Upper-limb Activity Research Articles

Effects and Adherence of Mirror Therapy in People with Chronic Upper Limb Hemiparesis: A Preliminary Study

Mirror therapy is a promising therapy with some benefit for motor recovery in people with chronic hemiparesis. However, there has been little investigation on the effect on upper limb sensory impairments, activity limitations, and participation restrictions. A within-subject, repeated-measures study with 12 people with chronic hemiparesis was conducted. Participants underwent a thirty minute sensorimotor mirror therapy home-based exercise program, conducted three times per week for six weeks. Compliance with the program and the effect on sensory outcomes were determined. Light touch threshold and proprioceptive error, upper limb activity limitations, and participation restrictions were measured at baseline (Week 0), immediately after (Week 6), and six weeks (Week 12) following the intervention. Compliance with the program was fair, 66% of supervised and 62% of unsupervised sessions were completed. The paretic hand performed worse compared to nonparetic hand at baseline with no difference in sensory measures demonstrated over time. Activity limitations and participation restrictions improved by Week 12 (). This sensorimotor mirror therapy home-based exercise program showed small improvements in light touch threshold and proprioception that appear to be functionally important for this group of people with chronic hemiparesis. Mirror therapy may be a useful tool for clinicians particularly for patient independent use.

The impact of upper limb resistance training intervention on the arterial stiffness among patients with type 2 diabetes mellitus

Objectives: To determine the risk benefits of moderate intensity resistance training of upper limbs in type 2 diabetes mellitus patients using augmentation index as a measure of arterial stiffness. Patients and Methods: Twenty middle aged individuals (40-60 years) with type 2 diabetes mellitus volunteered to participate. They were assigned to two groups: an upper limb training group 51.0±6.3 years old and a sedentary group 53.7±3.1 years. The upper limb group performed 12 weeks of moderate intensity resistance training (3 days/week). Results: Fasting blood glucose decreased from 135±23 to 118±23 mg/dl, total cholesterol decreased from 191±14 mg/dl to 174±11 mg/dl, serum triglyceride decreased from 168±21 mg/dl to 149±23 mg/dl (p<0.001 ), high density lipoprotein increased from 51.8±4.05 mg/dl to 56.3±4.0 mg/dl (p<0.001) and glycosylated hemoglobin decreased from 9.3±0.8% to 8.3±0.6 % (p<0.001) in upper limb resistance training group. The resting heart rate was increased from 78±6 bpm to 84±9 bpm (p<0.01) and the systolic blood pressure was increased from 122±2 mmHg to 132±35 mmHg (p<0.01) and diastolic blood pressure was increased from 81±3 mmHg to 93±6 mmHg (p<0.001) in upper limb resistance training group. Upper limb group also showed significant increase in augmentation index (1.9±2.5 to 5.2±2.4 mmHg, p<0.001) and decrease in heart rate variability (17±6 to 11.6±3.5 msec; p<0.001). Conclusion: Upper limb resistance training may lead to increase in arterial stiffness in patients with type 2 diabetes mellitus. Whereas, aerobic upper limb activity could offset the increase in stiffness caused by resistance training.

S.P.8 Validation of linear accelerations and angular velocities to estimate the efficacy of a subject when performing a quantified task in a controlled environment

Abstract The need for measures specifically designed to assess the muscle strength and activity of upper limbs of non-ambulatory patients with neuromuscular diseases is a major challenge. Aiming for a regular monitoring of the natural history of these patients, and trying to provide a powerful system for quantitative measurements, a movement Holter monitor is being developed in France at the Institute of Myology in collaboration with SYSNAV Company. The device consists of a watch equipped with sensors and specific software. The measuring principle is based on the use of Micro-Electro-Mechanical Systems inertial sensors and magnetometers operated through magneto-inertial equations. The issue lies in determining reliable variables representing the physical muscle level and in quantification of movement of non-ambulatory patients from the signals recorded by sensors: angular velocity, magnetic field and linear acceleration in 3D. In a preliminary study, we used a wired prototype to record healthy subjects performing Box and Block test. For each task, the exponential regression between the obtained task score and the activity levels as estimated by different computing of recorded linear acceleration and angular velocity indicate a strong correlation ( R 2 from 0.95 to 0.97). The results from other tests like Minnesota (score), computer typing (number of characters) and number of a standardized movement mimicking spoon elevation to mouth similarly showed strong correlation R 2 ranging from 0.88 to 0.96. These data demonstrate that variables issued from the computing of linear acceleration and angular velocities may predict the efficacy of a subject in a quantified task performed in a controlled environment. We therefore produce a wireless prototype that is now being evaluated in non-ambulatory patients at home.

S.P.10 Upper limb assessment in DMD: An exploratory study and critical review of the existing scales

Abstract In the last few years there has been increasing evidence of the lack of outcome measures in non ambulant patients affected by Duchenne muscular dystrophy. We report an exploratory study on upper limb function in 61 DMD patients using three measures previously used in DMD and an upper limb module previously developed for spinal muscular atrophy. This study, rather than being a formal suitability study, explored whether the existing scales were appropriate for DMD patients at different ages and spectrum of abilities. The Brooke scale proved to be easily and quickly administered and useful to subdivide patients into motor performance domains but comprises only few categories providing ordinal data and does not specifically assess hand function. The Jebsen Hand Function test is a standardized timed test. Most items are composite tasks that do not take into account compensatory strategies in the scoring system and are biased by testing positions and contractures. Some items proved not to be suitable due to age and IQ dependency. The MFM is a functional scale developed in NMD to assess motor performance. It includes items subdivided in functional domains and also assesses distal function. A floor and ceiling effect were observed in some items across the whole spectrum of abilities and age range. The ULM was developed for non-ambulant SMA patients and evaluates upper limb activities on all planes of workspace. When used in DMD the scoring system and weight bearing did not fully assess patients across spectrum of abilities with a ceiling effect in the stronger ones. Each measure had pros and cons and several shortcomings, related to posture, contractures and pattern of weakness requiring compensatory strategies. None of the existing scales proved to be suitable alone, this probably reflecting the fact that most of them had not been specifically designed for use in DMD. Studies are in progress to overcome some of these difficulties.

S.P.7 Validation trial of a movement Holter monitor based on accelerometry for the non-ambulatory neuromuscular patients

Abstract One of the most important and challenging issues regarding the clinical trials in non-ambulatory neuromuscular patients is the lack of a reliable and reproducible evaluation method, sensitive enough to quantitatively assess the function of the upper limbs of disabled patients. A movement Holter monitor composed of tri-axial accelerometer, gyroscope and magnetometer is being developed in France at the Institute of Myology in collaboration with SYSNAV Company. The measuring principle is based on inertial sensors. The device is sufficiently light and non-intrusive to be worn as a watch and has 18 h of autonomy. A validation trial of a wireless version of the system is ongoing in 10 non-ambulant neuromuscular patients. The upper limb function of the patients wearing the device is evaluated during a series of different filmed tasks. The evaluations take place at the Institute of Myology at the day of the inclusion and are repeated 14 days after. The system contains a second set of inertial sensors placed on the wheelchair in order to detect its movement. Between the two visits, the patients are continuously recorded in their own environment during daytime. The measurements were feasible even in a very weak 29 year-old Duchenne patient. The data permit to explore new variables representing the upper limb activity level and quantify specific movements. In a preliminary phase, the orientation of the wrist and periods of activity could be identified during a given period of time. Subsequent analyses will assess the identification, characterization and quantification of movements of the wrist taking into account the wheelchair movement. The novelty of this project resides in the possibility of a quantitative evaluation of non-ambulatory neuromuscular patients with limited abilities both in a standardized setting and in their natural environment, thanks to the high-autonomy of this wireless device and its high accuracy.

Virtual reality versus conventional treatment of reaching ability in chronic stroke: clinical feasibility study.

IntroductionThe objective of this study was to evaluate the potential of exercises performed in a 2D video-capture virtual reality (VR) training environment to improve upper limb motor ability in stroke patients compared to those performed in conventional therapy.MethodsA small sample randomized control trial, in an outpatient rehabilitation center with 12 patients with chronic stroke, aged 33–80 years, who were randomly allocated to video-capture VR therapy and conventional therapy groups. All patients participated in four clinical evaluation sessions (pre-test 1, pre-test 2, post-test, follow-up) and nine 45-minute intervention sessions over a 3-week period. Main outcomes assessed were Body Structure and Function (impairment: Fugl–Meyer Assessment [FMA]; Composite Spasticity Index [CSI]; Reaching Performance Scale for Stroke), Activity (Box and Blocks; Wolf Motor Function Test [WMFT]), and Participation (Motor Activity Log) levels of the International Classification of Functioning.ResultsImprovements occurred in both groups, but more patients in the VR group improved upper limb clinical impairment (FMA, CSI) and activity scores (WMFT) and improvements occurred earlier. Patients in the VR group also reported satisfaction with the novel treatment.ConclusionsThe modest advantage of VR over conventional training supports further investigation of the effect of video-capture VR or VR combined with conventional therapy in larger-scale randomized, more intense controlled studies.

The relative responsiveness of patient-rated outcome measures in evaluating clinical change after Dupuytren's surgery: A literature review and prospective observational pilot study

Introduction Patient-rated outcome measures (PROMs) to measure upper limb activity and participation exist but there is little evidence to support their responsiveness in Dupuytren's surgery. Methods A literature review was conducted to evaluate the relative responsiveness of PROMs used in patients treated surgically for Dupuytren's contracture. A prospective observational pilot study was performed to test feasibility and clarify procedures in advance of a larger study to compare the relative responsiveness of different PROMs. The Quick Disabilities of the Arm, Shoulder and Hand ( QuickDASH), the Patient Outcomes of Surgery-Hand/Arm (POS-Hand/Arm) and the Patient Evaluation Measure (PEM) were administered to eight patients before and 12 weeks after a fasciectomy. Results The literature review identified seven studies using PROMs before and after surgery for a Dupuytren's contracture. The PROMs were the Michigan Hand Questionnaire (MHQ), the DASH and the QuickDASH. All three had moderate-to-large effect sizes and standardized response means with the MHQ showing higher responsiveness than the DASH. In the pilot study the PEM demonstrated a higher responsiveness than the POS-Hand/Arm followed by the QuickDASH. No evidence was found to support responsiveness in terms of what is clinically relevant in relation to a patient-rated external criterion. Discussion The literature review and pilot study findings justify the need and feasibility to conduct a larger study to investigate the relative responsiveness of PROMs in patients undergoing Dupuytren's surgery.

Therapy management of the upper limb in children with cerebral palsy: A cross-sectional survey

Purpose: To establish perceived severity of upper limb (UL) impairments and their therapeutic management in children with cerebral palsy (CP).Methods: A cross-sectional questionnaire survey was mailed to all 208 paediatric physiotherapists (PTs) and occupational therapists (OTs) working in a region of the UK. Data analysis included descriptive statistics, frequency counts and chi-square tests.Results: A 74% response rate was achieved, of which 94 questionnaires were valid for analysis. Many impairments were rated as affecting the UL to a moderate or great extent. Goniometry and manual muscle testing were frequently reported for measuring UL impairment and by significantly more PTs than OTs. UL activity measures were rarely reported as being available or used by therapists. Participants frequently reported using positioning, neurodevelopmental therapy and task practice to treat UL dysfunction.Conclusions: UL management in children with CP could be enhanced by application of standardized measurement tools and evidence-based interventions.

Muscle Activity of Upper Limbs During Bimanual Driving Tasks

Muscle Activity of Upper Limbs During Bimanual Driving Tasks

Self-Management of Upper Limb Recovery after Stroke: How Effectively Do Occupational Therapists and Physiotherapists Train Clients and Carers?

Aim: A self-management approach to upper limb management following stroke has received little attention in the literature. The aim of the study was to investigate the impact of occupational therapists' and physiotherapists' standard practice on clients' and carers' self-management of upper limb recovery. Method: Fifteen clients, 7 carers, 11 occupational therapists and 7 physiotherapists were recruited. Therapists described five self-administered tasks they expected clients and carers were doing, using the Goal Attainment Scale (GAS). For each task, clients' and carers' performances were then evaluated using the GAS and their self-efficacy was rated on a 10-point Likert scale. A survey questionnaire investigated their perceptions of the training provided, with respect to a self-management approach. Results: At least a quarter of the self-administered tasks related to upper limb activity, strengthening and secondary prevention were performed below therapists' expectations. In contrast, mean self-efficacy ratings across these tasks were high (clients = 7.8–9.5, carers = 8.5–8.9). Seventy per cent of the self-management training strategies listed in the survey questionnaire were considered missing by more than 40% of carers. Conclusion: There is a need for therapy resources that enhance the content and delivery of self-management training related to upper limb management following stroke, particularly for carers.

Quantifying Nonuse in Chronic Stroke Patients: A Study Into Paretic, Nonparetic, and Bimanual Upper-Limb Use in Daily Life

Michielsen ME, Selles RW, Stam HJ, Ribbers GM, Bussmann JB. Quantifying nonuse in chronic stroke patients: a study into paretic, nonparetic, and bimanual upper-limb use in daily life. ObjectiveTo quantify uni- and bimanual upper-limb use in patients with chronic stroke in daily life compared with healthy controls. DesignCross-sectional observational study. SettingOutpatient rehabilitation center. ParticipantsPatients with chronic stroke (n=38) and healthy controls (n=18). InterventionNot applicable. Main Outcome MeasuresUpper-limb use in daily life was measured with an accelerometry-based upper-limb activity monitor, an accelerometer based measurement device. Unimanual use of the paretic and the nonparetic side and bimanual upper-limb use were measured for a period of 24 hours. Outcomes were expressed in terms of both duration and intensity. ResultsPatients used their unaffected limb much more than their affected limb (5.3h vs 2.4h), while controls used both limbs a more equal amount of time (5.4h vs 5.1h). Patients used their paretic side less than controls used their nondominant side and their nonparetic side more than controls their dominant side. The intensity with which patients used their paretic side was lower than that with which controls used their nondominant side, while that of the nonparetic side was higher than that of the dominant side of controls. Finally, patients used their paretic side almost exclusively in bimanual activities. During bimanual activities, the intensity with which they used their affected side was much lower than that of the nonaffected side. ConclusionOur data show considerable nonuse of the paretic side, both in duration and in intensity, and both during unimanual and bimanual activities in patients with chronic stroke. Patients do compensate for this with increased use of the nonparetic side.

Upper limb impairments and their impact on activity measures in children with unilateral cerebral palsy

BackgroundInsights in upper limb impairments and their relationship with activity measures in children with unilateral cerebral palsy (CP) are important to optimize treatment interventions. Aims(1) To investigate upper limb impairments and activity limitations in children with unilateral CP; (2) to compare these according to the Manual Ability Classification System (MACS), timing of lesion (congenital/acquired) and age; (3) to determine the impact of impairments on activity measures. MethodsEighty-one children with unilateral CP aged 5–15 years (mean 9 years 11 months; congenital N=69, acquired N=12) were recruited. Body function measurements included passive range of motion (PROM), muscle tone, strength and sensibility. At activity level, the Melbourne Assessment, Assisting Hand Assessment (AHA) and Abilhand-Kids were assessed. ResultsMost PROM limitations were found for elbow extension and supination. Increased tone and weakness were most prominent in distal muscles. Stereognosis and two-point discrimination were mostly affected. Children with a lower MACS level or acquired lesion had significantly more impairments and activity limitations. In children with congenital lesions, best predictors for unimanual capacity (Melbourne Assessment) were wrist strength, stereognosis and proprioception, and for bimanual performance (AHA) wrist strength and grip strength, explaining 76% of the variance. For the Abilhand-Kids, wrist strength and stereognosis predicted 46% of the variance. ConclusionsClassification according to MACS and timing of lesion is important to differentiate within the wide range of impairments and activity limitations. In children with congenital lesions, unimanual capacity and bimanual performance are highly determined by distal strength, supporting the additional use of impairment-based interventions.

Comparison of the effect of Action Observational training and Task-oriented training on Upper Limb Function and activities of daily living in People with Chronic stroke

Abstract This study aimed to compare the effectiveness of action-observational training and task-oriented training on upper limb function and activities of daily living in patients with post-stroke hemiparesis. This study included 12 voluntary participants with post-stroke hemiparesis. Subjects were randomly assigned to either group 1 or group 2, with 6 in each group. Each subject completed the crossover experiment that comprised of action-observational training (A) and task-oriented training (B). The intervention sequence was A-B for the group 1 and B-A for the group 2. Each training was performed for 30 min a day, 5 times a week for 2 weeks (total experimental period of 4 weeks). Assessments were made using the Wolf Motor Function Test (WMFT) and Modified Barthel Index (MBI) thrice: at baseline, after 2 weeks of intervention, and after 4 weeks of intervention. The results showed that the WMFT and MBI scores significantly improved after the completion of each training (p<.05). Therefore, a determination of the superior training method was difficult. The effect sizes of both groups were greater when performed the action-observational training. The findings suggest that both the action-observational training and task-oriented training may be helpful in improving the upper limb function and activities of daily living for patients with post-stroke hemiparesis, and support the clinical feasibility of the action-observational training.

Unilateral versus bilateral upper limb exercise therapy after stroke: A systematic review

To compare the effects of unilateral and bilateral training on upper limb function after stroke with regard to two key factors: severity of upper limb paresis and time of intervention post-stroke. Systematic review and meta-analysis of randomized controlled trials. Two authors independently selected trials for inclusion, assessed the methodological quality and extracted data. Study outcomes were pooled by calculating the (standardized) mean difference ((S)MD). Sensitivity analyses for severity and time of intervention post-stroke were applied when possible. All 9 studies involving 452 patients showed homogeneity. In chronic patients with a mild upper limb paresis after stroke a marginally significant SMD for upper limb activity performance (SMD 0.34; 95% confidence interval): 0.04-0.63), and marginally significant MDs for perceived upper limb activity performance (amount of use: MD 0.42; 95% confidence interval: 0.09-0.76, and quality of movement: MD 0.45; 95% confidence interval: 0.12-0.78) were found in favour of unilateral training. All other MDs and SMDs were non-significant. Unilateral and bilateral training are similarly effective. However, intervention success may depend on severity of upper limb paresis and time of intervention post-stroke.

Occurrence and Temporal Evolution of Upper Limb Spasticity in Stroke Patients Admitted to a Rehabilitation Unit

Kong KH, Lee J, Chua KS. Occurrence and temporal evolution of upper limb spasticity in stroke patients admitted to a rehabilitation unit. Objectives To document the temporal development and evolution of upper limb spasticity, and to establish clinical correlates and predictors of upper limb spasticity in a cohort of stroke patients. Design Prospective cohort study. Setting A rehabilitation unit. Participants Patients (N=163) with a first-ever ischemic stroke. Interventions Not applicable. Main Outcome Measures Ashworth Scale for measuring upper limb spasticity, Motor Assessment Scale for upper limb activity, Motricity Index for upper limb strength, and Modified Barthel Index for self-care. Upper limb spasticity was defined as an Ashworth Scale score of 1 or greater. Results Upper limb spasticity occurred in 54 patients (33%) at 3 months after stroke. Development of spasticity at later stages of the stroke was infrequent, occurring in only 28 patients (17%). In patients with mild spasticity (Ashworth Scale score 1) at 3 months after stroke, worsening of spasticity occurred in only 1 patient. On the other hand, almost half of the patients with moderate spasticity (Ashworth Scale score 2) at 3 months progressed to severe spasticity (Ashworth Scale score 3). Poor upper limb activity was the most important correlate of “moderate to severe spasticity” (Ashworth Scale score ≥2) ( P<.001), and poor upper limb strength on admission to rehabilitation, the most important predictor of “moderate to severe spasticity” ( P<.001). Conclusions Upper limb spasticity was relatively infrequent in this study, occurring in 33% of patients at 3 months after stroke. Selective monitoring to detect severe spasticity is recommended for patients with an Ashworth Scale score of 2 or greater at 3 months after stroke, and in patients with severe upper limb weakness on admission to rehabilitation.

Evaluation of upper-limb body postures based on the effects of back and shoulder flexion angles on subjective discomfort ratings, heart rates and muscle activities

A possible limitation of many ergonomics checklists that evaluate postures is an independent evaluation of each body segment without considering the coordination between body segments and resulting in the under-/over-estimation of body postures. A total of 20 men were selected to evaluate the effects of shoulder and back flexion angles on the upper-limb muscle activities, subjective discomforts and heart rates. Interesting findings were obtained from the coordination between back flexion angles and shoulder flexion angles. At a back flexion angle of 45°, the discomfort and heart rates were the least at a shoulder flexion angle of 45°. The %MVC also showed a similar trend. It could be inferred that the 0° shoulder flexion angle would be a natural posture, when the back flexion angle is 0°, whereas 45° shoulder flexion might be a more natural posture when the back flexion angle is 45°. Statement of Relevance: This study evaluated the effects of back and shoulder flexion angles on subjective as well as objective measures. The findings of this study considered the coordination between two body flexion angles and could be used to improve the accuracy of existing ergonomics evaluation methods for body postures.

Upper limb children action-observation training (UP-CAT): a randomised controlled trial in Hemiplegic Cerebral Palsy

BackgroundRehabilitation for children with hemiplegic cerebral palsy (HCP) aimed to improve function of the impaired upper limb (UL) uses a wide range of intervention programs. A new rehabilitative approach, called Action-Observation Therapy, based on the recent discovery of mirror neurons, has been used in adult stroke but not in children. The purpose of the present study is to design a randomised controlled trial (RCT) for evaluating the efficacy of Action-Observation Therapy in improving UL activity in children with HCP.Methods/DesignThe trial is designed according to CONSORT Statement. It is a randomised, evaluator-blinded, match-pair group trial. Children with HCP will be randomised within pairs to either experimental or control group. The experimental group will perform an Action-Observation Therapy, called UP-CAT (Upper Limb-Children Action-Observation Training) in which they will watch video sequences showing goal-directed actions, chosen according to children UL functional level, combined with motor training with their hemiplegic UL. The control group will perform the same tailored actions after watching computer games. A careful revision of psychometric properties of UL outcome measures for children with hemiplegia was performed. Assisting Hand Assessment was chosen as primary measure and, based on its calculation power, a sample size of 12 matched pairs was established. Moreover, Melbourne and ABILHAND-Kids were included as secondary measures. The time line of assessments will be T0 (in the week preceding the onset of the treatment), T1 and T2 (in the week after the end of the treatment and 8 weeks later, respectively). A further assessment will be performed at T3 (24 weeks after T1), to evaluate the retention of effects. In a subgroup of children enrolled in both groups functional Magnetic Resonance Imaging, exploring the mirror system and sensory-motor function, will be performed at T0, T1 and T2.DiscussionThe paper aims to describe the methodology of a RCT for evaluating the efficacy of Action-Observation Therapy in improving UL activity in children with hemiplegia. This study will be the first to test this new type of treatment in childhood. The paper presents the theoretical background, study hypotheses, outcome measures and trial methodology.Trial RegistrationNCT01016496

Randomized trial of constraint‐induced movement therapy and bimanual training on activity outcomes for children with congenital hemiplegia

To determine if constraint-induced movement therapy (CIMT) is more effective than bimanual training (BIM) in improving upper limb activity outcomes for children with congenital hemiplegia in a matched-pairs randomized trial. Sixty-three children (mean age 10.2, SD 2.7, range 5-16 y; 33 males, 30 females), 16 in Manual Ability Classification System level I, 46 level II, and 1 level III and 16 in Gross Motor Function Classification level I, 47 level II) were randomly allocated to either CIMT or BIM group day camps (60 hours over 10 days). The Melbourne Assessment of Unilateral Upper Limb Function assessed unimanual capacity of the impaired limb and Assisting Hand Assessment evaluated bimanual coordination at baseline, 3 and 26 weeks, scored by blinded raters. After concealed random allocation, there was no baseline difference between groups. CIMT had superior outcomes compared with BIM for unimanual capacity at 26 weeks (estimated mean difference [EMD] 4.4, 95% confidence interval [CI] 2.2-6.7; p < 0.001). There was no other significant difference between groups post-intervention. Both groups demonstrated significant improvements in bimanual performance at 3 weeks, with gains maintained by BIM at 26 weeks (EMD 2.3; 95% CI 0.6-4.0; p = 0.008). Interpretation Overall, there were only small differences between the two training approaches. CIMT yielded greater changes in unimanual capacity of the impaired upper limb compared with BIM. Results generally reflect specificity of practice, with CIMT improving unimanual capacity and BIM improving bimanual performance. Considerable inter-individual variation in response to either intervention was evident. Future research should consider serial sequencing unimanual then BIM approaches to optimize upper limb outcomes for children with congenital hemiplegia.

Is activity loss predictive for development of upper limb oedema after stroke?

To investigate the disuse hypothesis as an explanation for upper limb oedema in patients with stroke. Longitudinal observational study. Patients with acute hemiparetic stroke were recruited from 2006 to 2009 (n=139). Patients wore 2 uni-axial accelerometers, 1 on each wrist, for 2 periods of 48 h with a 1-week interval. Activity performed by the patients with acute stroke was measured by determining total activity, measured as a total sum of raw counts, and calculating the ratio variable. The National Institute of Health Stroke Scale (NIHSS), Fügl-Meyer Assessment and modified Rankin Scale were used. During a 3-month follow-up, patients underwent 3 assessments of upper limb oedema. The incidence of upper limb oedema range for the objective evaluation was 7.7-14.7%, while the incidence for the subjective evaluation ranged from 11.5% to 18.1%. No significant differences were found between patients with and without oedema concerning the activity variables; therefore no prognostic value could be determined. No difference in upper limb activity was found between patients with and without oedema after stroke. It is doubtful that loss of activity of the paretic limb is solely responsible for the development of upper limb oedema after stroke.

Exercise reduces impairment and improves activity in people after some upper limb fractures: a systematic review

What is the effect of exercise on reducing impairment and increasing activity in the rehabilitation of people with upper limb fractures? Systematic review of controlled trials. Adults following an upper limb fracture. Any exercise therapy program, including trials where exercise was delivered to both groups providing there was an expectation of different amounts of exercise. Body structure and function, and activity limitations. 13 relevant trials involving 781 participants with an upper limb fracture were identified. 12 of the 13 trials included exercise of different duration and administration in both intervention and comparison groups. In support of the role of exercise there is evidence that: exercise and advice compared to no intervention reduce pain and improve upper limb activity in the short term after distal radius fracture; starting exercise earlier after conservatively managed proximal humeral fractures can reduce pain and improve shoulder activity; and physiotherapy that included supervised exercise and home exercise increased wrist movement after distal radius fracture when compared to home exercise alone. There is contrary evidence from two trials one after distal radius fracture and one after proximal humeral fracture that a home exercise program was superior to a supervised plus home exercise program. Only a single meta-analysis was conducted due to clinical heterogeneity and a lack of common outcome measures among the included trials. There is evidence to support the role of specific exercise regimens in reducing impairments and improving upper limb function following specific upper limb fractures.