Movements Of Upper Extremities Research Articles

Computer-assisted approaches for measuring, segmenting, and analyzing functional upper extremity movement: a narrative review of the current state, limitations, and future directions.

The analysis of functional upper extremity (UE) movement kinematics has implications across domains such as rehabilitation and evaluating job-related skills. Using movement kinematics to quantify movement quality and skill is a promising area of research but is currently not being used widely due to issues associated with cost and the need for further methodological validation. Recent developments by computationally-oriented research communities have resulted in potentially useful methods for evaluating UE function that may make kinematic analyses easier to perform, generally more accessible, and provide more objective information about movement quality, the importance of which has been highlighted during the COVID-19 pandemic. This narrative review provides an interdisciplinary perspective on the current state of computer-assisted methods for analyzing UE kinematics with a specific focus on how to make kinematic analyses more accessible to domain experts. We find that a variety of methods exist to more easily measure and segment functional UE movement, with a subset of those methods being validated for specific applications. Future directions include developing more robust methods for measurement and segmentation, validating these methods in conjunction with proposed kinematic outcome measures, and studying how to integrate kinematic analyses into domain expert workflows in a way that improves outcomes.

The reliability and validity of the Korean version of the reaching performance scale for stroke after translation and cross-cultural adaptation.

The reaching performance scale for stroke evaluates reach-to grasp movement of the upper extremity and compensatory movements. The objective of the study was to translate and cross-culturally adapt the reaching performance scale for stroke into Korean and assess its reliability and validity. An expert committee supervised the forward and backward translation and the final translated Korean version of reaching performance scale for stroke (K-RPSS). Ninety-eight individuals (mean age 63.63 ± 13.13 years), with hemiplegia after stroke (97.82 ± 191.50 weeks) were evaluated independently by physiatrist and occupational therapist using K-RPSS. Degree of the motor impairment and functional status of patients were evaluated with the Fugl-Meyer assessment for upper limb and manual function test. The K-RPSS demonstrated excellent intra-rater (intraclass correlation coefficient = 0.9865), inter-rater (intraclass correlation coefficient 0.9866) reliability, and internal consistency (Cronbach α = 0.977 for total score). The validity of K-RPSS was confirmed with strong correlation with Fugl-Meyer assessment and manual function test. The K-RPSS had ceiling effect and the 3 points is the score change needed to indicate a change in a patient. K-RPSS has been shown to be a reliable and valid tool for assessing the compensation and movement quality of the upper limb and trunk when performing a reach-to grasp task. The K-RPSS is expected to be used widely by Korean speaking clinicians and researchers.

Disseminating MSSA Infection in a Preterm Infant With Rare Finding of Spinal Epidural Abscess: A Case Report.

Methicillin-susceptible Staphylococcus aureus (MSSA) occurs more frequently in the neonatal intensive care unit (NICU) than methicillin-resistant S. aureus (MRSA) and can result in comparable morbidity and mortality in the neonatal population. MSSA infection may present as pustulosis or cellulitis and evolve into bacteremia, pneumonia, endocarditis, brain abscesses, and osteomyelitis. There is a paucity of literature regarding the treatment and long-term outcomes in the premature infant. A 32-week twin developed MSSA sepsis with presentation of pain, decreased movement of upper extremities, and global hypotonia. Blood cultures remained positive despite antibiotic coverage. The infant was admitted to the level IV NICU with the diagnosis of MSSA bacteremia, with concern for dissemination and osteomyelitis. Diagnostic studies included laboratory testing for sepsis evaluation, radiologic studies to evaluate for dissemination, immunologic testing to rule out complement deficiency, and hematology testing to rule out hypercoagulable conditions. Diagnostic testing showed extensive cellulitis, osteomyelitis, multiple liver abscesses, and epidural abscesses suggestive of spinal epidural abscess (SEA). Abscess debridement and irrigation on the left distal femur, left elbow, and right tibia were performed. The infant completed 8 weeks of IV antibiotic therapy. Immunologic and hematology testing was within normal limits. Prompt recognition and follow-up for clinical signs of sepsis are vital when caring for premature infants. Inclusion of pediatric subspecialist recommendations to assure all diagnostic studies and treatments are completed can significantly impact the patient's outcome. Long-term follow-up is needed for premature infants with the diagnosis of SEA.

Control of paretic and non-paretic upper extremity during bimanual reaching after stroke

Most actions of daily life engage the two upper extremities (UEs) in a highly coordinated manner. While it is recognized that bimanual movements are impaired post-stroke, understanding how the paretic and non-paretic UE contributes to this impairment is important for future interventions. We investigated kinetic and kinematics at the shoulder, elbow, and wrist joints in the paretic and non-paretic UE in 8 individuals with chronic stroke and non-dominant UE in 8 healthy controls during unimanual and bimanual tasks. Kinematic analysis revealed little effect of stroke. However, kinetic analysis revealed that during unimanual movements, joint control was impaired during unimanual and bimanual movements in both UEs, although to a lesser extent in the non-paretic than paretic UE. During bimanual movements, joint control did not change in the paretic UE, and it further deteriorated in the non-paretic UE compared with the unimanual movements. Our findings suggest that a single session of bimanual task performance does not improve joint control of the paretic UE and it impairs control of the non-paretic UE, making it more like that of the paretic UE.

Evolution of a System to Monitor Infant Neuromotor Development in the Home: Lessons from COVID-19

In the nine months leading up to COVID-19, our biomedical engineering research group was in the very early stages of development and in-home testing of HUGS, the Hand Use and Grasp Sensor (HUGS) system. HUGS was conceived as a tool to allay parents' anxiety by empowering them to monitor their infants' neuromotor development at home. System focus was on the evolving patterns of hand grasp and general upper extremity movement, over time, in the naturalistic environment of the home, through analysis of data captured from force-sensor-embedded toys and 3D video as the baby played. By the end of March, 2020, as the COVID-19 pandemic accelerated and global lockdown ensued, home visits were no longer possible and HUGS system testing ground to an abrupt halt. In the spring of 2021, still under lockdown, we were able to resume recruitment and in-home testing with HUGS-2, a system whose key requirement was that it be contactless. Participating families managed the set up and use of HUGS-2, supported by a detailed library of video materials and virtual interaction with the HUGS team for training and troubleshooting over Zoom. Like the positive/negative poles of experience reported by new parents under the isolation mandated to combat the pandemic, HUGS research was both impeded and accelerated by having to rely solely on distance interactions to support parents, troubleshoot equipment, and securely transmit data. The objective of this current report is to chronicle the evolution of HUGS. We describe a system whose design and development straddle the pre- and post-pandemic worlds of family-centered health technology design. We identify and classify the clinical approaches to infant screening that predominated in the pre-COVID-19 milieu and describe how these procedural frameworks relate to the family-centered conceptualization of HUGS. We describe how working exclusively through the proxy of parents revealed the family's priorities and goals for child interaction and surfaced HUGS design shortcomings that were not evident in researcher-managed, in-home testing prior to the pandemic.

Evaluation of fluid leakage at the coverall and glove interface in single and double glove conditions

BackgroundFluid leakage through the glove-protective clothing interface is an area of concern for many health care personnel, including emergency medical service providers, who may wear coveralls to protect themselves from multiple types of hazards. There is currently no established standard test method to specifically evaluate the barrier performance of the glove-protective clothing interface region for any personal protective equipment ensemble. ObjectiveThis study quantifies the fluid leakage at the coverall and glove interface using single and double gloving. MethodsA robotic arm, which can simulate upper extremity movements of health care personnel, was used to test 5 coverall models and an extended examination glove model in single and double glove conditions. ResultsThe results show that there was a significant difference in fluid leakage amounts between some of the coverall models and the number of glove layers studied. Findings also highlight that there is a high correlation between basis weight and stiffness of the coverall fabrics and the fluid leakage amounts. ConclusionsThese results underline that coverall constructed from thin and less stiff fabrics can result in lower fluid leakage levels. Also, there was no significant difference in fluid leakage amounts between single and double gloves when tested with each of the coverall models, with the exception of the coveralls with the highest basis weight and stiffness.

Reconstruction of Upper Extremity Using Pedicled Latissimus Dorsi Myocutaneous Island Flap and Skin Graft after Necrotizing Fasciitis: A Case Report

Necrotizing fasciitis of the upper extremities is a severe, life-threatening condition, potentially resulting in amputation or death in the absence of prompt and aggressive surgical treatment. Reconstruction is eventually required after adequate surgical debridement, and patients are often referred to a plastic surgeon for this purpose. Herein, we present the case of a patient with extensive soft tissue defects on the upper extremity after fasciotomy for necrotizing fasciitis. We successfully performed a pedicled latissimus dorsi myocutaneous island flap, full-thickness skin graft, and split-thickness skin graft for this patient. After 2 months, the patient did not have any wound problems and could carry out adequate upper extremity motion.

"suMus," a novel digital system for arm movement metrics and muscle energy expenditure.

Objective: In the field of non-treatable muscular dystrophies, promising new gene and cell therapies are being developed and are entering clinical trials. Objective assessment of therapeutic effects on motor function is mandatory for economical and ethical reasons. Main shortcomings of existing measurements are discontinuous data collection in artificial settings as well as a major focus on walking, neglecting the importance of hand and arm movements for patients' independence. We aimed to create a digital tool to measure muscle function with an emphasis on upper limb motility. Methods: suMus provides a custom-made App running on smartwatches. Movement data are sent to the backend of a suMus web-based platform, from which they can be extracted as CSV data. Fifty patients with neuromuscular diseases assessed the pool of suMus activities in a first orientation phase. suMus performance was hence validated in four upper extremity exercises based on the feedback of the orientation phase. We monitored the arm metrics in a cohort of healthy volunteers using the suMus application, while completing each exercise at low frequency in a metabolic chamber. Collected movement data encompassed average acceleration, rotation rate as well as activity counts. Spearman rank tests correlated movement data with energy expenditure from the metabolic chamber. Results: Our novel application "suMus," sum of muscle activity, collects muscle movement data plus Patient-Related-Outcome-Measures, sends real-time feedback to patients and caregivers and provides, while ensuring data protection, a long-term follow-up of disease course. The application was well received from the patients during the orientation phase. In our pilot study, energy expenditure did not differ between overnight fasted and non-fasted participants. Acceleration ranged from 1.7 ± 0.7 to 3.2 ± 0.5m/sec2 with rotation rates between 0.9 ± 0.5 and 2.0 ± 3.4rad/sec. Acceleration and rotation rate as well as derived activity counts correlated with energy expenditure values measured in the metabolic chamber for one exercise (r = 0.58, p < 0.03). Conclusion: In the analysis of slow frequency movements of upper extremities, the integration of the suMus application with smartwatch sensors characterized motion parameters, thus supporting a use in clinical trial outcome measures. Alternative methodologies need to complement indirect calorimetry in validating accelerometer-derived energy expenditure data.

Usefulness of nerve-sparing pedicled segmental latissimus dorsi muscle flap combined with lateral thoracic skin flap for partial volume reconstruction in laterally located breast cancer

Abstract Background The latissimus dorsi muscle (LDM) is a flexible muscle that is frequently employed in various reconstructive operations. Breast-conserving surgery is widely acknowledged as an effective treatment for breast cancer, and the latissimus dorsi muscle flap is a straightforward, dependable technique for partial breast reconstruction. Methods A pedicled segmental latissimus dorsi muscle flap was employed in 20 patients with laterally situated breast cancer treated at our institution from January 2018 to December 2021. During a 6-month postoperative follow-up period, patients were polled on their overall satisfaction and cosmetic satisfaction. Plastic surgeons assessed the aesthetic and functional outcomes in terms of breast shape and symmetry, as well as muscular function. Results The mean operative time was 120 ± 35.2 min while the mean postoperative hospital stay was 2.5 days (range, 1.5–3 days). There were no donor site complications such as intraoperative bleeding, postoperative hematoma, or infection, and postoperative drain removal was done on average after 5 days. The average weight of specimens was 50–160 gm with a mean of 100 gm, and the locations of the masses were the upper lateral quadrant (n = 15), the lower lateral quadrant (n = 2), and the central lateral area (n = 3). Complications developed in 6 of the cases, hematoma in 2 cases, wound seroma developed in the donor site in 2 cases, and weakness in shoulder movement in 2 cases, and the majority of the patients were satisfied with their cosmetic outcomes. No tumor recurrence was reported. Conclusion Replacement of 20 to 40% of breast volume in the upper and the lower outer quadrants with a latissimus dorsi muscle flap as nerve-sparing pedicled segmental flap that can be harvested from the same axillary incision of lymphadenectomy is a good alternative reconstruction technique after partial mastectomy. This resulted in an acceptable postoperative scar, less pain, and early upper extremity movement, so this technique is considered a useful and reliable technique in correcting breast deformity after breast-conserving surgery, especially in laterally located breast cancer. Level of evidence: Level IV, therapeutic study.

Determining factors for compensatory movements of the left arm and shoulder in violin playing.

Despite a large number of available ergonomic aids and recommendations regarding instrument positioning, violin players at any proficiency level still display a worrying incidence of task-specific complaints of incompletely understood etiology. Compensatory movement patterns of the left upper extremity form an integral part of violin playing. They are highly variable between players but remain understudied despite their relevance for task-specific health problems. This study investigated individual position effects of the instrument and pre-existing biomechanical factors likely determining the degree of typical compensatory movements in the left upper extremity: (1) left elbow/upper arm adduction ("Reference Angle α", deviation from the vertical axis), (2) shoulder elevation ("Coord x", in mm), and (3) shoulder protraction ("Coord y", in mm). In a group of healthy music students (N = 30, 15 m, 15 f, mean age = 22.5, SD = 2.6), "Reference Angle α" was measured by 3D motion capture analysis. "Coord x" and "Coord y" were assessed and ranked by a synchronized 2D HD video monitoring while performing a pre-defined 16-s tune under laboratory conditions. These three primary outcome variables were compared between four typical, standardized violin positions varying by their sideward orientation ("LatAx-CSP") and/or inclination ("LoAx-HP") by 30°, as well as the players' usual playing position. Selected biomechanical hand parameter data were analyzed as co-factors according to Wagner's Biomechanical Hand Measurement (BHM). Mean "Reference Angle α" decreased significantly from 24.84 ± 2.67 to 18.61 ± 3.12° (p < 0.001), "Coord x" from 22.54 ± 7.417 to 4.75 ± 3.488 mm (p < 0.001), and "Coord y" from 5.66 ± 3.287 to 1.94 ± 1.901) mm (p < 0.001) when increasing LatAx-CSP and LoAx-HP by 30°. Concerning the biomechanical co-factors, "Reference Angle α", "Coord y", but not "Coord x", were found to be significantly increased overall, with decreasing passive supination range (r = -0.307, p = <0.001 for "Passive Supination 250 g/16Ncm", and r = -0.194, p = <0.001 for "Coord y"). Compensatory movements were larger during tune sections requiring high positioning of the left hand and when using the small finger. Results may enable to adapt individually suitable instrument positions to minimize strenuous and potentially unhealthy compensation movements of the left upper extremity.

Muscle activation patterns and muscle synergies reflect different modes of coordination during upper extremity movement.

A core issue in motor control is how the central nervous system generates and selects the muscle activation patterns necessary to achieve a variety of behaviors and movements. Extensive studies have verified that it is the foundation to induce a complex movement by the modular combinations of several muscles with a synergetic relationship. However, a few studies focus on the synergetic similarity and dissimilarity among different types of movements, especially for the upper extremity movements. In this study, we introduced the non-negative matrix factorization (NMF) method to explore the muscle activation patterns and synergy structure under 6 types of movements, involving the hand open (HO), hand close (HC), wrist flexion (WF), wrist extension (WE), supination (SU), and pronation (PR). For this, we enrolled 10 healthy subjects to record the electromyography signal for NMF calculation. The results showed a highly modular similarity of the muscle synergy among subjects under the same movement. Furthermore, Spearman's correlation analysis indicated significant similarities among HO-WE, HO-SU, and WE-SU (p < 0.001). Additionally, we also found shared synergy and special synergy in activation patterns among different movements. This study confirmed the theory of modular structure in the central nervous system, which yields a stable synergetic pattern under the same movement. Our findings on muscle synergy will be of great significance to motor control and even to clinical assessment techniques.

Relationship Between Diabetic Chorea and Timing of MRI Findings: A Systematic Review with Case Reports.

Diabetic chorea is a rare complication of diabetes mellitus for which head MRI is the most common diagnostic imaging modality. Cases have been reported where CT and/or MRI findings are inconsistent or clinical symptoms and imaging findings do not appear simultaneously. We aimed to compile the cases in which imaging findings appeared on MRI retests and to examine in a systematic review whether temporal differences in the appearance of imaging findings correlate with clinical characteristics. An 80-year-old man with type 2 diabetes mellitus came to a hospital with abnormal movements of the left upper and lower extremities. Two days after the first visit, his symptoms flared up, and his head MRI showed an old cerebral infarction and no new lesion. On day 14, he retested T1-weighted imaging and showed a high signal in the right putamen, which was considered diabetic chorea. Blood glucose was controlled with insulin, and the involuntary movements disappeared. PubMed and ICHUSHI were searched to identify patients with diabetic chorea who had undergone MRI retests. Patients grouped by the temporal change in the presence/absence of imaging findings were compared on age, sex, duration of diabetes mellitus, blood glucose level, HbA1c level, side of involuntary movement, time to first MRI, and follow-up MRI. Of the 64 cases analyzed, 43 (67.2%) were female. The mean age was 69.0 years. 16 (25.0%) had worsening findings upon MRI retesting, 37 (57.8%) had improvement, and 10 (15.6%) had unchanged findings. There were no significant differences in age, sex, mean blood glucose level or HbA1c at onset among the groups. There was no association between the pattern of appearance of imaging findings over time and clinical characteristics, including glucose levels. If initial MRI findings are negative, MRI retesting after a certain time may help diagnose diabetic chorea.

Deep Neural Network-based Video Processing to Obtain Upper-Extremity Motor Performance Toward Assessment of Cognitive and Motor Function.

Dementia is an increasing global health challenge. Motoric Cognitive Risk Syndrome (MCR) is a predementia stage that can be used to predict future occurrence of dementia. Traditionally, gait speed and subjective memory complaints are used to identify old adults with MCR. Our previous studies indicated that dual-task upper-extremity motor performance (DTUEMP) quantified by a single wrist-worn sensor was correlated with both motor and cognitive function. Therefore, the DTUEMP had a potential to be used in the diagnosis of MCR. Instead of using inertial sensors to capture kinematic data of upper-extremity movements, here we proposed a deep neural network-based video processing model to obtain DTUEMP metrics from a 20-second repetitive elbow flexion-extension test under dual-task condition. In details, we used a deep residual neural network to obtain joint coordinate set of the elbow and wrist in each frame, and then used optical flow method to correct the joint coordinates generated by the neural network. The coordinate sets of all frames in a video recording are used to generate angle sequence which represents rotation angle of the line between the wrist and elbow. Then, the DTUEMP metrics (the mean and SD of flexion and extension phase) are derived from angle sequence. Multi-task learning (MTL) is used to assess cognitive and motor function represented by MMSE and TUG scores based on DTUEMP metrics, with single-task learning (STL) linear model as a benchmark. The results showed a good agreement (r ≥ 0.80 and ICC ≥ 0.58) between the derived DTUEMP metrics from our proposed model and the ones from clinically validated sensor processing model. We also found that there were correlations with statistical significance (p < 0.05) between some of video-derived DTUEMP metrics (i.e. the mean of flexion time and extension time) and clinical cognitive scale (Mini-Mental State Examination, MMSE). Additionally, some of video-derived DTUEMP metrics (i.e. the mean and standard deviation of flexion time and extension time) was also associated with the scores of timed-up and go (TUG) which is a gold standard to measure functional mobility. Mean absolute percentage error (MAPE) of MTL surpassed that of STL (For MMSE, MTL: 18.63%, STL: 23.18%. For TUG, MTL: 17.88%, STL: 22.53%). The experiments with different light conditions and shot angles verified the robustness of our proposed video processing model to extract DTUEMP metrics in potentially various home environments (r ≥ 0.58 and ICC ≥ 0.71). This study shows possibility of replacing sensor processing model with video processing model for analyzing the DTUEMP and a promising future to adjuvant diagnosis of MCR via a mobile platform.

Isolated Unilateral EEG Findings in Juvenile Myoclonic Epilepsy: A Case Report

Juvenile myoclonic epilepsy (JME) has well-defined clinical and electrophysiological features. On the other hand, large case series have shown that focal and asymmetrical discharges may accompany generalized epileptiform activities in JME. Although it is known that these non-generalized electrophysiological findings do not exclude the diagnosis of this syndrome, some findings may create confusion in the differential diagnosis. In this case report, a case of JME with electroencephalographic findings characterized by isolated unilateral epileptiform activities without typical generalized discharges was discussed. The current case clinically presented with involuntary jerk movements in the bilateral upper extremities. It has been determined that these movements are uni/bilateral myoclonic beats based on home video recordings. Metabolic, toxic and structural problems were excluded in the investigations for the etiology of myoclonus. In the electrophysiological examination performed for epileptic processes, epileptiform discharges localized to the isolated right hemisphere were observed. JME was considered primarily due to clinical findings in the patient, and effective seizure control was achieved in a 4-year follow-up under anti-seizure treatment. The peculiarity of the case is the presence of electrophysiology recordings of isolated unilateral epileptiform activity during the 4-year follow-up period. It should be emphasized that there is no case of JME diagnosed with isolated unilateral epileptiform activity in the absence of generalized spike-slow waves or multiple spike-slow waves in the literature.

Examining kinematics and muscle activity of the upper extremity while performing cleaning tasks: A pre-post shift evaluation

Custodians engage in strenuous manual labour throughout their workday. Uncertainty exists on whether kinematics or muscle activation changes as workers progress through their shift. The purpose of this study was to examine muscle activation and upper extremity kinematics during typical custodial tasks performed at the start and end of the work shift. Electromyography (EMG) of 8 torso and upper extremity muscles and motion capture of the corresponding region were collected for 10 custodial participants while they completed garbage removal, dry mopping, and vacuuming tasks at the start and end of a work shift. The start of shift assessment demonstrated larger anterior deltoid, posterior deltoid and extensor digitorum activation by up to 12.6 %maximal voluntary contraction (%MVC) (p < 0.001–0.023). Task affected mean and peak EMG in all muscles except flexor digitorum (p < 0.001–0.0293), and the greatest activation was found during vacuuming (peak <55%MVC in anterior and middle deltoid) and the heaviest garbage removal task (84% MVC peak in upper trapezius). Mopping created the lowest amounts of activation for almost all muscles. Joint range of motion (p < 0.001–0.031) in the shoulder was highest in vacuuming, while trunk flexion was largest in garbage removal tasks. This work replicated common custodial tasks in a laboratory, using actual custodial workers at times relevant to their typical work shifts. The information presented is useful for ergonomists, work tasks designers and custodial administration staff to develop guidelines for injury prevention.

Feedback control of upright seating with functional neuromuscular stimulation during a reaching task after spinal cord injury: a feasibility study

BackgroundRestoring or improving seated stability after spinal cord injury (SCI) can improve the ability to perform activities of daily living by providing a dynamic, yet stable, base for upper extremity motion. Seated stability can be obtained with activation of the otherwise paralyzed trunk and hip musculature with neural stimulation, which has been shown to extend upper limb reach and improve seated posture.MethodsWe implemented a proportional, integral, derivative (PID) controller to maintain upright seated posture by simultaneously modulating both forward flexion and lateral bending with functional neuromuscular stimulation. The controller was tested with a functional reaching task meant to require trunk movements and impart internal perturbations through rapid changes in inertia due to acquiring, moving, and replacing objects with one upper extremity. Five subjects with SCI at various injury levels who had received implanted stimulators targeting their trunk and hip muscles participated in the study. Each subject was asked to move a weighted jar radially from a center home station to one of three target stations. The task was performed with the controller active, inactive, or with a constant low level of neural stimulation. Trunk pitch (flexion) and roll (lateral bending) angles were measured with motion capture and plotted against each other to generate elliptical movement profiles for each task and condition. Postural sway was quantified by calculating the ellipse area. Additionally, the mean effective reach (distance between the shoulder and wrist) and the time required to return to an upright posture was determined during reaching movements.ResultsPostural sway was reduced by the controller in two of the subjects, and mean effective reach was increased in three subjects and decreased for one. Analysis of the major direction of motion showed return to upright movements were quickened by 0.17 to 0.32 s. A 15 to 25% improvement over low/no stimulation was observed for four subjects.ConclusionThese results suggest that feedback control of neural stimulation is a viable way to maintain upright seated posture by facilitating trunk movements necessary to complete reaching tasks in individuals with SCI. Replication of these findings on a larger number of subjects would be necessary for generalization to the various segments of the SCI population.

Diabetic Chorea Mimicking Cerebral Infarction with Involuntary Movements of the Right Upper Extremity in a Patient with Slowly Progressive Insulin-dependent Diabetes Mellitus

Diabetic Chorea Mimicking Cerebral Infarction with Involuntary Movements of the Right Upper Extremity in a Patient with Slowly Progressive Insulin-dependent Diabetes Mellitus

Home-based portable fNIRS-derived cortical laterality correlates with impairment and function in chronic stroke.

Improved understanding of the relationship between post-stroke rehabilitation interventions and functional motor outcomes could result in improvements in the efficacy of post-stroke physical rehabilitation. The laterality of motor cortex activity (M1-LAT) during paretic upper-extremity movement has been documented as a useful biomarker of post-stroke motor recovery. However, the expensive, labor intensive, and laboratory-based equipment required to take measurements of M1-LAT limit its potential clinical utility in improving post-stroke physical rehabilitation. The present study tested the ability of a mobile functional near-infrared spectroscopy (fNIRS) system (designed to enable independent measurement by stroke survivors) to measure cerebral hemodynamics at the motor cortex in the homes of chronic stroke survivors. Eleven chronic stroke survivors, ranging widely in their level of upper-extremity motor deficit, used their stroke-affected upper-extremity to perform a simple unilateral movement protocol in their homes while a wireless prototype fNIRS headband took measurements at the motor cortex. Measures of participants' upper-extremity impairment and function were taken. Participants demonstrated either a typically lateralized response, with an increase in contralateral relative oxyhemoglobin (ΔHbO), or response showing a bilateral pattern of increase in ΔHbO during the motor task. During the simple unilateral task, M1-LAT correlated significantly with measures of both upper-extremity impairment and function, indicating that participants with more severe motor deficits had more a more atypical (i.e., bilateral) pattern of lateralization. These results indicate it is feasible to gain M1-LAT measures from stroke survivors in their homes using fNIRS. These findings represent a preliminary step toward the goals of using ergonomic functional neuroimaging to improve post-stroke rehabilitative care, via the capture of neural biomarkers of post-stroke motor recovery, and/or via use as part of an accessible rehabilitation brain-computer-interface.

Rhythm-Based and Tonal-Based Music Interventions on Upper Extremity in Parkinson's Disease: A Scoping Review

<h3>Objective(s)</h3> To compare the effects of rhythmic-based and tonal-based music interventions on upper extremity (UE) outcomes in individuals with Parkinson's Disease (PD). Rhythmic-cueing utilizes external beats to influence motor execution of rhythmic movements (e.g., walking); tonal-based interventions incorporate melody and harmony to motivate and affect movement performance. However, the majority of the PD studies exclusively focused on rhythmic cueing for gait, which is a naturally paced movement. As the upper extremity (UE) movements are more varied and may be less rhythmed (e.g., dressing, handwriting), we wonder whether different types of intervention may provide distinct benefits in UE. <h3>Data Sources</h3> Five electronic databases (Cochrane, PubMed, Medline, CINAHL, and Embase) were used, with keyword combinations of Parkinson, rhythm/music, and upper extremity. All the searches were completed in August 2021. <h3>Study Selection</h3> Two pairs of two reviewers split the potential 1560 articles from the literature search and independently reviewed the article titles and abstracts for inclusion. Forty-six English-written full-text articles were further examined by two independent reviewers from either pair, resulting in a total of 22 studies included. <h3>Data Extraction</h3> All four independent reviewers extracted the descriptive data related to the intervention, the outcome measures, and the results. <h3>Data Synthesis</h3> The four reviewers classified the studies into three groups based on the intervention type: Rhythm-Only (n=12), Music-No-Beats (n=7), and Music-With-Beats (n=4) interventions. <h3>Conclusions</h3> Regardless of the intervention types, PD participants demonstrated consistent improvements in non-functional, rhythmed tasks (e.g., finger tapping) after training. However, no studies of Rhythm-Only interventions examined UE functions (e.g., dressing). Although 4 studies of Music-No-Beats interventions assessed UE functions (e.g., eating), none showed significant improvements. Further analysis suggests that interventions using familiar melodies could be distracting and deteriorate PD patients' performance. All the Music-With-Beats studies demonstrated significant results, but only one measured and showed functional benefits (in handwriting). Overall, only limited PD studies examined UE functional outcomes. More studies are needed to understand the unique effects of each intervention type for better clinical applications in PD. <h3>Author(s) Disclosures</h3> No conflict of interest.

Developing Robot-Assisted Telerehabilitation System

<h3>Research Objectives</h3> The aim is to develop a novel telerehabilitation system to deliver robot-assisted rehabilitation using IIoT (Industrial Internet of Things) PTC ThingWorx, and AR (Augmented Reality) Vuforia Studio platforms. <h3>Design</h3> Experimental Study. <h3>Setting</h3> In the BioRobotics Lab. <h3>Participants</h3> Three healthy participants, age: 23–35 years, height: 1.60–1.80 m, weights: 51–110 kg. <h3>Interventions</h3> Remotely administer a wide range of robot-assisted rehab therapy ranging from passive to resistive exercises using either a joystick or AR session. <h3>Main Outcome Measures</h3> We assessed the functionality and usability of the developed Telerehabilitation system configuring human-robot collaborative sessions through the use of IIoT and AR-based user interface which enables the developed telerehabilitation system to provide various robot-assistive rehabilitation exercises. <h3>Results</h3> Results demonstrated the developed robot-assisted telerehabilitation system that can successfully and effectively follow the trajectories as commands passed by the therapist using an IIoT services and AR-based user interface and physical joystick. We conducted experiments on healthy subjects. The therapist monitored trajectories of robotic arm though digital twin on the Vuforia Studio, and feedback is recorded. Experiment results ensure that the robotic arm is used to provide various rehabilitation therapies for upper extremity movements at low latency. <h3>Conclusions</h3> Developed robot-assisted telerehabilitation system is mainly focused to provide individuals with physical and/or cognitive disabilities, including muscle weakness, spasms, and multi-joint coordination problems with remote assistance and evaluation. This system minimizes the distance between rehabilitative patients and therapists. By using this system, patients will regain the ability to lead normal daily lives. <h3>Author(s) Disclosures</h3> The authors have no conflicts of interest to declare.