Extremity Movement Research Articles

Infantile Intraparenchymal Brain Abscess due to Streptococcus pyogenes

Introduction Group A ß-hemolytic streptococcus (GABHS) are the most common bacterial cause of tonsillitis, and can cause noninvasive diseases such as pharyngitis and impetigo, as well as more severe invasive diseases. The incidence of invasive disease is 1-3/100,000 per year, and the morbidity and mortality rate is high. GABHS is rarely lead to brain abscesses. Case Report Acute phase reactants were found to be high in a 40-day-old patient who presented with fever, irritability and focal seizures. Acute phase reactants were high. Transfontanel ultrasonography showed increased thickness, echo and blood supply in the meninges. Brain magnetic resonance imaging (MRI) and diffusion MRI revealed a thick-walled abscess in the right cerebral hemisphere and parietooccipital parenchyma with diffusion restriction on diffusion-weighted images. Cerebrospinal fluid (CSF) polymerase chain reaction (PCR) test revealed S. pyogenes,and S. pyogenes grown in CSF culture. Initially, meropenem, vancomycin, metronidazole antibiotherapy was applied. Treatment was revised to cefotaxime and vancomycin after culture antibiogram and was completed for 8 weeks. Seizures regressed. Control brain imaging showed improvement. Restriction in left lower extremity movements remained. Physical therapy and rehabilitation was recommended and he was discharged. Conclusion GABHS, which is the causative agent of acute tonsillitis, rarely causes invasive disease which has high mortality and morbidity.

Exploring market-wide herding behavior in the major stock markets of Latin America

PurposeThis paper investigates market-wide herding behavior among investors in the stock markets of Brazil, Chile, Colombia and Mexico from January 2013 to December 2022.Design/methodology/approachWe analyze a survivor-bias-free dataset of daily stock returns, employing a measure reflecting the cross-sectional deviation of stock returns relative to market consensus.FindingsSignificant anti-herding is observed in Brazil and Mexico, while Chile and Colombia show results consistent with rational asset pricing models. The COVID-19 pandemic generally intensifies anti-herding trends. Additionally, significant asymmetries in herding/anti-herding effects are noted during different market trends and volatility levels. Furthermore, we identify the drivers of this phenomenon, revealing that extreme crude oil price movements are associated with more pronounced anti-herding, and herding/anti-herding effects appear synchronized across all four markets.Practical implicationsOur findings regarding synchronization in herding dynamics suggest challenges in realizing the desired benefits of international diversification in the region.Social implicationsThe significant cross-country effects indicate that herding dynamics may play a crucial role in precipitating regional financial crises.Originality/valueFor the first time, we examine various features of herding behavior in the sample markets, including the impact of the COVID-19 pandemic, psychological and economic drivers of the phenomenon and synchronization in herding dynamics among the four markets.

Quantifying the Impact of C7 Spinal Nerve Harvest on Spontaneous, Patient-Initiated Movement of the Donor Upper Extremity.

Transfer of a healthy C7 spinal nerve is a tool for upper extremity reanimation in patients with severe brachial plexus injury (BPI). Its use remains controversial owing to concern for neurological injury to the donor arm. Utilizing wearable motion-sensor technology, we aimed to quantify donor arm morbidity after C7 spinal nerve harvest in patients with pan-BPI, reporting both the time and magnitude of donor arm movement in a real-world setting compared to healthy controls. Seventeen patients who underwent contralateral C7 (CC7) transfer for traumatic pan-BPI at least 2 years prior were compared to 14 healthy controls. Each participant wore an accelerometer on both arms for 7 consecutive days. The vector time (VT), or time of movement measured in hours/day, and the vector magnitude (VM), or magnitude of arm movement measured as a single vector magnitude per second, were collected and compared between groups. The correlation between VT and VM and time from C7 spinal nerve harvest was also calculated. At mean 7.7 years after C7 spinal nerve harvest, there was no difference between donor and control arms for VT (5.76±1.55] vs 5.45±1.22 hours, P = 0.56) or VM (2242236±753853 vs 1919223±579723 activity counts, P = 0.20), regardless of donor arm dominance. The C7 harvest cohort used the injured arm 53% of the time and with 27% of the power of the donor arm. There was no significant difference in time or magnitude of arm movement between donor arms and the arms of healthy controls.

Evaluation of fabric-based pneumatic actuator enclosure and anchoring configurations in a pediatric soft robotic exosuit.

Soft robotics play an increasing role in the development of exosuits that assist, and in some cases enhance human motion. While most existing efforts have focused on the adult population, devices targeting infants are on the rise. This work investigated how different configurations pertaining to fabric-based pneumatic shoulder and elbow actuator embedding on the passive substrate of an exosuit for pediatric upper extremity motion assistance can affect key performance metrics. The configurations varied based on actuator anchoring points onto the substrate and the type of fabric used to fabricate the enclosures housing the actuators. Shoulder adduction/abduction and elbow flexion/extension were treated separately. Two different variants (for each case) of similar but distinct actuators were considered. The employed metrics were grouped into two categories; reachable workspace, which includes joint range of motion and end-effector path length; and motion smoothness, which includes end-effector path straightness index and jerk. The former category aimed to capture first-order terms (i.e., rotations and displacements) that capture overall gross motion, while the latter category aimed to shed light on differential terms that correlate with the quality of the attained motion. Extensive experimentation was conducted for each individual considered configuration, and statistical analyses were used to establish distinctive strengths, weaknesses, and trade-offs among those configurations. The main findings from experiments confirm that the performance of the actuators can be significantly impacted by variations in the anchoring and fabric properties of the enclosures while establishing interesting trade-offs. Specifically, the most appropriate anchoring point was not necessarily the same for all actuator variants. In addition, highly stretchable fabrics not only maintained but even enhanced actuator capabilities, in comparison to the less stretchable materials which turned out to hinder actuator performance. The established trade-offs can serve as guiding principles for other researchers and practitioners developing upper extremity exosuits.

DESIGN FEATURES OF THE MANIPULATOR-MOTOR FOR MULTI-PURPOSE ROBOTIC PLATFORMS

It has been established that the use of multi-purpose robotic platforms (MPRP), as one of the types of ground robotic complexes, is an important factor that allows preserving the life and health of servicemen on the battlefield. It was found that the movement of MPRP, and as a result, the performance of assigned tasks, is often limited (loss of stability and passability) as a result of difficult terrain areas, or as a result of destruction caused by enemy fire. The well-known approaches that allow to ensure the multi-functionality of individual parts of the MPRP to improve their stability and passability were analyzed and it was established that they do not realize in their design features the use of multi-functional manipulators, which, if necessary, can perform the functions of a stepping or wheel drive. A new approach is proposed, which consists in the application of multi-functional manipulators (manipulators-movers) on the MPRP, which, in the event of extreme movement conditions, can, in addition to the manipulator function (grab, transfer of objects), perform the function of a walking or wheeled mover (ensuring movement over areas of the terrain). The results of designing and modeling in the Solid Works software environment are presented. An analysis of the design features of the manipulator-mover for MPRP was carried out and it was established that the multi- functionality of the manipulator-mover is implemented by introducing new elements and connections, in particular, in the manipulator mode, with minimal mass-dimensional parameters, an increase in the available space is achieved with the possibility of endless rotational movements of the captured object in any direction, and in the driver mode, when four manipulators-drivers are located on top of the MPRP in pairs, symmetrically on both sides, the functions of stepping or wheel drivers are provided.

Intra- and interlimb effects of gait retraining in individuals with knee hyperextension

BackgroundGait retraining, which typically focuses on the most severely affected limb or joint, has shown promising results in treating faulty running and walking patterns. The closed-chain nature of gait during the stance phase may influence kinematic changes in the adjacent joints of the trained leg. In addition, the coupled nature of the lower extremity motion of gait suggests that changes in one leg may transfer to the other. This study aimed to assess the intra- and inter-limb transfer of kinematic changes following gait retraining to reduce knee extension in individuals with hyperextension walking patterns. MethodsSeventeen women with knee hyperextension gait patterns participated in six treadmill retraining sessions. All participants received verbal and real-time visual kinematic feedback in the form of knowledge of results. This intervention study took place at the Gait Analysis Laboratory at the University of Iowa. Mean peak sagittal-plane lower extremity joint kinematics during overground walking at pretraining, post-training, and 1- and 8-month follow-ups were calculated for analysis and comparisons. FindingsThe post-training changes in ankle range of motion returned to baseline values by the 8-month follow-up. There was a significant transfer effect of kinematic changes to the untrained knee following gait retraining. InterpretationTraining one knee did not result in long-term compensatory kinematic changes in the other joints. In addition, the improvements in knee extension range of motion were transferred to the untrained knee and retained at the 8-month follow-up. This study supports the use of gait retraining as an effective clinical intervention.

Liberatory or predatory? Gendered perspectives on the role of women in the Weather Underground

ABSTRACT The Weather Underground is a group that has divided opinion for over half a century. To some, they were legitimate anti-war activists, to others they were one of America’s most notorious domestic terror groups. Much of the secondary literature describing the group has highlighted the role of women in the organisation, differentiating them from the typical male-dominated structures of radical and extremist groups. Using comparative autobiographical analysis, this project explores the extent to which this assessment of gender equality is accurate by evaluating how members of the group described their experiences in their own words. The analysis identifies gendered discrepancies in the portrayal of women in the movement. Where men were likely to have a positive recollection of the gender equality within the Weather Underground, the accounts of women tread a complex line between acknowledging both the liberatory elements and the sexism within the movement. This research helps to demonstrate the value of first-hand accounts rather than secondary literature in trying to understand the internal dynamics of a movement. It also highlights the need for nuance when discussing the role of women in extremism movements.

How do people predict a random walk? Lessons for models of human cognition.

Repeated forecasts of changing values are common in many everyday tasks, from predicting the weather to financial markets. A particularly simple and informative instance of such fluctuating values are random walks: Sequences in which each point is a random movement from only its preceding value, unaffected by any previous points. Moreover, random walks often yield basic rational forecasting solutions in which predictions of new values should repeat the most recent value, and hence replicate the properties of the original series. In previous experiments, however, we have found that human forecasters do not adhere to this standard, showing systematic deviations from the properties of a random walk such as excessive volatility and extreme movements between subsequent predictions. We suggest that such deviations reflect general statistical signatures of cognition displayed across multiple tasks, offering a window into underlying mechanisms. Using these deviations as new criteria, we here explore several cognitive models of forecasting drawn from various approaches developed in the existing literature, including Bayesian, error-based learning, autoregressive, and sampling mechanisms. These models are contrasted with human data from two experiments to determine which best accounts for the particular statistical features displayed by participants. We find support for sampling models in both aggregate and individual fits, suggesting that these variations are attributable to the use of inherently stochastic prediction systems. We thus argue that variability in predictions is strongly influenced by computational noise within the decision making process, with less influence from "late" noise at the output stage. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Energy firms in China towards resilience: A dynamic quantile connectedness approach

Α comprehensive understanding of the energy and technology sectors is imperative for the implementation of effective climate and industrial policies. This study investigates the quantile interconnectedness between the top five energy equities and the top five technology equities, listed on the Shanghai Stock Exchange 50 Index (SSE50), based on market capitalization. Employing the Quantile VAR methodology, we uncover significant interconnectedness across various quantiles of the return distribution for both energy and technology equities. This implies that price fluctuations within one sector can have a significant effect on the other. Furthermore, our analysis reveals directional connectedness, where energy equities consistently influence technology equity prices throughout the entire period of investigation. Additionally, a heightened degree of interconnectedness is observed during periods of extreme market movements, i.e. in the upper and lower tails of the return distribution. This suggests a more integrated system during stressed conditions, where all equities under investigation exhibit a magnified influence on each other, potentially leading to amplified volatility spillovers. These findings provide valuable insights for investors, portfolio managers, and policymakers, enabling them to develop more informed investment strategies and construct robust risk management frameworks.

The Local “Salad Bar” of Hate: Global Hegemonic Masculinity in Australia’s Extreme Right

This paper examines a local manifestation of extreme right political mobilisation in Australia from the standpoint of Connell and Messerschmidt's (2005) global hegemonic masculinity. Using Messerschmidt and Rohde’s (2018) methods for analysing violent extremists’ public statements, we examine public blog posts by “The Lads [sic] Society” to scrutinise the relationship between local advocacy for a white ethno-state in Australia and global hegemonic masculinities. The analysis finds that localised white nationalism is both a response to, and constituted by, the tensions of global hegemonic masculinity and is, in part, an attempt to reclaim localised white hegemonic masculinity in the face of a multitude of perceived global societal failures. Through the analysis, this paper contributes to Messerschmidt and Rohde’s (2018) claim that various global hegemonic masculinities simultaneously coexist and compete, while pointing to how discursive processes continue to redefine masculinities at the local level. The paper also responds to a broader invitation to incorporate gender analysis into the study of extreme political movements, enabling a more critical understandings of the motivations and experiences of those that participate in them.

Analysis of Factors Influencing the Precision of Body Tracking Outcomes in Industrial Gesture Control.

The body tracking systems on the current market offer a wide range of options for tracking the movements of objects, people, or extremities. The precision of this technology is often limited and determines its field of application. This work aimed to identify relevant technical and environmental factors that influence the performance of body tracking in industrial environments. The influence of light intensity, range of motion, speed of movement and direction of hand movement was analyzed individually and in combination. The hand movement of a test person was recorded with an Azure Kinect at a distance of 1.3 m. The joints in the center of the hand showed the highest accuracy compared to other joints. The best results were achieved at a luminous intensity of 500 lx, and movements in the x-axis direction were more precise than in the other directions. The greatest inaccuracy was found in the z-axis direction. A larger range of motion resulted in higher inaccuracy, with the lowest data scatter at a 100 mm range of motion. No significant difference was found at hand velocity of 370 mm/s, 670 mm/s and 1140 mm/s. This study emphasizes the potential of RGB-D camera technology for gesture control of industrial robots in industrial environments to increase efficiency and ease of use.

Evaluating Joint Angle Data for Clinical Assessment Using Multidimensional Inverse Kinematics with Average Segment Morphometry.

Movement analysis is a critical tool in understanding and addressing various disabilities associated with movement deficits. By analyzing movement patterns, healthcare professionals can identify the root causes of these alterations, which is essential for preventing, diagnosing, and rehabilitating a broad spectrum of medical conditions, disabilities, and injuries. With the advent of affordable motion capture technologies, quantitative data on patient movement is more accessible to clinicians, enhancing the quality of care. Nonetheless, it is crucial that these technologies undergo rigorous validation to ensure their accuracy in collecting and monitoring patient movements, particularly for remote healthcare services where direct patient observation is not possible. In this study, motion capture technology was used to track upper extremity movements during a reaching task presented in virtual reality. Kinematic data was then calculated for each participant using a scaled dynamic inertial model. The goal was to evaluate the accuracy of joint angle calculations using inverse kinematics from motion capture relative to the typical movement redundancy. Shoulder, elbow, radioulnar, and wrist joint angles were calculated with models scaled using either direct measurements of each individual's arm segment lengths or those lengths were calculated from individual height using published average proportions. The errors in joint angle trajectories calculated using the two methods of model scaling were compared to the inter-trial variability of those trajectories. The variance of this error was primarily within the normal range of variability between repetitions of the same movements. This suggests that arm joint angles can be inferred with good enough accuracy from motion capture data and individual height to be useful for the clinical assessment of motor deficits.

Expectations of and perceived need for civil war in the USA: findings from a 2023 nationally representative survey

BackgroundSurveys have found concerningly high levels of agreement that the United States will experience civil war soon. This study assesses variation in expectation of and perceived need for civil war with respondent sociopolitical characteristics, beliefs, firearm ownership, and willingness to engage in political violence.MethodsFindings are from Wave 2 of a nationally representative annual longitudinal survey of members of the Ipsos KnowledgePanel, conducted May 18–June 8, 2023. All respondents to 2022’s Wave 1 who remained in KnowledgePanel were invited to participate. Outcomes are expressed as weighted proportions and adjusted prevalence differences, with p-values adjusted for the false discovery rate and reported as q-values.ResultsThe completion rate was 84.2%; there were 9385 respondents. After weighting, half the sample was female (50.7%, 95% CI 49.4%, 52.1%); the weighted mean (± standard deviation) age was 48.5 (25.9) years. Approximately 1 respondent in 20 (5.7%, 95% CI 5.1%, 6.4%) agreed strongly or very strongly that “in the next few years, there will be civil war in the United States.” About 1 in 25 (3.8%, 95% CI 3.2%, 4.4%), and nearly 40% (38.4%, 95% CI 32.3%, 44.5%) of those who strongly or very strongly agreed that civil war was coming, also agreed strongly or very strongly that “the United States needs a civil war to set things right.” Expectation of and perceived need for civil war were higher among subsets of respondents who in Wave 1 were more willing than others to commit political violence, including MAGA Republicans, persons in strong agreement with racist beliefs or statements of the potential need for violence to effect social change, persons who strongly approved of specified extreme right-wing political organizations and movements, firearm owners who purchased firearms in 2020 or later, and firearm owners who carried firearms in public all or nearly all the time.ConclusionsIn 2023, the expectation that civil war was likely and the belief that it was needed were uncommon but were higher among subsets of the population that had previously been associated with greater willingness to commit political violence. These findings can help guide prevention efforts.

Functional outcomes and participants’ perspectives during short-term application of spinal stimulation in individuals with spinal cord injury

Objective The primary objective of this study was to quantify changes in performance of task-specific motor activities over 12 motor rehabilitation sessions with lumbosacral spinal cord stimulation (SCS) via either transcutaneous stimulation or epidural stimulation. Both stimulation modalities have been used in recent years to restore functions lost to spinal cord injury (SCI). Secondary outcomes examine participants’ perspectives captured via the User Experience Questionnaire (UEQ) upon study completion to further understand their perception of SCS. Methods Six individuals with SCI completed 12 sessions with one modality of SCS during supine and/or side-lying, seated forward reaching, and standing activities. Changes in volitional lower extremity movement, the number of points of contact needed at hips and/or knees to facilitate standing, and changes in seated forward reaching distance were used to quantify performance. The UEQ was administered to gauge participants’ perspectives following use of SCS to enable functions impaired due to SCI. Results For all participants, performance of motor activities improved with SCS compared to without stimulation. Responses for the UEQ showed an overall positive perception of trialing SCS with rehabilitation to enhance motor functions impaired by SCI. Conclusions Regardless of injury severity, location of injury, time since SCI, or SCS modality, all participants experienced gains in motor function in the presence of SCS combined with a condensed rehabilitation program. However, no evidence of sustained motor functions was found in the absence of SCS. UEQ results highlight the positive perception of SCS with rehabilitation as well as the importance of consulting persons with lived experience of SCS during clinical trial design and protocol development. Trial registration: ClinicalTrials.gov identifier: NCT05095454.

Differential neural mechanisms for movement adaptations following neuromuscular training in young female athletes with a history of sports-related concussion

Sports-related concussion (SRC) in adolescent athletes is associated with an increased risk of subsequent lower extremity injury. Neuromuscular training (NMT) has shown promise for reducing lower extremity injuries following SRC, however, neural adaptations in response to changes in lower extremity biomechanics following NMT in athletes with a history of SRC (HxSRC) remains poorly understood. Therefore, the purpose of this study was to identify changes in neural activity associated with lower extremity movement adaptations following a six-week NMT intervention in athletes with a HxSRC. Thirty-two right-hand/foot-dominant female adolescent athletes (16 with self-reported HxSRC, 16 age- and anthropometrically-matched controls) completed a bilateral leg press task with 3D motion analysis during functional magnetic resonance imaging (fMRI). Movement adaptations were defined as a change in frontal and sagittal plane range of motion (ROM) during the fMRI bilateral leg press task. Significant pre- to post-NMT reductions were observed in the non-dominant (left) mean frontal plane ROM. Whole-brain neural correlate analysis revealed that increased cerebellar activity was significantly associated with reduced mean left-knee frontal ROM for matched controls. Exploratory within group analyses identified neural correlates in the postcentral gyrus for the HxSRC group which was associated with reduced mean left-knee frontal plane ROM. These distinct longitudinal changes provide preliminary evidence of differential neural activity associated with NMT to support knee frontal plane control in athletes with and without a HxSRC.

Gait Performance and Brain Activity Are Improved by Gait Automatization during Robot-Assisted Gait Training in Patients with Burns: A Prospective, Randomized, Single-Blinded Study.

Background: Patients with lower extremity burn injuries have decreased gait function. Gait dysfunctions are compensated by activation of executive areas such as the prefrontal cortex (PFC). Although robot-assisted gait training (RAGT) can improve gait function, the training mechanisms of RAGT are unknown. We aimed to determine the clinical effects of RAGT in patients with burns and investigate their underlying mechanisms. Methods: This single-blind, randomized controlled trial involved 54 patients with lower extremity burns. The RAGT group underwent RAGT using SUBAR® and conventional training. The control (CON) group underwent only conventional training. The primary outcome was cortical activity measured using a functional near-infrared spectroscopy device before and after 8 weeks of training to confirm the compensatory effect of gait dysfunction. The secondary outcomes were the functional ambulation category (FAC) to evaluate gait performance, 6-min walking test (6 MWT) distance to measure gait speed, isometric force and range of motion (ROM) of lower extremities to evaluate physical function, and the visual analog scale (VAS) score to evaluate subjective pain during gait. Results: PFC activation during the gait phase in the RAGT group decreased significantly compared with that of the CON. The VAS score decreased and FAC score improved after 8 weeks of training in both groups. The 6 MWT scores, isometric strengths (the left knee flexor and bilateral ankle plantar flexors), and the ROMs (the extensions of bilateral hip and bilateral knee) of the RAGT group were significantly improved compared with those of the CON. RAGT improved gait speed, lower extremity ROMs, and lower extremity muscles strengths in patients with burns. Conclusions: The improvement in gait speed and cerebral blood flow evaluation results suggests that the automatization of gait is related to the treatment mechanism during RAGT.

Real-Time Sensing of Upper Extremity Movement Diversity Using Kurtosis Implemented on a Smartwatch.

Wearable activity sensors typically count movement quantity, such as the number of steps taken or the number of upper extremity (UE) counts achieved. However, for some applications, such as neurologic rehabilitation, it may be of interest to quantify the quality of the movement experience (QOME), defined, for example, as how diverse or how complex movement epochs are. We previously found that individuals with UE impairment after stroke exhibited differences in their distributions of forearm postures across the day and that these differences could be quantified with kurtosis-an established statistical measure of the peakedness of distributions. In this paper, we describe further progress toward the goal of providing real-time feedback to try to help people learn to modulate their movement diversity. We first asked the following: to what extent do different movement activities induce different values of kurtosis? We recruited seven unimpaired individuals and evaluated a set of 12 therapeutic activities for their forearm postural diversity using kurtosis. We found that the different activities produced a wide range of kurtosis values, with conventional rehabilitation therapy exercises creating the most spread-out distribution and cup stacking the most peaked. Thus, asking people to attempt different activities can vary movement diversity, as measured with kurtosis. Next, since kurtosis is a computationally expensive calculation, we derived a novel recursive algorithm that enables the real-time calculation of kurtosis. We show that the algorithm reduces computation time by a factor of 200 compared to an optimized kurtosis calculation available in SciPy, across window sizes. Finally, we embedded the kurtosis algorithm on a commercial smartwatch and validated its accuracy using a robotic simulator that "wore" the smartwatch, emulating movement activities with known kurtosis. This work verifies that different movement tasks produce different values of kurtosis and provides a validated algorithm for the real-time calculation of kurtosis on a smartwatch. These are needed steps toward testing QOME-focused, wearable rehabilitation.

Shoulder Motion Overestimated by Mallet Scores.

Brachial plexus birth injuries (BPBI) occur in up 0.4 to 4.6 per 1000 live births. Weakness about the shoulder and development of glenohumeral joint contractures are common sequalae of BPBI. Shoulder function in children with BPBI is frequently assessed using the modified Mallet classification to evaluate upper extremity motion deficits. The purpose of this study was to assess the accuracy of the abduction, external rotation, and hand-to-mouth Mallet classification scores in children with BPBI using motion capture. A retrospective study of 107 children with BPBI who underwent motion capture assessment and Mallet scores on the same date were reviewed. Motion capture measurements were used to calculate humerothoracic elevation and external rotation joint angles in the abduction/hand-to-mouth and external rotation positions, respectively. The humerothoracic joint angles were converted to the corresponding Mallet scores. Discrepancies between the Mallet scores determined by clinicians and those determined by motion capture were assessed. For abduction, 24.3% of Mallet scores were misclassified during clinical examination. Of the misclassified scores, 22 were overestimated by 1 point and 4 were underestimated by 1 point compared with motion capture. For external rotation, 72.9% of Mallet scores were misclassified during clinical examination. Only 5 patients had an HT elevation that was less than 40 degrees, with 4 of them (80%) having a Mallet hand-to-mouth score of 4. There were no differences in proportion of patients with HT elevation less than 40 degrees who had a Mallet score of 4 or a Mallet score less than 4. There was better agreement in global abduction Mallet scores compared with external rotation and hand-to-mouth Mallet scores. This difference was likely due to the complex compensatory strategies that patients employ while performing external rotation and hand-to-mouth positions. The inaccuracy of the clinically determined Mallet scores is alarming given that they are frequently utilized to assist with surgical indications and are commonly used as outcome measures. Level IV Case series.

Maintaining Physical Health in Individuals with Duchenne Muscular Dystrophy Through Telerehabilitation

Aims To investigate the effects of a telerehabilitation program on walking performance, lower and upper extremity function, fall frequency, respiratory function, and satisfaction in individuals with Duchenne muscular dystrophy (DMD). Methods Thirty children (mean age 8.8 ± 4.2 years) were ambulant (Group 1), and 12 youth (18.5 ± 4.7 years) were non-ambulant (Group 2). The telerehabilitation program was applied by physiotherapists for 24 sessions (3 days/week). The 10-meter walking test, stand up from the supine position test, the modified upper extremity performance test, repetition of Lower and upper extremity movements, and the single breath count (SBC) test were administered. Fall frequency and satisfaction level were also recorded. Results Significant improvement was found after telerehabilitation in upper extremity performance, repetition of lower and upper extremity movements, fall frequency, and SBC scores in Group 1. Changes in the 10-minute Walk and Stand Up from the Supine Position tests were not significant. There was a significant improvement in SBC scores in Group 2. Satisfaction with the service was 88%. Conclusions The 8-week telerehabilitation program was effective in improving aspects of upper and lower extremity function, fall frequency, pulmonary function, and satisfaction levels in individuals with DMD.

Human Cervical Epidural Spinal Electrogram Topographically Maps Distinct Volitional Movements.

Little is known about the electrophysiologic activity of the intact human spinal cord during volitional movement. We analyzed epidural spinal recordings from a total of five human subjects of both sexes during a variety of upper extremity movements and found that these spinal epidural electrograms contain spectral information distinguishing periods of movement, rest, and sensation. Cervical epidural electrograms also contained spectral changes time-locked with movement. We found that these changes were primarily associated with increased power in the theta (4-8 Hz) band and feature increased theta phase to gamma amplitude coupling, and this increase in theta power can be used to topographically map distinct upper extremity movements onto the cervical spinal cord in accordance with established myotome maps of the upper extremity. Our findings have implications for the development of neurostimulation protocols and devices focused on motor rehabilitation for the upper extremity, and the approach presented here may facilitate spatiotemporal mapping of naturalistic movements.