Impaired Limb Function Research Articles

The first experience of individual revers shoulder arthroplasty in case of post-traumatic glenoid deformation (case from practice)

Total shoulder arthroplasty (anatomical or reversible) has gained considerable popularity, but the difficulty of installing the glenoid component determines the development of 30–50 % of mechanical complications and revision operations. To simplify glenoid installation, an individual tool of an unusual design is used. Objective. To show clinical case of individual modeling of a glenoid implant, made by 3D printing, for the patient with old fixed humeral dislocation. Methods. A 52-year-old patient complained of severe pain and impaired limb function 4 years after a fracture-dislocation of the left numeral head, that was not reduced. The difficulty was in the presence of a significant HillSachs impression and huge anterior glenoid defect, IV stage osteoarthritis. Results. To solve the problem, a three-dimensional modelof the scapula was built based on the results of computer tomography, and its plastic model was printed. Designed individual augment for glenosphere installation.Lateralization of the center of rotation by 5 mm and downward inclination of the glenosphere by 5° was performed in the implant. The implant stem channel and screw holes are modeled to pass through the most massive parts of the scapula. An individual tool has been developed for installing this component and drillings for the screws. During the surgical intervention, the prepared tools and implant allowed to install a revers total shoulder implant and obtain the nearest positive result. Conclusions. It is advisable to use three-dimensional modelling with 3D printing in cases of reversible shoulder arthroplasty for patients with old fixed humeral dislocation and significant glenoid defect.

What's New in Musculoskeletal Tumor Surgery.

What's New in Musculoskeletal Tumor Surgery.

Development and Rasch Validation of an Observational Assessment Tool of Upper Limb Functional Impairment in Stroke Survivors: Functional Assessment Test for Upper Limb

ObjectiveTo develop and validate a quick observational clinical tool, the Functional ASsessment Test for Upper Limb (FAST-UL), for the evaluation of upper limb impairment in goal-directed functional-oriented motor tasks after stroke. DesignObservational, cross-sectional, psychometric study. SettingInpatient and outpatient rehabilitation clinic. ParticipantsA total of 188 post-stroke survivors (mean age 65.2±17.7 years, 61% men, 48% with ischemic stroke and 66% in the sub-acute phase; N=188). InterventionsNot applicable. Main Outcome MeasuresPrincipal component analysis and Rasch analysis through a Partial Credit Model were used to assess the structure and psychometric properties of the 5 items of the FAST-UL (Hand to Mouth [HtM], Reach to Target, Prono-Supination, Grasp and Release, and Pinch and Release [PaR]). ResultsThe Cronbach's α equal to 0.96 was indicative of an acceptable internal consistency; the reliability, as measured through the Person Separation Reliability equal to 0.87, was good. The FAST-UL tool was unidimensional. All the FAST-UL items were found to fit well the Rasch measurement model. The easiest to perform FAST-UL item was the HtM movement while the most difficult was the PaR movement. ConclusionsThe FAST-UL is a quick, easy-to-administer observational assessment tool of upper limb motor impairment in post-stroke survivors with good item-level psychometric properties.

Effects of Expanded Constraint-Induced Movement Therapy on Hand Function in Children with Cerebral Palsy: A Randomized Controlled Trial

Background: Hemiplegic cerebral palsy children can attend schools regularly, but due to impairment of upper limb function, participation is restricted in leisure and educational tasks and it affects their social and functional activities. Constraint-induced movement therapy is specifically used for the upper extremity and can enhance cerebral palsy children’s hand function. Objective: To evaluate the effectiveness of expanded constraint-induced movement therapy on hand function in children with cerebral palsy. Methods: A single-blinded randomized controlled trial was conducted at the department of Physical Therapy, Children’s Hospital, Lahore, Pakistan from December 2021 to April 2022 using non-probability convenient sampling. Children with hemiplegic cerebral palsy aged between 5 and 12 years were randomly allocated into two groups (22 patients per group), the experimental group treated with expanded constraint-induced movement therapy and routine physical therapy and the conventional group treated with routine physical therapy only. The pediatric motor activity log scale and Wolf motor function test were the outcome measuring scales. The trial was approved by the ethical committee of the hospital and registered prospectively in the clinical trial registry of the US (ClinicalTrials.gov trial ID 57520). Results: As compared to the conventional group, the score of the pediatric motor activity log scale improved significantly (p-value ≤0.001) in the experimental group. Participants showed significant differences for both domains of the wolf motor function test in the experimental group as compared to other groups and they showed significant improvement in hand function (p≤0.001) within the groups. Conclusion: Expanded constraint-induced movement therapy along with routine physical therapy is found to be more effective in improving the function of the pelagic hand in children with hemiplegic cerebral palsy.

Thoracic Spine Deformity Post Tetanus: A Case Report of Tetanus Post Circumcision

Tetanus is caused by clostridium tetani bacteria through skin breach. The tetanus is characterized by tonic contraction and muscle spasm which can cause vertebral fracture in some patients. we are reporting a young male patient who after ring circumcision technique had tetanus complicated into thoracic vertebral fracture with severe kyphotic deformity and lower limb functional impairment. The surgical management was performed in two stages: First stage consisted of Shwab 2 osteotomy, pedicle screws and rod fixation with good result for deformity correction. The second stage of surgery involved left transpedicular T6 and T5 corpectomies (Shwab 3 osteotomy) plus interbody titanium cage fixation which provided good spinal cord decompression. Tetanus is still a major complication of circumcision, tetanus complication may be devastating Early surgical deformity correction and spinal cord decompression provide favorable neurological and functional outcome for patients with spine deformity post tetanus. The Patient was able to walk with crutches 3 months post-surgery.

Test–retest reliability of upper limb robotic exoskeleton assessments in children and youths with brain lesions

In children with congenital or acquired brain lesions, impaired upper limb function can affect independence. Assessing upper limb function is important for planning and evaluating neurorehabilitative interventions. Robotic devices increase measurement-objectivity and enable measuring parameters reflecting more complex motor functions. We investigated the relative and absolute test–retest reliability of assessments to measure upper limb functions in children and adolescents with brain lesions with the exoskeleton ChARMin. Thirty children (9 females, mean age ± SD = 12.5 ± 3.3 years) with congenital brain injuries (n = 15), acquired (n = 14), both (n = 1) and impaired upper limb function participated. They performed the following ChARMin assessments and repeated them within three to seven days: active and passive Range of Motion (ROM), Strength, Resistance to Passive Movement, Quality of Movement, Circle, and Workspace. We calculated the systematic difference, Intraclass Correlation Coefficient (ICC) and Smallest Real Difference (SRD) for each parameter. Six parameters of three assessments showed systematic errors. ICCs ranged from little to very high and SRD values varied considerably. Test–retest reliability and measurement errors ranged widely between the assessments. Systematic differences indicated that random day-to-day variability in performance would be responsible for reduced reliability of those parameters. While it remains debatable whether robot-derived outcomes should replace certain routine assessments (e.g., ROM, strength), we recommend applying certain technology-based assessments also in clinical practice.Trial registration: This study was registered prospectively at ClinicalTrials.gov (identifier: NCT02443857) on May 14, 2015.

A Review of Hand Function Rehabilitation Systems Based on Hand Motion Recognition Devices and Artificial Intelligence.

The incidence of stroke and the burden on health care and society are expected to increase significantly in the coming years, due to the increasing aging of the population. Various sensory, motor, cognitive and psychological disorders may remain in the patient after survival from a stroke. In hemiplegic patients with movement disorders, the impairment of upper limb function, especially hand function, dramatically limits the ability of patients to perform activities of daily living (ADL). Therefore, one of the essential goals of post-stroke rehabilitation is to restore hand function. The recovery of motor function is achieved chiefly through compensatory strategies, such as hand rehabilitation robots, which have been available since the end of the last century. This paper reviews the current research status of hand function rehabilitation devices based on various types of hand motion recognition technologies and analyzes their advantages and disadvantages, reviews the application of artificial intelligence in hand rehabilitation robots, and summarizes the current research limitations and discusses future research directions.

Autologous Breast Reconstruction in Conjuction with Lymphatic Microsurgery in Breast Cancer-Related Lymphedema

Breast cancer-related lymphedema of the upper extremity is the most significant non-oncological complication of tumour therapy, leading to functional impairment and impacting patients' quality of life. Autologous breast reconstruction per se effectively reduces incidence and stage of lymphedema after breast cancer treatment by surgical angiogenesis. In addition, modern surgical techniques for treating lymphedema are effective in reducing limb volume, circumference and functional impairment, and improving patients' quality of life, body image, integrity and local immunocompetence. Reconstructive surgery, including lymphovenous anastomoses (LVA) and vascularised lymph node transfer (VLNT), have been shown to rearrange or restore lymphatic flow and prevent stage progression. For patients with breast cancer-related lymphedema after mastectomy, autologous breast reconstruction in conjunction with lymphatic microsurgery using VLNT, LVA or a combination of these procedures offers the option of holistic and single-stage restoration in modern senology. Extensive scar release in the axilla is a crucial component of the surgical technique, aiming to prepare the recipient bed for the VLN transplant and to allow for the functional recruitment of remaining lymph vessels of the upper extremity. This article presents the indications, preoperative diagnostic evaluation, surgical techniques and precautions, complications and results of combined lymphatic and breast restoration.

Combined and Modified Gibson and Ilioinguinal Approaches in Type II + III Internal Hemipelvectomy for Periacetabular Tumors.

BackgroundThe routine iliofemoral approach and its modifications in type II+III resection require extensive skin incision and massive periacetabular muscle detachment, leading to prolonged hospital stay, increased complication incidence, and impaired lower limb function. Under the management of an enhanced recovery after surgery (ERAS) protocol, a combined and modified Gibson and ilioinguinal (MGMII) approach was used to avoid unnecessary soft tissue trauma during tumor resection and therefore advantageous to patients’ return to normal life.MethodsTwenty-five patients with type II + III (including type II) periacetabular tumors who underwent reconstruction with 3D printed customized endoprostheses at our center between January 2017 and March 2019 were included in this study. There were 13 cases using MGMII approach and 12 cases using iliofemoral approach. The operation duration and blood loss were assessed by chart review. The surgical margin was evaluated by the histopathological studies. The reconstruction accuracy, the abductor muscle strength, the 1993 version of the Musculoskeletal Tumor Society (MSTS-93), the Harris Hip scores (HHS), and the limp score were evaluated. Complications were recorded after reviewing the patients’ records.ResultsThe operative duration and blood loss in MGMII group were shorter than those in the iliofemoral group, but the postoperative hemoglobin was slightly higher than that in the iliofemoral group. The MGMII group had stronger postoperative hip abductors, better functional restoration, and relatively fewer patients with higher limp scores. No complication was observed in the MGMII group. In the iliofemoral group, three patients encountered wound healing delay, and one patient suffered deep infection.ConclusionsThe MGMII approach can better expose the posterior column of the acetabulum, especially the ischial tuberosity, which is beneficial for avoiding tumor rupture during resection. The MGMII approach also helps to preserve residual muscle function, such as the origin of the gluteus medius, while ensuring the extent of resection.

Body fat and skeletal muscle mass, but not body mass index, are associated with pressure hyperalgesia in young adults with patellofemoral pain

BackgroundYoung adults with patellofemoral pain (PFP) have a high prevalence of being overweight or obese, which is associated with impaired lower limb function and muscle weakness. However, the impact of being overweight or obese on pain sensitivity has not been explored. ObjectivesWe investigated the association between body fat, skeletal muscle mass, and body mass index (BMI) with pressure hyperalgesia and self-reported pain in young adults with PFP. Methods114 adults with PFP (24 ± 5 years old, 62% women) were recruited. Demographics and self-reported pain (current and worst knee pain intensity in the previous month - 0–100 mm visual analog scale) were recorded. Body fat and skeletal muscle mass were measured using bioelectrical impedance. Pressure hyperalgesia was measured using a handheld algometer (pressure pain threshold) at three sites: center of patella of the painful knee, ipsilateral tibialis anterior, and contralateral upper limb. The association between body fat, skeletal muscle mass, and BMI with pressure hyperalgesia and self-reported pain were investigated using partial correlations and hierarchical regression models (adjusted for sex, bilateral pain, and symptoms duration). ResultsHigher body fat and lower skeletal muscle mass were associated with local, spread, and widespread pressure hyperalgesia (ΔR2=0.09 to 0.17, p ≤ 0.001; ΔR2=0.14 to 0.26, p<0.001, respectively), and higher current self-reported pain (ΔR2=0.10, p<0.001; ΔR2=0.06, p = 0.007, respectively). Higher BMI was associated with higher current self-reported pain (ΔR2=0.10, p = 0.001), but not with any measures of pressure hyperalgesia (p>0.05). ConclusionHigher body fat and lower skeletal muscle mass help to explain local, spread, and widespread pressure hyperalgesia, and self-reported pain in people with PFP. BMI only helps to explain self-reported pain. These factors should be considered when assessing people with PFP and developing their management plan, but caution should be taken as the strength of association was generally low.

Can Early Neuromuscular Rehabilitation Protocol Improve Disability after a Hemiparetic Stroke? A Pilot Study.

Background: The impairment of limb function and disability are among the most im portant consequences of stroke. To date, however, little research has been done on the early reha bilitation trial (ERT) after stroke in these patients. The purpose of this study was to evaluate the impact of ERT neuromuscular protocol on motor function soon after hemiparetic stroke. The sample included twelve hemiparetic patients (54.3 ± 15.4 years old) with ischemic stroke (n = 7 control, n = 5 intervention patients). ERTwas started as early as possible after stroke and included passive range of motion exercises, resistance training, assisted standing up, and active exercises of the healthy side of the body, in addition to encouraging voluntary contraction of affected limbs as much as possible. The rehabilitation was progressive and took 3 months, 6 days per week, 2–3 h per session. Fu gle-Meyer Assessment (FMA), Box and Blocks test (BBT) and Timed up and go (TUG) assessments were conducted. There was a significantly greater improvement in the intervention group com pared to control: FMA lower limbs (p = 0.001), total motor function (p = 0.002), but no significant difference in FMA upper limb between groups (p = 0.51). The analysis of data related to BBT showed no significant differences between the experimental and control groups (p = 0.3). However, TUG test showed significant differences between the experimental and control groups (p = 0.004). The most important finding of this study was to spend enough time in training sessions and provide adequate rest time for each person. Our results showed that ERT was associated with improved motor function but not with the upper limbs. This provides a basis for a definitive trial.

Functional alterations in large-scale resting-state networks of amyotrophic lateral sclerosis: A multi-site study across Canada and the United States.

Amyotrophic lateral sclerosis (ALS) is a multisystem neurodegenerative disorder characterized by progressive degeneration of upper motor neurons and lower motor neurons, and frontotemporal regions resulting in impaired bulbar, limb, and cognitive function. Magnetic resonance imaging studies have reported cortical and subcortical brain involvement in the pathophysiology of ALS. The present study investigates the functional integrity of resting-state networks (RSNs) and their importance in ALS. Intra- and inter-network resting-state functional connectivity (Rs-FC) was examined using an independent component analysis approach in a large multi-center cohort. A total of 235 subjects (120 ALS patients; 115 healthy controls (HC) were recruited across North America through the Canadian ALS Neuroimaging Consortium (CALSNIC). Intra-network and inter-network Rs-FC was evaluated by the FSL-MELODIC and FSLNets software packages. As compared to HC, ALS patients displayed higher intra-network Rs-FC in the sensorimotor, default mode, right and left fronto-parietal, and orbitofrontal RSNs, and in previously undescribed networks including auditory, dorsal attention, basal ganglia, medial temporal, ventral streams, and cerebellum which negatively correlated with disease severity. Furthermore, ALS patients displayed higher inter-network Rs-FC between the orbitofrontal and basal ganglia RSNs which negatively correlated with cognitive impairment. In summary, in ALS there is an increase in intra- and inter-network functional connectivity of RSNs underpinning both motor and cognitive impairment. Moreover, the large multi-center CALSNIC dataset permitted the exploration of RSNs in unprecedented detail, revealing previously undescribed network involvement in ALS.

A case of heterotopic ossification of the elbow joint

Patients who have undergone severe elbow trauma often develop various complications. Heterotopic ossification is considered to be the most severe complication, which leads to severe impairment of upper limb function due to the formation of severe contractures and ankylosis in the elbow joint. The paper presents the results of surgical treatment of the elbow joint in a patient with «immature» ossification against the background of aged dislocation of the forearm, non-unionized fracture of the radial head, and stage II osteoarthritis. Analysis of the outpatient follow-up of the patient after injury revealed gross diagnostic and treatment errors. As a result of medical errors, inadequate treatment of injuries in the early stages after injury was prescribed, which contributed to the formation of heterotopic ossification and resulted in functional failure of the joint. During surgery, the ossification located in the ulnar fossa was removed via a small posterior access to the elbow joint, the remaining tissues of the joint were not affected, thorough hemostasis was performed, and a Volkov-Oganesian joint-distraction device was applied to provide a physiological range of motion in the elbow joint. Postoperative long-term rehabilitation ensured restoration of the elbow joint function with the patient's return to professional activities.

User Participatory Design of a Wearable Focal Vibration Device for Home-Based Stroke Rehabilitation.

Stroke often leads to the significant impairment of upper limb function and is associated with a decreased quality of life. Despite study results from several interventions for muscle activation and motor coordination, wide-scale adoption remains largely elusive due to under-doses and low user compliance and participation. Recent studies have shown that focal vibration has a greater potential to increase and coordinate muscle recruitment and build muscle strength and endurance. This form of treatment could widely benefit stroke survivors and therapists. Thus, this study aimed to design and develop a novel wearable focal vibration device for upper limb rehabilitation in stroke survivors. A user participatory design approach was used for the design and development. Five stroke survivors, three physical therapists, and two occupational therapists were recruited and participated. This pilot study may help to develop a novel sustainable wearable system providing vibration-based muscle activation for upper limb function rehabilitation. It may allow users to apply the prescribed vibratory stimuli in-home and/or in community settings. It may also allow therapists to monitor treatment usage and user performance and adjust the treatment doses based on progression.

Triboelectric nanogenerator integrated origami gravity support device for shoulder rehabilitation using exercise gaming

Patients with impaired upper limb and shoulder function need gravity support during their rehabilitation therapy. It could be beneficial to the patient if the gravity support device could also sustain rehabilitation tasks and exercises. Thus in this work we designed a gravity support device with integrated triboelectric nanogenerators (TENGs) for shoulder rehabilitation. The gravity support part of the device was based on origami design. The rehabilitation tasks were based on the popular exercise-gaming approach, with the TENGs acting as self-powered sensors for the gaming task and energy harvesters for the exercise task. The origami was strategically designed with minimal but sufficient folds and a spring based support. The TENGs were also foldable with an output voltage of 35 Vp-p. The data acquisition and digitization circuit for gaming was miniaturized on a printed circuit board to fit snugly into the origami structure. The gravity support behavior of the origami was verified using electromyography sensors. Finally a pilot study was conducted with three stroke patients. Their upper-arm range of motion (ROM) was measured without any gravity-support and during the tasks. In the first task the patients played a table-tennis game which required minimal brain-arm coordination effort. In the second task the patients harvested energy by moving their arm as fast as possible. After the tasks, patient feedback was obtained for the effectiveness of the device, and the results suggested that they would be interested in using the device for home-based rehabilitation. Thus this work demonstrated a potential product for tele-rehabilitation which has gained prominence due to the ongoing pandemic.

Non-drug and surgical treatment algorithm and recommendations for the 2020 update of the Japan College of Rheumatology clinical practice guidelines for the management of rheumatoid arthritis-secondary publication.

The aim of this study was to update the Japan College of Rheumatology (JCR) clinical practice guidelines (CPGs) for the management of rheumatoid arthritis (RA) and prepare an algorithm for non-drug and surgical treatments. This article is a digest version of the guidelines. The Japanese Ministry of Health, Labour and Welfare's research group, in collaboration with the JCR, used the Grading of Recommendations, Assessment, Development, and Evaluation method to update the 2014 JCR CPG for RA. The consensus was formed by CPG panel members. We raised 19 clinical questions regarding non-drug and surgical treatments for RA and developed recommendations. The treatments included exercise therapy; occupational therapy; joint injection of corticosteroids; and orthopaedic surgeries including cervical spine surgery, wrist and foot arthroplasty, ankle arthrodesis, and replacement arthroplasty of the shoulder, elbow, finger, hip, knee, and ankle. Recommendations regarding the risks of surgery and perioperative discontinuation of medications have also been developed. Based on these recommendations, we created an original algorithm for the non-drug and surgical treatment of RA. These recommendations are expected to serve rheumatologists, health care professionals, and patients with RA as tools for shared decision-making to treat residual limb joint symptoms and functional impairment.

Gait Improvement in Chronic Stroke Survivors by Using an Innovative Gait Training Machine: A Randomized Controlled Trial.

Chronic stroke leads to the impairment of lower limb function and gait performance. After in-hospital rehabilitation, most individuals lack continuous gait training because of the limited number of physical therapists. This study aimed to evaluate the effects of a newly invented gait training machine (I-Walk) on lower limb function and gait performance in chronic stroke individuals. Thirty community-dwelling chronic stroke individuals were allocated to the I-Walk machine group (n = 15) or the overground gait training (control) group (n = 15). Both groups received 30 min of upper limb and hand movement and sit-to-stand training. After that, the I-Walk group received 30 min of I-Walk training, while the control followed a 30-minute overground training program. All the individuals were trained 3 days/week for 8 weeks. The primary outcome of the motor recovery of lower limb impairment was measured using the Fugl–Meyer Assessment (FMA). The secondary outcomes for gait performance were the 6-minute walk test (6 MWT), the 10-meter walk test (10 MWT), and the Timed Up and Go (TUG). The two-way mixed-model ANOVA with the Bonferroni test was used to compare means within and between groups. The post-intervention motor and sensory subscales of the FMA significantly increased compared to the baseline in both groups. Moreover, the 6 MWT and 10 MWT values also improved in both groups. In addition, the mean difference of TUG in the I-Walk was higher than the control. The efficiency of I-Walk training was comparable to overground training and might be applied for chronic stroke gait training in the community.

Factors associated with upper limb function in breast cancer survivors.

Breast cancer survivors may have side effects from treatment, such as impaired upper limb function after surgery, which may be affected by a range of factors. To analyze the association between upper limb function and strength, fear avoidance, and central sensitization symptoms among breast cancer survivors, and to explore how these variables are associated with upper limb function. Validation cohort. Institutional practice at a public hospital. One hundred seventy-four breast cancer survivors who had been undergone surgery for a primary tumor. Not applicable. Upper limb function was measured by the Upper Limb Functional Index (ULFI-Sp). Independent outcomes were: handgrip strength, which was measured using a Jamar dynamometer on the dominant side; fear avoidance, measured using the Fear-Avoidance Components Scale (FACS-Sp); and central sensitization symptoms, which were measured using the Central Sensitisation Inventory (CSI-Sp). A linear regression model explaining the ULFI-Sp results was constructed with the variables. The regression model was significant (F=46.826; p< .0001), and explained 45% of the variance of the ULFI values. All variables showed strong associations with upper limb function. Greater upper limb function is associated with higher grip strength, lower fear-avoidance behavior and fewer central sensitization symptoms among breast cancer survivors. These variables explained 45% of the upper limb function in the regression model, and concur with earlier research showing that factors such as central sensitization symptoms and kinesiophobia negatively affect upper limb function in such patients. Clinicians should therefore take into account strength, fear avoidance, and central sensitization symptoms when considering interventions aimed at improving upper limb function among breast cancer survivors.

Treatment Outcomes of Manual Lymphatic Drainage in Pediatric Lymphedema

Pediatric lymphedema can result in irreversible, debilitating limb swelling, tissue fibrosis, skin ulcers, infection, and impaired limb function in children at an early age. Manual lymphatic drainage (MLD) is a noninvasive technique, which is a part of intensive decongestive therapy to reroute lymphatic flow to healthy channels used to manage lymphedema. Outcomes of this treatment option in children have not been studied. We evaluated the effect of decongestive therapy involving MLD in pediatric patients with complex lymphatic anomalies by measuring treatment progress and functional outcomes via changes in limb circumference, limb functionality, dexterity, skin quality, and pain. A single-institution retrospective study on a cohort of 8 pediatric patients with lymphatic anomalies who completed a course of MLD was conducted from 2015 to 2017 to investigate the role MLD plays in their lymphedema reduction. Pain scores were measured on a scale of 0-10, with 0 being no pain and 10 being the worst pain imaginable. The functional performance was measured by the Canadian Occupational Performance Measurement questionnaire. Among all patients, there were 4 cases affecting the upper extremities, 4 affecting the lower extremities, and 3 affecting the truncal region. Five of 8 patients demonstrated a reduction in lymphedema with an average girth reduction of 8.2% in the lower extremities, 3.0% in the upper extremities, and 7.4% in the truncal regions. In unilateral cases, the difference in limb circumference between the affected and normal extremity decreased by an average of 25.6%. Four patients completed the Canadian Occupational Performance Measurement questionnaire with an average improvement of 30% in daily task performance. Three patients reported complete resolution of pain. MLD can be used as a reliable noninvasive method for decongestion and analgesia to delay the onset of lymphedema-associated fibrosis and long-term disability in children with complex lymphatic malformations.

Motor Control Evaluation as a Significant Component in Upper Limb Function Assessment in Female Breast Cancer Patients after Mastectomy.

Breast cancer is the most prevalent malignancy among women. Conservative and operative treatment methods are associated with a risk of side effects pertaining to the shoulder complex. The surgery complications including chronic pain, upper limb and chest lymphedema, range of motion limitations, and motor control deficiencies may lead to upper limb function impairment and affect the quality of life negatively. Twenty-three women were examined in the tested group and twenty-two women in the control group. The motor control was assessed with dissociation tests as defined by Comerford and Mottram. In order to assess patient-perceived upper limb disability, the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was used. The test of glenohumeral (GH) abduction control in frontal plane and in scapular plane and medial rotation control outcomes were found to be statistically significant. It pertains to both: Comparison between groups and analysis within the tested group—body sides comparison. The DASH questionnaire results analysis indicates that there was a higher degree of subjectively perceived disability of upper limb in the tested group. Surgical interventions in the breast cancer treatment and other medical procedures affect the level of motor control and perceived disability of upper limb negatively in this group of patients. Movement faults are statistically more prevalent in the tested group. Movement faults are more prevalent on the operated side in the tested group.