Joints Of Upper Limb Research Articles

Angular Velocity Profiles of Upper Limb Joint Synergies in Reaching Movements: a pilot study.

The spatiotemporal kinematic synergy, a coupling of multiple degrees of freedom (DoF), runs through human activities of daily living (ADL). And it is an entry point for exploring the central nervous system's (CNS) control process of musculoskeletal system by analyzing the time-varying kinematic synergy. The aim of this study was to find more physiological properties from the angular velocity profiles of synergy. Ten healthy right-handed subjects were asked to reach target button at different locations. During reaching movement, the motion data of five right upper limb joints were recorded, and the synergistic patterns were extracted by PCA algorithm. Our results showed that the combinations of the first four synergies were sufficient to explain raw data. As far as possible to exclude the effects of individual and information differences, we found shoulder flexion/extension and elbow flexion/extension made distinct contribution in a period of time to the control procedure performed by CNS after targets were confirmed. Our preliminary results implied that reaching movements required comparatively constant scheduling of shoulder horizontal abduction/adduction, shoulder internal/external rotation and wrist ulnar/radial deviation by CNS, while scheduling of SFE and EFE depends on the objectives.Clinical relevance- The findings of this paper may provide a novel dynamic control evidence based on CNS for realizing near-natural control of assistive devices in motor rehabilitation area.

The Role of the Non-Playing Hand during Topspin Forehand in Table Tennis

Theoretical tutorials and the scientific literature do not provide information on the proper use of the non-playing hand in table tennis. This study aimed to evaluate the course of the movement in the joints of the non-playing limb during a table tennis topspin forehand stroke (played after a backspin ball) and to determine the inter-individual movement variability. The study involved 12 male table tennis players (178.7 ± 5.5 cm, 70.0 ± 6.6 kg, 23 ± 3 y) at a competitive level. The participants performed one topspin forehand as a response to a backspin ball. Kinematics were measured using an Inertial Motion Unit–MR3 myoMuscle Master Edition system. Changes in the angles of the upper limb joints (with particular emphasis on the non-playing hand) during the forehand topspin were analyzed. A novel method of normalized function of variance was used to characterize areas of high/low variability of movement. Most of the movements in the joints of the non-playing limb were performed symmetrically to the playing one, especially in the hitting phase. A rapid change of direction characterizes these movements, just before or during the hitting phase, which may indicate a supportive, ‘driving’ character for these movements. High inter-individual variability for the duration of the entire movement cycle in both limbs was observed; higher in the non-playing limb. This perhaps indicates a greater degree of individualization on the non-playing side.

Analysis of the Structure of Contractures of the Upper Limb Joints

Summary. Analysis of the restrictions in the amplitude of movements in the joints is traditionally considered from the standpoint of individual nosologies that cause them, but the systemic results of the inverse syndromological approach to the study of contractures are published only sporadically.
 Objective: to determine the structure, causes, nature, and severity of contractures of the upper extremity joints.
 Materials and Methods. The structure of contractures of the upper extremity joints as the consequences of injuries and diseases was analyzed on a large array of patients (16,710 patients). Distribution by location, etiology, severity of contracture, gender and age, and relationships between type and localization of contracture were assessed. The dynamics of the development of contractures and the number of necessary surgical interventions was traced.
 Results. Restriction of movements in the upper extremity joints was registered in 5,450 out of 16,710 (32.6%) patients; among them there were 3,485 male (63.9%) and 1,965 (36.1%) female patients. During reconstructive treatment, 7,892 surgeries were performed. Most often these were contractures of the finger joints (42.5%), then shoulder (26.9%), elbow (13.4%), carpal joint (13.3%), less often – radioulnar contractures (3.9%). The elbow, radioulnar and carpal joint contractures most often are caused by osteo-cartilaginous lesions; a polyetiological component is typical for the finger joints. The shoulder joint contractures may be caused evenly by desmogenic, myogenic, or osteo-cartilaginous lesions. Most of the joint contractures are of moderate severity. Contractures of the fingers require multi-stage surgical treatment (1.91±1.35 surgeries); one-stage treatment is used for contractures of the shoulder joint (1.34±0.81 surgeries). The most polystructural lesions were combat wounds, ischemic, and finger contractures (2.53±1.22; 2.52±1.34 and 2.5±1.24 structures, respectively), and the least – radioulnar contractures (1.59±1.34 structures). Radioulnar contractures in 37.3% of cases are accompanied by contractures of the fingers, but vice versa only in 1.2%. It was noted that contractures of the radioulnar joints are often accompanied by restriction of movements in the elbow and wrist joints – in 34.9 and 56.6% of cases, respectively. At the same time, the inverse dependence of the combination of contractures in the wrist and elbow joints with radioulnar joints is not very high – 4.2% and 6% of cases, respectively.
 Conclusions. In patients who are hospitalized for highly specialized surgical treatment of pathology of the upper extremity, contractures of its joints are moderate and severe, characterized by polyetiology, and, in most cases, caused by disorders of osteo-cartilaginous structures and their combination with desmogenic, tenogenic, and myogenic lesions. Specific relationships are traced in localization and mutual burden of contractures, rapidity of their progression. As a rule, upper limb contractures are chronic ones and require multi-stage surgical treatment.

Development and Feasibility of a Kinect-Based Constraint-Induced Therapy Program in the Home Setting for Children With Unilateral Cerebral Palsy.

Introduction: Cerebral palsy (CP) is the leading cause of childhood-onset physical disability. Children with CP often have impaired upper limb (UL) function. Constraint-induced therapy (CIT) is one of the most effective UL interventions for children with unilateral CP. However, concerns about CIT for children have been repeatedly raised due to frustration caused by restraint of the child’s less-affected UL and lack of motivation for the intensive protocol. Virtual reality (VR), which can mitigate the disadvantages of CIT, potentially can be used as an alternative mediator for implementing CIT. Therefore, we developed a VR-based CIT program for children with CP using the Kinect system. Aims: The feasibility of the Kinect-based CIT program was evaluated for children with unilateral CP using a two-phase study design. Materials and Methods: In phase 1, ten children with unilateral CP were recruited. To confirm the achievement of the motor training goals, maximal UL joint angles were evaluated during gameplay. To evaluate children’s perceptions of the game, a questionnaire was used. In phase 2, eight children with unilateral CP were recruited and received an 8 weeks Kinect-based CIT intervention. Performance scores of the game and outcomes of the box and block test (BBT) were recorded weekly. Results: In phase 1, results supported that the design of the program was CIT-specific and was motivational for children with unilateral CP. In phase 2, game performance and the BBT scores began showing stable improvements in the fifth week of intervention. Conclusion: It suggested the Kinect-based CIT program was beneficial to the motor function of the affected UL for children with unilateral CP. According to the results of this feasibility study, larger and controlled effectiveness studies of the Kinect-based CIT program can be conducted to further improve its clinical utility. Clinical Trial Registration: ClinicalTrials.gov, NCT02808195; Comparative effectiveness of a Kinect-based unilateral arm training system vs. CIT for children with CP

An Innovative Sensor Fusion Algorithm for Motion Tracking With On-Line Bias Compensation: Application to Joint Angles Estimation in Yoga

Magnetic Inertial Measurement Units (MIMUs) represent an increasingly used technology in the field of human motion. However, their applications are strongly affected by magnetic disturbances and poor calibration, which could determine inaccurate attitude estimations. Thus, Inertial Measurement Units (IMUs), relying exclusively on accelerometers and gyroscopes, could be used as an alternative to MIMUs for motion tracking, avoiding the negative effect of magnetic disturbances. Unfortunately, gyroscope signals are characterized by several error sources, among which gyroscope bias, whose variations due to environmental factors and temporal instability strongly affect the attitude estimation accuracy. Aim of the present work is to propose a novel sensor fusion algorithm for IMU-based applications that embodies an adaptive on-line bias capture module. The accuracy of the proposed filter was tested on ten expert yoga practitioners during the execution of a sun salutation sequence. The right upper limb joint angles were estimated and their accuracy assessed in terms of Mean Absolute Error (MAE) and Pearson’s correlation coefficient by comparison with an optoelectronic motion capture system. The achieved worst-case accuracy was 5.59, 6.75 and 3.49 degrees for the wrist, elbow and shoulder joints respectively. The accuracy of the algorithm is further confirmed by the high values of the Pearson’s correlation coefficients between IMUs and OMC angles, which were greater than 0.91, 0.92 and 0.98 respectively for the three considered joints. The proposed algorithm can thus be considered as a promising tool for attitude estimation in those contexts when magnetic interferences cannot be monitored and, thus, adequately compensated.

The Accuracy of Subjective Assessment of Upper Limb Associated Reactions During Walking in People with Acquired Brain Injury

Research Objectives To investigate the accuracy of subjective rating of upper limb associated reactions (ARs) during walking using the International Classification of Functioning, Disability and Health Framework's (ICF) Qualifiers Scale compared to criterion-reference three-dimensional motion analysis (3DMA). Design Cross-sectional observational study. Setting A major brain injury rehabilitation centre in Australia. Participants Forty-one participants with an ABI and hemiplegic upper limb AR during walking. Interventions N/A. Main Outcome Measures Participants underwent 3DMA at their self-selected walking speed to generate an AR outcome measure, quantifying upper limb kinematic deviation compared to healthy controls at each joint axis and whole upper limb. Three experienced neurological physiotherapists viewed video recordings of the participants’ walking trials and applied the ICF Qualifiers Scale to subjectively rate the global AR severity and severity at each upper limb joint on a 5-point scale. The comparative accuracy was calculated via quantifying relationships (Fisher's exact test), percentage agreement, sensitivity, and specificity. Results The ICF Qualifiers Scale had limited accuracy compared to 3DMA hemiplegic upper limb assessment. The wrist severity score was the only outcome demonstrating a significant relationship to the corresponding 3DMA outcome (p < 0.05). Four out of seven outcomes had ≤ 58% agreement in abnormality classification. None of the outcomes had high sensitivity and specificity. The sensitivity was relatively low for all outcomes (0.32-0.73) and specificity relatively high (>0.80) for four of the seven outcomes. Conclusions Given that the ICF Qualifiers scale tended to under classify abnormality with false negatives likely, it cannot be confidently implemented in clinical practice. There appears to be a disconnect between 3DMA and subjective rating of ARs. Evaluation of ARs during walking may require objective assessment. Author(s) Disclosures There are no disclosures to report. To investigate the accuracy of subjective rating of upper limb associated reactions (ARs) during walking using the International Classification of Functioning, Disability and Health Framework's (ICF) Qualifiers Scale compared to criterion-reference three-dimensional motion analysis (3DMA). Cross-sectional observational study. A major brain injury rehabilitation centre in Australia. Forty-one participants with an ABI and hemiplegic upper limb AR during walking. N/A. Participants underwent 3DMA at their self-selected walking speed to generate an AR outcome measure, quantifying upper limb kinematic deviation compared to healthy controls at each joint axis and whole upper limb. Three experienced neurological physiotherapists viewed video recordings of the participants’ walking trials and applied the ICF Qualifiers Scale to subjectively rate the global AR severity and severity at each upper limb joint on a 5-point scale. The comparative accuracy was calculated via quantifying relationships (Fisher's exact test), percentage agreement, sensitivity, and specificity. The ICF Qualifiers Scale had limited accuracy compared to 3DMA hemiplegic upper limb assessment. The wrist severity score was the only outcome demonstrating a significant relationship to the corresponding 3DMA outcome (p < 0.05). Four out of seven outcomes had ≤ 58% agreement in abnormality classification. None of the outcomes had high sensitivity and specificity. The sensitivity was relatively low for all outcomes (0.32-0.73) and specificity relatively high (>0.80) for four of the seven outcomes. Given that the ICF Qualifiers scale tended to under classify abnormality with false negatives likely, it cannot be confidently implemented in clinical practice. There appears to be a disconnect between 3DMA and subjective rating of ARs. Evaluation of ARs during walking may require objective assessment.

Quantifying the Nature And Extent of Upper-Limb Associated Reactions During Walking in People With Acquired Brain Injury

Research Objectives To use criterion-reference three-dimensional motion analysis (3DMA) during walking to; 1.Define upper-limb associated reaction (AR) kinematics 2.Devise composite score outcome measures to quantify Ars. Design Cross-sectional observational study. Setting A major brain injury rehabilitation centre. Participants Forty-two participants with an ABI and hemiplegic upper-limb AR during walking and 36 healthy controls (HCs). Interventions N/A. Main Outcome Measures Participants underwent 3DMA upper-limb assessment at self-selected and fast walking speeds. The mean, standard deviation (SD), peak and total joint range of motion (ROM) were calculated for each axis across the gait cycle. The AR kinematics were evaluated according to between-group differences (analysis of covariance) and individually with calculation of the percentage of ABI participants classified as abnormal (i.e., ±1.96 SD of the HC mean). Composite score outcome measures were devised and evaluated for validity (Pearson's r correlation), test-retest reliability (intra-class correlation coefficient (ICC)) and responsiveness (Cohen's d effect size (ES), % change scores). Results Significant between-group differences existed for all elbow and shoulder abduction outcome variables (p 0.81). Conclusions All upper-limb joints may be implicated in ARs and therefore all warrant inclusion in clinical assessment. Composite scores were able to comprehensively assess the whole upper-limb AR, accurately classifies abnormality, and quantify severity with very strong clinimetrics. Author(s) Disclosures There are no disclosures or conflicts of interest for this abstract. To use criterion-reference three-dimensional motion analysis (3DMA) during walking to; 1.Define upper-limb associated reaction (AR) kinematics 2.Devise composite score outcome measures to quantify Ars. Cross-sectional observational study. A major brain injury rehabilitation centre. Forty-two participants with an ABI and hemiplegic upper-limb AR during walking and 36 healthy controls (HCs). N/A. Participants underwent 3DMA upper-limb assessment at self-selected and fast walking speeds. The mean, standard deviation (SD), peak and total joint range of motion (ROM) were calculated for each axis across the gait cycle. The AR kinematics were evaluated according to between-group differences (analysis of covariance) and individually with calculation of the percentage of ABI participants classified as abnormal (i.e., ±1.96 SD of the HC mean). Composite score outcome measures were devised and evaluated for validity (Pearson's r correlation), test-retest reliability (intra-class correlation coefficient (ICC)) and responsiveness (Cohen's d effect size (ES), % change scores). Significant between-group differences existed for all elbow and shoulder abduction outcome variables (p 0.81). All upper-limb joints may be implicated in ARs and therefore all warrant inclusion in clinical assessment. Composite scores were able to comprehensively assess the whole upper-limb AR, accurately classifies abnormality, and quantify severity with very strong clinimetrics.

Force Sensation Induced by Electrical Stimulation of the Tendon of Biceps Muscle

Many wearable interfaces have been proposed to present force to the upper limb and elbow joint. One way to achieve a compact wearable haptic interface is to use electrical stimulation, and we have suggested that transcutaneous electrical stimulation above the wrist tendon can produce force a sensation in the direction of the muscle stretching; however, it has not been investigated in detail whether the force sensation presented by the electrical stimulation of the tendon occurs in the upper limb joints. In this study, to investigate whether the force sensation is generated when applying electrical stimulation of the skin at the tendon or at the muscle belly of the biceps brachii muscle, we quantitatively evaluated the direction and amount of the force sensation under the aforementioned conditions. The results showed that the electrical stimulation of the tendon produced significant force sensation in the direction of elbow extension. On the other hand, in some participants, the electrical stimulation of the muscle belly worked as a supporting force, resulting in the sensation of weakened force perception. In general, we concluded that the sensation produced by muscle stimulation was different from that produced by stimulation of the tendon.

Reducing Waste in 3D Printing Using a Neural Network Based on an Own Elbow Exoskeleton.

Traditional rehabilitation systems are evolving into advanced systems that enhance and improve rehabilitation techniques and physical exercise. The reliable assessment and robotic support of the upper limb joints provided by the presented elbow exoskeleton are important clinical goals in early rehabilitation after stroke and other neurological disorders. This allows for not only the support of activities of daily living, but also prevention of the progression neuromuscular pathology through proactive physiotherapy toward functional recovery. The prices of plastics are rising very quickly, as is their consumption, so it makes sense to optimize three dimensional (3D) printing procedures through, for example, improved artificial intelligence-based (AI-based) design or injection simulation, which reduces the use of filament, saves material, reduces waste, and reduces environmental impact. The time and cost savings will not reduce the high quality of the products and can provide a competitive advantage, especially in the case of thinly designed mass products. AI-based optimization allows for one free print after every 6.67 prints (i.e., from materials that were previously wasted).

Development of a participation assessment system based on multimodal evaluation of user responses for upper limb rehabilitation

The patient's active participation in exercises is a crucial factor to increase the functional outputs received from therapy. For improving the patient's active and voluntary involvement, the difficulty levels of therapy tasks and the device assistance are adjusted based on the patient's therapy performance. However, the existing performance evaluation methods are based on either some specific device designs or certain therapy tasks. In this work, a patient performance evaluation method is proposed based on a multimodal sensor fusion formed by the trajectory tracking error signal and the patient's physiological responses (heart rate and skin conductance) during the upper extremity rehabilitation. The novelty of the system is assessing the patient's performance independently from any device designs or therapy tasks. The developed system also evaluates the patient's tiredness and slacking, which are substantial factors affecting the therapy performance. The patient's upper limb joints' angles are measured via inertial measurement unit sensors. Arm movements of the patient are estimated by an upper limb kinematic module for evaluating the trajectory tracking. The patient's performance, tiredness, and slacking are assessed by a fuzzy inference system using physiological responses and exercise profile. The developed system is tested experimentally with healthy subjects on five therapy tasks. Also, for demonstrating the proposed method efficacy, additional experiments have been performed for different cases while measuring the sEMG signals of the subjects. The experimental results showed that the proposed system estimates subjects’ participation successfully and adjusts the therapy tasks according to subjects' performance and tiredness.

Placement Recommendations for Single Kinect-Based Motion Capture System in Unilateral Dynamic Motion Analysis.

Low-cost, portable, and easy-to-use Kinect-based systems achieved great popularity in out-of-the-lab motion analysis. The placement of a Kinect sensor significantly influences the accuracy in measuring kinematic parameters for dynamics tasks. We conducted an experiment to investigate the impact of sensor placement on the accuracy of upper limb kinematics during a typical upper limb functional task, the drinking task. Using a 3D motion capture system as the golden standard, we tested twenty-one Kinect positions with three different distances and seven orientations. Upper limb joint angles, including shoulder flexion/extension, shoulder adduction/abduction, shoulder internal/external rotation, and elbow flexion/extension angles, are calculated via our developed Kinect kinematic model and the UWA kinematic model for both the Kinect-based system and the 3D motion capture system. We extracted the angles at the point of the target achieved (PTA). The mean-absolute-error (MEA) with the standard represents the Kinect-based system’s performance. We conducted a two-way repeated measure ANOVA to explore the impacts of distance and orientation on the MEAs for all upper limb angles. There is a significant main effect for orientation. The main effects for distance and the interaction effects do not reach statistical significance. The post hoc test using LSD test for orientation shows that the effect of orientation is joint-dependent and plane-dependent. For a complex task (e.g., drinking), which involves body occlusions, placing a Kinect sensor right in front of a subject is not a good choice. We suggest that place a Kinect sensor at the contralateral side of a subject with the orientation around to for upper limb functional tasks. For all kinds of dynamic tasks, we put forward the following recommendations for the placement of a Kinect sensor. First, set an optimal sensor position for capture, making sure that all investigated joints are visible during the whole task. Second, sensor placement should avoid body occlusion at the maximum extension. Third, if an optimal location cannot be achieved in an out-of-the-lab environment, researchers could put the Kinect sensor at an optimal orientation by trading off the factor of distance. Last, for those need to assess functions of both limbs, the users can relocate the sensor and re-evaluate the functions of the other side once they finish evaluating functions of one side of a subject.

A Supernumerary Soft Robotic Limb for Reducing Hand-Arm Vibration Syndromes Risks.

The most common causes of the risk of work-related musculoskeletal disorders (WMSD) have been identified as joint overloading, bad postures, and vibrations. In the last two decades, various solutions ranging from human-robot collaborative systems to robotic exoskeletons have been proposed to mitigate them. More recently, a new approach has been proposed with a high potential in this direction: the supernumerary robotic limbs SRLs are additional robotic body parts (e.g., fingers, legs, and arms) that can be worn by the workers, augmenting their natural ability and reducing the risks of injuries. These systems are generally proposed in the literature for their potentiality of augmenting the user’s ability, but here we would like to explore this kind of technology as a new generation of (personal) protective equipment. A supernumerary robotic upper limb, for example, allows for indirectly interacting with hazardous objects like chemical products or vibrating tools. In particular, in this work, we present a supernumerary robotic limbs system to reduce the vibration transmitted along the arms and minimize the load on the upper limb joints. For this purpose, an off-the-shelf wearable gravity compensation system is integrated with a soft robotic hand and a custom damping wrist, designed starting from theoretical considerations on a mass-spring-damper model. The real efficacy of the system was experimentally tested within a simulated industrial work environment, where seven subjects performed a drilling task on two different materials. Experimental analysis was conducted according to the ISO-5349. Results showed a reduction from 40 to 60% of vibration transmission with respect to the traditional hand drilling using the presented SRL system without compromising the time performance.

Newborn joint mechanics

Introduction We aimed to evaluate joint mechanics in newborn by goniometric assessment of major joints in healthy babies born at different gestational ages (GAs). Materials and methods An institution based observational study was carried out on healthy newborn babies within two days of birth. Study subjects were born at 28–41 completed weeks of gestation. The major joints of upper and lower limbs were assessed with manual goniometer for joint angles in relation to specific passive movements and range of motion (ROM) calculated where applicable. All measurements were made by a single observer with careful consideration of plane of movement and axes involved. Strength of association between joint angles and GA was quantified by Pearson’s r coefficient. Results Six major joints (shoulder, elbow, wrist, hip, knee, and ankle) were evaluated on either side in 433 babies. No significant differences were found between male and female babies and left or right side of the body. For most joints, a secular declining trend of joint angle or ROM was noted with good to strong inverse correlation with GA. The strongest associations were for flexion–extension ROM and adduction–abduction ROM at shoulder, palmar flexion at wrist and dorsiflexion at ankle joint with r values of −0.76, −0.75, −0.75, and −0.75, respectively. Conclusions The reading of a specific joint angle in the newborn infants was found to be dependent on GA. Precise calibration of gestation appropriate joint angles had laid down the foundation for functional assessment of multimodal joint mechanics. Highlights Evaluation of newborn joint angles require stringent attention toward the plane and axis of the particular joint movement being assessed. Major joint angles and range of motion in newborn infants were observed to follow a secular declining trend according to the gestational age. Precise estimation of gestation appropriate joint angle will be helpful to understand the mechanics of musculoskeletal medicine in newborn.

Reliability of Image Capture Technique for the Measurement of Upper Limb Active Joint Position Sense in Healthy Adults

Objective: Proprioception is the conscious perception of limb position, motion, balance, and pressure. It has a vital role in movement control, especially motor planning and neuromuscular feedback mechanism. To investigate the proprioceptive function, it is essential to use the best measurement method. Different techniques and approaches have been introduced, which are usually expensive and not applicable for clinical use. One of these methods is the image capture technique which is easy and practical. Stillman introduced this technique to measure the joint position sense of the knee considering all variables affecting it and reported its good reliability. Many studies have used this technique for knee and lower limb joints and reported its good reliability, while few studies have used this technique for the upper limb joints. Therefore, this study investigates the reliability of the image capture technique for measuring the Active Joint Position Sense (AJPS) of the left shoulder and elbow in healthy adults. If it yields a good result, it can be used as an available and cost-effective method by clinicians. Materials &amp; Methods: In this methodological study, the participants were 10 healthy adults (5 men, 5 women) aged 18-40 years. To assess the AJPS, we used image capture technology which is one of the most reliable methods for the lower limb joint position sense measurement. Markers were attached on elbow and shoulder landmarks, and photos were taken during the reproduction of angles by participants. Then, the photos were entered into AutoCAD software, and the angles were calculated by drawing line segments from landmarks and connecting them. The absolute error and relative error (the difference between the initial and reproduced angles) were used to measure accuracy. The AJPS was assessed for internal and external rotation of the shoulder and elbow flexion. The measurements were repeated two hours later to assess intra-day reliability and two days later to assess inter-day reliability. Interclass Correlation Coefficient (ICC) and Standard Error of Measurement (SEM) were used for statistical analysis. Results: The ICC of inter-day reliability of the test for all shoulder and elbow movements in relative and absolute errors was reported as excellent (≥0.92). Intra-day reliability was reported excellent (≥0.90) for elbow flexion, and internal rotation of the shoulder in both relative and absolute errors were excellent (0.94). For external rotation of the shoulder, it was excellent in relative error (0.94) and good in absolute error (0.80). All measurements had absolute reliability based on the SEM results. Conclusion: The image capture technique is a simple, cost-effective, and available method tool for measuring AJPS and proprioception in upper limbs by clinicians and researchers.

Clinical Study of Qingpeng Ointment Treating Shoulder-hand Syndrome After Cerebral Hemorrhage During the Rehabilitation Period.

Shoulder-hand syndrome (SHS) refers to a syndrome causing sudden edema, shoulder pain and limited hand function. Qingpeng ointment, a kind of Tibetan medicine, can reduce swelling, relieve pain, tonify stagnation and clear the meridians, which is consistent with the pathological mechanism of SHS after stroke. Therefore, if clinical trials can be used to explore the effectiveness of Qingpeng ointment for the treatment of poststroke SHS and promote its application in clinical medicine, it may prove the specific significance for the treatment of poststroke SHS poststroke SHS. The aim of the study was to investigate the clinical efficacy and safety of Qingpeng ointment in the treatment of poststroke SHS and to provide an objective basis for a better therapeutic treatment for poststroke SHS. A prospective, randomized, controlled study was conducted. This study recruited 120 patients with poststroke SHS who met the inclusion criteria. They were randomized into the treatment group and the control group, with 60 patients allocated to each group. The treatment group received routine medical treatment and rehabilitative care after using the Qingpeng ointment, while the patients in the control group received only routine treatment without the ointment. All patients received clinical assessment with the Visual Analogue Scale (VAS), measurement of the range of motion (ROM) of the upper-limb joints, the Fugl-Meyer Assessment of Upper Extremity (FMA-U) and the Modified Barthel Index Score (MBI) before and after the whole treatment. After 4 weeks of treatment, the VAS scores of both the groups decreased significantly (P ＜0.05), and the difference between the two groups was statistically significant (P < 0.05). No statistical significance was observed for the difference between the treatment group and control group in terms of the FMA-U and MBI scores and the forward bend, backward, outstretch, external rotation and pronation angles after treatment. The increases in the values of VAS, FMA-M and MBI in the treatment group were greater than those in the control group, and the difference was statistically significant (P < 0.05). The increases in the values of the forward bend, outreach and external rotation angles in the treatment group were greater than those in the control group, and the difference was statistically significant (P < 0.05). The treatment group showed better results than the control group in terms of the relief of pain symptoms, the improvement of motor function and the improvement of the activities of daily living for patients with shoulder-hand syndrome after cerebral hemorrhage. Qingpeng ointment was found to be effective and safe for treating poststroke SHS.

Upper limb kinematics after Latissimus Dorsi transfer in children with brachial plexus birth palsy

BackgroundBrachial plexus birth palsy remains a frequent condition and one of its treatments is to transfer the Latissimus Dorsi tendon to the infraspinatus muscle. The aim of this study was to analyse, for the first time, the three-dimensional kinematic effects of this operation on the upper limb joints during the five Mallet tasks and their correlation with clinical parameters. MethodsKinematic analysis was performed using an electromagnetic device. An Index of Improvement taking into account the angle in preop and postop, the reproducibility and the angle of a control group was developed. Three groups of patients were analysed: sixteen patients (mean: 10,5 years) for the reproducibility, thirty children (mean: 9,5 years) for the control group and ten patients (mean: 8 years 7 months) who were operated. FindingsThe humerothoracic and glenohumeral external rotations improved during the external rotation, the neck and the abduction tasks and worsened during the spine task. The glenohumeral external rotation worsened during the mouth task. The Humerothoracic abduction improved during the abduction and the neck tasks. The elbow flexion improved for the neck task. Differences were observed between patients and correlations were obtained between the Index of Improvement and clinical parameters. InterpretationUsing kinematics allows to better analyse the evolution of joint angles after the latissimus dorsi transfer. The Index of Improvement allows to quickly analyse the effect of the operation for each angle and each patient. This effect depends on clinical parameters.

Age-related changes in upper limb coordination in a complex reaching task.

When reaching to targets within arm's reach, intentional trunk motion must be neutralized by compensatory motion of the upper limb (UL). Advanced age has been associated with deterioration in the coordination of multi-joint UL movements. In the current study, we looked to determine if older adults also have difficulties modifying their UL movements (i.e., coordination between the shoulder and elbow joints), during a complex reaching task when trunk motion is manipulated. Two groups of healthy participants were recruited: 18 young (mean age = 24.28 ± 2.89years old) and 18 older (mean age = 72.11 ± 2.39years old) adults. Participants reached to a target with their eyes closed, while simultaneously moving the trunk forward. In 40% of trials, the trunk motion was unexpectedly blocked. Participants performed the task with both their dominant and non-dominant arms, and at a preferred and fast speed. All participants were able to coordinate motion at the elbow and shoulder joints in a similar manner and modify this coordination in accordance with motion at the trunk, regardless of the hand used or speed of movement. Specifically, in reaches that involved forward trunk motion (free-trunk trials), all participants demonstrated increased elbow flexion (i.e., less elbow extension) compared to blocked-trunk trials. In contrast, when trunk motion was blocked (blocked-trunk trials), all reaching movements were accompanied by increased shoulder horizontal adduction. While coordination of UL joints was similar across older and young adults, the extent of changes at the elbow and shoulder was smaller and less consistent in older adults compared to young participants, especially when trunk motion was involved. These results suggest that older adults can coordinate their UL movements based on task requirements, but that their performance is not as consistent as young adults.

Exploring “wear and tear” of joints and “muscle function” assumptions in skeletons with known occupation at death

Changes in the joints are believed to result from "wear and tear," a consequence of activity, as entheseal changes (EC) result from muscle use. However, clinical data showed that activity does not necessarily increase the likelihood of degenerative joint changes (DJC) and that exercise results in healthier joints. We tested whether individuals with continuous repetitive biomechanical efforts (Group 1) were more likely to exhibit EC and if occupations known to exert strenuous but discontinued efforts (Group 2) would more likely cause DJC. Eighty-nine males with known occupations from Portuguese identified collections were used: shoemakers and carpenters (Group 1), workers (Group 2), and civil servants, and shop assistants as a control group. Major upper and lower limb joints and entheses sites were used. DJC and EC were tested between occupations - while controlling for age (overall approach) - and within occupation (occupation-specific approach). The overall approach showed that age - as a covariant - had a significant impact on DJC and EC development (p< 0.05), with occupation being non-significant (p> 0.05) despite the variability in the mean-values of lesions. The occupation-specific approach showed a significant variability of DJC and EC correlations, within and between occupations, with no clear trend of DJC and EC development according to occupation. The results showed that exploring overall patterns might conceal occupation-specific joint and muscle use, emphasizing age as a major contributor of changes; and that the occupation-specific approach highlighted particular aspects associated with occupations, allowing for a more informative assessment of strenuous repetitive or discontinuous activity-related technical gestures and their impact on skeletal biology.

Low cost exoskeleton manipulator using bidirectional triboelectric sensors enhanced multiple degree of freedom sensory system

Rapid developments of robotics and virtual reality technology are raising the requirements of more advanced human-machine interfaces for achieving efficient parallel control. Exoskeleton as an assistive wearable device, usually requires a huge cost and complex data processing to track the multi-dimensional human motions. Alternatively, we propose a triboelectric bi-directional sensor as a universal and cost-effective solution to a customized exoskeleton for monitoring all of the movable joints of the human upper limbs with low power consumption. The corresponding movements, including two DOF rotations of the shoulder, twisting of the wrist, and the bending motions, are detected and utilized for controlling the virtual character and the robotic arm in real-time. Owing to the structural consistency between the exoskeleton and the human body, further kinetic analysis offers additional physical parameters without introducing other types of sensors. This exoskeleton sensory system shows a great potential of being an economic and advanced human-machine interface for supporting the manipulation in both real and virtual worlds, including robotic automation, healthcare, and training applications.

A novel method based on long short term memory network and discrete-time zeroing neural algorithm for upper-limb continuous estimation using sEMG signals

In this paper, a novel closed-loop model based on surface electromyography (sEMG) comprised a long short term memory (LSTM) network and discrete-time zeroing neural algorithm called zeroing neural network (ZNN), which is developed to estimate joint angles and angular velocities of human upper limb with joint damping. The dynamic model of human upper limb with joint damping is set up as the initial equation. Then, the LSTM network is proposed as an open-loop model which described the input-output relationship between the sEMG signals and joint motion intention. Besides, a novel closed-loop model is built via ZNN for eliminating the predicted error of open-loop model and improving the accuracy of motion intention recognition. Founded on the sEMG signals, the continuous movement of human upper limb joint can be successfully estimated via the novel closed-loop model. The results show that for simple joint movements, the closed-loop model is able to estimate the movement intention of human upper limb with high accuracy.