Passive Rehabilitation Research Articles

Efficacy and safety of intravenous tranexamic acid drips at different time points in bilateral primary total knee replacement

Objective To investigate the effects of intravenous tranexamic acid (TA) drips at different time points on perioperative hemorrhage and postoperative venous thromboembolism (VTE) following bilateral primary total knee arthroplasty (TKA). Methods We reviewed 52 patients who had undergone primary bilateral TKA from February 2012 to February 2014. They were 25 men and 27 women, 50 to 75 years of age. They were divided into 4 even groups (n=13) according to timing of medication. Group A received a dose of 15 mg/kg TA intravenously 30 minutes preoperation and 30 minutes before wound closure; group B received a dose of 15 mg/kg TA intravenously 15 minutes preoperation; group C received 15 mg/kg TA intravenously 30 minutes before wound closure; group D received an equal volume of normal saline before surgery. The following indexes were recorded: 24 h postoperative drainage volume; total drainage volume; blood transfusion rate; postoperative haemoglobin (Hb) levels at 24 h, 72 h and 7 d; postoperative prothrombin time (PT); activated partial thromboplastin time (APTT); fibrinogen (FIB); visual analogue scale (VAS) at 24 h & 36 h postoperation; level of bilateral knee passive movement 3 days after surgery and VTE incidence. Patients' lower limbs were examined with Doppler ultrasound 2 weeks postoperatively. Results The 24h postoperative drainage volume and total drainage volume in groups A, B & C were significantly lower than in group D with group A being significantly less than groups B & C (P 0.05). No VTE occurred in any of the 4 groups. Conclusions In bilateral primary total knee arthroplasty, intravenous TA drips can reduce postoperative hemorrhage and blood transfusion rate but may not increase the risk of VTE or hinder passive movement rehabilitation of the knee early after the surgery. The intravenous infusion of 15 mg/kg of TA 30 minutes preoperation and 30 minutes before wound closure may lead to optimal efficacy. Key words: Tranexamic acid; Arthroplasty, replacement, knee; Postoperative hemorrhage; Embolism and thrombosis

Mechanical risk of rotator cuff repair failure during passive movements: A simulation-based study

BackgroundDespite improvements in rotator cuff surgery techniques, re-tear rate remains above 20% and increases with tear severity. Mechanical stresses to failure of repaired tendons have been reported. While optimal immobilization postures were proposed to minimize this stress, post-operative rehabilitation protocols have never been assessed with respect to these values. Purpose was to use musculoskeletal simulation to predict when the stress in repaired tendons exceeds safety limits during passive movements. Hence, guidelines could be provided towards safer post-operative exercises. MethodsSixteen healthy participants volunteered in passive three-dimensional shoulder range-of-motion and passive rehabilitation exercises assessment. Stress in all rotator cuff tendons was predicted during each movement by means of a musculoskeletal model using simulations with different type and size of tears. Safety stress thresholds were defined based on repaired tendon loads to failure reported in the literature and used to discriminate safe from unsafe ranges-of-motion. FindingsIncreased tear size and multiple tendons tear decreased safe range-of-motion. Mostly, glenohumeral elevations below 38°, above 65°, or performed with the arm held in internal rotation cause excessive stresses in most types and sizes of injury during abduction, scaption or flexion. Larger safe amplitudes of elevation are found in scapular plane for supraspinatus alone, supraspinatus plus infraspinatus, and supraspinatus plus subscapularis tears. InterpretationThis study reinforces that passive early rehabilitation exercises could contribute to re-tear due to excessive stresses. Recommendations arising from this study, for instance to keep the arm externally rotated during elevation in case of supraspinatus or supraspinatus plus infraspinatus tear, could help prevent re-tear.

Robot-assisted humanized passive rehabilitation training based on online assessment and regulation.

Robot-assisted rehabilitation has been developed and proved effective for motion function recovery. Humanization is one of the crucial issues in the designing of robot-based rehabilitation system. However, most of the previous investigations focus on the simplex position control when comes to the control system design of robot-assisted passive training, and pay little attention to the dynamic adjustment according to the patient's performances. This paper presents a novel method to design the passive training system using a developed assessing-and-regulating section to online assess the subject's performances. The motion regulating mechanism is designed to dynamically adjust the training range and motion speed according to the actual performances, which is helpful to improve the humanization of the rehabilitation training. Moreover, position-based impedance control is adopted to achieve compliant trajectory tracking movement. Experimental results demonstrate that the proposed method presents good performances not only in motion control but also in humanization.

Use of a mechanically passive rehabilitation device as a training tool in Vietnam: impact on upper extremity rehabilitation after stroke

Use of a mechanically passive rehabilitation device as a training tool in Vietnam: impact on upper extremity rehabilitation after stroke

The treatment of patellofemoral arthroplasty for isolated patellofemoral osteoarthritis

Objective To explore the effect and factors of patellofemoral arthroplasty (PFA) for isolated patellofemoral osteoarthritis. Methods Data of 18 patients (3 males, 15 females) with isolated patellofemoral osteoarthritis underwent PFA from March 2006 to December 2014 were retrospectively analyzed. There were 3 males and 15 females with a mean age of 54 years (range, 46-74 years). It was strict to grasp the surgical indications according to the clinical symptoms, signs and imaging data preoperatively. 11 patients were operated with AVON patellofemoral prosthesis (Stryker Inc.) and the other 7 patients were operated with the Gender Solutions patellofemoral prosthesis (Zimmer Inc.). Active and passive functional rehabilitation exercise was encouraged at the early stage after operation. Visual analogue scale (VAS) was 5.33±0.99 (range, 4-7) and hospital for special surgery knee score (HSS) was 53.28±5.71 (range, 44-63) before operation. Results The mean duration of follow-up was 63.98 months (range, 6-104 months). VAS after operation for 1 and 3 months were 1.17±0.79 (range, 0-3) and 0.72±0.67 (range, 0-2), and the pain was almost relieved after 9 months. HSS after operation for 1, 3, 9 months were 70.06±6.33 (range, 61-80), 86.06±5.12 (range, 77-95) and 91.39±4.83 (range, 82-97). HSS score of the latest follow-up was 92.06±4.05 (range, 84-97), which was improved obviously from the preoperative ones. The excellent and good rate was 100% (excellent 15 cases, good 3 cases). The satisfactory rate was 94.4% (17/18). Only one case got slightly knee pain when walking up and down the stairs after 2 years, and the pain was relieved after being administered with NSAIDs and rest. No incision infection, rupture, prosthesis supported bone fracture, prosthesis loosening and other complication was occurred during the follow-up period in the other patients. Conclusion The clinical outcomes of PFA are strictly related to surgical indications, implant design and appropriate surgical technique. Therefore, based on the appropriate PFA implants, strict surgical indications, appropriate patients, excellent operation skills and actively functional rehabilitation exercise, PFA could treat the isolated patellofemoral osteoarthritis effectively. Key words: Osteoarthritis, Knee; Patellofemoral joint; Arthroplasty, replacement

Robotic neurorehabilitation system design for stroke patients

In this article, a neurorehabilitation system combining robot-aided rehabilitation with motor imagery–based brain–computer interface is presented. Feature extraction and classification algorithm for the motor imagery electroencephalography is implemented under our brain–computer interface research platform. The main hardware platform for functional recovery therapy is the Barrett Whole-Arm Manipulator. The mental imagination of upper limb movements is translated to trigger the Barrett Whole-Arm Manipulator Arm to stretch the affected upper limb to move along the predefined trajectory. A fuzzy proportional–derivative position controller is proposed to control the Whole-Arm Manipulator Arm to perform passive rehabilitation training effectively. A preliminary experiment aimed at testing the proposed system and gaining insight into the potential of motor imagery electroencephalography-triggered robotic therapy is reported.

Design and Implementation of a Rehabilitation Training Control System for Stroke Patients

This paper involved designing and implementing a control system of lower limb exoskeleton. In order to combine the unity of the hardware with the flexibility of the software, a full digital control scheme integrated based on DSP processor was presented. By embedding advanced control strategies, the system can effectively control the exoskeleton joint motor. The proposed system can achieve accurate active or passive gait rehabilitation training along the trajectory planed and retrain their muscles and feeling of walking in their legs for paralysis patients at a lower cost.

Design of Wrist Rehabilitation Device for Hemiplegic Patients

There have been some devices for rehabilitations of upper limb such as electronic device and mechanical device which is well-known as the passive one. These devices make the motion of upper limbs and stimulate the wrist, elbow, shoulder joints with muscles. This motion does by using the patient’s normal hand (left or right hand) and rotating the wounded hand’s wrist to be recovered by the clockwise or counterclockwise with some angles. Electronic devices for upper limb rehabilitation have the advantage that the electronic ones can supply various rehabilitation exercises to the patients. However these electronic devices include relatively expensive components such as various kinds of sensors, controllers, and display device. Therefore, the prices of implementation are too expensive. On the other hand, in conventional passive upper limb rehabilitation, the patients grasp the both handles without any mechanical links. It does not supply proper rehabilitation motion because the normal hand does not supply the rehabilitation motion to hand to be recovered. So to speak, this is not proper to patients with the one hands trouble such as hemiplegic patients, by himself without the aids of any other persons. In this paper, we describe the mechanical device for rehabilitations of wrist and the proposed handles to be attached in this mechanical device. This proposed handles can generate the three angle motion of wrist such as the roll, pitch and yaw. This proposed device has some features that this device can be implemented with lower costs than electronic devices and can be used whatever the wounded hand is right or left by selecting the lever. Further, when the patient has the rehabilitation exercise intent, the patients can easily use the proposed upper limb rehabilitation devices without the aid of the rehabilitation therapist the energy source is the normal hands of the patients.

Development of a whole arm wearable robotic exoskeleton for rehabilitation and to assist upper limb movements

SUMMARYTo assist physically disabled people with impaired upper limb function, we have developed a new 7-DOF exoskeleton-type robot named Motion Assistive Robotic-Exoskeleton for Superior Extremity (ETS-MARSE) to ease daily upper limb movements and to provide effective rehabilitation therapy to the superior extremity. The ETS-MARSE comprises a shoulder motion support part, an elbow and forearm motion support part, and a wrist motion support part. It is designed to be worn on the lateral side of the upper limb in order to provide naturalistic movements of the shoulder (vertical and horizontal flexion/extension and internal/external rotation), elbow (flexion/extension), forearm (pronation/supination), and wrist joint (radial/ulnar deviation and flexion/extension). This paper focuses on the modeling, design, development, and control of the ETS-MARSE. Experiments were carried out with healthy male human subjects in whom trajectory tracking in the form of passive rehabilitation exercises (i.e., pre-programmed trajectories recommended by a therapist/clinician) were carried out. Experimental results show that the ETS-MARSE can efficiently perform passive rehabilitation therapy.

Anthropomorphic mechanical design and Lyapunov-based control of a new shoulder rehabilitation system

Article history: Received January 20, 2014 Received in Revised form April, 10, 2014 Accepted 7 May 2014 Available online 9 May 2014 Stroke is one of the main causes of disability. It affects millions of people worldwide. One symptom of stroke is disabled arm function. Restoration of arm function is necessary to resuming activities of daily living (ADL). Along with traditional rehabilitation techniques, robot-aided therapy has emerged recently. The control schemes of rehabilitation robots are designed for two reasons. First they are designed for passive rehabilitation in which the robot guides the patient's limb through a predefined path and second for active rehabilitation in which the patient initiates the movement and is partially assisted or resisted by the robotic device. This paper introduces a new robot for shoulder rehabilitation. The Shoulder Rehabilitation System (SRS) has three degrees of freedom (DOFs) for three rotational DOFs of the shoulder but additional translational DOFs of the shoulder are also allowed to avoid discomfort to the patient. A new open circular mechanism is proposed for the third joint that solves the known issues for rehabilitation robots such as long wiring and discomfort associated with closed mechanisms. Lyapunov-based controller with integral action is proposed to guide the robot through a predefined trajectory. Simulation results proved that the proposed controller can track the desired trajectory; reject constant bounded disturbance to the system and is robust due to its nonlinear nature. The proposed controller is designed to be used in passive rehabilitation. © 2014 Growing Science Ltd. All rights reserved.

Continuous decoding of movement intention of upper limb self-initiated analytic movements from pre-movement EEG correlates.

BackgroundBrain-machine interfaces (BMI) have recently been integrated within motor rehabilitation therapies by actively involving the central nervous system (CNS) within the exercises. For instance, the online decoding of intention of motion of a limb from pre-movement EEG correlates is being used to convert passive rehabilitation strategies into active ones mediated by robotics. As early stages of upper limb motor rehabilitation usually focus on analytic single-joint mobilizations, this paper investigates the feasibility of building BMI decoders for these specific types of movements.MethodsTwo different experiments were performed within this study. For the first one, six healthy subjects performed seven self-initiated upper-limb analytic movements, involving from proximal to distal articulations. For the second experiment, three spinal cord injury patients performed two of the previously studied movements with their healthy elbow and paralyzed wrist. In both cases EEG neural correlates such as the event-related desynchronization (ERD) and movement related cortical potentials (MRCP) were analyzed, as well as the accuracies of continuous decoders built using the pre-movement features of these correlates (i.e., the intention of motion was decoded before movement onset).ResultsThe studied movements could be decoded in both healthy subjects and patients. For healthy subjects there were significant differences in the EEG correlates and decoding accuracies, dependent on the moving joint. Percentages of correctly anticipated trials ranged from 75% to 40% (with chance level being around 20%), with better performances for proximal than for distal movements. For the movements studied for the SCI patients the accuracies were similar to the ones of the healthy subjects.ConclusionsThis paper shows how it is possible to build continuous decoders to detect movement intention from EEG correlates for seven different upper-limb analytic movements. Furthermore we report differences in accuracies among movements, which might have an impact on the design of the rehabilitation technologies that will integrate this new type of information. The applicability of the decoders was shown in a clinical population, with similar performances between healthy subjects and patients.Electronic supplementary materialThe online version of this article (doi:10.1186/1743-0003-11-153) contains supplementary material, which is available to authorized users.

Continuous passive motion-based rehabilitation equipment for the recovery of lower limb bearing joints

Applying continuous passive rehabilitation movements as part of the recovery programme of patients with post-traumatic disabilities of the bearing joints of the lower limbs requires the development of new high performance equipment. The proposed equipment is designed to be deployed in rehabilitation medical care, its specific objectives being maintenance and recovery of body functions, prevention of dysfunctions, using in this respect kinetic and orthotic techniques, as well as various supporting and adaptive accessories. This paper presents a variant of rehabilitation equipment the novelty of which consists in the utilisation of compliant (soft) fluidic actuators of linear type and variable stiffness. The proposed rehabilitation equipment benefits from a cost efficient, simple and robust construction, being easy to use by persons affected by dysfunctions of the bearing joints. By deploying compliant (soft) actuators, which allow slight deviations from the given position, the human-machine interaction can occur in a gentle and more comfortable manner. This paper presents cinematic and dynamic modelling of the proposed rehabilitation equipment, highlighting its advantages compared to equipments endowed with electric-mechanical linkages.

Force-position control of a robotic exoskeleton to provide upper extremity movement assistance

This paper presents an upper extremity (UE) wearable robot, ETS-MARSE and its control strategy to provide movement assistance and active rehabilitation exercises to physically disabled individuals having impaired UE function. The ETS-MARSE was designed to be worn on the lateral side of UE and is able to assist arm movements at the level of shoulder, elbow, forearm and wrist joint movements. Considering the dynamic modelling of the robot system and the UE motion which are non-linear in nature, a non-linear sliding mode control with exponential reaching law was used to manoeuvre the ETS-MARSE and to provide both passive and assisted arm movement therapy. To provide passive arm movement therapy, pre-programmed trajectories corresponding to recommended passive rehabilitation exercises were used to manoeuvre the ETS-MARSE, whereas in case of assisted rehabilitation therapy user interaction wrist force sensor signals were used to steer the ETS-MARSE in assisting the UE movements. Experiments involving healthy human subjects were performed with the developed ETS-MARSE to evaluate the controller’s performance and that of the ETS-MARSE in regards to providing the therapeutic exercises. Experimental results indicate that with the proposed control strategy, ETS-MARSE can effectively deliver rehabilitation exercises.

Intensive Treatment With Recombinant Factor VIIa (NovoSeven®) To Prevent Joint Bleeding In 4 Patients With Haemophilia A With Inhibitors Undergoing a Regular Program Of Physical Therapy

IntroductionThe development of anti-factor VIII inhibitors is the main complication of modern therapy of hemophilia A (HA) occurring in 25%-30% of severe forms. Inhibitors affect the possibility of a primary prophylaxis and regular physiotherapy, which is an important therapeutic tool to preserve joint function. In patients with severe HA with inhibitors, a prospective randomized study (Konkle et al J Thromb Haemost 5:1904, 2007) and the PRO-PACT retrospective multicenter observational study of a large case series (Young et al Thromb Res 130:864, 2012) have demonstrated the feasibility and effectiveness of secondary prophylaxis with recombinant activated factor VII (rFVIIa, NovoSeven®) in reducing hemarthrosis.Aim of the study: This study describes the unique experience of Hemophilia Pediatric Center of Turin (Italy) in a case series of 4 children with severe hemophilia A, history of high-titer inhibitor and mild or severe artropathy, who underwent to regular rehabilitation programme despite presence of inhibitors. MethodsPostural evaluation and gait analysis have been performed for each patient to assess posture and gait performance and plan a tailored therapeutic-rehabilitative treatment.Each physiotherapy session lasted about 45 minutes. rFVIIa at a dose of 90-180 mcg/kg in a preparation for rehabilitative treatment was administered immediately prior to each session.During physiotherapy sessions, children carried out both active and passive rehabilitation exercises to maintain adequate muscle strength and preserve joint range of movement (ROM). Basal and final joints angles (in degree) were measured with a goniometer. Manual Muscle Testing (MMT) was applied for grading muscle strength. ResultsClinical characteristics and individual physiotherapy program are listed below: Patient 1A 10-years-old African child with 2 target joints (knees) and 1 bleeding episode/month, has performed 102 sessions of active and passive rehabilitation treatment (November 2010 to November 2012) while on immune tolerance therapy (ITI). Patient 2A 12-years-old Caucasian child with 3 target joints (left elbow, knees) has performed a total of 16 sessions (February 2011 to April 2011). Patient 3A 2-years-old Caucasian child with a target joint (knee) has performed a total of 20 sessions (February 2011 to August 2012) while on ITI. Patient 4A 8-years-old Caucasian child with 4 target joint (elbow, 2 ankles) has performed a total of 149 sessions (November 2009 to November 2012) after failed ITI.Within 72 hours after each session, no joint nor muscle bleeding have been observed as evidence of the potential role of rFVIIa in preventing bleeding.The 4 children had a total of 287 physiotherapy sessions, each of them preceded by a single administration of rFVIIa. Treatment provided adequate hemostasis in all patients; no bleeding was observed during the sessions and in the following 3 days. The rehabilitative program obtained a gain of ROM in most of the 9 joints assessed and an improvement in muscle strength was also observed, as described in table. Postural evaluation and gait analysis confirmed these results. We did not observe thrombotic events nor infectious episodes. ConclusionCombination of rFVIIa and physiotherapy improved joint ROM and muscle strength in hemophilic children with inhibitors. The rehabilitation program has not given rise to safety issues in these young patients. Disclosures:Messina:Pfizer: Membership on an entity's Board of Directors or advisory committees; CSL Behring: Membership on an entity's Board of Directors or advisory committees; Novo Nordisk: Membership on an entity's Board of Directors or advisory committees; Baxter: Honoraria; Bayer: Honoraria. Forneris:Novo Nordisk: Honoraria, the autor has received reimbursement for attending a symposium and fees for speaking by Novo Nordisk Other. Off Label Use: rFVIIa is not licensed for nonsurgical prophylaxis in Italy. The use of rFVIIa in prophylaxis as a preparation for physiotherapy treatment currently is considered off label in Italy.

Output feedback control of an actuated lower limb orthosis with bounded input

Purpose – The purpose of this paper is the control of lower limb orthosis acting at the knee joint level for a passive rehabilitation purpose. Design/methodology/approach – A control law, based on a saturated proportional derivative controller, is proposed in order to drive the shank-foot-orthosis system along a desired trajectory. Findings – The proposed control law is tested in real time using the orthosis EICOSI of the LISSI-Laboratory. The experiments show that the proposed control law is capable of providing satisfactory trajectory tracking performance given only the knee joint angle measurement. Moreover, the control law is robust with respect to external disturbances. Originality/value – Robust control of an actuated lower limb orthosis.

Interest of passive rehabilitation during the first 45 days after rotator cuff repair

Interest of passive rehabilitation during the first 45 days after rotator cuff repair

The Analysis and Control of Exoskeleton Upper-Limb Rehabilitation Robot

Based on the analysis of the methods for upper limb rehabilitation training, an anthropomorphic upper-limb exoskeleton was developed. Anatomical and physiological characteristics and upper limb joint ranges of motion are also considered. The rehabilitation robot is achieved by 4 single-axis revolute joints which are shoulder abduction-adduction (abd-add), shoulder flexion-extension (flx-ext), elbow flx-ext and wrist flx-ext. Kinematics and dynamics analysis of the rehabilitation robot are made. The passive rehabilitation mode and active rehabilitation mode are researched, and the result of experenment is shown that the robot can finish the rehabilitation task well.

The nature of arm movement in children with cerebral palsy when using computer-generated exercise games

Purpose: To compare upper limb kinematics of children with spastic cerebral palsy (CP) using a passive rehabilitation joystick with those of adults and able-bodied children, to better understand the design requirements of computer-based rehabilitation devices. Method: A blocked comparative study involving seven children with spastic CP, nine able-bodied adults and nine able-bodied children, using a joystick system to play a computer game whilst the kinematics of their upper limb were recorded. The translational kinematics of the joystick’s end point and the participant’s shoulder movement (protraction/retraction) and elbow rotational kinematics (flexion/extension) were analysed for each group. Results: Children with spastic CP matched their able-bodied peers in the time taken to complete the computer task, but this was due to a failure to adhere to the task instructions of travelling along a prescribed straight line when moving between targets. The spastic CP group took longer to initiate the first movement, which showed jerkier trajectories and demonstrated qualitatively different movement patterns when using the joystick, with shoulder movements that were significantly of greater magnitude than the able-bodied participants. Conclusions: Children with spastic CP generate large shoulder and hence trunk movements when using a joystick to undertake computer-generated arm exercises. This finding has implications for the development and use of assistive technologies to encourage exercise and the instructions given to users of such systems.Implications for RehabilitationA kinematic analysis of upper limb function of children with CP when using joystick devices is presented.Children with CP may use upper body movements to compensate for limitations in voluntary shoulder and elbow movements when undertaking computer games designed to encourage the practice of arm movement.The design of rehabilitative computer exercise systems should consider movement of the torso/shoulder as it may have implications for the quality of therapy in the rehabilitation of the upper limb in children with CP.

The Resonating Arm Exerciser: design and pilot testing of a mechanically passive rehabilitation device that mimics robotic active assistance

BackgroundRobotic arm therapy devices that incorporate actuated assistance can enhance arm recovery, motivate patients to practice, and allow therapists to deliver semi-autonomous training. However, because such devices are often complex and actively apply forces, they have not achieved widespread use in rehabilitation clinics or at home. This paper describes the design and pilot testing of a simple, mechanically passive device that provides robot-like assistance for active arm training using the principle of mechanical resonance.MethodsThe Resonating Arm Exerciser (RAE) consists of a lever that attaches to the push rim of a wheelchair, a forearm support, and an elastic band that stores energy. Patients push and pull on the lever to roll the wheelchair back and forth by about 20 cm around a neutral position. We performed two separate pilot studies of the device. In the first, we tested whether the predicted resonant properties of RAE amplified a user’s arm mobility by comparing his or her active range of motion (AROM) in the device achieved during a single, sustained push and pull to the AROM achieved during rocking. In a second pilot study designed to test the therapeutic potential of the device, eight participants with chronic stroke (35 ± 24 months since injury) and a mean, stable, initial upper extremity Fugl-Meyer (FM) score of 17 ± 8 / 66 exercised with RAE for eight 45 minute sessions over three weeks. The primary outcome measure was the average AROM measured with a tilt sensor during a one minute test, and the secondary outcome measures were the FM score and the visual analog scale for arm pain.ResultsIn the first pilot study, we found people with a severe motor impairment after stroke intuitively found the resonant frequency of the chair, and the mechanical resonance of RAE amplified their arm AROM by a factor of about 2. In the second pilot study, AROM increased by 66% ± 20% (p = 0.003). The mean FM score increase was 8.5 ± 4 pts (p = 0.009). Subjects did not report discomfort or an increase in arm pain with rocking. Improvements were sustained at three months.ConclusionsThese results demonstrate that a simple mechanical device that snaps onto a manual wheelchair can use resonance to assist arm training, and that such training shows potential for safely increasing arm movement ability for people with severe chronic hemiparetic stroke.

Flexor tendon excursion and load during passive and active simulated motion: a cadaver study

The aim of this study was to quantify the amount of tendon excursion and load experienced during simulated active and passive rehabilitation exercises. Six cadaver specimens were utilized to examine tendon excursion and load. Lateral fluoroscopic images were used to measure the excursions of metal markers placed in the flexor digitorum superficialis and profundus tendons of the index, middle, and ring fingers. Measurements were performed during ten different passive and active simulated motions. Mean tendon forces were higher in all active versus passive movements. Blocking movements placed the highest loads on the flexor tendons. Active motion resulted in higher tendon excursion than did passive motion. Simulated hook position resulted in the highest total tendon excursion and the highest inter-tendinous excursion. This knowledge may help optimize the management of the post-operative exercise therapy regimen.