Individual Limb Research Articles

Investigating Relationships Among Interoceptive Awareness, Emotional Susceptibility, and Fatigue in Persons With Multiple Sclerosis.

Fatigue is a particularly debilitating symptom for people with multiple sclerosis (MS). Although personality traits and MS have been studied, interoception and emotional susceptibility and their links to fatigue have not yet been explored. Study participants provided demographic information and completed standardized patient-reported outcomes of walking function, physical activity, subjective fatigue, interoceptive awareness, and emotional susceptibility. A subset of participants participated in semistructured interviews discussing fatigue, body sensations, emotions, and their effects on exercise. Quantitative data were analyzed using multiple regression. Qualitative data were analyzed using thematic analysis. Mean ± SD Fatigue Severity Scale scores (5.0 ± 1.3) indicated that fatigue was a problematic symptom. Mean ± SD Multidimensional Assessment of Interoceptive Awareness, Version 2 (2.8 ± 0.6) and Emotional Susceptibility Scale (3.0 ± 1.0) scores indicated lower levels of interoceptive awareness and emotional susceptibility. Quantitative data indicated no relationship between fatigue and interoceptive awareness (β = -0.20; P = .88) and emotional susceptibility (β = 0.03; P = .83), and neither were these related to physical activity (β = -0.07; P = .64). Qualitative themes indicated strong fatigue experiences involving the whole body and individual limbs, anger and frustration, and effects on physical activity. Physically active people with MS report strong sensations of fatigue closely linked to frustration and helplessness. There was agreement between qualitative and quantitative assessments of fatigue but dissonance regarding interoceptive awareness and physical activity. The practice of clinicians, particularly those involved with facilitating or planning physical activity for persons with MS, would benefit from these findings about fatigue.

Comparison Of Lower Extremity Joint Coordination Between Limbs In Individuals With ACL Reconstruction During Landing

Individuals with anterior cruciate ligament reconstruction (ACLR) display smaller dorsiflexion angles (DFA) and knee flexion angles (KFA) during the landing and propulsive phases of jumping in their injured compared with their uninjured limb. Kinematic differences may be due to different sagittal plane ankle and knee joint coordination strategies that influence force attenuation and propulsion. PURPOSE: To compare peak DFA and KFA during landing and coordination pattern frequencies during the landing and propulsion phases of a drop vertical jump between the injured and uninjured limb of individuals with ACLR. METHODS: 15 females and 14 males with unilateral ACLR performed a drop vertical jump from a 30 cm box. Peak DFA and KFA were compared using paired t-tests. A modified vector coding technique and binning analysis were used to compare coordination patterns between sagittal plane DFA and KFA using Wilcoxon signed rank tests. RESULTS: The peak DFA was lower in the injured (121.07 ± 5.27°) compared with the uninjured (123.44 ± 4.70°) limb (Mean Difference: -2.37 [95%CI: -3.81, -.94], p = .002). The peak KFA was not different between the injured (-102.69 ± 14.78°) and uninjured (-103.77 ± 13.59°) limbs (Mean Difference: 1.08 [95%CI: -.66, 2.81], p = .215). The injured limb had more anti-phase (Z = -2.30, p = .022) and less exclusive knee flexion (KF) (Z = -2.11, p = .035) motion during landing than the uninjured limb. In-phase (Z = -.42, p = .676) and exclusive dorsiflexion (DF) (Z = -1.42, p = .157) motion were not different between the injured and uninjured limbs during landing. Anti-phase (Z = -1.32, p = .188), in-phase (z = -.69, p = .49), exclusive knee extension (Z = -1.85, p = .064), and exclusive plantarflexion (Z = -1.95, p = .052) motion were not different between limbs during propulsion. CONCLUSIONS: The injured limb had a smaller peak DFA, more simultaneous DF and KF, and less exclusive KF compared with the uninjured limb during landing. Individuals with ACLR may restrict peak DF in their injured limb during landing to limit isolated knee flexion as a protective mechanism to prevent anterior knee motion. More simultaneous DF and KF may be utilized to reduce the amount of force attenuation required from isolated KF. However, utilizing such a strategy for force attenuation may be perilous since the injured limb lands with less peak DF.

Longitudinal physiological remoulding of lower limb skin as a cause of diabetic foot ulcer: a histopathological examination.

Diabetic foot ulcer (DFU) is recognised as a severe complication in patients with type 2 diabetes. With the increasing incidence of diabetes, it represents a major medical challenge. Several models have been proposed to explain its aetiology; however, they have never been assessed by longitudinal histopathological examination, which this study aims to address. Multiplex-immunofluorescence analysis was carried out with lengthwise serial skin specimens obtained from the medial thigh, lower leg, ankle, dorsum of foot and acrotarsium close to the DFU region of a patient with type 2 diabetes receiving above the knee amputation. Proximal-to-distal gradual loss of peripheral nerve was demonstrated, accompanied by compromised capillaries in the superficial papillary plexus and distended CD31-positive capillaries in the dorsum of foot. Neural fibres and capillaries were also significantly compromised in the sweat gland acinus in the ankle and dorsum of foot. Injuries in the superficial papillary plexus, sweat gland acinus, and sweat gland-associated adipose tissues were accompanied by significant infiltration of macrophages. These results indicated that longitudinal impairment of local blood circulation could be the cause of peripheral neuropathy, which initiated ulcer formation. Resultant chronic inflammation, involving sweat gland-associated adipose tissue, gave rise to impairment of wound healing, and thus DFU formation. Longitudinal histopathological examination demonstrated that impairment of local microvascular circulation (rather than the systemic complication caused by type 2 diabetes) was considered the primary cause of peripheral neuropathy, which initiated ulceration. Together with chronic inflammation in the superficial papillary plexus and sweat gland-associated adipose tissue, it resulted in the development of a DFU. Although this is a study of just one individual's limb, our study provided a unique observation, contributing mechanistic insights into developing novel intervening strategies to prevent and treat DFUs.

A fluidic relaxation oscillator for reprogrammable sequential actuation in soft robots

A fluidic relaxation oscillator for reprogrammable sequential actuation in soft robots

Passive exercise increases cerebral blood flow velocity and supports a postexercise executive function benefit.

Executive function entails high-level cognitive control supporting activities of daily living. Literature has shown that a single-bout of exercise involving volitional muscle activation (i.e., active exercise) improves executive function and that an increase in cerebral blood flow (CBF) may contribute to this benefit. It is, however, unknown whether non-volitional exercise (i.e., passive exercise) wherein an individual's limbs are moved via an external force elicits a similar executive function benefit. This is a salient question given that proprioceptive and feedforward drive from passive exercise increases CBF independent of the metabolic demands of active exercise. Here, in a procedural validation participants (n=2) used a cycle ergometer to complete separate 20-min active and passive (via mechanically driven flywheel) exercise conditions and a non-exercise control condition. Electromyography showed that passive exercise did not increase agonist muscle activation or increase ventilation or gas exchange variables (i.e., V̇O2 and V̇CO2 ). In a main experiment participants (n=28) completed the same exercise and control conditions and transcranial Doppler ultrasound showed that active and passive exercise (but not the control condition) increased CBF through the middle cerebral artery (ps <.001); albeit the magnitude was less during passive exercise. Notably, antisaccade reaction times prior to and immediately after each condition showed that active (p < .001) and passive (p=.034) exercise improved an oculomotor-based measure of executive function, whereas no benefit was observed in the control condition (p=.85). Accordingly, results evince that passive exercise 'boosts' an oculomotor-based measure of executive function and supports convergent evidence that increased CBF mediates this benefit.

Kinematic Changes of the Lower Limb in Individuals With Chronic Ankle Instability During Unilateral Landing Tasks: A Systematic Review

Purpose: Ankle sprain is one of the most common sports injuries and many people suffer from chronic ankle instability after ankle sprains. Changes in the function of the lower limbs following chronic ankle instability make a person susceptible to re-injury of ankle sprains. This is a systematic review of studies that investigated the kinematic changes of the lower limbs in people with chronic ankle instability during unilateral jump landing tasks. Methods: Articles in English were searched in Google Scholar, Science Direct, PubMed, Scopus, ProQuest, and Cochrane Library databases without a time limit until 2021 with keywords related to “chronic ankle instability,” “kinematics,” and “single-leg jump-landing.” The inclusion criteria included the subjects being male and female with ankle instability and the type of single-leg jump-landing task. The modified checklist of Downs and Black (1998) was used to evaluate the quality of the studies. Results: Based on the inclusion and exclusion criteria and the study quality review, 15 articles out of 762 studies, which investigated the kinematics of the lower limbs in the performance of unilateral jump landing, were comprehensively examined. Conclusion: According to the findings of this study, individuals with chronic ankle instability showed kinematic changes in the lower limbs during various unilateral jump landing tasks. These changes are possible factors for the recurrence of ankle sprain injury. The findings show the necessity of developing and creating a rehabilitation program that comprehensively considers the kinematic changes.

The Role of Microglia/Macrophages Activation and TLR4/NF-κB/MAPK Pathway in Distraction Spinal Cord Injury-Induced Inflammation.

Distraction spinal cord injuries (DSCIs) often occur as the neurological complication of distraction forces following the implantation of internal fixation devices during scoliosis correction surgery. However, the underlying mechanism behind these injuries remains unclear. The present study aimed to explore the activation of microglia and macrophages, as well as changes in TLR4-mediated NF-κB and MAPK pathway activity after DSCIs in Bama miniature pigs. Prior to surgical intervention, the pigs were randomly divided into three groups: the sham group, the complete distraction spinal cord injury (CDSCI) group, and the incomplete distraction spinal cord injury (IDSCI) group. After surgery, the Tarlov scale and individual limb motor scale (ILMS) were used to evaluate changes in the pigs’ behavior. All pigs were euthanized 7 days after surgery, and histopathological examinations of the spinal cord tissues were performed. Immunohistochemistry was used to detect Caspase-3 expression in the anterior horn of spinal gray matter tissues. Immunofluorescence staining was utilized to assess the M1/M2 phenotype changes in microglia/macrophages and NF-κB P65 expression in central DSCI lesions, while western blotting was performed to determine the expression of TLR4/NF-κB/MAPK pathway-related proteins. The results of the present study showed that the Tarlov and ILMS scores decreased significantly in the two DSCI groups compared with the sham group. Hematoxylin and eosin (HE) and Nissl staining revealed that the tissue structure and nerve fiber tracts in the distracted spinal cord tissues were destroyed. Both DSCI groups showed the number of survived neurons decreased and the Caspase-3 expression increased. The results of the immunofluorescence staining indicated that the CD16 and CD206 expression in the microglia/macrophages increased. Between the two DSCI groups, the CDSCI group showed increased CD16 and decreased CD206 expression levels. The intensity of the fluorescence of NF-κB P65 was found to be significantly enhanced in pigs with DSCIs. Moreover, western blot results revealed that the expression of TLR4, p-IκBα, NF-κB P65, p-JNK, p-ERK, and p-P38 proteins increased in spinal cord tissues following DSCI. The present study was based on a porcine DSCI model that closely mimicked clinical DSCIs while clarifying DSCI-associated neuroinflammation mechanisms, in turn providing evidence for identifying potential anti-inflammatory targets.

Design of an Individual Cover for a Lower Limb Prosthesis

One of the modern trends in prosthetics and orthotics is the production of design covers for lower limb prostheses. Thanks to the advantages of CAD/CAM, there are no limits to the design of these covers. At present, there are companies that provide design covers produced by additive manufacturing, but their price is relatively high. In this work, the motivation and design procedure of an individual cover for a lower limb prosthesis for a specific user is discussed. The aim of this study is to propose a design methodology of an individual lower limb prosthesis cover using freely downloadable CAD software based on 3D scanning data, which will be produced by additive manufacturing technology.

Competing Models of Work in Quadrupedal Walking: Center of Mass Work is Insufficient to Explain Stereotypical Gait.

The walking gaits of cursorial quadrupedal mammals tend to be highly stereotyped as a four-beat pattern with interspersed periods of double and triple stance, often with double-hump ground reaction force profiles. This pattern has long been associated with high energetic economy, due to low apparent work. However, there are differing ways of approximating the work performed during walking and, consequently, different interpretations of the primary mechanism leading to high economy. A focus on Net Center of Mass (COM) Work led to the claim that quadrupedal walking is efficient because it effectively trades potential and kinetic energy of the COM. Individual Limbs COM Work instead focuses on the ability of the limbs to manage the trajectory of the COM to limit energetic losses to the ground (“collisions”). By focusing on the COM, both these metrics effectively dismiss the importance of rotation of the elongate quadrupedal body. Limb Extension Work considers work required to extend and contract each limb like a strut, and accounts for the work of body pitching. We tested the prescriptive ability of these approximations of work by optimizing them within a quadrupedal model with two approximations of the body as a point-mass or a rigid distributed mass. Perfect potential-kinetic energy exchange of the COM was possible when optimizing Net COM Work, resulting in highly compliant gaits with duty factors close to one, far different than observed mammalian gaits. Optimizing Individual Limbs COM Work resulted in alternating periods of single limb stance. Only the distributed mass model, with Limb Extension Work as the cost, resulted in a solution similar to the stereotypical mammalian gait. These results suggest that maintaining a near-constant limb length, with distributed contacts, are more important mechanisms of economy than either transduction of potential-kinetic energy or COM collision mitigation for quadrupedal walking.

Personalized digital humans for rehabilitation and assistive devices

Introduction: Ultrasound is routinely used by rehabilitation specialists to establish differential diagnosis of the residuum’s neuromusculoskeletal issues experienced by former and active Service Members suffering from limb loss1. Ultrasound offers real-time, non-ionizing, unspecialised facility assessment. Conventional imaging modalities record a qualitative static image. More fundamental signal/data display modalities such as the raw radio-frequency signal and A-mode are rarely utilised, although offer specialised opportunities, particularly for quantitative tissue characterisation, when the subject is mobile, and when several anatomical locations need to be synchronously assessed. Our aim is to develop a wearable ultrasound biosensor system that provides real-time assessment of various anatomical compartment dimensions within a post-amputation residual lower limb of former and active Service Members, termed Dynamic Anatomical Ultrasonography (DAU). Methods and results: The Olympus Omniscan MX is a highly-portable and rugged ultrasound instrument aimed primarily at the industrial sector. It incorporates the facility to connect up to eight individual single-element ultrasound transducers. A custom pseudo prosthetic socket was created for an asymptomatic subject, to which were attached two 1 MHz, 19 mm diameter ultrasound transducers, as shown in Fig. 1A. Ultrasound signal data was recorded for a defined measurement period of 10 seconds as the subject repeatedly lifted and lowered their thigh. Utilising the semi-automated time-gate signal detection facility, the depth of the femur bone surface was recorded, shown in Fig. 1B. Discussion/future directions: We have demonstrated the ability to monitor motions of the femur; of particular note is that measurements were obtained through the socket and silicone liner in addition to the overlying soft tissues. It is hypothesised that knowledge of the dynamic behaviour of the various tissue compartments will improve our understanding of the biomechanics associated with the residual limb of individuals suffering from limb loss and, furthermore, facilitate the fitting and development of bionics prostheses for former and active Service Members2. Our long-term aim is to investigate whether a combination of ultrasound and mechanical load biomarker data, fed into a ‘Digital Twin’ computational simulation will improve socket design, restore mobility, facilitate return to active duty, and, ultimately, enhance users’ quality of life. Acknowledgements: This work was supported by the FY19 Defense Medical Research and Development Program through the Joint Program Committee 8 / Clinical and Rehabilitative Medicine Research Program Restoring Warfighters with Neuromusculoskeletal Injuries Research Award (RESTORE) under Award No. W81XWH2110215-DM190659. Opinions, interpretations, conclusions and recommendations are those of the author and are not necessarily endorsed by the FY19 Defense Medical Research and Development Program. References 1Frossard LA, Powrie R, Langton CM. In-vivo kinestic system to sustain residuum health of service members with lower limb loss: from proof-of-concept to digital twin. Military Health System Research Symposium. Abstract #MHSRS-19-00882. Kissimmee, FL, US 2019:111 2Frossard LA, Lloyd DG. The future of bionic limbs. Res Feat 2021; 134:74-77. https://doi.org/10.26904/RF-134-7477

Altered mechanics and increased loading on intact limbs of individuals with a unilateral transtibial amputation in comparison with non-amputees during a start-stop task

Individuals with a unilateral transtibial amputation (ITTA) often experience greater loading on the intact limb during running and stepping tasks compared to individuals without amputation. This study aimed to investigate the mechanics of load absorption in the intact limb of ITTA and determine if increased ground reaction forces (GRF) persist during a start-stop task which (i) controlled touch-down velocity and (ii) removed the requirement for on-going locomotion. Data were collected using a twelve-camera motion capture system with two Kistler force platforms. Variables were extracted during the final loading phase of a 2-step start-stop task. The intact limb of ITTA and the dominant limb of able-bodied controls were compared using independent t-tests and effect size analysis. ITTA showed lower knee flexion angles at touchdown (p = 0.007, g = −1.43), and peak vertical GRF (p = 0.01, g = −1.33) compared to control subjects. ITTA also exhibited less hip (p = 0.14, g = 0.76) and ankle (p = 0.002, g = 1.82) absorptive power at touchdown and at peak vertical GRF (hip: p = 0.01, g = 1.23; ankle: p = 0.05, g = 0.97). ITTA exhibited greater peak vertical GRF (p = 0.01, g = 1.30) and braking GRF (p = 0.05, g = −0.96) on the intact limb compared to the controls. Our results indicate altered joint mechanics through the intact limb of ITTA are independent of the touchdown conditions or the need for ongoing locomotion. These altered joint mechanics increased loading experienced by the intact limb. Further work should be conducted examining a variety of other dynamic movements to fully understand the involved mechanics, so that intervention studies can be developed to reduce the load experienced by ITTA.

From fibre to function: are we accurately representing muscle architecture and performance?

ABSTRACTThe size and arrangement of fibres play a determinate role in the kinetic and energetic performance of muscles. Extrapolations between fibre architecture and performance underpin our understanding of how muscles function and how they are adapted to power specific motions within and across species. Here we provide a synopsis of how this ‘fibre to function’ paradigm has been applied to understand muscle design, performance and adaptation in animals. Our review highlights the widespread application of the fibre to function paradigm across a diverse breadth of biological disciplines but also reveals a potential and highly prevalent limitation running through past studies. Specifically, we find that quantification of muscle architectural properties is almost universally based on an extremely small number of fibre measurements. Despite the volume of research into muscle properties, across a diverse breadth of research disciplines, the fundamental assumption that a small proportion of fibre measurements can accurately represent the architectural properties of a muscle has never been quantitatively tested. Subsequently, we use a combination of medical imaging, statistical analysis, and physics‐based computer simulation to address this issue for the first time. By combining diffusion tensor imaging (DTI) and deterministic fibre tractography we generated a large number of fibre measurements (>3000) rapidly for individual human lower limb muscles. Through statistical subsampling simulations of these measurements, we demonstrate that analysing a small number of fibres (n < 25) typically used in previous studies may lead to extremely large errors in the characterisation of overall muscle architectural properties such as mean fibre length and physiological cross‐sectional area. Through dynamic musculoskeletal simulations of human walking and jumping, we demonstrate that recovered errors in fibre architecture characterisation have significant implications for quantitative predictions of in‐vivo dynamics and muscle fibre function within a species. Furthermore, by applying data‐subsampling simulations to comparisons of muscle function in humans and chimpanzees, we demonstrate that error magnitudes significantly impact both qualitative and quantitative assessment of muscle specialisation, potentially generating highly erroneous conclusions about the absolute and relative adaption of muscles across species and evolutionary transitions. Our findings have profound implications for how a broad diversity of research fields quantify muscle architecture and interpret muscle function.

Differences in paretic lower limb loading and fluidity in sit-to-walk according to selection of the leading limb in individuals with stroke

BackgroundSit-to-walk is an asymmetric task that is challenging for individuals with stroke, and paretic limb loading at seat-off and movement fluidity may change according to whether the non-paretic or paretic leg is used as the leading limb. This study aimed to investigate differences in paretic limb loading and fluidity depending on whether the non-paretic limb or paretic limb was used as the leading limb. MethodsThirty-eight individuals with stroke performed sit-to-walk with each leg as the leading limb, and their movements were measured using a 3D motion analysis system. The paired t-test or Wilcoxon signed-rank test was used to assess differences according to limb selection in paretic limb loading ratio at seat-off and fluidity (Fluidity Index: ratio of the lowest to peak forward velocity before first initial contact). FindingsTwenty-two of 38 participants preferred to use the paretic limb as the leading limb. When leading with the paretic limb, the paretic limb loading ratio was significantly larger (p = 0.002), and the Fluidity Index was lower (p = 0.007). InterpretationSit-to-walk with the paretic leading limb seems to be an adaptive movement because many participants preferred leading with the paretic limb. However, selection of the leading limb in sit-to-walk involves a biomechanical tradeoff between paretic limb loading at seat-off and movement fluidity in individuals with stroke. Use of the paretic leading limb requires loading capacity of this limb, and the non-paretic leading limb must have high balance ability to merge sit-to-stand and gait initiation.

Terrestrial force production by the limbs of a semi-aquatic salamander provides insight into the evolution of terrestrial locomotor mechanics.

Amphibious fishes and salamanders are valuable functional analogs for vertebrates that spanned the water-land transition. However, investigations of walking mechanics have focused on terrestrial salamanders and, thus, may better reflect the capabilities of stem tetrapods that were already terrestrial. The earliest tetrapods were likely aquatic, so salamanders that are not primarily terrestrial may yield more appropriate data for modeling the incipient stages of terrestrial locomotion. In the present study, locomotor biomechanics were quantified from semi-aquatic Pleurodeles waltl, a salamander that spends most of its adult life in water, and then compared with those of a primarily terrestrial salamander (Ambystoma tigrinum) and a semi-aquatic fish (Periophthalmus barbarus) to evaluate whether terrestrial locomotion was more comparable between species with ecological versus phylogenetic similarities. Ground reaction forces (GRFs) from individual limbs or fins indicated that the pectoral appendages of each taxon had distinct patterns of force production, but GRFs from the hindlimbs were comparable between the salamander species. The rate at which force is produced can affect musculoskeletal function, so we also calculated 'yank' (first time derivative of force) to quantify the dynamics of GRF production. Yank was sometimes slower in P. waltl but there were some similarities between the three species. Finally, the semi-aquatic taxa (P. waltl and P. barbarus) had a more medial inclination of the GRF compared to terrestrial salamanders, potentially elevating bone stresses among more aquatic taxa and limiting their excursions onto land.

Relationships between anthropometric characteristics, block settings, and block clearance technique during the sprint start

ABSTRACT This study aimed to identify how body dimensions interact with anteroposterior block distances to influence lower limb joint angles in the “set” position, how these angles relate to block clearance kinetic and kinematic parameters, and how these biomechanical parameters influence sprint start performance in sprinters of both sexes and of different ability levels. Seventy-eight sprinters performed six maximal-effort 10 m sprints. Joint angles in the “set” position were quantified through 2D video analysis, and the forces generated during block exit were measured by dynamometric starting blocks. Lower limb length was associated with the front block-starting line distance ([FB/SL], partial correlation [rPC] = 0.48) and was a significant predictor of FB/SL (R2 = 0.39). The FB/SL was associated with front hip angle (rPC = 0.38), which was consequently associated with numerous kinetic variables during block clearance (rPC from −0.41 to −0.61). Coaches should be encouraged to explore the interactions between individual lower limb lengths and the FB/SL distance in both male and female sprinters to manipulate the front hip angle in the “set” position in an attempt to achieve more favourable block clearance kinetics.

The Impact of Limited Prosthetic Socket Documentation: A Researcher Perspective.

The majority of limb prostheses are socket mounted. For these devices, the socket is essential for adequate prosthetic suspension, comfort, and control. The socket is unique among prosthetic components as it is not usually mass-produced and must instead be custom-made for individual residual limbs by a prosthetist. The knowledge of what constitutes “good” socket fit is gained by expert prosthetists and technicians over years of experience, and rarely documented. The reliance on tacit knowledge makes it difficult to standardize the criteria for a well-fitting socket, leading to difficulties understanding the impact of socket fit. Despite its importance, the workflow for socket fitting is often overlooked in literature. Due to the customized nature of sockets, if information is provided in literature, generally only the type of socket and suspension mechanism is noted, with information regarding the fitting and manufacturing processes omitted. In this article, the concerns, issues and consequences arising from lack of upper and lower limb socket documentation are discussed from a researcher perspective, supported by healthcare professionals and socket fabrication specialists. Key changes are proposed to the way socket manufacturing and evaluation are documented to assist future research.

Correlation between the range of motion of the tibiotarsal joint and blood circulation in the lower limbs in diabetic individuals.

The aim of this study was to evaluate the relationship between the range of motion and lower-limb hemodynamic indices in the tibiotarsal joint of individuals with diabetic neuropathy. Twenty volunteers of both sexes, with a mean age of 61.45±7.05 years, were diagnosed with type 2 diabetes mellitus and diabetic peripheral neuropathy. Arterial blood flow was assessed using Doppler ultrasound, and the variables such as average velocity, pulsatility index, and resistivity index were also evaluated. A range of dorsiflexion and plantar flexion joint movements were assessed using digital goniometry before and after exercise. Data distribution was assessed using the Shapiro-Wilk test, followed by Pearson's correlation for normal data and Spearman's correlation for non-normal data, in order to verify the association between variables. A moderate correlation was found between dorsiflexion and pulse rate on two occasions before (rs=0.497) and after initial evaluation (rs=0.511). A low correlation was found between plantar flexion and mean velocity (rs=-0.357), pulsatility index (rs=0.439), and resistivity index (rs=0.328); dorsiflexion and mean velocity (rs=0.374), pulse rate (rs=0.332), and resistance index (rs=0.327) before evaluation, and peak (rs=0.346) was observed after the evaluation of blood circulation. There is a correlation between the range of motion of the tibiotarsal joint and the blood circulation of diabetics, ranging from moderate to poor for the different variables evaluated.

Sensory and motor profiles of the contralateral upper limb and neuroplastic changes in individuals with unilateral rotator cuff related shoulder pain – a systematic review protocol

Background Numerous studies have established bilateral changes that underpin a reorganization of the central nervous system in individuals with unilateral tendinopathy. The evidence for sensory and motor profiles of the contralateral limb and neuroplastic (cortical) changes have not been specifically reviewed for rotator cuff related shoulder pain (RCRSP). Objectives To systematically review, summarize and appraise the evidence for sensory and motor profiles of the contralateral (non-injured) upper limb and neuroplastic changes in individuals with unilateral RCRSP. Methods This review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement and the guidelines for performing a Meta-analysis and Systematic Review of Observational Studies in Epidemiology (MOOSE). Two reviewers will screen, appraise, and extract the data using a customized data extraction tool, and synthesize findings from all studies irrespective of their methodological quality. The methodologically quality of the included studies will be assessed using a modified Downs and Black index. Statistical and clinical heterogeneity associated with the outcomes of interest will be assessed, and a meta-analysis will be done if appropriate. The certainty of evidence will be synthesized using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Discussion Previous studies indicate a reorganization of the nervous system with chronic musculoskeletal pain. If bilateral sensory/motor impairments or neuroplastic changes are evident in individuals with unilateral RCRSP, interventions may need to be tailored to include bilateral impairments as well as interventions that consider neuroplasticity. PROSPERO registration: CRD42020202756

The Effect of Robot-Mediated Virtual Reality Gaming on Upper Limb Spasticity Poststroke: A Randomized-Controlled Trial.

Objective: Stroke is a common reason for motor disability and is often associated with spasticity and poor motor function of the upper limbs involved. Spasticity management is important to accelerate motor recovery. The objective of this study was to investigate the effects of training with robot-mediated virtual reality gaming on upper limb spasticity and motor functions in individuals with chronic stroke. Materials and Methods: A total of 40 Saudi individuals with chronic stroke were involved in this study. Participants were randomly assigned to two groups. The experimental group received conventional physiotherapy and training with robot-mediated virtual reality gaming, and the control group received only conventional physiotherapy. Outcomes were measured by the Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT), WMFT-Time, Modified Ashworth Scale (MAS), Active Range of Motion (AROM) of multiple joints of the upper limb, and Handgrip Strength (HGS). The scores of all the outcome measures were recorded at baseline and after the completion of the treatment. Results: Individuals with stroke in the experimental group had a better improvement in most measured variables (AROM of shoulder abduction, elbow supination and wrist extension, WMFT-Time, HGS, ARAT, WMFT, and MAS) compared with the control group after the completion of the treatment. Both groups showed significant improvement in all the measured variables after completion of the treatment, except in MAS for wrist flexors in the control group. Conclusion: Training with robot-mediated virtual reality gaming was effective in modulating spasticity and improving the motor functions of the affected upper limbs in individuals with chronic stroke. This study was registered in ClinicalTrial.gov (NCT05069480).

A Mass-Producible Washable Smart Garment with Embedded Textile EMG Electrodes for Control of Myoelectric Prostheses: A Pilot Study.

Electromyography (EMG) is the resulting electrical signal from muscle activity, commonly used as a proxy for users’ intent in voluntary control of prosthetic devices. EMG signals are recorded with gold standard Ag/AgCl gel electrodes, though there are limitations in continuous use applications, with potential skin irritations and discomfort. Alternative dry solid metallic electrodes also face long-term usability and comfort challenges due to their inflexible and non-breathable structures. This is critical when the anatomy of the targeted body region is variable (e.g., residual limbs of individuals with amputation), and conformal contact is essential. In this study, textile electrodes were developed, and their performance in recording EMG signals was compared to gel electrodes. Additionally, to assess the reusability and robustness of the textile electrodes, the effect of 30 consumer washes was investigated. Comparisons were made between the signal-to-noise ratio (SNR), with no statistically significant difference, and with the power spectral density (PSD), showing a high correlation. Subsequently, a fully textile sleeve was fabricated covering the forearm, with 14 textile electrodes. For three individuals, an artificial neural network model was trained, capturing the EMG of 7 distinct finger movements. The personalized models were then used to successfully control a myoelectric prosthetic hand.