Limb Laterality Research Articles

Comparing the Effects of an Off-Ice Sprint-Change of Direction Task on Trunk Kinematics and Gait Laterality in Collegiate Ice Hockey Players

Laterality preferences are intrinsic in most physical activities, and ice hockey is one domain wherein these preferences might influence performance. Biomechanical laterality between dominant and nondominant (or preferred and nonpreferred) limbs is believed to be an advantageous attribute that is linked with skilled performance. Yet little is known about the implications of motor asymmetries for skilled performers in dynamic, time-constrained, team-based activities in an off-ice environment. This can be extended to when player position is considered, notably for those playing in a defensive or an offensive position. In this study, fourteen semi-professional collegiate male ice hockey players (age: 21.87 ± 2.98 years; BMI: 25.26 ± 3.21 kg/m) performed a randomized repeated 15 m sprint-change of direction task. Assessments of lower limb laterality were carried out as participants commenced the 15 m sprint change of direction task in both a right and left foot rear setback position. Biomechanical laterality between right and left rear foot setback positions was inferred by an ActiGraph GTx3 triaxial accelerometer that was located on the participants’ spinous process, representing the trunk centre of mass (CoM). Overall, ANOVA results indicated significant differences across all sprint split times between the right and left foot rear setback positions, with times significantly quicker when players commenced in a right rear foot setback position (p < 0.001). ANOVA revealed significant differences in trunk CoM acceleration between in a right and left rear setback position, specifically during the initial 0–10 m sprint split, with offensive players observed to have lesser trunk anteroposterior and vertical CoM acceleration (p = 0.05) and during the final 5 m sprint split (p = 0.002, d = 0.7), despite overall smaller effect sizes seen in the left foot rear setback position. It appears that starting with the foot in a right rear setback position results in quicker 15 m performance times and concurrent lower magnitudes of trunk CoM acceleration. Although we demonstrated that offensive players were quicker and displayed less trunk CoM acceleration, we recommend that future studies use a greater number of participants for inter-limb symmetry in these movement tests.

Outside the Laboratory Assessment of Upper Limb Laterality in Patients With Stroke: A Cross-Sectional Study.

The rehabilitation of upper limb sensorimotor performance after stroke requires the assessment of daily use, the identification of key levels of impairment, and monitoring the course of recovery. It needs to be answered, how laboratory-based assessments and everyday behavior are connected, which dimension of metrics, that is, volume, intensity, or quality, is most sensitive to reduced function, and what sensor, that is, gyroscope or accelerometer, is best suited to gather such data. Performance in laboratory-based sensorimotor tests, as well as smartwatch-derived kinematic data of everyday life relative upper limb activity, during 1 day of inpatient neurorehabilitation (Germany, 2022) of 50 patients with stroke, was cross-sectionally assessed and resulting laterality indices (performance ratios) between the limbs were analyzed using ANCOVAs and principal component analysis. Laboratory-based tests revealed the strongest laterality indices, followed by smartwatch-based (intensity>quality>volume) metrics. Angular velocity-based metrics revealed higher laterality indices than acceleration-based ones. Laterality indices were overall well associated; however, a principal component analysis suggested upper limb impairments to be unidimensional. Our findings suggest that the use of sensors can deliver valid information of stroke-related laterality. It appeared that commonly used metrics that estimate the volume of use (ie, energy expenditure) are not the most sensitive. Especially reached intensities could be well used for monitoring, because they are more dependent on the performance of the sensorimotor system and less on confounders like age. The unidimensionality of the upper limb laterality suggests that an impaired limb with reduced movement quality and the inability to reach higher intensities will be used less in everyday life, especially when it is the nondominant side.

Graded motor imagery and its phases for individuals with phantom limb pain following amputation: A scoping review

Objective Three-phase graded motor imagery (limb laterality, explicit motor imagery, and mirror therapy) has been successful in chronic pain populations. However, when applied to phantom limb pain, an amputation-related pain, investigations often use mirror therapy alone. We aimed to explore evidence for graded motor imagery and its phases to treat phantom limb pain. Data Sources A scoping review was conducted following the JBI Manual of Synthesis and Preferred Reporting Items for Systematic Review and Meta-Analyses extension for Scoping Reviews. Thirteen databases, registers, and websites were searched. Review Methods Published works on any date prior to the search (August 2023) were included that involved one or more graded motor imagery phases for participants ages 18+ with amputation and phantom limb pain. Extracted data included study characteristics, participant demographics, treatment characteristics, and outcomes. Results Sixty-one works were included representing 19 countries. Most were uncontrolled studies (31%). Many participants were male (75%) and had unilateral amputations (90%) of varying levels, causes, and duration. Most works examined one treatment phase (92%), most often mirror therapy (84%). Few works (3%) reported three-phase intervention. Dosing was inconsistent across studies. The most measured outcome was pain intensity (95%). Conclusion Despite the success of three-phase graded motor imagery in other pain populations, phantom limb pain research focuses on mirror therapy, largely ignoring other phases. Participant demographics varied, making comparisons difficult. Future work should evaluate graded motor imagery effects and indicators of patient success. The represented countries indicate that graded motor imagery phases are implemented internationally, so future work could have a widespread impact.

Clinician perspectives on postamputation pain assessment and rehabilitation interventions.

The purpose of this study was to explore self-reported Veterans Affairs (VA) amputation clinician perspectives and clinical practices regarding the measurement and treatment for amputation-related pain. Cross-sectional survey with 73 VA rehabilitation clinicians within the VA Health Care System. The most frequent clinical backgrounds of respondents included physical therapists (36%), prosthetists (32%), and physical medicine and rehabilitation specialist (21%). Forty-one clinicians (56%) reported using pain outcome measures with a preference for average pain intensity numeric rating scale (generic) (97%), average phantom limb pain intensity numeric rating scale (80%), or Patient-Reported Outcomes Measurement Information System pain interference (12%) measures. Clinicians' most frequently recommended interventions were compression garments, desensitization, and physical therapy. Clinicians identified mindset, cognition, and motivation as factors that facilitate a patient's response to treatments. Conversely, clinicians identified poor adherence, lack of belief in interventions, and preference for traditional pain interventions (e.g., medications) as common barriers to improvement. We asked about the frequently used treatment of graded motor imagery. Although graded motor imagery was originally developed with 3 phases (limb laterality, explicit motor imagery, mirror therapy), clinicians reported primarily using explicit motor imagery and mirror therapy. Most clinicians who use standardized pain measures prefer intensity ratings. Clinicians select pain interventions based on the patient's presentation. This work contributes to the understanding of factors influencing clinicians' treatment selection for nondrug interventions. Future work that includes qualitative components could further discern implementation barriers to amputation pain rehabilitation interventions for greater consistency in practice.

Variations in sural nerve formation and course in fetuses.

To investigate variations regarding the formation and course of the sural nerve (SN).We dissected 60 formalin-fixed Brazilian fetuses (n = 120 lower limbs) aged from the 16th to 34th weeks of gestational age. Three incisions were made in the leg to expose the SN, and the gastrocnemius muscle was retracted to investigate the SN course. Statistical analyses regarding laterality and sex were performed using the Chi-square test.Eight SN formation patterns were classified after analysis. Type 4 (in which the SN is formed by the union of the MSCN with the LSCN) was the most common SN formation pattern. Although there was no statistical association between the formation patterns and the lower limb laterality (p = 0.9725), there was as to sex (p = 0.03973), indicating an association between anatomical variation and sex. The site of branch joining was in the distal leg most time (53.75%). In all lower limbs, the SN or its branches crossed from the medial aspect of the leg to the lateral margin of the calcaneal tendon (CT).Most often, the SN is formed by joining the MSCN and the LSCN in the distal leg. The SN or its branches ran close to the saphenous vein, crossed the CT from medial to lateral, and distributed around the lateral malleolus.

Parietal/premotor lesions effects on visuomotor cognition in neuro-oncology patients: A multimodal study

BackgroundAssessing prior to surgery the functionality of brain areas exposed near the tumor requires a multimodal approach that combines the use of neuropsychological testing and fMRI tasks. Paradigms based on motor imagery, which corresponds to the ability to mentally evoke a movement, in the absence of actual action execution, can be used to test sensorimotor areas and the functionality of mental motor representations. MethodsThe most commonly used paradigm is the Limb Laterality Recognition Task (LLRT), requiring judgments about whether a limb belongs to the left or right side of the body. The group studied included 38 patients with high-grade (N = 21), low-grade (N = 11) gliomas and meningiomas (N = 6) in areas anterior (N = 21) and posterior (N = 17) to the central sulcus. Patients before surgery underwent neuropsychological assessment and fMRI. They performed the LLRT as an fMRI task. Accuracy, and neuroimaging data were collected and combined in a multimodal study. Structural MRI data analyses were performed by subtracting the overlap of volumes of interest (VOIs) plotted on lesions from the impaired patient group vs the overlap of VOIs from the spared group. The fMRI analyses were performed comparing the impaired patients and spared group. ResultsIn general, patients were within normal limits on many neuropsychological screening tests. Compared with the control group, 17/38 patients had significantly different performance. The subtraction between the VOIs overlay of the impaired patients' group vs. the VOIs overlay of the spared group revealed that the areas maximally involved by lesions in the impaired patients' group were the right postcentral gyrus, right inferior parietal lobe, right supramarginal gyrus, right precentral gyrus, paracentral lobule, left postcentral gyrus, right superior parietal lobe, left inferior parietal lobe, and left superior and middle frontal gyrus. Analysis of the fMRI data showed which of these areas contributes to a correct LLRT performance. The task (vs. rest) in the group comparison (spared vs. impaired patients) activated a cluster in the left inferior parietal lobe. ConclusionUnderlying the altered performance at LLRT in patients with lesions to the parietal and premotor areas of the right and left hemispheres is a difference in activation of the left inferior parietal lobe. This region is involved in visuomotor processes and those related to motor attention, movement selection, and motor planning.

O112 The COVID-19 pandemic-induced waiting list delays for shoulder and elbow surgery- analysis of the impact on patient reported EQ5D-5L data and their intention to proceed with the planned procedures

Abstract Introduction The aim of this comparative study was to evaluate patient reported outcome measures (PROMS) using the EQ5D-5L and EQ5D-5L visual analogue scale (VAS) following elective shoulder and elbow orthopaedic list delays arising from the COVID-19 pandemic. Methods Patients on the elective waiting list for more than 26 weeks were included in the study. Telephone interviews were conducted utilizing EQ5D-5L and the EQ5D-5L VAS data at the time of addition to the waiting list and current status. Results 75 out of 324 screened patients were eligible for inclusion. 62 (82.7%) patients still wanted to proceed with their planned procedure (group A) while 13 (17.3%) patients no longer wanted to proceed with surgery (group B). There was no statistically significant difference in the mean age, gender, initial trial of conservative treatment and limb laterality between these groups (P<0.05). There was a statistically significant difference in the mean duration of being on the waiting list between groups A and B (40.4 +/-19 weeks versus 62.9 +/-17.5 weeks respectively). Furthermore, statistically significant differences (P<0.05) in the current EQ5D-5L VAS scores were observed between these groups (52.4 versus 65.8 respectively). Conclusion This study has shown that majority of patients on elective shoulder and elbow orthopaedic lists with prolonged waiting list delays and improved EQ5D-5L scores are likely to decline the planned procedure and vice versa. Nevertheless, the unplanned “watchful waiting” caused by the COVID-19 pandemic and leading to patients deciding to decline surgery, is not a substitute for timely planned surgery to alleviate patients’ suffering.

The Influence of Emotional and Cognitive Factors on Limb Laterality Discrimination in Women with Fibromyalgia Syndrome: A Cross-Sectional Study Secondary Analysis

Previous scientific evidence has shown that patients with fibromyalgia syndrome (FMS) have alterations in the body schema. There have also been findings regarding the influence of psychological factors on pain, as well as evidence that patients with FMS have difficulty performing laterality discrimination tasks. The main objective of this study was to evaluate whether emotional and cognitive factors influence the limb laterality discrimination task in women with FMS. Seventeen of the participants were healthy female controls, and the other seventeen were women diagnosed with FMS. The main outcome measures were laterality discrimination, anxiety symptoms, depression symptoms, pain catastrophizing, and fear-related movement. The main analysis showed that patients with FMS had longer reaction times for laterality discrimination in hands (hand 20 images, p < 0.031; hands 50 images p < 0.013). In the secondary analysis, FMS patients showed emotional (anxiety (p < 0.0001); depression (p < 0.0001)) and cognitive (pain catastrophizing (p < 0.0001); fear-related movement (p < 0.0001)) disorders compared with healthy subjects. There was no correlation between limb laterality discrimination and psychological variables. In conclusion, patients with FMS showed impaired laterality discrimination, but psychological variables were not influenced. This could be due to the implicit nature of the task.

The impact of the post- COVID 19 pandemic elective waiting list delays on patient reported symptoms and intention to proceed with planned upper limb surgeries-A prospective cohort study.

The aim of this study was to evaluate patient reported outcome measures using the EQ5D-5L and EQ5D-5L visual analogue scale (VAS) following elective shoulder and elbow orthopaedic list delays. This was further correlated with patients' intention to proceed with the planned surgery. Patients on the waiting list for more than 26weeks were included in the study. Telephone interviews were conducted utilising the EQ5D-5L and the EQ5D-5L VAS at the time of addition to the waiting list and presently. 75 out of 324 screened patients were eligible. 62 (82.7%) patients still wanted to proceed with their planned procedure while 13 (17.3%) patients in the other group no longer wanted to proceed. There was no statistically significant difference in the mean age, gender, initial trial of conservative treatment and limb laterality between these groups (p<0.05). There was a statistically significant difference in the mean duration of being on the waiting list between these groups (40.4±19 vs. 62.9±17.5weeks respectively). Furthermore, statistically significant differences (p<0.05) in the current EQ5D-5L VAS scores were observed between these groups (52.4 vs. 65.8 respectively). This study has shown that majority of patients on elective shoulder and elbow orthopaedic lists with prolonged waiting list delays and improved EQ5D-5L scores are likely to decline the planned procedure and vice versa. Nevertheless, the unplanned 'watchful waiting' caused by the COVID-19 pandemic and leading to patients deciding to decline surgery, is not a substitute for timely planned surgery to alleviate patients' suffering.

Assessment of body perception disturbances in complex regional pain syndrome: A systematic review using the COSMIN guideline.

To conduct a systematic review to identify which tools are being used to assess body perception disturbances in Complex Regional Pain Syndrome (CRPS) and to provide an evidence-based recommendation in the selection of an assessment tool, based on measurement properties. Five electronic databases (EMBASE, Pubmed, PsycInfo, Science Direct and Web of Science) were searched for English or French written articles, with no time restrictions. All original articles using a body perception assessment tool with adult patients with CRPS were selected, regardless of their design (controlled trials, single case, qualitative study). Two investigators screened abstracts, selected full articles and extracted data independently. Thirty-eight full-text papers were obtained and three main methods to evaluate body perception disturbances were identified: The Bath Body Perception Disturbance Scale, the Neglect-like Symptoms questionnaire adapted from Galer and the patient's body perception description. No full psychometric assessments were found. The Limb Laterality Recognition Task was also used in conjunction with another method. Three main assessment methods for CRPS body perception disturbances are currently used. Full psychometric evaluation has not been completed for any of the assessment methods. As a consequence, we could not fully apply the COSMIN guideline. To date, there is no agreement concerning the use of a specific questionnaire or scale. The results indicate a need for further research such as psychometric properties of these questionnaires. This systematic review identified body perception disturbances assessment methods and their the psychometric properties in order to provide help and guidance to researchers and clinicians to investigate those clinical features.

Limb Laterality Discrimination, Evoked Sensations and Somatosensory Behavior in Fibromyalgia Syndrome: A Cross-Sectional Study

The main objective of this study was to assess the status of body schema using limb laterality discrimination tasks and pain measurement variables of patients with FMS compared to healthy subjects. The secondary aim was to analyze the relationships between laterality discrimination with respect to somatosensory variables. Thirty female patients with FMS (with a mean age of 52.43 ± 11.82 years) and thirty healthy women (with a mean age of 47.93 ± 5.92 years) were recruited. The main outcome measures were laterality discrimination, referral of evoked sensations, pressure pain threshold and conditioned pain modulation. The main analysis showed that patients with FMS have a longer reaction time for laterality discrimination in hands (hands—20 images, t = 4.044, p &lt; 0.0001, d = 1.04; hands—50 images t = 4.012, p &lt; 0.0001, d = 1.31; feet—20 images t = 2.982, p &lt; 0.01, d = 0.76; feet—50 images, t = 2.159, p &lt; 0.05, d = 0.55). With regard the secondary analysis, patients with FM have higher mechanical hyperalgesia (t = −9.550; p &lt; 0.0001, d = 2.51) and decreased response to conditioned pain modulation compared with healthy subjects (t = 15.519; p &lt; 0.0001, d = 4.17). A positive correlation was found in patients with FMS between greater laterality discrimination ability and better function of conditioned pain modulation (hands r = 0.676, p &lt; 0.0001; feet r = 0.485, p &lt; 0.01). In conclusion, patients with FMS have a longer reaction time and lower accuracy for laterality discrimination, increased mechanical hyperalgesia and decreased conditioned pain modulation compared to healthy subjects. Finally, it seems that there is a positive correlation between greater laterality discrimination ability and better conditioned pain modulation function.

Stress and Strain During Total Joint Arthroplasty Are Not Impacted by Hand Dominance or Operative Laterality in Orthopedic Surgeons.

Orthopedic surgeons experience significant musculoskeletal pain and work-related injuries while performing total joint arthroplasty (TJA). We sought to investigate the impact of operative extremity and surgeon limb dominance on surgeon physiologic stress and energy expenditure during TJA. This was a prospective cohort study conducted at a tertiary academic practice. Cardiorespiratory data was recorded continuously in 3 high-volume arthroplasty surgeons using a smart garment that measured heart rate (HR), HR variability, respiratory rate, minute ventilation, and energy expenditure (calories) during conventional total knee (TKA) and total hip arthroplasty (THA). Surgeon 1 and 2 (right-handed) performed 21 right TKAs, 10 left TKAs, 13 right THAs, and 10 left THAs. Surgeon 3 (left-handed) performed 6 right TKAs, 9 left TKAs, 16 right THAs, and 10 left THAs. While performing TKA or THA, limb laterality had no significant impact on operative time and no significant differences existed in HR, HR variability, respiratory rate, minute ventilation, or energy expenditure for any right-handed or left-handed surgeons, regardless of the operative limb laterality. While performing TKA, consistently standing on the side of hand dominance was associated with decreased strain and stress, compared to always standing on the operative side. This study suggests that surgeon hand dominance and operative limb laterality do not impact energy expenditure or physiologic strain during TJA. However, consistently standing on the side of hand dominance in TKA may lead to decreased physiologic strain and stress during surgery. Further study utilizing wearable technology during TJA may provide orthopedic surgeons with information about modifiable factors that contribute to differences in physiological parameters during surgery.

The effects of limb laterality and age on the inflammation and bone turnover of the acromioclavicular shoulder joint: 18 F-fluorodeoxyglucose and 18 F-sodium-fluoride-PET/computed tomography study.

The acromioclavicular (AC) joint is a common site of injury and degenerative changes such as osteoarthritis (OA) of the shoulder. Physical manifestations of OA are preceded by molecular changes, detection of which may enhance early prophylaxis and monitoring of disease progression. In this study, we investigate the use of 18 F-FDG and 18 F-NaF-PET/CT to assess the effects of limb laterality and age on the inflammation and bone turnover of the AC shoulder joint. We analyzed FDG and NaF-PET/CT scans of 41 females (mean age of 43.9 ± 14.2 years) and 45 males (mean age of 44.5 ± 13.8 years) using a semiquantitative technique based on predefined ROI. There was a greater NaF uptake in the right side of the AC joint compared with the left in both females (left: 2.22 ± 1.00; right: 3.08 ± 1.18; P < 0.0001) and males (left: 2.57 ± 1.49; right: 2.99 ± 1.40; P = 0.003). No consistent correlation between age and NaF or FDG uptakes were found in both females and males. There was also a positive correlation between FDG and NaF uptakes in both left ( P = 0.01; r = 0.37) and right ( P = 0.0006; r = 0.53) AC joints of male subjects. Our study is the first to reveal the varying effect of right-left limb laterality and aging on FDG and NaF uptake at the AC joint. Future studies correlating the history of shoulder trauma, pain, and degenerative change with FDG and NaF-PET/CT findings will be critical in the adoption of molecular imaging in the clinical setting.

Hemifield-Specific Rotational Biases during the Observation of Ambiguous Human Silhouettes

Both static and dynamic ambiguous stimuli representing human bodies that perform unimanual or unipedal movements are usually interpreted as right-limbed rather than left-limbed, suggesting that human observers attend to the right side of others more than the left one. Moreover, such a bias is stronger when static human silhouettes are presented in the RVF (right visual field) than in the LVF (left visual field), which might represent a particular instance of embodiment. On the other hand, hemispheric-specific rotational biases, combined with the well-known bias to perceive forward-facing figures, could represent a confounding factor when accounting for such findings. Therefore, we investigated whether the lateralized presentation of an ambiguous rotating human body would affect its perceived handedness/footedness (implying a role of motor representations), its perceived spinning direction (implying a role of visual representations), or both. To this aim, we required participants to indicate the perceived spinning direction (which also unveils the perceived handedness/footedness) of ambiguous stimuli depicting humans with an arm or a leg outstretched. Results indicated that the lateralized presentation of the stimuli affected both their perceived limb laterality (a larger number of figures being interpreted as right-limbed in the RVF than in the LVF) and their perceived spinning direction (a larger number of figures being interpreted as spinning clockwise in the LVF than in the RVF). However, the hemifield of presentation showed a larger effect size on the perceived spinning direction than on the perceived limb laterality. Therefore, as we already proposed, the implicit representation of others’ handedness seems to be affected more by visual than by motor processes during the perception of ambiguous human silhouettes.

Impaired Performance in Mental Rotation of Hands and Feet and Its Association with Social Cognition in Patients with Complex Regional Pain Syndrome

Objectives. So far, dysfunction in mental rotation has been assessed in relation to the left- or right-sided CRPS. Here we examined mental rotation in patients with upper or lower limb CRPS. Considering the potential role of socio-emotional functioning on the perception of body image, we further investigated the association between performance on mental rotation and socio-emotional characteristics.Methods. We examined the performance of 36 patients with upper or lower limb CRPS on the limb laterality recognition. Accuracy and response times for pictures of hands and feet at 4 rotation angles were evaluated. Socio-emotional functioning was measured by the Interpersonal Reactivity Scale and the Toronto Alexithymia Scale.Results. Patients with upper limb pain showed longer RTs to recognize the laterality of hands than feet (P = 0.002), whereas patients with lower limb pain showed longer RTs for feet than hands (P = 0.039). Exploratory correlation analyses revealed that RTs for feet were negatively correlated with the levels of empathic ability to take another’s perspective (P = 0.006) and positively correlated with the level of emotional difficulty in identifying feelings (P = 0.006).Conclusions. This study is the first to report selectively impaired mental rotation of hands vs feet in patients with upper or lower limb CRPS. The findings suggest that impaired mental rotation derives from relative deficits in the representation of the affected limb. Correlations between impaired mental rotation and socio-emotional inability indicate that an altered body schema may be closely associated with impaired social cognitive aspects in CRPS patients.

Asomatognosia: Structured Interview and Assessment of Visuomotor Imagery.

Asomatognosia designates the experience that one’s body has faded from awareness. It is typically a somaesthetic experience but may target the visual modality (“asomatoscopy”). Frequently associated symptoms are the loss of ownership or agency over a limb. Here, we elaborate on the rigorous nosographic classification of asomatognosia and introduce a structured interview to capture both its core symptoms and associated signs of bodily estrangement. We additionally report the case of a pure left-sided hemiasomatognosia occurring after surgical removal of a meningioma in the right atrium. Despite the wide lesions of the right angular gyrus and of the temporo-parietal junction, the patient did not present visuospatial deficits or bodily awareness disorders other than hemiasomatognosia. The patient and 10 matched controls’ motor imagery was formally assessed with a limb laterality task in which they had to decide whether hands and feet presented under different angles of rotation depicted a left or a right limb. Bayesian statistics showed that patient’s reaction times were significantly impaired exclusively for the left foot and especially for mental rotations requiring somatomotor rather than visual limb representations. This was in accordance with a more enduring left-sided hemiasomatognosia for the lower limbs confined to the somesthetic modality. Our findings shed new light on motor imagery in asomatognosia and encourage the future use of the structured interview introduced here. In addition, the limb laterality task may capture phenomenological elements of a case by chronometric means. This allows a more standardized reporting of phenomenological detail and improves communication across different clinical facilities.

Effect of one session of mirror therapy on phantom limb pain and recognition of limb laterality in military traumatic lower limb amputees: a pilot study

Up to 70 % of military amputees suffer phantom limb pain (PLP), which is difficult to treat. PLP has been attributed to cortical reorganisation and associated with impaired laterality. Repeated...

Limb Laterality Recognition Score: A Reliable Clinical Measure Related to Phantom Limb Pain.

To explore the usefulness of the limb laterality recognition score as a clinical measure of phantom limb pain, regarding test-retest reliability and association of limb laterality recognition scores with phantom limb pain measures. Retrospective cohort. Community support group. Eleven adults who averaged 4.8 years since lower limb amputation due to vascular pathologies (N = 9), trauma (N = 1), and cancer (N = 1). Subjects self-reported amputated limb pain using the sensation subsection of the Prosthetic Evaluation Questionnaire and back and sound limb pain. Using numbered iPads that corresponded to the self-reports, subjects played the Recognise Foot game to assess limb laterality recognition ability. Subjects identified the laterality of 20 foot images, within two seconds each. The software collected accuracy and speed scores in basic, vanilla, and context conditions for two rounds in random order. Basic showed feet against black backgrounds, vanilla showed feet with various monochromatic backgrounds, and context showed feet in clothed or environmental contexts. So that greater accuracy in less time meant a better score, accuracy scores were divided by completion speed. Intraclass correlation coefficient (ICC)3,1 assessed test-retest reliability. Correlations between accuracy/speed and phantom limb pain measures were assessed with Spearman's rho (categorical) and Pearson coefficients (continuous). Accuracy/speed test-retest reliability was strong (ICC = 0.72) and inversely associated with phantom limb pain frequency (context rho = 0.72). Limb laterality recognition accuracy/speed in the context condition had good test-retest reliability and correlated strongly with phantom limb pain frequency. Accuracy/speed limb laterality recognition ability relates to phantom limb pain and may be a valid clinical or research measure.

Development and psychometric properties of knee-specific body-perception questionnaire in people with knee osteoarthritis: The Fremantle Knee Awareness Questionnaire.

BackgroundRecent systematic reviews have demonstrated that pain associated with knee osteoarthritis (OA) is a complex phenomenon that involves various contributors. People with knee OA exhibit symptoms of impaired body-perception, including reduced tactile acuity, impairments in limb laterality recognition, and degraded proprioceptive acuity. The Fremantle Back Awareness Questionnaire (FreBAQ) was developed to assess body-perception specific to the back in people with chronic low back pain. The aim of this study was to develop and assess the psychometric properties of a knee-specific version of the FreBAQ-J (FreKAQ-J), determine whether people with knee pain experience perceptual impairments and investigate the relationship between disturbed self-perception and clinical status.MethodsSixty-five people with knee OA completed the FreKAQ-J. A subset of the participants completed the FreKAQ-J again two-weeks later. Rasch analysis was used to assess item order, targeting, category ordering, unidimensionality, person fit, internal consistency, and differential item functioning. Validity was investigated by examining the relationship between the FreKAQ-J and clinical valuables.ResultsThe FreKAQ-J had acceptable internal consistency, unidimensionality, good test-retest reliability, and was functional on the category rating scale. The FreKAQ-J was significantly correlated with pain in motion, disability, pain-related catastrophizing, fear of movement, and anxiety symptomatology.ConclusionsWe developed FreKAQ-J by modifying the FreBAQ-J. The FreKAQ-J fits the Rasch measurement model well and is suitable for use in people with knee OA. Altered body perception may be worth evaluating when managing people with knee OA.

Complex Regional Pain Syndrome type I (CRPS I) and self-rehabilitation: A health-related quality of life study

A rehabilitation program, with successive types of exercises, including limb laterality recognition, imagined movements and mirror therapy, can be conducted in patients with CRPS I1. This graded motor imagery program, developed by Moseley, needs patients’ participation, is educative, and improves edema, pain, and functional capacities. We want to investigate whether this program would improve health-related quality of life of patients with CRPS I. All patients with upper or lower limb CRPS I are included. The program includes physical and occupational therapies twice a week, in association with daily exercises at home, for a period of 6 weeks. Pain (Visual Analog Scale pain and Saint-Antoine survey), health-related quality of life (MOS-SF-36) and for upper limb strength (Jamar dynamometer), function (box and block test) and disabilities (DASH survey) are assessed at the beginning and the end of the therapy. Six patients (5 females and 1 male) are included, whose 4 with upper limb and 2 with lower limb CRPS I. The mean length of CRPS I is about 289 days. Emotional and sensory scores of Saint-Antoine survey decrease in all patients. At the upper limb, strength, dexterity and disabilities are improved. Health-related quality of life (all MOS-SF-36 items) is improved. Graded motor imagery program is successful for patients with CRPS I, by reducing pain and improving function and health-related quality of life, even after a significant delay. It requires a high level of motivation, and provides some educational value. However, the impact on daily life remains important, due to physical limitations. More studies, with larger populations, must obviously be conducted to confirm this data.