Upper-limb Mobility Research Articles

Innovations in Sports: A Key to Enhancing Rehabilitation Outcomes

Introduction and purpose: Traditional rehabilitation methods often have limitations in improving motor function and cognitive abilities. This review aims to provide an updated overview of innovative methods in rehabilitation, focusing on the role of immersive and interactive technologies in enhancing rehabilitation outcomes. The literature suggests that these technologies can improve upper limb mobility, grip strength, and manual dexterity, as well as cognitive function, attention, and spatial awareness. Additionally, innovative balance and gait rehabilitation programs have been shown to improve functional mobility and reduce the risk of falls. The use of these technologies in combination with other rehabilitation modalities, such as electrostimulation and robotic assistance, may lead to even greater improvements in motor function and cognitive abilities. While more research is needed to fully understand the benefits and limitations of these innovative approaches, the existing evidence suggests that they have the potential to revolutionize rehabilitation and improve quality of life for patients. Materials and Methods: A literature review was conducted using PubMed with search phrases immersive and interactive technologies and rehabilitation. Description of the state of knowledge: Traditional rehabilitation methods often have limitations in improving motor function and cognitive abilities.Upper extremity impairment is a common and debilitating consequence of stroke. Summary: imersive and interactive technologies have the potential to improve upper limb mobility, grip strength, and manual dexterity, as well as cognitive function, attention, and spatial awareness. Innovative balance and gait rehabilitation programs have been shown to improve functional mobility and reduce the risk of falls. The use of these technologies in combination with other rehabilitation modalities may lead to even greater improvements in motor function and cognitive abilities.

A Study to Assess the Effects of Intercostobrachial Nerve Block in the Management of Post-mastectomy Pain

Abstract Introduction: Mastectomy can lead to post-mastectomy pain syndrome (PMPS). The present study was planned to investigate the effectiveness of intercostobrachial nerve (ICBN) blockade in the alleviation and improvement of pain intensity and upper arm mobility. Materials and Methods: The present study was an observational descriptive study with a prospective longitudinal design conducted in the Department of Physical Medicine and Rehabilitation of a tertiary care hospital in West Bengal, over a period of 18 months. All consenting patients of breast cancer who had undergone mastectomy and presented with PMPS were included in the study. The calculated sample size was 34. After the ICBN block procedure, the pain and upper arm mobility of the patients were measured using a numerical rating scale (NRS) and QuickDASH (QD) scale at 1, 4, and 12 weeks and compared with baseline scores. Results: The mean age of the participants was 48 ± 9.2 years. Of the women, 23.5% were overweight. The mean body mass index of the study participants was 23 ± 2.6 kg/m2. Most participants in the present study had a per capita monthly income of <INR 11,595. The mean duration of PMPS amongst the participants was found to be 8.6 ± 2.9 months. The mean NRS score at baseline was 7.8 ± 0.9. The mean QD score was observed to be 49.9 ± 12.9 at presentation. After the ICBN block was performed, on subsequent measurements at 1 week, 4 weeks, and 12 weeks, it was observed that there was a significant lowering of both pain (mean ± standard deviation [SD] NRS score 3.1 ± 1.1, 2.3 ± 0.7, and 2 ± 0.7), and improvement of upper limb mobility (mean ± SD QD score 25 ± 12.9, 6.4 ± 4.6, and 6.4 ± 4.6). On comparing the pain scores over time, it was observed that there was a statistically significant lowering of the NRS score from baseline till 12 weeks. The same was observed for QD scores. Conclusions: ICBN blockade is an important modality of pain control and quality of life improvement in patients suffering from PMPS in their post-operative period.

Axilla Reconstruction Post Burn Contracture: Thoracodorsal Artery Flap Versus Local Flap and Skin Grafts

Background: Burns are a prevalent worldwide morbidity that frequently results in contractures that impede function and appearance, especially in the axilla, which has a major impact on upper limb mobility. Aim: To compare the functional results of local flaps with skin transplants versus Thoracodorsal artery flaps for axilla repair following burn contracture. Methods: A prospective comparative study was conducted. In the Department of Plastic and Reconstructive Surgery, thirty patients were split into two groups for a prospective comparative study. Group B underwent local flaps utilizing skin grafts, whereas Group A underwent thoracodorsal artery flaps. An analysis was conducted on pre- and post-operative shoulder joint abduction, complications, and demographic factors. Result: The two groups' post-operative shoulder abduction did not significantly differ, according to the results; however, younger patients and those with concomitant conditions including diabetes and hypertension were more likely to benefit from thoracodorsal artery flaps because of increased vascularization. The study discovered that middle-aged individuals typically had local flaps, but younger patients frequently had thoracodorsal artery flaps. Though not statistically significant, the gender distribution revealed a trend with more males obtaining local flaps and more females receiving thoracodorsal artery flaps. Thoracic dorsal artery flaps were substantially more common in patients with diabetes and hypertension. Practical Implication: The higher prevalence of thoracodorsal artery flaps in patients with diabetes and hypertension underscores importance of choosing flaps that provide better vascular support for patients with compromised vascular health. Conclusion: The findings highlight the significance of considering patient-specific criteria when choosing a flap, as thoracodorsal artery flaps provide better vascular support and are advantageous for patients with compromised vascular health. These results emphasize the need for customized surgical planning to improve results in post-burn contracture axilla repair. To enhance patient care and further improve surgical protocols, future research should concentrate on long-term results.

Biofeedback-Based Proprioceptive Training to Improve Functional Prerequisites of Dragon Boating in Breast Cancer Survivors.

Breast cancer (BC)-related sequelae drastically impact the psychophysical functioning and quality of life of affected women. Adapted physical activity (APA) has proved to effectively counteract these impairments in a non-medicalized framework. In particular, dragon boats are able to promote body functionality, social interaction, and quality of life in BC survivors, but the literature on specific motor gestures is scarce and practice is still based more on a re-educative perspective than a performative one. In this context, the present longitudinal study investigated the benefits of an adapted biofeedback-based sensorimotor training intervention on upper body functionality in a team of dragon ladies. The 8-week intervention was conceived as integrated dry workout sessions led by an APA kinesiologist and applied a novel sensorized proprioceptive device, such as a Libra board. Post-protocol evaluation revealed a significant improvement in bilateral upper limb mobility, core endurance, and trunk stability along with a distress decrease and quality of life enhancement through validated assessment tools. Our findings suggest that integrating biofeedback-based workout sessions can effectively promote upper body functionality in BC survivors practicing dragon boating. Furthermore, our innovative approach could help spread methodological hints able to boost exercise adherence in this target population, thus counteracting cancer recurrence while promoting overall well-being.

Effectiveness of Virtual Reality-Based Interventions for Upper Limb Rehabilitation in Breast Cancer Patients: Systematic Review and Meta-Analysis.

Purpose: To investigate the effectiveness of virtual reality (VR)-based interventions for functional rehabilitation of the upper limb in breast cancer patients through a systematic review and meta-analysis. Methods: The PubMed, Cochrane, Web of Science, CINAHL, Scopus, CNKI, Wanfang, and VIP databases were systematically searched for relevant literature published from the establishment of the database to June 2023. Differences in the effectiveness of VR-based interventions and other intervention therapies were compared using random effects model meta-analysis and standard deviation (SMD). Results: Seven eligible articles were identified and included in the meta-analysis. The combined analysis found that VR-based interventions had a positive impact on patients' upper limb mobility in terms of flexion (SMD = 1.33, 95% confidence interval; CI [0.48-2.19], P = 0.002), abduction (SMD = 1.22, 95% CI [0.58-1.86], P = 0.0002), and external rotation (SMD = 0.94, 95% CI [0.48-1.40], P < 0.0001). In addition, VR-based interventions could significantly improve the postoperative pain of patients with breast cancer. However, in grip strength (SMD = 0.43, 95% CI [-3.05 to 3.92], P = 0.81), shoulder muscle strength in flexion strength (SMD = 0.05, 95% CI [-2.07 to 2.18], P = 0.96), abduction strength (SMD = -0.10, 95% CI [-1.32 to 1.12], P = 0.88), external rotation strength (SMD = 0.46, 95% CI [-1.96 to 2.88], P = 0.71), and lymphedema, VR was as effective as other intervention treatments. A subgroup analysis showed that patients younger than 55 years had more benefit with VR-based rehabilitation than with other interventions and showed improvements with the intervention within 2 weeks. The intervention effect of using auxiliary equipment such as robotic arms is better than VR exercise based solely on games. Conclusion: The results of meta-analysis show that the intervention measures based on VR have positive effects on the improvement of upper limb mobility and pain relief in breast cancer patients. However, considering the low quality of evidence and small sample size, more clinical studies should be conducted to improve the credibility of the results.

Exergames as a rehabilitation tool to enhance the upper limbs functionality and performance in chronic stroke survivors: a preliminary study.

Post-stroke hemiplegia commonly occurs in stroke survivors, negatively impacting the quality of life. Despite the benefits of initial specific post-acute treatments at the hospitals, motor functions, and physical mobility need to be constantly stimulated to avoid regression and subsequent hospitalizations for further rehabilitation treatments. This preliminary study proposes using gamified tasks in a virtual environment to stimulate and maintain upper limb mobility through a single RGB-D camera-based vision system (using Microsoft Azure Kinect DK). This solution is suitable for easy deployment and use in home environments. A cohort of 10 post-stroke subjects attended a 2-week gaming protocol consisting of Lateral Weightlifting (LWL) and Frontal Weightlifting (FWL) gamified tasks and gait as the instrumental evaluation task. Despite its short duration, there were statistically significant results (p < 0.05) between the baseline (T0) and the end of the protocol (TF) for Berg Balance Scale and Time Up-and-Go (9.8 and -12.3%, respectively). LWL and FWL showed significant results for unilateral executions: rate in FWL had an overall improvement of 38.5% (p < 0.001) and 34.9% (p < 0.01) for the paretic and non-paretic arm, respectively; similarly, rate in LWL improved by 19.9% (p < 0.05) for the paretic arm and 29.9% (p < 0.01) for non-paretic arm. Instead, bilateral executions had significant results for rate and speed: considering FWL, there was an improvement in rate with p < 0.01 (31.7% for paretic arm and 37.4% for non-paretic arm), whereas speed improved by 31.2% (p < 0.05) and 41.7% (p < 0.001) for the paretic and non-paretic arm, respectively; likewise, LWL showed improvement in rate with p < 0.001 (29.0% for paretic arm and 27.8% for non-paretic arm) and in speed with 23.6% (p < 0.05) and 23.5% (p < 0.01) for the paretic and non-paretic arms, respectively. No significant results were recorded for gait task, although an overall good improvement was detected for arm swing asymmetry (-22.6%). Hence, this study suggests the potential benefits of continuous stimulation of upper limb function through gamified exercises and performance monitoring over medium-long periods in the home environment, thus facilitating the patient's general mobility in daily activities.

Nursing Experience Using Art Therapy to Help Women With Breast Cancer Face Changes in Body Image

The subject in this study was a female professional painter who underwent bilateral mastectomy because of bilateral breast cancer, experienced postoperative wound scarring, and developed alopecia due to the side effects of chemotherapy, which caused the patient to lose body image confidence and the motivation to engage in artistic creativity. The patient had shed tears early in the intervention and complained of difficulties with body image adjustment due to her altered appearance. Mastectomy patients must not only undergo drug treatment but also adjust psychologically to body image changes to decrease negative emotions. This was the author's motivation for involvement in this case. The nursing period was from 23 September to 30 December 2021. Physical, mental, spiritual, social, and family data were collected using observations and interviews. These data were evaluated and the main problems were determined to be disturbed body image related to altered body perception post-surgery, alopecia caused by chemotherapy, impaired physical mobility due to upper limb mobility limitations post-surgery, and nausea due to chemotherapy. The patient was encouraged to paint again and to use artistic creativity to comfort herself. Moreover, she was guided to express her innermost thoughts to face the impact of her changes in appearance. In addition, a care consultation channel was provided to facilitate experience sharing with other breast cancer patients, thus assisting the patient to cope with the mental impact of her treatments and face subsequent cancer treatments with a more positive attitude. Art therapy embraces a diverse variety of methods, including drawing and music. Art therapy is a valuable tool that facilitates both physical and mental healing. Based on this experience, nurses should include patients' close relatives when performing art therapy to facilitate shared care to overcome difficulties. We hope this nursing experience provides a practical reference for nurses.

OPERA and ORATORIO – how the world has been changed by “music”

Multiple sclerosis is a chronic autoimmune disease that progresses over time, leading to disability. The condition is still incurable, but available therapies are increasingly effective. Ocrelizumab is the first anti-CD20 monoclonal antibody approved for the treatment of relapsing-remitting and primary progressive forms of multiple sclerosis. In the article, based on the results of the OPERA and ORATORIO clinical trials, their extensions, and post-hoc and meta-analyses, the evidence for long-term high effectiveness of the molecule is presented. Aspects including the control of relapses (annual relapse rate and time to relapse), delay in the occurrence of confirmed disability, probability to achieve disability improvement, need to use a wheelchair and loss of upper limb mobility, as well as radiological activity (gadolinium-enhancing lesions, new T2 lesions, brain atrophy), are assessed. An additional advantage of the OPERA studies is that almost similar results, acquired with identical protocols in a different patient populations, were achieved. Moreover, the effects of therapy did not wear off over time. Based on these findings, ocrelizumab can be regarded as a highly effective therapy in multiple sclerosis, with the highest (48%) NEDA-3 index (no evidence of disease activity) and the greatest potential for delaying the onset of confirmed disability. The presented studies also confirm the benefit of introducing the drug in multiple sclerosis therapy as early as possible.

An intergenerational service-learning approach to improve hand function in older adults

ABSTRACT Homebound older adults are at greater risk for functional impairments, social isolation, and loss of independence. Adequate hand function is needed to perform many daily activities, yet is understudied, particularly in the homebound population. The purpose of this study was to pilot test an intergenerational program in which pre-health college students were trained to deliver hand exercises to homebound older adults receiving Meals on Wheels (MOW) services. Eight MOW clients (mean age: 80.1 ± 12.9y) and 17 students completed the program. Students visited clients 2×/week for 6 weeks and engaged in hand exercises and meaningful conversations. Measures of hand strength, dexterity, self-reported function, self-efficacy, depression, and social isolation were taken before and after the program. Clients and students also completed a post-program experience survey. Significant improvements in pinch strength were observed, and 75% of clients reported better upper limb mobility after training. Survey feedback was positive with clients saying they enjoyed interacting with college students, while students praised the hands-on nature of the program and engagement with older adults. Results from this pilot study demonstrate an intergenerational approach to deliver hand training is feasible and underscores the value of using such models to increase access to care for homebound older adults.

Influence of Manual Therapy and Stretching Exercises on Mobility Status and Pulmonary Function Tests Among Patients with Ankylosing Spondylitis

Introduction: AS (ankylosing spondylitis) is a systemic disease that impairs entire body functioning of a patient. The most common dysfunctions concern the area of the chest, spine and upper limb. As a consequence of these dysfunctions, the lungs of patients work in abnormal conditions, impairing their functioning.Objectives: The aim of the study is assessing the impact of rehabilitation among patients with AS on functional and respiratory parameters.Material and methods: The study comprised 45 patients divided into two groups. For 25 patients in the group rehabilitation was focused on manual therapy (TM) while 20 patients were rehabilitated on the basis of stretching exercises (SE). As part of improvement progress assessment, the following were measured: upper limb mobility, chest expansion, Occiput to Wall Distance test, spinal angle, functional examination of the respiratory system, the Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI) and Pain Disability Index (PDI) questionnaires.Results: After rehabilitation, the Occiput to Wall Distance test also improved expansion of the chest. The BASDAI, BASFI, questionnaires and the VAS scale improved in both study groups. Among respiratory parameters, inspiratory and respiratory muscle strength further increased.Conclusions: Rehabilitation is a very effective form of improving the patient's functional status and should be an indispensable element of the patient's treatment. Both manual therapy and stretching exercises have been shown to be successful.

Latent transition analysis to explore patterns of physical functional decline among older adults in China: A national 6-year longitudinal study

Background and aimsMultiple limitations often co-occur and accumulate, leading to subsequent function decline. However, there is a scarcity of longitudinal studies examining the progression of physical function among the general population of older adults in China. This study aimed to define typical physical function status and its change, which were characterized by the coexistence and accumulation of diverse limitations targeting a Chinese sample of older adults. MethodsThis study used the three recent public data waves of the Chinese Longitudinal Healthy Longevity Survey during a 6-year follow-up period. 9765 individuals who were over 65 and participated in the 2011 survey were included. Latent transition analysis was used to identify the latent physical function status and explore the transition of older adults among different latent statuses. ResultsSeven latent statuses of physical function were identified, with visual impairment and related limitations being particularly prevalent among older adults. Upper limb mobility appeared to be a differentiated indicator of physical functional status. Physical function decline mainly started with the limitations in squatting, carrying weights and walking, then to the status with intact upper limb mobility and hearing function only, or converted directly into the latter, then to complete dysfunction. ConclusionsOur findings suggest some indicative limitations and critical steps in the process of functional decline among older adults. These results may provide insight for researchers and policymakers to develop tailored preventive and rehabilitation care and provide support for physically limited elderly according to their latent status and course of functional decline.

Safety and efficacy of ultrasonography of tension after zone II flexor tendon repair: A randomized controlled trial

BackgroundPrimary flexor tendon repairs of lacerations in zone II of the hand are fraught with problems. Traditionally, exercise (active and passive), orthoses, and physical agents are common interventions for the rehabilitation of patients experiencing these issues. One area of focus in this field is how to safely utilize tension to lengthen gliding distance following zone II injury. Finding effective solutions in this area is a key priority for improving patient outcomes and quality of life. PurposeTo identify the optimal immobilization position that meets safety standards for tension and is the most efficient, and consequently, to validate our clinical effectiveness. Study DesignA cross-sectional study was adopted for the first part of the research (Research 1). A prospective, parallel, 2-group, randomized trial was conducted with concealed allocation and single blinding in the second part of the research (Research 2). MethodsA total of 60 healthy adults were recruited to select the best-fit protective immobilization position in Research 1, which was confirmed by tendon tension (via Young’s modulus) and excursion (via gliding distance). We then randomly assigned 45 patients after zone II flexor tendon repair into two groups in Research 2 to compare functional outcomes. The control group underwent the conventional modified Duran protocol with early passive motion, while the experimental group received the protocol (optimized by Research 1) with early active motion. Ultrasonography was used to measure the tension and excursion of the flexor tendons. The outcomes measured at 16 weeks post-repair included total active motion, strength, the Disabilities of the Arm, Shoulder and Hand, and Strickland scores. ResultsThree participants were unable to participate in Research 2 due to medical issues and poor attendance. The investigation found that the safe tendon threshold was 345.09 ± 87.74 kPa for partial active digital motion among the 60 participants. The optimal immobilization position requires the wrist to be neutral with a flexion angle of 30° at the metacarpophalangeal joint. The grip strengths (p = 0.012), ratio of grip strength (p = 0.015), the Disabilities of the Arm, Shoulder and Hand (p = 0.036), and total active motion (p = 0.023) differed significantly between the two groups. ConclusionsProtective immobilization of the wrist in a neutral flexion position and with the metacarpophalangeal joint flexed at 30° can secure the repaired flexor tendon safely and efficiently. The effects of an early active motion ‎protocol may improve the grip strength and upper limb mobility of individuals after zone II flexor tendon repair. Clinical trial registrationChiCTR2000030592.

Analysis and Clustering of Upper Limb Motion during the Hand Dexterity Pegboard Test using Inertial Sensor Systems.

Maintaining hand and upper limb mobility is important from the viewpoint of freedom in daily life and high performance in work. Few studies on the mobility and dexterity of the upper limb have focused on detailed hand and finger movements. Therefore, we measured the motion of the upper limbs during a general hand dexterity pegboard test using inertial sensor systems and our previous measuring method. To clarify the characteristics of each purpose of motion, we divided the peg-in-hole motion in the pegboard test into its three sections, focusing on two sections: the pinch section, and the carry and insert section. In addition, the obtained joint angles were grouped into arm group and finger group, and singular value decomposition was performed for each joint group in each section. By clustering the decomposition results across five subjects' multiple right and left arm tests, and averaging the singular vectors in the same cluster, the joint distributions and combinations could be clarified. In addition, by recalculating joint angles from averaged SVD results and applying them to the rigid link model, we obtained motion animation with characteristics that made it possible to more clearly understand the requirements for greater dexterity. These results suggested high dexterity motion characteristics in the pinch section, and the carry and insert section of the pegboard test.

Улучшение речи у детей с ДЦП на фоне реабилитации с применением нейроинтерфейса «мозг–компьютер–экзоскелет кисти»

As explained earlier, neurorehabilitation sessions involving the use of the non-invasive “brain – computer – hand exoskeleton” interface reduce hand muscle spasticity and improve motor skills in children with cerebral palsy (CP). However, the changes in the patients’ speech functions and their relationship with the upper limb mobility have not been analyzed. The study was aimed to assess the correlation between the motor and speech functions of children with CP, as well as to detect the changes in motor realization of speech production following complex treatment of patients including sessions of neurorehabilitation. The study involved children with CP aged 6–15. The index group (n = 40, 16 girls, 24 boys) received complex resort treatment with the course of neurorehabilitation, while the comparison group (n = 20, 10 girls, 10 boys) received standard resort treatment. A significant (р &lt; 0.001) correlation between the total ABILHAND-Kids score and the indicators of speech production motor realization was revealed. In patients of the index group, complex treatment with the course of neurorehabilitation resulted in the significant (р &lt; 0.001) decrease in hand spasticity and the increase in the total ABILHAND-Kids score and speech scores. No significant changes of these indicators were revealed in children of the comparison group. Beneficial effects of neurorehabilitation may be based on the enhanced plasticity of the neural circuits responsible for planning and execution of complex hand movements, as well as speech processes. The findings can be used to develop new methods for correction of motor and cognitive spheres in children with CP.

Criterion validity of the spatial exploration test of upper limb mobility to evaluate the active horizontal workspace of children with spinal muscular atrophy

Purpose To determine the criterion validity of the SET-ULM (Spatial Exploration Test of Upper Limb Mobility), a functional workspace test. Materials and Methods A prospective study from July 2017 to November 2018 in 30 children with SMA type 1 or 2. All children underwent assessment with the SET-ULM and the Motor Function Measure (MFM). Results We included 30 children. Median (Q1; Q3) MFM D1 (standing ability, ambulation and transfers), D2 (axial and proximal motor function), D3 (distal motor function) scores, Total MFM and Total SET-ULM active score were respectively 2.6% (2.6–3.8); 45.8% (19.9–65.3); 57.7% (36.9–80.9); 35.4% (16.7–43.2) and 70.2% (49.7–97.9). Total SET-ULM active score was strongly correlated with the MFM D2 dimension score (rho 0.82; p < 001), with the D3 dimension (rho 0.86; p < 0.001) and with the Total MFM score (rho 0.89; p < 0.005). Total SET-ULM active score differed between SMA types (p < 0.01). Conclusion The SET-ULM has good criterion validity for the evaluation of available horizontal active upper limb workspace in children with SMA1 and SMA2. Future studies should evaluate reliability and sensitivity to change during a longitudinal follow-up study, as well as in a longitudinal trial of therapeutic effectiveness. Clinical Trials NCT03223051 IMPLICATIONS FOR REHABILITATION The Spatial Exploration Test for Upper Limb Mobility is a useful adjunct to the Motor Function Measure. It provides a precise evaluation of horizontal reaching ability. The Spatial Exploration Test for Upper Limb Mobility will be of great clinical utility for the evaluation of the effects of treatments for spinal muscular atrophy.

Desktop Voice Assistant Using Artificial Intelligence

To make calls, send emails and texts, search things online, give directions, fold and unfold apps, set appointments on our calendars, and initiate or complete various tasks. For those in the e-Commerce industry, there is a great way to thrill customers, by providing them with the ease of online shopping on any device hours, but it's not possible to send them such assistance physically. At these situations, the virtual voice assistants help a lot by solving the problems of the consumers. While interacting with people or with some organization online, most people have to deal with language barriers. Personal assistant technology using voice assistant technology-enabled integrated with automatic translation helps to break the chatbots. Sometimes consumers requires assistant at odd language barrier. Artificial intelligence assistant technology helps your business or start-up to up to date regular operations. Things such as remembering important appointments, deadlines, arrangement etc. can be all triggered using specific voice commands. AI is capable of picking up teasing indications required to combine the data and give results at a moment's notice.Moreover, the voice feature frees up your arms so that we can complete tasks simultaneously. The car voice assistant experience has enabled drivers to have a safe hands-free experience: making and receiving phone calls, managing music, and navigation, taking out orders, booking services, and scheduling appointments. Voice assistant helps disabled persons Qike persons who have issues with upper limb mobility or eyesight) to perform various tasks. Recruiting a personal voice assistant gives you enough time to alleviate, take a check and get a grip on your life by finding balance. Once you embark on an enterprising venture family time is restricted to those occasional family trips. Get ample amount of time every day to sit at the dinner table and have a proper conversation with your family by hiring a virtual voice assistant.

Neurochondrin Autoimmunity With Slow Saccades: A Case Report

Objective N/A. Background Neurochondrin is a cytoplasmic neuronal antigen that can be targeted by specific antibodies, resulting in an antigen-specific T-cell response and autoimmune cerebellar and brain stem degeneration.1 Previously reported cases of neurochondrin antibody positivity have been predominantly associated with rapidly-progressive rhombencephalitis, but various other neurological symptoms and signs may be present.1,2 Design/Methods N/A. Results 34-year-old woman presented with 2 years of constant numbness in her toes, gradually worsening to involve the entire lower and upper extremities. She also reported dysarthria, imbalance, and leg spasticity. Neurological examination showed a slow, wide-based gait, brisk reflexes bilaterally, and bilateral extensor plantar responses. MRI brain was normal and CSF analysis showed 7 oligoclonal bands. The patient was diagnosed with probable multiple sclerosis and steroids were initiated but resulted in no improvement of symptoms. Plasmapheresis was also ineffective. 3 months later, MRI showed subtly increased T2 signal of the central cord mainly involving the gray matter at the level of C5 and C6. CSF analysis showed 15 oligoclonal bands and an elevated IgG index of 1.39. VDRL was nonreactive. HTLV, ANCA, AQP4, CSF VZ PCR, HSV PCR, and HHV6 PCR were all negative. EMG showed mild length-dependent axonal sensory motor peripheral neuropathy. On neuro-ophthalmic examination, the patient showed slowed saccades with some preservation of optokinetic nystagmus (OKN) fast phases. Repeat MR showed abnormal T2 hyperintensity in the anterior horns of the gray matter from C1-2 to T1. Serum testing at that time showed a positive neurochondrin antibody. She was then started on cyclophosphamide and mycophenolate mofetil. 6 months after initiation of cyclophosphamide, dysarthria and upper limb mobility improved, and she had no further neurological deterioration at that time. Conclusions Neurochondrin IgG-related autoimmunity is rare and can result in a wide variety of neurological signs and symptoms. Ocular dysmotility, including slowed saccades, may be present.

Design and Implementation of a Personalizable Alternative Mouse and Keyboard Interface for Individuals with Limited Upper Limb Mobility

People with neuromuscular diseases often experience limited upper limb mobility, which makes the handling of standard computer mice and keyboards difficult. Due to the importance of computers in private and professional life, this work aims at implementing an alternative mouse and keyboard interface that will allow for their efficient use by people with a neuromuscular disease. Due to the strongly differing symptoms of these diseases, personalization on the hardware and software levels is the focus of our work. The presented mouse alternative is based on a spectacle frame with an integrated motion sensor for head tracking, which enables the control of the mouse cursor position; the keyboard alternative consists of ten keys, which are used to generate word suggestions for the user input. The interface was tested in a user study involving three participants without disabilities, which showed the general functionality of the system and potential room for improvement. With an average throughput of 1.56 bits per second achieved by the alternative mouse and typing speeds of 8.44 words per minute obtained using the alternative keyboard, the proposed interface could be a promising input device for people with limited upper limb mobility.

PO153 / #860 LASER-MICROMACHINING OF PADDLE LEADS FOR SPINAL CORD STIMULATION: E-POSTER VIEWING

Spinal cord stimulation (SCS) is a rapidly growing area in the field of neuromodulation therapies. It is applied to treat chronic pain, peripheral vascular disease, refractory angina, painful diabetic neuropathy, incontinence, and other conditions. Future application will also address restoration of lower and upper limb mobility and other motor-related conditions. Electrical interfaces to the spinal cord are typically designed as percutaneous leads (contacts are arranged as electrically conductive segments of a cable) or as surgical (paddle) leads.

Improving Upper Extremity Bradykinesia in Parkinson's Disease: A Randomized Clinical Trial on the Use of Gravity-Supporting Exoskeletons.

Hand movements are particularly impaired in patients with Parkinson’s Disease (PD), contributing to functional disability and difficulties in activities of daily living. Growing evidence has shown that robot-assisted therapy may be considered an effective and reliable method for the delivery of the highly repetitive training that is needed to trigger neuroplasticity, as intensive, repetitive and task-oriented training could be an ideal strategy to facilitate the relearning of motor function and to minimize motor deficit. The purpose of this study is to evaluate the improvement of hand function with semi-autonomous exercises using an upper extremity exoskeleton in patients with PD. A multicenter, parallel-group, randomized clinical trial was then carried out at the IRCCS Centro Neurolesi Bonino-Pulejo (Messina, Italy). Thirty subjects with a diagnosis of PD and a Hoehn–Yahr score between 2 and 3 were enrolled in the study. Patients were 1:1 randomized into either the experimental group (ERT), receiving 45 min training daily, 6 days weekly, for 8 weeks with Armeo®Spring (Volketswil, Switzerland) (a gravity-supporting device), or the control group (CPT), which was subjected to the same amount of conventional physical therapy. Motor abilities were assessed before and after the end of the training. The main outcomes measures were the Nine-hole peg test and the motor section of the UPDRS. All patients belonging to ERT and 9 out of 15 patients belonging to the CPT completed the trial. ERT showed a greater improvement in the primary outcome measure (nine-hole peg test) than CPT. Moreover, a statistically significant improvement was found in ERT concerning upper limb mobility, and disease burden as compared to CPT. Using an upper extremity exoskeleton (i.e., the Armeo®Spring) for semi-autonomous training in an inpatient setting is a new perspective to train patients with PD to improve their dexterity, executive function and, potentially, quality of life.