Repetitive Arm Research Articles

Une cause rare du syndrome de Paget-Schroetter : un Swing de trop !

Effort thrombosis of the axillo/subclavian vein (Paget-Schroetter syndrome) is often a misdiagnosed syndrome, which consists of a venous compression at the upper thoracic outlet. It affects athletes, and workers with repetitive, forceful, or overhead arm activities. Treatment algorithms are varied and controversial, surgical approach should be directed toward the specific pathology. Through this article, the authors describe a rare case of Paget-Schroetter syndrome in a golf player caused by a clavicular osteochondroma.

Therapists' Use of the Graded Repetitive Arm Supplementary Program (GRASP) Intervention: A Practice Implementation Survey Study

Only a small percentage of research is ever successfully translated into practice. The Graded Repetitive Arm Supplementary Program (GRASP) is a stroke rehabilitation intervention that anecdotally has had rapid translation from research to clinical practice. This study was conducted to explore the characteristics of this practice implementation. The aims of this study were: (1) to explore the extent of practice implementation of GRASP in the United Kingdom; (2) using an implementation framework, to explore UK therapists' opinions of implementing GRASP; and (3) if GRASP is found to be used in the United Kingdom, to investigate differences in opinions between therapists who are using GRASP in practice and those who are not. A cross-sectional study design was used. Data were collected via an online questionnaire. Participants in this study were members of the College of Occupational Therapy Specialist Section Neurological Practice and the Association of Chartered Physiotherapists Interested in Neurology. Of the 274 therapists who responded to the survey, 61 (22.3%) had experience of using GRASP, 114 (41.6%) knew of GRASP but had never used it, and 99 (36.1%) had never heard of GRASP. Therapists displayed positive opinions toward the implementation of a manual with graded progressions of structured upper limb exercises for people after stroke. Opinions were different between therapists who had used GRASP and those who had not. The findings of this study may be limited by response bias. GRASP is a relatively new stroke rehabilitation intervention that has made impressive translation into the knowledge and practice of UK therapists. Therapists' opinions would suggest that GRASP is both an acceptable and feasible intervention and has the potential to be implemented by a greater number of therapists in a range of settings.

The effect of repetitive bilateral arm training with rhythmic auditory cueing on motor performance and central motor changes in patients with chronic stroke

The aim of this study was to compare the effects of bilateral arm training with auditory cueing (BATRAC) versus control intervention on motor performance of the upper extremity (UE) and to explore the central neurophysiological mechanism underlying this effect in moderately impaired chronic stroke patients. This was a randomized-controlled clinical trial. Overall, 76 chronic stroke patients (mean age = 50.2 ± 6.2 years), 6–67 months after the onset of the first stroke were enrolled. They received either BATRAC (with both UE trained simultaneously in symmetric and asymmetric patterns) or control intervention (unilateral therapeutic exercises for the paretic UE). Each session lasted for 1 h, scheduled as three sessions/week (on an alternate day) for 8 successive weeks. Outcome measures included the Fugl-Meyer motor performance test for the UE (FMUE) and percutaneous transcranial magnetic stimulation to elicit motor-evoked potential (MEP) in paretic abductor pollicis brevis muscle. Group comparisons indicated a significantly better improvement in the MEP parameters (transcranial magnetic stimulation threshold, central motor conduction time, and MEP amplitude) in the BATRAC group. The FMUE scores increased in both groups, but there was no significant difference between groups in the FMUE scores. These findings recommend the use of BATRAC in chronic stroke patients not only to improve motor performance but also to induce central neurophysiological effects.

Marble Burying and Nestlet Shredding as Tests of Repetitive, Compulsive-like Behaviors in Mice

Obsessive-compulsive disorder (OCD) and autism spectrum disorders (ASD) are serious and debilitating psychiatric conditions and each constitutes a significant public health concern, particularly in children. Both of these conditions are highlighted by the repeated expression of meaningless behaviors. Individuals with OCD often show checking, frequent hand washing, and counting. Children with ASDs also engage in repetitive tapping, arm or hand flapping, and rocking. These behaviors can vary widely in intensity and frequency of expression. More intense forms of repetitive behaviors can even result in injury (e.g.excessive grooming, hand washing, and self-stimulation). These behaviors are therefore very disruptive and make normal social discourse difficult. Treatment options for repetitive behaviors in OCD and ASDs are somewhat limited and there is great interest in developing more effective therapies for each condition. Numerous animal models for evaluating compulsive-like behaviors have been developed over the past three decades. Perhaps the animal models with the greatest validity and ease of use are the marble burying test and the nestlet shredding test. Both tests take advantage of the fact that the target behaviors occur spontaneously in mice. In the marble burying test, 20 marbles are arrayed on the surface of clean bedding. The number of marbles buried in a 30 min session is scored by investigators blind to the treatment or status of the subjects. In the nestlet shredding test, a nestlet comprised of pulped cotton fiber is preweighed and placed on top of cage bedding and the amount of the nestlet remaining intact after a 30 min test session is determined. Presently, we describe protocols for and show movie documentation of marble burying and nestlet shredding. Both tests are easily and accurately scored and each is sensitive to small changes in the expression of compulsive-like behaviors that result from genetic manipulations, disease, or head injury.

Discrete wavelet transform analysis of surface electromyography for the fatigue assessment of neck and shoulder muscles

Assessment of neuromuscular fatigue is essential for early detection and prevention of risks associated with work-related musculoskeletal disorders. In recent years, discrete wavelet transform (DWT) of surface electromyography (SEMG) has been used to evaluate muscle fatigue, especially during dynamic contractions when the SEMG signal is non-stationary. However, its application to the assessment of work-related neck and shoulder muscle fatigue is not well established. Therefore, the purpose of this study was to establish DWT analysis as a suitable method to conduct quantitative assessment of neck and shoulder muscle fatigue under dynamic repetitive conditions. Ten human participants performed 40min of fatiguing repetitive arm and neck exertions while SEMG data from the upper trapezius and sternocleidomastoid muscles were recorded. The ten of the most commonly used wavelet functions were used to conduct the DWT analysis. Spectral changes estimated using power of wavelet coefficients in the 12–23Hz frequency band showed the highest sensitivity to fatigue induced by the dynamic repetitive exertions. Although most of the wavelet functions tested in this study reasonably demonstrated the expected power trend with fatigue development and recovery, the overall performance of the “Rbio3.1” wavelet in terms of power estimation and statistical significance was better than the remaining nine wavelets.

Complex Motor Stereotypies: An Evolving Neurobiological Concept

Complex motor stereotypies are repetitive arm and/or hand flapping, waving and wiggling movements that begin before the age of 3 years, occur repeatedly throughout the day and stop with distraction. These movements are commonly seen in children with autism, but also appear in otherwise normally developing individuals labelled as primary. Although proposed to have a psychological and neurobiological mechanism, evidence suggests that there is an abnormality within the corticostriatal–thalamocortical circuitry or its connecting structures. Animal models include both drug-induced (i.e., via stimulants or cocaine) and spontaneously appearing prototypes. Neurochemical investigations, primarily in rodents, have identified a variety of neurotransmitter alterations, with an emphasis on dopamine or glutamate; however, findings are inconsistent. We hypothesize that, based on its various roles in controlling and modulating movements, the frontal cortex will ultimately be shown to be the prime site of abnormality in this disorder. Future studies investigating both humans and animal models are essential for attaining a greater understanding of the pathobiology underlying motor stereotypies.

A gender comparison of electromyography (EMG) during repetitive arm work with and without mental stress

EMG of the trapezius muscle was monitored throughout a 45 min arm work task that included without (on one occasion) and with stress (another occasion) for 8 males and 8 females. The work task involved raising and lowering the arm, constituting one cycle, at a rate of 30 cycles per min. The stress session included periodic implementation of the Stroop color word task and mathematical equation solving concurrent with the work. EMG signal response was on/off representing raising (contracting) and lowering (relaxing) the arm, respectively. The root mean square (RMS) was calculated, and overall RMS and RMS during the arm lowering phase (RMS‐relax) were determined over time. The overall RMS increased significantly over time, and the increase was greater for females than males. However, these data were not dependent on work type (i.e. with vs. without stress). RMS‐relax also increased significantly over time with females increasing greater than males; there was no difference due to type of work. Thus, over the 45 min work task females showed more fatigue (based on RMS increase) and less relaxation (based on RMS‐relax) than males; stress had no impact on these data.

Abstract TMP104: Arm Ischemic Preconditioning Prevents Stroke Recurrence in Octogenarians with Intracranial Arterial Stenosis

Introduction: Symptomatic atherosclerotic intracranial arterial stenosis (SAIS) has a high incidence of stroke and recurrence, especially in octogenarians. Currently available therapies including stenting are unable to prevent strokes recurrence completely and may result in worse clinical outcomes. Emerging experimental investigations have suggested that remote ischemic preconditioning may be clinically effective in stroke intervention. Hypothesis: Brief repetitive bilateral arm ischemic preconditioning (BAIPC) may be safe and prevent stroke occurrence and recurrence in octogenarians with SAIS. Methods: A total of 58 consecutive octogenarians with SIAS (diagnosed by imaging) enrolled in this prospective, single blind and randomized study. All patients enrolled underwent standard medical care. In addition, patients in BAIPC group (n=30) underwent five cycles consisting of bilateral arms 5min ischemia followed by 5min reperfusion twice daily for the total of 180 consecutive days. Blood pressure, heart rate, local skins integrity and plasma myoglobin levels before and during the first 30-days of treatment were documented. Finally, Plasma levels of thrombosis and inflammation markers, clinical outcomes (modified Rankin Scale 0-1) and the incidence of stroke recurrence during the180-days of treatment in the two groups were compared. Clinical Trial Registration-URL: www.clinicaltrials.gov , unique identifier: NCT01570231 . Results: Compared to the controls (n=28), BAIPC had no adverse effects on blood pressure, heart rate, local skins integrity and plasma myoglobin, and BAIPC did not contribute to cerebral hemorrhage. BAIPC decreased plasma levels of hsCRP, IL-6, PAI-1, leukocyte count, platelet aggregation rate as well as increased TPA, improved the 180-days of modified Rankin Scale and decreased the incidences of ischemic stroke recurrence and TIA onset (6.7% and 23.3% in BAIPC group versus 28.6% and 39.3% in control group, P < 0.01). Conclusions: Our study provides a proof-of-concept that BAIPC is a safe and feasible method to protect the ischemic brain in octogenarians with SIAS. Further investigation in an enlarged trial is ongoing.

Reliability and Safety of Functional Capacity Evaluation in Patients with Whiplash Associated Disorders

Introduction Whiplash-associated disorders (WAD) are a burden for both individuals and society. It is recommended to evaluate patients with WAD at risk of chronification to enhance rehabilitation and promote an early return to work. In patients with low back pain (LBP), functional capacity evaluation (FCE) contributes to clinical decisions regarding fitness-for-work. FCE should have demonstrated sufficient clinimetric properties. Reliability and safety of FCE for patients with WAD is unknown. Methods Thirty-two participants (11 females and 21 males; mean age 39.6 years) with WAD (Grade I or II) were included. The FCE consisted of 12 tests, including material handling, hand grip strength, repetitive arm movements, static arm activities, walking speed, and a 3 min step test. Overall the FCE duration was 60 min. The test–retest interval was 7 days. Interclass correlations (model 1) (ICCs) and limits of agreement (LoA) were calculated. Safety was assessed by a Pain Response Questionnaire, observation criteria and heart rate monitoring. Results ICCs ranged between 0.57 (3 min step test) and 0.96 (short two-handed carry). LoA relative to mean performance ranged between 15 % (50 m walking test) and 57 % (lifting waist to overhead). Pain reactions after WAD FCE decreased within days. Observations and heart rate measurements fell within the safety criteria. Conclusions The reliability of the WAD FCE was moderate in two tests, good in five tests and excellent in five tests. Safety-criteria were fulfilled. Interpretation at the patient level should be performed with care because LoA were substantial.

Study of the scapular muscle latency and deactivation time in people with and without shoulder impingement

Changes in muscle activities are commonly associated with shoulder impingement and theoretically caused by changes in motor program strategies. The purpose of this study was to assess for differences in latencies and deactivation times of scapular muscles between subjects with and without shoulder impingement. Twenty-five healthy subjects and 24 subjects with impingement symptoms were recruited. Glenohumeral kinematic data and myoelectric activities using surface electrodes from upper trapezius (UT), lower trapezius (LT), serratus anterior (SA) and anterior fibers of deltoid were collected as subjects raised and lowered their arm in response to a visual cue. Data were collected during unloaded, loaded and after repetitive arm raising motion conditions. The variables were analyzed using 2 or 3 way mixed model ANOVAs. Subjects with impingement demonstrated significantly earlier contraction of UT while raising in the unloaded condition and an earlier deactivation of SA across all conditions during lowering of the arm. All subjects exhibited an earlier activation and delayed deactivation of LT and SA in conditions with a weight held in hand. The subjects with impingement showed some significant differences to indicate possible differences in motor control strategies. Rehabilitation measures should consider appropriate training measures to improve movement patterns and muscle control.

Spotlight on the October 30 Issue

This study followed 1,768 women who used hormone therapy, with 176 developing incident Alzheimer disease. Hormone therapies are associated with a reduced risk of subsequent Alzheimer dementia if taken during a critical window near menopause, but may be associated with an increased risk if initiated later in life. See p. 1846; Editorial, p. 1840 The authors evaluated protective effects of brief repetitive bilateral arm ischemic preconditioning on stroke recurrence in 68 patients with symptomatic atherosclerotic intracranial arterial stenosis. This noninvasive strategy has promise …

Upper limb ischemic preconditioning prevents recurrent stroke in intracranial arterial stenosis

This study aims to evaluate protective effects of brief repetitive bilateral arm ischemic preconditioning (BAIPC) on stroke recurrence in patients with symptomatic atherosclerotic intracranial arterial stenosis (IAS). A total of 68 consecutive cases with symptomatic IAS, diagnosed by imaging, were enrolled in this prospective and randomized study. All patients received standard medical management. Patients in the BAIPC group (n = 38) underwent 5 brief cycles consisting of bilateral upper limb ischemia followed by reperfusion. The BAIPC procedure was performed twice daily over 300 consecutive days. Incidence of recurrent stroke and cerebral perfusion status in BAIPC-treated patients were compared with the untreated control group (n = 30). In the control group, incidence of recurrent stroke at 90 and 300 days were 23.3% and 26.7%, respectively. In the BAIPC group, incidence of recurrent stroke was reduced to 5% and 7.9% at 90 and 300 days (p < 0.01), respectively. The average time to recovery (modified Rankin Scale score 0-1) was also shortened by BAIPC. Cerebral perfusion status, measured by SPECT and transcranial Doppler sonography, improved remarkably in BAIPC-treated brain than in control (p < 0.01). This study provides a proof-of-concept that BAIPC may be an effective way to improve cerebral perfusion and reduce recurrent strokes in patients with IAS. Further investigation of this therapeutic approach is warranted as some patients were excluded after randomization.

Assessment of neck and shoulder muscle fatigue using discrete wavelet transforms of surface electromyography

Objective assessment of neuromuscular fatigue is important for the early detection and prevention of risks of work-related musculoskeletal disorders (MSDs). Although, in recent years, a number of researchers have used discrete wavelet transforms (DWT) of surface electromyography (SEMG) to evaluate muscle fatigue, its application to neck and shoulder muscle fatigue assessment is not well established. Therefore, the purpose of this study was to establish DWT analysis as a suitable method to conduct quantitative assessment of neck and shoulder muscle fatigue caused by dynamic exertions. Six human participants performed 40 minutes of fatiguing repetitive arm and neck exertions. SEMG data from the right upper trapezius and left sternocleidomastoid muscles were recorded. Six most commonly used orthogonal wavelet functions were used to conduct DWT analysis. With the development of fatigue for most of the wavelet functions a significant increase in the power in the lower frequency bands of 12-23Hz and 23-46Hz was observed. Bior 3.1 wavelet showed the highest power, statistically consistent and meaningful power trend and the highest overall power contrast compared to the remaining five wavelets tested in this study.

Management of Deep Vein Thrombosis of the Upper Extremity

Case 1: A 34-year-old previously healthy male office manager was admitted with acute onset of heaviness, pain, and functional impairment of his right arm. The arm was cyanotic and massively swollen (Figure 1). For the past weeks, he reported transient paresthesia of his right arm during overhead activities and was unable to perform repetitive or strenuous arm exercise. He had a fracture of the right clavicle after a ski accident 5 years previously. The fracture was managed conservatively. There was no personal or family history of thrombosis. Conventional phlebography confirmed axillary and subclavian vein thrombosis (Figure 2, top), and treatment with intravenous unfractionated heparin was started. Figure 1. Clinical presentation of case 1 with massive swelling and cyanosis of the right arm (left). One day after pharmacomechanical thrombolysis, signs of thrombosis have markedly improved (right). Figure 2. Baseline digital subtraction venogram from case 1 with extensive filling defects in the axillary subclavian veins (top). Control venogram after 15 hours of pharmacomechanical thrombectomy confirmed resolution of filling defects and restored venous flow (middle). Positional venography obtained during abduction of the right arm confirmed the venous thoracic outlet syndrome with residual stenosis of the subclavian vein at the costoclavicular junction (white arrow, bottom). Case 2: A 55-year-old man with lung cancer presented with swelling, heaviness, and pain in his left arm 1 week after completion of chemotherapy administered via a left-sided indwelling central venous catheter. Axillary and subclavian vein thrombosis was confirmed by ultrasonography. Low-molecular-weight heparin (LMWH) was initiated, and the catheter was removed 3 days later because it was no longer functional. At 1 week, pain and functional impairment had not improved, and the circumference of the left upper arm had increased by 2 cm. Case 3: A 65-year-old woman with metastatic ovarian cancer presented with swelling of the face and both arms, headache, …

Repetitive arm motion-induced fatigue affects shoulder but not endpoint position sense

Neck/shoulder pain has previously been linked to repetitive work and muscle fatigue. We have shown that asymptomatic people performing repetitive upper limb tasks display signs of shoulder fatigue and of whole-body compensatory strategies. However, the role played by the proprioceptive system in the production of these compensatory strategies has not been studied. A group of asymptomatic adults (n = 18) performed a repetitive pointing task at shoulder height to fatigue. Before and after fatigue, they performed two position sense tasks, eyes closed: a single-joint task where they abducted their shoulder to the perceived horizontal and a multi-joint task, where they stood and placed their finger at the perceived location of a target in front of them at shoulder height. After fatigue, subjects made larger shoulder errors by raising their elbow higher above the horizontal (~ +1.3 cm) than before fatigue; however, their finger position accuracy was not changed, despite all subjects performing the movement in less time (~ -0.18 s) while fatigued. There were no gender differences in shoulder or finger position accuracy before or after fatigue; however, there were gender differences in the perceived finger-target location and in the temporal characteristics of the finger movement toward the target. Results suggest that healthy individuals are able to develop strategies to compensate for fatigue-induced deficits at one joint to maintain the endpoint accuracy of a multi-joint task constant. Gender differences in movement strategies and perception of endpoint location may play parts in the previously reported gender differences in work-related neck/shoulder symptoms.

Coordination of fingertip forces in object transport during gait in children with hemiplegic cerebral palsy

Coordination of fingertip forces in object transport during gait in children with hemiplegic cerebral palsy

Activation of the striated urethral sphincter to maintain continence during dynamic tasks in healthy men

Function of the striated urethral sphincter (SUS) in men is debated. Current evidence is limited to electromyographic (EMG) recordings made with concentric needle electrodes in supine. Understanding of SUS function requires investigation of SUS EMG activity using new recording techniques in dynamic tasks. The aim of this study was to evaluate timing and amplitude of SUS EMG at rest and during dynamic tasks that challenge continence by increasing intra-abdominal pressure (IAP). Investigative study of five healthy men aged 25-39 years. Measurements included SUS, anal sphincter (AS), and transversus abdominus (TrA) EMG, and IAP (recorded with a nasogastric pressure catheter). Participants performed four tasks that challenged postural control in standing (single and repetitive arm movement, stepping and load catching). IAP amplitude and SUS activity were linearly correlated during repetitive arm movement (R(2): 0.67-0.88). During stepping SUS EMG onset preceded the IAP increase, but followed it with rapid arm movements. When the trunk was loaded unpredictably onset of SUS generally followed the increase in IAP. The modest sample size meant only younger men were tested. Future studies might investigate healthy older men or those with certain pathologies. Data show that SUS activity increases proportionally with IAP. This provided evidence that SUS contributes to continence when IAP is increased, and that postural control of the trunk involves activation of this muscle.

Shoulder muscle endurance: the development of a standardized and reliable protocol

BackgroundShoulder muscle fatigue has been proposed as a possible link to explain the association between repetitive arm use and the development of rotator cuff disorders. To our knowledge, no standardized clinical endurance protocol has been developed to evaluate the effects of muscle fatigue on shoulder function. Such a test could improve clinical examination of individuals with shoulder disorders. Therefore, the purpose of this study was to establish a reliable protocol for objective assessment of shoulder muscle endurance.MethodsAn endurance protocol was developed on a stationary dynamometer (Biodex System 3). The endurance protocol was performed in isotonic mode with the resistance set at 50% of each subject's peak torque as measured for shoulder external (ER) and internal rotation (IR). Each subject performed 60 continuous repetitions of IR/ER rotation. The endurance protocol was performed by 36 healthy individuals on two separate occasions at least two days apart. Maximal isometric shoulder strength tests were performed before and after the fatigue protocol to evaluate the effects of the endurance protocol and its reliability. Paired t-tests were used to evaluate the reduction in shoulder strength due to the protocol, while intraclass correlation coefficients (ICC) and minimal detectable change (MDC) were used to evaluate its reliability.ResultsMaximal isometric strength was significantly decreased after the endurance protocol (P < 0.001). The total work performed during the last third of the protocol was significantly less than the first third of the protocol (P < 0.05). The test-retest reliability of the post-fatigue strength measures was excellent (ICC >0.84).ConclusionsChanges in muscular performance observed during and after the muscular endurance protocol suggests that the protocol did result in muscular fatigue. Furthermore, this study established that the resultant effects of fatigue of the proposed isotonic protocol were reproducible over time. The protocol was performed without difficulty by all volunteers and took less than 10 minutes to perform, suggesting that it might be feasible for clinical practice. This protocol could be used to induce local muscular fatigue in order to evaluate the effects of fatigue on shoulder kinematics or to evaluate changes in shoulder muscle endurance following rehabilitation.

Shoulder functional assessments in persons with chronic neck/shoulder pain and healthy subjects: Reliability and effects of movement repetition

Obtaining reliable functional capacity measures from injured workers is an essential part of the return to work (RTW) process. The present study compares shoulder functional outcomes between healthy individuals and others with neck/shoulder pain, assesses reliability and examines the influence of repetitive movements on shoulder function. Subjects performed trials of flexion and abduction active range of motion (ROM), and cumulative power output (PO) in a pushing/pulling task on the Baltimore Therapeutic Equipment Simulator II in two consecutive sessions. Tasks were assessed before and after performing a repetitive arm task, during which heart rate (HR) was recorded, until scoring 8 on the Borg CR-10 scale or on a 11-point numeric rating scale (NRS) for pain. Persons with chronic neck/shoulder pain (intensity ≥ 3/10 for > 3 months) (n = 16) and an age- and sex-matched control group (n = 16). Functional shoulder measures demonstrated strong inter-session reliability, except PO in the pain group. Average repetitive task duration was shorter in the pain group (4 min vs. 7 min). The protocol detected both pain- and time-related impairments, with HR and PO being sensitive to movement duration and ROM to pain.

Heat Shock Transcription Factor 1 Localizes to Sex Chromatin during Meiotic Repression

Heat shock factor 1 (HSF1) is an important transcription factor in cellular stress responses, cancer, aging, and developmental processes including gametogenesis. Disruption of Hsf1, together with another HSF family member, Hsf2, causes male sterility and complete lack of mature sperm in mice, but the specific role of HSF1 in spermatogenesis has remained unclear. Here, we show that HSF1 is transiently expressed in meiotic spermatocytes and haploid round spermatids in mouse testis. The Hsf1−/− male mice displayed regions of seminiferous tubules containing only spermatogonia and increased morphological abnormalities in sperm heads. In search for HSF1 target genes, we identified 742 putative promoters in mouse testis. Among them, the sex chromosomal multicopy genes that are expressed in postmeiotic cells were occupied by HSF1. Given that the sex chromatin mostly is repressed during and after meiosis, it is remarkable that HSF1 directly regulates the transcription of sex-linked multicopy genes during postmeiotic repression. In addition, our results show that HSF1 localizes to the sex body prior to the meiotic divisions and to the sex chromocenter after completed meiosis. To the best of our knowledge, HSF1 is the first known transcription factor found at the repressed sex chromatin during meiosis.