Use Of Upper Limb Research Articles

Surgical treatment of clavicular malignancies

Primary and metastatic malignancies of the clavicle are very rare, and little literature is available regarding the long-term functional and oncologic outcome after surgical treatment. To what advantage or disadvantages clavicle reconstruction following claviculectomy will lead is not clear. The hypothesis is that there is no advantage of allograft reconstruction over no reconstruction in terms of the functional outcome and complications. From 1999 to 2009, 11 patients with clavicular malignancy underwent total or subtotal claviculectomy with or without allograft reconstruction. Oncologic and functional results were assessed. The average age at time of operation was 31.9 years. The mean follow-up time was 42.4 months. Six patients had allograft reconstruction after tumor resection, and 5 had claviculectomy alone. No local recurrence occurred. The oncologic result was continuous disease-free in 5 patients, no evidence of disease in 1, alive with disease in 2, and died of disease in 3. Patients with and without allograft reconstruction had average Musculoskeletal Tumor Society score of 92.2% vs 96.2% and Constant-Murley scores of 84.8 vs 88.8. Patients with allograft reconstruction had more complications than patients without reconstruction. Considering complications, allograft reconstruction does not guarantee a satisfied patient. Total or subtotal excisions of the clavicle without reconstruction for malignancies are rarely associated with a clinically significant loss of function. Furthermore, the average time of full use of upper limb was slower in patients with reconstruction compared with those without reconstruction. Clavicular malignancies had poor prognosis, although claviculectomy could provide good local tumor control. Allograft reconstruction after claviculectomy was not justified for malignancies in terms of its functional outcomes as well as complications.

Validity and reliability of the VOAA-DDD to assess spontaneous hand use with a video observation tool in children with spastic unilateral cerebral palsy

BackgroundIn 2003 new computer software, the VOAA (Video Observations Aarts and Aarts), was designed to score and evaluate two important aspects of spontaneous upper limb use, i.e. overall duration and frequency of specific behaviours. The aim of this study was to investigate the test-retest, interrater and intrarater reliability and the construct validity of a new module, the VOAA-DDD, to determine developmental disregard in children with spastic unilateral cerebral palsy (CP).MethodsA test-retest design with three raters for reliability and a two-group design for construct validity were used. Subjects were a total of 20 children with spastic unilateral CP equally divided in two age groups (2.5-5 and 5-8 years), and 56 healthy children of the same age groups. Overall duration and frequency of specific behaviours of the affected arm and hand were assessed during a task demanding ('stringing beads') and a task stimulating ('decorating a muffin') the use of both hands. Reliability was estimated by intraclass correlation coefficients (ICCs). Construct validity was assessed by comparing children with CP to healthy children.ResultsAll ICCs exceeded 0.87. In contrast with healthy children, children with CP used their affected hand less during the 'muffin' task compared to the 'beads' task. Of the children with CP, 90% in the age group of 2.5-5 years and 50% in the age group of 5-8 years showed values exceeding the extreme values of healthy controls, respectively, indicating developmental disregard.ConclusionThe VOAA-DDD is a reliable and valid instrument to assess spontaneous use of the affected arm and hand in order to determine developmental disregard in children with spastic unilateral CP.

Benchmark Comparison of Outcomes for Clients With Upper-Limb Dysfunction After Stroke Using the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs–OT)

The objective was to benchmark upper-limb outcomes for clients after stroke by confirming a local benchmark and comparing this benchmark with data from a prospective sample. METHOD. Expert occupational therapists were surveyed to confirm benchmark sample data (n=20). Treatment sample data (n=20) were collected at three subacute units. Outcomes were recorded using the Australian Therapy Outcome Measures for Occupational Therapy Upper-Limb Use scale. Results confirmed benchmark sample scores. Treatment sample participants were significantly younger than the benchmark sample; however, a two-way analysis of variance indicated that both samples improved to a similar degree. Therapists at the facilities where the treatment was provided can feel confident that they are meeting benchmark standards and may strive in the future to achieve better outcomes. Further benchmarking studies are required to encourage therapists to evaluate their performance and implement strategies to improve the efficiency and effectiveness of practice.

A Self-Administered Graded Repetitive Arm Supplementary Program (GRASP) Improves Arm Function During Inpatient Stroke Rehabilitation

More than 70% of individuals who have a stroke experience upper limb deficits that impact daily activities. Increased amount of upper limb therapy has positive effects; however, practical and inexpensive methods of therapy are needed to deliver this increase in therapy. This was a multi-site single blind randomized controlled trial to determine the effectiveness of a 4-week self-administered graded repetitive upper limb supplementary program (GRASP) on arm recovery in stroke. 103 inpatients with stroke were randomized to the experimental group (GRASP group, n=53) or the control group (education protocol, n=50). The primary outcome measure was the Chedoke Arm and Hand Activity Inventory (CAHAI), a measure of upper limb function in activities of daily living. Secondary measures were used to evaluate grip strength and paretic upper limb use outside of therapy time. Intention-to-treat analysis was performed. Group differences were tested using analysis of covariance. At the end of the 4-week intervention (approximately 7 weeks poststroke), the GRASP group showed greater improvement in upper limb function (CAHAI) compared to the control group (mean difference 6.2; 95% CI: 3.4 to 9.0; P<0.001). The GRASP group maintained this significant gain at 5 months poststroke. Significant differences were also found in favor of the GRASP protocol for grip strength and paretic upper limb use. No serious adverse effects were experienced. A self-administered homework exercise program provides a cost-, time-, and treatment-effective delivery model for improving upper limb recovery in subacute stroke.

Articular morphology of the proximal ulna in extant and fossil hominoids and hominins

Extant hominoids share similar elbow joint morphology, which is believed to be an adaptation for elbow stability through a wide range of pronation–supination and flexion-extension postures. Mild variations in elbow joint morphology reported among extant hominoids are often qualitative, where orangutans are described as having keeled joints, and humans and gorillas as having flatter joints. Although these differences in keeling are often linked to variation in upper limb use or loading, they have not been specifically quantified. Many of the muscles important in arboreal locomotion in hominoids (i.e., wrist and finger flexors and extensors) take their origins from the humeral epicondyles. Contractions of these muscles generate transverse forces across the elbow, which are resisted mainly by the keel of the humeroulnar joint. Therefore, species with well-developed forearm musculature, like arboreal hominoids, should have more elbow joint keeling than nonarboreal species. This paper explores the three- and two-dimensional morphology of the trochlear notch of the elbow of extant hominoids and fossil hominins and hominoids for which the locomotor habitus is still debated. As expected, the elbow articulation of habitually arboreal extant apes is more keeled than that of humans. In addition, extant knuckle-walkers are characterized by joints that are distally expanded in order to provide greater articular surface area perpendicular to the large loads incurred during terrestrial locomotion with an extended forearm. Oreopithecus is characterized by a pronounced keel of the trochlear notch and resembles Pongo and Pan. OH 36 has a morphology that is unlike that of extant species or other fossil hominins. All other hominin fossils included in this study have trochlear notches intermediate in form between Homo and Gorilla or Pan, suggesting a muscularity that is less than in African apes but greater than in humans.

Acute phase functional electrical stimulation for the upper limb after cervical spinal cord injury

Aims Anecdotal evidence suggests that early treatment with functional electrical stimulation (FES) to specific upper limb muscles and muscle groups may improve functional outcome and long-term independence in the high-level tetraplegic patient. This improvement may lead to increased independence in daily life. The authors aimed to investigate these assertions using a case study design, and encourage further work on this treatment strategy. Methods The implementation of FES at an early stage post-injury in one cervical spinal cord-injured patient is described. FES was applied with the aim of improving functional use of upper limbs. Muscle strength was assessed, using manual muscle testing with the Oxford scale, at commencement and cessation of FES treatment. Independence in activities of daily living was also recorded. Findings This case study suggests that use of FES applied during the acute phase following injury can have a positive effect on both physical and psychological outcomes. Conclusions Further work is recommended to strengthen the evidence for this intervention.

Intérêt de la thérapie par contrainte induite chez l’enfant hémiplégique après lésion cérébrale acquise

Constraint-induced movement therapy is a promising technique for improving upper limb function in adults with hemiplegia. It involves restraint of the non-involved limb and intensive movement practice with the paretic limb. Although the technique has been applied successfully to children with cerebral palsy, only two studies have used it in children with acquired brain injury. ObjectiveTo assess the feasibility and efficacy of constraint-induced movement therapy in children with acquired brain injury. MethodsWe used a single-subject experimental design in three children (aged five at the time of the intervention) with hemiplegia in the chronic phase following acquired brain injury. The intervention involved restraint of the unaffected arm with a Mayo Clinic elbow brace for seven hours a day in a hospital setting, together with three hours a day of physical and occupational therapy rehabilitation for five days a week for two weeks. The children were assessed twice at baseline and then once immediately post-treatment and again two months post-treatment. Assessment included a range of timed, quantitative measures of upper limb use, assessment of unilateral spatial neglect and qualitative assessment by therapists and parents in terms of activities of daily living. ResultsThe three children completed the full protocol and improved significantly in all timed, quantitative tests of motor function. These improvements were partially maintained at two months. No improvement in unilateral spatial neglect was found in the paper-and-pencil tasks, although less spatial neglect was observed in activities of daily living such as eating and walking. ConclusionConstraint-induced movement therapy appears to be both feasible and efficient in children with acquired brain injury.

Conservative management of neuromuscular scoliosis: Personal experience and review of literature

Purpose. The principles of conservative management of neuromuscular scoliosis in childhood and adolescence are presented.Methods. Analysis of personal experience and literature review. The topic is discussed separately for patients with flaccid or spastic paresis.Results. These demonstrate that conservative management might be proposed for patients with neuromuscular scoliosis in many clinical situations. In spastic disorders, it maintains the symmetry around the hip joints. Bracing is technically difficult and often is not tolerated well by cerebral palsy children. In patients with flaccid paresis, the fitting and the use of brace is easier than in spastic patients. The flexibility of the spinal curvature is more important. Functional benefits of conservative management of neuromuscular scoliosis comprise stable sitting, easier use of upper limbs, discharge of the abdomen from the collapsing trunk, increased diaphragm excursion, and, not always, prevention of curve progression.Conclusions. Specific natural history and multiple medical problems associated with the disease make the treatment of children with neuromuscular scoliosis an extremely complex issue, best addressed when a team approach is applied. Continuously improving techniques of conservative management, comprising bracing and physiotherapy, together with correctly timed surgery incorporated in the process of rehabilitation, provide the optimal care for patients.

Shoulder kinematic features in the prediction of response to physical therapy in patients with frozen shoulder syndrome

Previous studies have stated that the scapulohumeral rhythm dysfunction can make person prone to glenohumeral joint pathologies. The purpose of this study was to compare scapular upward rotation and scapulohumeral rhythm between dominant and non-dominant shoulder in male overhead athletes and non-athletes. Seventeen overhead athletes and seventeen non-athletes volunteered for this study. Two inclinometers were used to measure humeral abduction and scapular upward rotation in rest position, 45°, 90° and 135° humeral abduction in frontal plane. Findings indicated there was no significant asymmetry in scapular upward rotation and scapulohumeral rhythm in different abduction angles between dominant and non-dominant shoulder in non-athletes. In contrast, overhead athletes' dominant shoulders have more downward rotation in scapular rest position and more upward rotation in 90° and 135° shoulder abduction than non-dominant shoulders. Also, overhead athletes presented scapulohumeral rhythm asymmetry between dominant and non-dominant shoulder in 90° and 135° humeral abduction as dominant shoulders have less scapulohumeral rhythm ratio than non-dominant shoulders. Furthermore, overhead athletes dominant shoulders have more scapular downward rotation in scapular rest position, more scapular upward rotation in 90° and 135° humeral abduction and less scapulohumeral rhythm ratio in 45°, 90° and 135° humeral abduction than non-athletes in dominant shoulders. We suggest that clinicians should be aware that some scapular asymmetry may be common in some athletes. It should not be considered as a pathological sign but rather an adaptation to extensive use of upper limb.

Efficacy of Constraint-Induced Movement Therapy on Involved Upper-Extremity Use in Children With Hemiplegic Cerebral Palsy Is Not Age-Dependent

Constraint-induced (CI) movement therapy has been shown recently to be promising for improving upper-limb function in children with cerebral palsy (CP). Because little is known about patient characteristics predicting treatment efficacy, not all children may benefit from this intervention. Here we examine the relationship between efficacy of a child-friendly form of CI therapy and age on involved upper-extremity function. Twenty children with hemiplegic CP age 4 to 13 years received CI therapy and completed evaluations. Based on established functional and neuromaturational changes in hand skill development, the children were divided into a "younger group" (age 4-8 years, n = 12) and "older group" (age 9-13 years, n = 8). Children wore a sling on their noninvolved upper extremity for 6 hours per day for 10 of 12 consecutive days, during which time they were engaged in play and functional activities. Each child was evaluated by trained evaluators who were blinded to the fact that the children received treatment. The evaluations took place once before the intervention and at 1 week, 1 month, and 6 months after the intervention. Efficacy was examined at the movement efficiency (Jebsen-Taylor Test of Hand Function, subtest 8 of the Bruininks-Oseretsky Test of Motor Proficiency), environmental (caregiver frequency and quality of involved upper-limb use), and impairment (strength, tactile sensitivity, and muscle tone) levels. Children in both age groups had significant improvements in involved hand-movement efficiency and environmental functional limitations, which were retained through the 6-month posttest. However, there were no differences in efficacy between younger and older children. Both hand severity and the children's behavior during testing (number of redirections), with the latter serving as a reasonable correlate for attention during the intervention, were related to changes in performance in the younger group but not in the older group. The results suggest that the intensive practice associated with CI therapy can improve movement efficiency and environmental functional limitations among a carefully selected subgroup of children with hemiplegic CP of varying ages and that this efficacy is not age-dependent.

Adaptations to humeral torsion in medieval Britain

Adaptations to the humeral torsion angle have been identified in the professional throwing athlete. This movement pattern increases the humeral torsion angle, and also increases the extent of external rotation movements in the dominant, throwing limb when compared with the nondominant limb. The purpose of this paper is to test the hypothesis that the humeral torsion angle is an adaptation to upper limb use. This project examines the humeral torsion angle in a number of medieval British populations, as well as a modern cadaver-based sample. The results identify significant differences in the humeral torsion angle both between and within male (P < 0.001, ANOVA) and female (P < 0.014, ANOVA) populations, although the results are not consistent with expected behavior patterns. Statistically significant differences between males and females within the same site were identified in 2 of the 5 samples examined. The mean level of bilateral asymmetry does not approach that reported for the professional throwing athlete. However, a number of individuals have high levels of asymmetry in excess of that identified in the professional throwing athlete. This analysis demonstrates the need for individual rather than population-based analyses, as the heterogeneity within population samples obscures individual variation in activity patterns. The diversity within British medieval society and a lack of specific known behaviors prevent further identification of the functional significance of the humeral torsion angle within the archaeological record examined here.

Measuring Outcomes using the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT): Data Description and Tool Sensitivity

Although there is increasing demand for greater accountability from occupational therapists for the outcomes of their practice, there are few quick, simple and psychometrically sound tools available to measure these outcomes. This paper reports on the first data collection exercise using a new outcome measure, the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT). The aims of this paper are to present the scales, describe the data set and examine whether the scales are sufficiently sensitive to detect change over time in client status. Data were collected with 466 clients at 12 metropolitan and rural health care facilities using the 12 AusTOM-OT scales, which rate the client in relation to the four domains of Impairment, Activity limitation, Participation restriction and Distress/wellbeing. The findings indicated that the most frequently used scales were Self-care, Upper limb use, Transfers and Functional walking and mobility, and that all scales were successful in demonstrating statistically significant client change over time. The AusTOMs-OT can be used to document client outcomes in relation to four important practice domains and thus be of value in research and quality assurance activities seeking to provide evidence that occupational therapy does make a difference to the lives of clients.

Perceived safety and biomechanical stress to the lower limbs when stepping down from fire fighting vehicles

Injuries related to emergency vehicles represent 19% of compensated work accidents for fire fighters, 37% of which occur while stepping down from their vehicles. This study compared the impact forces, the use of upper limbs and the perception of danger of fire fighters as they step down from five different locations on fire trucks. The results show that stepping down from the crew cab facing the street produces impact forces averaging 3.2 times the subject's body weight, but is also perceived as the safest way to descend in one of the two groups of fire fighters that participated in the study. Stepping down from the same location, but facing the truck, produced significantly less impact force and a better distribution of the energy over time. This may be achieved through better control of the descending leg, ankle flexion, and the use of grab bars. A re-design of the access to emergency vehicles should take into account both the safety needs and reduction in biomechanical stress of fire fighters.

Aids, orthoses, and environmental control systems

The provision of effective aids, orthoses, and environmental control systems for people with neurological disability is particularly challenging because of the spectrum of deficits that arise from disease or damage...

Splinting the hand in the functional position after brain impairment: A randomized, controlled trial

Lannin NA, Horsley SA, Herbert R, McCluskey A, Cusick A. Splinting the hand in the functional position after brain impairment: a randomized, controlled trial. Arch Phys Med Rehabil 2003;84:297-302. Objective: To evaluate the effects of 4 weeks of hand splinting on the length of finger and wrist flexor muscles, hand function, and pain in people with acquired brain impairment. Design: Randomized, assessor-blinded trial. Setting: Rehabilitation center in Australia. Participants: Twenty-eight adults with acquired brain impairment, all within 6 months of the first injury. There was 1 withdrawal. Interventions: Subjects in both experimental (n=17) and control (n=11) groups participated in routine therapy[mdash ]motor training for upper-limb use and upper-limb stretches[mdash ]5 days a week. The experimental group also wore an immobilizing hand splint in the functional position (10[deg ][ndash ]30[deg ] wrist extension) for a maximum of 12 hours each night for the duration of the 4-week intervention period. Main Outcome Measures: The length of the wrist and extrinsic finger flexor muscles was evaluated by measuring the torque-controlled range of wrist extension with the fingers extended. Functional hand use was evaluated with the Motor Assessment Scale. Pain was evaluated with a visual analog scale. Results: The effects of splinting were statistically nonsignificant and clinically unimportant. At follow-up, estimates of treatment effects slightly favored the control group: range of motion at the wrist favored controls by 2[deg ] (95% confidence interval [CI], [minus ]7.2[deg ] to 3.2[deg ]), function favored controls by 0.2 points (95% CI, [minus ]2.7 to 2.3), and pain favored the experimental group by 1cm (95% CI, [minus ]4.6 to 2.2). Conclusions: An overnight splint-wearing regimen with the affected hand in the functional position does not produce clinically beneficial effects in adults with acquired brain impairment. [copy ] 2003 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Forced use after TBI: promoting plasticity and function through practice

Objective : To review the literature supporting, and determine the efficacy of, modified constraint-induced therapy (mCIT) in improving more affected upper limb use and function in patients with traumatic brain injury (TBI). Design : Multiple-baseline, pre-post, case series. Setting : Outpatient clinic. Patients : Three patients with TBI occurring >1 year ago and exhibiting stable upper limb hemiparesis and learned non-use. Intervention : Patients participated in 10 sessions of 30 minute, structured physical and occupational therapy, emphasizing more affected arm use in valued, functional activities, three times/week for 10 weeks and using shaping techniques. Their less affected upper limbs were also restrained 5 days/week during 5 hours identified as times of frequent use during the same 10-week period. Main outcome measures : The Action Research Arm Test (ARA), Wolf Motor Function Test (WMFT) and Motor Activity Log (MAL). Results : Following intervention, subjects exhibited improvements > 2.0 in their amount and quality of more affected limb use, as measured by the MAL. Subjects 1, 2 and 3 also displayed functional improvements on the ARA (14.0, 5.5 and 6.0, respectively), improvements in ratings of WMFT task performance (1.15, 1.7 and 1.35, respectively) and diminished time needed to perform all WMFT tasks. Conclusions : mCIT is a promising approach by which improved more affected limb use and function can be realized following TBI.

Demographics of rehabilitation robotics users

Assistive robotic technology can be used to augment manipulation tasks for individuals who have little to no use of upper extremities. By understanding user demographics and the market potential for such a device, an assistive robot can be designed and marketed to optimally meet the needs of the targeted audience. Consequently, the demographics and characteristics of a dozen disabling conditions often associated with minimal use of upper limbs are described. The conditions included are: cerebral palsy, arthrogryposis, spinal muscular atrophy, muscular dystrophies, rheumatoid arthritis, juvenile rheumatoid arthritis, multiple sclerosis, amyotrophic lateral sclerosis, poliomyelitis, spinal cord injury, head injury, and locked-in syndrome. An estimate of the number of people with these conditions who also have minimal use of upper limbs was calculated to be at least 150 ODD. The market potential is presumably lower than this number given the medical needs and financial constraints of these populations. While the market potential is small, the independence and quality of life made available by way of robotic technology is potentially