Daily Life Benefits and Usage Characteristics of Dynamic Arm Supports in Subjects with Neuromuscular Disorders

Evaluation of fatigue and fatigability in people with Duchenne muscular dystrophy using a dynamic arm support - a pilot study

BACKGROUND

Due to progressive muscle wasting and weakness in patients with Duchenne Muscular Dystrophy (DMD), physical fatigability increases, upper extremity function reduces, which negatively impacts quality of life. Assistive technology such as dynamic arm supports (DAS) may help reduce this fatigability. This study aims to assess whether the novel Yumen 'EXone' DAS can reduce upper extremity fatigue and fatigability in DMD patients and healthy controls (HC), both with and without the DAS. Additionally, longitudinal changes in DMD patients were evaluated.

METHODS

Five DMD patients from the Yumen Bionics pioneer program and five HCs participated. Two submaximal tests simulating drinking and reaching were performed for two minutes, each with and without DAS. DMD participants completed these tests twice, at baseline (T0) and after 6-9 months (T1), while HCs completed them once. Physical fatigability was measured by the number of repetitions and changes in surface electromyography (sEMG) amplitude. Subjective fatigue was assessed using the Borg Scale (6-20) Rate of Perceived Exertion (RPE).

RESULTS

DMD participants generally performed more repetitions with the DAS than without. HCs showed similar or increased repetitions with the DAS. Assessing fatigability with sEMG was difficult due to the compensatory mechanisms used for the tests. Subjective fatigue scores on the Borg Scale were lower with the DAS for both DMD patients and HCs.

CONCLUSION

The Yumen 'EXone' DAS effectively reduces both fatigue and fatigability in DMD patients and healthy controls. Despite the methodological shortcomings, this research is one of the first studies investigating the impact of DAS on fatigue and fatigability.

Usability of mechanical assistive technologies for performing activities involving the upper extremities in individuals with impairments: a systematic review

PURPOSE

To conduct a systematic review on the impacts of using mechanical assistive devices on function, performance in activities and participation of persons with upper extremity impairments, and to synthesize the strengths and limitations of these devices.

METHOD

Three independent reviewers conducted systematic searches of articles published between 2003 and 2023 in Compendex, Inspec, Embase, PubMed/Medline, IEEE Xplore, and Web of Science, as well as manual searches on the RESNA website for conference papers over the same period. The methodological quality of articles was appraised using the QualSyst tool.

RESULTS

From the 34 retained studies, 28 mechanical devices were identified and classified into two categories: (1) mobile arm supports (MASs) designed to perform multiple activities, and (2) devices used to assist with a specific activity of daily living (ADL). Overall, MASs helped users to perform manual activities in elevation and/or against gravity. Specific ADL devices allowed users to perform unique activities requiring fine motor skills such as opening a medicine container. Some of these devices have advantages like portability, adaptability, low cost, and ease of use. Limitations most often reported included interference or mobility restraints.

CONCLUSION

This review synthesizes the impacts of mechanical devices on the three domains of the International Classification of Functioning, Disability and Health (ICF) for individuals with upper extremity impairments. Impacts regarding function and performance in activities were more often measured than participation. Future studies should include outcomes related to participation, as taking this aspect into account might favor successful continued use of assistive devices.

Use of a dynamic arm support to drive a power wheelchair: a case report

PURPOSE

Dynamic arm supports (DAS) can assist individuals with severe upper limb disabilities who use a wheelchair to accomplish their daily activities. The objective of this case series was to assess the potential of a DAS to improve power wheelchair (PWC) control in real-life contexts and to describe the integration process. A secondary objective was to explore factors that may influence the DAS integration process.

METHODS

This case series includes four participants fitted with the Kinova DAS O110. A one-year follow-up was planned for each participant with qualitative and quantitative data collection to assess DAS outcomes. Assessment methods were selected to cover the three vantages of assistive technology outcomes assessment: effectiveness, subjective well-being, and social significance.

RESULTS

Among the four participants, one used the DAS to help with his wheelchair control for at least 12 months (successful integration). For him, the DAS led to significantly improved wheelchair skills and an important positive psychosocial impact. He was, however, only able to use the DAS for PWC control (no effects on other daily activities), and could not use it in some contexts because the device increased his PWC width. As for the other participants, they stopped using the DAS for different reasons, including a DAS-related adverse event.

CONCLUSION

This study demonstrated that a wheelchair-bound DAS has the potential to improve PWC use, but successful integration requires specific factors. The service delivery process and the environmental accessibility are crucial for the successful integration of such a device and to avoid safety issues.IMPLICATIONS FOR REHABILITATIONNo study deeply assessed the impacts of dynamic arm support on power wheelchair control, and the associated facilitators and obstacles.A wheelchair-bound dynamic arm support has the potential to improve power wheelchair control for individuals with upper limb disabilities and to lead to positive psychosocial impacts if some conditions conductive to successful integration are met.The service delivery process and the environmental accessibility appear as crucial aspects for the successful integration of a new device, such as dynamic arm support and avoiding safety issues.

The effects of facioscapulohumeral dystrophy and dynamic arm support on upper extremity muscle coordination in functional tasks

This study's objective is to understand the effect of muscular weakness in persons with facioscapulohumeral dystrophy as well as the effect of a dynamic arm support on muscle coordination and activity performance, during activities of daily living. People with facioscapulohumeral dystrophy (n=12, 56.0±14.5 years) and healthy controls (n=12, 55.5±13.4 years) performed five simulated daily activity tasks, while unsupported and supported by the Gowing dynamic arm support. Surface electromyography, kinematics, and maximum force output were recorded. Outcomes were calculated for muscle coordination (muscle synergies), maximum muscle activity, movement performance indicators, and upper limb muscular weakness (maximum force output). Muscle coordination was altered and less consistent in persons with facioscapulohumeral dystrophy compared with healthy controls. The dynamic arm support alleviated muscle efforts and affected muscle coordination in both populations. While populations became more similar, the internal consistency of persons with facioscapulohumeral dystrophy remained unaffected and lower than that of healthy controls. Furthermore, the support affected movements' performance in both groups. The maximum force outputs were lower in persons with facioscapulohumeral dystrophy than controls. Muscle coordination differences were presumably the result of individual-specific in muscle weakness and compensatory strategies for dealing with gravity compensation and movement constraints.

The use of a three-dimensional dynamic arm support prevents the development of muscle fatigue during repetitive manual tasks in healthy individuals

Work-related upper extremity disorders are costly to society due to resulting medical costs, presenteeism and absenteeism. Although their aetiology is likely multifactorial, physical workplace factors are known to play an important role in their development. Promising options for preventing work-related upper extremity disorders include assistive technologies such as dynamic arm supports designed to follow the movement of the arm while compensating for its weight. The objective of this study was to assess the effects of a dynamic arm support on perceived exertion, muscle activity and movement patterns of the upper limb during repetitive manual tasks in healthy individuals. Thirty healthy right-handed individuals were allocated either a static or a dynamic task to perform with and without a dynamic arm support. During the task, surface electromyographic activity (anterior and middle deltoid, upper trapezius) and upper limb kinematics (elbow, shoulder, sternoclavicular) were measured using surface EMG and inertial sensors. Results showed that the dynamic arm support significantly reduced perceived exertion during the tasks and limited the development of muscular fatigue of the anterior and middle deltoid as demonstrated by EMG signal mean epoch amplitudes and median frequency of the EMG power spectrum. The dynamic arm support also prevented a decrease in shoulder elevation and an increase in total shoulder joint excursion during static and dynamic task, respectively. These results denote the potential benefits of dynamic arm supports in work environments. Further studies should focus on their efficacy, acceptability and implementability in work settings.