Portable robots for upper-limb rehabilitation after stroke: a systematic review and meta-analysis

BACKGROUND

Robot-assisted upper-limb rehabilitation has been studied for many years, with many randomised controlled trials (RCTs) investigating the effects of robotic-assisted training on affected limbs. The current trend directs towards end-effector devices. However, most studies have focused on the effectiveness of rehabilitation devices, but studies on device sizes are relatively few.

GOAL

Systematically review the effect of a portable rehabilitation robot (PRR) on the rehabilitation effectiveness of paralysed upper limbs compared with non-robotic therapy.

METHODS

A meta-analysis was conducted on literature that included the Fugl-Meyer Assessment (FMA) obtained from the PubMed and Web of Science (WoS) electronic databases until June 2023.

RESULTS

A total of 9 studies, which included RCTs, were completed and a meta-analysis was conducted on 8 of them. The analysis involved 295 patients. The influence on upper-limb function before and after treatment in a clinical environment is analysed by comparing the experimental group using the portable upper-limb rehabilitation robot with the control group using conventional therapy. The result shows that portable robots prove to be effective (FMA: SMD = 0.696, 95% = 0.099 to.293, p < 0.05).

DISCUSSION

Both robot-assisted and conventional rehabilitation effects are comparable. In some studies, PRR performs better than conventional rehabilitation, but conventional treatments are still irreplaceable. Smaller size with better portability has its advantages, and portable upper-limb rehabilitation robots are feasible in clinical rehabilitation.

CONCLUSION

Although portable upper-limb rehabilitation robots are clinically beneficial, few studies have focused on portability. Further research should focus on modular design so that rehabilitation robots can be decomposed, which benefits remote rehabilitation and household applications.

Gamified exercise for the distal upper extremity in people with post-stroke hemiparesis: feasibility study on subjective perspectives during daily continuous training

INTRODUCTION

Dose (number of repetitions) has been suggested as a key element in the effectiveness of rehabilitation exercises to promote motor recovery of the hemiparetic upper limb. However, rehabilitation exercises tend to be monotonous and require significant motivation to continue, making it difficult to increase the exercise dose. To address this issue, gamification technology has been implemented in exercises to promote self-engagement for people with hemiparesis in continuing monotonous repetitive movements. This study aimed to investigate how subjective perspectives, specifically enjoyability, motivation to continue, and expectancy of effectiveness, change through continuous daily exercise using a developed gamified exercise system.

MATERIALS AND METHOD

Ten people with stroke suffering upper limb dysfunction underwent daily gamified exercise for seven days. The gamified exercise consisted of an electromyography (EMG)-controlled operating system that enabled users to play virtual games using repetitive finger movements. The participants performed conventional self-exercise on the same day as the control exercise, and rated their subjective perspectives on both exercises on a numerical rating scale on each exercise day.

RESULTS

Ratings for enjoyability and motivation to continue consistently showed significantly higher scores for the gamified exercise than for conventional self-exercise on all exercise days. A similar trend was observed in the ratings for the expectancy of effectiveness. No changes over time were found in any of the ratings throughout the exercise period.

CONCLUSIONS

Exercise using the developed EMG-controlled gamified system may have the potential to maintain motivation and enjoyment in people with stroke to continue monotonous repetitive finger movements.

One size does not fit all: universal cuff overestimates oscillometric blood pressure in persons with large arm circumference

OBJECTIVE

Some brachial cuffs for oscillometric blood pressure (BP) measurement are claimed to cover a wide range of upper-arm circumferences; however, their validation is rarely conducted. Our aim was to compare oscillometric BP measurements obtained with a universal cuff with those obtained with an appropriately sized cuff.

METHODS

We utilised the Microlife B6 Connect monitor, conducting oscillometric BP measurements in a random sequence with both a universal cuff (recommended for arm circumferences from 22 to 42 cm) and an appropriately sized cuff (medium for circumference 22-32 cm and large for 32-42 cm). We included 91 individuals with an arm circumference of 22-32 cm and 64 individuals with an arm circumference of 32-42 cm.

RESULTS

For arm circumferences > 32 cm, systolic and diastolic BP measured with the universal cuff was higher than that measured with the large cuff (systolic 6.4 mmHg, 95% confidence interval [CI]). 3.9-8.8, diastolic 2.4 mmHg, 95%CI, 1.2-3.7, p < 0.001 for both). Overestimation of BP with the universal cuff was statistically significant after correcting for the sequence of measurements. No statistical difference was found between the universal cuff and medium cuff for circumferences in the 22-32 cm range. The bladder size in the universal cuff matched the dimensions of the medium-sized cuff; however, the cuff was larger.

CONCLUSION

Overestimation of BP measured with a universal cuff in persons with large arm circumferences is clinically important. It poses the risk of unnecessary initiation or intensification of antihypertensive medication in persons using the universal cuff.

Isolated Hypoglossal Nerve Palsy: A Rare Complication of Organophosphate Poisoning

PURPOSE

This case report aims to describe a rare manifestation of isolated hypoglossal nerve palsy (HNP) resulting from organophosphate poisoning (OP), specifically organophosphate- induced delayed neuropathy (OPIDN). The primary objective of this case report is to highlight this unusual manifestation and discuss its potential underlying mechanisms, emphasizing the importance of timely diagnosis and appropriate management.

CASE REPORT

A 31-year-old male with a history of consuming a commercial chlorpyrifos formulation presented with acute organophosphate poisoning symptoms that improved with appropriate treatment. However, two weeks later, the patient developed neurological deficits (numbness and weakness spreading from the plantar region to the upper limbs) involving the hypoglossal nerve, manifesting as left-sided tongue deviation, fasciculation, and atrophy, resulting in speech and swallowing difficulties. A comprehensive workup ruled out other potential causes of HNP, supporting the link between OPIDN and isolated HNP. Despite regaining limb strength, the patient's speech and swallowing issues persisted, prompting a follow-up visit to our hospital for further management and rehabilitation.

CONCLUSION

This case report highlights a unique manifestation of OPIDN, resulting in isolated HNP, a rare phenomenon. The correlation between exposure to chlorpyrifos, acute organophosphate poisoning, and delayed onset of HNP suggests a causative relationship. Prompt diagnosis, appropriate treatment, and timely speech and swallowing rehabilitation are vital for optimizing outcomes in such cases. Further research is needed to understand the mechanisms underlying this selective vulnerability of OPIDN and to develop targeted interventions.

Effects of task-oriented training on dexterous movements of hands in post stroke patients

Objective: The objective of the study was to determine the effect of task-oriented training on the dexterous movements of hands in Hemiplegic post-stroke patients.Methods: This study has been registered on site ClinicalTrial.gov with clinical trial number NCT05201196. The study was Randomized controlled trial, 18 patients were recruited that meet the inclusion criteria, randomly allocated to task-oriented training Group A (n = 9) and Conventional Therapy Group B (n = 9). Both exercise trainings were applied for 45 min/session, 5 times/week for 6 weeks. Fugl-Meyer Assessment Scale Motor, sensory and coordination portion, Wolf Motor Function Scale and Barthel Index were used as outcome measures, assessed patients at Baseline, after 3 weeks and 6 weeks after training. Data were analyzed by SPSS version 23.Results: The results suggested the mean Age was 60.78 ± 9.08 and 61.33 ± 6.78 for Group A and Group B, respectively. Average BMI was 23.66 ± 2.66 for Task-oriented group and 21.36 ± 2.46 for Conventional group. Fugl-Meyer scale shows significant P-value 0.03 post treatment compare to pre-treatment which was .283, Wolf Motor Function test and Barthel Index also showed significant P-values as 0.023 and 0.007, respectively, indicating that Task-oriented training shows more significant improvements than conventional group.Conclusion: Task-based training produced statistically significant as well as clinically meaningful enhancement in the dexterous hand movements of acute and subacute stroke patients than conventional therapy and ultimately improves the functional independence in their daily activities such as feeding, bathing and hygiene.

Atom-ProteinQA: Atom-level protein model quality assessment through fine-grained joint learning

MOTIVATION

Protein model quality assessment (ProteinQA) is a fundamental task that is essential for biologically relevant applications, i.e., protein structure refinement, protein design, etc. Previous works aimed to conduct ProteinQA only on the global structure or per-residue level, ignoring potentially usable and precise cues from a fine-grained per-atom perspective. In this study, we propose an atom-level ProteinQA model, named Atom-ProteinQA, in which two innovative modules are designed to extract geometric and topological atom-level relationships respectively. Specifically, on the one hand, a geometric perception module exploits 3D sparse convolution to capture the geometric features of the input protein, generating fine-grained atom-level predictions. On the other hand, natural chemical bonds are utilized to construct an atom-level graph, then message passing from a topological perception module is applied to output residue-level predictions in parallel. Eventually, through a cross-model aggregation module, features from different modules mutually interact, enhancing performance on both the atom and residue levels.

RESULTS

Extensive experiments show that our proposed Atom-ProteinQA outperforms previous methods by a large margin, regardless of residue-level or atom-level assessment. Concretely, we achieved state-of-the-art performance on CATH-2084, Decoy-8000, public benchmarks CASP13 & CASP14, and the CAMEO.

AVAILABILITY

The repository of this project is released on: https://github.com/luyfcandy/Atom_ProteinQA.

Neurostimulation After Stroke

Neural stimulation technology aids stroke survivors in regaining lost motor functions. This article explores its applications in upper and lower limb stroke rehabilitation. The authors review various methods to target the corticomotor system, including transcranial direct current stimulation, repetitive transcranial magnetic stimulation, and vagus nerve stimulation. In addition, the authors review the use of peripheral neuromuscular electrical stimulation for therapeutic and assistive purposes, including transcutaneous electrical nerve stimulation, neuromuscular electrical stimulation, and functional electrical stimulation. For each, the authors examine the potential benefits, limitations, safety considerations, and FDA status.

Estimating the minimal clinically important difference of upper extremity outcome measures in chronic stroke patients with moderate to severe impairment: a cross-sectional study

BACKGROUND

Approximately 70% of chronic stroke patients experience upper extremity (UE) functional impairments, and UE outcome measures are often used as quality-of-life indicators.

OBJECTIVE

The purpose of this study was to estimate minimal clinically important difference (MCID) values for UE outcome measures in chronic stroke patients with moderate to severe UE hemiplegia.

METHODS

This study was a cross-sectional study, conducted as a secondary analysis of data from the ReoGo-J study, a multicenter, prospective, randomized, parallel-group trial of robot-assisted self-training for UE hemiplegia in chronic stroke. The patients were randomized to 1 of 3 treatment groups. Treatment was provided 3 times a week for 10 weeks, and UE outcome measures were evaluated before and after treatment. The anchor-based method was used to estimate MCID values for UE outcome measures, with Stroke Impact Scale (SIS) subscales as anchors. MCID values were estimated by identifying cutoff values in a receiver operating characteristic (ROC) curve.

RESULTS

Between-group comparisons of UE outcome measures, based on the clinically important difference (CID) values of SIS subscales, revealed significant differences in both the Amount of Use (AOU) and Quality of Movement (QOM) components of the Motor Activity Log (MAL)-14. The estimated MCID values were 0.89 for the AOU component and 0.77 for the QOM component.

CONCLUSIONS

The estimated MCID values for the MAL-14 not only add information regarding the clinical characteristics of the MAL-14 but also facilitate interpretations of changing scores in chronic stroke patients with moderate to severe UE hemiplegia undergoing rehabilitation therapy.

STUDY REGISTRATION

https://www.umin.ac.jp/ctr/index.htm (UMIN000022509; 1 July 2016).

Simultaneous or Delayed Free Tissue Transfer in Combination with Replantation Surgery

In hand and upper extremity replantation surgery, simultaneous free flap reconstruction restores the physiologic circulation to the amputated part, ensuring its survival, and promotes wound healing through anatomic restoration. Especially in digit replantation, an arterialized venous flap serves to reconstruct both vessel and soft tissue defects simultaneously. Delayed free flap reconstruction aims to enhance both functional improvement and cosmetic acceptance in a successfully replanted part using flaps that include functioning muscle, bone, joint, nerve, and soft tissue.

Throwing Shoulder Adaptations Are Not Related to Shoulder Injury or Pain: A Preliminary Report

BACKGROUND

Overhead throwing in baseball and softball athletes induces shoulder adaptations theorized to increase risk of shoulder musculoskeletal injury (MSI) and/or pain due to range of motion (ROM) deficits.

HYPOTHESIS

Shoulder ROM adaptations are associated with a higher risk for developing shoulder MSI and pain.

STUDY DESIGN

Prospective cohort study.

LEVEL OF EVIDENCE

Level 3.

METHODS

A total of 60 National Collegiate Athletic Association Division I athletes cleared for full athletic participation and free from upper extremity MSI in the last 4 weeks (age, 19.0 ± 1.2 years; weight, 82.1 ± 13.7 kg; height, 178.6 ± 11.2 cm; softball, n = 23; baseball, n = 37). Passive glenohumeral internal rotation (IR), external rotation (ER), and horizontal adduction (HA) ROM were measured with the scapula stabilized and used to categorize participants with/without external rotation gain (ERG), external rotation insufficiency (ERI), glenohumeral internal rotation deficit (GIRD), pathological GIRD, and posterior shoulder tightness (PST) before the competitive season. Groups were then compared to assess the incidence of shoulder MSI prospectively and prevalence of shoulder pain at the initial evaluation.

RESULTS

Baseball and softball athletes demonstrated significantly less IR ROM in the dominant shoulder (50.6° ± 9.4°) compared with the nondominant shoulder (59.1° ± 8.6°; P < 0.01) and significantly more ER ROM (dominant, 104.6° ± 12.1°; nondominant, 97.7° ± 12.0°; P < 0.01). Incidence of shoulder MSI was 15% but was not significantly related to any shoulder adaptations. No significant relationship was found between prevalence of pain and any shoulder adaptations in the 27% of athletes with pain.

CONCLUSION

Increased ER and decreased IR ROM adaptations in intercollegiate overhead throwing athletes do not appear to be correlated to risk of shoulder MSI or pain.

CLINICAL RELEVANCE

The findings of this level 3 prospective study provide clinicians working with overhead athletes information regarding shoulder MSI risk and pain. It is recommended that clinicians should not use ROM adaptations exclusively to determine increased risk of shoulder MSI.

A Dual Inertial Measurement Unit System for Classifying Standard Overhead Drill Movements in Elite Women's Water Polo

INTRODUCTION

Water polo upper limb external load monitoring cannot be currently measured accurately because of technological and methodological challenges. This is problematic as large fluctuations in overhead movement volume and intensity may affect performance and alter injury risk. Inertial measurement units (IMU) and machine learning techniques have been shown to accurately classify overhead movements in other sports. We investigated the model accuracy and class precision, sensitivity, and specificity of IMU and machine learning techniques to classify standard overhead drill movements in elite women's water polo.

METHODS

Ten women's water polo players performed standard drills of swimming, blocking, low-intensity throwing and high-intensity throwing under training conditions. Athletes wore two IMU: one on the upper back and the other on the distal forearm. Each movement was videoed and coded to a standard overhead drill movement. IMU and coded video data were merged to verify the IMU-detected activity classification of each movement to that of the video. Data were partitioned into a training and a test set and used to form a decision tree algorithm. Model accuracy and class precision, sensitivity, and specificity were assessed.

RESULTS

IMU resultant acceleration and angular velocity values displayed drill-specific values. A total of 194 activities were identified by the model in the test set, with 8 activities being incorrectly classified. Model accuracy was 95.88%. Percentage class precision, sensitivity, and specificity were as follows: blocking (96.15, 86.21, 99.39), high-intensity throwing (100, 100, 100), low-intensity throwing (93.48, 93.48, 97.97), and swimming (94.81, 98.65, 96.67).

CONCLUSIONS

IMU and machine learning techniques can accurately classify standard overhead drill movements in elite women's water polo.

'Reading the palm' - A pilot study of grip and finger flexion strength as an outcome measure in 5q spinal muscular atrophy

BACKGROUND

Innovative RNA modifying and gene replacement therapies are currently revolutionizing the therapeutic landscape in 5q-associated spinal muscular atrophy (SMA). In order to provide individual recommendations for choice of treatment and therapy (dis-) continuation, objective outcome measures are needed. The purpose of this study was to determine whether maximum isometric voluntary grip and finger flexion strength is a useful sensitive outcome measure in children and adult patients with SMA.

METHODS

In this non-interventional, longitudinal pilot study, we assessed grip and finger flexion strength on 39 patients with SMA II and III (n = 16 children, mean age = 10.0; n = 23 adults, mean age = 38.4) using the Weber hand and finger dynamometer HFD 200. Grip and finger flexion strength, clinical examinations and motor function scores (Revised Upper Limb Module, Hammersmith Functional Motor Scale Expanded) were assessed over a 12-month treatment period concurrent with the nusinersen treatment.

RESULTS

Grip and finger flexion strength was highly associated with motor function and disease severity, SMA type and SMN2 copy number. During nusinersen treatment, grip and finger flexion strength significantly increased in children and adults with SMA.

CONCLUSION

Grip and finger flexion strength measured with the HFD 200 is a promising sensitive outcome measure for SMA.

Weisfeiler-Lehman goes dynamic: An analysis of the expressive power of Graph Neural Networks for attributed and dynamic graphs

Graph Neural Networks (GNNs) are a large class of relational models for graph processing. Recent theoretical studies on the expressive power of GNNs have focused on two issues. On the one hand, it has been proven that GNNs are as powerful as the Weisfeiler-Lehman test (1-WL) in their ability to distinguish graphs. Moreover, it has been shown that the equivalence enforced by 1-WL equals unfolding equivalence. On the other hand, GNNs turned out to be universal approximators on graphs modulo the constraints enforced by 1-WL/unfolding equivalence. However, these results only apply to Static Attributed Undirected Homogeneous Graphs (SAUHG) with node attributes. In contrast, real-life applications often involve a much larger variety of graph types. In this paper, we conduct a theoretical analysis of the expressive power of GNNs for two other graph domains that are particularly interesting in practical applications, namely dynamic graphs and SAUGHs with edge attributes. Dynamic graphs are widely used in modern applications; hence, the study of the expressive capability of GNNs in this domain is essential for practical reasons and, in addition, it requires a new analyzing approach due to the difference in the architecture of dynamic GNNs compared to static ones. On the other hand, the examination of SAUHGs is of particular relevance since they act as a standard form for all graph types: it has been shown that all graph types can be transformed without loss of information to SAUHGs with both attributes on nodes and edges. This paper considers generic GNN models and appropriate 1-WL tests for those domains. Then, the known results on the expressive power of GNNs are extended to the mentioned domains: it is proven that GNNs have the same capability as the 1-WL test, the 1-WL equivalence equals unfolding equivalence and that GNNs are universal approximators modulo 1-WL/unfolding equivalence. Moreover, the proof of the approximation capability is mostly constructive and allows us to deduce hints on the architecture of GNNs that can achieve the desired approximation.

Is musculoskeletal pain associated with increased muscle stiffness? Evidence map and critical appraisal of muscle measurements using shear wave elastography

INTRODUCTION AND AIMS

Approximately 21% of the world's population suffers from musculoskeletal conditions, often associated with sensations of stiff muscles. Targeted therapy requires knowing whether typically involved muscles are objectively stiffer compared to asymptomatic individuals. Muscle stiffness is quantified using ultrasound shear wave elastography (SWE). Publications on SWE-based comparisons of muscle stiffness between individuals with and without musculoskeletal pain are increasing rapidly. This work reviewed and mapped the existing evidence regarding objectively measured muscle stiffness in musculoskeletal pain conditions and surveyed current methods of applying SWE to measure muscle stiffness.

METHODS

A systematic search was conducted in PubMed and CINAHL using the keywords "muscle stiffness", "shear wave elastography", "pain", "asymptomatic controls" and synonyms. The search was supplemented by a hand search using Google Scholar. Included articles were critically appraised with the AXIS tool, supplemented by items related to SWE methods. Results were visually mapped and narratively described.

RESULTS

Thirty of 137 identified articles were included. High-quality evidence was missing. The results comprise studies reporting lower stiffness in symptomatic participants, no differences between groups and higher stiffness in symptomatic individuals. Results differed between pain conditions and muscles, and also between studies that examined the same muscle(s) and pathology. The methods of the application of SWE were inconsistent and the reporting was often incomplete.

CONCLUSIONS

Existing evidence regarding the objective stiffness of muscles in musculoskeletal pain conditions is conflicting. Methodological differences may explain most of the inconsistencies between findings. Methodological standards for SWE measurements of muscles are urgently required.

Kinetic and kinematic determinants of shuttlecock speed in the forehand jump smash performed by elite male Malaysian badminton players

Badminton is the fastest racket sport in the world with smash speeds reaching over 111 m/s (400 kph). This study examined the forehand jump smash in badminton using synchronised force plates and full-body motion capture to quantify relationships to shuttlecock speed through correlations. Nineteen elite male Malaysian badminton players were recorded performing forehand jump smashes with the fastest, most accurate jump smash from each player analysed. The fastest smash by each participant was on average 97 m/s with a peak of 105 m/s. A correlational analysis revealed that a faster smash speed was characterised by a more internally rotated shoulder, a less elevated shoulder, and less extended elbow at contact. The positioning of the arm at contact appears to be critical in developing greater shuttlecock smash speeds. Vertical ground reaction force and rate of force development were not correlated with shuttlecock speed, and further investigation is required as to their importance for performance of the jump smash e.g., greater jump height and shuttle angle. It is recommended that players/coaches focus on not over-extending the elbow or excessively elevating the upper arm at contact when trying to maximise smash speed.

Influence of microarchitecture on stressed volume and mechanical fatigue behaviour of equine subchondral bone

Fractures of the equine metacarpophalangeal (MCP) joint are among the most common and fatal injuries experienced by racehorses. These bone injuries are a direct result of repetitive, high intensity loading of the skeleton during racing and training and there is consensus that they represent a mechanical fatigue phenomenon. Existing work has found the fatigue life of bone to be strongly determined by bone microarchitecture and the resulting stressed volume (i.e., the volume of bone stressed above assumed yield). The purpose of this study was to quantify the influence of bone microarchitecture on the mechanical fatigue behaviour of equine subchondral bone from the MCP joint across a wide variety of sample types. Forty-eight subchondral bone samples were prepared from the third metacarpal (MC3) and proximal phalanx (P1) of 8 horses and subsequently imaged using high resolution micro-computed tomography (μCT) to quantify microarchitectural features of interest, including bone volume fraction, tissue mineral density, pore size, pore spacing, and pore number. Samples were cyclically loaded in compression to a stress of 70 MPa, and fatigue life was defined as the number of cycles until failure. Finite element models were created from the μCT images and used to quantify stressed volume. Based on the expected log point-wise predictive density, stressed volume was a strong predictor of fatigue life in both the MC3 and P1. A regional analysis indicated fatigue life was more strongly associated with bone volume fraction in the superficial (r2 = 0.32, p < 0.001) and middle (r2 = 0.70, p < 0.001) regions of the subchondral bone, indicating the prominent role that the cortical plate played in the fatigue resistance of equine subchondral bone. By improving our understanding of the variance in fatigue life measurements, this research helps clarify the underlying mechanisms of the mechanical fatigue process and provides a basic understanding of subchondral bone injuries in the equine fetlock joint.

Prospective evaluation of upper extremity access and total transfemoral approach during fenestrated and branched endovascular repair

OBJECTIVE

Total transfemoral (TF) access has been increasingly used during fenestrated-branched endovascular aortic repair (FB-EVAR). However, it is unclear whether the potential decrease in the risk of cerebrovascular events is offset by increased procedural difficulties and other complications. The aim of this study was to compare outcomes of FB-EVAR using a TF vs upper extremity (UE) approach for target artery incorporation.

METHODS

We analyzed the clinical data of consecutive patients enrolled in a prospective, nonrandomized clinical trial in two centers to investigate the use of FB-EVAR for treatment of complex abdominal aortic aneurysms (CAAA) and thoracoabdominal aortic aneurysms (TAAA) between 2013 and 2022. Patients were classified into TF or UE access group with a subset analysis of patients treated using designs with directional branches. End points were technical success, procedural metrics, 30-day cerebrovascular events defined as stroke or transient ischemic attack, and any major adverse events (MAEs).

RESULTS

There were 541 patients (70% males; mean age, 74 ± 8 years) treated by FB-EVAR with 2107 renal-mesenteric TAs incorporated. TF was used in175 patients (32%) and UE in 366 patients (68%) including 146 (83%) TF and 314 (86%) UE access patients who had four or more TAs incorporated. The use of a TF approach increased from 8% between 2013 and 2017 to 31% between 2018 and 2020 and 96% between 2021 and 2022. Compared with UE access patients, TF access patients were more likely to have CAAAs (37% vs 24%; P = .002) as opposed to TAAAs. Technical success rate was 96% in both groups (P = .96). The use of the TF approach was associated with reduced fluoroscopy time and procedural time (each P < .05). The 30-day mortality rate was 0.6% for TF and 1.4% for UE (P = .67). There was no early cerebrovascular event in the TF group, but the incidence was 2.7% for UE patients (P = .035). The incidence of MAEs was also lower in the TF group (9% vs 18%; P = .006). Among 237 patients treated using devices with directional branches, there were no significant differences in outcomes except for a reduced procedural time for TF compared with UE access patients (P < .001).

CONCLUSIONS

TF access was associated with a decreased incidence of early cerebrovascular events and MAEs compared with UE access for target artery incorporation. Procedural time was decreased in TF access patients irrespective of the type of stent graft design.

Locking of the metacarpophalangeal joint: A comprehensive review of the literature

Locked metacarpophalangeal joint is an uncommon phenomenon with many possible etiologies. Diagnosis can be difficult because of the many more common pathologies (trigger finger, sagittal band lesion, etc.) that can lead to a clinical picture that may resemble the locked metacarpophalangeal joint. Once the differential diagnoses have been eliminated, the etiology of this blockage must be determined and the surgical procedure must be oriented. The origin of the problem is often difficult to determine, especially since standard imaging tests are often not very informative. Several clinical forms are possible, with blockages in extension or flexion, but which will have a disabling functional impact on the overall function of the hand. Currently, there is no gold standard for the management of this condition. In this study, we performed a review of the literature in order to better understand the different possible etiologies but also to analyze the different diagnostic and therapeutic management. LEVEL OF EVIDENCE: IV.

Safety and efficacy of non-invasive brain stimulation for the upper extremities in children with cerebral palsy: A systematic review

AIM

To evaluate available evidence examining safety and efficacy of non-invasive brain stimulation (NIBS) on upper extremity outcomes in children with cerebral palsy (CP).

METHOD

We electronically searched 12 sources up to May 2023 using JBI and Cochrane guidelines. Two reviewers selected articles with predetermined eligibility criteria, conducted data extraction, and assessed risk of bias using the Cochrane Risk of Bias criteria.

RESULTS

Nineteen studies were included: eight using repetitive transcranial magnetic stimulation (rTMS) and 11 using transcranial direct current stimulation (tDCS). Moderate certainty evidence supports the safety of rTMS and tDCS for children with CP. Very low to moderate certainty evidence suggests that rTMS and tDCS result in little to no difference in upper extremity outcomes.

INTERPRETATION

Evidence indicates that NIBS is a safe and feasible intervention to target upper extremity outcomes in children with CP, although it also indicates little to no significant impact on upper extremity outcomes. These findings are discussed in relation to the heterogeneous participants' characteristics and stimulation parameters. Larger studies of high methodological quality are required to inform future research and protocols for NIBS.

Typical brachial plexus: the legacy of a forgotten anatomist, Abram T. Kerr (1873-1938)

The brachial plexus, a complex network of nerves responsible for innervating the upper limb, exhibits remarkable anatomical variations. This editorial explores the composite drawing of a "typical" brachial plexus portrayed by Abram T. Kerr in 1918. This composite drawing of the typical brachial plexus stands as a critical contribution to the field of anatomy and surgery, and encapsulates the most prevalent patterns of formation, branching, and origins within the brachial plexus, offering a statistical map of its common variants. Kerr portrays the typical brachial plexus as a foundational resource for anatomists and medical professionals seeking to navigate the intricate landscape of this neural structure. It serves as a hypothetical model, reflecting the common arrangement of trunks, cords, and branches, shedding light on the typical composition of the plexus observed in most individuals. Beyond being a visual representation, the 'typical' brachial plexus provides a bridge between theoretical knowledge and practical applications, aiding in the identification of variations and deviations in surgical contexts. This composite drawing enhances our comprehension of the intricate and ever-evolving anatomy of the brachial plexus, reinforcing its role as a fundamental reference point for anatomical studies and clinical practice.

Sports-related peripheral nerve injuries of the upper limb

Peripheral nerve injuries in athletes affect the upper limb more commonly than the lower limb. Common mechanisms include compression, traction, laceration, and ischemia. Specific sports can have unique mechanisms of injury and are more likely to be associated with certain neuropathies. Familiarity with these sport-specific variables and recognition of the common presentations of upper limb neuropathic syndromes are important in assessing an athlete with a suspected peripheral nerve injury. Evaluation may require imaging modalities and/or electrodiagnostic testing to confirm a nerve injury. In some cases, diagnostic injections may be needed to differentiate neuropathic versus musculoskeletal etiology. Early and accurate diagnosis is essential for treatment/management and increases the likelihood of a safe return-to-sport and avoidance of long-term functional consequences. Most nerve injuries can be treated conservatively, however, severe or persistent cases may require surgical intervention. This monograph reviews key diagnostic, management, and preventative strategies for sports-related peripheral nerve injuries involving the upper limb.

Behavioral and phylogenetic correlates of limb length proportions in extant apes and monkeys: Implications for interpreting hominin fossils

The body proportions of extant animals help inform inferences about the behaviors of their extinct relatives, but relationships between body proportions, behavior, and phylogeny in extant primates remain unclear. Advances in behavioral data, molecular phylogenies, and multivariate analytical tools make it an opportune time to perform comprehensive comparative analyses of primate traditional limb length proportions (e.g., intermembral, humerofemoral, brachial, and crural indices), body size-adjusted long bone proportions, and principal components. In this study we used a mix of newly-collected and published data to investigate whether and how the limb length proportions of a diverse sample of primates, including monkeys, apes, and modern humans, are influenced by behavior and phylogeny. We reconfirm that the intermembral index, followed by the first principal component of traditional limb length proportions, is the single most effective variable distinguishing hominoids and other anthropoids. Combined limb length proportions and positional behaviors are strongly correlated in extant anthropoid groups, but phylogeny is a better predictor of limb length proportion variation than of behavior. We confirm convergences between members of the Atelidae and extant apes (especially Pan), members of the Hylobatidae and Pongo, and a potential divergence of Presbytis limb proportions from some other cercopithecoids, which correlate with adaptations for forelimb-dominated behaviors in some colobines. Collectively, these results substantiate hypotheses indicating that extinct hominins and other hominoid taxa can be distinguished by analyzing combinations of their limb length proportions at different taxonomic levels. From these results, we hypothesize that fossil skeletons characterized by notably disparate limb length proportions are unlikely to have exhibited similar behavioral patterns.

Development of Upper-Extremity Morphological Asymmetries in Male and Female Elite Youth Tennis Players: A Longitudinal Study

PURPOSE

This 2-year longitudinal study examined the development of upper-extremity bone mineral density (BMD), bone mineral content (BMC), and lean mass (LM) asymmetry magnitudes in male and female youth tennis players.

METHODS

Dominant and nondominant upper-extremity BMD, BMC, and LM values of 49 male and 31 female players were measured yearly using dual X-ray absorptiometry. From these values, asymmetry magnitudes were calculated and expressed as a percentage. Maturity offset was estimated using anthropometric measurements. Linear mixed effect models examined the development of BMD, BMC, and LM asymmetry magnitudes according to players' maturity offset, sex, and training volume.

RESULTS

Adjusted for sex and training volume, a 1-year increment in maturity offset was associated with a significant increase in BMD (1.3% [2.2%]; P < .001) and BMC (0.6% [2.4%]; P = .011) asymmetry magnitudes. Male players displayed significantly higher LM asymmetry magnitudes (Δ3.2% [8.4%]; P = .002) compared with their female counterparts. Training volume was not significantly associated with asymmetry magnitude development.

CONCLUSION

In contrast to LM, male and female youth tennis players' upper-extremity bones are still responsive to mechanical loading with a significant increase in BMD and BMC asymmetry magnitudes according to maturity offset.

Clinical evaluation of a patient participation assessment system for upper extremity rehabilitation exercises

In conventional and robotic rehabilitation, the patient's active participation in exercises is essential for the maximum functional output to be received from therapy. In rehabilitation exercises performed with robotic devices, the difficulty levels of therapy tasks and the device assistance are adjusted based on the patient's therapy performance to improve active participation. However, the existing therapy performance evaluation methods are based on either some specific device designs or certain therapy tasks, which limits their widespread use. In this paper, the effectiveness of a participation assessment system, which can evaluate patients' therapy performance, tiredness, and slacking independent of any device design and therapy exercise, was clinically tested on ten patients diagnosed with frozen shoulder syndrome. The patients performed exercises using the system once a week throughout their 4-week treatment period. Multiple clinical measurements and scales were employed during the clinical study to assess patients' progress and status, such as tiredness throughout the therapy process. The clinical data, along with the patient findings obtained from the participation assessment system, were statistically analyzed and compared. The findings revealed that the patients' improvements and progress during the therapy process clinically coincide with the variations in the performance evaluation results of the system, and the implemented method successfully assesses the patients' participation during the rehabilitation exercises.

Hybrid Soft-Rigid Active Prosthetics Laboratory Exercise for Hands-On Biomechanical and Biomedical Engineering Education

This paper introduces a hands-on laboratory exercise focused on assembling and testing a hybrid soft-rigid active finger prosthetic for biomechanical and biomedical engineering (BME) education. This hands-on laboratory activity focuses on the design of a myoelectric finger prosthesis, integrating mechanical, electrical, sensor (i.e., inertial measurement units (IMUs), electromyography (EMG)), pneumatics, and embedded software concepts. We expose students to a hybrid soft-rigid robotic system, offering a flexible, modifiable lab activity that can be tailored to instructors' needs and curriculum requirements. All necessary files are made available in an open-access format for implementation. Off-the-shelf components are all purchasable through global vendors (e.g., DigiKey Electronics, McMaster-Carr, Amazon), costing approximately USD 100 per kit, largely with reusable elements. We piloted this lab with 40 undergraduate engineering students in a neural and rehabilitation engineering upper year elective course, receiving excellent positive feedback. Rooted in real-world applications, the lab is an engaging pedagogical platform, as students are eager to learn about systems with tangible impacts. Extensions to the lab, such as follow-up clinical (e.g., prosthetist) and/or technical (e.g., user-device interface design) discussion, are a natural means to deepen and promote interdisciplinary hands-on learning experiences. In conclusion, the lab session provides an engaging journey through the lifecycle of the prosthetic finger research and design process, spanning conceptualization and creation to the final assembly and testing phases.

The effect of changes in fundamental skill complexity on upper limb loading and biomechanical characteristics of performance in female gymnastics

Aims of this study were to investigate if changes in elbow and wrist joints loading and biomechanical characteristics of performance existed as a function of (a) different hand placement and (b) fundamental skills development in female gymnastics. Ten female gymnasts performed 54 successful trials of round-off skills (cartwheel [18], round-off [18], round-off to back handspring [18]), with three different hand positions (parallel, T-shape and reverse). Kinematic and kinetic data were collected for each trial. A two-way repeated measures ANOVA was used to analyse the injury risk factors. Findings of the current study showed that an increase in RO skill difficulty level significantly influences the mechanical load on the upper extremities. With the increase in mechanical load on the upper extremities during the reverse and parallel hand positions, this study suggests that that T-shape hand position should be used as the primary technique for the young female. Differences in vertical velocity from touchdown to take-off between the three hand positions for the RO and RO-BH suggested that the reverse position was less effective for young female gymnasts. The findings of the current study demonstrated no clear performance benefits between hand position selection.

Manual preference, performance, and dexterity for bimanual grass-feeding behavior in wild geladas (Theropithecus gelada)

We assessed whether wild geladas, highly specialized terrestrial grass eaters, are lateralized for bimanual grass-plucking behavior. According to the literature, we expected that complex motor movements in grass feeding would favor the emergence of a population-level hand bias in these primates. In addition, we described geladas' manual behavior based on systematic observations of several individuals. Our study group included 28 individuals belonging to a population of free-ranging geladas frequenting the Kundi plateau, Ethiopia. We filmed monkeys while feeding on grass, and hand preference and performance were coded. Geladas performed more plucking movements per second with their left hand (LH) compared to the right one and preferred their LH both to start and finish collection bouts. Also, the rhythmic movements of each hand had a significant tendency toward isochrony. Finally, geladas used forceful pad-to-pad precision grips, in-hand movements, and compound grips to pluck and collect grass blades, considered the most advanced manual skills in primate species. The LH's leading role suggests an advantage of the right hemisphere in regulating geladas' bimanual grass-feeding behavior. The tactile input from the hands and/or rhythmic hand movements might contribute to explaining this pattern of laterality. Our findings highlighted the importance of adopting multiple laterality measures to investigate manual laterality. Moreover, the need to speed up the execution time of manual foraging might be a further important factor in studying the evolution of manual laterality and dexterity in primates.

Procedures and measurement properties of the 6-min step test: A systematic review with clinical recommendations

OBJECTIVE

To provide information regarding the procedures, safety, tolerability, and measurement properties of the 6-min step test.

DATA SOURCES

MEDLINE, EMBASE, CINAHL, and SPORTDiscus (from inception until January 2024).

REVIEW METHODS

Studies that examined adults with acute or chronic diseases, and outcomes related to procedures, safety, tolerability, or measurement properties of the 6-min step test were included. Outcome data were summarized and combined in meta-analyses. The quality of included studies was assessed by the Consensus-based Standards for the selection of health Measurement Instruments checklist, and the quality of evidence was determined according to the Grading of Recommendations Assessment, Development, and Evaluation system.

RESULTS

Fourteen studies, involving 847 participants, were included. All studies performed the 6-min step test in 6 min; however, some studies varied the step height and the use of upper limb support. The test appears to be safe and well tolerated by individuals. Moderate- to high-quality evidence demonstrated appropriate results for test-retest reliability (4 studies; Intraclass correlation coefficient 0.96; 95% CI 0.91-0.98; n = 125), criterion validity (4 studies; r = 0.53; 95% CI 0.30-0.71; n = 307), and construct validity (4 studies; r = 0.63; 95% CI 0.52-0.73; n = 233).

CONCLUSION

This review provides recommendations for applying the 6-min step test in clinical and research settings. No adverse events were reported, and the test appears to be well tolerated. Adequate results were found for test-retest reliability, criterion validity, and construct validity.

REVIEW REGISTRATION

PROSPERO (CRD42022347744).

The Role of Upper Extremity Motor Function in the Choice of Bladder Management in Those Unable to Volitionally Void due to Neurologic Dysfunction

It is estimated that 425,000 individuals with neurologic bladder dysfunction (spinal cordinjury, spina bifida and multiple sclerosis) are unable to volitionally void and must rely oncatheter drainage. Upper extremity (UE) motor function is one of the most important factors indetermining the type of bladder management chosen in individuals who cannot volitionally void. Novel bladder management solutions for those with impaired UE motor function and concurrent impairments involitional voiding continue to be an area of need. Those with poor UE motor function more often choose an indwelling catheter, whereas those with normal UE motor function more often choose clean intermittent catheterization.

Agreement between face-to-face and tele-assessment of upper limb disability in lung cancer survivors during COVID-19 era

INTRODUCTION

Upper limb disability can limit the quality of life of lung cancer survivors. The COVID-19 era has required a finding of alternatives to attend the monitoring of presented disturbances with the minor risk of spread. Tele-assessment offers new possibilities for clinical assessment demonstrating good reliability compared to traditional face-to-face assessment in a variety of patients. No previous study has applied this type of assessment in lung cancer survivors. For this reason, the aim of this study was to evaluate the level of agreement between upper limb disability assessment using tele-assessment and the face-to-face method in lung cancer survivors.

METHODS

A reliability study was conducted with 20 lung cancer survivors recruited from the Oncological Radiotherapy Service of the "Hospital PTS" (Granada). Patients attended a session for clinical face-to-face and real-time online tele-assessment. The main outcome measurements of the study included upper limb function (shirt task) and musculoskeletal disturbances (active range of movement and trigger points), and these outcomes were recorded by two independent researchers.

RESULTS

The outcome measures showed good agreement between both assessments. The active range of movement presented heterogeneous results, being excellent reliability (ρ > 0.75) in extension, internal rotation, homolateral adduction, and contralateral abduction, good (0.4 < ρ < 0.75) for flexion, homolateral abduction, contralateral adduction and contralateral external rotation, and poor (ρ < 0.4) for homolateral external rotation. The measure evaluating upper limb function and trigger points show the highest interrater reliability with confidence interval lower limits ≥0.99.

DISCUSSION

The tele-assessment of upper limb function and musculoskeletal disorders of lung cancer survivors present a good interrater reliability compared to face-to-face assessment. It could be useful for monitoring the disability presented by cancer survivors whose access is difficult by the residential situation, physical limitations or the risk of COVID-19 spread.

On-block mechanistic determinants of start performance in high performance swimmers

This study aimed to 1) identify what starting block outcome kinetics have the greatest relationship to 15 m start time; 2) investigate key mechanistic determinants of the block phase and how these forces are sequenced. One hundred and fifty-two high-level competitive swimmers were included in the study. Linear mixed modelling identified four on-block outcome kinetic variables (work, average power, horizontal take-off velocity (HTOV), and average acceleration) as having a very large relationship (R2 = 0.79-0.83) to 15 m start time, with average power having the most substantial impact. On-block force sequencing started with the rear leg, followed by upper limb grab forces and the front leg. Further exploration of underlying determinants was performed for average power and HTOV of the centre of mass. Multiple linear regression identified grab resultant peak force, rear resultant average force, front horizontal peak force, and resultant peak force as significant predictors of average power (R2 = 0.88). HTOV was predicted using the same variables, apart from the inclusion of rear horizontal peak force instead of rear resultant average force (R2 = 0.73). These findings may influence how strength and conditioning and skill acquisition interventions are designed to improve swim start performance.

Is more always better? Effectiveness of constraint-induced movement therapy in children with high-risk or unilateral cerebral palsy (0-6 years): Systematic review and meta-analysis

BACKGROUND

While constraint-induced movement therapy is strongly recommended as an intervention for infants with unilateral cerebral palsy, the optimal dosage remains undefined. This systematic review aims to identify the most effective level of intensity of constraint-induced movement therapy to enhance manual function in infants at high risk of asymmetric brain lesions or unilateral cerebral palsy diagnosis.

METHODS

This systematic review with meta-analysis encompassed a comprehensive search across four electronic databases to identify articles that met the following criteria: randomised controlled trials, children aged 0-6 with at high risk or with unilateral cerebral palsy, and treatment involving constraint-induced movement therapy for upper limb function. Studies with similar outcomes were pooled by calculating the standardised mean difference score for each subgroup, and subgroups were stratified every 30 h of total intervention dosage (30-60, 61-90, >90 h). Risk of bias was assessed with Cochrane Collaboration's tool.

RESULTS

Seventeen studies were included. Meta-analyses revealed significant differences among subgroups. The 30-60 h subgroup showed a weak effect for spontaneous use of the affected upper limb during bimanual performance, grasp function, and parents' perception of how often children use their affected upper limb. Additionally, this subgroup demonstrated a moderate effect for the parents' perception of how effectively children use their affected upper limb.

CONCLUSIONS

Using a dosage ranging from 30 to 60 h when applying a constraint-induced movement therapy protocol holds promise as the most age-appropriate and cost-effectiveness approach for improving upper limb functional outcomes and parent's perception.

A generative adaptive convolutional neural network with attention mechanism for driver fatigue detection with class-imbalanced and insufficient data

Over the past few years, fatigue driving has emerged as one of the main causes of traffic accidents, necessitating the development of driver fatigue detection systems. However, many existing methods involves tedious manual parameter tunings, a process that is both time-consuming and results in task-specific models. On the other hand, most of the researches on fatigue recognition are based on class-balanced and sufficient data, and effectively "mine" meaningful information from class-imbalanced and insufficient data for fatigue recognition is still a challenge. In this paper, we proposed two novel models, the attention-based residual adaptive multiscale fully convolutional network-long short term memory network (ARMFCN-LSTM), and the Generative ARMFCN-LSTM (GARMFCN-LSTM) aiming to address this issue. ARMFCN-LSTM excels at automatically extracting multiscale representations through adaptive multiscale temporal convolutions, while capturing temporal dependency features through LSTM. GARMFCN-LSTM integrates Wasserstein GAN with gradient penalty (WGAN-GP) into ARMFCN-LSTM to improve driver fatigue detection performance by alleviating data scarcity and addressing class imbalances. Experimental results show that ARMFCN-LSTM achieves the highest classification accuracy of 95.84% in driver fatigue detection on the class-balanced EEG dataset (binary classification), and GARMFCN-LSTM attained an improved classification accuracy of 84.70% on the class-imbalanced EOG dataset (triple classification), surpassing the competing methods. Therefore, the proposed models are promising for further implementations in online driver fatigue detection systems.

Upper extremity contact pressure measurement in robot-assisted pelvic surgery

Upper extremity complications are often a problem in robot-assisted pelvic surgery (RAPS) with the lithotomy-Trendelenburg position (LT-position). This study focused on upper extremity contact pressure (UEP) and examined the relationship between UEP and upper extremity complications. From May 2020 to April 2022 at the University of Tokyo Hospital, UEP was measured in 155 patients undergoing RARP and 20 patients undergoing RARC. A total of 350 sets of UEP were investigated in this study. UEP was measured using a portable interface pressure sensor (Palm Q, Cape CO., Kanagawa, Japan) in the preoperative lithotripsy position (L-position), preoperative LT-position, and postoperative L-position. UEP was increased in the preoperative LT-position than in the preoperative L-position (right side 5.2 mmHg vs. 17.1 mmHg, left side 5.3 mmHg vs. 17.1 mmHg, P < 0.001, respectively), and was decreased in the postoperative L-position than in preoperative LT-position (right side 17.1 mmHg vs. 10.8 mmHg, left side 17.1 mmHg vs. 10.6 mmHg, P < 0.001, respectively). Eleven upper extremities developed shoulder pain. UEP of the preoperative LT-position tended to be higher in the upper extremity exhibiting shoulder pain (25.6 mmHg (15.4-30.3) vs. 17.1 mmHg (12.0-24.4) P = 0.0901). UEP measurements may help prevent postoperative shoulder pain.

Participation and autonomy, independence in activities of daily living and upper extremity functioning in individuals with spinal cord injury

Improvements in care and rehabilitation have resulted in a higher proportion of people living with spinal cord injury (SCI), which calls for an increased focus on participation and autonomy. This observational cross-sectional study investigated the impact of SCI on autonomy and how it correlates to activity performance and upper extremity functioning. A total of 25 adults (mean age 58 years) with chronic cervical or thoracic SCI were included. Self-perceived autonomy was measured with Impact on Participation and Autonomy questionnaire, independence in activities of daily living (ADL) with Spinal Cord Independence Measure, upper extremity functioning with Action Research Arm Test (ARAT) and kinematic measures of the drinking task. The results showed that most participants perceived injury-related restrictions in outdoor autonomy (80%), family role (76%), and in indoor autonomy (72%). Independence in self-care (r = 0.72), mobility (r = 0.59) and upper extremity kinematics of movement time (r = 0.63) and smoothness (r = 0.49) were correlated to indoors autonomy. Social life autonomy was correlated to self-care (r = 0.50) and ARAT (r = 0.41). In conclusion, autonomy was perceived restricted after SCI in several major life areas and correlated with independence in ADL and upper extremity functioning. The aspects of autonomy should be considered more in goal setting and clinical decision-making.

Bone microarchitecture and strength assessment in adults with osteogenesis imperfecta using HR-pQCT: normative comparison and challenges

Data on bone microarchitecture in osteogenesis imperfecta (OI) are scarce. The aim of this cross-sectional study was to assess bone microarchitecture and strength in a large cohort of adults with OI using high-resolution peripheral quantitative computed tomography (HR-pQCT) and to evaluate challenges of using HR-pQCT in this cohort. Second-generation HR-pQCT scans were obtained at the distal radius and tibia in 118 men and women with Sillence OI type I, III, or IV using an extremity-length-dependent scan protocol. In total, 102 radius and 105 tibia scans of sufficient quality could be obtained, of which 11 radius scans (11%) and 14 tibia scans (13%) had a deviated axial scan angle as compared with axial angle data of 13 young women. In the scans without a deviated axial angle and compared with normative HR-pQCT data, Z-scores at the radius for trabecular bone mineral density (BMD), number, and separation were -1.6 ± 1.3, -2.5 ± 1.4, and -2.7 (IQR: 2.7), respectively. They were -1.4 ± 1.5 and -1.1 ± 1.2 for stiffness and failure load and between ±1 for trabecular thickness and cortical bone parameters. Z-scores were significantly lower for total and trabecular BMD, stiffness, failure load, and cortical area and thickness at the tibia. Additionally, local microarchitectural inhomogeneities were observed, most pronounced being trabecular void volumes. In the scans with a deviated axial angle, the proportion of Z-scores <-4 or >4 was significantly higher for trabecular BMD and separation (radius) or most total and trabecular bone parameters (tibia). To conclude, especially trabecular bone microarchitecture and bone strength were impaired in adults with OI. HR-pQCT may be used without challenges in most adults with OI, but approximately 12% of the scans may have a deviated axial angle in OI due to bone deformities or scan positioning limitations. Furthermore, standard HR-pQCT parameters may not always be reliable due to microarchitectural inhomogeneities nor fully reflect all inhomogeneities.

Socially Assistive Robot for Stroke Rehabilitation: A Long-Term in-the-Wild Pilot Randomized Controlled Trial

Socially assistive robots (SARs) have been suggested as a platform for post-stroke training. It is not yet known whether long-term interaction with a SAR can lead to an improvement in the functional ability of individuals post-stroke. The aim of this pilot study was to compare the changes in motor ability and quality of life following a long-term intervention for upper-limb rehabilitation of post-stroke individuals using three approaches: 1) training with a SAR in addition to usual care; 2) training with a computer in addition to usual care; and 3) usual care with no additional intervention. Thirty-three post-stroke patients with moderate-severe to mild impairment were randomly allocated into three groups: two intervention groups - one with a SAR (ROBOT group) and one with a computer (COMPUTER group) - and one control group with no intervention (CONTROL group). The intervention sessions took place three times/week, for a total of 15 sessions/participant; The study was conducted over a period of two years, during which 306 sessions were held. Twenty-six participants completed the study. Participants in the ROBOT group significantly improved in their kinematic and clinical measures which included smoothness of movement, action research arm test (ARAT), and Fugl-Meyer upper-extremity assessment (FMA-UE). No significant improvement in these measures was found in the COMPUTER or the control groups. 100% of the participants in the SAR group gained improvement which reached - or exceeded - the minimal clinically important difference in the ARAT, the gold standard for upper-extremity activity performance post-stroke. This study demonstrates both the feasibility and the clinical benefit of using a SAR for long-term interaction with post-stroke individuals as part of their rehabilitation program. Trial Registration: ClinicalTrials.gov NCT03651063.

Experimental evaluation of the impact of sEMG interfaces in enhancing embodiment of virtual myoelectric prostheses

INTRODUCTION

Despite recent technological advances that have led to sophisticated bionic prostheses, attaining embodied solutions still remains a challenge. Recently, the investigation of prosthetic embodiment has become a topic of interest in the research community, which deals with enhancing the perception of artificial limbs as part of users' own body. Surface electromyography (sEMG) interfaces have emerged as a promising technology for enhancing upper-limb prosthetic control. However, little is known about the impact of these sEMG interfaces on users' experience regarding embodiment and their interaction with different functional levels.

METHODS

To investigate this aspect, a comparison is conducted among sEMG configurations with different number of sensors (4 and 16 channels) and different time delay. We used a regression algorithm to simultaneously control hand closing/opening and forearm pronation/supination in an immersive virtual reality environment. The experimental evaluation includes 24 able-bodied subjects and one prosthesis user. We assess functionality with the Target Achievement Control test, and the sense of embodiment with a metric for the users perception of self-location, together with a standard survey.

RESULTS

Among the four tested conditions, results proved a higher subjective embodiment when participants used sEMG interfaces employing an increased number of sensors. Regarding functionality, significant improvement over time is observed in the same conditions, independently of the time delay implemented.

CONCLUSIONS

Our work indicates that a sufficient number of sEMG sensors improves both, functional and subjective embodiment outcomes. This prompts discussion regarding the potential relationship between these two aspects present in bionic integration. Similar embodiment outcomes are observed in the prosthesis user, showing also differences due to the time delay, and demonstrating the influence of sEMG interfaces on the sense of agency.

The limitations of automatically generated curricula for continual learning

In many applications, artificial neural networks are best trained for a task by following a curriculum, in which simpler concepts are learned before more complex ones. This curriculum can be hand-crafted by the engineer or optimised like other hyperparameters, by evaluating many curricula. However, this is computationally intensive and the hyperparameters are unlikely to generalise to new datasets. An attractive alternative, demonstrated in influential prior works, is that the network could choose its own curriculum by monitoring its learning. This would be particularly beneficial for continual learning, in which the network must learn from an environment that is changing over time, relevant both to practical applications and in the modelling of human development. In this paper we test the generality of this approach using a proof-of-principle model, training a network on two sequential tasks under static and continual conditions, and investigating both the benefits of a curriculum and the handicap induced by continuous learning. Additionally, we test a variety of prior task-switching metrics, and find that in some cases even in this simple scenario the a network is often unable to choose the optimal curriculum, as the benefits are sometimes only apparent with hindsight, at the end of training. We discuss the implications of the results for network engineering and models of human development.

A cutting tool architecture designed to address the parasitic mechanisms consuming excess power during machining and manufacturing operations-A review-based study towards sustainable manufacturing

Metal cutting has been extensively studied over the years for improving its efficacy, yet, parasitic mechanisms like chatter and tool wear continue to generate higher forces and energy consumption with poor surface integrity. To address these parasitic mechanisms, a single-point turning cutter design is proposed based on the physics-of-machining including chatter theory to achieve reduced power consumption during the cutting of various metallic alloys like Al-6061, Ti-6Al-4V and others used by critical sectors such as aerospace and automotive. The current work focuses on aspects of machining that effectively reduce parasitic forces feeding into cutting power. The proposed cutter amalgamates features such as optimum side and end cutting edge angles, smaller nose radius and textured rake face into the cutter-body. Such a design is further proposed for use with a mechanochemical effect on a recently discovered plastic flow mode called sinuous flow, which has been reported to bring down cutting forces significantly. Experimental and analytical tests on the cutter design features validate reduction of cutting forces and through that alleviate the tendency to chatter as well as bring about energy savings for cutting of Al 6061. The potential for reduced real-time power consumption makes this design-framework significant for multipoint milling cutters too. It will greatly facilitate frugal manufacturing to account for sustainability in manufacturing operations.

A systematic review of instrumented assessments for upper limb function in cerebral palsy: current limitations and future directions

INTRODUCTION

Recently, interest in quantifying upper limb function in cerebral palsy has grown. However, the lack of reference tasks and protocols, have hindered the development of quantified movement analysis in clinical practice. This study aimed to evaluate existing instrumented assessments of upper limb function in cerebral palsy, with a focus on their clinical applicability, to identify reasons for the lack of adoption and provide recommendations for improving clinical relevance and utility.

METHODS

A systematic review was conducted by a multidisciplinary team of researchers and clinicians (Prospero CRD42023402382). PubMed and Web of Science databases were searched using relevant keywords and inclusion/exclusion criteria.

RESULTS

A total of 657 articles were initially identified, and after the selection process, 76 records were included for analysis comprising a total of 1293 patients with cerebral palsy. The quality assessment of the reviewed studies revealed a moderate overall quality, with deficiencies in sample size justification and participant information. Optoelectronic motion capture systems were predominantly used in the studies (N = 57/76). The population mainly consisted of individuals with spastic cerebral palsy (834/1293) with unilateral impairment (N = 1092/1293). Patients with severe functional impairment (MACS IV and V) were underrepresented with 3.4% of the 754 patients for whom the information was provided. Thirty-nine tasks were used across the articles. Most articles focused on unimanual activities (N = 66/76) and reach or reach and grasp (N = 51/76). Bimanual cooperative tasks only represented 3 tasks present in 4 articles. A total of 140 different parameters were identified across articles. Task duration was the most frequently used parameter and 23% of the parameters were used in only one article.

CONCLUSION

Further research is necessary before incorporating quantified motion analysis into clinical practice. Existing protocols focus on extensively studied populations and rely on costly equipment, limiting their practicality. Standardized unimanual tasks provide limited insights into everyday arm use. Balancing methodological requirements and performance evaluation flexibility is a challenge. Exploring the correlation between outcome parameters and therapeutic guidance could facilitate the integration of quantified movement assessment into treatment pathways.

Long term quality of life follow-up and functional impairment study in patients with Hirayama disease

Hirayama Disease (HD) is a focal motor neuron disorder generally affecting young adults with a male predominance who experience weakness and atrophy in distal upper extremity muscles in an asymmetric or unilateral pattern. Progression is insidious though significant weakness occurs during a progressive phase of the disease over 2-5 years. The long-term outcome of HD is not as well-known and, thus, this study presents self-reported outcomes from HD patients years after a diagnosis. Thirty HD patients reported quality of life (QOL) and other functional outcome measures after a mean of just over 11 years from diagnosis. Variables that predicted better or worse outcome were analyzed. Overall, QOL was affected by HD though most patients were functional with limitations. No clear attributes of patients or their disease predicted outcome.

The effect of joint position sense therapy on chronic shoulder pain with central sensitization

BACKGROUND

Chronic shoulder pain is a common musculoskeletal problem associated with unreleased pain and functional dysfunction that can evolve into central sensitization. Some forms of manual therapy may exacerbate pain and central sensitization. This study investigated the impact of joint position sense therapy (JPST), a moderate joint proprioception training technique, on central sensitization, shoulder functional dysfunction, and pain in patients with chronic shoulder pain compared with more intense exercises or aggressive manual therapies.

METHODS

We assessed the pressure pain threshold (PPT) in 30 patients with and 30 patients without chronic shoulder pain. The assessment focused on 4 muscle sites: deltoid, upper trapezius, brachioradialis, and tibialis anterior. Thirty patients with chronic shoulder pain were randomly divided into the JPST and control groups. The JPST group underwent additional shoulder joint position-sense training. The efficiency outcomes were the disabilities of the arm, shoulder, and hand questionnaire, visual analog scale (VAS), and PPT, evaluated at baseline and after the intervention.

RESULTS

Significant differences were observed in the PPT values at the brachioradialis (P < .05), deltoid (P < .01), and trapezius (P < .001) among the non-chronic and chronic groups, but not in the tibialis anterior muscle (P > .05). Although both control and JPST interventions effectively improved the disabilities of the arm, shoulder, and hand questionnaire score, pain intensity, and PPT values in the upper limb, the outcomes in the JPST group were significantly different from those in the control group.

CONCLUSIONS

Generalized hyperalgesia changes limited to the upper limbs were observed in patients with chronic shoulder pain. JPST has beneficial effects on pain control and functional dysfunction in patients with chronic shoulder pain.

Effects of task-based mirror therapy on upper limb motor function in hemiplegia: study protocol for a randomized controlled clinical trial

BACKGROUND AND PURPOSE

Research to date has lacked definitive evidence to determine whether mirror therapy promotes the recovery of upper extremity function after stroke. Considering that previous studies did not stratify patients based on structural retention, this may be one of the reasons for the negative results obtained in many trials. The goal evaluates the efficacy of TBMT (utilizing an innovatively designed mirror) versus standard occupational therapy for stroke patient's upper limb functionality.

METHODS AND ANALYSIS

This single-center randomized controlled trial will involve 50 patients with stroke. All patients will be randomly assigned to either the task-based mirror therapy or the control group. The interventions will be performed 5 days per week for 4 weeks. The primary outcomes will be the mean change in scores on both the FMA-UE and modified Barthel Index (MBI) from baseline to 4 weeks intervention and at 12 weeks follow-up between the two groups and within groups. The other outcomes will include the Action Research Arm Test (ARAT), the Nine Hole Peg Test (9HPT), the Functional Independence Measure, and MRI.

DISCUSSION

This trial will not only to establish that task-based mirror therapy (TBMT) could improve the recovery of hand function after stroke but also to explore the underlying mechanisms. We expect that this finding will clarify the brain activation and brain network mechanisms underlying the improvement of hand function with task-oriented mirror therapy and lead to new ideas for stroke hand function rehabilitation.

TRIAL REGISTRATION

URL: https://www.chictr.org.cn ; Unique identifier: ChiCTR2300068855. Registered on March 1, 2023.