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Context: Analyzing flick movement kinematics biomechanically is important to prevent sport-related injuries in underwater hockey players since the aquatic-based flick movement is completely different from land-based flick movements. The study aimed to describe the flick movement kinematic biomechanically in underwater hockey players. Moreover, this study further aimed to investigate the effect of the Thrower's Ten exercises on flick movement kinematics in underwater hockey players. Design: Descriptive laboratory study. Methods: Seventeen underwater hockey players (age: 26.2 [4.3] y; sports age: 6.2 [4.5] y) were included. First, 2 underwater cameras using motion capture video analysis MATLAB were used to biomechanically analyze the angular changes on the shoulder, elbow, wrist, and body while players were performing the flick movements. Players were then recruited to the Thrower's Ten exercise program for 6 weeks. Flick movement kinematics and flick-throwing distance were recorded at baseline and 6 weeks. Results: The flick movement kinematic patterns demonstrated increased shoulder flexion (from 102.5° to 144.9°), wrist extension (from 9.5° to 10.8°), and upper-extremity rotation (from 5.7° to 56.8°) while decreased elbow extension (from 107.7° to 159.2°) from the stick met the puck until the competition of the movement. The Thrower's Ten exercises improved the elbow extension (P =.04), wrist extension (P =.01), body rotation (P <.001), and flick-throwing distance (P <.001) from baseline to 6 weeks. Conclusion: This study describes the underwater flick kinematic technique biomechanically and interprets preliminary findings for the first time. Thus, 6 weeks of Thrower's Ten exercise program provides more body muscle movements than the smaller ones during the flick movements and higher flick-throwing distance in underwater hockey players. [ABSTRACT FROM AUTHOR]

Sleep problems are prevalent in autism spectrum disorder (ASD) and have a range of causes, including circadian rhythm misalignment. However, little is known about sleep in autistic children with co-occurring attention deficit hyperactivity disorder (ADHD). A cross-sectional descriptive and analytic study was conducted in 87 autistic children and adolescents (10.22 ± 3.36), 27 of whom had a diagnosis of ADHD, and 30 children with typical development (9.07 ± 2.75). An ambulatory circadian monitoring device was used to record wrist temperature (WT), motor activity, sleep, and light intensity. Higher WT values were detected in the comparison group, followed by autistic children and, ultimately, participants with co-occurring ADHD. In addition, atypical daily WT patterns were observed in autistic children, with slope flattening during afternoon and evening hours and an absent or subtle postprandial peak. Participants with co-occurring ADHD showed greater motor activity during sleep. Our findings, especially concerning WT rhythm, appear to support previous findings on the etiology of sleep problems in autism, as WT is closely connected to sleep-wakefulness. We found specific sleep patterns in autistic children depending on the presence of co-occurring ADHD, particularly regarding sleep maintenance, which may be an area of future research. Sleep problems are common in autism spectrum disorder (ASD) and different factors can contribute to its occurrence in this population. Misalignment of the biological clock (our circadian system) has been described as one possible explanation. While there is a body of research on sleep problems, relatively less is known about circadian functioning and the specific population of autistic children with co-occurring attention deficit hyperactivity disorder (ADHD). Using an ambulatory circadian monitoring (ACM) system, which resembles a common watch, we gathered sleep parameters and the different rhythms obtained from measuring motor activity, light exposure and distal temperature in 87 autistic children and adolescents, 27 of whom were diagnosed with co-occurring ADHD, and 30 neurotypical children and adolescents as a comparison group. Autistic children and, especially, those with co-occurring ADHD showed greater motor activity during sleep which would be worth studying in future projects which could better define this restless sleep. Of note, we observed an atypical pattern of wrist temperature, with higher values in neurotypical children, followed by autistic children and, ultimately, those with co-occurring ADHD. Temperature is one of the most valuable factors evaluated here as it is closely connected to sleep-wakefulness and the hormone melatonin. Its special pattern during day and nighttime would support the hypothesis of an atypical secretion of melatonin in autistic individuals which would also link with the higher presence of sleep problems in this neurodevelopmental condition. [ABSTRACT FROM AUTHOR]

Purpose: Ulnar styloid process (USP) fractures are present in 40–65% of all distal radius fractures (DRFs). USP base fractures can be associated with distal radioulnar joint (DRUJ) instability and ulnar sided wrist pain and are treated by conservative management and surgical fixation, without consensus. This systematic review and meta-analysis compares operative to non-operative treatment of concomitant ulnar styloid base fractures in patients with distal radius fractures. Methods: PubMed/Medline/Embase/CENTRAL databases were searched identifying RCTs and comparative observational studies. Effect estimates were extracted and pooled using random effect models to account for heterogeneity across studies. Results were presented as (standardized) mean differences (SMD or MD) or odds ratios (OR) and corresponding 95% confidence intervals (95%CI). Results: Two RCTs (161 patients) and three observational studies (175 patients) were included. Tension band wiring was used for surgically treated USP fractures. Results were comparable across the different study designs and hence pooled across studies. Non-surgically treated patients had better wrist function at 6 months (SMD 0.57, 95%CI 0.30; 0.90, I2 = 0%). After 12 months there was no observed difference (MD 2.31, 95%CI −2.57; 7.19, I2 = 91%). Fewer patients had USP non-unions in the operative group (OR 0.08, 95%CI 0.04; 0.18, I2 = 0%). More patients suffered complications in the operative group (OR 14.3; 95%CI 1.08; 188, I2 = 89%). Conclusion: Routinely fixating USP base fractures as standard of care is not indicated. Surgery may be considered in selective cases (e.g. persistent DRUJ instability during ballottement test after fixation of the radius). [ABSTRACT FROM AUTHOR]

Background: Determining the optimal number of dry needling (DN) sessions to satisfactorily treat a stroke patient with spasticity is important from both clinical and economic perspective. Objective: To explore the effects of one versus three sessions of DN on spasticity of the wrist flexors and motor recovery after stroke. Methods: In this single-blind randomized clinical trial, 24 patients were randomly and equally divided into two groups: one group received one session of DN, while the other group received three sessions of DN in one week. Both groups received one minute of DN of the flexor carpi radialis and flexor carpi ulnaris. The outcome measures were the Modified Modified Ashworth Scale (MMAS), passive resistance torque (PRT), wrist active and passive extension range of motion (ROM), and the Brunnstrom Stages of Stroke Recovery (BSSR) measured before, immediately after, and one week after the last DN session. Results: Both groups demonstrated a significant improvement in all outcomes (p <.05). The MMAS scores in both groups meaningfully improved (p <.001). No significant differences were found between the two groups; however, a significant time-by-group interaction was observed for the PRT (p =.02; Cohen's d = 0.23–0.73), wrist active extension ROM (p =.001; Cohen's d = 0.37–0.67), and wrist passive extension ROM (p =.02; Cohen's d = 0.32–1.30). The BSSR significantly improved from 3 to 4 in both groups (p <.001). Conclusion: Administering three sessions of DN can effectively improve spasticity and motor function after stroke. [ABSTRACT FROM AUTHOR]

Background and Purpose: Individuals post traumatic brain injury (TBI) are likely to experience cognitive, sensory, and motor impairments. Tremor is a common movement disorder that can affect this patient population. The purpose of this case report was to describe the effects that progressive muscle relaxation, meditation, and mental practice-based interventions have on the treatment of chronic right upper extremity tremor in a patient post-TBI. Case Description: A 47-year-old male with a traumatic brain injury presented with a resting and postural tremor of the right wrist flexors and deficits in cognition, sensation, proprioception, balance, and motor function. The patient's primary goal for therapy was to decrease the tremor to improve his quality of life and ability to perform activities of daily living. Methods: Progressive muscle relaxation, breath-focused meditation, and mental practice-based intervention were administered to the patient. Active range of motion activities occurred during weekly in-person sessions and daily practice occurred at home. Results: The patient demonstrated improvements in quality of life, self-ratings of tremor severity, ratings of tremor impact on ADL's, gross motor object manipulation, frequency of tremor via surface electromyography, and visual inspection of a spirograph. Conclusion: A combination of progressive muscle relaxation, meditation, and mental practice-based interventions appeared to positively impact tremor across physical and psychosocial domains in a patient with a chronic tremor. Further investigation is needed to verify these findings. [ABSTRACT FROM AUTHOR]

The aim of the study was to examine whether the width of the base of support (BOS) has an influence on early postural adjustments (EPA) and armed upper limb and COM kinematics during lunging. Eight elite female fencers participated in the study. The displacement of the centre of foot pressure (COP) and kinematics of centre of mass (COM) were recorded using force platforms. The kinematics of the wrist of the armed upper limb were obtained using a 3D accelerometer. The results show that EPA were characterised by a very small COP displacement (about 0.6 to 1.2 cm). The COP amplitude showed a tendency to decrease with an increase in BOS width under reaction time conditions. In contrast, a greater BOS width was associated with a significant increase in COM acceleration at foot-off and peak COM acceleration during lunging also under reaction time instructions. The kinematics of the wrist were not influenced by BOS. The results show that in elite fencers, the upper limb movement is dissociated from the whole body movement. We suppose that a small COP amplitude is a postural skill which is integrated into the lunging skill and might influence the acceleration of COM. [ABSTRACT FROM AUTHOR]

The kick-start technique in competitive swimming generates a force acting on the starting platform owing to gravity, muscle contraction and resulting joint torque. To understand optimal body movement on the starting platform for maximising take-off velocity, it is necessary to investigate the joint torque in relation to the joint's rotation effects. Joint torques were calculated by inverse dynamics using kinetic and kinematic data. A one-way ANOVA showed significantly greater extensional torque for shoulders than for elbows or wrists, and for hips than for knees or ankles. The results indicated that the force of the hands was mainly influenced by extension torque at the shoulder joint. Hip joint extension torque on the front side lower limb (FSLL) was mainly used for supporting the body weight until hands off. After hands off, the front-foot force originated mainly by increases in ankle joint plantar flexion and knee joint extension torque on the FSLL. Rear side lower limb torque increases in the hip, knee and ankle joints provided the rear-foot force. This investigation clarified the magnitudes and functions of each joint torque acting on the extremities during the kick-start, providing practical information for improving starting performance. [ABSTRACT FROM AUTHOR]

Studies of lifestyle through comprehensive objective and subjective measurements of health outcomes are lacking. An examination of lifestyle factors in middle-aged and older adults in terms of age, gender, and the interaction effect of age and gender from physiological and psychological perspectives are imperative. Recent advances in technology such as actigraphy have facilitated objective measurements. This exploratory study contributes to research on age and gender interactions on circadian rhythm, physical activity, sleep, and psychological variables by employing wrist accelerometers to measure behavioral circadian rhythm objectively and by using questionnaires to assess psychological status subjectively. The data were drawn from 218 participants aged 50 and older from the "Middle-aged and older adults Chinese Health and Actigraphy in Taiwan (MOCHA-T)". The results: (1) older adult group is associated with declined physical activity (MVPA time 79.9 min VS. 107.9 min, p =.002), worse sleep efficiency (78.1% VS. 81.9%, p =.008), and earlier lifestyle (Acrophase 14.19 h VS. 14.69 h, p =.01) comparing to middle-aged group. (2) Women have a more regular lifestyle (Interdaily stability 0.6 VS. 051, p < 0.001), higher physical activity (MVPA time 105.7 min VS. 79.3 min, p =.004), and better sleep efficiency (81.6% VS. 77.8%, p =.011) than men. (3) Significant age-by-gender interactions existed in life satisfaction (p =.025), relative amplitude (p =.016), and total wake time (p =.038). Furthermore, aging was associated with significant increases in life satisfaction among men as well as significant decreases in relative amplitude and reductions in the total wake time among women. In conclusion, aging exerted differential effects on life satisfaction in men as well as relative amplitude and the total wake time in women. This result highlights disparities in lifestyle arising from interconnected social and biological challenges. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Robotic surgery for localized prostate cancer offers a greater range of motion attributed to the EndoWrist instruments. Postoperative outcomes are linked to the quality of vesico-urethral anastomosis. Trainees frequently complain of suturing difficulty in a back-handed fashion. We aimed to analyze wrist motion using the DaVinci simulator. We hypothesized that using the thumb and index finger would allow superior surgical proficiency when compared to the middle finger. METHODS: After institutional review board approval, we recruited 42 medical students in one academic medical center. Students were randomly assigned to start with their thumb and index finger (1&2) or thumb and middle finger (1&3). Three standardized modules were used with nine metrics calculated, including: score, total time, economy of motion, efficiency score, collisions, inaccurate puncture, wound approximation, out of view, and penalty subtotal. Statistical analysis of the metrics was calculated using SPSS. RESULTS: Three metrics were found to have differences between the finger placement of 1&3compared to 1&2. The number of collisions, wound approximation, and penalty score where 1&3 were used had a lower score in each. The number of collisions was 5.7 less in the 1&3 finger placement (p=0.046). This metric was found to have statistically significant differences between finger placement where 1&3 had a lower score compared to 1&2. The wound approximation score was 0.2 points lower when using the 1&3 placement (p=0.075). Lastly, the penalty assigned was 6.5 points lower when using 1&3 (p=0.069). CONCLUSIONS: Although finger placement did not affect the overall score of the completed simulation, instrument collisions and unnecessary wound complications may lead to adverse outcomes when using 1&2 despite offering a wider range of motion. This may be due to decreased comfort in hand position. Trainees may be able to improve the effectiveness of their vesico-urethral anastomosis during robotic-assisted radical prostatectomy. [ABSTRACT FROM AUTHOR]

Objectives. This study aimed to investigate the consistency between results of the American Conference for Governmental Occupational Hygienists (ACGIH) threshold limit value (TLV) for hand activity and proposed action levels of objective measurements in risk assessments of work-related musculoskeletal disorders. Methods. Wrist velocities and forearm muscular load were measured for 11 assemblers during one working day. Simultaneously, each assembler's hand activity level (HAL) during three sub-cycles was rated twice on two separate occasions by two experts, using a HAL scale. Arm/hand exertion was also rated by the assemblers themselves using a Borg scale. In total, 66 sub-cycles were assessed and assigned to three exposure categories: A) below ACGIH action limit (AL) (green); B) between AL and TLV (yellow); and C) above TLV (red). The median wrist velocity and the 90th percentile of forearm muscular load obtained from the objective measurements corresponding to the sub-cycles were calculated and assigned to two exposure categories: A) below or C) above the proposed action level. Results. The agreement between ACGIH TLV for hand activity and the proposed action level for wrist velocity was 87%. Conclusions. The proposed action level for wrist velocity is highly consistent with the TLV. Additional studies are needed to confirm the results. [ABSTRACT FROM AUTHOR]

Purpose: The accuracy of heart rate measured with a wrist photoplethysmography monitor can be influenced by the tightening of the wristband, movement of arms, or kinetics of the signal (eg, steady-state exercise vs on- and off-transients). To test these hypotheses, photoplethysmographic and electrocardiographic (ECG) signals were compared. Methods: Thirty participants (50% female) randomly performed two 13′ sequences (3′ rest, 5′ submaximal-intensity exercise, and 5′ passive recovery) on a motorized treadmill and a bicycle ergometer. Heart rate was measured concomitantly with a 10-lead ECG, a chest-strap monitor, and 2 wrist photoplethysmography monitors (Polar Unite) with different tightening (free vs imposed at the maximum tolerable). Results: The level of association (r) and coefficient of variation (CV; ie, the error of measurement) of the Polar Unite versus the 10-lead ECG is affected by the tightness of the wristband (normal vs high; r =.83 and.96, CV = 16.1 and 8.1% for the treadmill, respectively; r =.71 and.97, CV = 20.3% and 6.2% for the bicycle, respectively) by the phase of the signal (transition vs steady state; r =.90 and.97, CV = 9.0% and 7.6% for the treadmill, respectively; r =.93 and.99, CV = 7.5% and 3.1% for the bicycle, respectively) and movement of arms (treadmill vs bicycle; r =.90 and.93, CV = 9.0% and 7.5% during the transition phase, respectively; r =.97 and.99, CV = 7.6% and 3.1% during the steady-state phase, respectively). Conclusion: The accuracy of heart rate measured with a wrist photoplethysmography monitor is affected by the tightness of the wristband and the phase of the signal. A high tightening is required when high accuracy is expected. [ABSTRACT FROM AUTHOR]

Purpose: With this prospective randomized control trial (RCT), we aim to provide the outcome analyses of the three most used treatment modalities for distal end of radius (DER) fracture management in the elderly. Methods: A prospective randomized control trial was performed. Fifty-two patients with DER fractures (AO A2, A3, C1, or C2) were randomized to the casting (n = 17), percutaneous pinning (n = 18), and the volar plating group (n = 17). Radiological measurements measured were radial inclination (RI), radial height (RH), volar tilt (VT), and ulnar variance (UV). The outcome was measured based on range-of-motion, grip strength, Patient-Related-Wrist-Evaluation (PRWE) score, and the Quick-Disabilities-of-the-Arm-Shoulder-Hand (QDASH) score. Results: Immediate post-operative and 1-year-follow-up X-rays showed a significant difference measurement between the groups (p < 0.05). Pairwise comparisons of the casting and pinning groups (p < 0.05) and the casting and plating groups (p < 0.05) revealed significant differences at the 1-year follow-up, but not the pinning and plating groups (p > 0.05). The analysis found significant differences in clinical outcomes after 1 month of follow-up, with the plating group outperforming the other two (p > 0.05). However, after a year of follow-up, all groups had comparable outcomes; however, the plating group showed improved palmar flexion (p < 0.001), radial deviation (p < 0.001), and a lower PRWE score (p < 0.05), indicating better wrist function. Complications were more in casting group. Conclusion: The study found a radiologically significant difference between groups throughout the follow-up, but it did not affect functional results. Clinical outcomes were similar across the groups, with plating showing better palmar flexion and radial deviation. Grip strength was also better in the plating group, but statistically insignificant. The study suggests plating should be chosen over other treatments for high-demand patients. [ABSTRACT FROM AUTHOR]

Introduction: This study was to evaluate the efficacy of multiple platelet-rich plasma injections in reflex sympathetic dystrophy following distal radius fracture after previous various treatments have failed. Materials and methods: This comparative prospective study was designed for 64 patients of reflex sympathetic dystrophy developed following distal radius fracture, from January 2009 to December 2020 were enrolled in this study. This cohort of patient was given either four multiple subcutaneous platelet-rich plasma injections at weekly interval (n = 32) or two injections in a month with 15 days interval (n = 32). The primary outcome measure assessed with patient rated wrist evaluation questionnaire score. The secondary outcome was a visual analogue scale pain score. The final follow up was at 2 years. p ≤ 0.05 is considered statistically. Results: The patient rated wrist evaluation score for usual and specific activities and EQ-VAS for pain level showed statistically significant greater improvement in group A (42 ± 21%) compared to group B (19 ± 24%), (p = 0.37). Patients also had improvement in wrist movements with no statistically significant differences in both groups. The standard difference in means of all three functional scores was almost similar between both groups A and B (standard difference in means = 0.032; 95% CI 0.236–0.830; p = 0.495), considered clinically meaningful. Conclusion: This study results suggest autologous platelet-rich plasma injections seem to be safe, cost effective, efficacious algorithm treatment for reflex sympathetic dystrophy following distal radius fracture patients where previous treatments have failed. [ABSTRACT FROM AUTHOR]

Background: A 12-week-old female was presented for Chiropractic care with parents listing primary concerns of screaming during tummy time, difficulty lifting her head, and exhibiting no arm weight-bearing ability. Further examination revealed difficulties with digestion, a significant head tilt resulting in flat spots (plagiocephaly) on the rear of the head, and excessive gagging while sleeping. Management: The infant was placed on a care plan where she was seen twice a week for three weeks, and then a further two sessions. During this time she was cared for using spinal adjusting, cranial and palate adjusting, as well as peripheral adjusting for shoulder dysfunction. All methods were modified appropriately for the infant's stage of development. Outcomes: Significant improvements were noted across all areas of concern, and the infant was able to clear her milestones whereas she had been lagging behind prior to care. This case report illustrates the potential for chiropractic to support developmental milestones by integrating primitive reflexes, supporting the development of the cervical curve, and allowing the nervous system to better adapt to issues like feeding, sleeping and overall well-being. Conclusion: Basic science has bedded down the importance of tummy time in cervical curve development, and chiropractic case report data has often indicated improvements in mood and digestion, this case report provides a rationale for further research into retained primitive reflexes under chiropractic care. [ABSTRACT FROM AUTHOR]

Bat–ball contacts are critical in the baseball hitting process. However, an effective training method for increasing the impact perception of a bat–ball contact is currently unavailable. Although not widely used, hitting a stationary weighted baseball can be an appropriate method for batters to simulate the perception of hitting a moving baseball. Therefore, swing velocity, wrist vibration, and forearm muscle activation for hitting stationary weighted, stationary regulation, and pitched baseballs were investigated in this study. Twelve position players hit a stationary weighted, stationary regulation, and pitched baseball at a speed of 70.28 ± 3.84 km/h in a random order. The swing velocity, wrist vibration, forearm muscle activation, and co-contraction ratio during hitting phases were analysed. The results indicated that the swing velocity during each specific phase demonstrated no significant differences between the different conditions. Hitting weighted and pitched baseballs caused higher wrist vibration, muscle activation, and co-contraction ratio during the contact phase than hitting regulation balls (p < 0.05). The conclusion was that hitting weighted baseballs could mimic the impact condition of hitting pitched baseballs without changing the pattern of swing velocity, which suggested that this method has potential as a hitting drill for improving hitting perception at bat–ball contact. [ABSTRACT FROM AUTHOR]

The purpose of this study was to clarify the temporal coordination between gaze, head, and arm movements during forehand rallies in table tennis. Collegiate male table tennis players (n = 7) conducted forehand rallies at a constant tempo (100, 120, and 150 bpm) using a metronome. In each tempo condition, participants performed 30 strokes (a total of 90 strokes). Gaze, head, and dominant arm (shoulder, elbow, and wrist) movements were recorded with an eye‐tracking device equipped with a Gyro sensor and a 3‐D motion capture system. The results showed that the effect of head movements relative to gaze movements was significantly higher than that of eye movements in the three tempo conditions. Our results indicate that head movements are closely associated with gaze movements during rallies. Furthermore, cross‐correlation coefficients (CCs) between head and arm movements were more than 0.96 (maximum coefficient: 0.99). In addition, head and arm movements were synchronized during rallies. Finally, CCs between gaze and arm movements were more than 0.74 (maximum coefficient: 0.99), indicating that gaze movements are temporally coordinated with arm movements. Taken together, head movements could play important roles not only in gaze tracking but also in the temporal coordination with arm movements during table tennis forehand rallies. Highlights: This study examined temporal coordination between gaze, head, and arm movements during table tennis rallies.Head movements were closely associated with gaze movements, suggesting that head movements play important roles in gaze tracking during rallies.Head and gaze movements were temporally coordinated with arm movements. This result suggests that head movements could also play important roles in the temporal coordination with arm movements during rallies. [ABSTRACT FROM AUTHOR]

Background Sleep–wake problems and depressive symptoms are common in people with intellectual disabilities (IDs) and are thought to be related to the unstable sleep–wake rhythm in this population. Previously, we showed that after increasing environmental light exposure, mid-sleep and sleep onset advanced, and mood improved over a period of 14 weeks after installing environmental dynamic light installations in the living room of people with IDs. We invited participants of that short-term study to take part in the current study on sleep–wake rhythm, mood and behaviour in older adults with IDs 1 year after installing environmental dynamic light installations in the common living rooms of six group homes. Methods A pre–post study was performed from October 2017 to February 2019. We included 45 participants (63.5 ± 8.5 years, 67% female) from six group home facilities who provided data at baseline (9, 4 and 1 weeks prior to installing light installations), short term (3, 7 and 14 weeks after installing light installations) and 1 year (54 weeks after installing light installations). Wrist activity was measured with actigraphy (GENEActiv) to derive the primary outcome of interdaily stability of sleep–wake rhythms as well as sleep estimates. Mood was measured with the Anxiety, Depression and Mood Scale. Behaviour was measured with the Aberrant Behaviour Checklist. Results One year after installing dynamic lighting, we did not find a change in interdaily stability. Total sleep time decreased (β = −25.40 min; confidence interval: −10.99, −39.82), and sleep onset time was delayed (β = 25.63 min; confidence interval: 11.18, 40.08). No effect on mood or behaviour was found. Conclusions We did not find a change in sleep–wake rhythm, mood or behaviour in older persons with IDs living in care facilities 1 year after installing the light. We did find evidence for a long-term effect on sleep duration and sleep timing. The results have to be interpreted with care as the current study had a limited number of participants. The need for more research on the long-term effects of enhancing environmental light in ID settings is evident. [ABSTRACT FROM AUTHOR]

BACKGROUND: Physical and psychosocial demands (e.g., serving, cleaning, fulfilling orders) can lead to work-related musculoskeletal pain (WRMSP). OBJECTIVE: To assess the prevalence of WRMSP in the upper quadrant and lower back among skilled male Arab waiters; to evaluate the disability related to WRMSP; to evaluate the association between work demands and WRMSP with related disability. METHODS: 100 skilled male Arab waiters working full-time, aged 18–60, participated in the cross-sectional study. Participants completed basic demographics and working conditions; the NDI; QuickDASH; the OswestryQ; workload, burnout, and job satisfaction at work; the adjusted NordicQ; and the TaskQ, compiled especially for this study. RESULTS: A 12-month pain prevalence, pain frequency, and work avoidance were high: neck- 42%, 60.5%, 89.5%; shoulders –53%, 78.2%, 94.4%; elbows- 46%, 78.6%, 83.3%; lower back- 45%, 44%, 78.7%, respectively. Pain prevalence in at least one site was 83%. The OswestryQ, QuickDASH, and NDI revealed mild-moderate pain and disability (14.85/50, 25.54/75, 13.74/50, respectively). Burnout score was positively associated with OswestryQ, QuickDASH, and NDI. Job satisfaction was negatively associated with 12 months of pain in the lower back, hands, arms, shoulders, and hands (NordicQ). TaskQ was positively associated with OswestryQ. CONCLUSION: Male Arab waiters who work in physically and psychologically challenging conditions report high levels of WRMSP with a high frequency and related work avoidance. Many of them must keep their jobs as they are their families' primary or sole providers. It is possible that they are trying to prevent more severe disabilities in the future by ensuring temporary rest and pain prevention. [ABSTRACT FROM AUTHOR]

Describing the outcomes of an exercise program on wrist and hand function for patients with midcarpal instability (MCI). This study has a prospective cohort design. Two hundred and thirteen patients with MCI were included. The intervention was a 3-month exercise program consisting of hand therapy and home exercises. The primary outcome was perceived wrist and hand function evaluated with the Patient-Rated Wrist/Hand Evaluation (PRWHE) three months after treatment onset. Secondary outcomes were conversion to surgery, pain, and satisfaction with treatment results. PRWHE total scores improved from 51 ± 19 (mean ± SD) to 33 ± 24 at 3 months (95% CI: 36–30, p < 0.001). All visual analog scales for pain demonstrated clinically relevant improvements at 6 weeks and 3 months (p < 0.001). At 3 months, 81% of the participants would undergo the treatment again. After a median follow-up of 2.8 years, 46 patients (22%) converted to surgery. We found clinically relevant improvements in hand and wrist function and pain. Most participants would undergo treatment again and 78% of the participants did not convert to surgery. Hence, non-invasive treatment should be the primary treatment choice for patients with MCI. Midcarpal instability (MCI) is a disabling condition and treatment options are limited. Patients with MCI can benefit from an exercise program aiming to improve the strength and coordination of the wrist muscles. Participants improved in hand/wrist function and 78% did not convert to surgery. Non-invasive treatment should be the primary treatment choice for these patients. [ABSTRACT FROM AUTHOR]

This study aimed to investigate inter- and intra-athlete technique variability in pre-elite and elite Australian fast bowlers delivering new ball conventional swing bowling. Ball grip angle and pelvis, torso, shoulder, elbow, wrist, upper arm, forearm, and hand kinematics were investigated at the point of ball release for inswing and outswing deliveries. Descriptive evaluations of group and individual data and k-means cluster analyses were used to assess inter- and intra-bowler technique variability. Inter-athlete technique and ball grip variability were identified, demonstrating that skilled bowlers use individualised strategies to generate swing. Functional movement variability was demonstrated by intra-athlete variability in successful swing bowling trials. Bowlers demonstrated stable technique parameters in large proximal body segments of the pelvis and torso, providing a level of repeatability to their bowling action. Greater variation was observed in bowling arm kinematics, allowing athletes to manipulate the finger and ball position to achieve the desired seam orientation at the point of ball release. This study demonstrates that skilled bowlers use individualised techniques and grips to generate swing and employ technique variations in successive deliveries. Coaches should employ individualised training strategies and use constraints-led approaches in training environments to encourage bowlers to seek adaptive movement solutions to generate swing. [ABSTRACT FROM AUTHOR]

Introduction: Clinical assessment of upper limb sensorimotor function poststroke is often constrained by low sensitivity and limited information on movement quality. To address this gap, recent studies proposed a standardized instrumented drinking task, as a representative daily activity combining different components of functional arm use. Although kinematic movement quality measures for this task are well-established, and optical motion capture (OMC) has proven effective in their measurement, its clinical application remains limited. Inertial Measurement Units (IMUs) emerge as a promising low-cost and user-friendly alternative, yet their validity and clinical relevance compared to the gold standard OMC need investigation. Method: In this study, we conducted a measurement system comparison between IMUs and OMC, analyzing 15 established movement quality measures in 15 mild and moderate stroke patients performing the drinking task, using five IMUs placed on each wrist, upper arm, and trunk. Results: Our findings revealed strong agreement between the systems, with 12 out of 15 measures demonstrating clinical applicability, evidenced by Limits of Agreement (LoA) below the Minimum Clinically Important Differences (MCID) for each measure. Discussion: These results are promising, suggesting the clinical applicability of IMUs in quantifying movement quality for mildly and moderately impaired stroke patients performing the drinking task. [ABSTRACT FROM AUTHOR]

BACKGROUND: The positive contribution of dry needling (DN) in conjunction with exercise therapy for patients with stroke and spasticity remains uncertain. OBJECTIVE: To examine the effects of DN combined with exercise therapy on wrist flexor spasticity and motor function in patients with stroke. METHODS: Twenty-four participants with stroke were randomly assigned to either the DN and exercise therapy group or the DN alone group. Assessments were conducted at baseline, after the 4th treatment session, and 3 weeks post-treatment. RESULTS: A significant Group×Time interaction was observed for wrist active range of motion (ROM) (P = 0.046), favoring the DN with exercise therapy group (∼10° at baseline, ∼15° immediately after the 4th session, and 15.4° at follow-up). The improvements in spasticity, passive ROM, and H-reflex latency were sustained during follow-up. However, there were no significant between-group differences in any outcome at any measurement time point. CONCLUSION: The combined DN and exercise therapy did not exhibit superiority over DN alone concerning spasticity severity and motor function. However, it demonstrated additional advantages, particularly in improving motor neuron excitability and wrist passive extension. [ABSTRACT FROM AUTHOR]

Background: Carpal tunnel syndrome (CTS) is a common entrapment neuropathy. It is clinically presented by nocturnal pain, paresthesia, and weakness in the distribution of the median nerve. However, extra-median symptoms may develop in some patients, particularly those with mild to moderate CTS. This raised the assumption of possible concomitant ulnar nerve entrapment at the wrist, or Guyon's canal syndrome (GCS). The aim of this study is to evaluate functional and structural changes that may take place in the ulnar nerve at the wrist in those patients. Methods: This is a retrospective case–control study that included forty patients with mild to moderate CTS and 40 matched subjects as a control group. Electrophysiological evaluation was done for all the participants in addition to measuring median and ulnar nerves sonographic parameters in the form of median cross-sectional area (m-CSA) at the level of pisiform bone, median flattening ratio (m-FR), median swelling ratio (m-SR), the difference between m-CSA at the inlet of the carpal tunnel and m-CSA at the distal third of the pronator quadratus (Δ m-CSA), as well as the ulnar cross-sectional area (u-CSA) at the same level. Results: The u-CSA was larger in the patients relative to the control (5.23 ± 1.21 mm2 versus 3.28 ± 0.64 mm2). It did not correlate with m-CSA. However, a statistically significant correlation was demonstrated between u-CSA and median motor conduction parameters (P ≤ 0.001). Conclusion: Although patients with mild to moderate idiopathic CTS may have normal electrophysiological parameters of the ulnar nerve, ultrasonographic evaluation is valuable to detect early ulnar nerve structural changes, which appear to be likely due to concomitant distal ulnar nerve entrapment at the Guyon's canal, which may contribute to the development of extra-median symptoms in those patients. [ABSTRACT FROM AUTHOR]

Enormous assistance is required during rehabilitation activities, which might result in a variety of complications if performed manually. To solve this issue, several solutions in the form of assistive devices have been presented recently. Another issue highlighted is the lack of kinematic compatibility in low degrees-of-freedom (dof) systems. The proposed approach of developing a human-motion-oriented rehabilitation device deals with the problem through hybrid architectures. A novel modular synthesis approach is used for the purpose to induce generality in the design process. Using a modular strategy, three planar hybrid configurations are generated for two-dof mechanisms for supporting flexion/extension motion. Three such architectures are optimally synthesised and kinematically analysed over the entire workspace. A Genetic Algorithm (GA) is used to synthesise the architecture parameters optimally. Moreover, the outcomes are evaluated against a set of seven poses and posture locations of the wrist to choose the most suitable configuration among the others. Subsequently, kinematic compatibility is analysed for the coupled system – formed by the selected architecture and the human arm – while wearing the proposed mechanism. According to the findings of optimal synthesis, workspace and singularity analysis, configuration-III is capable of achieving the optimal postures for all task space locations (TSLs). Further, the work modifies the design by attaching additional three revolute passive joints for correcting misalignment concerns using coupled mobility analysis. The modular strategy for hybrid architectures and the subsequent mobility analysis provides an algorithmic framework for synthesising a task-based rehabilitation device. Manual physiotherapy is reported as repeated task, expensive and time-consuming, and considered stressful for the therapist or assistants to provide one-on-one physiotherapy to each patient in the traditional method. Robotic rehabilitation is, therefore, a viable option. In the several reported works on robotic rehabilitation exoskeletons, misalignment of the exoskeleton and the human motion is considered an open challenge. Normally, it is being managed through large number of degrees of freedom, which is certainly expensive and complex in control. The proposed approach of developing a human-motion-oriented rehabilitation device deals with the problem through hybrid architectures and modular strategy to develop them. While focusing upon the emulation of natural human motion trajectory, the compatibility of orthotic joint and human joint motion needs attention. As biological joint possesses complex kinematic characteristics, closed-loops are used in the design. Overall, a complete framework of a cost effective low-dof rehabilitation device is proposed and detailed through coupled analysis. [ABSTRACT FROM AUTHOR]

Background: Lateral epicondylitis is considered to be the most prevalent overuse injury which affects 1% to 3% of the total population among all age groups and genders. The tendon of extensor carpi radialis brevis gets affected and can be strengthened by resistance exercises. It also affects plumbers, carpenters, housewives etc. The daily activities are interrupted which increases pain in lateral epicondylitis can be treated conservatively and surgically. Purpose: To compare the effectiveness of concentric vs Eccentric training programs for lateral epicondylitis by reducing pain. Materials and Methods: 68 subjects were selected from Active physio care physiotherapy clinic based on the inclusion and exclusion criteria. The detailed procedure for performing the study was explained to the subjects, and the informed consent form was collected from them before starting the study. The pre and post test values were measured using the numerical pain rating scale (NPRS) and pain rated tennis elbow evaluation (PRTEE). The subjects selected based on the inclusion and exclusion criteria were divided into two groups: concentric group and Eccentric group (n = 34). Study period: November 2022 to April 2023. Results: Statistical analysis of numerical pain rating scale and pain rated tennis elbow evaluation post test result revealed that both groups show similar effect but Eccentric exercise Group (Group B) exceeds Concentric Exercise group (Group A) with p VALUE of p<0.0001. Conclusion: When comparing the concentric group to the Eccentric group, the Eccentric group indicates significant effects in improving the strength of the elbow, improving the functional activity and strength of the forearm [ABSTRACT FROM AUTHOR]

Background: This study was conducted explicitly on the efficacy of task-oriented exercises paired with wrist flexibility training on enhancing wrist mobility and reducing wrist injuries in badminton players. Purpose: The purpose of this study was to see how a structured intervention integrating task- oriented exercises and wrist flexibility training benefited wrist mobility and injury prevention in badminton players. Materials and Methods: A randomized controlled trial design was used, with a sample of 70 intermediate- level badminton players participating. The participants were split into two groups: conventional and intervention. The intervention group participated in a four-week programme that included task-oriented workouts with badminton movements and targeted wrist flexibility training. The typical group continued with their regular training schedule, with no wrist mobility modification. Validated metrics - ROM and Quick DASH score - were used to assess wrist mobility and function. (Study period: September 2022-May 2023) Result: Preliminary research found that the intervention group had significantly better wrist mobility than the control group. They also demonstrated enhanced ROM, flexibility, and functional performance of the wrist joint, as well as a significant decrease in wrist injury occurrence. Conclusion: These data indicate that combining task-oriented exercises with wrist flexibility training in badminton players can successfully improve wrist mobility and lower the incidence of wrist injuries. [ABSTRACT FROM AUTHOR]

Distal radius fractures are a common sports injury, often managed with reduction, immobilization, and rehabilitation. However, structured sport specific return to play protocols have yet to be developed, specifically within hockey. This case report reviews the various factors to consider when managing an athlete's recovery from a radius fracture, and objective measures to aid with return to play decision making when managing a hockey player. [ABSTRACT FROM AUTHOR]

Nowadays there are various prosthetic arm designs in the literature, the market, and CAD design websites, with different shapes, sizes, and degrees of freedom. Only limited options are available for controlling such prostheses. Prosthetic arm users reported muscle fatigue and unreliability when using the market-dominated myoelectric sensors. This work presents the "Infinity Foot Controller" as a new approach to control a five-finger below-the-elbow prosthetic arm with wrist rotation and bending capabilities. This foot control system receives user input from a custom insole and a sensor-controller unit placed alongside the user's shoe to perform various hand grips, gestures, and/or rotations. To demonstrate the new foot controller, a design of a 3D-printed below-the-elbow prosthetic arm, called the "Infinity Arm", is presented. This arm is suitable for gripping relatively lightweight objects and making hand gestures. It includes a wrist actuation system that permits 120° wrist rotation and 70° wrist extension and flexion. It also includes a haptic feedback system that utilizes fingertip force sensors to relay a vibratory response in an armband placed on the user's arm, giving the user a sense of touch. A proof-of-concept model was built to demonstrate the system and a testing procedure was proposed. [ABSTRACT FROM AUTHOR]

BACKGROUND: With progressing technology in the portable computing field, laptops are now integral for work, home and social settings. Different working postures adopted by laptop users impose different loads on the relevant muscles, which can be associated with musculoskeletal discomfort in the various body regions. Some Arabic and Asian cultures adopted postures are not well investigated, particularly for the 20–30 years age-group. OBJECTIVE: This study compared muscle activity in the cervical spine, arm, and wrist among different laptop workstation setups. METHODS: In this cross-sectional study, 23 healthy female university students (age = 24.2±2.28 years, range 20–26 years) performed a standardized 10 minute typing task in four different laptop workstation setups: DESK, SOFA, GROUND sitting with back support, and laptop table (LAP-Tab). Differences between electromyography (EMG) muscle activity recorded in the trapezius (TR), cervical extensors (CE), deltoid (DEL), and wrist extensors (WE) were determined using one-way repeated ANOVA measures with a post-hoc Bonferroni test. RESULTS: Significantly higher muscle activity was observed respectively in the workstations of DESK > LAP-Tab > SOFA > GROUND. Significant differences were found between WE muscle activity and the three other muscle groups (p < 0.001). There was a significant interaction between workstations and muscle activity (F(9,264) = 3.81, p < 0.001, = 0.11), where the WE and DEL muscles showed respectively higher and lower muscle activity in all setups. CONCLUSION: Muscles showed variable activity in different workstations such that the GROUND workstation provided the minimum load, while the DESK workstation showed the maximum load on the measured muscle groups. These findings require further investigation in different cultural and gender specific groups. [ABSTRACT FROM AUTHOR]

Shear wave elastography imaging of the ulnar collateral ligament (UCL) is used to help understand changes in material properties of the ligament. Ensuring that the wrist flexors are relaxed is essential as muscle contractions can alter the alignment of the medial elbow. The purpose of this study was to determine how the structural and material properties of the medial elbow respond to various elbow torques. The medial elbows of 20 healthy adults, free from upper extremity disorders, were imaged in 3 of the following torque conditions: (1) neutral relaxed, (2) passive valgus, and (3) active varus. Structural properties (ulnohumeral gap and UCL length) using B-mode and material properties (UCL and flexor muscle stiffness) using shear wave were measured. Passive valgus torque opened the ulnohumeral gap (P <.001), and increased UCL (P <.001) and wrist flexor stiffness (P =.001), compared with the neutral condition. Under an active varus contraction, the gap returned back to the neutral position, but UCL (P <.008) and wrist flexor stiffness (P <.004) remained elevated compared with neutral, meaning low-intensity torques can influence structural and material properties of the medial elbow. Therefore, effort should be taken to minimize muscle activation during imaging in order to accurately measure medial elbow properties. [ABSTRACT FROM AUTHOR]

Lateral epicondylitis, also known as tennis elbow, is a major health issue among tennis players. This musculo‐skeletal disorder affects hand extensor tendons, results in substantial pain and impairments for sporting and everyday activities and requires several weeks of recovery. Unfortunately, prevention remains limited by the lack of data regarding biomechanical risk factors, especially because in vivo evaluation of hand tendon forces remains challenging. Electromyography‐informed musculo‐skeletal modeling is a noninvasive approach to provide physiological estimation of tendon forces based on motion capture and electromyography but was never applied to study hand tendon loading during tennis playing. The objective of this study was to develop such electromyography‐informed musculo‐skeletal model to provide new insight into hand tendon loading in tennis players. The model was tested with three‐dimensional kinematics and electromyography data of two players performing forehand drives at two‐shot speeds and with three rackets. Muscle forces increased with shot speed but were moderately affected by racket properties. Wrist prime extensors withstood the highest forces, but their relative implication compared to flexors depended on the player‐specific grip force and racket motion strategy. When normalizing wrist extensor forces by shot speed and grip strength, up to threefold differences were observed between players, suggesting that gesture technique, for example, grip position or joint motion coordination, could play a role in the overloading of wrist extensor tendons. This study provided a new methodology for in situ analysis of hand biomechanical loadings during tennis gesture and shed a new light on lateral epicondylitis risk factors. [ABSTRACT FROM AUTHOR]

• Measurement of functional dart thrower's motion is clinically feasible. • Lower functional dart thrower's motion was noted on affected wrists in postoperative and nonoperative patients. Cross-sectional and descriptive study Functional dart thrower's motion (F-DTM) is an obliquely oriented wrist motion that occurs in activities such as throwing and drinking from a cup. There is limited data on clinical measurement of F-DTM. The purpose of this study was to 1) describe and establish reference scores for F-DTM measurement for nonoperative and postoperative wrist patients 2) compare F-DTM between the affected and nonaffected sides and 3) determine F-DTM score agreement across three consecutive trials. Two certified hand therapists evaluated F-DTM in consecutive adult patients with a unilateral wrist condition undergoing nonoperative or postoperative therapy. Three trials of goniometer measurements for radial extension (RE) and ulnar flexion (UF) were assessed on the nonaffected and affected wrists. A total arc F-DTM was computed. Mean, 95% confidence intervals (CI), and Cohen's d effect size described side-to-side differences in RE, UF, and total arc F-DTM. Agreement in scores across trials was assessed with an intraclass correlation coefficient (ICC). Thirty-one nonoperative (mean ± SD age = 40.0 ± 13.9 years, 74% female, 94% right hand dominant) and 44 postoperative patients (mean ± SD age = 44.9 ± 14.9 years, 66% female, 84% right hand dominant) were enrolled. The average side-to-side difference, in degrees, in the nonoperative group was -6.4 (95% CI: -9.4 to -3.4, Cohen's d = 0.8) for RE, -10.4 (-16.7 to -4.0, d = 0.6) for UF, and -16.8 (-24.3 to -9.2, d = 0.8) for total arc F-DTM. The average side-to-side difference in the postoperative group was -33.6 (-38.8 to -28.3, d = 1.9) for RE, -34.7 (-40.6 to -28.7, d = 1.8) for UF, and -68.2 (-77.9 to -58.5, d = 2.1) for total arc F-DTM. The range of ICCs for F-DTM measurements was 0.82-0.96. Goniometer measurement of F-DTM is a clinically feasible method to quantify functional motion loss in an injured wrist population, particularly patients with postoperatively managed wrist conditions. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to investigate the potential of arthroscopic scapholunate ligament repair and dorsal capsulodesis with suture anchor as a treatment option for patients experiencing symptomatic acute and subacute (< 3 months) scapholunate instability. Methods: From Jan. 2017 to Jan 2020, 19 wrists with acute or subacute tears of the SL ligament with symptomatic instability were treated with arthroscopic SL repair and dorsal capsulodesis with a suture anchor. The average time from injury to operation was 8.8 weeks (range, 4–11 weeks) and the regular follow-up mean duration at our clinic was 26.5 months (range, 24–32 months). The pain score according to the visual analog scale, wrist range of motion, grip strength, radiographic outcomes and functional outcomes according to the Modified Mayo Wrist Score (MMWS) were evaluated preoperatively and postoperatively during the follow-up period. Results: All 19 patients had rupture and dissociation of the SL ligament in the radiocarpal joint. The total arc of wrist motion in the flexion–extension plane loss averaged 5.1° (P >.01).The Wilcoxon signed-rank test was used to compare the results: grip force improved significantly with 14.7% improvement of that on the normal side (P <.01); the postoperative MMWS was significantly better than the preoperative scores (P <.01). Of 19 patients of the series, 18 patients (94.7%) achieved good or excellent results according to the MMWS and 16 patients (84.2%) resumed their previous activities. Only one patient (5.3%) had residual laxity of the scapholunate ligament joint at 15 months of follow-up. Conclusions: At a minimum of two years of follow-up, patients with acute or subacute symptomatic dissociation of scapholunate ligament instability who underwent arthroscopic scapholunate ligament repair and dorsal capsulodesis with suture anchor treatment had satisfactory results. Level of Evidence: Level IV, case series. [ABSTRACT FROM AUTHOR]

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Aim: In this study, the effects of the addiction level of smartphone use in university students on the range of motion and proprioception of the dominant hand, wrist range of motion (ROM), and thumb ROM were investigated. Material and Methods: Wrist and thumb ROMs were measured with a manual goniometer with a sensitivity of 1 degree, and hand grip strength was measured with a hand grip dynamometer in a total of 100 volunteer university students with a mean age of 18-25. Smartphone Addiction Scale-Short Form (SAS-SF) and Patient Rated Wrist and Hand Evaluation (PRWHE) questionnaire were applied to the students. Statistical analyzes were made using the SPSS 25 program. Results: The students' usage time of smartphones and addiction levels do not affect the hand grip strength; the increase in smartphone addiction statistically correlates with the right thumb flexion (0.016) and abduction ROMs (0.015), statistically correlated with increased pain level in daily life and statistically correlated with the decrease of the wrist radial deviation ROM (0.009). As the duration of smartphone use increases, the error rate in right thumb abduction proprioception statistically increases (0.027). In addition, we determined the statistically correlations in both thumb flexion and abduction movements. Conclusion: We determined that the excessive usage of smartphones affects the ROM of thumb flexion and abduction, the ROM of wrist radial deviation, and the proprioception of thumb abduction, and it does not affect the hand grip strength. The findings of our research will be a source for future studies. [ABSTRACT FROM AUTHOR]

Purpose: Early diagnosis and treatment of scaphoid fractures is critical to achieve union and prevent wrist degenerative arthritis. Plain radiographic measurements can guide the early approach to suspected fractures. Specifically, the ability to predict fracture or fracture stability from plain radiographs may allow the traumatologist to expand initial referral to three-dimensional imaging. We evaluated the ability of four measured angles to predict presence of a scaphoid fracture and stability. Methods: Fifty patients with a scaphoid fracture and 50 patients without fracture were evaluated for the cortical ring sign, scapho-lunate gapping, lateral scapholunate (SL), radio-scaphoid (RS), radio-lunate (RL), and radio-capitate (RC) angles by two-blinded observers. Results: Measurement of an increased SL interval was associated with the presence of a scaphoid fracture as diagnosed on three-dimensional imaging [odds ratio (OR) 3.0, confidence interval (CI) 1.53–5.87, p = < 0.01]. The measured RL angle was associated with fracture displacement (OR 1.13, 95% CI 1.02–1.25, p = 0.02). Conclusions: Scapholunate gapping on plain radiographs in the context of a clinically suspected scaphoid fracture should increase suspicion for a fracture and may prompt earlier 3-dimensional imaging, while the presence of an abnormal radiolunate angle should increase wariness for instability and can be used in preoperative planning. [ABSTRACT FROM AUTHOR]

Upper limb function is a high priority for people with cervical spinal cord injury (SCI). This case report describes an application of technology to activate spared neural pathways and improve wrist motor control. A 73-year-old man with chronic incomplete C5 SCI completed 24 training sessions over 92 days. Each session included 2 maximal contractions, 6 test trials, and 10 training trials of a visuomotor force tracking task. The participant attempted to match a sinusoidal target force curve, using isometric wrist flexor and extensor contractions. Electromyography (EMG) and force signals were recorded. Errors were elevated initially and improved with training, similarly during extension and flexion phases of the force tracking task. Improvement in both phases was associated with greater flexor activation in flexion phases and greater extensor relaxation in flexion phases. Errors were not related to EMG modulation during the extensor phases. Small improvements in active range of motion, grip force, spasticity, touch sensation, and corticospinal excitability were also observed. Motor skill training improved motor control after incomplete SCI, within the range of residual force production capacity. Performance gains were associated with specific adjustments in muscle activation and relaxation, and increased corticospinal excitability. [ABSTRACT FROM AUTHOR]

Taping has been suggested to reduce the incidence of tendinopathy in tree planters. However, the ability of taping to reduce wrist postures during planting has not yet been formally evaluated. The primary aim was to test the effect of rigid taping on wrist postures during tree planting tasks. Eleven tree planters planted up to 50 trees in three conditions: no-tape (NT), tape-on-the-dorsum-of-the-hand (T1) and tape-on-the-thumb (T2) in a randomised cross-over, within-participant, repeat-measures design. Electrogoniometers (EG) recorded continuous wrist postures. Digital video recordings were used to segment EG traces of each planting cycle (one planted tree) into 4 kinematically distinct Phases. The tree and shovel wrist were analysed separately. Tree-wrist peak ulnar deviation and frequency of shovel-wrist awkward frontal plane postures were significantly reduced in the T2 condition. Taping may be effective at reducing non-neutral postures and should be researched further to determine its effectiveness in reducing tree planting injuries. Practitioner summary: The effect of rigid taping on wrist postures during tree planting has not yet been formally evaluated. A randomised cross-over, within-participant, repeat measures design was used to evaluate the effect of rigid taping on wrist postures during planting. Thumb rigid taping appeared to reduce wrist range of motion during planting. Taping of the thumb reduced peak ulnar deviation of the tree wrist and frequency of awkward frontal plane postures of the shovel wrist. While taping of the dorsum of the hand appeared to be more restrictive, it did not significantly reduce wrist movement; this is likely because only its effect on sagittal plane posture was assessed which had a higher variance. Upon application, tape appeared to restrict voluntary movement patterns, decreased voluntary grip force exertion and physically restrain wrist movement. Overall, rigid tape was found to be an acceptable intervention for the tree planting occupation, with financial costs and perceived effort identified as the primary barriers to acceptability. [ABSTRACT FROM AUTHOR]

Background: Lateral epicondylitis is a chronic tendinopathy of humeral origin of the common extensor tendon. Most patients show improvement after nonoperative treatment. However, 4% to 11% of patients require surgical treatment. Although corticosteroid injection is one of the most commonly applied nonoperative treatment methods, to the authors' knowledge, no study has reported the effect of the number of preoperative corticosteroid injections on the final postoperative outcome. Thus, the objective of this study was to determine the effect of the number of preoperative corticosteroid injections on postoperative clinical outcomes. Hypothesis: The number of corticosteroid injections before surgical treatment does not affect postoperative clinical outcomes. Study Design: Case series; Level of evidence, 4. Methods: As a retrospective review, from January 2007 to December 2019, a total of 99 patients who had undergone surgical treatment of lateral epicondylitis with a modified Nirschl technique were enrolled. The number of preoperative corticosteroid injections was investigated by medical record review. Outcome measurements included visual analog pain scale; Disabilities of the Arm, Shoulder and Hand (DASH) score; Mayo Elbow Performance Score; and the Nirschl and Pettrone grade. Grip power and wrist extension power were measured using a digital dynamometer. Results: A total of 99 patients were included in this study. The mean total number of injections of patients was 4.37 ± 2.46 times (range, 1-15 times). Total duration of nonoperative treatment before surgery was 25.4 ± 20.5 months (range, 4-124.8 months). The mean postoperative follow-up period was 42.8 ± 28.0 months (range, 12-110 months). For all injection numbers, clinical scores showed significant improvement in visual analog pain scale, DASH score, Mayo elbow score, grip power, and wrist extension power after surgery. Regression analysis showed that the degree of improvement according to the injection number was not statistically significant. The Nirschl and Pettrone grade was excellent in 82 (82.8%) patients, good in 14 (14.1%) patients, fair in 2 (2%) patient, and failure in 1 (1%) patient. Conclusion: The number of preoperative corticosteroid injections does not appear to affect postoperative clinical outcomes of patients with lateral epicondylitis who undergo surgery with a modified Nirschl technique. [ABSTRACT FROM AUTHOR]

Digital skin defects resulting from trauma are often associated with dysfunction of the digital nerve and the extensor and flexor tendons in the affected fingers. The repair of these complex tissue defects requires a graft containing multiple tissues that can be used to reconstruct the tendons and nerves and restore the skin. Such procedures can cause multiple injuries and significant damage to the donor site. The current study used a novel technique to repair complex dorsal and palmar digital soft‐tissue defects. First, multiple tissues were cut and collected from the donor site. Then, part of the flexor carpi ulnaris tendon was transplanted to repair the tendon defect, and a medial antebrachial cutaneous nerve graft was used to repair the digital nerve defect. Finally, a skin flap was used to cover the skin defect. This paper reports on 31 cases of complex soft‐tissue digital defects, with defect areas of 2–18 cm2. One patient presented with a postoperative arterial crisis in the flap. All other patients recovered without experiencing a vascular crisis, flap necrosis, or wound infection. The postoperative flaps were similar in texture to the original digital skin. The sensation and the extension/flexion functions in the affected fingers recovered well. The effect on grip strength, wrist flexion, and forearm sensation was minor and the postoperative total active motion scores of the affected digits were good or excellent in 96.77% of the cases. The flap sensation recovery rate was also excellent in 83.87% of the cases. The present technique facilitates the repair of multiple dorsal and palmar digital soft‐tissue, tendon and nerve defects, reduces the damage to the donor site, and significantly improves the success of surgical repair. [ABSTRACT FROM AUTHOR]

A task involving an instructed finger movement causes involuntary movements in the noninstructed fingers of the hand, also known as finger interdependence. It is associated with both mechanical and neural mechanisms. The current experiment investigated the effect of finger interdependence due to systematic changes of the wrist posture, close to neutral. Eight right- handed healthy human participants performed submaximal cyclic flexion and extension at the metacarpophalangeal joint at 0° neutral, 30° extension, and 30° flexion wrist postures, respectively. The experiment comprised of an instruction to move one of the 4 fingers--index, middle, ring, and little. Movements of the instructed and noninstructed fingers were recorded. Finger interdependence was quantified using enslavement matrix, individuation index, and stationarity index, and it was compared across wrist postures. The authors found that the finger interdependence does not change with changes in wrist posture. Further analysis showed that individuation and stationarity indices were mostly equivalent across wrist postures, and their effects were much smaller than the average differences present among the fingers. The authors conclude that at wrist postures close to neutral, the finger interdependence is not affected by wrist posture. [ABSTRACT FROM AUTHOR]

Purpose: To examine changes in, and relationships between, sleep quality and quantity, salivary testosterone, salivary cortisol, testosterone-to-cortisol ratio (T:C), and sell-reported muscle soreness during a residential-based training camp in elite rugby players. Methods: Nineteen male rugby players age 26.4 (3.9) years, height 186.0 (9.4) cm, and weight 104.1 (13.4) kg (mean [SD]) participated in this study. Wrist actigraphy devices were worn for 8 nights around a 4-d training camp (2 nights prior, during, and 2 nights after). Sleep-onset latency, sleep duration, sleep efficiency, and waking time were measured. Participants provided saliva samples during camp on waking and again 45 min later, which were then assayed for testosterone and cortisol levels. They also rated their general muscle soreness daily. Results: Little variation was observed for sleep quality and quantity or testosterone. However, significant differences were observed between and within days for cortisol, T:C, and muscle soreness (P < .001). Few relationships were observed for sleep and hormones; the strongest, an inverse relationship for sleep efficiency and T:C ( r=-.372, P < .01). Conclusions: There may be no clear and useful relationship between sleep and hormone concentration in a short-term training camp context, and measures of sleep and testosterone and cortisol should be interpreted with caution because of individual variation. Alterations in hormone concentration, particularly cortisol, may be affected by other factors including anticipation of the day ahead. This study adds to our knowledge that changes in hormone concentration are individual and context specific. [ABSTRACT FROM AUTHOR]

This laboratory cross-sectional study aimed at explore the muscle response (MR) of the upper trapezius, infraspinatus, biceps brachii and extensor carpi radialis brevis (ECRB) during the radial nerve-biased upper limb neurodynamic test (RN-ULNT) in healthy participants. Myoelectric activity was stage-by-stage recorded during two sequencing variants of the RN-ULNT: S1, in which elbow extension was the last movement; and S2, in which wrist flexion was the last movement. Final elbow and wrist joint angle and sensory response (SR) in five zones (Z1-Z5) were also registered. MR was qualitatively categorized as 'absent' (No-MR), 'true' (TMR) or 'uneven' (UMR). In both sequences, significant increases in muscle activity occurred mostly during shoulder abduction and elbow extension (p ≤ 0.009). Also, elbow extension but not wrist flexion increased the activity of the ECRB muscle (p ≤ 0.009). S2 showed significantly higher upper trapezius (p = 0.04) and biceps brachii (p = 0.036) muscle activity during wrist flexion, and higher report of SR in Z1 and Z4 (p < 0.001) compared to S1. Only the ECRB muscle showed significant differences in the MR type between S1 and S2 (TMR, p = 0.016; UMR, = 0,012). Our results may be useful in the assessment of upper limb musculoskeletal disorders. [ABSTRACT FROM AUTHOR]

BACKGROUND: Using both hands is regularly needed for force/torque exertions in many activities, especially when using hand tools. OBJECTIVE: To investigate the effects of tool grip span, workpiece orientation, moving direction, and working height on two-handed wrist U/R deviation torque strength, usability, comfort, and discomfort while using locking pliers. METHODS: Participants (n = 22) took part in an experimental study which evaluated the effects of tool grip span (4.5–6.5 cm), workpiece orientation (transverse/sagittal), moving direction (clockwise (CW)/counterclockwise (CCW)), and working height (shoulder/elbow/knuckle) on two-handed wrist U/R deviation torque, (dis)comfort, and usability while using locking pliers. RESULTS: The results showed no significant effect of tool grip span on wrist U/R deviation torque strength, but the locking pliers with 4.5 cm handle grip span led to more comfort and better usability. The two-handed wrist U/R deviation torque strengths were significantly higher in sagittal plane than in transverse plane, and in CW direction than in CCW direction. The highest values of two-handed wrist U/R deviation torque strength in sagittal and transverse planes were exerted in knuckle and elbow heights, respectively. CONCLUSION: The findings can be used to develop guidelines and recommendations with regard to daily and occupational activities which require the use of both hands for force exertion with manual hand tools. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study is to investigate the effects of a virtual reality–mediated gamified rehabilitation program on upper limb functions, skills, range of motion, muscle tone, and quality of life in children with hemiplegic cerebral palsy. Design: This prospective, randomized, and controlled study included 36 children with hemiplegic cerebral palsy. Children were randomized into two groups, the virtual reality group (n = 18) and the control group (n = 18). Stretching and range-of-motion exercises were performed on the affected upper limb of the children in both groups. In addition to this exercise program, in the virtual reality group, virtual reality–mediated upper limb rehabilitation was performed under supervision. The children were assessed at baseline and 1 and 3 mos after the intervention. Results: There was a significant increase in Assisting Hand Assessment, ABILHAND-Kids, Quality of Upper Extremity Skills Test, and KINDL values in the virtual reality group. In addition, there were significant increases in the active joint range of motion of the finger flexion, wrist flexion, pronation, and supination in the virtual reality group. Conclusions: In this study, it was determined that upper limb function, quality of life, and active joint range of motion of the children with hemiplegic cerebral palsy were increased with virtual reality–mediated upper limb rehabilitation. [ABSTRACT FROM AUTHOR]

Introduction: Exercise is the most recommended treatment for chronic low back pain (CLBP) and is effective in reducing pain, but the mechanisms underlying its effects remain poorly understood. Exercise‐induced hypoalgesia (EIH) may play a role and is thought to be driven by central pain modulation mechanisms. However, EIH appears to be disrupted in many chronic pain conditions and its presence in people with CLBP remains unclear. As people suffering from chronic pain often exhibit psychological factors and central sensitization symptoms influencing pain perception, EIH might be associated with these factors. Objective: The aim of this study is to compare the level of EIH between participants with and without CLBP following back and wrist exercises and to assess the associations between EIH, psychological factors, and symptoms of central sensitization (using the central sensitization inventory ‐ CSI) in CLBP. Method: Twenty‐eight participants with CLBP and 23 without pain were recruited. Pressure pain thresholds (PPT) were measured at 4 sites (2 bony sites = capitate, S1|2 muscle sites = wrist flexors, lumbar erector spinae) before and after each of two exercises (wrist flexion and lumbar extension). Exercise‐induced hypoalgesia was defined as percent change in PPT from pre‐ to post‐exercise. Participants with CLBP also completed questionnaires to measure psychological factors (e.g., kinesiophobia, catastrophizing, anxiety, and self‐efficacy) and symptoms of central sensitization (CSI), and correlations with EIH were calculated. Results: After wrist exercise, EIH measured at the muscle sites was lower in the CLBP group compared with the pain‐free group (p = 0.047) but no differences were found at bony sites (p = 0.49). No significant differences for EIH were observed following back exercise at muscle sites (p = 0.14) or at bony sites (p = 0.65). Exercise‐induced hypoalgesia was not correlated with any psychological factors or with the CSI score. Conclusion: The lower EIH following wrist exercises may represent an alteration in pain modulation control in CLBP. However, psychological factors and central sensitization symptoms may not explain the differences observed. [ABSTRACT FROM AUTHOR]

Aim: Morphological variations in carpal bone may affect wrist pathologies. In this study, we examined the relationship between carpal bone morphologies and scaphoid fractures. Materials and Methods: Patients with a prominent scaphoid fracture on posteroanterior and ulnar deviation X-rays were included in the study. Morphological types of lunate, hamate, capitate, presence of capitate-fourth metacarpal joint, and scaphoid fracture location were documented retrospectively. A total of 68 patients, 65 (95.6%) male, and 3 (4.4%) female were included in the study. Results: Considering the scaphoid fracture types, 40 (58.8%) patients had waist fractures, and 28 (41.2%) patients had proximal pole fractures. The association of fracture type and morphology of carpal bones was examined. Conclusion: In our study, we found that lunate, capitate, hamatum morphology and ulnar variance, fourth metacarpal articulation did not affect the scaphoid fracture pattern. [ABSTRACT FROM AUTHOR]

Prosthetics are an extension of the human body and must provide functionality similar to that of a non-disabled individual to be effective. Sports prosthetics such as the Flex-Foot Cheetah from Össur have demonstrated the value of creating devices that both provide mechanical support and introduce passive energy return to mimic forces otherwise produced at joints. These energy return mechanisms have not yet been demonstrated for upper limb prosthetics but could improve their effectiveness and provide a greater range of motion and control. Using multi-material 3D printing technology, we extend energy return components to upper limb prosthetics by developing novel force-sensing springs and applying them to a basketball prosthetic. The 3D-printed springs compensate for the forces otherwise generated by wrist and finger flexion while measuring the mechanical deflection. We discuss design guidelines, methods for integrated 3D printed energy return within prosthetics, and broader applications in assistive technologies. [ABSTRACT FROM AUTHOR]

Osseous deformities in children arise due to progressive angular growth or complete physeal arrest. Clinical and radiological alignment measurements help to provide an impression of the deformity, which can be corrected using guided growth techniques. However, little is known about timing and techniques for the upper extremity. Treatment options for deformity correction include monitoring of the deformity, (hemi-)epiphysiodesis, physeal bar resection, and correction osteotomy. Treatment is dependent on the extent and location of the deformity, physeal involvement, presence of a physeal bar, patient age, and predicted length inequality at skeletal maturity. An accurate estimation of the projected limb or bone length inequality is crucial for optimal timing of the intervention. The Paley multiplier method remains the most accurate and simple method for calculating limb growth. While the multiplier method is accurate for calculating growth prior to the growth spurt, measuring peak height velocity (PHV) is superior to chronological age after the onset of the growth spurt. PHV is closely related to skeletal age in children. The Sauvegrain method of skeletal age assessment using elbow radiographs is possibly a simpler and more reliable method than the method by Greulich and Pyle using hand radiographs. PHV-derived multipliers need to be developed for the Sauvegrain method for a more accurate calculation of limb growth during the growth spurt. This paper provides a review of the current literature on the clinical and radiological evaluation of normal upper extremity alignment and aims to provide state-of-the-art directions on deformity evaluation, treatment options, and optimal timing of these options during growth. [ABSTRACT FROM AUTHOR]

Background: There has been little examination of force production of the upper limb in people with Parkinson's disease (PD), despite its impact on activities of daily living and clear evidence that force production is significantly reduced in lower limb muscle groups. The aim of this study was to determine the force production of the major muscle groups of the upper limb in people with PD during the "on" phase after medication, compared with aged‐matched neurologically‐normal controls. Method: A cross‐sectional study was carried out. Participants: Thirty people with mild PD (Hoehn Yahr mean 1.1) and 24 age‐matched neurologically‐normal controls. Outcome measures: Maximum isometric force production of the shoulder flexors, extensors, abductors, adductors, internal rotators and external rotators, elbow flexors and extensors, wrist flexors and extensors and hand grip using dynamometry. Results: There was a significant impairment in force production in all upper limb muscle groups, compared with control participants, except in the wrist flexors. On average the deficit in force production was 22%, despite people with PD having mild disease, being physically active and being measured during the "on" phase of medication. The most severely affected muscle groups were the upper limb extensors. Conclusion: People with PD have a significant deficit in force production of the upper limb muscle groups compared with age‐matched neurologically normal controls. Clinical Implications: Regular assessment of strength of the upper limb should be considered by clinicians and strengthening interventions could be implemented if a deficit is identified. [ABSTRACT FROM AUTHOR]