Movements Of Upper Extremities Research Articles

Evaluation of Upper Extremity Movement, Pain Intensity, and Respiratory Functions in Patients Who Received Thoracotomy Sparing the Serratus Anterior Muscle

Evaluation of Upper Extremity Movement, Pain Intensity, and Respiratory Functions in Patients Who Received Thoracotomy Sparing the Serratus Anterior Muscle

Impact of Startling Acoustic Stimuli on Word Repetition in Individuals With Aphasia and Apraxia of Speech Following Stroke.

The StartReact effect, whereby movements are elicited by loud, startling acoustic stimuli (SAS), allows the evaluation of movements when initiated through involuntary circuitry, before auditory feedback. When StartReact is applied during poststroke upper extremity movements, individuals exhibit increased muscle recruitment, reaction times, and reaching distances. StartReact releases unimpaired speech with similar increases in muscle recruitment and reaction time. However, as poststroke communication disorders have divergent neural circuitry from upper extremity tasks, it is unclear if StartReact will enhance speech poststroke. Our objective is to determine if (a) StartReact is present in individuals with poststroke aphasia and apraxia and (b) SAS exposure enhances speech intelligibility. We remotely delivered startling, 105-dB white noise bursts (SAS) and quiet, non-SAS cues to 15 individuals with poststroke aphasia and apraxia during repetition of six words. We evaluated average word intensity, pitch, pitch trajectories, vowel formants F1 and F2 (first and second formants), phonemic error rate, and percent incidence of each SAS versus non-SAS-elicited phoneme produced under each cue type. For SAS trials compared to non-SAS, speech intensity increased (∆ + 0.6 dB), speech pitch increased (∆ + 22.7 Hz), and formants (F1 and F2) changed, resulting in a smaller vowel space after SAS. SAS affected pitch trajectories for some, but not all, words. Non-SAS trials had more stops (∆ + 4.7 utterances) while SAS trials had more sustained phonemes (fricatives, glides, affricates, liquids; ∆ + 5.4 utterances). SAS trials had fewer distortion errors but no change in substitution errors or overall error rate compared to non-SAS trials. We show that stroke-impaired speech is susceptible to StartReact, evidenced by decreased intelligibility due to altered formants, pitch trajectories, and articulation, including increased incidence of sounds that could not be produced without SAS. Future studies should examine the impact of SAS on voluntary speech intelligibility and clinical measures of aphasia and apraxia.

Spatial, But Not Temporal, Kinematics of Spontaneous Upper Extremity Movements Are Related to Gross and Fine Motor Skill Attainment in Infancy

Background: Spontaneous upper extremity movements in infancy provide insight on neuromotor development. Spatiotemporal kinematics have been used to evaluate typical development of reaching, a foundational motor skill in infancy. This study evaluates the relationship between spontaneous upper extremity movements, not elicited by a toy, and motor skill attainment. Methods: N = 12 healthy infants (2–8 months) participated in this longitudinal study (one to four sessions). Motor skills were assessed with the Bayley Scales of Infant and Toddler Development, 3rd Edition: gross motor subtest (GM) and fine motor subtest. Spontaneous upper extremity movements were collected using 3D motion capture technology. Infants were placed in supine for three to twelve 30-s trials, and their movements were recorded. Repeated measure correlation coefficients (Rmcorr) were used to evaluate relationships between variables. Results: There were significant, moderate, positive relationships between the straight distance from start to end of a movement and (a) fine motor score (Rmcorr = .55, p = .03), (b) GM score (Rmcorr = .63, p = .01), and (c) age (Rmcorr = .56, p = .02). There was a significant, moderate, negative relationship between straightness ratio and GM score (Rmcorr = −.52, p = .047). Discussion: Fine and GM skills are related to the straight distance from start to end of a movement and the straightness ratio of underlying spontaneous upper extremity movements.

İnternal Jugüler Ven Kateterizasyonu Sonrası Brakiyal Pleksus Yaralanması

Central venous catheters are often used as a vascular access for uremic patients who need hemodialysis in both acute and chronic renal failure disease. Among different locations, the most preferable access for catheter is internal jugular vein (IJV) due to its less adverse effects. Herein, we present case of brachial plexus injuries (BPI) as a complication of percutaneous IJV catheterization. After the development of acute renal failure due to lupus nephritis in a 25-years-old pregnant woman; pregnancy was terminated and hemodialysis treatment administered since she has uremic symptoms. Brachial plexus injury occurred after the insertion of IJV catheter. IJV catheterization is safe procedure if the doctor has enough experience. If weakness develops in ipsilateral upper extremity movements after catheterization, doctors should be suspected of BPI.

Using Machine Learning to Identify Feelings of Energy and Fatigue in Single-Task Walking Gait: An Exploratory Study

The objective of this study was to use machine learning to identify feelings of energy and fatigue using single-task walking gait. Participants (n = 126) were recruited from a university community and completed a single protocol where current feelings of energy and fatigue were measured using the Profile of Moods Survey–Short Form approximately 2 min prior to participants completing a two-minute walk around a 6 m track wearing APDM mobility monitors. Gait parameters for upper and lower extremity, neck, lumbar and trunk movement were collected. Gradient boosting classifiers were the most accurate classifiers for both feelings of energy (74.3%) and fatigue (74.2%) and Random Forest Regressors were the most accurate regressors for both energy (0.005) and fatigue (0.007). ANCOVA analyses of gait parameters comparing individuals who were high or low energy or fatigue suggest that individuals who are low energy have significantly greater errors in walking gait compared to those who are high energy. Individuals who are high fatigue have more symmetrical gait patterns and have trouble turning when compared to their low fatigue counterparts. Furthermore, these findings support the need to assess energy and fatigue as two distinct unipolar moods as the signals used by the algorithms were unique to each mood.

Effects of Augmented Reality Intervention on the Range of Motion and Muscle Strength of Upper Extremity in Children with Spastic Hemiplegic Cerebral Palsy: A Randomized Clinical Trial.

Objective: To determine the effects of augmented reality (AR) interventions on the upper extremity's (UE's) range of motion (ROM) and muscle strength in children with spastic hemiplegic cerebral palsy (SHCP). Materials and Methods: Thirty children with SHCP, aged 6 to 12 years, were randomly divided into three interventional groups. Each group received an AR game that is, Balance It, Bubble Pop, or Scoop'd (WonderTree, Pakistan). The UE's ROM and muscle strength were assessed at the baseline and after 8 weeks of intervention through goniometer and manual muscle testing, respectively. Paired-sample t-test and Wilcoxon signed-rank test were used for analyzing the changes in ROM and muscle strength within the groups respectively. One-way analysis of variance (ANOVA) and Tukey's test were used for the differences in ROM, whereas the Kruskal-Wallis test was used for the differences in muscle strength, between the groups. Results: Within-group analysis revealed that all the groups significantly improved in ROM of the majority of joints and in the strength of various muscles of UE (P < 0.05). The elbow extension ROM was significantly different when a comparison was made between the interventional groups (P < 0.05). Balance It group showed more significant improvement in the elbow extension ROM as compared with the Scoop'd group. However, the comparison between the groups showed no significant difference in the muscle strength of UE (P > 0.05). Conclusion: The AR games intervention was beneficial and effective for improving the ROM of majority of the joints and strength of various muscles of UE in children with SHCP. Clinical Trial Registration number: NCT04171232.

An FPGA-Based Upper-Limb Rehabilitation Device for Gesture Recognition and Motion Evaluation Using Multi-Task Recurrent Neural Networks

Upper-Extremity motor impairment affects millions of Americans due to cerebrovascular incidents, spinal cord injuries, or brain trauma. Current therapy practices used to assist these individuals in regaining motor functionality often require extensive time at rehabilitation facilities with potentially prohibitive travel or financial costs. This work presents a mobile low-cost field programmable gate array (FPGA)-smart rehabilitation system that can be used in home environments. The prototype is a rehabilitation table instrumented with a capacitive sensor array (CSA) to track upper-extremity motions of the user through proximity or touch. In addition, inertial measurement units (IMUs) are placed on the affected upper limb and combined with the CSA data with our sensor fusion signal processing architecture. Motions are classified and evaluated using multi-task convolutional recurrent neural networks with three additional motion quality output classes to personalize recognition based on the particular motor skills of each patient. The prototype achieves above 99&#x0025; accuracy with 32-bit fixed-point format implementation for recognizing dynamic motions and identifying unnatural characteristics (i.e., tremor or limited flexion and extension) in upper limb motions based on sensor values. The convolutional recurrent neural network (C-RNN) fusion classification network is implemented on a 200 MHz Zynq ZCU104 FPGA using an HLS-based design optimized with pipelining and parallelism techniques and achieves 5.4x speedup compared to ARM&#x00AE; Cortex-A53 implementation running at an operating frequency of 1.3 GHz. The prototype is also demonstrated to perform the machine learning classification in real-time.

Hemispheric Differences in Self-evaluation Errors of Upper Extremity Movement in Patients with Chronic Stroke.

There is growing evidence that the side of brain lesions results in distinct upper extremity deficits in motor control, movement behavior, and emotional and cognitive function poststroke. We investigated self-evaluation errors, which are the differences in scores between patient self-evaluation and clinician evaluations, and compared patients with left hemisphere damage (LHD) and right hemisphere damage (RHD) poststroke. Twenty-eight patients with chronic stroke (LHD = 16) performed the actual amount of the test twice with a one-week interval. We videotaped the participants' movements, and participants with stroke and evaluators graded the quality of movement scores by watching video recordings. Self-evaluation errors were significantly lower in patients with LHD than in those with RHD (t = 2.350, p = .019). Interestingly, this error did not change after the clinician provided the correct score as feedback. Chi-squared analysis revealed that more patients with LHD underestimated their movements (χ2 = 9.049, p = .002), while more patients with RHD overestimated (χ2 = 7.429, p = .006) in the send evaluation. Furthermore, there were no correlations between self-evaluation error and age, cognitive function, physical impairment, ability to control emotions, or onset months poststroke. Patients with stroke and therapists evaluated the same movements differently, and this can be dependent on hemispheric damage. Therapists might need to encourage patients with LHD who underestimate their movement to ensure continuous use of their more-affected arm. Patients with RHD who overestimate their movement might need treatment to overcome impaired self-awareness, such as video recordings, to protect from unexpected dangerous situations.

Differential regional pectoralis major activation indicates functional diversity in healthy females

Pectoralis major activation enables the performance of several upper extremity movements. Its regional activation, however, is not documented in healthy females. This work used high-density surface electromyography to investigate regional pectoralis major activation in twenty-nine healthy young females across two independent experiments in several ramp and hold isometric tasks and force levels. Regional mean root mean square amplitudes (normalized to the task-specific maxima) were quantified for the clavicular, superior, and middle sternocostal regions. Two-way ANOVAs were used to determine if differences in normalized regional activation exist within each task and force level. The middle sternocostal region activated 12–108% more than the clavicular and the superior sternocostal region in extension, adduction with external rotation, and high elevation internal rotation. In high elevation adduction, the middle sternocostal region activated more (7–22%) than the superior sternocostal region. In low elevation, internal rotation (60°), the clavicular and middle sternocostal regions activated more (9–13%) than the superior sternocostal region, while in adduction 60°, the clavicular region activated 9–19% more than the superior sternocostal region. Lastly, in forward and horizontal flexion, all three regions activated similarly irrespective of the force level, except at 25% MVF in forward flexion, where the clavicular region activated 21% more than the superior sternocostal region. This work provides a first comprehensive evaluation of the normalized regional pectoralis major activation in healthy females. The present findings indicate that the performance of isometric tasks in different directions activates different pectoralis major regions in healthy females, suggesting regional specificity to functional actions.

Predicting post-stroke motor recovery of upper extremity using clinical variables and performance assays: A prospective cohort study protocol.

Measurement of movement quality is essential to distinguish motor recovery patterns and optimize rehabilitation strategies post-stroke. Recently, the Stroke Recovery and Rehabilitation Roundtable Taskforce (SRRR) recommended four kinetic and kinematic performance assays to measure upper extremity (UE) movements and distinguish behavioral restitution and compensation mechanisms early post-stroke. The purpose of this study is to develop and validate a prediction model to analyze the added prognostic value of performance assays over clinical variables assessed up to 1-month post stroke for predicting recovery of UE motor impairment, capacity and quality of movement (QoM) measured at 3months post-stroke onset. In this prospective cohort study, 120 stroke survivors will be recruited within seven days post-stroke. Candidate predictors such as baseline characteristics, demographics and performance assays as per SRRR recommendations along with tonic stretch reflex threshold will be measured up to 1-month post-stroke. Upper extremity motor recovery will be evaluated in terms of motor impairment (Fugl-Meyer assessment for UE), UE capacity measured with Action Research Arm Test (ARAT) and QoM (movement smoothness in the form of peak metrics [PM]) assessed with a reach-to-grasp-to-mouth task (mimicking a drinking task) at 3months post-stroke. Three multivariable linear regression models will be developed to predict factors responsible for the outcomes of Fugl-Meyer assessment for upper extremity (FM-UE), ARAT and movement quality. The developed models will be internally validated using a split-sample method. This study will provide a validated prediction model inclusive of clinical and performance assays that may assist in prediction of UE motor recovery. Predicting the amount of recovery and differentiating between behavioral restitution and compensation (as reflected by the FM-UE, QoM and ARAT) would enable us in realistic goal formation and planning rehabilitation. It would also help in encouraging patients to partake in early post-stroke rehabilitation thus improving therecovery potential.

Therapeutic Effects of a Newly Developed 3D Magnetic Finger Rehabilitation Device in Subacute Stroke Patients: A Pilot Study.

We developed a magnetic-force-based three-dimensional (3D) rehabilitation device that can perform motor rehabilitation treatment for paralyzed fingers, regardless of upper extremity movement and position, and investigated the therapeutic effects of the device. An end-effector type rehabilitation device that can generate magnetic fields in three directions was developed using electromagnets and permanent magnetics. A double-blinded randomized controlled pilot study was conducted with a total of 12 patients. The intervention group had rehabilitation treatment using the developed magnetic finger rehabilitation device for 30 min a day for four weeks. The control group underwent exercise rehabilitation treatment. The control group received conventional occupational therapy on the upper limbs, including hands, from an occupational therapist, for the same amount of time. Adverse effects were monitored, and the patient’s sensory or proprioceptive deficits were examined before the intervention. No participants reported safety concerns while the intervention was conducted. The Wolf Motor Function Test (WMFT) scores were significantly improved in the intervention group (from 13.4 ± 3.6 to 20.9 ± 4.0 points) compared to the control group (from 13.1 ± 4.0 to 15.2 ± 3.8 points) (p = 0.016). The patients in the intervention group (from 88 ± 12 to 67 ± 13 s) showed greater improvement of WMFT times compared to the control group (from 89 ± 10 to 73 ± 11 s) (p = 0.042). The Manual Function Test and the upper limb score of the Fugl-Meyer Assessment were significantly improved in the intervention group compared with the control group (p = 0.038 and p = 0.042). The patients in the intervention group also showed significantly greater enhancement of the Korean version of the modified Barthel Index than the control group (p = 0.042). Rehabilitation treatment using the 3D magnetic-force-driven finger rehabilitation device helped improve finger motor function and activities of daily living in subacute stroke patients.

Relations between Visual Axis and Upper Extremity Motion during Eating in Healthy People: Correspondence of Eye Movement Pattern and Velocity Curve

Relations between Visual Axis and Upper Extremity Motion during Eating in Healthy People: Correspondence of Eye Movement Pattern and Velocity Curve

Functional outcomes of modified constraint-induced movement therapy versus Kinesio taping in children with Erb’s palsy

IntroductionFunctional improvement is the primary goal in chronic cases with neurological deficits. The aim of this study was to compare using modified constraint-induced movement therapy and Kinesio taping to improve functional outcomes in children with Erb’s palsy.MethodsThe study investigated 46 children with Erb’s palsy aged 5–7 years. They were randomly classified into 2 equal groups. Patients in group A engaged in a modified constraint-induced movement therapy program which included restraining of the movement of the non-involved upper extremity, while those in group B received a selected rehabilitative program based on the Kinesio taping method. The treatment programs were conducted 5 times per week for 6 successive weeks. Measurements obtained included active range of motion of shoulder flexion, abduction, and external rotation, as well as modified Mallet scale scores. These measurements were recorded before and after the application of the treatment program in both groups.ResultsThere was a significant improvement in external rotation range of motion and forearm supination when comparing pre- and post-treatment mean values in each study group. There were no differences between the groups regarding any of the measured variables.ConclusionsAccording to the applied procedures and collected data, there was no evidence for a superiority of modified constraint-induced movement therapy when compared with Kinesio taping in improving functional outcomes in children with Erb’s palsy.

Effect of the Perceptive Exploration Approach on Upper Extremity Movement Disorder in Patients with Acute Stroke Hemiparesis: Case Series Study

Effect of the Perceptive Exploration Approach on Upper Extremity Movement Disorder in Patients with Acute Stroke Hemiparesis: Case Series Study

Critical review of the justification of limitations in physical therapy and activities of daily living in cardiac surgery patients

IntroductionThe study aim was to analyse the justification of limitations in physical therapy and activities of daily living in patients after cardiac surgery via sternotomy.MethodsA narrative review design was followed. This study is the result of analysing and comparing the data obtained through investigating sternal closure stability after sternotomy, the load on the sternum during physical therapy, activities of daily living and coughing, as well as the effectiveness of sternum external fixation.ResultsSternum closure stability after sternotomy and the force of the load on the sternum during cough are greater than when performing upper extremity movements and most of the activities of daily living. The benefits of using sternum external fixation are not marked. Mathematically, most of the presented statistical benefits of sternum external fixation were achieved owing to the large number of individuals in the samples. Therefore, it is important to analyse such statistical indicators as odds ratio, attributable risk, the number needed to treat in terms of such a ‘harmful factor’ as lack of sternum external fixation. The use of sternum external fixation should be biomechanically grounded.ConclusionsConventional restrictions and recommendations for patients after cardiac surgery via sternotomy lack theoretical justification and research to confirm their necessity.

A Case Report of Valproic Acid-Induced Tremor by Korean Traditional Medicine

A 56-year-old male patient with a sudden onset of tremor and involuntary movement of right upper and lower extremities, head, and voice was diagnosed as having a drug-induced tremor, with valproic acid being the culprit drug. The patient had undergone admission treatment at an internal Korean medicine department with herbal medicine according to constitutional diagnosis, acupuncture, moxibustion, cupping, and rehabilitation. The change in the severity of tremor was assessed with the Fahn Tolosa Marine scale. After discharge, the patient took herbal medicine for two more months. After 20 days of admission and 2 months of treatment with herbal medicine, the patient's tremor improved. In this case, the patient with valproic acid– induced tremor showed improvement in symptoms after 20 days of hospitalization and further reduction of tremor and improvement of quality of life were confirmed through follow-up for 2 months.

Reachable workspace with real-time motion capture feedback to quantify upper extremity function: A study on children with brachial plexus birth injury

Clinical upper extremity (UE) functional assessments and motion capture measures are limited to a set of postures and/or motions that may provide an incomplete evaluation of UE functionality. Reachable workspace analysis offers a more global assessment of UE function, but is reliant on patient compliance with instructions and may result in underestimates of a patient’s true UE function. This study evaluated a clinical tool that incorporates real-time visual feedback with motion capture to provide an innovative means of engaging patients to ensure a ‘best effort’ quantification of their available UE workspace. Reachable workspace for 10 children with brachial plexus birth injury was collected with and without real-time feedback on the affected and unaffected limbs. Real-time feedback consisted of subjects reaching for virtual targets surrounding their physical space using a virtual cursor controlled by the real-time location of their hand. Real-time feedback resulted in significantly greater workspace in multiple regions on both the affected (3/6 octants; mean differences 10.8%-20.0%) and unaffected (6/6 octants; mean differences 24.3%-40.0%) limbs. Use of real-time feedback also yielded significant interlimb differences in workspace across more regions (4/6 octants; mean differences 29.0%-39.9% vs. 1/6 octants; mean difference 17%). Finally, real-time feedback resulted in significant interlimb differences in median reach distance across more regions (4/6 octants; mean differences 7.5%-44.8% vs. 1/6 octants; mean difference 11.2%). A reachable workspace tool with real-time feedback results in more workspace and UE function recorded and offers a highly visual and intuitive depiction of a patient’s UE abilities.

Novel clinically-relevant assessment of upper extremity movement using depth sensors

ABSTRACT Background For individuals post-stroke, home-based programs are necessary to deliver additional hours of therapy outside of the limited time in the clinic. Virtual reality (VR)-based approaches show modest outcomes in improving client function when delivered in the home. The movement sensors used in these VR-based approaches, such as the Microsoft Kinect® have been validated against gold standards tools but have not been used as an assessment of upper extremity movement quality in the stroke population. Objectives The purpose of this study was to explore the use of a movement sensor paired with a VR-based intervention to assess upper extremity movement for individuals post-stroke. Methods Movement data captured with the Microsoft Kinect® from four separate studies were aggregated for analysis (n = 8 individuals post-stroke, n = 30 individuals without disabilities). For all participants, the skeletal data (x, y, z coordinates for 15 tracked joints) for each game play session were processed in MatLab and movement variables (normalized jerk, movement path ratio, average path sway) were calculated using an OPTICS density-based cluster algorithm. Results Data from the 30 healthy individuals created a normative baseline for the three kinematic variables. Individuals post-stroke were less efficient and had more jerky movements in both upper extremities as compared to healthy individuals. Conclusion It is feasible to use a movement sensor paired with a VR-based intervention to quantify and qualify upper extremity movement for individuals post-stroke. Further research with a larger cohort is necessary to establish clinical sensitivity and specificity.

Bilateral actigraphic quantification of upper extremity movement in hemiparetic children with perinatal stroke: a case control study

BackgroundHemiparetic cerebral palsy impacts millions of people worldwide. Assessment of bilateral motor function in real life remains a major challenge. We evaluated quantification of upper extremity movement in hemiparetic children using bilateral actigraphy. We hypothesized that movement asymmetry correlates with standard motor outcome measures.MethodsHemiparetic and control participants wore bilateral wrist Actiwatch2 (Philips) for 48 h with movement counts recorded in 15-s intervals. The primary outcome was a novel statistic of movement asymmetry, the Actigraphic Movement Asymmetry Index (AMAI). Relationships between AMAI and standard motor outcomes (Assisting Hand Assessment, Melbourne Assessment, and Box and Block Test [BB]) were explored with Pearson or Spearman correlation.Results30 stroke (mean 11 years 2 months (3 years 10 months); 13 female, 17 male) and 23 control (mean 11 years 1 month (4 years 5 months); 8 female, 15 male) were enrolled. Stroke participants demonstrated higher asymmetry. Correlations between AMAI and standard tests were moderate and strongest during sleep (BB: r = 0.68, p < 0.01).ConclusionsStandard tests may not reflect the extent of movement asymmetry during daily life in hemiparetic children. Bilateral actigraphy may be a valuable complementary tool for measuring arm movement, potentially enabling improved evaluation of therapies with a focus on child participation.

The Rehabilitation Effects of Myoelectric Powered Wearable Orthotics on Improving Upper Extremity Function in Persons with SCI.

Upper extremity (UE) weakness and/or paralysis following spinal cord injury (SCI) can lead to a limited capacity to perform activities of daily living (ADL). Such disability significantly reduces an individual's level of independence. Further, restoration of UE motor function in people with SCI remains a high priority in rehabilitation and the field of assistive technology. The overall goal of this study was to evaluate the effects of a myoelectric-powered wearable orthosis (MPWO) manufactured by MyoMo, Inc. (Boston, MA) for UE movement assistance on ameliorating UE motor function in order to improve ADL and quality of life in people with SCI. Two male participants with chronic incomplete SCI (iSCI), a 75- and a 31-year-old with AIS D and B, respectively, underwent 18 sessions (over 6 weeks) of UE movement rehabilitation using the MPWO. Handgrip strength, active range of motion (AROM) of the hand, response time to initiate a movement, and muscles activations were examined before and after the rehabilitation training using the MPWO. The response time to initiate UE movements decreased, and handgrip strength and AROM improved after training with the MPWO. These preliminary data suggest that rehabilitation with the use of the UE-MPWO device could enhance the participants' UE activities that led to improved function.Clinical Relevance- These preliminary results from two individuals with iSCI suggest that training with UE-MPWO assistive devices may improve UE utilization during ADL for individuals with muscle weakness or paralysis but still possessing residual voluntary muscle activation capabilities.