Peg Board Research Articles

Cologne ergonomic measurement for robotic surgery (CEMRobSurg) using the Hugo™ RAS System.

The ergonomic advantages and potential challenges that robotic surgery poses to the well-being of surgeons are mainly unexplored. The most recent surgical robot introduced on the European market is the Hugo™ RAS System by Medtronic. This study aims to evaluate the ergonomic benefits of the Hugo™ RAS System, which is available in our training laboratory, CeMIT (Center for Medical Innovation and Technology Cologne). Using the previously established Cologne Ergonomic Measurement Setup for Robotic Surgery (CEMRobSurg), we measured three parameters related to ergonomic posture from subjects with different levels of surgical expertise (laypeople, medical students, surgical residents, and expert robotic surgeons). The heart rate was measured continuously using a polar band. The noise level was measured while using the Hugo™ RAS System, and automated photographs using our locally developed methodology were captured of the participant every 2s to assess body posture. The ergonomic measurements were conducted while the subject performed the same standardized robotic training exercises (Peg Board, Rope Walk, and Ring Walk). A total of 53 participants were enrolled in this study. The average noise level during all measurements was 54.87 dB. The highest stress level was measured in surgical residents with a sympathetic nervous system index (SNS index) of 1.15 (min - 1.43, max 3.56). The lowest stress level was measured in robotic experts with an SNS index of 0.23 (min - 0.18, max 0.91). We observed a risk-prone positioning of the neck and elbow in medical students (mean 39.6° and 129.48°, respectively). Robotic experts showed a risk positioning in the knee and hip region (mean 107.89° and 90.31°, respectively). This is the first study to analyze and objectify the ergonomic posture of medical students, surgical trainees, surgeons, and laypeople using the open console, modular Hugo™ RAS System. Our findings offer recommendations for operating surgeons and allow for a comparative analysis between the different robotic systems. Further evaluations in real-time operative scenarios will follow.

Stroke Survivors' Interaction With Hand Rehabilitation Devices: Observational Study.

The hand is crucial for carrying out activities of daily living as well as social interaction. Functional use of the upper limb is affected in up to 55% to 75% of stroke survivors 3 to 6 months after stroke. Rehabilitation can help restore function, and several rehabilitation devices have been designed to improve hand function. However, access to these devices is compromised in people with more severe loss of function. In this study, we aimed to observe stroke survivors with poor hand function interacting with a range of commonly used hand rehabilitation devices. Participants were engaged in an 8-week rehabilitation intervention at a technology-enriched rehabilitation gym. The participants spent 50-60 minutes of the 2-hour session in the upper limb section at least twice a week. Each participant communicated their rehabilitation goals, and an Action Research Arm Test (ARAT) was used to measure and categorize hand function as poor (scores of 0-9), moderate (scores of 10-56), or good (score of 57). Participants were observed during their interactions with 3 hand-based rehabilitation devices that focused on hand rehabilitation: the GripAble, NeuroBall, and Semi-Circular Peg Board. Observations of device interactions were recorded for each session. A total of 29 participants were included in this study, of whom 10 (34%) had poor hand function, 17 (59%) had moderate hand function, and 2 (7%) had good hand function. There were no differences in the age and years after stroke among participants with poor hand function and those with moderate (P=.06 and P=.09, respectively) and good (P=.37 and P=.99, respectively) hand function. Regarding the ability of the 10 participants with poor hand function to interact with the 3 hand-based rehabilitation devices, 2 (20%) participants with an ARAT score greater than 0 were able to interact with the devices, whereas the other 8 (80%) who had an ARAT score of 0 could not. Their inability to interact with these devices was clinically examined, and the reason was determined to be a result of either the presence of (1) muscle tone or stiffness or (2) muscle weakness. Not all stroke survivors with impairments in their hands can make use of currently available rehabilitation technologies. Those with an ARAT score of 0 cannot actively interact with hand rehabilitation devices, as they cannot carry out the hand movement necessary for such interaction. The design of devices for hand rehabilitation should consider the accessibility needs of those with poor hand function.

Effect of Postural Training in Improving Hand Eye Coordination in Autism Children - An Interventional Study

Autism is one of the major developmental delays that affect the children at an early age. It presents as a series of motor and sensory impairments that constantly needs adjustment in posture. Evaluation of motor skills and enhancing it quite often results in postural adjustment. The primary objective of this current study is to investigate the effect of postural training exercises prior to administration of motor activities in improving the hand eye coordination to perform upper limb tasks. The study was a randomised control trial that included children of both sexes with a diagnosis of autism between the age group of 5 and 10. All the participants of the study underwent the pre-test assessment of Gross motor skill and fine motor skill and were entered in the data sheet as pre-test score. The children’s Gross motor skill and Fine Motor Skill were assessed through Box and Block test and 25 grooved peg board test respectively. The test was performed for the dominant hand of the participant. The participants in control group underwent the motor and fine motor activities for a period of 30 minutes each session on alternate days for 8 weeks. The participants in experimental group received postural stability exercises along with these activities. At the end of 8 weeks the results of the study showed significant improvement in the experimental group. The study concluded that postural stability exercises prior to the activities improved the motor and fine motor skill of the autism children. Keywords: Autism, Postural Exercises in autism children, Hand eye coordination, Postural instability.

Cerebellar, Not Nigrostriatal Degeneration Impairs Dexterity in Multiple System Atrophy.

Multiple system atrophy (MSA) clinically manifests with either predominant nigrostriatal or cerebellopontine degeneration. This corresponds to two different phenotypes, one with predominant Parkinson's symptoms (MSA-P [multiple system atrophy-parkinsonian subtype]) and one with predominant cerebellar deficits (MSA-C [multiple system atrophy-cerebellar subtype]). Both nigrostriatal and cerebellar degeneration can lead to impaired dexterity, which is a frequent cause of disability in MSA. The aim was to disentangle the contribution of nigrostriatal and cerebellar degeneration to impaired dexterity in both subtypes of MSA. We thus investigated nigrostriatal and cerebellopontine integrity using diffusion microstructure imaging in 47 patients with MSA-P and 17 patients with MSA-C compared to 31 healthy controls (HC). Dexterity was assessed using the 9-Hole Peg Board (9HPB) performance. Nigrostriatal degeneration, represented by the loss of cells and neurites, leading to a larger free-fluid compartment, was present in MSA-P and MSA-C when compared to HCs. Whereas no intergroup differences were observed between the MSAs in the substantia nigra, MSA-P showed more pronounced putaminal degeneration than MSA-C. In contrast, a cerebellopontine axonal degeneration was observed in MSA-P and MSA-C, with stronger effects in MSA-C. Interestingly, the degeneration of cerebellopontine fibers is associated with impaired dexterity in both subtypes, whereas no association was observed with nigrostriatal degeneration. Cerebellar dysfunction contributes to impaired dexterity not only in MSA-C but also in MSA-P and may be a promising biomarker for disease staging. In contrast, no significant association was observed with nigrostriatal dysfunction. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

The 6–Minute Pegboard and Ring Test (6PBRT) for Evaluation of Upper Limbs Functional Capacity in Hemodialysis Patients: A Validation Study

Objectives: To verify the 6–minute peg board and ring test (6PBRT) validity for functional evaluation in hemodialysis patients and upper limb (UL) functional capacity by the 6PBRT. Methods: In a cross–sectional study, patients on hemodialysis three times a week for at least 6 months performed the 6PBRT as well as handgrip strength and endurance. Health–related quality of life (HRQoL) by KDQOL–SF questionnaire, Human Activities Profile (HAP), and level of social participation were also evaluated. Convergent validity was verified by correlation analysis. Results: Thirty–seven individuals were evaluated, predominantly adult males (67.6%). The mean age was 50.1 ± 16.4 years old. The average number of rings moved during the 6PBRT was 306.2 ± 68.2. The 6PBRT correlated with handgrip strength ( r = 0.37; p = 0.025), the domain “Functional Capacity” ( r = 0.49; p = 0.008) of the KDQOL–SF questionnaire, and with HAP score ( r = 0.43; p = 0.01). There was no correlation between handgrip endurance ( r = 0.18; p = 0.281) and social participation ( r = −0.12; p = 0.48). Heart rate and dyspnea (modified Borg scale) increased by 13.3 bpm (95% CI: 9.8, 16.8) and 0.5 points (95% CI: 0.1, 0.9) during the 6PBRT. Conclusion: The 6PBRT is associated with UL strength, physical aspects related to HRQoL, and daily activity level, which accounts for its construct validity. Therefore, the test has potential value in the functional evaluation of the ULs in hemodialysis patients. However, in this population, the level of social participation seems to depend on other factors than the functional capacity of the UL itself.

Effect of blood flow restriction training on pressure pain threshold and hand function among adults with persistent neck pain: A study protocol for a randomized controlled trial

Background: Persistent neck pain is a prevalent musculoskeletal condition that affects the quality of life and functional abilities of individuals. Blood Flow Restriction Training (BFRT) is a novel therapeutic approach that involves restricting blood flow to exercising muscles to enhance strength and function. However, limited research has been conducted on the effects of BFRT on pressure pain threshold and hand function in adults with persistent neck pain. This randomized controlled trial aims to investigate the potential benefits of BFRT as a treatment intervention for this population. Methods: This study will be a prospective parallel group active controlled trail done at Physiotherapy Department, Galgotias University. Ethical clearance has been obtained from Departmental Ethics Committee on 19/05/2023 with reference number DEC/PT/GU/2023 and the Trial has been registered with Clinical Trial Registry India CTRI/2023/06/053439. Informed consent will be obtained from all the participants who are eligible to be included in the study. 110 patients with persistent neck pain will be randomly allocated into two groups. The BFRT group will receive supervised training sessions three times a week for eight weeks, performing low-load resistance exercises with blood flow restriction applied using personalized cuff pressure. The control group will receive standard care for neck pain, which may include general advice, manual therapy, and/or home exercises without BFRT. The primary outcome measures will be the pressure pain threshold, assessed using a pressure Algometer, and hand function, evaluated using standardized tests such as Hand Grip Strength and Purdue Peg board Test. Results: The data obtained will be analyzed using appropriate statistical methods, and the significance level will be set at p<0.05. Conclusion: This trial will contribute valuable contribution highlighting the potential benefits of BFR training in improving pressure pain threshold and hand function in adults with persistent neck pain.

Accelerated brain age and associated neurocognitive impairments in adult survivors of childhood cancer.

10028 Background: Structural brain aging assessed from routine clinical MRI exams is associated with neurologic and neurocognitive impairments in older non-cancer populations yet is unexplored in childhood cancer survivors. Methods: Neurocognitive assessments and clinical 3-D T1 MRI whole brain images were obtained on 253 childhood cancer survivors (acute lymphoblastic leukemia = 118; brain tumor = 49; Hodgkin lymphoma = 86) and 43 community controls. Brain age was estimated using open-source Gaussian process regression software (BrainAgeR) on visually inspected, segmented, and normalized MRI scans. Benjamin-Hochberg adjusted T-tests were used to compare age-adjusted neurocognitive z-scores between controls and survivors. Linear regression tested associations between brain age acceleration (brain age-chronological age) and treatment (multivariable), and neurocognitive outcomes (univariable). Results: Survivors (mean(SD) age 31.2[8.9]) had poorer executive function (Trails B survivors -0.72 vs controls 0.32, p < 0.0001), processing speed (Grooved Peg Board -0.77 vs 0.05, p < 0.0001), memory (visual selection -0.73 vs -0.10, p = 0.0010; digit backward span -0.45 vs 0.08, p = 0.0304), vocabulary (WASI vocabulary -0.43 vs 0.14, p = 0.0007), and reading (WJ letter word -0.43 vs -0.05, p = 0.0006) compared to controls. In survivors, mean[95%CI] brain age was 7.5[6.4 to 8.6] years older than chronologic age; 0.65[-1.0 to 2.3] years for controls. Compared to males without cranial radiation, for females age≥10 years at cancer diagnosis treated with ≥40Gy cranial radiation, brain age acceleration was 13.35 years (p < 0.001), which worsened by an additional 9.81 years (p = 0.017) for those diagnosed < 10 years. Greater brain age acceleration was associated with a worse performance in executive function (β = -1.73, p < 0.001), processing speed (β = -2.18, p < 0.001), memory (β = -2.07, p < 0.001; β = -1.78, p < 0.029), vocabulary (β = -2.04, p < 0.001), and reading (β = -3.77,p < 0.001). Conclusions: Survivors of childhood cancer experience significant brain age acceleration that is associated with impairments in neurocognitive function. In non-cancer populations, accelerated brain age has been shown to predict late morbidities and mortalities. BrainAge is a promising surrogate biomarker that could predict cognitive decline and improve early detection of dementia risk. Finally, it highlights the risk of cranial radiation in < 10-year-old female cancer survivors.

Comparing the effect of rhythmic stabilization and combination of isotonic technique on grip strength, pinch strength and dexterity of hand among middle aged healthy individuals - a randomized clinical trial

Purpose: The aim of the study was to evaluate and compare the effects of Rhythmic Stabilization and a combination of isotonic technique on grip strength, pinch strength, and dexterity of hand among middle aged healthy individuals. Methods
 Forty middle aged healthy individuals were selected on the basis of inclusion and exclusion criteria. Participants were randomly allocated to two groups, with 20 in group A (Rhythmic Stabilization) and 20 in group B (Combination of Isotonic Technique). Treatment was given for 4 weeks, thrice a week.
 Outcome measures: grip strength, pinch strength, and dexterity were assessed by the Jamar hand dynamometer, the Pinch gauge, and the Perdue peg board, respectively. Outcome measures were assessed at baseline and after 4 weeks of treatment.
 Results
 Notably, Group A participants showed a significant improvement in all outcome measures compared to Group B (p<0.05) when compared. Both the interventions were effective for dexterity outcome in both groups (p<0.05). Conclusion: This study provides evidence that application of Rhythmic Stabilization improves grip strength and pinch strength. This suggests that static Proprioceptive Neuromuscular Facilitation (PNF) exercises performed on the fingers can improve dexterity, grip strength, and pinch strength in the middle-aged population.
 Highlights
 As age increases, there is decrease in grip strength and dexterity of a person.
 The grip strength, finger strength and dexterity are inter-related.
 The Proprioceptive Neuromuscular Facilitation increases strength of muscles.
 The static PNF exercises are more effective than the dynamic PNF exercises to improve strength of grip strength, finger strength and dexterity.

Personal protective equipment-induced systemic hypercapnic hypoxaemia: translational implications for impaired cognitive-clinical functional performance.

Personal protective equipment (PPE) adversely affects pulmonary gas exchange and may result in systemic hypercapnic hypoxaemia and headache. This study aimed to determine what extent PPE affects cerebral symptoms, global cerebral blood flow, and cognitive functional performance. Higher surgical trainees participated in a randomized, repeated-measures, crossover study, completing 60 min of laparoscopic surgical simulation in both standard operating attire and type 3 PPE. Measurements were collected at baseline and after 60 min of simulation. The primary outcome measure was headache. Headache was examined using the validated visual analogue scale (VAS) and Environmental Symptoms Questionnaire C (ESQ-C), global cerebral blood flow with duplex ultrasonography, and visuospatial and executive gross/fine motor function with grooved peg board (GPB) and laparoscopic bead (LSB) board tasks. Thirty-one higher surgical trainees (20 men, 11 women) completed the study. Compared with standard operating attire, PPE increased headache assessment scores (mean(s.d.) VAS score 3.5(5.6) versus 13.0(3.7), P < 0.001; ESQ-C score 1.3(2.0) versus 5.9(5.1), P < 0.001) and was associated with poorer completion times for GPB-D (61.4(12.0) versus 71.1(12.4) s; P = 0.034) and LSB (192.5(66.9) versus 270.7(135.3) s; P = 0.025) tasks. Wearing PPE increased heart rate (82.5(13.6) versus 93.5(13.0) beats/min; P = 0.022) and skin temperature (36.6(0.4) versus 37.1(0.5)°C; P < 0.001), but decreased peripheral oxygen saturation (97.9(0.8) versus 96.8(1.0) per cent; P < 0.001). Female higher surgical trainees exhibited higher peripheral oxygen saturation across all conditions. No differences were observed in global cerebral blood flow as a function of attire, time or sex. Despite no marked changes in global cerebral blood flow, type 3 PPE was associated with increased headache scores and cerebral symptoms (VAS and ESQ-C) alongside impaired executive motor function highlighting the clinical implications of PPE-induced impairment for cognitive-clinical performance.

In Vitro Assessment of Compounded Lurasidone Suspensions for Enteral Feeding Tubes.

Purpose: Extemporaneously compounded drug suspensions are often necessary for patients who are intubated or receiving nutrition through enteral feeding tubes. Lurasidone is a relatively new antipsychotic medication available only as oral tablets (Latuda®), and there is no data to support its use in this patient population as a compounded liquid formulation. This study was designed to assess the feasibility of preparing lurasidone suspensions from tablets and their compatibility with enteral feeding tubes. Methods: Representative nasogastric tubes were selected for this study, including polyurethane, polyvinylchloride, and silicone tubes with a range of 8 to 12 Fr (2.7-4.0 mm) in diameter and 35 to 55″ in length. Two strengths of lurasidone suspensions, 1 and 8 mg/mL, were prepared by the standard mortar-pestle method. Latuda® tablet 120 mg was used as the drug source, and a 1:1 mixture of Ora-Plus®:water was used as the suspension vehicle. The drug suspensions were delivered through the tubes mounted on a peg board to simulate patient position in a hospital bed. The ease of administration through the tubes was evaluated visually. The drug concentration before and after the tube delivery was analyzed by high performance liquid chromatography (HPLC). In addition, a 14-day stability study of the compounded suspensions was performed at room temperature to support the beyond-use dating. Results: Freshly prepared lurasidone suspensions, 1 and 8 mg/mL, met the potency and uniformity requirements. Both strengths of suspensions exhibited satisfactory flowability through all the tube types studied with no signs of clogging. The HPLC results confirmed that greater than 97% of drug concentration was retained after tube delivery. During the 14-day stability study, the suspensions retained greater than 93% of their original concentration. There was no significant change in pH or visual appearance. Conclusions: The study demonstrated a practical procedure to prepare 1 and 8 mg/mL lurasidone suspensions that are compatible with commonly used enteral feeding tube materials and dimensions. A beyond-use date of 14-day was established for the suspensions stored at room temperature.

Hand function and its determinants in patients with lateral epicondylitis

Background: Hand function is an important aspect of most of the activities of daily living. There are many conditions that cause direct impact on hand function but few of musculoskeletal conations indirectly influence the hand function but often ignored in rehabilitation. Objective: The aims of this study were to analyse the hand function among lateral epicondylitis (LE) patients and identify the influence of various parameters (Age, dominance, pain, range of motion (ROM), and chronicity) that may influence the hand function. Methods: Eighty six LE patients participated in this cross sectional study. The hand function was assessed using Perdue peg board along with various other parameters like age, dominance, pain, range of motion, and chronicity. Results: There was a significant difference between the hand function of affected and unaffected extremity (p&lt;0.001, effect size of 0.425). Pain severity, chronicity of LE and wrist extension was strongly related to hand function with R value of -0.910, -0.788 and 0.698 respectively. Conclusions: The results highlight the possible hand function compromise among patients with LE. Out of all the assessed parameters pain severity, wrist extension ROM and chronicity of condition were associated with hand function compromise.

Acquisition of robotic surgical skills does not require laparoscopic training: a randomized controlled trial.

Robotic surgery is a valid option for minimally invasive surgery in most surgical specialties. However, the need to master laparoscopy is questionable before starting specific training in robotic surgery. We compared the development of basic robotic surgery skills between individuals randomized to train in conventional, laparoscopic, or robotic skills. We conducted a single-centered, single-blinded randomized trial. Medical students were randomly assigned to 20h of conventional, laparoscopic, or robotic surgical training. Students with previous surgical experience were excluded. Participants were evaluated pre- and post-training on the dV-Trainer robotic surgical simulator with the following exercises: Camera Targeting 1, Peg Board 1, Ring and Rail 1, and Ring and Rail 2. Sixty-six students were randomly assigned to each training group. Eight individuals did not complete the study (2 in the conventional group, 3 in the laparoscopic group, and 3 in the robotic group). All groups demonstrated significant improvement in the composite score and in each task following the training period (p &lt; 0.001). No differences were seen between the conventional and laparoscopic groups in the composite score or individual tasks. The robotic group showed greater improvement in number of errors, economy of motion, workspace utilization, and time for completion compared to the other groups. The laparoscopic group showed improved camera manipulation skills compared to the conventional group, while the conventional group showed improved errors and economy of motion compared to the laparoscopic group. There was no difference in the acquisition of basic robotic surgical skills between individuals trained in basic conventional or laparoscopic surgical skills. We believe surgeons mastery in laparoscopy is not needed before initiating robotic surgical training. However, basic principles of laparoscopy remain applicable to robotic surgery. Future studies should compare transferability of conventional and laparoscopic training to robotic skills in the operating room.

Abstract WMP20: Association Of Periventricular And Deep White Matter Hyperintensity With Cognitive Performance In A Middle-aged Population

Introduction: White matter hyperintensity (WMH) has been associated with manual dexterity performance in apparently healthy middle-aged population. However, the relative effect of WMH topographic distribution on cognition remains unknown. We hypothesized that periventricular WMH (PVWMH) is more strongly associated with manual dexterity and cognitive measures compared to deep WMH (DWMH) given its proximity to the white matter tracts involved in motor and executive functions. Methods: Apparently healthy middle-aged participants in the Genetic Study of Atherosclerosis Risk with brain MRI and cognitive measurements were selected. Cognitive measures included delayed word recall short (DWRS) and long (DWRL), digit symbol substitution (DSS), word fluency (WF), digit span forward test (DSFT), backward (DSBT) and total (DSTS), and grooved peg board test (GPBT) including the dominant and non-dominant hand (GPBTD, GPBTnD). PVWMH and DWMH volumes were measured using semi-automated segmentation paradigm. The relative associations of these measurements with PVWMH and DWMH volumes as multiple measurements within the same individual further nested within families were determined using multilevel linear models adjusting for intracranial volume, age, sex and cardiovascular risk factors. Results: 782 subjects were included (age 51.1±10.6, 58.4% female and 39% African American, PVWMH volume 437.4 [0-1646] mm 3 , DWMH volume 273.5 [76-665] mm 3 ). Within the same subject, PVWMH showed greater association than DWMH with worse performance on GPBT, GPBTD, GPBTnD, DWRS, and DWRL (P=0.006, 0.01, 0.01, 0.01 and 0.03, respectively) after adjusting for age and other cardiovascular risk factors. There was no difference in the association of PVWMH versus DWMH volumes with DSS, WF, DSFT, DSBT, DSTS (P=0.19, 0.52, 0.13, 0.6, and 0.6, respectively). Conclusions: PVWMH shows greater association than DWMH with cognitive measures of manipulative manual dexterity and recall suggesting that PVWMH and DWMH may have different cognitive phenotypes in middle-aged population with cerebral small vessel disease.

Ensemble deep learning for the prediction of proficiency at a virtual simulator for robot-assisted surgery

BackgroundArtificial intelligence (AI) has the potential to enhance patient safety in surgery, and all its aspects, including education and training, will derive considerable benefit from AI. In the present study, deep-learning models were used to predict the rates of proficiency acquisition in robot-assisted surgery (RAS), thereby providing surgical programs directors information on the levels of the innate ability of trainees to facilitate the implementation of flexible personalized training.Methods176 medical students, without prior experience with surgical simulators, were trained to reach proficiency in five tasks on a virtual simulator for RAS. Ensemble deep neural networks (DNN) models were developed and compared with other ensemble AI algorithms, i.e., random forests and gradient boosted regression trees (GBRT).ResultsDNN models achieved a higher accuracy than random forests and GBRT in predicting time to proficiency, 0.84 vs. 0.70 and 0.77, respectively (Peg board 2), 0.83 vs. 0.79 and 0.78 (Ring walk 2), 0.81 vs 0.81 and 0.80 (Match board 1), 0.79 vs. 0.75 and 0.71 (Ring and rail 2), and 0.87 vs. 0.86 and 0.84 (Thread the rings 2). Ensemble DNN models outperformed random forests and GBRT in predicting number of attempts to proficiency, with an accuracy of 0.87 vs. 0.86 and 0.83, respectively (Peg board 2), 0.89 vs. 0.88 and 0.89 (Ring walk 2), 0.91 vs. 0.89 and 0.89 (Match board 1), 0.89 vs. 0.87 and 0.83 (Ring and rail 2), and 0.96 vs. 0.94 and 0.94 (Thread the rings 2).ConclusionsEnsemble DNN models can identify at an early stage the acquisition rates of surgical technical proficiency of trainees and identify those struggling to reach the required expected proficiency level.

Aging and Bimanual Effects on Finger Center of Pressure during Precision Grip: Different Strategies for Spatial Stability.

The purpose of this study was to examine aging and bimanual effects on finger spatial stability during precision grip. Twenty-one older and 21 younger adults performed precision grip tasks consisting of a single task (grip and lift an object with the thumb and index finger) and a dual task (the grip-lifting task with one hand and a peg board task with the other hand). The center of pressure (COP) trajectory and the grip force were evaluated using a pressure sensor with a high spatial resolution. In the COP trajectory, the main effects of age for the thumb (F1,140 = 46.17, p < 0.01) and index finger (F1,140 = 22.14, p < 0.01) and task difficulty for the thumb (F1,140 = 6.47, p = 0.01) were significant based on ANCOVA. The COP trajectory was statistically decreased in the older adults. The COP trajectory was also decreased in the dual task, regardless of age. The results suggest the existence of a safety strategy to prioritize the spatial stability in the elderly group and in the dual task. This study provides new insights into the interpretation of the COP trajectory.

Evaluation of Cognitive and Psychomotor Functional Changes in Anesthesiology Residents after 12 hours of Continuous Work in Operation Theater: An Observational Study.

Background:Prolonged working hours in operation theater may impair cognitive and psychomotor function.Aims:This study was done to evaluate the changes in cognitive and psychomotor changes in the anesthesia residents after 6 and 12 h of continuous work in operation theater.Settings and Design:Sixty anesthesia residents whose working hours were expected to be longer than 12 h were recruited for this prospective, observational study.Methods:The study consisted of a set of five tests used for assessing the cognitive and psychomotor functions. The tests were conducted for the participants at 0, 6, and 12 h of work and the total scores at the respective time period were noted. The tests were manual dexterity test using purdue peg board, finger tapping test, visual spatial capacity memory test, digit symbol substitution test (DSST), and frontal assessment battery.Statistical Analysis:The observations of the purdue peg board test, finger tapping test, and digit symbol substitution test at 0, 6, and 12 h were tested using the repeated measures analysis of variance and paired t-test. The observations of visual spatial capacity memory test and frontal assessment battery were tested using the Chi-square test.Results:In the purdue peg board test, there was significant reduction in the mean number of pins assembled by the participants over 12 h of work. There was a significant difference in the number of finger taps by the dominant hand between 0 and 12 h and also between 6 and 12 h. In the visual spatial memory test, there was no significant difference in the performance of the participants with incorrect response at 0 and 12 h of duration. There was a significant decrease in the number of correct response among the participants in the digit symbol substitution test at 0 and 12 h of work. There was no significant difference in the scores obtained in frontal assessment battery test which was used to assess the cognitive function.Conclusion:There was a significant reduction in the psychomotor functions of the anesthesiology residents after 12 continuous hours of work in the operation theater and there was no significant reduction in cognitive function observed during that period.

Correlation of Exercise Capacity with Functional Disability in Patients with Osteoarthritis of Knee

Introduction: Osteoarthritis of knee is a progressive joint disease which produces pain, inflammation and destruction of joint which in turn leads to range of motion limitation and walking disabilities. Affection in physical functioning is determined not only by just activities involving lower limb capacity but also by the activities which require use of upper extremities. Hence in this study, 6MWD and no. of rings moved in 6 minutes were taken as an outcome measures for determining the exercise capacity. KOOS is a self-administered questionnaire which was used in its cross culturally adapted format for determining the functional disability in patients. Objectives: 1. To study correlation of exercise capacity with functional disability in patients with osteoarthritis of knee. 2. To study correlation of upper limb exercise capacity with lower limb exercise capacity in patients with osteoarthritis of knee. Methods: Cross sectional, observational study including 30 patients of either gender having unilateral osteoarthritis of knee conducted in a tertiary care hospital. Results: No. of rings moved in 6 minutes and global KOOS score showed no statistically significant correlation. 6MWD and global KOOS score showed no statistically significant correlation. 6 minute walk distance and 6 minute peg board ring test showed no statistically significant correlation. Conclusion: The study suggests that there is no correlation of exercise capacity with functional disability in patients with osteoarthritis of knee. Also, there is no correlation found between upper limb exercise capacity and lower limb exercise capacity in patients with osteoarthritis of knee. KEY WORDS: Knee osteoarthritis, Knee pain, squat depth, functional disability, cardiorespiratory endurance, Knee Injury and Osteoarthritis Outcome Score, Quality of life.

Is laparoscopic experience helpful in simulator based robotic training in general surgery?

To evaluate whether or not prior laparoscopic training improves performance during robotic surgery utilising DaVinci robotic skills simulator. The cross-sectional study was conducted at the Civil Hospital, Karachi, from May 4 to November 11, 2018, and comprised first year residents in Group A with no laparoscopic skills and fourth year residents doing laparoscopic cholecystectomy independently and surgical faculty members in Group B who had laparoscopic skills. Both the groups had no previous exposure to robotic surgery and skills simulator. There were 4 exercises which were repeated three times by each participant. Scoring was done using the DaVinci robotic skills simulator software. Data was analysed using SPSS 22. Of the 30 surgeons, there were 15(50%) in Group A with a mean age of 26±0.56 years, and 15(50%) in Group B with a mean age of 32 ± 9.16 Years (p<0.001). The overall mean age was 32±9.16 years (range: 25-52 years). There were 19(63.3) females in the sample compared to 11(36.6%) males. Mean scores of Ring walk 2, Peg board 2, and Suture sponge 3 were better in Group A, while mean score of Matchboard 2 was better in Group although B (p>0.05). Group B fared better in the individual scoring of Suture sponge 2 (p>0.05). Laparoscopic skills apparently did not confer any benefit while performing exercises on the DaVinci skills simulator.

UPPER LIMB RELATED FACTORS IN DETERMINING POSTURAL CONTROL

Postural control is an outcome of complex interactions between many systems and structures to control body position in space. Appropriate postural control is necessary for the initiation and continuation of movements in different body parts, such as the upper limbs. Although the importance of maintaining postural control for movement is well recognized, its relationship with upper limb functions is unknown. The present study investigated the factors related to the upper limb in determining postural control in healthy young adults. We included 68 nonsymptomatic individuals in this cross-sectional study. The static and dynamic postural stability and upper limb performance parameters of the participants were evaluated. Multiple Linear Regression analysis was performed to determine the independent determinants of postural control. According to the results of the analysis, Six Minute Peg Board Ring Test (6PBRT) explaining 11% of the variance was the independent determinant of static general stability index (p&lt;0.05). Nine-Hole Peg Test (9HPT) explaining 5.3% of the variance was the independent determinant of static anterior-posterior stability index (p&lt; 0.05). It was concluded that upper limb functions were a determinant of static postural control in non-symptomatic young adults. The 6PBRT and Medicine Ball Chest Launch Test (MBCLT) explaining 16.5% of the variance were found as independent determinants of static medial-lateral stability index (p&lt;0.05). It was concluded that upper limb functions were a determinant of static postural control in non-symptomatic young adults. There was no significant relationship between dynamic stability indices and upper extremity functional parameters (p&gt;0.05). It was concluded that upper limb functions were a determinant of static postural control in non-symptomatic young adults.

Quantification of Compensatory Torso Motion in Post-Stroke Patients Using Wearable Inertial Measurement Units

Occupational Therapy (OT) tasks performed at home are not usually observable by a clinician. For remote environments, wearable sensor technologies could provide quantitative assessment of movement strategies to support clinical evaluation via telemedicine. This work presents an algorithm for estimating torso orientation and an individualized metric of compensatory torso motion for upper extremity tasks using an Inertial Measurement Unit (IMU) worn on the sternum. Two post-stroke males with hemiparesis and two healthy age-matched males were evaluated during a series of OT assessments, including active range of motion, pinch strength, standing balance, Moberg pick-up test, Nine-hole peg test, and a custom peg board grasp task. Torso orientation was estimated by decomposing IMU orientation into angles (pitch, roll, yaw) in each anatomical plane (sagittal, coronal, transverse) and referenced against standing balance posture. For each participant, a threshold of nominal torso motion was created from the variance in orientation for tasks performed with the Dominant or Unaffected arm. A percentage of time out of range (PTOR) of nominal variation was developed to distinguish operationally relevant differences. In this study, large PTOR values (greater than 30%) were consistent with OT observations of notable compensatory movement. IMU sensitivity to sensor-to-torso alignment was also evaluated in simulation and demonstrated interactions between pitch and roll angles when an IMU misalignment existed about the yaw axis. These case studies support the use of wearable IMUs to quantitatively assess compensatory torso motions and convey operationally relevant information about movement strategy to a clinician without the use of visual observation.