Concept: Upper limb
This study, conducted in a group of nine chronic patients with right-side hemiparesis after stroke, investigated the effects of a robotic-assisted rehabilitation training with an upper limb robotic exoskeleton for the restoration of motor function in spatial reaching movements. The robotic assisted rehabilitation training was administered for a period of 6 weeks including reaching and spatial antigravity movements. To assess the carry-over of the observed improvements in movement during training into improved function, a kinesiologic assessment of the effects of the training was performed by means of motion and dynamic electromyographic analysis of reaching movements performed before and after training. The same kinesiologic measurements were performed in a healthy control group of seven volunteers, to determine a benchmark for the experimental observations in the patients' group. Moreover degree of functional impairment at the enrolment and discharge was measured by clinical evaluation with upper limb Fugl-Meyer Assessment scale (FMA, 0-66 points), Modified Ashworth scale (MA, 0-60 pts) and active ranges of motion. The robot aided training induced, independently by time of stroke, statistical significant improvements of kinesiologic (movement time, smoothness of motion) and clinical (4.6 ± 4.2 increase in FMA, 3.2 ± 2.1 decrease in MA) parameters, as a result of the increased active ranges of motion and improved co-contraction index for shoulder extension/flexion. Kinesiologic parameters correlated significantly with clinical assessment values, and their changes after the training were affected by the direction of motion (inward vs. outward movement) and position of target to be reached (ipsilateral, central and contralateral peripersonal space). These changes can be explained as a result of the motor recovery induced by the robotic training, in terms of regained ability to execute single joint movements and of improved interjoint coordination of elbow and shoulder joints.
The concept of reachable workspace is closely tied to upper limb joint range of motion and functional capability. Currently, no practical and cost-effective methods are available in clinical and research settings to provide arm-function evaluation using an individual’s three-dimensional (3D) reachable workspace. A method to intuitively display and effectively analyze reachable workspace would not only complement traditional upper limb functional assessments, but also provide an innovative approach to quantify and monitor upper limb function.
Abstract Purpose: To develop a patient reported outcome measure of active and passive function in the hemiparetic upper limb. Methods: Potential items for inclusion were identified through (a) systematic review and analysis of existing measures and (b) analysis of the primary goals for treatment in a spasticity service. Item reduction was achieved through consultation with a small, purposively selected multi-disciplinary group of experienced rehabilitation professionals (n = 10) in a three-round Delphi process. This was followed by a confirmatory survey with a larger group of clinicians (n = 36) and patients and carers (n = 13 pairs). Results: From an initial shortlist of 75 items, 23 items were initially identified for inclusion in the arm activity measure (ArmA), and subsequently refined to a 20-item instrument comprising 7 passive and 13 active function. In common with the six measures identified in the systematic review, a five-point ordinal scaling structure was chosen, with ratings based on activity over the preceding 7 days. Conclusions: The ArmA is designed to measure passive and active function following focal interventions for the hemiparetic upper limb. Content and face validity have initially been addressed within the development process. The next phase of development has involved formal evaluation of psychometric properties. Implications for Rehabilitation In clinical practice or research, outcome measures in rehabilitation need to have face and content validity. Following stroke or brain injury, goals for rehabilitation of the hemiparetic upper limb may be: to restore active function, if there is return of motor control or to improve passive function making it easier to care for the limb (e.g. maintain hygiene) if no motor return is possible, measurement of both constructs should be considered. This study describes the systematic development of the ArmA, a measure of active and passive function in the hemiparetic upper limb.
This study investigated the shape of bone grafts and associations with upper limb function over the long term after free vascularized fibular head graft (FVFHG) for reconstruction of the proximal humerus after wide resection for bone sarcoma.
The lower extremity has received its fair share of attention as a vascular access site in patients who have exhausted their upper arm vessels. However, experiences with lower extremity arteriovenous grafts (AVGs) have so far been disappointing because of high infection rates and severe limb ischemia. We report our experience with hemodialysis access from the lower extremity.
Unilateral strength training leads to muscle-specific sparing effects during opposite homologous limb immobilization
- Journal of applied physiology (Bethesda, Md. : 1985)
- Published about 2 years ago
Cross education (CE) occurs after unilateral training whereby performance of the untrained contralateral limb is enhanced. A few studies have shown that CE can preserve or “spare” strength and size of an opposite immobilized limb, but the specificity (i.e., trained homologous muscle and contraction type) of these effects is unknown. The purpose was to investigate specificity of CE “sparing” effects with immobilization. The nondominant forearm of 16 participants was immobilized with a cast, and participants were randomly assigned to a resistance training (eccentric wrist flexion, 3 times/week) or control group for 4 weeks. Pre- and posttesting involved wrist flexors and extensors eccentric, concentric and isometric maximal voluntary contractions (via dynamometer), muscle thickness (via ultrasound), and forearm muscle cross-sectional area (MCSA; via peripheral quantitative computed tomography). Only the training group showed strength preservation across all contractions in the wrist flexors of the immobilized limb (training: -2.4% vs. control: -21.6%; P = 0.04), and increased wrist flexors strength of the nonimmobilized limb (training: 30.8% vs. control: -7.4%; P = 0.04). Immobilized arm MCSA was preserved for the training group only (training: 1.3% vs. control: -2.3%; P = 0.01). Muscle thickness differed between groups for the immobilized (training: 2.8% vs. control: -3.2%; P = 0.01) and nonimmobilized wrist flexors (training: 7.1% vs. control: -3.7%; P = 0.02). Strength preservation was nonspecific to contraction type ( P = 0.69, [Formula: see text] = 0.03) yet specific to the trained flexors muscle. These findings suggest that eccentric training of the nonimmobilized limb can preserve size of the immobilized contralateral homologous muscle and strength across multiple contraction types. NEW & NOTEWORTHY Unilateral strength training preserves strength, muscle thickness, and muscle cross-sectional area in an opposite immobilized limb. The preservation of size and strength was confined to the trained homologous muscle group. However, strength was preserved across multiple contraction types.
BACKGROUND: Paralysis or amputation of an arm results in the loss of the ability to orient the hand and grasp, manipulate, and carry objects, functions that are essential for activities of daily living. Brain-machine interfaces could provide a solution to restoring many of these lost functions. We therefore tested whether an individual with tetraplegia could rapidly achieve neurological control of a high-performance prosthetic limb using this type of an interface. METHODS: We implanted two 96-channel intracortical microelectrodes in the motor cortex of a 52-year-old individual with tetraplegia. Brain-machine-interface training was done for 13 weeks with the goal of controlling an anthropomorphic prosthetic limb with seven degrees of freedom (three-dimensional translation, three-dimensional orientation, one-dimensional grasping). The participant’s ability to control the prosthetic limb was assessed with clinical measures of upper limb function. This study is registered with ClinicalTrials.gov, NCT01364480. FINDINGS: The participant was able to move the prosthetic limb freely in the three-dimensional workspace on the second day of training. After 13 weeks, robust seven-dimensional movements were performed routinely. Mean success rate on target-based reaching tasks was 91·6% (SD 4·4) versus median chance level 6·2% (95% CI 2·0-15·3). Improvements were seen in completion time (decreased from a mean of 148 s [SD 60] to 112 s ) and path efficiency (increased from 0·30 [0·04] to 0·38 [0·02]). The participant was also able to use the prosthetic limb to do skilful and coordinated reach and grasp movements that resulted in clinically significant gains in tests of upper limb function. No adverse events were reported. INTERPRETATION: With continued development of neuroprosthetic limbs, individuals with long-term paralysis could recover the natural and intuitive command signals for hand placement, orientation, and reaching, allowing them to perform activities of daily living. FUNDING: Defense Advanced Research Projects Agency, National Institutes of Health, Department of Veterans Affairs, and UPMC Rehabilitation Institute.
The evolution of the human upper limb involved a change in function from its use for both locomotion and prehension (as in apes) to a predominantly prehensile and manipulative role. Well-preserved forelimb remains of 1.98-million-year-old Australopithecus sediba from Malapa, South Africa, contribute to our understanding of this evolutionary transition. Whereas other aspects of their postcranial anatomy evince mosaic combinations of primitive (australopith-like) and derived (Homo-like) features, the upper limbs (excluding the hand and wrist) of the Malapa hominins are predominantly primitive and suggest the retention of substantial climbing and suspensory ability. The use of the forelimb primarily for prehension and manipulation appears to arise later, likely with the emergence of Homo erectus.
Malapa is one of the richest early hominin sites in Africa and the discovery site of the hominin species, Australopithecus sediba. The holotype and paratype (Malapa Hominin 1 and 2, or MH1 and MH2, respectively) skeletons are among the most complete in the early hominin record. Dating to approximately two million years BP, MH1 and MH2 are hypothesized to have fallen into a natural pit trap. All fractures evident on MH1 and MH2 skeletons were evaluated and separated based on wet and dry bone fracture morphology/characteristics. Most observed fractures are post-depositional, but those in the right upper limb of the adult hominin strongly indicate active resistance to an impact, while those in the juvenile hominin mandible are consistent with a blow to the face. The presence of skeletal trauma independently supports the falling hypothesis and supplies the first evidence for the manner of death of an australopith in the fossil record that is not attributed to predation or natural death.