Upper Extremity Function In People Research Articles

Exploring the Psychometric Properties of Upper Extremity Functional Scale: A Narrative Review

Introduction: The Upper Extremity Functional Scale (UEFS) is a 20- item, region-specific, patient-reported outcome measure developed by Glenn Pransky and colleagues in 1997. The UEFS is used to measure upper extremity function in individuals with hand and upper extremity disorders. Patients rate their function on a 0 to 4 Likert scale, where 0 indicates extreme difficulty and 4 indicates no difficulty performing the task. This translates into a maximum possible score of 80, which indicates excellent function. The UEFS takes about 5 minutes to complete and is easy to administer and score with minimal training. The total score is computed by adding up individual item scores. Aim: To examine the psychometric properties of the UEFS. Materials and Methods: A narrative review was conducted from August 2023 to February 2024 and included searches in PubMed, Physiotherapy Evidence Database (PEDro), and Scopus (2015- 2023) The search strategy included keywords such as “Upper Extremity Functional Scale,” “psychometric properties,” “reliability” “validity,” and “responsiveness.” There were 10 articles investigating the psychometric properties of the UEFS in individuals with upper extremity musculoskeletal disorders were included. Results: The summary of the psychometric evidence of the Upper Extremity Functional Index (UEFI) available version in terms of reliability, validity and responsiveness. The UEFI and UEFI-15 versions showed consistent test-retest reliability results {Intraclass Correlation Coefficient (ICC)=0.94}. Convergent validity for both the UEFI and UEFI-15 versions was supported by their strong correlation with the Upper Extremity Functional Scale (UEFS) ≥0.6. Conclusion: The UEFS exhibits strong psychometric properties. It is widely used in clinical practice and research, with solid evidence supporting its usefulness in measuring upper extremity function in people with musculoskeletal diseases.

Assessment of Upper Extremity Function in Multiple Sclerosis: Feasibility of a Digital Pinching Test.

The development of touchscreen-based assessments of upper extremity function could benefit people with multiple sclerosis (MS) by allowing convenient, quantitative assessment of their condition. The Pinching Test forms a part of the Floodlight smartphone app (F. Hoffmann-La Roche Ltd, Basel, Switzerland) for people with MS and was designed to capture upper extremity function. This study aimed to evaluate the Pinching Test as a tool for remotely assessing upper extremity function in people with MS. Using data from the 24-week, prospective feasibility study investigating the Floodlight Proof-of-Concept app for remotely assessing MS, we examined 13 pinching, 11 inertial measurement unit (IMU)-based, and 13 fatigability features of the Pinching Test. We assessed the test-retest reliability using intraclass correlation coefficients [second model, first type; ICC(2,1)], age- and sex-adjusted cross-sectional Spearman rank correlation, and known-groups validity (data aggregation: median [all features], SD [fatigability features]). We evaluated data from 67 people with MS (mean Expanded Disability Status Scale [EDSS]: 2.4 [SD 1.4]) and 18 healthy controls. In this cohort of early MS, pinching features were reliable [ICC(2,1)=0.54-0.81]; correlated with standard clinical assessments, including the Nine-Hole Peg Test (9HPT) (|r|=0.26-0.54; 10/13 features), EDSS (|r|=0.25-0.36; 7/13 features), and the arm items of the 29-item Multiple Sclerosis Impact Scale (MSIS-29) (|r|=0.31-0.52; 7/13 features); and differentiated people with MS-Normal from people with MS-Abnormal (area under the curve: 0.68-0.78; 8/13 features). IMU-based features showed similar test-retest reliability [ICC(2,1)=0.47-0.84] but showed little correlations with standard clinical assessments. In contrast, fatigability features (SD aggregation) correlated with 9HPT time (|r|=0.26-0.61; 10/13 features), EDSS (|r|=0.26-0.41; 8/13 features), and MSIS-29 arm items (|r|=0.32-0.46; 7/13 features). The Pinching Test provides a remote, objective, and granular assessment of upper extremity function in people with MS that can potentially complement standard clinical evaluation. Future studies will validate it in more advanced MS. ClinicalTrials.gov NCT02952911; https://clinicaltrials.gov/study/NCT02952911.

Poster (Knowledge Generation) ID 2002621

Background Nerve transfer surgery for patients with spinal cord injury (SCI) is an emergent practice for upper extremity reconstruction currently being implemented in a few clinical settings around the world. In 2019, we implemented an interdisciplinary clinic for upper extremity care in tetraplegic patients. Since the beginning of this collaboration, thirteen patients underwent nerve transfer surgery and followed a specific two-year rehabilitation protocol. Presentation objectives: Methods Thirteen patients underwent a surgical reconstruction of their upper extremity. They followed a rehabilitation process with occupational therapists and physiotherapists. So far, eight patients have completed their two-year rehabilitation process. Routine outcome assessments were collected at 0, 6, 12, 24 months following the surgery. Results Twenty-four arms were operated, for a total of 51 nerve transfers. We will present our epidemiological data, details of the surgeries and results on hand opening, grip and pinch strength, functional testing, as well as satisfaction questionnaires. Conclusion Nerve transfer surgery is an exciting and innovative technique for our SCI patients. An interdisciplinary setting is the key to success. Our data shows that this surgery, well planned and accompanied by proper rehabilitation, is a promising avenue to improve upper extremity function in people with cervical spinal cord injury.

Can the Shriners Hospital Upper Extremity Evaluation (SHUEE) Detect Change in Dynamic Position and Spontaneous Function of the Upper Limb in People With Hemiplegic Cerebral Palsy?

The Shriners Hospital Upper Extremity Evaluation (SHUEE) is a video-based measure designed to assess upper extremity function in people with cerebral palsy (CP). The SHUEE completes both dynamic positional analysis (DPA; position during functional activities) and spontaneous functional analysis (spontaneous use of the involved limb). Although the SHUEE has been suggested as a measure for planning upper limb interventions and evaluating outcomes, limited evidence of its ability to detect change exists. Thus, this study aimed to describe responsiveness of the SHUEE to detect change after orthopaedic surgery. In this Institutional Review Board-approved retrospective cohort study, we identified children with CP who were administered SHUEE on≥2 encounters. We formed pairs of initial and follow-up visits between temporally adjacent visits. Pairs were assigned to a surgery or non-surgery group based on intervening upper limb orthopaedic surgery. We compared differences in baseline SHUEE scores between groups and differences in temporally adjacent SHUEE scores within groups using Welch unequal variances t tests and paired t tests, respectively. Nineteen people (7 female) with hemiplegic CP had≥2 SHUEE assessments; Manual Ability Classification System levels I (3), II (8), III (7), IV (1); Gross Motor Function Classification System levels I (10), II (7), IV (2); mean age at baseline 11.9 (5.1 to 19.1) years; and follow-up at 13.4 (5.5 to 19.7) years. Six people had≥2 visits leading to 14 surgical pairs and 10 non-surgical pairs. At baseline, DPA of the wrist and forearm were significantly lower in the surgical group ( P <0.05). At follow-up, no significant difference between the groups existed in DPA measures ( P >0.05). After surgical intervention, there was a significant change in overall and wrist DPA ( P <0.05). The DPA measures demonstrated responsiveness to expected positional changes in the arm after orthopaedic surgery in people with CP. The SHUEE was useful in identifying abnormal segmental alignment pre-surgically and documenting changes in alignment postoperatively. As orthopaedic surgery does not address limb neglect or bimanual ability, spontaneous functional analysis scores were as expected-unchanged. Level III, retrospective cohort study.

Developing guiding principles for technology-based rehabilitation program by engaging people with motor incomplete tetraplegia

BackgroundTechnology-aided rehabilitation is well established in the field of neurologic rehabilitation. Despite the widespread availability, the development of technology-based interventions that incorporate perspectives of the people who will use them is lacking.ObjectivesThis qualitative study aims to understand how people with chronic motor incomplete cervical spinal cord injury view rehabilitation technology to improve upper extremity function and neuromuscular recovery to inform future intervention development.MethodsSeven participants with chronic upper extremity impairment due to spinal cord injury/dysfunction trialed five rehabilitation technology devices. After a 30–45 min trial for each device, participants engaged in a semi-structured interview. Interviews were analyzed using a qualitative approach to explore the experience using and understand features that support motivation to use of rehabilitation technology.ResultsQualitative analysis revealed three major themes: (1) devices must be flexible to meet diverse needs; (2) intervention protocols must be individualized to address unique needs and contexts of users; (3) intervention protocols should be developed and updated by a skilled clinician. These themes and subthemes were used to describe guiding principles to inform future intervention design.ConclusionThe experiences of people with cervical spinal cord injury can be elicited as part of the intervention design process to systematically develop protocols for future feasibility trials. The findings from this study can be used to inform the development of technology-aided rehabilitation programs to improve upper extremity function in people with chronic motor incomplete tetraplegia.Clinical trials registration number: NCT04000256

Assessment of Upper Extremity Function in People With Stroke Based on the Framework of the ICF: A Narrative Review.

Although there are many assessment tools for upper extremity (UE) function, it is still difficult to select an appropriate outcome measurement for the rehabilitation process of individuals with stroke. This review aims to classify each tool within the International Classification of Functioning, Disability and Health (ICF) framework and provide an overview of UE assessments. Through a comprehensive understanding of assessments based on ICF, health care professionals will be able to choose suitable measurement tools for individuals, facilitating their rehabilitation.

Investigating the Relationship Between Balance and Upper Extremity Function in People with Multiple Sclerosis

Investigating the Relationship Between Balance and Upper Extremity Function in People with Multiple Sclerosis

Is mental practice effective for treating upper extremity deficits in individuals with hemiparesis after stroke? A Cochrane Review summary with commentary.

Mental practice, which is proposed for the rehabilitation of people post-stroke, is a training method based on the repetition of the internal representation of a movement or a task with the aim of improving the performance. The aim of this commentary is to discuss Cochrane evidence on the efficacy of mental practice in improving upper extremity functioning in people with hemiparesis after stroke. To summarize and discuss from a rehabilitation perspective the published Cochrane Review "Mental practice for treating upper extremity deficits in individuals with hemiparesis after stroke" by Barclay et al.RESULTS:This Cochrane Review included 25 studies involving 676 people with hemiparesis after stroke. The authors analysed the following two comparisons: mental practice versus conventional therapy and mental practice in addition to other treatment versus other treatment (±placebo). Mental practice in addition to other treatment, compared with other treatment, probably improves upper extremity activity and function in people with hemiparesis after stroke.

Relationships within and between lower and upper extremity dysfunction in people with diabetes

IntroductionDiabetes mellitus (DM) is associated with systemic musculoskeletal system impairments suggesting concurrent development of lower and upper extremity musculoskeletal problems. This study aims to examine relationships between lower and upper extremity function in people with DM. MethodsSixty people with type 2 DM and peripheral neuropathy [mean (standard deviation); 67(6) years old, DM duration 14(10) yrs] completed the following measures: 1) Self-reports of function: Foot and Ankle Ability Measure (FAAM; higher = better function) and Shoulder Pain and Disability Index (SPADI; lower = better function), 2) Range of motion (goniometry): ankle dorsiflexion and shoulder flexion, and 3) Strength: unilateral heel rise power (UHR, 3D kinetics) and hand grip dynamometry. Pearson correlations examined associations between lower and upper extremity measures, p < .05. ResultsForty of 60 (67%) reported pain/disability in both the foot/ankle and shoulder and 95% of study participants had some limitation in foot or shoulder function. Significant between extremity correlations: FAAM and SPADI (r = −0.39), ankle dorsiflexion and shoulder flexion range of motion (r = 0.35), and UHR and hand grip strength (r = 0.40). Significant within extremity correlations: FAAM and UHR (r = .47) and SPADI with shoulder flexion (r = −0.44). ConclusionUpper and lower extremity inter- and intra-relationships indicate systemic musculoskeletal impairments in people with DM. Healthcare practitioners should consider the potential for concurrent and disabling musculoskeletal problems in people with DM.

만성 뇌졸중 환자들의 체간 조절이 상지 기능에 미치는 영향

만성 뇌졸중 환자들의 체간 조절이 상지 기능에 미치는 영향

Functional Rehabilitation of the Paralyzed Upper Extremity After Spinal Cord Injury by Noninvasive Hybrid Neuroprostheses

For individuals with high spinal cord injury (SCI), restoring missing grasping function is a high priority. Neuroprostheses based on functional electrical stimulation (FES) can partly compensate the loss of upper extremity function in people suffering from tetraplegia. With noninvasive, multichannel neuroprostheses a pinch and power grasp can be accomplished for everyday use. Hybrid systems combining FES with active orthoses hold promise for restoring a completely lost arm function. Novel control interfaces are needed to make full use of the many degrees of freedom of complex hybrid neuroprostheses. Motor imagery (MI)-based brain–computer interfaces (BCIs) are an emerging technology that may serve as a valuable adjunct to traditional control interfaces for neuroprosthetic control. Shared control and context-specific autonomy are most effective for reducing the users' workload. The modularity of upper extremity neuroprostheses as well as their associated control interfaces enable customization of the systems to adapt to the impairment and needs of each individual end user. This work provides an overview of the application of noninvasive hybrid BCI-controlled upper extremity neuroprostheses in individuals with high SCI with a strong focus on the results from the European Integrated Project Tools for Brain-Computer Interaction and will describe the challenges and promises for the future.

Effect of Trunk Support on Upper Extremity Function in People With Chronic Stroke and People Who Are Healthy.

Trunk control is thought to contribute to upper extremity (UE) function. However, this common assumption in neurorehabilitation has not been validated in clinical trials. The study objectives were to investigate the effect of providing external trunk support on trunk control and UE function and to examine the relationship between trunk control and UE function in people with chronic stroke and people who were healthy. A cross-sectional study was conducted. Twenty-five people with chronic stroke and 34 people who were healthy and matched for age and sex were recruited. Trunk control was assessed with the Trunk Impairment Scale (TIS), and UE impairment and UE function were assessed with the UE subsection of the Fugl-Meyer Assessment (FMA-UE) and the Streamlined Wolf Motor Function Test (SWMFT), respectively. The TIS and SWMFT were evaluated, with and without external trunk support; the FMA-UE was evaluated without trunk support. With trunk support, people with stroke showed improvement from 18 to 20 points on the TIS, a reduction in SWMFT performance times from 37.20 seconds to 35.37 seconds for the affected UE, and improvement from 3.3 points to 3.4 points on the SWMFT Functional Ability Scale for the function of the affected UE. With trunk support, the SWMFT performance time for people who were healthy was reduced from 1.61 seconds to 1.48 seconds for the dominant UE and from 1.71 seconds to 1.59 seconds for the nondominant UE. A significant moderate correlation was found between the TIS and the FMA-UE (r=.53) for people with stroke. The limitations included a nonmasked assessor and a standardized height of the external trunk support. External trunk support improved trunk control in people with chronic stroke and had a statistically significant effect on UE function in both people with chronic stroke and people who were healthy. The findings suggest an association between trunk control and the UE when external trunk support was provided and support the hypothesis that lower trunk and lumbar stabilization provided by external support enables an improvement in the ability to use the UE for functional activities.

Clinician's Commentary on Janaudis-Ferreira et al.

Clinician's Commentary on Janaudis-Ferreira et al.

Surgical restoration of arm and hand function in people with tetraplegia.

Improved hand and arm function is the most sought after function for people living with a cervical spinal cord injury (SCI). Surgical techniques have been established to increase upper extremity function for tetraplegics, focusing on restoring elbow extension, wrist movement, and hand opening and closing. Additionally, more innovative treatments that have been developed (implanted neuroprostheses and nerve transfers) provide more options for improving function and quality of life. One of the most important steps in the process of restoring upper extremity function in people with tetraplegia is identifying appropriate candidates - typically those with American Spinal Injury Association (ASIA) motor level C5 or greater. Secondary complications of SCI can pose barriers to restoring function, particularly upper extremity spasticity. A novel approach to managing spasticity through high-frequency alternating currents designed to block unwanted spasticity is being researched at the Cleveland FES Center and may improve the impact of reconstructive surgery for these individuals. The impact of these surgeries is best measured within the framework of the World Health Organization's International Classification of Function, Disability and Health. Outcome measures should be chosen to reflect changes within the domains of body functions and structures, activity, and participation. There is a need to strengthen the evidence in the area of reconstructive procedures for people with tetraplegia. Research continues to advance, providing more options for improved function in this population than ever before. The contribution of well-designed outcome studies to this evidence base will ultimately help to address the complications surrounding access to the procedures.

A synthesis of best evidence for the restoration of upper-extremity function in people with tetraplegia.

Because upper-limb function represents overall function for individuals with tetraplegia, the restoration of upper-extremity function is exceedingly important for this population. The purpose of this review was to identify interventions that optimize upper-limb function after tetraplegia based on best available evidence. A search of MEDLINE, AMED, and PubMed with the search terms "hand function AND tetraplegia" and "upper limb function AND tetraplegia" found 384 articles. After elimination of duplicates and review of titles and abstracts, 43 studies were found to be applicable. Study quality of all applicable studies was assessed with a modified version of the Scottish Intercollegiate Guidelines Network for Cohort Studies methodology. The applicable studies were organized into three categories: conventional therapies (CT), electrical stimulation therapies (ES), and surgical interventions (SI). The proportion of papers in each category that presented with sufficient methodological quality to contribute to best evidence was as follows: CT: 0/2; ES: 10/21; SI: 6/20. ES therapies are beneficial as assistive technologies and as therapeutic intervention in the subacute phase of recovery. SIs are suitable for individuals who meet very specific criteria for tendon-transfer surgery. Further clinical trials are warranted for ES and SI therapies to substantiate prescription of therapeutics.

Comparison of Constraint-Induced Movement Therapy and Bilateral Treatment of Equal Intensity in People With Chronic Upper-Extremity Dysfunction After Cerebrovascular Accident

We compared the effectiveness of constraint-induced movement therapy (CIMT) with bilateral treatment of equal intensity for chronic upper-extremity (UE) dysfunction caused by cerebrovascular accident (CVA). We conducted a 2-group, randomized intervention trial with stratification by severity of UE dysfunction. Twelve community-dwelling adults were provided with 6 hr of occupational therapy for 10 days plus additional home practice. Six participants wore a mitt on the unimpaired UE, and 6 participants were intrusively and repetitively cued to use both UEs. The Wolf Motor Function Test (WMFT) and the Canadian Occupational Performance Measure (COPM) were administered before and after treatment and at 6-mo follow-up. Significant improvements were found in WMFT and COPM scores across time in both groups. No significant between-group differences were found on the WMFT. High-intensity occupational therapy using a CIMT or a bilateral approach can improve UE function in people with chronic UE dysfunction after CVA. Treatment intensity rather than restraint may be the critical therapeutic factor.

Psychometric Comparisons of 4 Measures for Assessing Upper-Extremity Function in People With Stroke

Functional limitation of the upper extremities is common in patients with stroke. An upper-extremity measure with sound psychometric properties is indispensable for clinical and research use. The purpose of this study was to compare the psychometric properties of 4 clinical measures for assessing upper-extremity motor function in people with stroke: the upper-extremity subscale of the Fugl-Meyer Motor Test (UE-FM), the upper-extremity subscale of the Stroke Rehabilitation Assessment of Movement, the Action Research Arm Test (ARAT), and the Wolf Motor Function Test. This was a prospective, longitudinal study. Fifty-three people with stroke were evaluated with the 4 measures at 4 time points (14, 30, 90, and 180 days after stroke). Thirty-five participants completed all of the assessments. The ceiling and floor effects, validity (concurrent validity and predictive validity), and responsiveness of each measure were examined. Interrater reliability and test-retest reliability also were examined. All measures, except for the UE-FM, had significant floor effects or ceiling effects at one or more time points. The Spearman rho correlation coefficient for each pair of the 4 measures was > or =.81, indicating high concurrent validity. The predictive validity of the 4 measures was satisfactory (Spearman rho, > or =.51). The responsiveness of the 4 measures at 14 to 180 days after stroke was moderate (.52 < or = effect size < or = .79). The 4 measures had good interrater reliability (intraclass correlation coefficient [ICC], > or =.92) and test-retest reliability (ICC, > or =.97). Only the minimal detectable changes of the UE-FM (8% of the highest possible score) and the ARAT (6%) were satisfactory. The sample size was too small to conduct data analysis according to type or severity of stroke. In addition, the timed component of the Wolf Motor Function Test was not used in this study. All 4 measures showed sufficient validity, responsiveness, and reliability in participants with stroke. The UE-FM for assessing impairment and the ARAT for assessing disability had satisfactory minimal detectable changes, supporting their utility in clinical settings.

Scapular Stabilization in Patients With Spinal Cord Injury

Background: Severe scapular instability can be a considerable problem for people with high-level cervical spinal cord injury. Scapular instability reduces the effectiveness of the already weakened shoulder flexors and abductors, thereby limiting hand-to-mouth and hand-to-head activities. The winged scapula may cause inferior pole skin breakdown, as well as neck and shoulder pain.Objective: To report the efficacy of a fusionless scapular stabilization procedure as a means to enhance function in a consecutive group of patients with high-level cervical spinal cord injury.Methods: Four people with spinal cord injury at C4-C5 (2 male, 2 female; mean age = 17.3 years, range = 14-20 years) underwent scapular stabilization via scapulothoracic fusion (N = 2) or by tethering the scapula to the rib cage with Mersilene tape as a fusionless stabilization (N = 2). One patient died of unrelated causes 18 months after surgery, and the remaining 3 were followed for 26, 39, and 41 months, respectively. Data collection included radiographic analysis, active range of motion measures, and functional assessment.Results: Active shoulder flexion and abduction remained unchanged in 2 patients, but functional scores improved with regard to feeding and grooming capability. All patients reported satisfaction with postoperative appearance, and 3 patients reported considerable reduction in shoulder pain after surgery. Radiographs demonstrated maintenance of stable scapular alignment in all patients at final follow up. Wound breakdown, requiring removal of instrumentation, occurred in 2 patients.Conclusion: Scapular stabilization with or without fusion is a viable option to improve appearance, pain, and upper extremity function in people with high-level tetraplegia and scapular instability.

Fractal dimension assessment of brain white matter structural complexity post stroke in relation to upper-extremity motor function

Little is known about the association between brain white matter (WM) structure and motor function in humans. This study investigated complexity of brain WM interior shape as determined by magnetic resonance imaging (MRI) and its relationship with upper-extremity (UE) motor function in patients post stroke. We hypothesized that (1) the WM complexity would decrease following stroke, and (2) higher WM complexity in non-affected cortical areas would be related to greater UE motor function. Thirty-eight stroke patients (16 with left-hemisphere lesions) underwent MRI anatomical brain scans. Fractal dimension (FD), a quantitative shape metric, was applied onto skeletonized brain WM images to evaluate WM internal structural complexity. Wolf Motor Function Test (WMFT) and Fugl–Meyer Motor Assessment (FM) scores were measured to assess motor function of the affected limb. The WM complexity was lower in the stroke-affected hemisphere. The FD was associated with better motor function in two subgroups: with left-subcortical lesions, FD values of the lesion-free areas of the left hemisphere were associated with better FM scores; with right-cortical lesions, FD values of lesion-free regions were robustly associated with better WMFT scores. These findings suggest that greater residual WM complexity is associated with less impaired UE motor function, which is more robust in patients with right-hemisphere lesions. No correlations were found between lesion volume and WMFT or FM scores. This study addressed WM complexity in stroke patients and its relationship with UE motor function. Measurement of brain WM reorganization may be a sensitive correlate of UE function in people recovering from stroke.

Single-Stage Tendon Transfer Reconstruction for Active Pinch and Grasp in Tetraplegia

Surgically restoring hand and upper extremity function in people with tetraplegia is well established with a long, reliable history. Individuals, properly selected and counseled, are consistently pleased with the improvements they gain in terms of both independence and meaningful activities of daily living. Restoration of complex hand functions, such as palmar grasp, tends to involve sophisticated techniques and multiple surgeries in people with lower level tetraplegia. We have identified a subgroup of individuals for whom we have been restoring such function in a single-stage operation. This article will review pertinent concepts of tetraplegia hand and upper extremity restoration with particular focus on the former techniques.