Limb Functional Activities Research Articles

Kirschner wire intramedullary fixation combined with improved nice knot-end cerclage temporarily fixation-assisted reduction before plate osteosynthesis in treating displaced and comminuted clavicle fractures

Background and objectiveNice knots have been used as an assisted reduction technique in surgery for displaced and comminuted fractures. This study aims to investigate the clinical efficacy of Kirschner wire intramedullary fixation combined with improved Nice knot-end cerclage temporarily fixation-assisted reduction before plate osteosynthesis in treating displaced and comminuted clavicle fractures.MethodsA retrospective study selected 210 patients with comminuted displaced clavicle fractures (January 2017–December 2020) in our hospital. The patients were divided into two groups via the fracture reduction method: the observation group (intramedullary Kirschner’s wire fixation combined with modified Nice node-to-end cerclage temporarily fixation-assisted reduction; n = 42) and the control group (including four subgroups with 42 cases in each subgroup, with assisted reduction methods of clamp fixation, screw fixation, square knot fixation and Kirschner wire fixation; each subgroup n = 42). The operation time, intraoperative bleeding, visual analogue scale (VAS) score at 24 h after the operation, healing time, postoperative limb functional activities, patients’ self-perception, subjective satisfaction and shoulder joint function were compared.ResultsThe operation time and the intraoperative blood loss of the observation group was significantly lower than that of each subgroup in the control group (p < 0.05). The VAS score of the observation group 24 h after the operation was significantly lower than that of each subgroup in the control group apart from the screw fixation group (p < 0.05). The Neer score of the observation group was significantly higher than that of each subgroup in the control group apart from the square knot fixation group (p < 0.05). The square knot is relatively better than the other four methods. Patients were generally satisfied with the modified Nice treatment.ConclusionThe use of a Kirschner wire intramedullary fixation combined with improved Nice knot-end cerclage temporarily fixation-assisted reduction before plate osteosynthesis in treating displaced and comminuted clavicle fractures can achieve satisfactory postoperative clinical results.

A Study to Find Out Effect of Trunk Training Exercises on Trunk Control by using Swiss Ball in Parkinson’s Patients: An Experimental Study

Background: The trunk being central key point of body, proximal trunk control is a pre-requisite for distal limb movement control, balance and functional activities. Sufficient trunk stability and control of trunk movements are essential for postural stability and normal gait as the upper body constitutes two thirds of the total body weight. In Parkinson’s disease approximately 13% to 33% of patients present with postural instability as their initial motor symptom. So, purpose of this study was to compare the effect of Swiss ball trunk training exercise and trunk exercise on a bed for trunk control in Parkinson’s patients. Method: Total 30 Parkinson’s patient were selected for the study as per selection criteria and divided into two groups (15 in each group). group A was treated with trunk exercise on Swiss ball and group B was treated with trunk exercise on bed. each subject received treatment for 3 weeks,4 days/week.an assessment was done prior to treatment and after 3 weeks using Trunk Impairment Scale test. Inter-group analysis by unpaired t-test showed statistically significant improvement on Trunk Impairment Scale. (P value ≤0.05) Conclusion: The Swiss ball trunk training exercise and trunk exercise on a bed had a significant effect on trunk control. Out of the two treatment Swiss ball trunk training had a more significant effect on improving trunk control.

Estimation of Hand Function Impairment in Breast Cancer Survivors with Lymphedema

Breast cancer (BC) is one of the most frequent cancers in women, and breast cancer-related lymphedema (BCRL) is a common side effect of BC treatment. When the lymphatic drainage system is damaged, lymphedema develops, which further exacerbates swelling and leads to pain, an increase in limb circumference, a reduction in joint range of motion, and a decrease in the use of the affected hand for functional tasks. Handgrip strength is essential for performing upper limb functional daily activities. Less is known about the long-term effects of lymphedema on hand function. The objective of the study was estimation of hand function impairment in BC survivors with lymphedema. This study was carried out by randomly selecting 100 out of 1,200 women with lymphedema, aged between 40 and 80 years, and who underwent sentinel lymph node biopsy along with radiotherapy, were included in this study. The handgrip strength was tested using an electronic handheld dynamometer. The functional wrist and hand scales were used to evaluate hand function. The Michigan Hand Outcome Questionnaire (MHQ) was used to evaluate the hand's overall function. A statistical analysis was done using SPSS statistical software (version 23.0). Handgrip strength of the affected hand by BCRL when compared with the unaffected hand was reduced. Functional hand and wrist scale have shown very poor results of the affected hand when compared with the unaffected hand. Majority of participants in the MHQ were unsatisfied with the overall functioning of the hand (p &lt; 0.0001). This study concluded that there was significant hand function impairment in BC survivors with lymphedema. BCRL had a negative impact on daily activities of the individual and also affected the mental, emotional, and social aspects. BCRL also had an impact on overall self-reported physical function and quality of life.

The effectiveness of the use of various methods of shock wave therapy in the complex treatment of athletes with lateral epicondylitis

The purpose of the study: to evaluate the effectiveness of various methods of shock wave therapy in the complex treatment of athletes with lateral epicondylitis.Materials and methods: the study involved 122 people. with a diagnosis of Lateral epicondylitis, aged 20 to 45 years, of which 55 (45.1 %) women and 67 (54.9 %) men. All patients were divided into 4 groups: a control group, which included 28 people who underwent standard treatment, and 3 groups, a total of 94 people, who underwent shock wave procedures using various methods against the background of standard treatment. The examination included the collection of complaints, anamnesis, physical examination, assessment of the function of the upper limb using the QuickDASH questionnaire, assessment of tennis elbow using the PRTEE questionnaire, carpal dynamometry was performed on a MEGEON-34090 dynamometer, and statistical methods. All studies were conducted before, after treatment, as well as after 3 weeks and 1 month. after treatment.Results: shockwave therapy applied to tendons, flexors of the hand, and triceps brachii outperformed shockwaves to tendons or tendons and flexors of the hand in terms of Upper Limb Functional Activity (DASH) (p &lt; 0,05) and score tennis elbow (PRTEE) (p &lt; 0,05) after 3 weeks and after 1 month after treatment.Conclusion: reducing the severity of pain syndrome and functional disorders of the upper limb when performing various types of activities, when conducting shock wave therapy on the area of the tendons, flexor muscles of the hand and the triceps muscle of the shoulder indicates a faster recovery of the functions of the upper limb, which is especially important for athletes.

Predictors of upper limbs’ function in patients with cervical tetraplegia

The aim of the study is to determine the predictors of upper limb functional motor activity in patients in the late period after spinal cord injury (SCI). The study included 190 patients with SCI: 151 men and 49 women. The mean age of patients was 30.0±12.9 years, the age of SCI - 1.9 [0.60; 5.40] years, in 93% of cases SCI was traumatic. Patients were classified using the ASIA International Neurological Standard. Upper limb function was evaluated using a short version of the Van Lushot Test (VLT). Stimulation electroneuromyography (SENMG) from the median and ulnar nerves was performed. The distribution at the motor level (ML) was as follows: C4-C6 - 117 patients; C7-D1 - 73 patients; depending on the severity of injury (SI): type A and B - 132 patients; upper limb motor score (ASIAarm) was 25.0±12.2, on VLT - 38.3±20.9. The factor loading of 10 factors was evaluated simultaneously in a linear discriminant analysis, the cut-off point was 20 and 40 scores on VLT (25 and 50% on the International Classification of Functioning, Disability and Health without the domain «balance»). According to SENMG, denervation changes were detected in 15% of median and in 23% of ulnar nerves. The rank significance for the VLT threshold of 20 scores was: ASIAarm - 100, functional tenodesis (FT) - 91, ML - 73, SI - 18; the classification tree had one branching at the ASIAarm point of 17.3 score. The rank significance for the threshold of 40 scores was: ASIAarm - 100, ML - 59, SI - 50, FT - 28, M response from the median nerve - 5; the classification tree had one branching at the ASIAarm point of 26.9 score. The results of multivariate linear regression analysis confirmed the highest factor loading of ML predictor, motor score for upper limb (ASIAarm) in both cases (R=0.67, R2=0.45, F=38.0, p=0.00 and R=0.69, R2=0.47; F=42.0, p=0.00, respectively). In the late period after a spinal injury the leading predicative value for functional motor activity has the motor score of ASIA for the upper limb. The ASIA score more than 27 scores is the prediction of moderate and mild impairments, and less than 17 - severe impairments.

EFFECTIVENESS OF PHYSIOTHERAPY INTERVENTION ON FUNCTIONAL ACTIVITIES OF LOWER LIMBS IN A PATIENT WITH POTT’S SPINE

Spinal Tuberculosis (TB) is also known as a disorder that typically leads to a progressive onset of neurological deficits. The anterior part of the vertebral body adjacent to the subchondral plate is the usual involvement site which occurs most often in the lower thoracic vertebrae. Vertebral collapse is a potential consequence of this disease and if this happens anteriorly, anterior wedging results, leading to kyphotic spine deformity. The present case report is of a 30-year-old male diagnosed with Potts spine, presented with neurological deficits and pain. He underwent 4 weeks of physiotherapy primarily focussing on lower limb functional activities. He was under medical management for same. After 4 weeks patient showed good clinical response towards therapy and there was a significant improvement in his range, strength and transitions involving lower limbs. Through this case report we want to conclude that medical and physiotherapy management should go on hand in hand to gain optimal functional recovery in patients with Pott’s Spine.

Rehabilitation Approaches for Knee Arthroplasty

Up to 25% of patients after knee arthroplasty are not satisfied with the results of the operation. Revision interventions are performed in 60–80% of cases in the first 2–5 years after the primary arthroplasty. Aim. To evaluate the effectiveness of the early postoperative rehabilitation comprehensive program from the standpoint of the International Classification of Functioning (ICF) to improve the results of rehabilitation after arthroplasty. Material and methods. The results of 180 patients rehabilitation after the total knee arthroplasty (TKA) with simultaneous reconstruction of the lower limb biological axis were evaluated in two groups: I – observations (n=120), II – comparisons (n=60). Postoperative rehabilitation in the group I was carried out according to of the early rehabilitation comprehensive program after TKA, developed in the clinic, in the group II – according to the standard scheme. State of the patient was assessed by the dynamics of the pain syndrome, lower limbs muscle strength, goniometric indicators, the severity of lameness, muscle hypotrophy, limb shortening value, functional activity and quality of life. For analysis of changes in the level of damage according to the ICF, clinical tests were used. Results. From the standpoint of the ICF, the results of patients using the early postoperative rehabilitation program were equal or superior to the results of the comparison group. Conclusion. A rehabilitation program for patients after TKA, formed on the basis of a system for assessing the structural, functional and social adaptation characteristics of the patient, is effective and allows to predict the effectiveness of the rehabilitation technologies.

Relationship between the more-affected upper limb function and daily activity performance in children with cerebral palsy: a cross-sectional study

BackgroundThere are differences in roles between the more-affected and less-affected upper limb of children with cerebral palsy (CP). However, there is a lack of studies of the relationship between the more-affected limb function and activities of daily living (ADL) in children with CP. Thus, the aim of this prospective cross-sectional study was to investigate the relationship between more-affected upper limb function and ADL in children with CP.MethodsChildren with spastic CP (unilateral CP n = 28, bilateral CP n = 31; 34 males, 25 females; mean age ± SD, 6.8 ± 3.1y [range, 3-14y]) participated in this study. Function of the more-affected upper limb was measured using the Melbourne Assessment of Unilateral Upper limb Function, version 2 (MA2) and the Upper Limb Physician’s Rating Scale (ULPRS). Performance of daily living activities was measured using the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT).ResultsThe range, accuracy and fluency dimension of MA2 and ULPRS total scores were moderately correlated with the daily activity domain (r = 0.47, 0.47, 0.56 for MA2 and r = 0.50 for ULPRS, respectively; P < 0.001) rather than the mobility, social/cognitive, and responsibility domains of the PEDI-CAT. ULPRS scores for elbow extension, supination in extension, supination in flexion, and two-handed function were moderately correlated with the PEDI-CAT daily activity domain (r = 0.44, 0.43, 0.41, and 0.49, respectively; P < 0.01). Finger opening and thumb-in-palm deformity of the ULPRS did not correlate with any PEDI-CAT domain.ConclusionsThe MA2 range, accuracy, and fluency domains (rather than dexterity) had the strongest correlations with the PEDI-CAT daily activity domain. Elbow extension, forearm supination, and two-handed function (rather than wrist and finger movements) of the ULPRS had the strongest correlations with the PEDI-CAT daily activity domain.

Health-related physical fitness in patients with complaints of hand, wrist, forearm and elbow: an exploratory study

ObjectivesLittle is known about the physical fitness of patients with complaints of hand, wrist, forearm and/or elbow and its possible determinants. Aims were to assess health-related physical fitness (HRPF) in...

Effect of Immersive Virtual Reality-Based Bilateral Arm Training in Patients with Chronic Stroke.

Virtual reality (VR)-based therapies are widely used in stroke rehabilitation. Although various studies have used VR techniques for bilateral upper limb training, most have been only semi-immersive and have only been performed in an artificial environment. This study developed VR content and protocols based on activities of daily living to provide immersive VR-based bilateral arm training (VRBAT) for upper limb rehabilitation in stroke patients. Twelve patients with chronic stroke were randomized to a VRBAT group or a normal bilateral arm training (NBAT) group and attended 30-min training sessions five times a week for four weeks. At the end of the training, there was a significant difference in upper limb function in both groups (p < 0.05) and in the upper limb function sensory test for proprioception in the NBAT group (p < 0.05). There was no significant between-group difference in upper limb muscle activity after training. The relative alpha and beta power values for electroencephalographic measurements were significantly improved in both groups. These findings indicate that both VRBAT and NBAT are effective interventions for improving upper limb function and electroencephalographic activity in patients with chronic stroke.

Effectiveness of hand splints on upper limb skills and functional activities in children with cerebral palsy: a review

Cerebral Palsy is a non-progressive neurological disorder in which children may experience similar physical limitations, including those related to upper limb skills that affect the child's ability to participate in age-specific activities. The use of hand-splints in children with neurological conditions is little reported, they continue to be widely used to improve upper limb skills and functional activities. This review was done to investigate the use and effects of hand splints in Cerebral Palsy patient as orthotic treatment found to be very positive result in correcting and maintaining the achieved results. Electronic database search was conducted using Google scholar, Science direct, Pub Med, Cochrane Library and reference lists from all retrieved articles. Common problems in upper limb due to CP are flexion contractures of the fingers and wrist due to spasticity, pronation deformity of the forearm, thumb-in-palm deformity and hand-related disabilities, all lead to decrease in grip and muscle strength. Hand splints are often used to help a weak or ineffective joint or muscle to enhance a person's arm or hand posture, mobility, quality of motion, and function. The findings suggest that children with CP experience increased grip strength and fine motor dexterity when using different hand splints. This review summarizes the present state of understanding the extent to which orthotic management in CP can improve in the patient’s skills and functional activities by improving the muscle strength and hand function, also offers clinical suggestions for prescribing orthosis in order to optimize efficacy.

Effect of rehabilitation robot rehabilitation training synchronizing acupuncture exercise therapy on postoperative rehabilitation with hip fracture

To compare the therapeutic effect between rehabilitation robot rehabilitation training synchronizing acupuncture exercise therapy and simple acupuncture exercise therapy on lower limb function and life activity ability for postoperative patients with hip fracture. A total of 50 elderly postoperative patients with hip fracture were randomly divided into an observation group and a control group, 25 cases in each group. Both groups were treated with acupuncture at hip three points of the affected side and lateral line 1 of vertex, anterior oblique parietotemporal line of the healthy side, hip three needles were retained for 30 min. The scalp acupuncture needles were continue retained, the observation group was given acupuncture exercise therapy to synchronize lower limb rehabilitation robot rehabilitation training, and the control group was given acupuncture exercise therapy. The two groups were treated once a day, 7 times as a course of treatment, and totally 4 courses were required. The Harris score, Barthel index score and quadriceps femoris isokinetic muscle strength indexes [peak torque (PT), average power (AP), flexor peak torque/extensor peak torque (F/E)] were compared between the two groups before and after treatment. After treatment, the Harris score, Barthel index score, PT and AP were higher than those before treatment (P<0.05), and F/E was lower than that before treatment in the two groups (P<0.05). After treatment, the Harris score, Barthel index score, PT and AP in the observation group were higher than those in the control group (P<0.05), and the F/E in the observation group was lower than that in the control group (P<0.05). Rehabilitation robot rehabilitation training of lower limbs synchronizing acupuncture exercise therapy could enhance the hip joint activity function and quadriceps muscle group function of elderly postoperative patients with hip fracture, and effectively improve the lower limb function and life activity ability.

Innovative Long-Dose Neurorehabilitation for Balance and Mobility in Chronic Stroke: A Preliminary Case Series.

(1) Objective: The objective was two-fold: (a) test a protocol of combined interventions; (b) administer this combined protocol within the framework of a six-month, intensive, long-duration program. The array of interventions was designed to target the treatment-resistant impairments underlying persistent mobility dysfunction: weakness, balance deficit, limb movement dyscoordination, and gait dyscoordination. (2) Methods: A convenience sample of eight chronic stroke survivors (>4 months post stroke) was enrolled. Treatment was 5 days/week, 1–2.5 h/day for 6 months, as follows: strengthening exercise, balance training, limb/gait coordination training, and aerobic exercise. Outcome measures: Berg Balance Scale (BBS), Fugl-Meyer Lower Limb Coordination (FM), gait speed, 6 Minute Walk Test (6MWT), Timed up and Go (TUG), Functional Independence Measure (FIM), Craig Handicap Assessment Rating Tool (CHART), and personal milestones. Pre-/post-treatment comparisons were conducted using the Permutation Test, suitable for ordinal measures and small sample size. (3) Results: For the group, there was a statistically (p ≤ 0.04) significant improvement in balance, limb movement coordination (FM), gait speed, functional mobility (TUG), and functional activities (FIM). There were measurable differences (minimum detectible change: MDC) in BBS, FM, gait speed, 6MWT, and TUG. There were clinically significant milestones achieved for selected subjects according to clinical benchmarks for the BBS, 6MWT, gait speed, and TUG, as well as achievement of personal milestones of life role participation. Effect sizes (Cohen’s D) ranged from 0.5 to 1.0 (with the exception of the (6MWT)). After six months of treatment, the above array of gains were beyond that reported by other published studies of chronic stroke survivor interventions. Personal milestones included: walking to mailbox, gardening/yardwork, walking a distance to neighbors, return to driving, membership at a fitness center, vacation trip to the beach, swimming at local pool, returning to work, housework, cooking meals. (4) Conclusions: Stroke survivors with mobility dysfunction were able to participate in the long-duration, intensive program, with the intervention array targeted to address impairments underlying mobility dysfunction. There were either clinically or statistically significant improvements in an array of measures of impairment, functional mobility, and personal milestone achievements.

Respiratory Function and Upper Extremity Functional Activity Performance in People With Dementia: A Shout for Attention

The aim of this study was to explore respiratory function and upper extremity functional activity in people with dementia (PWD) and the associations between these variables and cognitive function (n = 22 institutionalized PWD, 28 community-dwelling PWD, and 26 healthy older people). All measures were significantly lower in PWD who live in an institution, such as a nursing home or long-term care facility or who attend adult daycare than PWD who live in a community dwelling . The values from these two groups were significantly lower than those from healthy older people. Moderate to high negative correlations between upper extremity functional activity and respiratory function (-.73 < rs < -.49) and cognitive function (rs = -.83), and between cognitive function and respiratory function (-.74 < rs < -.58) were identified (p < .001). When adjusted for cognitive function (-.38 < rs < -.29; p < .05), the association between upper limb functional activity and respiratory function decreased. The decline demonstrates the importance of physical activity and cognitive and respiratory function in PWD.

Effect of augmented biofeedback for improvement of range of motion and upper extremity functionality in obstetric brachial plexus injury: a randomised control trial

Background/Aims The loss of mobility and functional activities of the upper limb are the main longstanding complications of obstetric brachial plexus injury. The aim of this study was to investigate the effect of the augmented biofeedback system in conjunction with traditional physical therapy on the range of motion and functional activities in children with obstetric brachial plexus injury. Methods A total of 45 children aged from 6 to 10 years with obstetric brachial plexus injury were assigned into two groups. The control group received a traditional physical therapy programme, and the study group received the same programme with augmented biofeedback for 6 weeks. The main outcome parameters were the upper limb active range of motion, Mallet scale and Active Movement scale. Results The children in the study group showed greater significant improvement in all measured parameters compared with those in the control group. Conclusions Adding augmented biofeedback to the physical therapy programme provided greater improvement in upper limb mobility and functional activities for children with obstetric brachial plexus injury children.

Facilitating Upper Limb Function using Assistive Technology in a Neurological Patient with Bilateral Upper Limb Impairment: A Case Report

Purpose: A combination of a stroke and spinal cord injury adversely affecting both upper limbs is an unusual combination for a patient presenting for outpatient rehabilitation services. Although the management of these conditions in isolation is well documented, there is limited literature regarding rehabilitation for these conditions in combination, particularly the use of assistive technology in this setting. Methods: A case report is presented of a 53-year-old male referred for outpatient rehabilitation following a left-sided stroke, with resultant dense right sided hemiplegia. A pre-existing spinal cord injury had affected his left upper limb such that he had marked proximal weakness. This combination of impairments meant he was unable to perform even basic activities of daily living involving the upper limbs. A therapy program, led by an occupational therapist with support and input from the multi-disciplinary team, included the use of an assistive device (a mobile arm support) to facilitate functional upper limb activities. This greatly improved his ability to do upper limb functional activities. Conclusion: The use of an assistive device enabled the patient to engage in meaningful activities of daily living involving the upper limbs.

Physiotherapy Following Extensor Tendon Reconstruction in Zone 5-A Case Study

Background: Extensor tendon attrition in Rheumatoid arthritis is very common and if not treated properly, can lead to substantial loss of hand function. Here we present the rehabilitation of a 45 years female patient following extensor tendon reconstruction in zone 5. Materials and Method: The motor assessment included examination of active range of motion, grip and pinch strength and hand function was done during first visit and at the end of 3rd week, 6th week and 12th week. The patient received physiotherapy (immobilization method) and the program was divided into three phases. Results: The test results were used to find the efficacy of immobilisation method, author’s modification of the program and home based exercises. There was 60 to 80 percentile of ROM improvement in wrist joint, 50 to 90 percentile of ROM improvement in digits .By comparing 6th week and 12th week DASH there was about 47% improvement in upper limb functional activities The results show that the management combined with a comprehensive rehabilitation programme and commitment on the part of the patient makes it possible to achieve satisfactory treatment out comes enabling a return to normal daily functioning Conclusion: The functional recovery achieved indicates the advisability of using immobilisation method in post-operative rehabilitation of patients with extensor tendon injury.

To Know the Effectiveness of Rocker Board Training Programe on Trunk Balance and Gait in Subjects with Stroke

Stroke is a clinical syndrome with signs of focal or global disturbance of cerebral functions with apparent causes of vascular origin. Stroke is one of the leading causes of death and disability in India. As per available literature, in India 104.39 deaths per 1’00’000 populations. The incidence rate was 99.54 per 1,00,000 in men and 149.49 per 1,00,00 in women. 80 percent of stroke patents didn’t survive after 10 years. Moreover stroke patients face balance problems which limit lower limb functional activities which demand rapid and optimal improvement of postural control for their independence, social participation and general health. Balance training, on Rocker Board in sitting position has proved to be effective in improving balance in stroke patients, but there is no available study evaluated effectiveness of balance training program on Rocker Board in standing position which is an urgent need for stroke patients with difficulty in standing balance. To fill this gap, the present research work studied the effectiveness of Rocker Board training program on balance and gait in stroke patients with the help of‘Berg balance scale’(BBS), ‘Functional reach test’(FRT) and ‘Timed walking test’(TWT).Values obtained were compared by using a paired t-test. According to obtained values the pre and posttest values of BBS, FRT, TWT had shown a significant effect on ‘p’ values <0.05 in experimental group and after 6 weeks of intervention protocol, the present study concludes that the trunk balance and gait have significant improvement in experimental group than the control group

FES-UPP: A Flexible Functional Electrical Stimulation System to Support Upper Limb Functional Activity Practice.

There is good evidence supporting highly intensive, repetitive, activity-focused, voluntary-initiated practice as a key to driving recovery of upper limb function following stroke. Functional electrical stimulation (FES) offers a potential mechanism to efficiently deliver this type of therapy, but current commercial devices are too inflexible and/or insufficiently automated, in some cases requiring engineering support. In this paper, we report a new, flexible upper limb FES system, FES-UPP, which addresses the issues above. The FES-UPP system consists of a 5-channel stimulator running a flexible FES finite state machine (FSM) controller, the associated setup software that guides therapists through the setup of FSM controllers via five setup stages, and finally the Session Manager used to guide the patient in repeated attempts at the activities(s) and provide feedback on their performance. The FSM controller represents a functional activity as a sequence of movement phases. The output for each phase implements the stimulations to one or more muscles. Progression between movement phases is governed by user-defined rules. As part of a clinical investigation of the system, nine therapists used the FES-UPP system to set up FES-supported activities with twenty two patient participants with impaired upper-limbs. Therapists with little or no FES experience and without any programming skills could use the system in their usual clinical settings, without engineering support. Different functional activities, tailored to suit the upper limb impairment levels of each participant were used, in up to 8 sessions of FES-supported therapy per participant. The efficiency of delivery of the therapy using FES-UPP was promising when compared with published data on traditional face-face therapy. The FES-UPP system described in this paper has been shown to allow therapists with little or no FES experience and without any programming skills to set up state-machine FES controllers bespoke to the patient’s impairment patterns and activity requirements, without engineering support. The clinical results demonstrated that the system can be used to efficiently deliver high intensity, activity-focused therapy. Nevertheless, further work to reduce setup time is still required.

Functional levels and MRI patterns of muscle involvement in upper limbs in Duchenne muscular dystrophy

The aim of the study was to evaluate the spectrum of upper limb functional activities and imaging finding in a cohort of patients affected by Duchenne muscular dystrophy. Thirty-one patients of age between 5 and 29 years were included in the study (17 ambulant and 14 non-ambulant). They were all assessed using the Performance of Upper Limb (PUL) test and muscle MRI of shoulder, arm and forearm in order to establish if the functional scores obtained at shoulder, mid and distal level related to specific patterns of involvement in each upper limb segment on muscle MRI. At shoulder level, latissimus dorsi, serratus anterior, infraspinatus and subscapularis were always involved, even in patients with full functional scores at shoulder level. Diffuse and severe involvement of all muscles was found in the patients with a PUL shoulder functional score of ≤ 5. At arm level biceps brachii, brachialis and triceps were generally concordantly involved or spared. Some degree of involvement could already be detected in patients with reduced scores on the PUL mid domain. They were generally severely involved in patients with functional scores less than 6 at mid-level. At distal level supinator and pronator muscles were often involved, followed by brachioradialis and, less frequently, by the muscles of the flexor compartment. The extensor muscles were generally completely spared. A diffuse and severe involvement was found only in patients who had very low scores (8 or below) on the PUL distal domain. The integrated use of functional scales and imaging allowed to establish patterns of involvement at each level, and the functional scores that were more frequently associated with diffuse and severe involvement.