Upper-limb Disability Research Articles

Learning to teleoperate an upper-limb assistive humanoid robot for bimanual daily-living tasks

Objective. Bimanual humanoid platforms for home assistance are nowadays available, both as academic prototypes and commercially. Although they are usually thought of as daily helpers for non-disabled users, their ability to move around, together with their dexterity, makes them ideal assistive devices for upper-limb disabled persons, too. Indeed, teleoperating a bimanual robotic platform via muscle activation could revolutionize the way stroke survivors, amputees and patients with spinal injuries solve their daily home chores. Moreover, with respect to direct prosthetic control, teleoperation has the advantage of freeing the user from the burden of the prosthesis itself, overpassing several limitations regarding size, weight, or integration, and thus enables a much higher level of functionality. Approach. In this study, nine participants, two of whom suffer from severe upper-limb disabilities, teleoperated a humanoid assistive platform, performing complex bimanual tasks requiring high precision and bilateral arm/hand coordination, simulating home/office chores. A wearable body posture tracker was used for position control of the robotic torso and arms, while interactive machine learning applied to electromyography of the forearms helped the robot to build an increasingly accurate model of the participant’s intent over time. Main results. All participants, irrespective of their disability, were uniformly able to perform the demanded tasks. Completion times, subjective evaluation scores, as well as energy- and time- efficiency show improvement over time on short and long term. Significance. This is the first time a hybrid setup, involving myoeletric and inertial measurements, is used by disabled people to teleoperate a bimanual humanoid robot. The proposed setup, taking advantage of interactive machine learning, is simple, non-invasive, and offers a new assistive solution for disabled people in their home environment. Additionnally, it has the potential of being used in several other applications in which fine humanoid robot control is required.

Research on the Application of Machine Learning Algorithm and Fuzzy Logic in Eating Assistive Robot

More than 110 million people in this world are facing some kind of disability, for which they experience difficulty while eating food. Eating Assistive Robots could meet the needs of the elderly and people with upper limb disabilities or dysfunctions in gaining independence in eating. We are researching making a robot, which can assist the disabled in eating their meals. Our Eating Assistive Robot will detect the face of the disabled and process it for whether his/her mouth is opened or closed. Our robot will put a pre-prepared replaceable spoon of food in his/her mouth iteratively until the food lasts in the food container. The methodology we used for it i.e. firstly there is a live camera feed through which we are detecting human faces, after this, a library of Affectiva calculates how much mouth is open. We have set a certain threshold after which the program starts the stepper motor which brings the pre-filled spoon of food into the mouth of the disabled.

Exercise versus usual care after non-reconstructive breast cancer surgery (UK PROSPER): multicentre randomised controlled trial and economic evaluation

ObjectiveTo evaluate whether a structured exercise programme improved functional and health related quality of life outcomes compared with usual care for women at high risk of upper limb disability after...

Effect of Robot-assisted Rehabilitation to Botulinum Toxin A Injection for Upper Limb Disability in Patients with Chronic Stroke: A Case Series and Systematic Review.

Combining single-joint hybrid assistive limb (HAL-SJ) with botulinum toxin A (BTX-A) therapy is novel and has great therapeutic potential for the rehabilitation of stroke patients with upper limb paralysis. The purpose of this observational case series study was to evaluate the effect of BTX-A and HAL-SJ combination therapy on different exoskeleton robots used for treating upper limb paralysis. The HAL-SJ combination received a BTX-A injection followed by HAL-SJ-assisted rehabilitation for 60 min per session, 10 times per week, during 2 weeks of hospitalization. Clinical evaluations to assess motor function, limb functions used during daily activities, and spasticity were performed prior to injection, at 2-week post-treatment intervention, and at the 4-month follow-up visit. The total Fugl-Meyer assessment-upper limb (FMA-UE), proximal FMA-UE, action research arm test (ARAT), Motor Activity Log (MAL), and Disability Assessment Scale (DAS) showed a statistically significant difference, and a large effect size. However, the FMA distal assessment at 2-week post-treatment intervention showed no significant difference and a moderate effect size. The FMA-UE scores of the extracted systematic review articles showed that our design improved upper limb function. The change in the total FMA-UE score in this study showed that, compared to previous reports in the exoskeletal robotic therapy group, our combination therapy had a higher score than five of the seven references. Our results suggest that BTX-A therapy and HAL-SJ combination therapy may improve upper limb function, similar to other treatment methods in the literature.

Web Axillary Pain Syndrome-Literature Evidence and Novel Rehabilitative Suggestions: A Narrative Review.

Axillary web syndrome (AWS) is defined as a visible and palpable network of cords in the skin of the axillary cavity that are tensed by shoulder abduction following surgery for breast cancer, causing significant functional limits of the ipsilateral upper limb (UL) and pain. The purpose of this narrative review is to discuss rehabilitation approaches for greater efficacy with respect to pain and novel suggestions. AWS is a frequent complication of axillary lymphadenectomy that necessitates a thorough follow-up in the medium to long term. Physiotherapy is effective in the treatment of functional limb deficits, the management of pain, and the treatment of upper limb disability. The best management approach involves the use of soft tissue techniques to slow the natural course of the syndrome, in association with therapeutic exercises for functional recovery and muscle strengthening. AWS is linked secondary lymphedema, requiring integration with manual lymphatic drainage. The physiotherapy management of AWS is currently fragmented, and insufficient information is available on the nature of the disease. Thus, randomized and controlled studies that compare rehabilitation approaches in AWS are desirable, including the possibility of using mesotherapy in the treatment of axillary and upper limb pain.

Correlation between Heavy School Bags and Upper Limb Disabilities among School Going Children

Aim: To find out correlation between heavy school bags and upper limb disabilities among school going children. Methods: This descriptive cross-sectional survey, using non-probability convenience sampling, was conducted on 396 students of 11 to 15 years after ethical approval in 6 months. Height (in cm) and weight (in Kg) were noted and BMI was calculated. Students with the normal BMI were included in the study. Weigh of the students were recorded with their shoes off while the weight of the bags was calculated with all the stationary included. Quick DASH scale score was calculated and correlated with the weight of the bag by applying Chi-Square test. Results: The mean age of the participants was13.49±1.12 years. The mean weight of the school bag was 6.10±2.1Kgs while the students were carrying more than one-quarter of their body weight. The disability calculated from the quick DASH scale was as high as 40%. Chi-square showed a significant correlation between the upper limb disabilities and the weight of the bag. Conclusion: The study showed that there is a significant correlation that the use of heavy school bags can cause upper limb disabilities in children. Keywords: Heavy School Bags, Upper Limb Disabilities, Children, Disabilities of Arm Shoulder and Hand

What are the Elements of Upper Limb Motor Therapy That May Impact Changes in Neuroimaging Biomarkers After Stroke? A Systematic Review

<h3>Objective(s)</h3> To investigate the relationship between the elements of upper limb motor therapy, neuroimaging biomarkers and clinical outcomes. <h3>Data Sources</h3> A systematic search of Cochrane Register of Controlled Trials (CENTRAL), EMBASE and Medline was conducted. <h3>Study Selection</h3> Studies with adult stroke survivors who underwent motor interventions aimed at improving motor function of the upper limb post-stroke were eligible. Included studies indexed change in brain structure or function in addition to motor impairment or activity limitation prior to, and post intervention. <h3>Data Extraction</h3> Quality of each study was assessed using Cochrane Risk-of-Bias Tool (RoB 2) or Risk of Bias in Non-Randomized Studies - of Interventions (ROBINS-I). Intervention reporting was assessed using Template for Intervention Description and Replication (TIDieR) Checklist. Demographic, neuroimaging biomarker and clinical outcome data were extracted. Intervention details were extracted including active ingredients such as type, dose, and difficulty. <h3>Data Synthesis</h3> 3681 records were screened, and 175 full texts were evaluated. Fifty-four studies comprising 88 intervention groups (n=1545 participants) were included. Functional Magnetic Resonance Imaging (fMRI) (48%) and Transcranial Magnetic Stimulation (TMS) (7%) were the most common neuroimaging biomarkers used. Improvement was seen in 43 intervention groups on their neuroimaging biomarkers. 23 groups achieved a MCID on impairment outcomes and 37 groups achieved a MCID on activity outcomes. Only 7 groups demonstrated improvement in both their neuroimaging biomarker, and both impairment and activity outcomes. No consistent combination of elements led to improvements on both neuroimaging biomarkers and motor outcomes. <h3>Conclusions</h3> There is no single element of therapy that drives change neuroimaging biomarkers and clinical outcomes. Deeper investigation is needed into the most effective combinations of elements for specific cohorts with upper limb disability after stroke. <h3>Author(s) Disclosures</h3> No disclosures

Impacts of a Robotic Arm on People with Upper-Limb Disabilities Due to Neuromuscular Disorder

ABSTRACT Introduction Research is still limited on the impacts of robotic arms in improving independent living and social participation of individuals with upper-limb disabilities, and several knowledge gaps remain. This study aims to investigate the impacts of the JACO robotic arm on individuals with upper-limb impairments due to a neuromuscular disease. Methods For this prospective study, participants used the robotic arm in their daily life for a 2-month period. The effectiveness of the robotic arm was objectively observed during activities performed in a controlled environment. The perception of the users and of their main family caregivers was also documented. Finally, the nature and importance of activities carried out with the robotic arm in a community-living environment were explored. Results Participants' abilities with the JACO robotic arm improved continuously during the trial duration. Participants actively took part in more life habits, perceived fewer difficulties, and were more satisfied with their social participation. Despite these findings, very few life habits could be performed completely independently, limiting the impacts on global caregivers' burden. Conclusions Even if participants encountered some difficulties, this study demonstrates short-term benefits of the robotic arm for individuals with upper-limb impairments due to a neuromuscular disorder. Future studies should mainly focus on the psychosocial, economic, and occupational long-term impacts of the robotic arm. The development of services to assist the integration of such devices in people's lives could optimize their impacts. Clinical Relevance The results of this study contribute to the body of knowledge of clinicians for the prescription of a robotic arm.

SaeboGlove therapy for upper limb disability and severe hand impairment after stroke (SUSHI): Study protocol for a randomised controlled trial.

BackgroundImpaired active digital extension is common after stroke, hindering functional rehabilitation, and predicting poor recovery. The SaeboGlove assists digital extension and may improve outcome after stroke. We recently performed a single group, open, pilot trial of the SaeboGlove early after stroke which demonstrated satisfactory safety, feasibility and acceptability. An adequately powered randomised clinical trial is now needed to assess the clinical effectiveness of the SaeboGlove.MethodsSUSHI is a pragmatic, multicentre, parallel-group, randomised controlled trial with blinded outcome assessment, and embedded process and economic evaluations. Adults, 7–60 days post-stroke, with upper limb disability and severe hand impairment, including reduced active digital extension, will be recruited from NHS inpatient stroke services in Scotland. Participants will be randomised on a 1:1 basis to receive 6 weeks of self-directed, repetitive, functional-based practice involving a SaeboGlove plus usual care, or usual care only. The primary outcome is upper limb function measured by the Action Research Arm Test (ARAT) at 6 weeks. Secondary outcomes will be measured at 6 and 14 weeks. A process evaluation will be performed via interviews with ‘intervention’ participants, and their carers and clinical therapists. A within-trial cost-effectiveness analysis will be performed. 110 participants are required to detect a difference between groups of 9 in the ARAT with 90% power at a 5% significance level allowing for 11% attrition.DiscussionSUSHI will determine if SaeboGlove self-directed, repetitive, functional-based practice improves upper limb function after stroke, whether it is acceptable to stroke survivors and whether it is cost-effective.

Motor Control Evaluation as a Significant Component in Upper Limb Function Assessment in Female Breast Cancer Patients after Mastectomy.

Breast cancer is the most prevalent malignancy among women. Conservative and operative treatment methods are associated with a risk of side effects pertaining to the shoulder complex. The surgery complications including chronic pain, upper limb and chest lymphedema, range of motion limitations, and motor control deficiencies may lead to upper limb function impairment and affect the quality of life negatively. Twenty-three women were examined in the tested group and twenty-two women in the control group. The motor control was assessed with dissociation tests as defined by Comerford and Mottram. In order to assess patient-perceived upper limb disability, the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was used. The test of glenohumeral (GH) abduction control in frontal plane and in scapular plane and medial rotation control outcomes were found to be statistically significant. It pertains to both: Comparison between groups and analysis within the tested group—body sides comparison. The DASH questionnaire results analysis indicates that there was a higher degree of subjectively perceived disability of upper limb in the tested group. Surgical interventions in the breast cancer treatment and other medical procedures affect the level of motor control and perceived disability of upper limb negatively in this group of patients. Movement faults are statistically more prevalent in the tested group. Movement faults are more prevalent on the operated side in the tested group.

Effectiveness of Mirror Therapy on the Motor Ability of Post Stroke Patients: Systematic Review

Th e incidence of stroke is increased, and more than 50% of stroke patients suffer from upper limb disability, and 87% of motor damage to the upper limb occurs in the acute stage. About 30-60% of stroke patients never regain the motor function of the hands affected by a stroke, which can cause post-stroke patients difficulty in daily living activities. The purpose of this study is to systematically review research on the effectiveness of Mirror Therapy as a motor rehabilitation intervention in improving motor skills in post-stroke patients. A search strategy was applied to the Proquest and Science Direct database. The search results are then selected using inclusion and exclusion criteria. Only studies using quantitative methods were chosen of 155 articles found, 30 articles met the inclusion criteria. Most studies were reviewed using an experimental design of 9 articles from 9 studies examined to prove that Mirror Therapy can improve motor function, especially upper extremity. In enhancing further research, it is necessary to determine the optimal training intensity and duration of improvement to survive and generalize to other functional domains. It also needs to pay attention to the number and homogeneity of the subject (age, sex, level of disability, and the onset of stroke) so as not to bias the research results. Keywords : , motor ability , mirror therapy , post-stroke

Interrater and intrarater reliability of the single arm military press (SAMP) test for upper limb function in patients with non-specific neck pain

BackgroundPerformance measures that assess the upper limb disability (ULD) in patients with neck pain can provide useful information for making clinical decisions regarding the optimal management of those patients. The Single Arm Military Press (SAMP) test is a performance based ULD measure developed specifically for populations with neck pain. In this test, patients are asked to lift a 1 kg weight repetitively overhead for 30 s with repetitions counting as the score. Whilst the test has been shown to be acceptable and feasible for use by clinicians and patients, its reliability in a patient group is still unknown. ObjectiveTo assess the interrater, intrarater reliability and measurement error of the SAMP test in patients with non-specific neck pain (NSNP). MethodsA total of 210 patients with NSNP and 81 healthy subjects were recruited for this study. The Disabilities of the Arm, Shoulder and Hand (DASH) and the Neck Disability Index (NDI) were assessed at baseline to ensure eligibility of the participants. The SAMP test was assessed at baseline and repeated 4–7 days later. A VAS symptom score was used to establish the stability of the participants across time. Interrater, intrarater reliability and measurement error were evaluated using Interclass Correlation Coefficient (ICC2,1) and the standard error of measurement (SEM). ResultsThe ICCs for interrater and intrarater reliability for the SAMP test ranged from 0.993 to 0.996 in the patient group. The SEM was ≤1 and smaller than the Smallest Detectable Change (SDC) and Bland-Altman plot indicated that the test is accurate. ConclusionThe almost perfect interrater and intrarater reliability and low levels of measurement error indicate that the 1 kg SAMP test has potential for evaluating upper limb functional capacity in female patients with NSNP. Before the test can be fully recommended, further studies are required to evaluate the validity and responsiveness of the SAMP test in population with NSNP and other neck disorders.

Real-World Adherence to OnabotulinumtoxinA Treatment for Spasticity: Insights From the ASPIRE Study

ObjectiveTo identify baseline characteristics and treatment-related variables that affect adherence to onabotulinumtoxinA treatment from the Adult Spasticity International Registry (ASPIRE) study. DesignProspective, observational registry (NCT01930786). SettingInternational clinical sites. ParticipantsAdults with spasticity (N=730). InterventionsOnabotulinumtoxinA at clinician's discretion. Main Outcome MeasuresClinically meaningful thresholds used for treatment adherent (≥3 treatment sessions during 2-year study) and nonadherent (≤2 sessions). Data analyzed using logistic regression and presented as odds ratios (ORs) with 95% confidence intervals (CIs). Treatment-related variables assessed at sessions 1 and 2 only. ResultsOf the total population, 523 patients (71.6%) were treatment adherent with 5.3±1.6 sessions and 207 (28.4%) were nonadherent with 1.5±0.5 sessions. In the final model (n=626/730), 522 patients (83.4%) were treatment adherent and 104 (16.6%) were nonadherent. Baseline characteristics associated with adherence: treated in Europe (OR=1.84; CI, 1.06-3.21; P=.030) and use of orthotics (OR=1.88; CI, 1.15-3.08; P=.012). Baseline characteristics associated with nonadherence: history of diplopia (OR=0.28; CI, 0.09-0.89; P=.031) and use of assistive devices (OR=0.51; CI, 0.29-0.90; P=.021). Treatment-related variables associated with nonadherence: treatment interval ≥15 weeks (OR=0.43; CI, 0.26-0.72; P=.001) and clinician dissatisfaction with onabotulinumtoxinA to manage pain (OR=0.18; CI, 0.05-0.69; P=.012). Of the population with stroke (n=411), 288 patients (70.1%) were treatment adherent with 5.3±1.6 sessions and 123 (29.9%) were nonadherent with 1.5±0.5 session. In the final stroke model (n=346/411), 288 patients (83.2%) were treatment adherent and 58 (16.8%) were nonadherent. Baseline characteristics associated with adherence: treated in Europe (OR=2.99; CI, 1.39-6.44; P=.005) and use of orthotics (OR=3.18; CI, 1.57-6.45; P=.001). Treatment-related variables associated with nonadherence: treatment interval ≥15 weeks (OR=0.42; CI, 0.21-0.83; P=.013) and moderate/severe disability on upper limb Disability Assessment Scale pain subscale (OR=0.40; CI, 0.19-0.83; P=.015). ConclusionsThese ASPIRE analyses demonstrate real-world patient and clinical variables that affect adherence to onabotulinumtoxinA and provide insights to help optimize management strategies to improve patient care.

The role of kinesiotherapy in treating the symptoms of obstetric palsy

Obstetric palsy (OP) is the partial or total paralysis of the upper limb due to injury of the brachial plexus during childbirth. Early kinesiotherapy intervention helps to treat motor disorders faster and more effectively by reducing upper limb disability. The aim of this review is to describe recent research data on kinesiotherapy applications in patients with OP. The Google Scholar and PubMed databases were searched with the following keywords: obstetric palsy, kinesiotherapy, rehabilitation. This review included five articles. In conclusion, the application of kinesiotherapy contributes to the better treatment of motor and sensory disorders of the paretic muscles caused by OP as it helps to maintain the range of motion of the glenohumeral joint, to prevent stiffness, to maintain muscle tone, to increase muscle strength and endurance and, consequently, to improve function of the affected limb.

Research and Design of Wearable Intelligent Umbrella to Help People in Rainy Days

Because the people with upper limb disability will encounter travel problems in rainy days, researchers designed and made wearable intelligent umbrellas, so as to improve the rain-shield efficiency of the disabled when traveling in rainy days. People with upper limb disabilities will suffer from poor balance and low rain-shield efficiency when holding umbrellas with one hand. This umbrella can be used as a backpack for people with upper limb disabilities. When traveling in rainy days, the umbrella will automatically adjust the orientation of the umbrella surface according to the wind speed sensor on the other side of the backpack to improve the rain-shield efficiency. The design of umbrella is based on physical experiments, and the conclusion of rain-shield efficiency is also drawn from experiments, which ensures the strong scientific nature of the research. At present, the conclusion of the experiment verifies that umbrellas can be used in daily life and can run normally under turning, walking, turning and other actions. This study can improve the travel convenience of disabled people and improve their social identity.

Hand Strength Deficit in Patients with Neurogenic Thoracic Outlet Syndrome.

Neurogenic thoracic outlet syndrome (NTOS) is a chronic painful and disabling condition. Patients complain about upper-limb paresthesia or weakness. Weakness has been considered one of the diagnostic criteria of NTOS, but objective comparisons to healthy controls are lacking. We compared the grip and the key pinch strengths between NTOS patients and healthy controls. Grip strength was evaluated with a hydraulic hand dynamometer and the key pinch with a pinch gauge. All the patients with NTOS completed a QuickDASH. We included prospectively 85 patients with NTOS, 73% female and 27% male. The mean age was 40.4 ± 9.6. They were compared to 85 healthy subjects, 77.6% female and 22.4% male. Concerning the grip, symptomatic hands of NTOS patients had significantly 30% less strength compared to control hands (p ≤ 0.001), and 19% less strength compared to asymptomatic hands (p = 0.03). Concerning the key pinch, symptomatic hands of patients with NTOS had significantly 19.5% less strength compared to control hands (p ≤ 0.001). Grip and key pinch strengths had a significant correlation with the QuickDASH (r = −0.515 and r = −0.403, respectively; p ≤ 0.001). Patients with NTOS presented an objective hand strength deficit compared to healthy controls. This deficit was significantly correlated to the upper-limb disability. These findings confirm the interest of hand strength evaluation in the diagnostic process of patients with NTOS.

Validation of the Bath CRPS Body Perception Disturbance Scale

The Bath Complex Regional Pain Syndrome Body Perception Disturbance Scale (“B-CRPS-BPDS”) measures alterations in body perception. We assessed its internal consistency, known group validity, construct validity, and associations with demographic and clinical characteristics. We also evaluated changes in, and baseline predictors of B-CRPS-BPDS scores at follow-up. We included people with CRPS (N = 114) and pain-free controls (N = 69). People with CRPS obtained higher scores than pain-free controls on all B-CRPS-BPDS items, except the item on attention. Because this item also had an insufficient corrected item-total correlation, we propose a revised B-CRPS-BPDS (r-B-CRPS-BPDS) excluding this item. The internal consistency of the r-B-CRPS-BPDS was good. The r-B-CRPS-BPDS showed a large positive relationship with “motor neglect-like symptoms”, indicating good construct validity. The r-B-CRPS-BPDS showed positive relationships with pain intensity, fear of movement, depression, and upper limb disability. There were no independent relationships with handedness, affected side, affected limb, disease duration, CRPS severity score, tension, anger, fatigue, confusion, and vigour. Finally, r-B-CRPS-BPDS scores did not consistently change over time. Our results demonstrate the utility of the r-B-CRPS-BPDS for measuring body perception disturbances in CRPS. PerspectiveThis article evaluates the validity of the Bath Complex Regional Pain Syndrome Body Perception Disturbance Scale (“B-CRPS-BPDS”) in CRPS, and assesses relationships with demographic and clinical variables. The proposed revised B-CRPS-BPDS appears to be a valid measure of body perception disturbances in CRPS.

Assessment of hand function in women with lymphadenopathy after radical mastectomy.

BackgroundBreast cancer related upper limb lymphedema (BCRL) is a common complication in post-mastectomy patients. It is known to cause upper limb disability, which subsequently may affect the grip strength and hand function. There is little evidence on the objective assessment of functional activities particularly hand function in women with BCRL. Therefore, this study objectively assesses the handgrip strength and hand functions in women with BCRL.MethodA cross-sectional study design was conducted on a sample of women with (n = 31) and without (n = 31) BCRL. The Handgrip strength and hand functions were measured using a dynamometer and Jebsen-Taylor hand function test, respectively.ResultsThe results showed a significantly reduced handgrip strength in women with BCRL as compared to age-matched healthy adult women for both right and left hands (p < 0.05). Similarly, hand functions were significantly impaired in women with BCRL as compared to healthy adult women (p < 0.05). Reduction in handgrip strength and hand function in women with BCRL were clinically meaningful as indicated by moderate to large effect sizes (Cohen’s d = 0.61 to 0.99 and 0.54 to 3.02, respectively) in all outcomes except power handgrip strength in left hand (Cohen’s d = 0.38).ConclusionThe results of this study indicate a significant reduction of hand grip strength and hand function in women with BCRL. Our findings suggest that objective measures of grip strength and function be included in the assessment of women with BCRL to better guide clinical decision making and patient care, which may include management of impairment associated with hand strength and function. Future studies that evaluate hand grip strength and function in a larger sample which includes a more diverse age group of women with BCRL are warranted to confirm the current findings.

Comparison of Upper Limb Disability in Overhead Women Athletes of Handball, Volleyball, Softball, and Swimming

Purpose: The shoulder joint is one of the most commonly injured joints in sports and may lead to disability, especially in the upper extremities of overhead players (handball, volleyball, softball, and swimming). Methods: This research is a causal-comparative study. After the approval of the Ethics Committee of the Medical University of Tehran, this study was conducted on 120 overhead athletes (Mean±SD height: 1.69±0.07 m, Mean±SD weight: 63.54±7.79 kg, Mean±SD age: 21.96±2.94 years, Mean±SD body mass index: 22.11±2.32 kg/m2). The inclusion criteria were elite female players in overhead sports with at least three years of experience in one of these sports (handball, volleyball, softball, and swimming). Samples with a history of surgery or cervical nerve problems, fractures in the shoulder area, and inflammatory joint disease were excluded from the study. The demographic information was obtained through a researcher-made questionnaire, and the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire was used to measure the degree of upper limb disability in daily activities. Results: In comparison between the study groups, a significant difference was observed between the dependent variable (DASH) and the research groups (F=6.067, df=3, P=0.002, Eta=0.342). Using the Bonferroni post hoc tests, the difference between volleyball and softball (P=0.44), volleyball and swimming (P=0.009), and handball and swimming players (P=0.022) were reported. In the next step, BMI characteristics, weekly training hours, and the number of training sessions per week were entered into the data analysis process as covariate variables (F=8.099, df=0.3, P=0.000, Eta=0.432). The Bonferroni post hoc test indicates the difference between volleyball and swimming athletes (P=0.001) and handball and swimming (P=0.002). Conclusion: The present study results indicate a high rate of upper limb disability in elite women athletes. The present study results showed no difference between volleyball and handball due to the nature of these two disciplines and handball, softball, and swimming.

The importance of early and long-lasting medical rehabilitation in patients with brachial plexus injury

Introduction. Brachial plexus lesions vary in severity, depending on the etiopathogenic mechanism and the level of force to which the plexus is exposed. In the same patient, several nerves of the plexus can be damaged in varying degrees of severity. Brachial plexus injuries lead to upper limb paralysis and disability. Material and Methods. We present the case of a 68-year-old woman diagnosed a year ago with multiple myeloma, clavicular plasmacytoma and secondary spontaneous clavicle fracture. At the same time she presented several dislocations of the shoulder and was diagnosed with brachial plexus palsy after the last dislocation. The patient was hospitalized in our department with a large motor deficit in the upper limb. A comprehensive motor rehabilitation program has been established three weeksafter installing the palsy. Results and discussion. The evolution of the patient was favorable. It was noticed the reduction of the symptoms and slight improvement in motor deficit of the affected upper limb. Thepatient rehabilitation should continue for several months because the nerve regenerates slowly. Conclusion. In patients with brachial plexus injury, motor rehabilitation should be instituted as early as possible and continued for a longer periodoftime until nerve regeneration occurs.It results that early and continuous medical rehabilitation is essential in patients with brachial plexus injury. Keywords: Brachial plexus injury, shoulder dislocation, rehabilitation,