Muscles Of Upper Extremities Research Articles

Multi-channel EMG manifestations of upper-extremity muscle coordination imbalance among community-dwelling sarcopenic seniors

Multi-channel EMG manifestations of upper-extremity muscle coordination imbalance among community-dwelling sarcopenic seniors

Effects of Type II Diabetes on upper extremity muscle characteristics in older adults.

With one in every four older adults living with T2D and one in every two older adults meeting the criteria for prediabetes, neuromuscular changes due to T2D are likely to impact functional activities in this population. Limited work in evaluating motor unit number and size across muscles in the upper extremity in persons with Type II Diabetes (T2D) exists, mostly due to the traditional belief bias that the upper extremity is relatively spared in T2D as compared to the lower extremities. The purpose of the current study was to evaluate motor unit number and size (using electrophysiological motor unit number index (MUNIX) and motor unit size index (MUSIX)) across the upper extremity in older adults with T2D (n = 13) as compared to healthy age- and sex-matched controls (n = 12). Persons with T2D presented with more motor units and larger motor unit sizes (p < 0.05) as compared to age- and sex-matched control participants. These changes were not dependent upon muscle location within a limb, indicating systemic neuromuscular changes associated with T2D. These group effects were clarified when health state covariates (e.g., blood pressure) were accounted for. Findings are consistent with emerging data that show altered neuromuscular characteristics with health state considerations in persons with T2D.

Transcranial MEPs predict clinical outcome during minimally invasive dorsal decompression for cervical spondylotic myelopathy

ObjectivesMotor evoked potential (MEP) monitoring is a reliable method for real-time assessment of corticospinal tract integrity. However, the potential benefits of MEP monitoring during degenerative spine surgery remain controversial. This study aims to determine the role of MEP monitoring during surgery for cervical spondylotic myelopathy (CSM) in prediction of prognosis. MethodsTranscranial electrical stimulation was performed to elicit MEPs during dorsal decompression for the treatment of CSM. MEP-threshold levels were assessed separately at the beginning and end of the surgery in upper extremity muscles corresponding to nerve roots at the level of/distal to the decompression site. Clinical outcome was measured using the modified Japanese Orthopedic Association score (mJOA). ResultsThe study included 47 patients. 31 patients (66 %) showed improvements in neurological function at discharge. A measurable improvement in the majority of tested muscles, or in at least one muscle group, in a given patient highly correlated with mJOA score increase at discharge (p < 0.001) with an odds ratio of 10.3 (CI:2.6–34.4) and 11.4 (CI:2.8–41.3), respectively. Conversely, MEP deterioration was not associated with worse clinical outcome, nor was it predictive of failure to recover. ConclusionMEP improvement during CSM surgery seems to be highly predictive of early postoperative neurological recovery and could indicate subclinically enhanced signal conduction. This highlights the potential of MEP monitoring as an intraoperative, real-time predictive tool for clinical recovery after decompression in patients with CSM.

Identifying Factors for Predicting Postoperative Segmental Motor Paralysis in Patients Undergoing Anterior Cervical Spine Surgery: A Multicenter Study.

Retrospective cohort study. To investigate the incidence of and risk factors for segmental motor paralysis after anterior cervical spine surgery. Segmental motor paralysis is a potential complication following both anterior and posterior cervical decompression procedures; however, previous studies investigating risk factors for segmental motor paralysis after anterior cervical spine surgery were limited by small sample sizes. Consequently, the exact pathogenesis and risk factors for this complication remain poorly understood, highlighting the need for larger-scale investigations focused exclusively on anterior cervical spine surgeries. We retrospectively reviewed the clinico-demographic and operative factors and postoperative outcomes of 1,428 patients undergoing anterior cervical spine surgery at three spine centers in Japan. Postoperative segmental motor paralysis was defined as deterioration of upper extremity muscle strength by ≥1 grade; recovery was defined as a return to preoperative muscle strength levels. Univariate and multivariate analyses were performed to identify risk factors. Ninety-nine patients (6.9%) developed segmental motor paralysis, mostly involving the C5 segment (81.8%), the incidence being highest in patients with ossification of the posterior longitudinal ligament (OPLL) and those undergoing anterior cervical corpectomy and fusion or hybrid fusion (discectomy + corpectomy). Older age, male sex, higher body mass index, OPLL, and cervical corpectomy were independent risk factors for paralysis, with these patients having significantly worse clinical outcomes at 1 year postoperatively. Most patients (74/99, 79.6%) regained preoperative muscle strength levels an final follow up. This study identified important clinico-demographic and operative risk factors for segmental motor paralysis after anterior cervical spine surgery. Patients undergoing corpectomy, with or without OPLL, were found to be at particularly high risk. While most patients recover well, worse outcomes with segmental motor paralysis highlight the importance of preventing this complication, particularly for OPLL patients and corpectomy procedures. III.

Intersession Intra-Rater and Inter-Rater Reliability of Myotonometer for Upper and Lower Extremity Muscles in Children with Spinal Muscular Atrophy.

Background/Objectives: This study aimed to examine intra- and inter-rater reliability of a myotonometer (MyotonPRO) in measuring upper and lower extremity mechanical properties in children with spinal muscular atrophy types I and II. Methods: Biceps brachii, triceps brachii, rectus femoris, and gastrocnemius muscle tone and stiffness in children (n = 21) were measured using the MyotonPRO device. Examiner 1 performed two sets of measurements in 60 min to determine intra-rater reliability. Examiner 2 performed measurements between Examiner 1's sets. Intra-interclass correlation coefficient, minimal detectable change, and standard error of measurement values were calculated to assess intra- and inter-rater reliabilities in this cross-sectional study. Results: The results showed excellent intra- and inter-rater reliability analyses for frequency and stiffness values except for the stiffness value of the gastrocnemius muscle, which presented good reliability (ICC = 0.71). Minimal detectable change values ranged from 0.59 to 1.98 Hz for muscle tone and 16.08 to 124.74 N/m for stiffness (for both intra- and inter-rater reliabilities). Conclusions: Our findings indicate that MyotonPRO is a reliable tool for quantifying upper and lower extremity mechanical properties within one session in children with spinal muscular atrophy types I and II. Mechanical properties of the extremity muscle can be determined using this easily applied tool in future studies.

12521 Electrical Impedance Myography And Muscle Health In Older Adults With Type 1 Diabetes

Abstract Disclosure: A. Fremaint: None. G. Jung: None. E. Yu: None. M. Bouxsein: None. Introduction: Recent studies indicate that individuals with Type 1 diabetes mellitus (T1D) develop skeletal muscle health impairments which might contribute to falls and explain their high fracture risk. A novel handheld Electrical Impedance Myography (EIM) device (mScan model 1301, Myolex) has been developed to assess muscle quality by calculating tissue impedance. We hypothesized that mScan could identify individuals with worse strength and body composition outcomes among older adults with and without T1D. Methods: We studied participants of the T1D Bone Health Connection (BEACON) Study who were aged 50+ and who had undergone EIM testing (n=63 T1D, n=50 non-diabetic controls). We analyzed EIM-derived phase angle [Phase = arctan(reactance/resistance)] at 100 kHz in 3 upper extremity muscles (biceps brachii, lateral deltoid, and wrist extensors), where lower phase values indicate poorer muscle quality. Correlations of EIM data were performed with grip strength measured by a handheld dynamometer and appendicular lean mass/height2 (ALM/ht2) and visceral adipose tissue (VAT) from whole-body DXA scans. Pearson’s correlations were used for all statistical analyses. Results: Mean age (63±7 years), sex (54% female), and BMI (26.5 kg/m2) were similar between T1D and control groups. Adults with T1D had a nonsignificant trend towards lower muscle quality at the biceps brachii than controls (8.9±5.4 vs 10.9 ±6.0 degrees, p=0.078). There were no differences between groups in phase angle for lateral deltoid nor wrist extensors. Higher muscle quality at the biceps brachii was associated with higher grip strength (r=0.28, p=0.005) in the full cohort as well as in the T1D group (r=0.40, p &amp;lt;0.001). In the full cohort, greater VAT was associated with lower muscle health at the biceps brachii (r = -0.34, p=0.003) and lateral deltoid (r = -0.23, p&amp;lt;0.014), with similar patterns in both T1D and controls. There were no correlations of muscle quality with ALM/ht2. Conclusion: Our data suggest that mScan holds promise for detection of skeletal muscle health impairments in older adults, including those with T1D, potentially aiding in the diagnosis and prevention of related falls and fractures. Further research is required to investigate the association between VAT and muscle health and to validate the effectiveness of mScan in T1D and other populations. Presentation: 6/3/2024

Ergonomic differences in mesh placement and mesh fixation between laparoscopic and robotic inguinal hernia repair with mesh.

General differences in surgeon ergonomics between laparoscopic and robotic-assisted inguinal hernia repairs (LIHR vs. RIHR) have been previously studied. However, specific differences in the ergonomics of mesh placement (MP) and mesh fixation (MF) are undetermined. Our aim was to determine if there are differences in the ergonomics of MP and MF between the surgical approaches. We hypothesize that we will identify differences, with the potential for worse ergonomics during LIHR. Data was collected from fifteen LIHR and fifteen RIHR. All cases were elective, primary inguinal hernias completed by a fellowship-trained minimally invasive surgeon. Surface electromyography (EMG) of four upper extremity muscle groups, including the upper trapezius (UT), anterior deltoid (AD), flexor carpi radialis (FCR) and extensor digitorum (ED), was recorded bilaterally during MP and MF. Muscle activation as a percent of maximum voluntary contraction (%MVCRMS) and muscle fatigue denoted as the median frequency of muscle activations (Fmed) were calculated for each muscle. EMG analysis showed increased %MVCRMS in LIHR compared to RIHR cases, with significant findings in the left UT, right UT, ED, and FCR for MP and MF and the left FCR during MP. Muscle fatigue was decreased in LIHR compared to RIHR cases, with significant differences in left FCR and right ED and AD. Despite greater muscle activations during LIHR, RIHR had greater muscle fatigue. It is possible that short periods of high muscle activation are ergonomically protective during minimally invasive inguinal hernia repair. Identifying these differences may aid in development of procedure-specific interventions to improve ergonomics.

Enhancing upper extremity muscle strength in individuals with spinal cord injury using low-intensity blood flow restriction exercise.

This study explores the feasibility and effects of low-intensity blood flow restriction exercise on forearm muscle strength and function in individuals with spinal cord injury. Pilot randomized clinical trial. Ten male and female adult participants with chronic cervical and thoracic spinal cord injury underwent an 8-week low-intensity blood flow restriction exercise programme that targeted forearm muscles. Each participant's contralateral forearm served as the control. Grip strength was the primary outcome measure, and participants also provided qualitative feedback on their experiences. The study revealed a significant increase in participants' forearm muscle strength on the experimental side engaged in low-intensity blood flow restriction training, with an average strength gain of 7.5 ± 0.36 kg after 16 exercise sessions (Cohen's d = -6.32, 95% CI -8.34, -6.68). In comparison, the control side, following a conventional high- intensity exercise regimen without BFR, showed a more modest strength increase of 4.4 ± 0.67 kg. A mean Patient's Global Impression of Change score of 2.2 reflected overall improvements in participants' daily activities and health status. This study highlights the feasibility and effectiveness of low-intensity blood flow restriction exercise as a safe and promising approach to enhancing forearm muscle strength in individuals with spinal cord injury. The observed positive outcomes, coupled with a high level of participant satisfaction, underscore the potential of this innovative method to significantly improve limb muscle strength, thereby contributing to greater functional independence in this population.

A systematic review and meta-analysis on effect of different exercise training on grip strength and upper extremity muscle strength in patients with type 2 diabetes mellitus.

Individuals with type 2 diabetes mellitus (T2DM) are prone to musculoskeletal complications, particularly in the upper extremities (UE), which can significantly impair their grip strength and UE muscle strength. This review will provide valuable insights for developing optimized exercise interventions aimed at enhancing upper limb functionality and improving patient outcomes. To determine the effect of different exercise training on grip strength & UE muscle strength in patients suffering from T2DM. A comprehensive search from electronic databases was performed based on the selection criteria and 13 randomized controlled trials (RCT's) were included in the study. Mean changes in grip strength and UE muscle strength were the primary outcome measures. Included studies ranked high on the PEDro rating scale and eta-analysis was performed by Rev Man 5.4 software. Meta-analysis results indicated that there was a statistically significant improvement in UE muscle strength of experimental group when compared to control group (mean differences [MD]=2.91, 95% confidence interval=0.12, 5.71; p=0.04) with moderate heterogeneity (I2=49%, p<0.07). Grip strength improved significantly in the experimental group when compared to the control group with (MD=2.93, 95% CL=-0.00, 5.86; p=0.05) and moderate heterogeneity (I2=66%, p<0.08). This review indicated a positive role of supervised resistance & aerobic exercises on UE muscle strength in patients with T2DM. Due to lack of RCT's, grip strength needs to be explored by further investigations in these patients.

A 24-Week Combined Resistance and Balance Training Program Improves Physical Function in Older Adults: A Randomized Controlled Trial

Abstract Jiang, G, Tan, X, Zou, J, and Wu, X. A 24-week combined resistance and balance training program improves physical function in older adults: a randomized controlled trial. J Strength Cond Res XX(X): 000–000, 2024—This randomized controlled trial assessed the feasibility of older adults performing combined resistance and balance training (RBT) and compared the effects of RBT on physical function with those of resistance training (RT) alone and with no exercise training in older adults. In total, 65 community-dwelling adults aged 60–74 years were randomly assigned to an RT (n = 22), RBT (n = 22), or control (n = 21) group. The exercise intervention consisted of RT or RBT for 45 minutes, 3 times per week for 24 weeks. The control group engaged in no exercise training. The compliance rates were 93% in the RT group and 92% in the RBT group. No training-related adverse effect was observed. In the RT and RBT groups, dynamic balance (p = 0.017; p &lt; 0.001, respectively), maximum walking speed (p = 0.014; p &lt; 0.001), upper extremity (p = 0.013; p = 0.009) and lower extremity (p = 0.009; p &lt; 0.001) muscle strength, and spirometry (p = 0.043; p = 0.018) were significantly improved at 24 weeks compared with the control group. Only the RBT group showed significant improvement in normal walking speed (p = 0.002). Compared with the RT group, the RBT group showed additional significant improvements in dynamic balance (p = 0.001) and lower limb muscle strength (p = 0.027). The findings of this randomized controlled trial indicated that RBT was safe and feasible for older adults. Long-term RBT had better effects than either no exercise training or RT alone on improving physical function in older adults. Compared with RT, RBT additionally benefited dynamic balance and lower limb muscle function, which are clinically important factors in preventing falls, frailty, disability, and other geriatric syndromes.

Corticospinal excitability during motor preparation of upper extremity reaches reflects flexor muscle synergies: A novel principal component-based motor evoked potential analyses.

Previous research has shown that noninvasive brain stimulation can be used to study how the central nervous system (CNS) prepares the execution of a motor task. However, these previous studies have been limited to a single muscle or single degree of freedom movements (e.g., wrist flexion). It is currently unclear if the findings of these studies generalize to multi-joint movements involving multiple muscles, which may be influenced by kinematic redundancy and muscle synergies. The objective of this study was to characterize corticospinal excitability during motor preparation in the cortex prior to functional upper extremity reaches. 20 participants without neurological impairments volunteered for this study. During the experiment, the participants reached for a cup in response to a visual "Go Cue". Prior to movement onset, we used transcranial magnetic stimulation (TMS) to stimulate the motor cortex and measured the changes in motor evoked potentials (MEPs) in several upper extremity muscles. We varied each participant's initial arm posture and used a novel synergy-based MEP analysis to examine the effect of muscle coordination on MEPs. Additionally, we varied the timing of the stimulation between the Go Cue and movement onset to examine the time course of motor preparation. We found that synergies with strong proximal muscle (shoulder and elbow) components emerged as the stimulation was delivered closer to movement onset, regardless of arm posture, but MEPs in the distal (wrist and finger) muscles were not facilitated. We also found that synergies varied with arm posture in a manner that reflected the muscle coordination of the reach. We believe that these findings provide useful insight into the way the CNS plans motor skills.

Diverse Phenotypic Presentation of the Welander Distal Myopathy Founder Mutation, With Myopathy and Amyotrophic Lateral Sclerosis in the Same Family.

Welander distal myopathy is a rare myopathy with prominent and early involvement of distal upper extremity muscles, prevalent in individuals of Scandinavian origin, and caused by a founder mutation in the cytotoxic granule-associated RNA-binding protein (T-cell intracellular antigen-1; TIA1), E384K. Different pathogenic variants in the TIA1 gene, distinct from the founder 1, have recently been associated with frontotemporal dementia and amyotrophic lateral sclerosis (ALS), suggesting that TIA1-related disorders belong to the group of multisystem proteinopathies. We describe the first case of a two-generation family with the founder E384K TIA1 mutation demonstrating phenotypic variability; the mother manifested as Welander myopathy, whereas 2 daughters manifested as ALS. No other genetic cause of ALS was found in 1 of the affected daughters. We also discuss the possible mechanisms explaining this pleotropic presentation of the founder mutation.

Casting Light on Mechanical Properties of Lower and Upper Extremity Muscles in Children with Spinal Muscular Atrophy and Healthy Peers

Casting Light on Mechanical Properties of Lower and Upper Extremity Muscles in Children with Spinal Muscular Atrophy and Healthy Peers

THE EFFECT OF TRUNK STABILITY TRAINING ON UPPER EXTREMITY ENDURANCE, STABILITY AND SHOULDER JOINT PROPRIOCEPTION IN POSTMENOPAUSAL WOMEN

Purpose: The incidence of shoulder pathologies is increasing in postmenopausal women. In this period, there is a need for protective approaches to be applied to prevent shoulder injuries. The aim of this study is to investigate the effects of clinical pilates exercises on upper extremity stability, endurance, function and shoulder joint proprioception in postmenopausal women. Methods: 30 postmenopausal women between the ages of 40-60 were included in our study. Participants were given clinical pilates training for 6 weeks, 3 days a week, 60 minutes by a physiotherapist. Before and after pilates training, dynamic stability of the shoulder was evaluated with Closed Kinetic Chain Upper Extremity Stability Test (CKCUES Test) and Upper Quarter Y Balance Test (UQYBT). Upper extremity muscle endurance was evaluated with the modified push up test. Laser Pointer-Assisted Angle Reproduction Test (LP-ART) was used to evaluate shoulder joint position sense. Results: A statistically significant difference was found in CKCUES Test (p=0.000, r=0.594), UQYBT (p=0.000, r=0.537), modified push up (p=0.000, r=0.594), LP-ART abduction (p=0.000, r= 0.491) and LP-ART flexion (p=0.000, r=0.484) at end of the training compared to the pre-training. The exercise program was found to be highly effective on all parameters. Conclusion: It was concluded that clinical pilates training applied in postmenopausal women increased the dynamic stability of the shoulder, endurance and position sense. Trunk stabilization exercises may be beneficial as a preventive approach in the prevention of shoulder pathologies in postmenopausal women.

Upper Extremity Function and Neuromuscular Parameters in Primary Headaches: A Cross-Sectional Study

Objectives: To investigate the upper extremity function, muscle strength, endurance, and proprioception in patients with primary headache compared to healthy controls. Materials and Methods: The study was completed with 37 patients with primary headache (22 patients with tension-type headache and 15 patients with migraine) and 36 healthy controls with matched age and gender. Headache severity was evaluated with the Visual Analog Scale (VAS); upper extremity function with Nine-Hole Peg Test (9-HPT); upper extremity isometric muscle strength of shoulder flexor, extensor, and elbow flexor with a hand-held dynamometer; upper extremity endurance with 6-Minute Pegboard and Ring Test (6PBRT); and upper extremity proprioception with shoulder reposition tests using Dualer IQTM digital inclinometer. Intergroup differences were examined using the Mann-Whitney U Test, and the Spearman correlation analysis was used to ascertain the relationship between the variables in headache groups. Results: There was a significant difference between the results for the 9-HPT, some upper extremity isometric muscle strength tests, 6PBRT, and shoulder reposition tests between patients with tension-type headache, migraine, and healthy controls (p&amp;lt;0.05). Except for the 9-HPT and 6PBRT (r between -0.518 and -0.645; p&amp;lt;0.05 for all), there was no significant relationship between the results for patients with tension type and migraine (p&amp;gt;0.05). Conclusion: Upper extremity function, some upper extremity muscle strength parameters, endurance, and proprioception were decreased in patients with tension-type headache and migraine compared to healthy controls, and upper extremity function was found to be associated with upper extremity endurance in these patients.

Agreement and Consistency of Absolute and Relative Corticospinal Stimulus-Response Curves for Upper, Lower, and Axial Musculature in Healthy Adults.

To assess the agreement and consistency of absolute and relative stimulus-response curve (SRC) parameter estimates for upper extremity, lower extremity, and axial muscles. Thirty (15 W, age: 27.0 ± 6.3 y, height: 171.9 ± 8.9 cm, weight: 80.2 ± 19.3 kg) healthy adults completed absolute (5% to 100% stimulator output) and relative (65% to 160% motor threshold) SRCs of the first dorsal interosseous, vastus lateralis, and rectus abdominis during submaximal isometric contractions. Mean motor-evoked potential amplitudes were fit with nonlinear regression to derive MEPmax, V50, and slope. Absolute agreement and consistency were assessed with ICCs, Cronbachs alphas, and Bland-Altman plots. Independent t-tests were used to examine differences in motor threshold, physical activity, strength, and muscle activity among participants with valid and invalid SRC parameters. Absolute and relative SRCs displayed good agreement and consistency for MEPmax and V50 but not slope. Motor thresholds were lower among participants with valid absolute SRCs for the rectus abdominis and vastus lateralis. Motor threshold, physical activity, strength, and muscle activity did not differ among those with valid and invalid parameters for all relative SRCs and absolute SRCs for the first dorsal interosseous. Absolute and relative SRCs produce similar MEPmax and V50 estimates in the first dorsal interosseous, vastus lateralis, and rectus abdominis. The validity of absolute and relative SRC results may differ depending on individual characteristics and tested muscles.

Plantar Plate Increase Upper Extremity Muscle Strength in Patients with Flat Foot

Plantar Plate Increase Upper Extremity Muscle Strength in Patients with Flat Foot

Physical loads on upper extremity muscles while interacting with virtual objects in an augmented reality context

Augmented reality (AR) environments are emerging as prominent user interfaces and gathering significant attention. However, the associated physical strain on the users presents a considerable challenge. Within this background, this study explores the impact of movement distance (MD) and target-to-user distance (TTU) on the physical load during drag-and-drop (DND) tasks in an AR environment. To address this objective, a user experiment was conducted utilizing a 5× 5 within-subject design with MD (16, 32, 48, 64, and 80 cm) and TTU (40, 80, 120, 160, and 200 cm) as the variables. Physical load was assessed using normalized electromyography (NEMG) (%MVC) indicators of the upper extremity muscles and the physical item of NASA-Task load index (TLX). The results revealed significant variations in the physical load based on MD and TTU. Specifically, both the NEMG and subjective physical workload values increased with increasing MD. Moreover, NEMG increased with decreasing TTU, whereas the subjective physical workload scores increased with increasing TTU. Interaction effects of MD and TTU on NEMG were also significantly observed. These findings suggest that considering the MD and TTU when developing content for interacting with AR objects in AR environments could potentially alleviate user load.

High delta angle after reverse total shoulder arthroplasty increases stresses of the acromion: biomechanical study of different implant positions

BackgroundAcromial fractures after Reverse Total Shoulder Arthroplasty (RTSA) are a common complication. Nevertheless, only a few studies have identified risk factors for acromial fractures after RTSA. High delta angle (combination of inferiorization and medialization of the center of rotation) after RTSA was identified as a risk factor in recent studies. The aim of this study was the biomechanical exploration of different delta angles and implant configurations with regard to the acromial stress. MethodsIn a rigid body model of the upper extremity muscle, forces of the deltoid muscle were calculated before and after implanting RTSA in different arm and implant positions. The deltoid muscle was divided into an anterior, middle, and posterior part. Implant positions of the glenoid components were changed in the medialization, lateralization and inferiorization of the center of rotation (COR) as well as lateralization of the humeral component. Further, in a finite element model of the upper extremity, the stresses of the acromion in the same implant design configurations were measured. ResultsDifferences in acromial stress between different delta angle model configurations were observed. Lateralization (5 mm, 10 mm) of the glenosphere reduced maximal acromial stress by 21% (1.5 MPa) and 31% (1.3 MPa), respectively. Inferiorization (5 mm, 10 mm) of the glenosphere increased maximal acromial stress by 5% (2.0 MPa) and 15% (2.2MPa), respectively. Changes in positioning the humeral component was found to have the highest impact in this model configuration. A 10 mm lateralized humeral component reduced acromial stress by 37% (1.2 MPa) while in the 6 mm medialized configuration, an increase in acromial stress by 83% (3.48 MPa) was observed. There was a high correlation between delta angle and acromial stress (R-squared = 0.967). ConclusionImplant design configuration has an impact on the acromial stress. High delta angles correlate with an increase in acromial stress. Both lateralization of the COR and the humerus decreased the acromial stress in our study. The lateralization of the humerus has the highest impact in influencing acromial stress. Due to contrary results in the current literature, further studies with focus on the acromial stress influenced by different anatomical variants of the shoulder and the acromion are needed before a clinical recommendation can be made.

Comparison of the Effect of Online Physical Exercise and Computerized Cognitive Stimulation in Patients with Alzheimer’s Disease during the Covid-19 Pandemic

IntroductionTo investigate the effect of physical exercise alone and in combination with cognitive stimulation on cognition, physical function, and quality of life in patients with Alzheimer’s Disease (PwAD). MethodsThe study was a randomized controlled, single-blinded trial with pre-and post-treatment and follow-up assessments conducted at the private hospital and home environment in PwAD. Seventy-five (N=75) participants diagnosed with AD were enrolled, but sixty (N=60) participants (mean age 77.8 years, standard deviation (SD) 6.7) were randomized as physical exercise group (PEG) (n=20), physical exercise and cognitive stimulation group (PE+CSG) (n=20) and control group (CG) (n=20). Participants in PEG and PE+CSG performed an online supervised physical exercise program (SPEP) given biweekly for 12 weeks. Additionally, the cognitive stimulation (CS) program was offered for at least three or five days for 12 weeks for PE+CSG. No treatment was given for the CG. The primary outcome measures were cognition, balance, functional mobility (FM), upper extremity muscle strength (UEMS) and lower extremity muscle strength (LEMS), and quality of life (QoL). Furthermore, depression, basic activities of daily living (BADL) and instrumental activities of daily living (IADL) were measured secondarily. ResultsPE+CSG demonstrated significant improvement in cognition, balance, FM, UEMS, IADL and reduction in depression compared to the CG (p<0.05). Besides, participants in the PE+CSG had statistically superior QoL and IADL than the PEG (p<0.05). ConclusionsThe addition of CS to the SPEP was a safe and effective method to gain statistically significant improvements in cognition, balance, FM, UEMS, IADL, and reduction in depression in PwAD.