Effects of computer use on upper limb musculoskeletal disorders and function in academicians

Objectives. This study aimed to investigate the effects of academician's demographic characteristics and computer usage habits on upper limb musculoskeletal disorders (MSDs) and function. Methods. A cross-sectional observational study was conducted with 100 academicians. Data were collected using questionnaires, which included the patient-rated wrist evaluation questionnaire - Turkish version (PRWE-T), the Cornell musculoskeletal discomfort questionnaire - Turkish version (CMDQ-T), the upper extremity functional index - Turkish version (UEFI-T), demographic characteristics and average daily computer usage time. Results. A low-level significant correlation was found between the age of the individuals and the CMDQ-T forearm (p = 0.044; r = 0.202) and CMDQ-T wrist (p = 0.001; r = 0.337) scores. Women had higher CMDQ-T neck scores and lower UEFI-T scores than men (p < 0.05). Academicians who used computers for 6 h a day or more had higher PRWE-T and CMDQ-T neck, shoulder, upper arm and forearm scores, and had a lower UEFI-T score (p < 0.05). Conclusion. Neck, shoulder, upper arm and forearm symptoms were higher and upper extremity function was impaired in academicians who used computers for 6 h a day or more. Besides, gender and age were associated with upper limb MSDs and function, but occupation duration did not affect those outcomes in academicians.

Physiotherapist-supervised exercises versus unsupervised home-based exercises after nonsurgically treated proximal humerus fracture: a multicenter randomized controlled trial

BACKGROUND

Proximal humerus fracture (PHF) is a common fragility fracture in older adults and can have a substantial impact on upper limb function. Although most patients with PHF can be treated nonsurgically, it is unknown whether older adults benefit from supervised exercise therapy after PHF. Therefore, the objective of this trial was to investigate whether 10 weeks of physiotherapist-supervised exercises once a week were superior to 10 weeks of unsupervised home-based exercises in older adults with a nonsurgically treated displaced 2-part PHF.

METHODS

This was designed as an assessor-blinded, prospective, randomized controlled trial and took place in 3 Nordic countries. In total, 72 patients (≥60 years) with nonsurgically treated displaced 2-part PHF were randomized to either physiotherapist-supervised exercises once a week for 10 weeks, combined with daily home-based exercises, or to 10 weeks of daily unsupervised home-based exercises. The primary outcome measure was the Disability of the Arm, Shoulder, and Hand (DASH) with a primary endpoint at 3 months. Secondary outcomes were DASH (at 12 months), Constant-Murley Score, the 15D-instrument, Visual Analog Scale, General Self-Efficacy Scale, and Pain Catastrophizing Scale, with follow-up visits after 3 and 12 months. Non-union and patient death within 3 months were counted as complications.

RESULTS

The mean age of the patients in both groups was 72 years. At 3 months follow-up, the mean DASH score in the supervised group was 25.9 (SD 16.0) compared to 22.4 (SD 18.9) in the unsupervised group. The mean between-group difference (3.5, 95% CI -5.0 to 12.5) was not clinically relevant. None of the secondary outcome measures presented any clinically relevant or statistically significant between-group differences at 3 or 12 months follow-up. One patient in the supervised group and 3 in the unsupervised group were diagnosed with non-union. One patient from each group died before 3 months follow-up.

CONCLUSIONS

This trial provides no evidence that supervised exercises are superior to unsupervised home-based exercises in improving functional outcome or health-related quality of life in older patients with a nonsurgically treated 2-part PHF. Further, our results suggest that most older adults with a nonsurgically treated 2-part PHF can perform home-based exercises without the supervision of a physiotherapist.

Impact of Upper Limb Motor Recovery on Functional Independence After Traumatic Low Cervical Spinal Cord Injury

Cervical spinal cord injury (SCI) causes devastating loss of upper limb function and independence. Restoration of upper limb function can have a profound impact on independence and quality of life. In low-cervical SCI (level C5-C8), upper limb function can be restored via reinnervation strategies such as nerve transfer surgery. The translation of recovered upper limb motor function into functional independence in activities of daily living (ADLs), however, remains unknown in low cervical SCI (i.e., tetraplegia). The objective of this study was to evaluate the association of patterns in upper limb motor recovery with functional independence in ADLs. This will then inform prioritization of reinnervation strategies focused to maximize function in patients with tetraplegia. This retrospective study performed a secondary analysis of patients with low cervical (C5-C8) enrolled in the SCI Model Systems (SCIMS) database. Baseline neurological examinations and their association with functional independence in major ADLs-i.e., eating, bladder management, and transfers (bed/wheelchair/chair)-were evaluated. Motor functional recovery was defined as achieving motor strength, in modified research council (MRC) grade, of ≥ 3 /5 at one year from ≤ 2/5 at baseline. The association of motor function recovery with functional independence at one-year follow-up was compared in patients with recovered elbow flexion (C5), wrist extension (C6), elbow extension (C7), and finger flexion (C8). A multi-variable logistic regression analysis, adjusting for known factors influencing recovery after SCI, was performed to evaluate the impact of motor function at one year on a composite outcome of functional independence in major ADLs. Composite outcome was defined as functional independence measure score of 6 or higher (complete independence) in at least two domains among eating, bladder management, and transfers. Between 1992 and 2016, 1090 patients with low cervical SCI and complete neurological/functional measures were included. At baseline, 67% of patients had complete SCI and 33% had incomplete SCI. The majority of patients were dependent in eating, bladder management, and transfers. At one-year follow-up, the largest proportion of patients who recovered motor function in finger flexion (C8) and elbow extension (C7) gained independence in eating, bladder management, and transfers. In multi-variable analysis, patients who had recovered finger flexion (C8) or elbow extension (C7) had higher odds of gaining independence in a composite of major ADLs (odds ratio [OR] = 3.13 and OR = 2.87, respectively, p < 0.001). Age 60 years (OR = 0.44, p = 0.01), and complete SCI (OR = 0.43, p = 0.002) were associated with reduced odds of gaining independence in ADLs. After cervical SCI, finger flexion (C8) and elbow extension (C7) recovery translate into greater independence in eating, bladder management, and transfers. These results can be used to design individualized reinnervation plans to reanimate upper limb function and maximize independence in patients with low cervical SCI.

Assessment of the upper limb function, strength, and mobility in treatment-naive children with spinal muscular atrophy Types 2 and 3

INTRODUCTION/AIMS

Current upper limb assessments in pediatric spinal muscular atrophy (SMA) may not adequately capture change with disease progression. Our aim was to examine the relationship between motor function, strength, and hand/finger mobility of the upper limb in treatment-naïve children with SMA Types 2 and 3 to assess new methods to supplement current outcomes.

METHODS

The Revised Upper Limb Module (RULM), grip and pinch strength, and hand/finger mobility data were collected from 19 children with SMA Types 2 and 3 aged 5.2-16.9 years over a year.

RESULTS

A median loss between 0.5 and 2.5 points in the RULM was seen across all SMA subgroups with the biggest median loss recorded between 10 and 14 years of age. The grip strength loss was -0.06 kg (-4.69 to 3.49; IQR, 1.21); pinch improvement of 0.05 (-0.65 to 1.27; IQR, 0.48); hand/finger mobility test improvement of 4 points (-24 to 14; IQR, 6.75) for the whole cohort. Significant correlations were found between the RULM and grip strength (p < .001), RULM and pinch strength (p < .001), RULM and revised Brooke (p < .001), grip strength and pinch strength (p < .001).

DISCUSSION

The combined use of the RULM, dynamometry, and hand mobility provide insight about correlations between function and strength in children with SMA. The RULM and grip strength assessments captured a significant decline in upper limb function, whereas the pinch and finger/hand mobility showed an improvement over the course of 1 year and these results should be considered for future studies.

Impact of Virtual Rehabilitation in Adjunct to Conventional Physical Therapy on Proximal Humerus Fracture: A Randomized Controlled Trial

Introduction Humerus fractures are fairly prevalent in the general population, and their incidence increases with age. The majority of minimally displaced fractures may be treated with prompt rehabilitation. An interdisciplinary team strategy involving experienced musculoskeletal specialists, geriatricians, and skilled physiotherapists should be employed for optimal therapy. Rehabilitation is essential in coping with the consequences of the fracture. The greatest current information for shoulder rehabilitation comprises the use of counseling, exercises, and mobility of restricted joints to regain upper limb function. Virtual reality (VR) based therapies are among the most effective since they may give visual, aural, and somatosensory cues to help patients. In fact, VR-based treatments have been shown to enhance motor function, neuropathic pain, balance, and aerobic performance in individuals with neurological disorders. However, there is limited evidence on the use of VR's therapeutic efficacy on individuals with musculoskeletal disorders. This study applied oculus-guided VR rehabilitation in addition to conventional physical therapy for the rehabilitation of patients with proximal humerus fractures. This study aims to assess the impact of virtual rehabilitation in adjunct to conventional physical therapy on proximal humerus fracture. Methods This study is a randomized controlled trial in which 50 patients were divided randomly into two groups: 25 patients in group A and 25 patients in group B. Group A was an experimental group that received VR plus conventional therapy. At the same time, group B was a control group that received only conventional therapy. Shoulder range of motion (ROM), manual muscle testing (MMT), numerical pain rating scale (NPRS), disabilities of arm, shoulder, and hand (DASH), and Shoulder pain and disability index (SPADI) were used as outcome measures of this study. Results There is an increase in flexion (t=7.58, P=0.0001), extension (t=6.90, P=0.0001), abduction (t = 9.57, P=0.0001), internal rotation (t=6.31, P=0.0001), and external rotation (t=3.41, P=0.001) in group A is statistically more significant than group B. The improvement in MMT scores in group B (t=1.71, P=0.10) is not significant, whereas improvements in group A are statistically significant (t=13.86, P=0.0001). The SPADI and DASH scores improved more significantly in group A (t=62.46, P=0.0001, and t=57.48, P=0.0001, respectively) than in group B (t=39.14, P=0.0001 and 46.58, P=0.0001, respectively). There is no significant difference in pain outcomes between the two groups. Conclusion The findings of this study reveal that virtual rehabilitation in adjunct to conventional physical therapy on proximal humerus fracture is more effective in improving shoulder ROM, muscle strength, and upper limb function than conventional therapy alone. However, no intervention can be considered superior to others in terms of the management of pain associated with proximal humerus fracture.

The feasibility of the adapted H-GRASP program for perceived and actual daily-life upper limb activity in the chronic phase post-stroke

(Purpose: Assessing feasibility and initial impact of the Home-Graded Repetitive Arm Supplementary Program combined with in-home accelerometer-based feedback (AH-GRASP) on perceived and actual daily-life upper limb (UL) activity in stroke survivors during the chronic phase with good UL motor function but low perceived daily-life activity. Material and methods: A 4-week intervention program (4 contact hours, 48 h self-practice) encompassing task-oriented training, behavioral techniques, phone-based support, monitoring, and weekly feedback sessions using wrist-worn accelerometery was implemented using a pre-post double baseline repeated measures design. Feasibility, clinical assessments, patient-reported outcomes, and accelerometer data were investigated. Results: Of the 34 individuals approached, nineteen were included (recruitment rate 56%). Two dropped out, one due to increased UL pain (retention rate 89%). Seven (41%) achieved the prescribed exercise target (120 min/day, six days/week). Positive patient experiences and improvements in UL capacity, self-efficacy, and contribution of the affected UL to overall activity (p < 0.05, small to large effect sizes) were observed. Additionally, seven participants (41%) surpassed the minimal clinically important difference in perceived UL activity.Conclusions: A home-based UL exercise program with accelerometer-based feedback holds promise for enhancing perceived and actual daily-life UL activity for our subgroup of chronic stroke survivors.

Impact of evidence-based nursing on postoperative psychological state, quality of life, and function of affected limbs in breast cancer patients: An observational study

To analyze the effect of evidence-based nursing on postoperative psychological state, quality of life, and function of affected limbs in breast cancer (BC) patients. This study is a retrospective analysis. The clinical data of 122 BC patients in our hospital were selected and divided into evidence-based group and routine group according to different nursing programs. Patients in evidence-based group received evidence-based nursing, and patients in the conventional group received routine nursing intervention. The acceptance level of BC diagnosis in evidence-based group was significantly higher than that in the conventional group, showing statistical significance (P < .05). After intervention, Self-rating Anxiety Scale and Self-rating Depression Scale scores of both groups were significantly reduced, and the Self-rating Anxiety Scale and Self-rating Depression Scale scores in evidence-based group were significantly lower than those in conventional group, showing statistically significant difference (P < .05); Self-Esteem Scale scores were significantly increased in both groups after intervention, and the scores in evidence-based group were significantly higher than those in conventional group, showing statistically significant difference (P < .05). After intervention, in evidence-based group, the proportion of patients without edema was significantly increased, while the proportion of patients with mild, moderate and severe edema was significantly decreased, exhibiting statistically significant difference (P < .05). After intervention, the circumference difference of the healthy side and the affected side decreased significantly, which was much lower in evidence-based group, showing statistically significant difference (P < .05). After intervention, range of motion of the upper limbs increased significantly between the 2 groups, which was much higher in evidence-based group, exhibiting statistical significance (P < .05). The scores of quality of life (role, emotion, body, cognition and society dimension) in evidence-based group were higher than those in conventional group, exhibiting statistically significant difference (P < .05). Evidence-based nursing can develop more targeted nursing measures according to patients' problems, thus effectively promoting the recovery of upper limb function of BC patients after surgery.

A deep learning wearable-based solution for continuous at-home monitoring of upper limb goal-directed movements

Introduction

Monitoring upper limb function is crucial for tracking progress, assessing treatment effectiveness, and identifying potential problems or complications. Hand goal-directed movements (GDMs) are a crucial aspect of daily life, reflecting planned motor commands with hand trajectories towards specific target locations. Previous studies have shown that GDM tasks can detect early changes in upper limb function in neurodegenerative diseases and can be used to track disease progression over time.

Methods

In this study, we used accelerometer data from stroke survivor participants and controls doing activities of daily living to develop an automated deep learning approach to detect GDMs. The model performance for detecting GDM or non-GDM from windowed data achieved an AUC of 0.9, accuracy 0.83, sensitivity 0.81, specificity 0.84 and F1 0.82.

Results

We further validated the utility of detecting GDM by extracting features from GDM periods and using these features to classify whether the measurements are collected from a stroke survivor or a control participant, and to predict the Fugl-Meyer assessment score from stroke survivors.

Discussion

This study presents a promising and reliable tool for monitoring upper limb function in a real-world setting, and assessing biomarkers related to upper limb health in neurological, neuromuscular and muscles disorders.

Non-immersive virtual reality based treatment for children with unilateral cerebral palsy: Preliminary results

PURPOSE

Unilateral cerebral palsy (UCP) represents about 30-40% of overall cerebral palsy diagnoses. Upper limb impairment has a significant negative impact on activities of daily living (ADL), and recent studies have shown that the use of virtual reality (VR) can increase motivation and promote an improvement in ADL. This preliminary study was aimed at exploring the acceptability and usability of a VR rehabilitation treatment, using the VITAMIN Platform, for children with UCP. A secondary goal of the study was to compare the results of usual standardized clinical scales and questionnaires with kinematic results as well as with the quantitative measures acquired by the VITAMIN platform in each exercise of the rehabilitation sessions.

METHODS

Six children with UCP (aged 7-15) were recruited for a preliminary investigation in using a non-immersive VR system. The treatment was composed of 10 weekly sessions of 45 minutes. Each child played five types of exergames, using the impaired upper limb to hit virtual objects projected on a wide screen. Standardized clinical scales, kinematic analysis, and questionnaires were used to extensively assess upper limb function before and at the end of treatment. Five typically-developing children provided a reference for the instrumented kinematic assessment.

RESULTS

At the end of the treatment, Melbourne Assessment 2 (MA2) scores increased for all the participants (mean increase in range of movement (ROM) + 19.1%, accuracy + 4.6%, dexterity + 13.1%, fluency + 10.3%). Shoulder flexion-extension ROM also improved (mean increase + 10.5°), and according to the kinematic analysis, shoulder movements became more similar to reference profiles. These results were confirmed by a general improvement in performing ADL, assessed by the ABILHAND-Kids questionnaire. Finally, a general agreement among the different measures and indexes emerged from the acquired data.

CONCLUSION

The results show that VR treatment with the VITAMIN platform could be engaging and functional for rehabilitation of children with UCP. The good agreement among the qualitative and quantitative measures and indexes confirms the potential of such novel treatment. However, due to the limited sample size and small number of sessions, further and larger investigations are required to evaluate the effectiveness and to generalize the results.

Effect of wrist orthoses on upper limb function, activities of daily living, and stress response

Introduction

This study examined the effects on upper limb function, activities of daily living, and stress responses when wearing a wrist orthosis made of padded fiberglass or thermoplastic and provided essential information for selecting an orthosis.

Methods

Thirty-one healthy adults performed two tests while not wearing a wrist orthosis, wearing a padded fiberglass wrist orthosis, and wearing a thermoplastic wrist orthosis. The Purdue Pegboard Test examined upper limb control. In the second test, the actions indicated by the Hand20 questionnaire were performed while wearing a wrist orthosis. An electrocardiogram was obtained before and after each test to identify any changes in sympathetic nervous system activity.

Results

The Purdue Pegboard Test scores were significantly higher when not wearing a wrist orthosis than when wearing wrist orthosis, and the Hand20 scores for all question were significantly lower. Thermoplastic wrist orthoses had fewer restrictions for upper limb function compared to padded fiberglass wrist orthoses, however activities of daily living were more limited. The low frequency/high frequency ratio and high frequency measures showed no significant differences.

Conclusions

Pegboard test scores and the Hand 20 scores suggest that a wrist orthosis causes restriction of upper limb function.

Patient-reported function, quality of life and prosthesis wear in adults born with one hand: a national cohort study

We invited individuals aged above 16 years with a congenital transverse reduction deficiency at and above the wrist born in Norway between 1970 and 2006 to complete the short version of the Disabilities of the Arm, Shoulder and Hand Outcome Measure, the 5-Level EuroQoL-5-Dimension instrument, the RAND 36-Item Short Form Health Survey and a single-item questionnaire on arm function, appearance, pain and prosthesis wear. Of 154 eligible participants, 58 (38%) responded. Their scores were not different from the general population. All had been offered prostheses, and 56 (97%) had been fitted at a median age of 1 year (interquartile range 0-2.8). Of the participants, 37 (64%) were still prosthesis wearers, while 21 (36%) were non-wearers or using gripping devices only. Prosthesis wearers had higher levels of 'vitality' as assessed by the RAND-36 and rated their arm appearance higher, but there were no other score differences, indicating that prosthesis rejection is not associated with worse functional outcomes.Level of evidence: III.

The effectiveness of intermittent theta burst stimulation for upper limb motor recovery after stroke: a systematic review and meta-analysis of randomized controlled trials

Background

Intermittent theta burst stimulation (iTBS) is a promising noninvasive therapy to restore the excitability of the cortex, and subsequently improve the function of the upper extremities. Several studies have demonstrated the effectiveness of iTBS in restoring upper limb function and modulating cortical excitability. We aimed to evaluate the effects of iTBS on upper limb motor recovery after stroke.

Objective

The purpose of this article is to evaluate the influence of intermittent theta-burst stimulation on upper limb motor recovery and improve the quality of life.

Method

A literature search was conducted using PubMed, EMBASE, MEDLINE, The Cochrane Library, Web of Science, and CBM, including only English studies, to identify studies that investigated the effects of iTBS on upper limb recovery, compared with sham iTBS used in control groups. Effect size was reported as standardized mean difference (SMD) or weighted mean difference (WMD).

Results

Ten studies were included in the meta-analysis. The results of the meta-analysis indicated that when compared to the control group, the iTBS group had a significant difference in the Fugl-Meyer Assessment (FMA) and Action Research Arm Test (ARAT) (WMD: 3.20, 95% CI: 1.42 to 4.97; WMD: 3.72, 95% CI: 2.13 to 5.30, respectively). In addition, there was also a significant improvement in the modified Ashworth scale (MAS) compared to the sham group (WMD: -0.56; 95% CI: -0.85 to -0.28). More evidence is still needed to confirm the effect of Barthel Index (BI) scores after interventions. However, no significant effect was found for the assessment of Motor Evoked Potential (MEP) amplitude and MEP latency (SMD: 0.35; 95% CI: -0.21 to 0.90; SMD: 0.35, 95% CI: -0.18 to 0.87; SMD: 0.03, 95% CI: -0.49 to 0.55; respectively).

Conclusion

Our results showed that iTBS significantly improved motor impairment, functional activities, and reduced muscle tone of upper limbs, thereby increasing the ability to perform Activities of Daily Living (ADL) in stroke patients, while there were no significant differences in MEPs. In conclusion, iTBS is a promising non-invasive brain stimulation as an adjunct to therapy and enhances the therapeutic effect of conventional physical therapy. In the future, more randomized controlled trials with large sample sizes, high quality, and follow-up are necessary to explore the neurophysiological effects.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023392739.

Personalized Use of an Adjustable Movement-Controlled Video Game in Obstetric Brachial Plexus Palsy during Physiotherapy Sessions at School: A Case Report

This case study explores the use of a personalized, adjustable Kinect exergame in 10 physiotherapy sessions for a 10-year-old girl with incomplete right-sided obstetric brachial plexus palsy (OBPP). The aim was to observe the impact on the patient's upper limb mobility that could be achieved through maximization of the player's motivation, possibly due to continuous game parameter adjustments. It had been achieved that the patient was playing 87% of the total gaming time with a personally challenging setting that increased her arm speed from one to four movements. Strength in abduction and flexion were increased by 8 N and 7 N, respectively. Furthermore, the patient showed better muscular balance and an increase of 50% in speed of the Jebsen-Taylor hand function test (JTHFT). The patient reported high levels of motivation, low perception of fatigue, and just slight discomfort. The study found that the use of personalized video games as a complement to conventional physiotherapy can be successful in OBPP patients when the game allows for the adjustment of the difficulty level as a response to personal performance. Predefined difficulty levels and automatic performance analysis can be helpful. Results are promising; however, further research is needed to confirm the results.

Home-based virtual reality-enhanced upper limb training system in children with brain injury: a randomized controlled trial

Background

Rehabilitation of upper limb function can be challenging in children with brain lesion. Recent virtual reality (VR) rehabilitation may be an additional treatment option in pediatric rehabilitation.

Objectives

To assess the feasibility and effectiveness of a home-based VR-enhanced rehabilitation program with wearable multi-inertial measurement unit (IMU) sensors on upper limb functions in children with brain injury.

Methods

This multicenter single blind randomized controlled trial included 40 children with cerebral palsy (CP) or static brain injury. Subjects were randomized 1:1 to experimental and control group. Both the groups maintained the same therapeutic content and dose of occupational therapy during the intervention period. The experimental group performed additional training at home using the VR-enhanced program for at least 30 min/day, 5 days/week, for 6 weeks. VR training consisted of daily activities or games promoting wrist and forearm articular movements using wearable IMU sensors. The Melbourne Assessment of Unilateral Upper Limb Function-version 2 (MA2), Upper Limb Physician's Rating Scale (ULPRS), Pediatric Evaluation of Disability Inventory-computer adaptive test (PEDI-CAT), computerized 3D motion analysis, and user satisfaction survey were performed. Mann-Whitney U test was used to compare treatment effects between groups, and Friedman and Wilcoxon signed-rank tests were used to compare pre and post intervention.

Results

Overall 35 children (15 in VR group and 20 in control group) completed the protocol. In the experimental group, an average VR training time was 855 min. The accuracy of motion measured by MA2, segmental movements by ULPRS, daily living capability and social cognitive function by PEDI-CAT, movement time and shoulder movement pattern by motion analysis showed significant improvements. However, there were no significant differences in any of the functional outcome measures compared to the control group. All the children and parents reported positive experiences.

Conclusions

Home-based VR training though it had limited impact on improving upper limb function, it could help improve social cognitive function, movement pattern, and efficiency in children with brain injury and could be an effective means of extending clinical therapy to the home.

Clinical Trial Registration

CRIS.nih.go.kr: identifier KCT0003172.

Does frequent use of an exoskeletal upper limb robot improve motor function in stroke patients?

PURPOSE

To determine how differences in frequency of the single-joint hybrid assistive limb (HAL-SJ) use affect the improvement of upper limb motor function and activities of daily living (ADL) in stroke patients.

MATERIALS AND METHODS

Subacute stroke patients were divided into the high or low frequency of HAL-SJ use groups. The two groups were matched by propensity score, and the degree of changes 30 days after initiating HAL-SJ use was compared. A logistic regression analysis was performed to examine whether frequent use would increase the number of subjects experiencing the efficacy of more than the minimal clinically important difference (MCID) of Fugl-Meyer assessment (FMA).

RESULTS

Twenty-five stroke patients were matched by propensity score, and nine pairs were matched. The high-frequency group showed a significantly superior increase to total FMA shoulder, elbow, forearm, and Barthel index compared with the low-frequency group. Logistic regression analysis revealed no significant associations between frequent use and MCID.

CONCLUSIONS

The frequency of HAL-SJ use may affect the improvement of motor function and ADL ability of the upper limb with exception of the fingers and wrist. However, the frequency of intervention was not effective enough to further increase the number of subjects with clinically meaningful changes in upper limb motor function.IMPLICATIONS FOR REHABILITATIONThe current study aimed to clarify how differences in the frequency of single-joint hybrid assistive limb (HAL-SJ) use can affect the improvement of upper-limb motor functions and ADL in subacute stroke patients.Our results implied that the frequency of HAL-SJ use may influence the recovery of upper limb function.However, even if HAL-SJ is used frequently, it does not mean that more patients will achieve clinically meaningful recovery.

Effects of Intensive Versus Distributed Constraint-Induced Movement Therapy for Children With Unilateral Cerebral Palsy: A Quasi-Randomized Trial

BACKGROUND

Previous studies have compared the effectiveness of constraint-induced movement therapy (CIMT) by different training doses. However, whether the dosing schedule, that is, intensive or distributed, influences the effectiveness of CIMT in children with unilateral cerebral palsy (CP) is unknown.

OBJECTIVE

To investigate the effectiveness of intensive and distributed CIMT for children with unilateral CP.

METHODS

Fifty children with unilateral CP were assigned to intensive or distributed CIMT group with a total of 36 training hours. The intensive CIMT was delivered within 1 week, and the distributed CIMT was delivered twice a week for 8 weeks. The outcomes were the Melbourne Assessment 2, Box and Block Test, Pediatric Motor Activity Log-Revised (PMAL-R), Bruininks-Oseretsky test of motor proficiency 2, ABILHAND-Kids and Parenting Stress Index-Short Form. The intensive group was assessed at the initiation of treatment (week 0), at the end of 1 week treatment (week 1), and 8 weeks after the initiation of treatment (week 8). The distributed group was assessed at week 0 and week 8.

RESULTS

The within-group analyses demonstrated significant differences on all motor outcomes. There were no significant between-group differences at post-treatment, while the intensive CIMT demonstrated larger improvements than the distributed CIMT did on quality of use of the more-affected hand, as rated by parents on the PMAL-R at week 8.

CONCLUSIONS

The 2 dosing schedules of CIMT had similar effectiveness for children with unilateral CP. The intensive CIMT yielded additional improvement on parent rated motor quality of the more-affected hand at 8 weeks after the initiation of treatment.

TRIAL REGISTRATION

ClinicalTrials.gov (ID: NCT03128385).

The Role of Extra-motor Networks in Upper Limb Motor Performance Post-stroke

BACKGROUND

Motor improvement post-stroke may happen even if resting state functional connectivity between the ipsilesional and contralesional components of the sensorimotor network is not fully recovered. Therefore, we investigated which extra-motor networks might support upper limb motor gains in response to treatment post-stroke.

METHODS

Both resting state functional connectivity and upper limb capacity were measured prior to and after an 8-week intervention of task-specific training in 29 human participants [59.24 ± (SD) 10.40 yrs., 12 females and 17 males] with chronic stroke. The sensorimotor and five extra-motor networks were defined: default mode, frontoparietal, cingulo-opercular, dorsal attention network, and salience networks. The Network Level Analysis toolbox was used to identify network pairs whose connectivities were enriched in connectome-behavior relationships.

RESULTS

Mean upper limb capacity score increased 5.45 ± (SD) 5.55 following treatment. Baseline connectivity of some motor but mostly extra-motor network interactions of cingulo-opercular and default-mode networks were predictive of upper limb capacity following treatment. Also, changes in connectivity for extra-motor interactions of salience with default mode, cingulo-opercular, and dorsal attention networks were correlated with gains in upper limb capacity.

CONCLUSIONS

These connectome-behavior patterns suggest larger involvement of cingulo-opercular networks in prediction of treatment response and of salience networks in maintenance of improved skilled behavior. These results support our hypothesis that cognitive networks may contribute to recovery of motor performance after stroke and provide additional insights into the neural correlates of intensive training.

Does anterior plus posterior interosseus neurectomy lead to better outcomes than isolated posterior interosseus denervation in the treatment of chronic wrist pain? A systematic review of the literature and meta-analysis

Purpose

Partial wrist denervation can be performed by isolated posterior interosseous nerve (PIN) or combined PIN plus (+) anterior interosseous nerve (AIN) neurectomy procedures. The purpose of the current systematic review is to investigate any differences in clinical outcomes and failures in patients undergoing AIN + PIN vs isolated PIN neurectomy.

Methods

A review of the English Literature was performed on Medline, WOS and Scopus according to PRISMA protocol combining 'wrist denervation', 'PIN neurectomy', 'AIN neurectomy', anterior interosseous nerve neurectomy' and 'posterior interosseous nerve neurectomy'. Studies were assessed with a modified Coleman Methodology Score (CMS). The primary outcome for meta-analysis was 'Failures', including all patients who have required a second surgery or those who are left with pain (defined as 'bad').

Results

Overall, 10 studies totalling 347 wrists were included in this systematic review, with a 'moderate' CMS. The isolated PIN neurectomy technique showed a 15.1% pooled failure rate at a median follow-up of 22 months, while the combined AIN+PIN denervation had a pooled failure rate of 23.6% at a follow-up with a median of 29 months. The combined analysis of both procedures did not show significantly better results in favour of either technique, with a general failure rate of 21.6% (P = 0.0501).

Conclusion

Partial denervation for chronic wrist pain is a salvage procedure that leads to an overall success of 78.4% for pain relief, with no substantial complications. Apparently, performing the neurectomy also of the AIN does not offer greater advantages compared to the isolated PIN neurectomy.

Effect of somatosensory simulation training combined with EMG biofeedback on upper limb dysfunction in stroke patients

OBJECTIVE

To explore the effect of somatosensory simulation training combined with EMG biofeedback in the rehabilitation of upper limb function in stroke patients with hemiplegia.

METHODS

Retrospective analysis of clinical data of 96 stroke patients with upper limb hemiplegia who underwent rehabilitation treatment in Xi'an International Medical Center Hospital from August 2019 to August 2021. These patients were divided into the patients into combined therapy group and control group according to the treatment modality. Patients in control group were given routine rehabilitation, and on this basis, somatosensory simulation training (SST) combined with EMG biofeedback were carried out in combined therapy group. Upper limb motor function [Fugl-Meyer assessment (FMA score), simple Test for Evaluating Hand Function (STEF score)], hand grab and relax test (HGRT), wrist active range of motion (AROM), nerve function [National Institutes of Health Stroke Scale (NIHSS score)], peripheral nerve conduction velocity, integrated EMG (iEMG) value of upper limb muscle group, and activities of daily living [modified Barthel Index (MBI score)] were compared between the two groups.

RESULTS

After treatment, the FMA score and STEF score of upper limb function in combined therapy group were higher, and HGTR and dorsiflexion AROM of the affected hand were also higher. Besides, NIHSS score and peripheral nerve conduction velocity of patients in combined therapy group were better improved, and iEMG values of upper limb muscle groups were higher, which effectively improved patients' activities of daily living and BMI score.

CONCLUSION

SST combined with EMG biofeedback can better help stroke patients control the movement and muscle contraction of hemiplegic upper limbs, and improve the conduction velocity of peripheral nerve, so as to better improve patients' activities of daily living.

Effect of different modalities of artificial intelligence rehabilitation techniques on patients with upper limb dysfunction after stroke-A network meta-analysis of randomized controlled trials

Background

This study aimed to observe the effects of six different types of AI rehabilitation techniques (RR, IR, RT, RT + VR, VR and BCI) on upper limb shoulder-elbow and wrist motor function, overall upper limb function (grip, grasp, pinch and gross motor) and daily living ability in subjects with stroke. Direct and indirect comparisons were drawn to conclude which AI rehabilitation techniques were most effective in improving the above functions.

Methods

From establishment to 5 September 2022, we systematically searched PubMed, EMBASE, the Cochrane Library, Web of Science, CNKI, VIP and Wanfang. Only randomized controlled trials (RCTs) that met the inclusion criteria were included. The risk of bias in studies was evaluated using the Cochrane Collaborative Risk of Bias Assessment Tool. A cumulative ranking analysis by SUCRA was performed to compare the effectiveness of different AI rehabilitation techniques for patients with stroke and upper limb dysfunction.

Results

We included 101 publications involving 4,702 subjects. According to the results of the SUCRA curves, RT + VR (SUCRA = 84.8%, 74.1%, 99.6%) was most effective in improving FMA-UE-Distal, FMA-UE-Proximal and ARAT function for subjects with upper limb dysfunction and stroke, respectively. IR (SUCRA = 70.5%) ranked highest in improving FMA-UE-Total with upper limb motor function amongst subjects with stroke. The BCI (SUCRA = 73.6%) also had the most significant advantage in improving their MBI daily living ability.

Conclusions

The network meta-analysis (NMA) results and SUCRA rankings suggest RT + VR appears to have a greater advantage compared with other interventions in improving upper limb motor function amongst subjects with stroke in FMA-UE-Proximal and FMA-UE-Distal and ARAT. Similarly, IR had shown the most significant advantage over other interventions in improving the FMA-UE-Total upper limb motor function score of subjects with stroke. The BCI also had the most significant advantage in improving their MBI daily living ability. Future studies should consider and report on key patient characteristics, such as stroke severity, degree of upper limb impairment, and treatment intensity/frequency and duration.

Systematic review registration

www.crd.york.ac.uk/prospero/#recordDetail, identifier: CRD42022337776.

Motor network reorganization after motor imagery training in stroke patients with moderate to severe upper limb impairment

BACKGROUND

Motor imagery training (MIT) has been widely used to improve hemiplegic upper limb function in stroke rehabilitation. The effectiveness of MIT is associated with the functional neuroplasticity of the motor network. Currently, brain activation and connectivity changes related to the motor recovery process after MIT are not well understood.

AIM

We aimed to investigate the neural mechanisms of MIT in stroke rehabilitation through a longitudinal intervention study design with task-based functional magnetic resonance imaging (fMRI) analysis.

METHODS

We recruited 39 stroke patients with moderate to severe upper limb motor impairment and randomly assigned them to either the MIT or control groups. Patients in the MIT group received 4 weeks of MIT therapy plus conventional rehabilitation, while the control group only received conventional rehabilitation. The assessment of Fugl-Meyer Upper Limb Scale (FM-UL) and Barthel Index (BI), and fMRI scanning using a passive hand movement task were conducted on all patients before and after treatment. The changes in brain activation and functional connectivity (FC) were analyzed. Pearson's correlation analysis was conducted to evaluate the association between neural functional changes and motor improvement.

RESULTS

The MIT group achieved higher improvements in FM-UL and BI relative to the control group after the treatment. Passive movement of the affected hand evoked an abnormal bilateral activation pattern in both groups before intervention. A significant Group × Time interaction was found in the contralesional S1 and ipsilesional M1, showing a decrease of activation after intervention specifically in the MIT group, which was negatively correlated with the FM-UL improvement. FC analysis of the ipsilesional M1 displayed the motor network reorganization within the ipsilesional hemisphere, which correlated with the motor score changes.

CONCLUSIONS

MIT could help decrease the compensatory activation at both hemispheres and reshape the FC within the ipsilesional hemisphere along with functional recovery in stroke patients.

Study Protocol for a Multicenter, Randomized Controlled Trial to Improve Upper Extremity Hemiparesis in Chronic Stroke Patients by One-to-One Training (NEURO(®)) with Repetitive Transcranial Magnetic Stimulation

During recovery from upper limb motor paralysis after stroke, it is important to (1) set the exercise difficulty level according to the motor paralysis severity, (2) provide adequate exercises, and (3) motivate the patient to achieve the goal. However, these factors have not been well-formulated. This multicenter, randomized controlled trial study aims to examine the therapeutic effects of these three factors on patients undergoing a novel intervention using repetitive transcranial magnetic stimulation and intensive one-to-one training (NEURO^®) and to formulate a corresponding research protocol. The control group will receive conventional NEURO^® occupational therapy. In the intervention group, four practice plans will be selected according to the Fugl-Meyer assessment (FMA-UE) scores of the upper extremity. The goal is to predict the post-treatment outcomes based on the pre-treatment FMA-UE scores. Based on the degree of difficulty and amount of practice required, we can formulate a practice plan to promote upper limb motor recovery. This occupational therapy plan will be less influenced by the therapist's skill, facilitating effective rehabilitation. The study findings may be utilized to promote upper limb motor paralysis recovery and provide a basis for proposing activities of daily living adapted to upper limb function.

Does bimanual task training benefit manual ability and hand function of children with bilateral spastic cerebral palsy?

PURPOSE

Sixty percent of children with bilateral cerebral palsy have impaired hand function. The study's purpose was to examine the benefits of bimanual task practice on the manual ability and hand function of children with bilateral spastic cerebral palsy.

METHODS

In this pre-post study design, 18 children with bilateral spastic cerebral palsy with an average age of 11.5 (+/-1.9) years, Manual Ability Classification System levels I-III and Bimanual Fine Motor Function levels I-III participated in bimanual task practice of upper extremities. The task practice included clay activities, paper manipulation and activities of daily needs. The children underwent 45-minute training sessions 3 times a week over 6 weeks. The outcome measures were ABILHAND-Kids, Quality of Upper Extremity Skills Test and grip strength.

RESULTS

Post-training, a mean change of 6.44 logits in ABILHAND-Kids, 11 points on the Quality of Upper Extremity Skills Test, and 3.3 and 3.1 kilograms grip strength in the dominant and nondominant hands respectively were observed with a statistical significance (p <  0.05).

CONCLUSION

Bimanual task training might be beneficial in improving manual ability, hand function and grip strength in children with bilateral spastic cerebral palsy.

Horticultural Therapy for Improving the Work Performance and Interpersonal Relationships of Persons with Intellectual Disabilities

For the occupational adaptation and social integration of the intellectually disabled, it is helpful to improve their work performance and interpersonal skills. The purpose of the study was to evaluate the effectiveness of horticultural therapy (HT) programs to improve work performance and interpersonal relationships of persons with intellectual disabilities. Based on observations and analyses of how people with intellectual disabilities work, we have developed a 12-session HT program that includes upper limb movements and physical activities to improve hand function. We recruited, with the consent of their legal guardians, 14 (6 males, 8 females) participants who had intellectual disabilities and were working at a sheltered workshop in K-gu, Seoul, South Korea. The program consisted of twelve sixty-minute sessions that were conducted twice a week at a rooftop garden. For pre- and post-evaluation of the program, the survey of functional adaptive behavior (SFAB), interpersonal negotiation strategies, a horticultural job evaluation (self), hand function tests (pegboard, pinch gauge, fingertips), and blood sample tests for physiological indicators of exercise were conducted. Interpersonal negotiation strategies, functional adaptive behaviors, and physical abilities for job behaviors, including agility and grasping of the hand, improved significantly from before to after the program (p < 0.05). A positive result of VEGF (vascular endothermic growth factor) in blood sample tests implies the need for further research on cognitive changes caused by horticultural activities. This study has limitations due to the small number of participants, but the results suggest that low- to medium-intensity horticultural treatment programs using the upper body and hands could be effective for vocational rehabilitation of the intellectually disabled.

Superior treatment efficacy of neuromodulation rehabilitation for upper limb recovery after stroke: a meta-analysis

BACKGROUND

This study aims to explore the treatment efficacy of different motor rehabilitation interventions for upper limb impairment recovery.

RESEARCH DESIGN & METHODS

Publications were searched in PubMed and Embase. 4 grouped motor rehabilitation treatments (training, technological intervention, pharmacological intervention, and neuromodulation) were compared. The change of the Fugl-Meyer Assessment Scale for Upper Extremity (FMA-UE) was applied to assess upper limb function after stroke.

RESULTS

56 studies including 5292 patients were identified. A significant difference was found among the 4 groups (P = 0.02). Neuromodulation interventions had the best treatment efficacy among the 4 types of interventions (P < 0.01). Among neuromodulation interventions, acupuncture, electric, or magnetic intervention all had therapeutic efficacy for stroke upper limb recovery, without significant subgroup difference (P = 0.34). Stroke patients with mild upper limb impairment might not benefit from motor rehabilitation (P = 0.14).

CONCLUSION

Neuromodulation interventions might have the best therapeutic efficacy among motor rehabilitation treatments for upper limb impairment after stroke. It is a potential treatment direction for upper limb recovery among stroke patients. However, since a large proportion of the original studies are low to very low-quality evidence, large-scale RCTs should be conducted in the future to validate current findings and assess treatment effects based on patient characteristics.

Selecting assessment tools to characterize upper limb function of children with cerebral palsy: A mega-review of systematic reviews

AIM

A mega-review of published systematic reviews without restriction on year of publication was implemented to summarize available assessment tools of upper limb (UL) function in children with Cerebral Palsy (CP).

METHOD

A multi-prong search strategy was used to identify 12 systematic literature reviews for inclusion in the mega-review. Included reviews were coded by descriptive analyses, which included methodological and reported measurement property description. Methodological quality of the selected systematic reviews was evaluated with the AMSTAR-2. We synthetized the measurement properties of the revised assessment tools and their coverage within the International Classification of Functioning, Disability and Health (ICF) domains.

RESULTS

The 12 systematic reviews addressed 84 assessment tools. Systematic reviews' methodological quality varied between critically low to moderate. Suggested assessment tools covered ICF domains of body structure and function, and activities and participation. Measurement property data analysis was based mostly on reliability and validity.

INTERPRETATION

Based on the findings of the mega-review, the ABILHAND-Kids, Assisting Hand Assessment (AHA) and Melbourne Assessment of Unilateral Upper Limb Function (MUUL) are the most suitable tools to evaluate children between 6 and 12 years of age with unilateral CP.

The Effectiveness of Intermittent Theta Burst Stimulation for Stroke Patients With Upper Limb Impairments: A Systematic Review and Meta-Analysis

Background

Upper limb impairments are one of the most common health problems of stroke, affecting both motor function and independence in daily life. It has been demonstrated that intermittent theta burst stimulation (iTBS) increases brain excitability and improves upper limb function. Our study sought to determine the role of iTBS in stroke recovery.

Objective

The purpose of this study was to determine the efficacy of iTBS in individuals with upper limb impairments following stroke.

Methods

The databases used included Cumulative Index to PubMed, EMBASE, ESCBOhost, The Cochrane Library, Chinese Biomedical Database, Web of Science, China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), Technology Periodical Database (VIP), and WanFang Database. Studies published before November 2021 were included. Each participant received an iTBS-based intervention aimed at improving activity levels or impairment, which was compared to usual care, a sham intervention, or another intervention. The primary outcome measure was a change in upper limb function assessment. Secondary outcomes included impairment, participation, and quality of life measures.

Result

A total of 18 studies (n = 401 participants) that met the inclusion criteria were included in this study. There was a slight change in the upper limb function of the iTBS group compared with the control group, as measured by the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) score (mean difference 2.70, 95% CI −0.02 to 5.42, p = 0.05). Significant improvement in resting motor threshold (RMT) and motor-evoked potential (MEP) was also observed in the meta-analysis of iTBS (MD 3.46, 95% CI 2.63 to 4.28, p < 0.00001); (MD 1.34, 95% CI 1.17 to 1.51, P < 0.00001). In addition, we got similar results when the studies were using the Modified Barthel Index (MBI) assessment (mean difference of 7.34, 95% CI 0.47 to 14.21, p = 0.04).

Conclusion

Our study established the efficacy of iTBS in improving motor cortical plasticity, motor function, and daily functioning in stroke patients. However, the review requires evidence from additional randomized controlled trials and high-quality research.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO/

Bilateral Movement-based Computer Games Improve Sensorimotor Functions in Subacute Stroke Survivors

BACKGROUND

Previous studies have reported that movement-based computer gaming is more effective than conventional intervention in enhancing upper limb rehabilitation.

OBJECTIVE

To evaluate whether the use of bilateral movement-based computer games could augment the effects of conventional intervention in improving the upper limb motor function, grip strength and health-related quality of life of subacute stroke survivors.

METHODS

A total of 93 subjects with subacute stroke were randomized into 2 groups receiving one of two 3.5-h interventions for 2 days per week over 8 weeks: (i) "bilateral movement-based computer games + conventional rehabilitation"; and (ii) "video-directed exercise + conventional rehabilitation" (control group).

RESULTS

A total of 83 subjects completed the interventions and follow-up assessments. Compared with video-directed exercise + conventional rehabilitation, bilateral movement-based computer games + conventional rehabilitation produced greater improvements in upper limb motor impairment from midtreatment to follow-up 1 month post-intervention, greater improvements in upper limb function from post-intervention to 1 month follow-up, and earlier improvements in grip strength (paretic) from midintervention to follow-up 1 month post-intervention. Subjects who received bilateral movement-based computer games + conventional rehabilitation also continued to improve in motor function from postintervention to 1 month post-intervention.

CONCLUSION

Bilateral movement-based computer games may serve as an adjuvant therapy to conventional rehabilitation programmes for improving upper limb recovery among stroke survivors.

Construct validity, reliability, and responsiveness of the Wrist Position Sense Test for use in children with hemiplegic cerebral palsy

INTRODUCTION

We investigate the construct validity, test re-test reliability, and responsiveness of the Wrist Position Sense Test (WPST) for children with hemiplegic cerebral palsy (CP).

METHODS

Twenty-eight children with spastic hemiplegic CP [mean age 10.8 years; SD 2.4 years] and 39 typically developing (TD) children [mean age 11 years; SD 2.9 years] participated in a cross-sectional study to investigate construct validity and association with an upper limb activity measure, the Box and Block Test (BBT). Twenty-two TD children were tested at a second time-point to examine reliability. Test responsiveness was determined by random allocation of 17 children with CP to a treatment (n = 10) or control (n = 7) group with assessments completed at four time-points.

RESULTS

Significantly greater differences were observed in mean error of indicated wrist position (p < 0.01) in children with CP at baseline (M = 21.6°, SD = 21.6°) than in TD children (M = 12.8°, SD = 11.0°). Larger WPST errors were associated with poorer performance on the BBT (p < 0.01) indicating a substantial association, and there were no consistent differences between time-points indicating test re-test reliability within a TD population. The WPST demonstrated responsiveness to intervention with a statistically significant reduction in mean error following treatment (p < 0.001), not seen in the control group (p = 0.28).

CONCLUSION

The WPST demonstrated construct validity in this preliminary study. Scores were associated with an upper limb activity measure, and scores changed significantly following somatosensory training. These findings support further research and future psychometric investigation of the WPST in children with CP.

KEY POINTS FOR OCCUPATIONAL THERAPY

This study provides psychometric knowledge about the WPST tool The WPST shows promise as a discriminative measure with preliminary evidence of responsiveness and intra-rater reliability Until further testing, the WPST can be used cautiously in future research studies to measure wrist position sense.

Upper Limb Stroke Rehabilitation Using Surface Electromyography: A Systematic Review and Meta-Analysis

Background

Upper limb impairment is common after stroke, and many will not regain full upper limb function. Different technologies based on surface electromyography (sEMG) have been used in stroke rehabilitation, but there is no collated evidence on the different sEMG-driven interventions and their effect on upper limb function in people with stroke.

Aim

Synthesize existing evidence and perform a meta-analysis on the effect of different types of sEMG-driven interventions on upper limb function in people with stroke.

Methods

PubMed, SCOPUS, and PEDro databases were systematically searched for eligible randomized clinical trials that utilize sEMG-driven interventions to improve upper limb function assessed by Fugl-Meyer Assessment (FMA-UE) in stroke. The PEDro scale was used to evaluate the methodological quality and the risk of bias of the included studies. In addition, a meta-analysis utilizing a random effect model was performed for studies comparing sEMG interventions to non-sEMG interventions and for studies comparing different sEMG interventions protocols.

Results

Twenty-four studies comprising 808 participants were included in this review. The methodological quality was good to fair. The meta-analysis showed no differences in the total effect, assessed by total FMA-UE score, comparing sEMG interventions to non-sEMG interventions (14 studies, 509 participants, SMD 0.14, P 0.37, 95% CI –0.18 to 0.46, I² 55%). Similarly, no difference in the overall effect was found for the meta-analysis comparing different types of sEMG interventions (7 studies, 213 participants, SMD 0.42, P 0.23, 95% CI –0.34 to 1.18, I² 73%). Twenty out of the twenty-four studies, including participants with varying impairment levels at all stages of stroke recovery, reported statistically significant improvements in upper limb function at post-sEMG intervention compared to baseline.

Conclusion

This review and meta-analysis could not discern the effect of sEMG in comparison to a non-sEMG intervention or the most effective type of sEMG intervention for improving upper limb function in stroke populations. Current evidence suggests that sEMG is a promising tool to further improve functional recovery, but randomized clinical trials with larger sample sizes are needed to verify whether the effect on upper extremity function of a specific sEMG intervention is superior compared to other non-sEMG or other type of sEMG interventions.

Wearable Immersive Virtual Reality Device for Promoting Physical Activity in Parkinson's Disease Patients

Parkinson’s disease (PD) is a neurological disorder that usually appears in the 6th decade of life and affects up to 2% of older people (65 years and older). Its therapeutic management is complex and includes not only pharmacological therapies but also physiotherapy. Exercise therapies have shown good results in disease management in terms of rehabilitation and/or maintenance of physical and functional capacities, which is important in PD. Virtual reality (VR) could promote physical activity in this population. We explore whether a commercial wearable head-mounted display (HMD) and the selected VR exergame could be suitable for people with mild–moderate PD. In all, 32 patients (78.1% men; 71.50 ± 11.80 years) were a part of the study. Outcomes were evaluated using the Simulator Sickness Questionnaire (SSQ), the System Usability Scale (SUS), the Game Experience Questionnaire (GEQ post-game module), an ad hoc satisfaction questionnaire, and perceived effort. A total of 60 sessions were completed safely (without adverse effects (no SSQ symptoms) and with low scores in the negative experiences of the GEQ (0.01–0.09/4)), satisfaction opinions were positive (88% considered the training “good” or “very good”), and the average usability of the wearable HMD was good (75.16/100). Our outcomes support the feasibility of a boxing exergame combined with a wearable commercial HMD as a suitable physical activity for PD and its applicability in different environments due to its safety, usability, low cost, and small size. Future research is needed focusing on postural instability, because it seems to be a symptom that could have an impact on the success of exergaming programs aimed at PD.

Combining transcranial direct current stimulation and peripheral electrical stimulation to improve upper limb function in a patient with acute central cord syndrome: a case report

We report the immediate improvement of weakened muscles after combined treatment with transcranial direct current stimulation (tDCS) and peripheral electrical stimulation (PES) in a patient with acute central cord syndrome (CCS) who presented with severe upper limb motor dysfunction. A 70-year-old man sustained CCS with severe motor deficits in the left upper limb, which did not improve with conventional training until 6 days after injury. On the seventh day after the injury, the left upper limb was targeted with combined tDCS (1 mA for 20 minutes/day, anode on the right, cathode on the left) and PES (deltoid and wrist extensors, 20 minutes/day at the motor threshold), and his performance score immediately improved from 0 to 6 on the Box and Block test. After four sessions, the left upper limb function improved to 32 on the Box and Block test, and manual muscle test scores of the stimulated deltoid and wrist extensors improved from 1 to 2. This improvement of the left upper limb led to improved self-care activities such as eating and changing clothes. Exercise combined with tDCS and PES may be a novel treatment for upper limb movement deficits after acute CCS.

[Effectiveness of using a hardware complex with biofeedback in the rehabilitation of children with dysfunction of the upper limbs]

The upper limb is of exceptional importance for human life as an organ of cognitive and practical activity. Fine motor skills of hands are a set of small, highly coordinated, precise and coordinated movements of varying degrees. Diseases and injuries of the musculoskeletal and nervous systems lead to violations of fine motor skills. Effective programs for medical rehabilitation of hand and fingers include using biofeedback devices (BFB).

PURPOSE OF THE STUDY

Efficiency evaluation of the hardware-software complex with BFB in restoring the impaired function of the upper limb in children.

MATERIAL AND METHODS

The clinical study included 79 patients aged 4 to 18 years with dysfunction of the upper limb not higher than level III according to MACS (The Manual Ability Classification System), who were divided by simple randomization into the main group (49 patients) who received 21 days of a comprehensive rehabilitation program (physiotherapy exercises, paretic muscle massage, mechanotherapy, hydrokinesiotherapy, methods of apparatus physiotherapy) using a hardware-software complex, and a comparison group (30 patients), in which the complex rehabilitation program did not include biofeedback procedures.

RESULTS

This performed prospective open randomized comparative study revealed the effectiveness of the standard rehabilitation program in combination with training on the BFB complex (main group) to be higher than using only the standard program. After treatment, patients of the main group showed a noticeable decrease in the degree of muscle spasticity in the affected limb, strengthening of muscle strength, improvement of fine and gross motor skills of the hands, and improvement of manual skills.

CONCLUSION

The use of a hardware-software complex with biofeedback in children with dysfunction of upper limbs increases effectiveness of the rehabilitation program.

AUTOMA: a wearable device to assess the upper limb muscular activity in patients with neuromuscular disorders

Inherited muscular dystrophies and congenital myopathies present in early childhood with progressive muscle weakness, determining severe motor limitations. Active surveillance and management of associated complications have improved ambulation, function, quality of life and life expectancy. The need for repeatable, objective and quantitative measures to monitor the clinical course of the disease is a current issue, particularly in the new era where new flows of therapies are proposed to the patients. In this scenario, we designed and tested a wearable device termed AUTOMA that is able to provide quantification of the muscular impairment in the upper limb upon isokinetic tests through the integration of a force sensor and an electric goniometer. This allows qualitatively estimating the muscular functions with a systematic procedure. We carried out a preliminary pilot study on 9 patients that revealed the suitability of AUTOMA as an objective measurement tool for diagnosing and monitoring neuromuscular disorders, and opens to a more extensive clinical study in which to test and validate our platform intensively.

Impact of Sensory Impairment on Improvement of Upper-limb Function in Patients under 75 Years of Age with Subacute Stroke: A Preliminary Study

Objectives:

The aim of this study was to investigate whether an interaction exists between sensory impairment and age with respect to the recovery of upper-limb function in patients with subacute stroke.

Methods:

This retrospective observational study included 83 patients recovering from subacute stroke in a rehabilitation hospital ward. The recovery of upper-limb function in four groups classified by age and sensory impairment were compared using analysis of covariance. Furthermore, multiple regression analysis was performed with recovery of upper-limb function as the dependent variable and with binarized sensory impairment and binarized age and their interaction term as the independent variables.

Results:

The estimated marginal means of upper-limb recovery were significantly higher in the non-late elderly (≤74 years) without sensory impairment group than in the other three groups. No significant differences were observed among the following three groups: the non-late elderly with sensory impairment, the late elderly (≥75 years) without sensory impairment, and the late elderly with sensory impairment. In multiple regression analysis, the interaction term between sensory impairment and age was significantly associated with improvement in upper-limb function (β=0.16, P <0.05). Age alone was significant, but sensory impairment alone was not significant.

Conclusions:

Sensory impairment in patients with subacute stroke affects the recovery of upper-limb function as a result of age interactions.

Effectiveness of mirror therapy on upper limb function, activities of daily living, and depression in post-stroke depression patients

Objectives

This study aims to investigate the effects of mirror therapy (MT) on upper limb function, activities of daily living (ADLs), and depression in post-stroke depression patients.

Patients and methods

Between November 2018 and December 2019, a total of 60 post-stroke patients (33 males, 27 females; mean age: 58.45±11.13 years; range, 35 to 88 years) were included. The patients were randomly divided into either the cosntrol group (n=30) or the MT group (n=30). Regular occupational therapy was provided for the control group (two times per day for 30 min per session, five times per week over four weeks). Occupational therapy and MT were used to treat patients in the mirror group (one 30 min session once per day, five times per week over four weeks). Motor function (Fugl-Meyer Assessment of the Upper Extremity, FMA-UE), ADL (Modified Barthel Index, MBI) and depression (17-item Hamilton Depression Scale, HAMD-17) were used to evaluate the treatment outcomes.

Results

Before treatment, the mean HAMD-17, FMA-UE, and MBI scores showed no significant difference between the two groups (p>0.05). After treatment, the mirror group exhibited more significant improvements than the control group in terms of the mean HAMD-17, FM-UE, and MBI (p<0.05). After four weeks, the mean FMA-UE and MBI scores revealed more significant improvements than the baseline scores in the control group (p<0.01). The mean HAMD-17, FMA-UE, and MBI scores showed more significant improvements than the baseline scores in the MT group (p<0.001).

Conclusion

Based on these results, MT can effectively improve motor function, ADLs, and depression in post-stroke depression patients. The curative effectiveness of MT seems to be more prominent than the regular occupational therapy.

Evidence of altered interhemispheric communication after pediatric concussion

OBJECTIVES: To investigate neurophysiological alterations within the typical symptomatic period after concussion (1-month) and throughout recovery (6-months) in adolescents; and (2) to examine relationships between neurophysiological and upper limb kinematic outcomes.METHODS: 18 adolescents with concussion were compared to 17 healthy controls. Transcranial magnetic stimulation (TMS) was used to assess neurophysiological differences between groups including: short- and long-interval intracortical inhibition, intracortical facilitation, short- and long-latency afferent inhibition, afferent facilitation, and transcallosal inhibition (TCI). Behavioral measures of upper limb kinematics were assessed with a robotic device.RESULTS: Mixed model analysis of neurophysiological data identified two key findings. First, participants with concussion demonstrated delayed onset of interhemispheric inhibition, as indexed by TCI, compared to healthy controls. Second, our exploratory analysis indicated that the magnitude of TCI onset delay in adolescents with concussion was related to upper limb kinematics.CONCLUSIONS: Our findings indicate that concussion in adolescence alters interhemispheric communication. We note relationships between neurophysiological and kinematic data, suggesting an affinity for individuals with less concussion-related physiological change to improve their motor behavior over time. These data serve as an important step in future development of assessments (neurobiological and clinical) and interventions for concussion.

Influence of Electrotherapy with Task-Oriented Training on Spasticity, Hand Function, Upper Limb Function, and Activities of Daily Living in Patients with Subacute Stroke: A Double-Blinded, Randomized, Controlled Trial

The effects of electrotherapy with task-oriented training on upper limb function in subacute stroke patients are unclear. This study investigated the influence of transcutaneous electrical nerve stimulation (TENS) with task-oriented training on spasticity, hand function, upper limb function, and activities of daily living in patients with subacute stroke. Forty-eight patients with subacute stroke were randomly assigned to either the TENS group (n = 22) or the placebo-TENS group (n = 21). High-frequency (100 Hz) TENS with below-motor threshold intensity or placebo-TENS was applied for 30 min/day, five times a week, for 4 weeks. The two groups also received task-oriented training after TENS. The Modified Ashworth Scale (MAS), Jebsen–Taylor Hand Function Test (JTHFT), Manual Function Test (MFT), and Modified Barthel Index (MBI) were used to assess spasticity, hand function, upper limb function, and activities of daily living, respectively. There was a significant time–group interaction with the MFT (p = 0.003). The TENS group showed significantly improved MAS (p = 0.003), JTHFT (p < 0.001), MFT (p < 0.001), and MBI (p < 0.001) scores after the intervention. The placebo-TENS group showed significantly improved JTHFT (p < 0.001), MFT (p = 0.001), and MBI scores (p < 0.001). There was a significant correlation between the MFT and MBI scores (p = 0.025). These results suggest that electrotherapy with task-oriented training can be used to improve upper limb function in patients with subacute stroke.

The effect of clinical application of transcranial direct current stimulation combined with non-immersive virtual reality rehabilitation in stroke patients

BACKGROUND

The ability to manipulate the upper limbs and fingers of stroke patients is very important for independent daily life. Among the latest approaches for upper limb rehabilitation training, transcranial direct current stimulation (tDCS) is a non-invasive stimulation method that stimulates the cranial nerves by attaching electrodes to the scalp. In addition, virtual reality (VR) is an intervention method that provides an environment similar to reality and can help restore function by performing body movements as if playing a game. In addition, VR is an intervention method that provides an environment similar to reality and helps to recover functions by performing body movements as if playing a game.

OBJECTIVE

This study was conducted to investigate the effect of anodal tDCS applied to the ipsilateral primary motor cortex (M1) during VR training on the upper limb function, cognition, and executive function of stroke patients.

METHODS

After 20 patients were randomly assigned to the experimental group and the control group, the experimental group received tDCS and VR, and the control group received sham tDCS and VR for 20 minutes a day, 5 days a week, for a total of 4 weeks. Participants were evaluated for upper limb function using Box and Block Test (BBT) and Jebsen-Taylor Hand Function Test (JTHFT), and cognitive and executive function using the Stroop Test (ST) and Trail Making Test (TMT).

RESULTS

In the experimental group, significant differences were found in the pre- and post-test for the all variance (p< 0.05). Control group is significant differences were found in the pre- and post-test for BBT, ST, TMT (p< 0.05). There were significant differences between the two groups in the post test of BBT and ST (p< 0.05).

CONCLUSION

The results of this study suggest that anodal tDCS applied to the ipsilateral M1 during VR training is effective for upper limb function, cognitive function, and executive function in stroke patients.

Effects of brain-computer interface training on upper limb function recovery in stroke patients: A protocol for systematic review and meta-analysis

BACKGROUND

In recent years, with the development of medical technology and the increase of inter-disciplinary cooperation technology, new methods in the field of artificial intelligence medicine emerge in an endless stream. Brain-computer interface (BCI), as a frontier technology of multidisciplinary integration, has been widely used in various fields. Studies have shown that BCI-assisted training can improve upper limb function in stroke patients, but its effect is still controversial and lacks evidence-based evidence, which requires further exploration and confirmation. Therefore, the main purpose of this paper is to systematically evaluate the efficacy of different BCI-assisted training on upper limb function recovery in stroke patients, to provide a reference for the application of BCI-assisted technology in stroke rehabilitation.

METHODS

We will search PubMed, Web of Science, The Cochrane Library, Chinese National Knowledge Infrastructure Database, Wanfang Data, Weipu Electronics, and other databases (from the establishment to February 2021) for full text in Chinese and English. Randomized controlled trials were collected to examine the effect of BCI-assisted training on upper limb functional recovery in stroke patients. We will consider inclusion, select high-quality articles for data extraction and analysis, and summarize the intervention effect of BCI-assisted training on the upper limb function of stroke patients. Two reviewers will screen titles, abstracts, and full texts independently according to inclusion criteria; Data extraction and risk of bias assessment were performed in the included studies. We will use a hierarchy of recommended assessment, development, and assessment methods to assess the overall certainty of the evidence and report findings accordingly. Endnote X8 will be applied in selecting the study, Review Manager 5.3 will be applied in analyzing and synthesizing.

RESULTS

The results will provide evidence for judging whether BCI is effective and safe in improving upper limb function in patients with stroke.

CONCLUSION

Our study will provide reliable evidence for the effect of BCI technology on the improvement of upper limb function in stroke patients.

PROSPERO REGISTRATION NUMBER

CRD42021250378.

The application of personalized rehabilitation exercises in the postoperative rehabilitation of breast cancer patients

BACKGROUND

This study sought to explore the effects of personalized rehabilitation exercises in the postoperative rehabilitation of breast cancer patients.

METHODS

A total of 93 breast cancer patients admitted to our hospital from January 2018 to December 2019 were taken as research subjects for this study. Based on order of admission, patients were assigned to a control group (46 cases) or an observation group (47 cases). All patients underwent a modified radical mastectomy for breast cancer. Patients in the control group received routine nursing and rehabilitation training after their operations, while those in the observation group received personalized rehabilitation exercises (for a period of 6 months) in addition to the rehabilitation training received by the control group. The immune function indicators, the incidence of upper limb-related complications, the movement of the shoulder joint, upper limb function, ability of daily living (ADL), and quality of life (QoL) was then compared between the two groups before and after the intervention.

RESULTS

Patients in the observation group had lower incidences of upper limb edema and subcutaneous fluid than those in the control group (P<0.05). Further, following the intervention, compared to patients in the control group, patients in the observation group had higher CD4+, CD4+/CD8+ levels, lower CD8+ levels, a greater range of motion in their shoulder joints (P<0.05), lower upper limb function impairment scores [based on the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire] (P<0.05), higher ADL scores (P<0.05), and higher QoL scores (P<0.05).

CONCLUSIONS

Personalized rehabilitation exercises reduced the postoperative upper limb complications experienced by breast cancer patients, improved their immune function, shoulder joint mobility and upper limb function, and improved their ADL and QoL.

The Effect of Trunk Stability Training Based on Visual Feedback on Trunk Stability, Balance, and Upper Limb Function in Stroke Patients: A Randomized Control Trial

This study aimed to investigate the effects of trunk stability training based on visual feedback on trunk stability, balance, and upper limb function in patients with stroke. Twenty-eight patients with chronic stroke were randomly assigned to either a trunk support group (n = 14) or a trunk restraint group (n = 14) that practiced upper limb training with trunk support and trunk restraint, respectively, based on visual feedback for 30 min per day, three times per week, for 4 weeks. The postural assessment scale for stroke (PASS) was used to assess the stability of patients, and the functional reaching test (FRT) was performed to assess balance. To assess upper extremity function, a range of motion (ROM) test, manual muscle testing (MMT), and Fugl–Meyer assessment-upper limb (FMA-upper limb) were performed. Consequently, both groups showed significant differences before and after training in the PASS, FRT, shoulder flexion ROM, triceps brachii MMT, and FMA-upper limb (p < 0.05), while the trunk support group showed more significant improvements than the trunk restraint group in the PASS, FRT, and FMA-upper limb (p < 0.05). Trunk support-based upper limb training effectively improved trunk stability, balance, and upper limb function and is beneficial as an upper limb training method. Providing trunk support is more effective than restricting the trunk; trunk support-based upper limb training is expected to promote voluntary participation when combined with visual feedback.

Effects of peripheral nerve stimulation on paralysed upper limb functional recovery in chronic stroke patients undergoing low-frequency repetitive transcranial magnetic stimulation and occupational therapy: A pilot study

Objective

Upper limb paralysis, which is a sequela of stroke, limits patients’ activities of daily living and lowers quality of life. The objective of this study was to examine the effects of peripheral nerve stimulation on hemiparetic upper limb functional recovery in chronic stroke patients undergoing low-frequency repetitive transcranial magnetic stimulation and occupational therapy.

Methods

The subjects were chronic stroke patients who participated in a two-week inpatient programme including repetitive transcranial magnetic stimulation and occupational therapy. There were two groups of patients: the peripheral nerve stimulation group (11 patients who underwent peripheral nerve stimulation) and the control group (11 patients who previously participated in the same inpatient programme but without peripheral nerve stimulation, selected via propensity score matching). The peripheral nerve stimulation group had 1 h of peripheral nerve stimulation on the median and ulnar nerves during occupational therapy. The outcome measures were the Wolf Motor Function Test, Fugl-Meyer Assessment, and Motor Activity Log.

Results

Wolf Motor Function Test, Fugl-Meyer Assessment, and Motor Activity Log showed significant improvement after the intervention in the peripheral nerve stimulation group. Particularly, the Fugl-Meyer Assessment hand score significantly improved in the peripheral nerve stimulation group compared to that in the control group (median change: 2 versus 0; p = 0.021, r = 0.49).

Conclusion

The combined use of peripheral nerve stimulation with occupational therapy after repetitive transcranial magnetic stimulation may result in a better functional recovery of in hemiparetic upper limb. Peripheral nerve stimulation with stimulation above the sensory threshold and below the motor threshold is easy to combine with occupational therapy upper limb function training and is therefore clinically useful.

Effect of neurocognitive rehabilitation on upper limb function in community-dwelling chronic stroke patients: A pilot study

Background: Although it has been reported that neurocognitive rehabilitation is effective for improving upper limb function in acute and subacute stroke patients, its effectiveness has not been clarified in community-dwelling chronic stroke patients.Objective: To examine the effect of neurocognitive rehabilitation on upper limb function in community-dwelling chronic stroke patients.Methods: Eight community-dwelling chronic stroke patients participated in the study. The mean period from the stroke onset to the start of the intervention was 425.3 days (approximately 14 months post-stroke). All patients received neurocognitive rehabilitation for 60 min, twice per week, for 3 months. Fugl-Meyer Assessments (FMA) were performed, and the amount of use (AOU) and quality of movement (QOM) of the Motor Activity Log (MAL) were measured before and after the intervention. We used the Wilcoxon signed-rank test to analyze the data.Results: The total, shoulder/elbow/forearm, and wrist scores of the FMA, MAL-AOU, and MAL-QOM significantly improved after the intervention compared to those before the intervention. However, significant improvement was not observed in the hand score of the FMA.Conclusion:Neurocognitive rehabilitation could be effective for improving upper limb function in community-dwelling chronic stroke patients.

[Clinical observation of dynamic scalp acupuncture combined with task-oriented mirror therapy for upper limbs function impairment in patients with hemiplegia after ischemic stroke]

OBJECTIVE

To explore the effect of dynamic scalp acupuncture combined with task-oriented mirror therapy (TOMT) for upper limb motor function and activity ability of daily living in patients with hemiplegia after ischemic stroke.

METHODS

Seventy-eight patients with hemiplegia after ischemic stroke were randomly divided into a dynamic scalp acupuncture group, a TOMT group, and a scalp acupuncture group, 26 cases in each group (1 case dropped off in the TOMT group and the scalp acupuncture group respectively). All three groups received routine rehabilitation training and medication treatment. The TOMT group was treated with TOMT for 40 min a day, 5 days a week for 8 weeks. The scalp acupuncture group was treated with TOMT after the scalp acupuncture, and the dynamic scalp acupuncture group was treated with TOMT during the scalp acupuncture treatment. The scalp acupuncture treatment was applied at ipsilateral up 1/5 and mid 2/5 of Dingnie Qianxiexian and Dingnie Houxiexian, and the needles were retained for 40 min. The scalp acupuncture treatment was given once a day, 5 days a week for 8 weeks. Before treatment and after 4 weeks and 8 weeks of treatment, the functions of upper limb and hand were evaluated by simplified Fugl-Meyer assessment (FMA) scale upper limb part and functional test for the hemiplegic upper extremity-Hong Kong version (FTHUE-HK) grade, the muscle tension of the upper extremity flexor elbow muscle group was assessed by modified Ashworth scale (MAS) and the activity ability of daily living was assessed by modified Barthel index (MBI).

RESULTS

After 4 weeks and 8 weeks of treatment, the FMA scores, FTHUE-HK grades and MBI scores in the three groups were better than those before treatment (P<0.01, P<0.05), and MAS scores after 4 weeks of treatment in the three groups were better than those before treatment (P<0.05). After 4 weeks and 8 weeks of treatment, the FMA scores, FTHUE-HK grades and MBI scores in the dynamic scalp acupuncture group were better than those in the TOMT group and the scalp acupuncture group (P<0.05), and these items in the scalp acupuncture group were better than those in the TOMT group (P<0.05).

CONCLUSION

The dynamic scalp acupuncture combined with TOMT treatment can effectively improve the upper limb function and the activities ability of daily living in patients with hemiplegia after ischemic stroke, which is better than TOMT after scalp acupuncture and simple TOMT treatment.

Biodex© training post-stroke for postural stability in the upper trunk: A pilot study

Background

Stroke affects upper trunk postural stability and upper limb function in approximately 85% of stroke survivors. Upper trunk postural stability is essential for functioning of the upper limb and is a prerequisite for hand function. The rehabilitation of the upper limb and upper trunk post-stroke remains a challenge because of poor recovery of motor and sensory function.

Objectives

To determine the effect of Biodex© upper limb weight-bearing training on upper trunk postural stability in patients post-stroke.

Method

A longitudinal randomised control pilot trial with single blinding was undertaken to assess postural stability on the Biodex© at baseline and 1-month post-baseline. In addition to standard rehabilitative care, upper limb weight-bearing training on the Biodex© was added for participants in the experimental group. Descriptive data analysis and the Mann–Whitney test for group comparisons were done using STATA (p < 0.05).

Results

Fifteen participants took part, seven in the control and eight in the experimental group, with an overall median age of 55 years. At baseline there were statistically significant lower scores in the experimental group on overall (p = 0.02) and anterior/posterior (p = 0.009) stability level 6 (moderately unstable base of support) in the upper trunk postural stability scores. No statistically significant improvements were noted between groups on any of the Biodex© stability levels at 1-month post-baseline testing (p > 0.05).

Conclusion

Upper limb weight-bearing training with the addition of Biodex© training did not result in improvements in upper trunk postural stability.

Clinical implications

The findings suggest that exercising on a moderately unstable base of support may improve upper trunk postural stability in patients post-stroke. The addition of Biodex© training to standard rehabilitative care for retraining and exercising upper trunk postural control in a weight-bearing position does not lead to better outcomes than standard care.

Do Infants at Risk of Developing Cerebral Palsy or Other Neurodevelopmental Disorders Learn What They Practice?

Through secondary analyses of the Small Step. Randomized Control Trial, we tested the hypothesis that children at risk of developing cerebral palsy (CP) or other neurodevelopmental disorders would learn what they practice, i.e., that they would have a more rapid development within the specifically trained foci (hand use or mobility) of each time period compared to the development rate within the foci not trained at that time. Nineteen infants (6.3 (1.62) months corrected age) included in the Small Step program were assessed at six time points during the intervention. For statistical analysis, general and mixed linear models were used, and the independent variables were the Peabody Developmental Motor scale (stationary, locomotion, grasping and visuomotor sub scales), the Gross Motor Function Measure-66 and the Hand Assessment for Infants. Outcomes related to gross motor function improved significantly more after mobility training than after hand use training, while fine motor function was improved to the same extent following both training types. Significantly higher improvements after the first training period were seen in one out of three outcome measures in both gross and fine motor assessments. The improvements observed were all independent of diagnosis at two years. The concept “you learn what you practice” was most clearly confirmed in the case of gross motor development.

Mobile arm supports in Duchenne muscular dystrophy: a pilot study of user experience and outcomes

PURPOSE

This pilot study examined whether two different types of non-powered mobile arm supports (MAS) enhanced upper limb function and independence with activities of daily living (ADLs) in people with Duchenne muscular dystrophy (DMD).

METHOD

A mixed methods cross-sectional design was used. Participants were four males with DMD, aged 16 to 20 years (M = 18.25 years). Two participants were current MAS users, and two had previously used MAS. To explore experiences of MAS use, semi-structured interviews were undertaken, then transcribed verbatim and analysed thematically. To measure the impact of MAS on arm function and ADLs, participants using MAS completed the Performance of the Upper Limb (PUL) and the DMD Upper Limb Patient Reported Outcome Measure with and without MAS. Participants no longer using MAS only completed the PUL without MAS.

RESULTS

MAS enhanced upper limb function and independence with ADLs in three of four participants. Eating and drinking was most often positively impacted by MAS. Access to informal support for MAS set-up, and ongoing input from a clinician or assistive technology (AT) supplier with MAS expertise, were important enablers to successful MAS use. Barriers to use included inadequate upper limb strength, interference of MAS with wheelchair controls, and AT funding delays.

CONCLUSION

MAS should be considered by individuals with DMD and clinicians working with them as the disease progresses and strength declines. Potential barriers to MAS use need to be addressed to ensure maximum utility. AT funding delays must also be minimized to avoid impact on outcomes of people with DMD.Implications for RehabilitationIndividuals with DMD, and clinicians working with them, may consider MAS to aid achievement of functional goals as the disease progresses and upper limb function declines.Both objective and subjective outcome measures should be used when evaluating the effectiveness of MAS.Consideration should be given to the potential interference of MAS with wheelchair controls and the availability of informal or paid supports (e.g., family, support workers, teachers) to aid MAS use.Efficient and timely funding of MAS is required, as delays may negatively impact outcomes for people with progressive neurological conditions, such as DMD.

Contra-Lateral Unintended Upper Arm Movement during Unimanual Tasks in Children with Cerebral Palsy

PURPOSE

To characterize associated reactions (ARs) in the contralateral arm across multiple muscles during unimanual tasks and to identify factors related to ARs in children with cerebral palsy (CP).

MATERIALS AND METHODS

This was a prospective, cross-sectional study of 35 children with CP. The extent of ARs of the contra-lateral, non-task hand was assessed while performing three unimanual tasks (opening and clenching the fist, a finger opposition task, and tapping fingers). The occurrence of ARs in each trial was evaluated separately for each task using a four-point scale (total scores ranged from 0 to 12). Surface electromyography (SEMG) was used to measure the firing activity of the muscles of the opposite arm during the task. The Manual Ability Classification System and Melbourne Assessment 2 (MA-2) were used to evaluate upper limb function.

RESULTS

AR scores were higher in the more-affected limb than in the less-affected limb. SEMG data on the non-task hand showed motor overflow up to the elbow muscles in the more-affected limb. Root mean square ratios of EMG signals were significantly higher in children with ARs than in children without ARs. Multiple regression analysis showed both age and MA-2 to be significant factors related to ARs in the more-affected limb.

CONCLUSION

Children with visible ARs showed motor overflow in the non-task limb during unimanual hand tasks. Age and upper limb function were significantly related to the extent of ARs in the more-affected limb of children with CP.

Effect of evidence-based nursing intervention on upper limb function in postoperative radiotherapy patients with breast cancer

To investigate the effect of evidence-based nursing (EBN) intervention on upper limb function in postoperative breast cancer patients undergoing radiotherapy.A total of 126 breast cancer patients who had received postoperative radiotherapy in the Union Hospital affiliated with Tongji Medical College, Huazhong University of Science and Technology from September 2017 to September 2018 were randomly divided into 2 groups, namely, experimental and control groups, with 63 cases in each group. Both the control and experimental groups received routine postoperative radiotherapy followed by traditional and EBN interventions, respectively. All patients were followed up for 6 months and differences in the upper limb function after nursing intervention were compared between the 2 groups.The scores of self-rating anxiety scale (SAS), self-rating depression scale (SDS), and short form-36 survey (SF-36) in the 2 groups had no statistical significance before intervention. After the EBN intervention, the SAS and self-rating depression scale scores of patients in the experimental group were lower than that of those in the control group. In the experimental group, 90.67% of the patients had an excellent score for the University of California, Los Angeles shoulder score, which was higher than that of the control group (73.92%). The Mayo Elbow Performance Score of the experimental group (95.01) was higher than that of the control group (91.33). The total length of the sum of arm circumference in the experimental group was (128.39 cm) lower than that of the control group (143.66 cm). The scores of SF-36 in the overall health, physical pain, mental health, and physiological functions of the patients in the experimental group were higher than those of the control group. All of these parameters' differences between the 2 groups were of statistical significance (P < .05).EBN can positively influence the negative emotional state of breast cancer patients after radiotherapy. At the same time, it is helpful in reducing the degree of lymph node edema on the affected side of the upper limb, thereby improving the function of the shoulder joint, which has a positive effect on the upper limb function.