Limb Disorders Research Articles

Efficacy of quantifying marker-cluster rigidity in a multi-segment foot model: a Monte-Carlo based global sensitivity analysis and regression model

Marker-based clinical gait analysis and multi-segment foot models (MSFM) have been successfully used for the diagnosis and clinical management of various lower limb disorders. The accuracy and validity of the kinematics measured depend on the design of the model, as well as on the adherence to its inherent rigid body assumption. This study applies a Monte-Carlo based global sensitivity analysis to evaluate the efficacy of using ‘rigid body error ()’ in quantifying the rigidity of a MSFM marker-cluster. A regression model is proposed. It is concluded that is effective in quantifying rigidity.

Foot Arch and Plantar Pressure in the Age of 17-21 Years

Research on the plantar segment has not been widely carried out in Indonesia’s population, even though the plantar segment data will be essential in further research and therapy of plantar-related problems. Therefore, this research intends to describe the plantar profile: the foot arch and the plantar pressure difference between the right and left foot. This research applied a cross-sectional study. Subjects were recruited from the Faculty of Medicine students, Universitas Indonesia, class 2012, with inclusion criteria aged 17-21 years and normal gait. Meanwhile, the exclusion criteria consisted of having postural abnormalities, a history of neuromusculoskeletal disorders in the lower limbs, a history of fractures in the spine and legs, a history of surgery on the spine and legs, and refusing to participate in the study. Research subjects stood on a plantar scanner, conducted at the Anatomy Laboratory, the Faculty of Medicine, Universitas Indonesia. The Mann-Whitney test was then used to analyze the difference in plantar pressure between the right and left foot. The results revealed that a hundred research subjects had a proportion of a low foot arch of 4%, a normal foot arch of 89%, and a high foot arch of 7%. The median right plantar pressure was 273.5 KPa, while the median left plantar pressure was 253.5 KPa. The Mann-Whitney test showed a p-value of 0.954 for the pressure difference between right and left foot. There was no plantar pressure difference between the right and left foot.

‘radical gleaning’: Doing Prac Crip

This article develops what I call ‘prac crip’ as an innovative methodology to perform on the page the scholarly realities of working, living and writing with the disability of repetitive strain injury. Prac crip is a prac crit of crips that complicates liberatory crip criticism. It shows how repetitive strain injury changes an approach to practical criticism, but also, by association with ‘crit’, how practices of practical criticism with repetitive strain injury shift some key uses of the ‘crip’. Critical of this mode of cripping as well as cripical, prac crip demonstrates the emancipatory limits of practising crip criticism for those crips the work also hurts in the act.Peter Larkin’s fascination with gleaning runs parallel to the rise of lean. To glean and its derivatives have a ‘distinctive presence’ in his lexis from Pastoral Advert (1988) to Seven Leaf Sermons (2018), a thirty-year period during which lean management has become increasingly global. The article traces through Larkin the eco-politically crucial relationships between the common right of gathering after harvest known as gleaning, historically, a practice for disabled people; the gesture of leaning; and the genealogy of global lean management technologies in the packing of lean meat. The essay explores how disability is an integral part of how its readings are produced, as well as addressing the predicament that work-related upper limb disorders, which are driven by lean managed environments, continue to be driven by writing against lean managed environments.

Design and control of a sit-to-stand assistive device based on analysis of kinematics and dynamics

Sit-to-stand is a common activity in daily life. It is difficult for the elderly and patients with lower limb disorders to complete this motion due to limb pain, muscle weakness, partial loss of motor control function, and physical defects in joints. An STS assistive device is a piece of automated medical equipment that can facilitate rehabilitation training for patients with lower limb disorders and improve their lower limb function. In this paper, we introduce a 3-DOF series type STS assistive device. First, we selected 26 healthy adults to carry out an STS transfer experiment, and we obtained the trajectory and velocity of each joint and the law of plantar pressure during STS motion. Second, based on the above kinematics and dynamics law, a 3-DOF series mechanism was designed. Through forward and inverse kinematics analysis, the relationship between the end-effector and the linear actuator was established. The trajectory planning of the end-effector was carried out according to the natural STS transfer trajectory, and the law of the linear actuator was obtained. The trajectory planning was verified by ADAMS. Finally, the Arduino controller was used to build the control system of the STS assistive device, and the prototype experiment was carried out.

Developments in work-related upper limb disorders (WRULD) amongst Dutch university students from 2004 to 2014.

Former studies on work-related upper limb disorders (WRULD) within university education report substantial prevalence rates. In this study, developments in WRULD amongst students in the period 2004-2014 were investigated. Our findings can be a benchmark for future studies, in particular when there are major societal changes as in the case of the COVID-19 pandemic. Differences in time (academic year), how long students have been studying (year of studying), relations with computer time and societal changes were points of interest. 2254 students (average age 20.0 years) responded to a questionnaire on WRULD. Students experiencing complaints were further questioned about the severity of complaints and associated body locations. The average percentage of students experiencing complaints was 57%. The highest prevalence rates and severity scores were found in the first and last recorded academic years. The neck, shoulder, back and wrist were most often indicated. The prevalence of complaints raised from the 1st (49%) to the 4th (75%) year of studying. Two seriousness measures showed highest scores in the 5th/6th/7th year of studying. Relations were found between both the prevalence and seriousness of complaints with reported computer time. After an initial decreasing trend from the academic year 2006/2007 to 2010/2011 there was an increase in WRULD amongst students from 2010/2011 to 2013/2014. Limiting financial and study time factors may have played a role. Structural attention for WRULD prevention and risk factors seems to be effective in reducing prevalence and severity of WRULD. This seems to be even more necessary due to recent COVID-related changes in the students' lives.

Developing countries and the use of ISO Standard 11228-3 for risk management of Work-Related Musculoskeletal Disorders of the Upper Limbs (WRMSDs-ULs): The case of Chile

Work-Related Musculoskeletal Disorders of the Upper Limbs (WRMSDs-ULs) are one of the most common occupational diseases worldwide. Repetitive motion is one of the main risk factors associated with these conditions. Several efforts have been made within the scientific community in order to develop specific methods to assess the risk that repetitive work represents. Furthermore, internationally coordinated work has resulted in the generation of a series of ISO standards to address issues around ergonomics in the workplace. In 2012, Chile adopted the ISO11228-3 standard checklist in its regulatory process, creating the first technical standard of risk management for repetitive motion. The aim of this study is to present the results of a nation-wide online survey of Chilean Health and Safety Practitioners and Ergonomists, which was conducted in order to identify their level of application experience, most commonly adopted practices, and opinions on the first Chilean Standard for WRMSDs-ULs risk assessment. A second aim is to discuss common issues and possible improvements in public policies, and the adoption of international instruments by developing countries. A total of 331 respondents completed the survey (183 Ergonomists and 148 non-ergonomist). It was observed that a number of the participants consider that the adaptation of the ISO standard has several issues, ranging from simple ones as wording and format to more complex ones regarding overall structure, logic, and ease of use. One of the main issues expressed is the fact that during the adaptation process the instrument is applied in multitask jobs, without providing clear instructions or training. Furthermore, among the top three most used assessment methods were RULA and REBA, which are posture-driven, instead of methods validated for repetitive motion. The issues detected by the Chilean OHS practitioners are common in developing countries, where an intersection of lack of resources, public agency authoritarianism, and poor communication between public-private and public-public organizations contribute to poor consultation, validation, and adaptation processes. Suggestions to improve the current Chilean standard, as well as considerations for developing countries, are presented.

Surface Electromyography and Electroencephalogram-Based Gait Phase Recognition and Correlations Between Cortical and Locomotor Muscle in the Seven Gait Phases.

The classification of gait phases based on surface electromyography (sEMG) and electroencephalogram (EEG) can be used to the control systems of lower limb exoskeletons for the rehabilitation of patients with lower limb disorders. In this study, the slope sign change (SSC) and mean power frequency (MPF) features of EEG and sEMG were used to recognize the seven gait phases [loading response (LR), mid-stance (MST), terminal stance (TST), pre-swing (PSW), initial swing (ISW), mid-swing (MSW), and terminal swing (TSW)]. Previous researchers have found that the cortex is involved in the regulation of treadmill walking. However, corticomuscular interaction analysis in a high level of gait phase granularity remains lacking in the time–frequency domain, and the feasibility of gait phase recognition based on EEG combined with sEMG is unknown. Therefore, the time–frequency cross mutual information (TFCMI) method was applied to research the theoretical basis of gait control in seven gait phases using beta-band EEG and sEMG data. We firstly found that the feature set comprising SSC of EEG as well as SSC and MPF of sEMG was robust for the recognition of seven gait phases under three different walking speeds. Secondly, the distribution of TFCMI values in eight topographies (eight muscles) was different at PSW and TSW phases. Thirdly, the differences of corticomuscular interaction between LR and MST and between TST and PSW of eight muscles were not significant. These insights enrich previous findings of the authors who have carried out gait phase recognition and provide a theoretical basis for gait recognition based on EEG and sEMG.

Study of Biomechanical Risk Factors for Musculoskeletal Disorders in the Bakery Business Based on ART and OCRA Index

Background:Bakery workers, Beacause of their nature, are at risk of musculoskeletal disorders caused by ergonomic factors. The purpose of this study was to evaluate the biomechanical risk factors for musculoskeletal disorders in bakery workers. Methods: In the current study, all tasks of sangak, taftoon, and lavash bakery in Gonabad were selected based on the census method. Next, Hierarchical Task Analysis (HTA) method was used for task analysis, and the job was degraded to tasks, actions, and movements. For the following step, the ART and OCRA method was implemented to identify common risk factors in repetitive tasks that can contribute to developing musculoskeletal disorders of upper limbs. Analysis of the results in this study was performed using SPSS 17. Results: According to the results study, the ART and OCRA index score for shater and chonegir tasks for all three kinds of bakeries is at high risk (red zone). In ART index score of arm movements, repetition, force, head/neck posture, and back posture for shater and choonegir task in lavash and taftoon bakery and shater task in sangak bakery is in its maximum levels. This reflects the level of red risk and indicates that in these tasks, fast arm movements, repetition, force, head/neck posture, and back posture are recognized as major occupational risk factors in these tasks. Conclusion: The results showed that the risk of musculoskeletal disorders owing to repetitive tasks is relatively high in the bakery and ergonomic interventions are required to redesign the job. This study shows the use of the ART method as a practical, applicable, easy, and convenient method for evaluation and ergonomics interventions in repetitive work tasks.

Rehabilitation in multiple sclerosis in 2021

Patients with multiple sclerosis, despite advances in therapy, often suffer from locomotor impairment that limits their mobility and affect quality of life. Rehabilitation is part of the treatment of MS and has shown its beneficial effects in numerous studies. While traditional rehabilitation techniques remain in the limelight, new technologies are emerging and make it possible to improve the management of disabling symptoms. The aim of this update is to synthesize the new therapy techniques proposed in rehabilitation for patients with multiple sclerosis according to the symptoms as balance, gait, upper limb disorders, fatigue, spasticity and disease progression published over the past 5 years. With regard to balance and walking disorders, neuromotor rehabilitation, physical exercise, rhythmic auditory stimulation, gait robot training and exergaming are effective. Only physical exercise has shown a positive effect on fatigue management. Spasticity is improved by classic rehabilitation techniques however non-invasive brain stimulation are promising.The rehabilitation of upper limb dysfunctions uses various effective techniques such as the repetition of functional tasks in real or virtual situations. In case of a more severe disability, arm robots can be used to relearn the impaired movement. Action observation training in real or virtual situations is also effective. Finally, under certain conditions the constraint induced movement therapy is proposed. The effects of rehabilitation are not only positive on the pyramidal symptoms and fatigue but also increase neuroplasticity and perhaps a neuroprotective effect as shown in some studies.

Application of Rapid Upper Limb Assessment (RULA) for Designing a Lab-scale Flexible Conveyor

The limited area of laboratory space (3000 x 3000 mm) triggered the importance of designing a flexible conveyor to support practicum activities. The process design of flexible conveyor consist of 1) Planning and preparation of product specifications; collection of product ideas based on needs and material selection. 2) Designing concepts; product dimensions with anthropometric data approach eg. elbow height, forward knee height and hand grip distance. 3) Product design; schemes or sketches that are developed into products or technical objects. 4) Pictures and specifications of product manufacture; complete review of all product elements with geometry, dimensions and material. The Rapid Upper Limb Assessment (RULA) method is used to analyze product function by investigating disorders of the upper limbs consisting of group A; upper arm, forearm, wrist, and wrist rotation, then group B; neck, torso, and feet, which are measured by the degree of injury risk. From the anthropometry approach a flexible conveyor specification was obtained with a length of 2000 mm, a width of 610 mm, a minimum height of 544 mm, and a maximum height of 957 mm. The results of the final score assessment of the standing posture and sitting position that the RULA action category is 4, with a small level of risk and for action to take some time to come.

Effect of Traditional Plus Virtual Reality Rehabilitation on Prognosis of Stroke Survivors: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Virtual reality technology has begun to be gradually applied to clinical stroke rehabilitation. The study aimed to evaluate the effect of traditional plus virtual reality rehabilitation on motor function recovery, balance, and activities of daily living in stroke patients. Studies published in English before October 2020 were retrieved from PubMed, Embase, Web of Science, and the Cochrane Library. This study used RevMan 5.3 software for meta-analysis. A total of 21 randomized controlled trials were included, which enrolled 619 patients. Traditional plus virtual reality rehabilitation is better than traditional rehabilitation in upper limb motor function recovery measured by Fugl-Meyer Assessment-Upper Extremity (mean difference = 3.49, 95% confidence interval = 1.24 to 5.73, P = 0.002) and manual dexterity assessed by Box and Block Test (mean difference = 6.59, 95% confidence interval = 3.45 to 9.74, P < 0.0001). However, there is no significant difference from traditional rehabilitation in activities of daily living assessed by Functional Independence Measure (mean difference = 0.38, 95% confidence interval = -0.26 to 1.02, P = 0.25) and balance assessed by Berg Balance Scale (mean difference = 2.18, 95% confidence interval = -0.35 to 4.71, P = 0.09). Traditional plus virtual reality rehabilitation therapy is an effective method to improve the upper limb motor function and manual dexterity of patients with limb disorders after stroke, and immersive virtual reality rehabilitation treatment may become a new option for rehabilitation after stroke.

A study on the prevalence of musculoskeletal disorders among ageing workforce of Indian construction industry

Ageing work force is one of the leading causes behind the reduction in the rate of growth of the labour force in construction industries. Construction industry is a major source of employment worldwide after agriculture, and generally the primary one in urban areas. Manual material handling in construction industries causes musculoskeletal disorders affecting both upper and lower extremities of the body. Studies on lower limb problems due to dynamic work like handling of heavy loads in construction industries are scanty. To analyze the level of exertion, ergonomics risk factors and the prevalence of work-related lower limb disorders among the young and elderly construction workforce. 20 male construction workers in the age group of i) 20 to 30 years (golden age group); ii) 50 years and above were selected from a local construction site in Mumbai. Demographic data like age, height, weight, BMI, body fat, waist hip ratio and risk assessment by questionnaires study comprising QEC, NMQ, VAS, and LEFS were collected. Compared to the golden age group, the elderly subjects were found to feel uncomfortable to their lower back, knee and calf due to the immoderate forces and motions applied to their lower limbs during their daily work. Muscle pliability and proper coordination diminishes with age and it is appearing to be the most probable reason behind the pain experienced in their lower limbs might be due to improper techniques and postures. For elderly workers, age related limitations become an additional factor to maintain their normal work life.

Lymphedema of the upper limb think of Kaposi sarcoma

A 58 year old man, heterosexual with no past medical-surgical history, came to the dermatology for oedema with skin disorders of the right upper limb evolving for 9 months. Clinical examination revealed a red oedema, firm and painful around the right upper limb with multiple purplish red papulo-nodular lesions (Figure 1). Confluent keratosic tuberous lesions on the right hand (Figure 2) and fissured palmar keratoderma (Figure 3) were seen. Buccal examination revealed violaceous papulo-nodular lesion (Figure 4).

Development of an integrated, holistic care package for people with lymphoedema for use at the level of the Primary Health Care Unit in Ethiopia.

BackgroundNeglected Tropical Diseases (NTDs) are a group of several communicable and non-communicable diseases prevalent in tropical and subtropical areas. The co-endemicity of these diseases, the similarity of their clinical signs, and the need to maximize limited financial and human resources suggest the importance of adoptingan integratedapproach to their prevention and treatment.AimsThis study describes the development of a comprehensive package of physical, mental health and psychosocial care for people with lower-limb lymphoedema caused bypodoconiosis, lymphatic filariasis (LF)or leprosy as part of the EnDPoINT program in Ethiopia.MethodThe care package was developed using a mixed-methods approach, consisting of a literature review, situational analysis, Theory of Change (ToC) workshops, qualitative research, and additional workshops to fine-tune the draft care package. The care package was developed between March 2018 and January 2020 in Addis Ababa and the implementation research site, Awi zone in the North-West of Ethiopia.ResultsThe holistic care package includes components implemented at three levels of the health care system:health organization, facility, and community. Sections of the care package are directed at strengthening capacity building, program management, community engagement, awareness-raising, stigma-reduction, morbidity management, disability prevention, follow-up visits, referral linkage, community-based rehabilitation, and monitoring and evaluation.ConclusionsThe study developed a holistic integrated care package for lower limb disorder and co-morbid mental health problems caused by podoconiosis, LF or leprosy. The approach has the potential to significantly reduce lower limb disorder-associated morbidity, disability, and psychosocial problems. It also standardizes a scalable approach appropriate for the Ethiopian setting and, most likely, other countries where these NTDs are present.

Co-contraction in patients with obstetric palsy (literature review)

The frequency of obstetric palsy ranges from 0.5 to 3.0 cases per 1000 live births. The functional outcome disorders are determined by the nature of the damage and the number of damaged roots of the brachial plexus. There are 50 % of patients have complete recovery, 15 % have severe functional disorders of the upper limb, and 35 % have some limitation of the shoulder joint function. There are 3 variants of residual phenomena in children with obstetric palsy: paresis, paralysis, and co‑contraction. The article describes the mechanisms of nerve regeneration in children and adults, the pathogenesis of contractions and motor disorders in general in children with obstetric palsy, and modern methods of treatment of co‑contraction. This article will be useful for neurologists, rehabilitation specialists, and orthopedists.

A Review: Sensory System, Data Processing, Actuator Type on a Hand Exoskeleton Design

A rehabilitation device for a post-stroke is essential because stroke attacks can cause disable to part or half of the human body. An exoskeleton could be a vital device for rehabilitation for a post-stroke patient. Several studies have proposed the exoskeleton design for rehabilitation purposes to a human limb disorder. This study aims to review the state-of-the-art of hand exoskeleton devices based on myoelectric or any other sensors. This paper is expected to contribute to design a hand exoskeleton device using both myoelectric and force sensors. This was achieved by reviewing several articles related to the development of the exoskeleton, especially in the sensor system, data processing, and actuator system. The results show that the use of Ag electrode disposable Ag (AgCl) is still commonly found to detect the movement of the fingers on the hand because this sensor can reduce the artifact noise. The use of myo-armband is also found in several studies because it has wireless properties so that it is easy to use. In terms of processors, Arduino microcontrollers are more widely used than others. In order to activate the hand exoskeleton, servo motors are more widely used to actuate the finger joints, which is more precise than other actuators. In a further development, integration between exoskeleton systems and information systems will be an expected challenge. Furthermore, hopefully, the development of this exoskeleton can be applied as a rehabilitation device for patients with malfunction or hand paralysis.

Lower limb rehabilitation exoskeleton robot: A review

Lower limb rehabilitation exoskeleton robots (LLRERs) play a positive role in lower limb rehabilitation and assistance for patients with lower limb disorders, and they are helpful to improve patients’ physical status. More and more experiments pay more attention to the kinematic and dynamic data characteristics of different patient groups. However, it is not clear whether these devices have broad adaptability and their clinical significance, so it is necessary to summarize and analyze these research results. This paper summarizes the LLRERs prototype and product in recent years, also compares the advantages and disadvantages of the theory and technology used in these research, and compares the functional characteristics of the devices, finally summarizes the aspects of the LLRERs to be improved. These devices apply advanced theories, techniques or structures, as well as human kinematics and dynamics data. However, due to the complexity of human body characteristics and movement rules, the theory or technology applied in the study design of LLRERs remains to be further studied, which can be improved in many aspects, such as improve the human-computer cooperation of equipment or carry out clinical trials. This paper can provide reference for researchers and designers in the future study, as well as understanding and selecting LLRERs for all kinds of therapist and patients.

Prevalence of Musculoskeletal Disorder of Upper Limb In Gardeners of Pakistan Horticulture Authority

For non-lethal professional traumas, the most prevailing injuries were nonfatal and ailment every year. However, for the fitness care and community based job occupation, half of the total absence because of ailment is reported at jobor due to job. Objective: To determine the Prevalence of Musculoskeletal Disorder of Upper Limb in Gardeners of PHA. Methodology: An observational study conducted Dash and VAS questionnaire used for the study. Data collected from gardeners of PHA. Participants participated voluntarily by completing a questionnaire with excellent reliability. The questionnaire contained many items to evaluate problems in shoulder, elbow and hand. The duration of the study were 4 months after approval of synopsis. A sample technique was convenient sample technique result analyzedwith SPSS version 21.Results: 185 participants are selected for study. Data collected from PHA gardeners.50 (23.9%)reported with severe difficulty that was highest frequency reported for severe difficulty while doing garden work in gardeners. Moderate difficulty reported with high frequency in gardeners while carrying heavy objects. Workactivities reported like hammering with high frequency of inability to perform this activity due to disability.it is also reported that gardeners are very limited in work .high frequency reported in severity of symptoms in shoulder,arm and hands in gardeners Conclusions: This study indicates gardeners are direct sufferers of musculoskeletal disorders with pain symptoms in shoulder, arm and hands.VAS scale measures showing upper limb disorderssymptoms are producing limitations in daily work.

Influence of the upper limb motor deficit on the functional independence in patients with cerebral palsy

Cerebral palsies (CPs) disturb the voluntary movement control at extremities’ level, entailing various disability degrees. In over 80% of the CP cases there is an upper limb disorder, mainly manifested by the decrease in hand control and the presence of contractures, which, in time, lead to the adoption of abnormal postures which affect the abilities of the CP patients’ hands. The aim of this study was to identify the way the motor deficit at upper limb level – reflected by coordination disturbances and by the condition of the three fingered (tripod) grasp – influences the CP patient’s functional independence. The study demonstrated the existence of significant correlations between Functional Independence Measure (FIM) score, coordination and three fingered grasp. It was proven that the unilateral coordination dysfunctions have a strong negative influence on the coordination of the opposite side and lead to a decrease of the functional independence level. Therefore, the rehabilitation treatment is recommended to be based on a bilateral training, both in order to improve coordination and to obtain a functional level of the three fingered grasp power and of the physiological amplitude at wrist flexion level.

The effectiveness of blood-flow restricted resistance training in the musculoskeletal rehabilitation of patients with lower limb disorders: A systematic review and meta-analysis

Objective: This meta-analysis aimed to evaluate the effectiveness of low-load Resistance Training (RT) with or without Blood Flow Restriction (BFR) compared with conventional RT on muscle strength in open and closed kinetic chains, muscle volume and pain in individuals with orthopaedic impairments. Data sources: Searches were conducted in the PubMed, Web of Science, Scopus and Cochrane databases, including the reference lists of randomised controlled trials (RCT’s) up to January 2021. Review method: An independent reviewer extracted study characteristics, orthopaedic indications, exercise data and outcome measures. The primary outcome was muscle strength of the lower limb. Secondary outcomes were muscle volume and pain. Study quality and reporting was assessed using the TESTEX scale. Results: A total of 10 RCTs with 386 subjects (39.2 ± 17.1 years) were included in the analysis to compare low-load RT with BFR and high or low-load RT without BFR. The meta-analysis showed no significant superior effects of low-load resistance training with BFR regarding leg muscle strength in open and closed kinetic chains, muscle volume or pain compared with high or low-load RT without BFR in subjects with lower limb impairments. Conclusion: Low-load RT with BFR leads to changes in muscle strength, muscle volume and pain in musculoskeletal rehabilitation that are comparable to conventional RT. This appears to be independent of strength testing in open or closed kinetic chains.