Upper-extremity Tasks Research Articles

Predictors of functional shoulder recovery at 1 and 12 months after breast cancer surgery

The objective of this study are (1) to determine if upper extremity function, as represented by shoulder ROM, self-reported symptoms and upper extremity functional limitations in activities of daily living could be predictively related to demographic and cancer characteristics post-surgery for breast cancer. And (2) to examine if variables related to early onset impairment contribute to late onset impairments in women after breast cancer surgery. Subjects were assessed preoperatively and 1, 3, 6, 9, and 12+ months post breast cancer surgery for impairments and symptoms and at 12+ months for shoulder functional limitations using a physical therapy surveillance model. Body weight, shoulder ROM, manual muscle testing, and upper limb volume were recorded. At 12+ months, the Harvard Alumni Health Study Physical Activity Questionnaire, and an Upper Limb Disability Questionnaire were administered. Symptoms and ROM impairments were compared by functional limitations. Characteristics significantly associated with early ROM impairment (but not later impairment) were axillary lymph node dissection, removal of ≥15 nodes, mastectomy surgery and stage II breast cancer. Positive nodes, older age, and BMI≥25 were significantly associated with reduced shoulder ROM at 12+ months. At 12+ months, only 10 % of the patients experienced ROM impairments while rates of self-reported symptoms in the affected upper extremity at 12+ months were as follows: pain-49%, weakness-47.1%, numbness-55.9%, feeling tired-42.5%. The majority of patients used the affected upper extremity for reaching without limitation, but ≥35% reported limitation with household chores, carrying and lifting. Difficulty carrying and lifting could be predicted by BMI≥25 and use of the dominant affected upper limb. Different factors are associated with early versus later ROM loss. Symptoms reported by breast cancer survivors are frequently associated with functional limitations in upper extremity tasks and warrant intervention. Physical therapy using a prospective surveillance model of care may reduce severity of ROM loss, symptoms and functional upper extremity limitations 1 year after breast cancer surgery.

Biceps Brachii Long Head Overactivity Associated with Elbow Flexion Contracture in Brachial Plexus Birth Palsy

The etiology of elbow flexion contracture in children with brachial plexus birth palsy remains unclear. We hypothesized that the long head of the biceps brachii muscle assists with shoulder stabilization in children with brachial plexus birth palsy and that overactivity of the long head during elbow and shoulder activity is associated with an elbow flexion contracture. Twenty-one patients with brachial plexus birth palsy-associated elbow flexion contracture underwent testing with surface electromyography. Twelve patients underwent repeat testing with fine-wire electromyography. Surface electrodes were placed on the muscle belly, and fine-wire electrodes were inserted bilaterally into the long and short heads of the biceps brachii. Patients were asked to perform four upper extremity tasks: elbow flexion-extension, hand to head, high reach, and overhead ball throw. The mean duration of muscle activity in the affected limb was compared with that in the contralateral, unaffected limb, which was used as a control. Three-dimensional motion analysis, surface dynamometry, and validated function measures were used to evaluate upper extremity kinematics, elbow flexor-extensor muscle imbalance, and function. The mean activity duration of the long head of the biceps brachii muscle was significantly higher in the affected limb as compared with the contralateral, unaffected limb during hand-to-head tasks (p = 0.02) and high-reach tasks (p = 0.03). No significant differences in mean activity duration were observed for the short head of the biceps brachii muscle between the affected and unaffected limbs. Isometric strength of elbow flexion was not significantly higher than that of elbow extension in the affected limb (p = 0.11). Overactivity of the long head of the biceps brachii muscle is associated with and may contribute to the development of elbow flexion contracture in children with brachial plexus birth palsy. Elbow flexion contracture may not be associated with an elbow flexor-extensor muscle imbalance, as previously hypothesized. The negative impact of elbow flexion contracture on upper extremity function warrants future research in the development of preventive and therapeutic techniques to address elbow flexion contractures in children with brachial plexus birth palsy.

Experimentally induced pain alters the EMG activity of the lumbar multifidus in asymptomatic subjects

Lumbar musculature plays an important role in stabilization during functional movements such as walking, bending and overhead activities. Current research has focused on the lumbar multifidus (LM) muscle to determine if altered activity of the LM may contribute to low back pain (LBP). Therefore, the purpose of this study was to determine whether experimentally induced LBP affects deep LM muscle activity during functionally oriented tasks, weight shifting and upper extremity lifting. Intramuscular electromyography (EMG) activity of the LM at L4 was measured in 17 healthy adults during a dominant side shoulder flexion and extension task and during a staggered-stance weight shift task. Data were collected at baseline, after pain was induced with hypertonic saline and after the pain had subsided. Comparisons of within-subjects effects were performed with the use of a two-way repeated-measure ANOVA. A significantly higher magnitude of activity was found in the induced pain condition as compared to the baseline condition for the shoulder extension phase of the upper extremity task (p = 0.04). During forward weight shifting, lower values in both the induced pain (p = 0.02) and the recovery conditions (p = 0.01) were measured. During backward weight shifting, lower values were measured during the recovery condition as compared to baseline (p = 0.03). Across trials and subjects the EMG amplitudes were increased during the extension phase of the upper extremity task and decreased during the weight shifting task. These results suggest that the LM does not respond to induced pain in the same manner during different phases of functionally oriented tasks.

Abnormalities and Cue Dependence of Rhythmical Upper-Limb Movements in Parkinson Patients With Freezing of Gait

Background. Freezing of gait (FOG) is a significant clinical problem in Parkinson disease (PD). Similar freezing-like episodes occur during finger movements, but little is known about ongoing motor problems during repetitive hand movements. Objective. To investigate if the regulation of bimanual movements is impaired in those with FOG and if withdrawal of an auditory cue amplifies this problem. Methods. A total of 23 PD patients (11 with and 12 without FOG) and 11 controls (CTRLs) performed repetitive finger movements, either externally paced or following cue withdrawal. Movement frequency, amplitude, and coordination pattern were manipulated. The stability and accuracy of movement were evaluated after exclusion of freezing trials. Results. With auditory pacing present, movement performance was comparable between groups. Following cue withdrawal, motor control deteriorated in those with FOG, resulting in smaller and less stable amplitudes, hastened and more variable frequency, and decreased coordination stability. Conversely, the performance of those without FOG remained mostly similar to that of CTRLs. Conclusions. Compared with those without FOG, those with FOG show greater continuous dyscontrol of bimanual movements, similar to the continuous timing and scaling difficulties during locomotion. Those with FOG also benefit from auditory cueing during upper-limb movements, but these are highly cue dependent. This implies that internal timekeeping functions are more disturbed in those with FOG, who may require rehabilitation strategies for repetitive upper-extremity tasks that include cueing and imagery.

Rehabilitation and Parkinson’s Disease

Rehabilitation and Parkinson’s Disease

Person-Specific Changes in Motor Performance Accompany Upper Extremity Functional Gains After Stroke

In animal models, hundreds of repetitions of upper extremity (UE) task practice promote neural adaptation and functional gain. Recently, we demonstrated improved UE function following a similar intervention for people after stroke. In this secondary analysis, computerized measures of UE task performance were used to identify movement parameters that changed as function improved. Ten people with chronic poststroke hemiparesis participated in high-repetition UE task-specific training 3 times per week for 6 weeks. Before and after training, we assessed UE function with the Action Research Arm Test (ARAT), and evaluated motor performance using computerized motion capture during a reach-grasp-transport-release task. Movement parameters included the duration of each movement phase, trunk excursion, peak aperture, aperture path ratio, and peak grip force. Group results showed an improvement in ARAT scores (p = .003). Although each individual changed significantly on at least one movement parameter, across the group there were no changes in any movement parameter that reached or approached significance. Changes on the ARAT were not closely related to changes in movement parameters. Since aspects of motor performance that contribute to functional change vary across individuals, an individualized approach to upper extremity motion analysis appears warranted.

Sex-Specific Strategies in Spinal Reflex Modulation during a Secondary Task

Attenuation of lower extremity (soleus) spinal reflexes has been documented during upper extremity motor tasks such as arm cycling. It is unknown whether similar neural coupling occurs in soleus spinal reflexes during an upper extremity task involving mental concentration and only minimal movement. PURPOSE: To assess soleus H reflex excitability in males and females during an attention-consuming secondary task. METHODS: Soleus H reflex recruitment curves were obtained from 13 male (25.6 ± 4.6 yrs; BMI 24.9 ± 3.8 kg/m2) and 16 female (25.1 ± 3.4 yrs; BMI 23.8 ± 2.4 kg/m2) volunteers. A stimulating electrode and dispersal pad were affixed to the participant's dominant leg over the tibial nerve and proximal to the patella, respectively. Disposable surface EMG (Ag/AgCl) electrodes recorded soleus peak-to-peak H reflex amplitude. With the participant positioned in a reclining chair fitted with a foot rest, soleus H reflexes were elicited at gradually increasing stimulus intensities, from H reflex threshold to maximal H reflex (H-max). Next, a similar recruitment curve was obtained while the participant typed a predetermined sequence of 3-letter nonsense words on a laptop computer. The dependent variables were H-max and the slope of the linear ascending portion (H-slope) of the recruitment curve, as determined using least squares regression. H-max and H-slope were analyzed using separate 2[testing position] × 2[sex] ANOVA. RESULTS: H-max was reduced in both males and females during the secondary task (control: 8.3 ± 2.7, typing 7.5 ± 2.8; p<.001). For H-slope, males and females demonstrated different responses. Males showed a significant reduction in H slope (control: 6.14 ± 1.7, typing 4.86 ± 2.0; p=.018) while females demonstrated a significant increase in H slope (control: 5.95 ± 1.8; typing 6.20 ± 3.0; p=.024). CONCLUSION: Soleus H-max is attenuated by an attention-consuming task in both sexes. H-slope was attenuated in males, but facilitated in females, suggesting potential sex differences in lower-extremity reflex modulation when attention is diverted to a secondary task.

Learning in a Virtual Environment Using Haptic Systems for Movement Re-Education: Can This Medium Be Used for Remodeling other Behaviors and Actions?

Robotic systems that are interfaced with virtual reality gaming and task simulations are increasingly being developed to provide repetitive intensive practice to promote increased compliance and facilitate better outcomes in rehabilitation post-stroke. A major development in the use of virtual environments (VEs) has been to incorporate tactile information and interaction forces into what was previously an essentially visual experience. Robots of varying complexity are being interfaced with more traditional virtual presentations to provide haptic feedback that enriches the sensory experience and adds physical task parameters. This provides forces that produce biomechanical and neuromuscular interactions with the VE that approximate real-world movement more accurately than visual-only VEs, simulating the weight and force found in upper extremity tasks. The purpose of this article is to present an overview of several systems that are commercially available for ambulation training and for training movement of the upper extremity. We will also report on the system that we have developed (NJIT-RAVR system) that incorporates motivating and challenging haptic feedback effects into VE simulations to facilitate motor recovery of the upper extremity post-stroke. The NJIT-RAVR system trains both the upper arm and the hand. The robotic arm acts as an interface between the participants and the VEs, enabling multiplanar movements against gravity in a three-dimensional workspace. The ultimate question is whether this medium can provide a motivating, challenging, gaming experience with dramatically decreased physical difficulty levels, which would allow for participation by an obese person and facilitate greater adherence to exercise regimes.

Strengthening and Optimal Movements for Painful Shoulders (STOMPS) in Chronic Spinal Cord Injury: A Randomized Controlled Trial

Shoulder pain is a common problem after spinal cord injury (SCI), with negative effects on daily activities and quality of life (QOL). The purpose of this study was to determine the effect of an exercise program and instruction to optimize performance of upper-extremity tasks on shoulder pain in people with paraplegia from SCI. Design Eighty individuals with paraplegia from SCI and shoulder pain were randomly assigned to receive either an exercise/movement optimization intervention or an attention control intervention. The exercise/movement optimization intervention consisted of a 12-week home-based program of shoulder strengthening and stretching exercises, along with recommendations on how to optimize the movement technique of transfers, raises, and wheelchair propulsion. The attention control group viewed a 1-hour educational video. Outcome measures of shoulder pain, muscle strength (force-generating capacity), activity, and QOL were assessed at baseline, immediately after intervention, and 4 weeks later. Shoulder pain, as measured with the Wheelchair User's Shoulder Pain Index, decreased to one third of baseline levels after the intervention in the exercise/movement optimization group, but remained unchanged in the attention control group. Shoulder torques, most 36-Item Short-Form Health Survey questionnaire (SF-36) subscale scores, and QOL scores also were improved in the exercise/movement optimization group, but not in the attention control group. Improvements were maintained at the 4-week follow-up assessment. Limitations Many of the outcome measures were self-reported, and the participant dropout rate was high in both groups. Additional studies are needed to determine whether the results of this study can be generalized to individuals with tetraplegia. This home-based intervention was effective in reducing long-standing shoulder pain in people with SCI. The reduction in pain was associated with improvements in muscle strength and health-related and overall QOL.

Vestibular Rehabilitation Therapy: Review of Indications, Mechanisms, and Key Exercises

Vestibular rehabilitation therapy (VRT) is an exercise-based treatment program designed to promote vestibular adaptation and substitution. The goals of VRT are 1) to enhance gaze stability, 2) to enhance postural stability, 3) to improve vertigo, and 4) to improve activities of daily living. VRT facilitates vestibular recovery mechanisms: vestibular adaptation, substitution by the other eye-movement systems, substitution by vision, somatosensory cues, other postural strategies, and habituation. The key exercises for VRT are head-eye movements with various body postures and activities, and maintaining balance with a reduced support base with various orientations of the head and trunk, while performing various upper-extremity tasks, repeating the movements provoking vertigo, and exposing patients gradually to various sensory and motor environments. VRT is indicated for any stable but poorly compensated vestibular lesion, regardless of the patient's age, the cause, and symptom duration and intensity. Vestibular suppressants, visual and somatosensory deprivation, immobilization, old age, concurrent central lesions, and long recovery from symptoms, but there is no difference in the final outcome. As long as exercises are performed several times every day, even brief periods of exercise are sufficient to facilitate vestibular recovery. Here the authors review the mechanisms and the key exercises for each of the VRT goals.

Effects of Sensory Cueing on Voluntary Arm Use for Patients With Chronic Stroke: A Preliminary Study

Fong KN, Lo PC, Yu YS, Cheuk CK, Tsang TH, Po AS, Chan CC. Effects of sensory cueing on voluntary arm use for patients with chronic stroke: a preliminary study. Objective To investigate the effect of a 2-week program of sensory cueing in which vibration induces the use of the paretic upper extremity in participants with chronic stroke in the community. Design A single-group longitudinal study. Setting Self-help organizations. Participants A convenience sample of 16 community residents (N=16) with chronic unilateral stroke and mild to moderate upper-extremity impairment stratified by the severity of their paretic arm function, measured by using the Functional Test for the Hemiplegic Upper Extremity (FTHUE). Interventions Participants engaged in repetitive upper-extremity task practice for 2 weeks while wearing an ambulatory sensory cueing device on their affected hand for 3 hours a day. Main Outcome Measures Evaluations were conducted on the 3 occasions of pretest (1 day before training), posttest (immediately after training), and follow-up test (2 weeks after training) by using the following behavioral measures of paretic upper-extremity performance: the Action Research Arm Test (ARAT), the Box and Block Test, the Fugl-Meyer Assessment (FMA), the FTHUE, power and pinch grips, the Motor Activity Log assessment of arm use, and kinematic data obtained from the device. Results Significant differences were found in ARAT and FMA scores among the pretest, posttest, and follow-up evaluations. The lower functioning group achieved a more significant increase in overall upper-extremity score than in the hand score for the FMA. Conclusion A combination of sensory cueing and movement-based strategies is useful and feasible in improving paretic upper-extremity performance in participants with chronic stroke; however, additional studies with a larger sample size and longer treatment period in a randomized controlled trial would be beneficial.

Poster 163: Robotically Facilitated Upper-Extremity Task Practice in Complex Virtual Environments for Children With Cerebral Palsy

Poster 163: Robotically Facilitated Upper-Extremity Task Practice in Complex Virtual Environments for Children With Cerebral Palsy

Interfacing a haptic robotic system with complex virtual environments to treat impaired upper extremity motor function in children with cerebral palsy

Objective: To investigate the ability of the New Jersey Institute of Technology Robot Assisted Virtual Rehabilitation (NJIT-RAVR) system training to elicit changes in upper extremity (UE) function in children with hemiplegia secondary to cerebral palsy.Methods: Nine children (mean age 9 years, three males) participated in three pilots. Subjects trained 1 hour, 3 days a week for 3 weeks. Two groups performed this protocol as their only intervention. The third group also performed 5–6 hours of constraint-induced movement therapy.Results: All subjects participated in a short programme of nine, 60-minute training sessions without adverse effects. As a group, subjects demonstrated statistically significant improvements in Melbourne Assessment of Unilateral Upper Limb Function Test, a composite of three timed UE tasks and several measurements of reaching kinematics. Several subjects demonstrated clinically significant improvements in active shoulder abduction and flexion as well as forearm supination.Conclusion: Three small pilots of NJIT-RAVR training demonstrated measurable benefit with no complications, warranting further examination.

비대칭적 입식자세에서 상지 조립 작업 시 체간 및 둔부 근육의 좌우 근활성도 비교

The purpose of this study was to compare the electromyographic(EMG) activities of trunk and hip muscles between right and left sides while subjects performed prolonged manual task in asymmetric and symmetric weight-bearing posture. Fifteen healthy male college students were recruited for this study. The subjects were asked to perform bimanual upper extremity task for 6 minutes in two different standing postures. In the symmetric weight-bearing posture, the subjects were standing with evenly distributed body weights to both legs. In the asymmetric weight-bearing posture, the subjects distributed about 90% of their body weight onto their preferred(supporting) leg and 10% of their body weight onto the opposite leg while they were standing. EMG activities of the right and left internal oblique, erector spinae, gluteus maximus, and gluteus medius were measured and normalized as % MVIC. Then the EMG data were statistically analyzed using paired t-tests. The EMG activities of all measured muscles were not significantly different between the right and left side in the symmetrical weight-bearing posture(p>0.05). However, the EMG of the supporting side internal oblique was significantly lower than the opposite side(p<0.05), and the EMG of the erector spinae, gluteus maximus, and gluteus medius were significantly greater on the supporting side(p<0.05). The results of this study support that unbalanced use of right and left muscle possibly causes the changes in muscle length which results in asymmetry of trunk and hip muscles. Furthermore, the uneven weight support onto right and left legs will cause a distortion of viscoelastic ligaments around hip and sacroiliac joints in the long run. Further studies to determine the effect of various manual tasks on the trunk and hip muscles as well as the effect of asymmetrical weight-bearing standing posture on hip and back muscle fatigue may be required.

Mental Practice for Relearning Locomotor Skills

Over the past 2 decades, much work has been carried out on the use of mental practice through motor imagery for optimizing the retraining of motor function in people with physical disabilities. Although much of the clinical work with mental practice has focused on the retraining of upper-extremity tasks, this article reviews the evidence supporting the potential of motor imagery for retraining gait and tasks involving coordinated lower-limb and body movements. First, motor imagery and mental practice are defined, and evidence from physiological and behavioral studies in healthy individuals supporting the capacity to imagine walking activities through motor imagery is examined. Then the effects of stroke, spinal cord injury, lower-limb amputation, and immobilization on motor imagery ability are discussed. Evidence of brain reorganization in healthy individuals following motor imagery training of dancing and of a foot movement sequence is reviewed, and the effects of mental practice on gait and other tasks involving coordinated lower-limb and body movements in people with stroke and in people with Parkinson disease are examined. Lastly, questions pertaining to clinical assessment of motor imagery ability and training strategies are discussed.

Muscle fatigue does not lead to increased instability of upper extremity repetitive movements

Muscle fatigue alters neuromuscular responses. This may lead to increased sensitivity to perturbations and possibly to subsequent injury risk. We studied the effects of muscle fatigue on movement stability during a repetitive upper extremity task. Twenty healthy young subjects performed a repetitive work task, similar to sawing, synchronized with a metronome before and after performing each of two fatiguing tasks. The first fatigue task (LIFT) primarily fatigued the shoulder flexor muscles, while the second fatigue task (SAW) fatigued all of the muscles of the arm. Subjects performed each task in random order on two different days at least seven days apart. Instantaneous mean EMG frequencies (IMNF) decreased over both fatiguing tasks indicating that subjects did experience significant muscle fatigue. The slopes of the IMNF over time and the decreases in maximum force measurements demonstrated that the LIFT fatigue task successfully fatigued the shoulder flexors to a greater extent than any other muscle. On average, subjects exhibited more locally stable shoulder movements after the LIFT fatigue task ( p=0.035). They also exhibited more orbitally stable shoulder ( p=0.021) and elbow ( p=0.013) movements after the SAW fatigue task. Subjects also had decreased cocontraction at the wrist post-fatigue for both tasks ( p=0.001) and at the shoulder ( p<0.001) for the LIFT fatigue task. Therefore, increased dynamic stability of these repeated movements cannot be explained by increased muscle cocontraction. Possible alternative mechanisms are discussed.

Pain, Functional Limitations, and Aging

To examine the relationship between functional limitations and pain across a spectrum of age, ranging from mid life to advanced old age. Cross-sectional study. The 2004 Health and Retirement Study (HRS), a nationally representative study of community-living persons aged 50 and older. Eighteen thousand five hundred thirty-one participants in the 2004 HRS. Participants who reported that they were often troubled by pain that was moderate or severe most of the time were defined as having significant pain. For each of four functional domains, subjects were classified according to their degree of functional limitation: mobility (able to jog 1 mile, able to walk several blocks, able to walk one block, unable to walk one block), stair climbing (able to climb several flights, able to climb one flight, not able to climb a flight), upper extremity tasks (able to do 3, 2, 1, or 0), and activity of daily living (ADL) function (able to do without difficulty, had difficulty but able to do without help, need help). Twenty-four percent of participants had significant pain. Across all four domains, participants with pain had much higher rates of functional limitations than subjects without pain. Participants with pain were similar in terms of their degree of functional limitation to participants 2 to 3 decades older. For example, for mobility, of subjects aged 50 to 59 without pain, 37% were able to jog 1 mile, 91% were able to walk several blocks, and 96% were able to walk one block without difficulty. In contrast, of subjects aged 50 to 59 with pain, 9% were able to jog 1 mile, 50% were able to walk several blocks, and 69% were able to walk one block without difficulty. Subjects aged 50 to 59 with pain were similar in terms of mobility limitations to subjects aged 80 to 89 without pain, of whom 4% were able to jog 1 mile, 55% were able to walk several blocks, and 72% were able to walk one block without difficulty. After adjustment for demographic characteristics, socioeconomic status, comorbid conditions, depression, obesity, and health habits, across all four measures, participants with significant pain were at much higher risk for having functional limitations (adjusted odds ratio (AOR)=2.85, 95% confidence interval (CI)=2.20-3.69, for mobility; AOR=2.84, 95% CI=2.48-3.26, for stair climbing; AOR=3.96, 95% CI=3.43-4.58, for upper extremity tasks; and AOR=4.33; 95% CI=3.71-5.06, for ADL function). Subjects with pain develop the functional limitations classically associated with aging at much earlier ages.

Can the Wolf Motor Function Test be Streamlined?

Background. To assess upper extremity (UE) capabilities following stroke, the Wolf Motor Function Test (WMFT) measures time to complete 15 UE tasks and 2 strength tasks, but takes 30 to 45 minutes for the clinician to complete. Objective. In an effort to streamline the WMFT, this study evaluated the association between the magnitude of improvement on any timed task of the WMFT and the change score on all other tasks among participants in the Extremity Constraint Induced Therapy Evaluation (EXCITE) trial. Methods. This association was evaluated using regression methods according to chronicity and controlling for key covariates (functional level, gender, concordance) for log mean WMFT scores. Results. After controlling for covariates, 6 tasks (hand to table [front], hand to box [front], reach and retrieve, lift can, lift pencil, and fold towel) influenced the overall WMFT score for survivors meeting EXCITE criteria and treated within 3 to 9 months poststroke. Six different tasks (extend elbow weight, hand to box [front], lift can, lift pencil, turn key in lock, and fold towel) influenced the overall WMFT score for those receiving constraint-induced movement therapy (CIMT) 1 year later. The importance of certain tasks relative to others may best represent overall UE function, but this streamlining enables the clinician to prioritize these tasks in the evaluation. Conclusions. The delineation of those tasks depends on the time poststroke from enrollment to CIMT. This study demonstrates that the WMFT can be streamlined from 17 to 6 tasks.

Facilitating skilled right hand motor function in older subjects by anodal polarization over the left primary motor cortex

Healthy ageing is accompanied by limitations in performance of activities of daily living and personal independence. Recent reports demonstrated improvements in motor function induced by noninvasive anodal direct current stimulation (tDCS) of the primary motor cortex (M1) in young healthy adults. Here we tested the hypothesis that a single session of anodal tDCS over left M1 could facilitate performance of right upper extremity tasks required for activities of daily living (Jebsen-Taylor hand function test, JTT) in older subjects relative to Sham in a double-blind cross-over study design. We found (a) significant improvement in JTT function with tDCS relative to Sham that outlasted the stimulation period by at least 30 min, (b) that the older the subjects the more prominent this improvement appeared and (c) that consistent with previous results in younger subjects, these effects were not accompanied by any overt undesired side effect. We conclude that anodal tDCS applied over M1 can facilitate performance of skilled hand functions required for activities of daily living in older subjects.

Serum and Tissue Cytokines and Chemokines Increase with Repetitive Upper Extremity Tasks

Serum and Tissue Cytokines and Chemokines Increase with Repetitive Upper Extremity Tasks