that the interplay between attentional, executive and motor networks may support processes leading to transfer, whereas, following training, transfer translates into increased connectivity within the motor network.

Design and Performance Evaluation of a Hybrid Hand Exoskeleton for Hand Opening/Closing

Abstract Finger extensor muscle weakness and flexor hypertonia are the most commonly reported issues among patients suffering from amyotrophic lateral sclerosis (ALS). Moreover, the relative hyperflexion of the wrist and fingers has limited their ability to voluntarily open the hand and interact with the external environment. In this work, a hybrid hand exoskeleton is developed to prevent the relative hyperflexion of the fingers and wrist and facilitate the users in their functional hand opening by compensating the flexor hypertonia. This exoskeleton, combining a passive device with the soft extra muscle (SEM) glove, assists users in normal hand opening/closing required for some basic activities of daily living. The paper presents kinematic and static models of passive hand exoskeleton design. Moreover, the proposed design is tested and evaluated by comparing the volunteer hand opening with the exoskeleton assistance using the flex sensors attached on the dorsal side of the middle finger, ring finger, and thumb with both healthy subjects and patients. The results show the effectiveness of using the hybrid exoskeleton in improving anatomical hand opening/closing capabilities.

The "Federica" Hand.

Hand prostheses partially restore hand appearance and functionalities. In particular, 3D printers have provided great opportunities by simplifying the manufacturing process and reducing costs. The “Federica” hand is 3D-printed and equipped with a single servomotor, which synergically actuates its five fingers by inextensible tendons; no springs are used for hand opening. A differential mechanical system simultaneously distributes the motor force on each finger in predefined portions. The proportional control of hand closure/opening is achieved by monitoring muscle contraction by means of a thin force sensor, as an alternative to EMG. The electrical current of the servomotor is monitored to provide sensory feedback of the grip force, through a small vibration motor. A simple Arduino board was adopted as the processing unit. A closed-chain, differential mechanism guarantees efficient transfer of mechanical energy and a secure grasp of any object, regardless of its shape and deformability. The force sensor offers some advantages over the EMG: it does not require any electrical contact or signal processing to monitor muscle contraction intensity. The activation speed (about half a second) is high enough to allow the user to grab objects on the fly. The cost of the device is less then 100 USD. The “Federica” hand has proved to be a lightweight, low-cost and extremely efficient prosthesis. It is now available as an open-source project (CAD files and software can be downloaded from a public repository), thus allowing everyone to use the “Federica” hand and customize or improve it.

Real-World Functional Grasping Activity in Individuals With Stroke and Healthy Controls Using a Novel Wearable Wrist Sensor

Background. While wrist-worn accelerometers have been used to measure upper extremity use in the past, they primarily measure arm motion and lack the ability to capture functional hand opening and grasping activities which are essential for activities of daily living. Objectives. To characterize real-world functional hand opening and grasping activities captured over multiple days in adults with stroke and in matched controls using a novel wrist-worn device. Methods. Twenty-eight individuals (fourteen individuals with stroke and 14 healthy controls) wore the devices on both wrists for 3 days. Functional hand activity was characterized by daily hand counts, hourly hand counts, and asymmetry between hands. The Mann–Whitney U test was used to evaluate differences in functional hand activities between the two groups. Results. The stroke group had 1480 and 4691 daily hand counts in their affected and nonaffected hands, respectively. The control group had 3559 and 5021 daily hand counts in their nondominant and dominant hands, respectively. Significantly fewer daily hand counts (P = .019), fewer hourly hand counts (P = .024), and a larger asymmetry index (P = .01) of the affected hand in the stroke group were found compared to that of the nondominant hand in the control group. Conclusions. Real-world functional upper extremity activity can be measured using this novel wrist-worn device. Unlike wrist-worn accelerometers, this wrist-worn device can provide a measurement of functional grasping activity. The findings have implications for clinicians and researchers to monitor and assess real-world hand activity, as well as to apply specific doses of repetitions to improve neural recovery after stroke.

Prosthetic control system based on motor imagery

A brain–computer interface (BCI) can be used for function replacement through the control of devices, such as prostheses, by identifying the subject’s intent from brain activity. We process electroencephalography (EEG) signals related to motor imagery to improve the accuracy of intent classification. The original signals are decomposed into three layers based on db4 wavelet basis. The wavelet soft threshold denoising method is used to improve the signal-to-noise ratio. The sample entropy algorithm is used to extract the features of the signal after noise reduction and reconstruction. Combined with event-related synchronisation/desynchronisation (ERS/ERD) phenomenon, the sample entropy in the motor imagery time periods of C3, C4 and Cz is selected as the feature value. Feature vectors are then used as the input of three classifiers. From the evaluated classifiers, the backpropagation (BP) neural network provides the best EEG signal classification (93% accuracy). BP neural network is thus selected as the final classifier and used to design a prosthetic control system based on motor imagery. The classification results are wirelessly transmitted to control a prosthesis successfully via commands of hand opening, fist clenching, and external wrist rotation. Such functionality may allow amputees to complete simple activities of daily living. Thus, this study is valuable for subsequent developments in rehabilitation.

Активация процессов сенсомоторной интеграции с помощью интерфейса «мозг–компьютер»

A BCI-controlled hand exoskeleton activates neuroplasticity mechanisms, promoting motor learning. The contribution of perception to this phenomenon is understudied. The aim of this study was to assess the impact of sensorimotor integration on the effectiveness of neurorehabilitation based on the learning of a hand opening movement by stroke patients using BCI and to investigate the effect of ideomotor training on spasticity in the paretic hand. The study was conducted in 58 patients (median age: 63 (22; 83) years) with traumatic brain injury, ischemic (76%) or hemorrhagic (24%) stroke in the preceding 2 (1.0; 12.0) months. The patients received 15 (12; 21) ideomotor training sessions with a BMI-controlled hand exoskeleton. Hand function was assessed before and after rehabilitation on the Fugl–Meyer, ARAT, Frenchay, FIM, Rivermead, and Ashworth scales. An increase in muscle strength was observed in 40% of patients during flexion and extension of the radiocarpal joint and in 29% of patients during the abduction and adduction of the joint. Muscle strength simultaneously increased during the abduction and adduction of the radiocarpal joint (p < 0.004). Ideomotor training is ineffective for reducing spasticity because no statistically significant reduction in muscle tone was detected. Improved motor performance of the paretic hand was positively correlated with improvements in daily activities. Motor training of the paretic hand with a robotic orthosis activates kinesthetic receptors, restores sensation and improves fine motor skills through better sensorimotor integration.

Role of economic growth and innovative technologies in the outlook of energy and environmental efficiency: a way forward for developing Asian economies.

Energy consumption is widely regarded as the primary driver of economic development and environmental degradation. The current study examines how energy use is related to technological innovation, human resources, energy pricing, economic development, and trade openness. For this context, the data set of OECD economies' indicators as mentioned above has been compiled for the period 1991-2019. Three estimators were used in this study from the family of autoregressive distributed lag (ARDL): the mean group (MG), the dynamic fixed effect (DFE), and the pooled mean group (PMG). According to empirical research, technical advances, human resources, and energy pricing all have a negative impact on OECD countries' long-run energy consumption. In the short term, however, these variables have a negligible or inverse effect on energy consumption. On the other hand, economic growth and trade openness in OECD economies all contribute positively to energy demand in the short and long run. Based on the empirical findings, this study recommends a policy structure for emerging economies.