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The forearm muscles coordinately control wrist motion, and their activity is affected by forearm rotation. Although forearm rotation has been implicated in the development of lateral and medial epicondylitis, its biomechanical background remains unknown. Therefore, the present study investigated the activity of wrist muscles in various forearm positions. Surface electromyography of the extensor carpi radialis brevis, extensor carpi ulnaris, flexor carpi radialis, and flexor carpi ulnaris was performed on 40 healthy upper limbs. We initially measured muscle strength and electromyographic activity (integrated electromyographic value per second) at maximum voluntary output towards wrist extension and flexion in a neutral position. We then assessed electromyographic activity under constant wrist torque (75% of maximum strength in the neutral position) in pronation, the neutral position, and supination. The percentage of maximum electromyographic activity was evaluated for each position. In wrist extension, the extensor carpi radialis brevis was activated during forearm pronation, while extensor carpi ulnaris activity did not change in any forearm position. In wrist flexion, the flexor carpi radialis was activated during forearm supination, while flexor carpi ulnaris activity was significantly lower with forearm pronation than in the neutral position. Since muscle activation increases traction force at the tendon origin, forearm positions that increase muscle activity may be a biomechanical risk factor for the development of tendinopathy. The present results are consistent with epidemiological and pathological findings on lateral and medial epicondylitis. These results provide insights into wrist biomechanics and the pathophysiology of lateral and medial epicondylitis., Competing Interests: Declarations. Ethics approval and consent to participate: This study was conducted according to the principles of the Declaration of Helsinki. The Institutional Review Board of Kikkoman General Hospital approved the study protocol. Consent for publication: Not applicable. Consent to participate: Written consent for publication was obtained from all study participants. Clinical trial number: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

The purpose of this study was to determine how wrist exertion direction and forearm posture independently influence upper arm muscle activity during isometric wrist contractions. Surface electromyography was recorded from three muscles of the upper-limb: biceps brachii, triceps brachii, and brachioradialis. Participants were seated with their forearm supported in one of three postures (supinated/neutral/pronated) with an adjustable force transducer that could be placed either above, below, or to the right/left of the participant's hand. Participants performed randomized trials of isometric wrist flexion or extension at five relative intensities: 20, 40, 60, 80, or 100% of maximal force. Trials lasted 4.5 s and both wrist force and electromyography data were assessed. In general, the elbow flexors were more active during wrist flexion, while the triceps were more active in wrist extension, but this pattern reversed in certain forearm postures and wrist exertion directions. Both forearm posture and wrist exertion direction resulted in unique effects on upper arm muscle activity. These findings suggest that muscle activity of the upper arm muscles is influenced independently by both posture and force direction, which should be carefully considered by both motor control specialists and ergonomists., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Crown Copyright © 2024. Published by Elsevier Ltd. All rights reserved.)

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 90 th 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.

Objective. The use of electromyogram (EMG) signals recorded from the wrist is emerging as a desirable input modality for human-machine interaction (HMI). Although forearm-based EMG has been used for decades in prosthetics, there has been comparatively little prior work evaluating the performance of wrist-based control, especially in online, user-in-the-loop studies. Furthermore, despite different motivating use cases for wrist-based control, research has mostly adopted legacy prosthesis control evaluation frameworks. Approach. Gaining inspiration from rhythm games and the Schmidt's law speed-accuracy tradeoff, this work proposes a new temporally constrained evaluation environment with a linearly increasing difficulty to compare the online usability of wrist and forearm EMG. Compared to the more commonly used Fitts' Law-style testing, the proposed environment may offer different insights for emerging use cases of EMG as it decouples the machine learning algorithm's performance from proportional control, is easily generalizable to different gesture sets, and enables the extraction of a wide set of usability metrics that describe a users ability to successfully accomplish a task at a certain time with different levels of induced stress. Main results. The results suggest that wrist EMG-based control is comparable to that of forearm EMG when using traditional prosthesis control gestures and can even be better when using fine finger gestures. Additionally, the results suggest that as the difficulty of the environment increased, the online metrics and their correlation to the offline metrics decreased, highlighting the importance of evaluating myoelectric control in real-time evaluations over a range of difficulties. Significance. This work provides valuable insights into the future design and evaluation of myoelectric control systems for emerging HMI applications., (Creative Commons Attribution license.)

A wrist joint in upper limb prostheses significantly increases its handling capacity. However, current prostheses cannot reproduce the ability of torque combined with the volume and weight of the human wrist. Consequently, they do not provide high efficiency in handling and generate user dissatisfaction. In this context, this study aims to optimal design a wrist supination and pronation brake to improve the handling capacity of an upper limb prosthesis. The wrist actuator consists of an EC motor and harmonic drive parallel with a magnetorheological brake. The brake guarantees a fast response time, low energy consumption, controllability, and small dimensions. A particle swarm algorithm is applied to optimize design variables to minimize mass and energy consumption. As a result, the brake provided resistive torque of 7.4 N.m with dimensions close to a healthy member and weighing 0.1972 kg. Finally, a finite element analysis confirmed a satisfactory magnetic flux for the magnetorheological brake operating conditions. The designed brake addressed all the desired characteristics and is suitable to integrate the forearm prosthesis with wrist rotation.

The purpose of this work was to investigate forearm muscle activity and wrist angular displacement during radial and ulnar wrist perturbations across various isometric hand grip demands. Surface electromyography (EMG) was recorded from eight muscles of the upper extremity. A robotic device delivered perturbations to the hand in the radial and ulnar directions across four pre-perturbation grip magnitudes. Angular displacement and time to peak displacement following perturbations were evaluated. Muscle activity was evaluated pre- and post-perturbation. Results showed an inverse relationship between grip force and angular displacement ( p ≤ 0.001). Time to peak displacement decreased as grip force increased ( p ≤ 0.001). There was an increase in muscle activity with higher grip forces across all muscles both pre-and post-perturbation ( p ≤ 0.001) and a greater average muscle activity in ulnar as compared to radial deviation ( p = 0.02). This work contributes to the wrist joint stiffness literature by relating wrist angular displacement to grip demands during novel radial/ulnar perturbations and provides insight into neuromuscular control strategies., Competing Interests: Michael W.R. Holmes is an Academic Editor for PeerJ., (© 2022 Mannella et al.)

Background: Electromyographic systems are widely used in scientific and clinical practice. The reproducibility and reliability of these measures are crucial when conducting scientific research and collecting experimental data., Objective: To test the reliability of surface electromyography signals from both the Flexor Digitorum Superficialis (FDS) and Extensor Carpi Radialis Brevis (ECRB) muscles of both the left and right arms during an individual, static multi-planar maximum voluntary contraction handgrip task using the Myon 320 system (Myon AG, Switzerland)., Methods: Eight right-handed male participants performed two maximal handgrip tests in five separate wrist positions using both hands. Muscle activity was recorded from both forearms. Reliability was measured using the Standard Error of Measurement (SEM), Coefficient of Variation (CV) and Intra-class correlation coefficients. Wrist joint position correlations within and between the FDS and ECRB muscle activities were also analysed., Results: Absolute reliability was shown across all positions for both hands with CV and SEM recorded at below 10%. The output measures indicate that the Myon 320 system (Myon AG, Switzerland) produces good to fair reliability when assessing forearm muscle activity. Correlations in the left FDS muscles were negative. Correlations between the left ECRB and left FDS muscles were variable but positive between the right ECRB and right FDS muscles., Conclusions: The data sets retrieved from all participants were reliably evaluated. Wrist position correlations within and between the FDS and ECRB muscles may have been influenced by hand dominance. The findings demonstrate that the methods and systems outlined in this study can be used reliably in future research.

Changes in joint angle can change the position and orientation of muscle fibers relative to the surface EMG electrode. Our previous study has shown that EMG patterns can identify hand/wrist movements with a greater degree of classification accuracy (CA) when muscle contractions involve a change in the joint angle. The results of this study suggest that changes in the position of the muscle relative to the recording electrode can influence the properties of the recorded EMG signals, however, this was not directly quantified. The present study aims to further investigate the effect of subcutaneous muscle displacement caused by the changes in joint angle on surface EMG signals. Nine able-bodied subjects were tested. The subjects were instructed to perform wrist flexion at five different joint angles (0, 20, 40, 60, and 80) with the same level of muscle contraction. EMG signals and ultrasound images were acquired from the flexor carpi radialis (FCR) simultaneously. Time and frequency domain analysis was adopted to extract features from the EMG signals. The subcutaneous muscle displacement of the FCR relative to the skin surface was measured from the ultrasound images. Spearmans rank correlation coefficient was employed to analyze the correlation between the subcutaneous muscle displacement and the EMG signals. The results showed the subcutaneous muscle displacement of the FCR measured by the ultrasound images was 1 cm when the wrist joint angle changed from 0 to 80. There was a positive relationship between the subcutaneous muscle displacement and the mean absolute value (MAV) ( r s = 0.896 ) and median frequency (MF) ( r s = 0.849 ) extracted from the EMG signals. The results demonstrated that subcutaneous muscle displacement associated with wrist angle change had a significant effect on FCR EMG signals. This property might have a positive effect on the CA of dynamic tasks.

This study examined the morphologic changes of the ulnar nerve in different elbow positions by ultrasonography and the effects of fatigue on forearm muscle control during overhand movements. We enrolled 12 tennis players who performed flat serves and 15 baseball pitchers who performed fastball pitching. The motion capture was conducted with 14 reflective markers attached on anatomic landmarks of the participant for tennis serve and baseball pitching data collection. The distance from the nerve to the medial condyle between the tennis players and baseball pitchers showed significant differences ( p  = 0.006) as the elbow flexed to 90°. The differences are due to the baseball player's repetitive pitching motion while such motion does not apply to tennis player. Activity of the extensor carpi radialis (ECR) during the cocking phase in the tennis serves showed significant differences ( p  = 0.022) between the nonfatigued and fatigued states; the maximal value was observed in the fatigued state. The significant increase in the ECR activity in the fatigued state might be responsible for grasp-and-release activities and maintaining the wrist joint stability when performing overhand movements. Forearm fatigue influenced their overhand motion ability in accurate ball control, although it did not decrease the ball speed.

We have previously proposed a model of motor lateralization that attributes specialization for predictive control of intersegmental coordination to the dominant hemisphere/limb system, and control of limb impedance to the non-dominant system. This hypothesis was developed based on visually targeted discrete reaching movement made predominantly with the shoulder and elbow joints. The purpose of this experiment was to determine whether dominant arm advantages for multi-degree of freedom coordination also occur during continuous distal movements of the wrist that do not involve visual guidance. In other words, are the advantages of the dominant arm restricted to controlling intersegmental coordination during discrete visually targeted reaching movements, or are they more generally related to coordination of multiple degrees of freedom at other joints, regardless of whether the movements are discrete or invoke visual guidance? Eight right-handed participants were instructed to perform alternating wrist ulnar/radial deviation movements at two instructed speeds, slow and fast, with the dominant or the non-dominant arm, and were instructed not to rotate the forearm (pronation/supination) or move the wrist up and down (flexion/extension). This was explained by slowly and passively moving the wrist in each plane during the instructions. Because all the muscles that cross the wrist have moment arms with respect to more than one axis of rotation, intermuscular coordination is required to prevent motion about non-instructed axes of rotation. We included two conditions, a very slow condition, as a control condition, to demonstrate understanding of the task, and an as-fast-as-possible condition to challenge predictive aspect of control, which we hypothesize are specialized to the dominant controller. Our results indicated that during as-fast-as-possible conditions the non-dominant arm incorporated significantly more non-instructed motion, which resulted in greater circumduction at the non-dominant than the dominant wrist. These findings extend the dynamic dominance hypothesis, indicating that the dominant hemisphere-arm system is specialized for predictive control of multiple degrees of freedom, even in movements of the distal arm and made in the absence of visual guidance.

Objective: Several forward dynamics estimation approaches have been proposed to estimate individual muscle force. However, characterization of the estimation error that arises when measurements are available only from a subset of the muscles involved in the movement under analysis, as is the case of the forearm muscles, has been limited. Our objectives were: first, to quantify the accuracy of forward-dynamics muscle force estimators for forearm muscles; and second, to develop a muscle force estimator that is accurate even when measurements are available only from a subset of muscles acting on a given joint or segment., Methods: We developed a neuromusculoskeletal (NMSK) estimator that integrates forward dynamics estimation with a neural model of muscle cocontraction to estimate individual muscle force during isometric contractions, suitable to operate when measurements are not available for all muscles. We developed a computational framework to assess the effect of physiological variability in muscle cocontraction, cross-talk, and measurement error on the estimator accuracy using a sensitivity analysis. We thus compared the performance of our estimator with that of a standard estimator that neglects the contribution of unmeasured muscles., Results: The NMSK estimator reduces the estimation error by 25% in average noise conditions. Moreover, the NMSK estimator is robust against physiological variability in muscle cocontraction and outperforms the standard estimator even when the validity of the neural model is compromised., Conclusion and Significance: In isometric tasks, the NMSK estimator reduces muscle force estimation error compared to a standard estimator, and may enable future applications involving estimation of forearm muscle force during coordinated movements.

Objective: The aim of this study was to evaluate the ergonomic benefits of an angle grinder with a rotatable main handle in a cutting task., Background: Angle grinder manufacturers rarely address ergonomic features in their advertisements, and if they do, the benefits are expressed in a qualitative manner. Meanwhile, quantitative information about the effects of the device on the worker is required to make informed decisions during tool selection and cumulative trauma prevention., Method: Eleven maintenance workers and metalworkers used an angle grinder to cut a horizontal steel rod using three wrist postures. Only one of the postures was exclusively available in the case of a rotatable main handle. The postural effect was evaluated objectively with electromyography and a force-sensing-resistor-based force glove. Subjective ratings about discomfort and control were obtained with a visual analog scale., Results: The subjective ratings favor the near-neutral wrist posture. The forearm muscles' electromyographic activities were similar across the postures. Forces on the hand-handle interface were concentrated on the intermediate phalanges. If the device is operated without gloves, the forces on the intermediate phalanges may exceed the discomfort pressure threshold regardless of wrist posture., Conclusion: In the cutting task, the subjective measures favor the posture with a near-neutral wrist, which is a feature of the rotatable main handle. The objective measures did not allow one to prefer one posture to another., Application: The findings give insight into the impact of wrist posture on muscle activity, forces on the hand-handle interface, and discomfort. This is useful information for the person responsible for tool selection.

Purpose : The purpose of this study was to test the concurrent validity of using hydraulic dynamometers in comparison to the gold standard isokinetic dynamometers in measuring wrist and forearm strength. Materials and methods : Healthy adults between the ages of 18-65 participated, including 24 participants, 8 men and 16 women. The examiner used a handheld dynamometer, forearm/wrist dynamometer, and an isokinetic dynamometer to measure force/torque production in forearm rotation and wrist flexion/extension using a standardized protocol of two handle types for each motion. Sequence of testing was randomized. The data were analyzed using Pearson correlation coefficients and paired t -tests. Results : When matched for handle type, three of the four correlations between the strength measurements taken with the different dynamometers were moderate to high with Pearson product moment coefficients ranging from 0.72 to 0.96; the screwdriver handle demonstrated less than acceptable correlation ( r  = 0.45, 0.67 for wrist flexion and extension, respectively). There were significant differences in most of the force/torque values obtained by different handle types for wrist and forearm motions. Discussion and conclusions : Overall, the dynamometers demonstrated acceptable correlations supporting concurrent validity for measuring forearm and wrist strength, except with the screwdriver handle. However, different tools, positions, and handle interfaces provided different absolute values, therefore the tools cannot be used interchangeably. It is recommended that repeated measurements to monitor patient progress are taken with the same tool and handle type.

The purpose of this study was to examine forearm muscle activity during simultaneous execution of dual motor tasks; hand-gripping and wrist forces. Surface electromyography was recorded from eight muscles of the upper-limb: flexor carpi radialis, flexor carpi ulnaris, flexor digitorum superficialis, extensor carpi radialis, extensor carpi ulnaris, extensor digitorum, biceps brachii and triceps brachii. Participants were seated with their forearm supported in a neutral position with an adjustable force transducer placed on either the palmar or dorsal side of the hand (for palmar/dorsal forces). Participants performed trials of simultaneous handgrip and wrist forces of various magnitudes, ranging in intensity from 0 to 40% of their maximal voluntary contraction. Trials lasted 5 s and force and electromyography data were assessed. The wrist flexors provided greatest contributions to tasks dominated by palmar forces but exhibited very low muscle activity in dorsal dominant tasks. Wrist extensors were active at moderate-to-high levels across nearly all conditions and demonstrated greater activity than the wrist flexors during handgrip-dominant tasks. These findings suggest that the wrist extensors provide the greatest contribution to wrist stiffness in complex motor tasks, and highlight the importance of investigating forearm muscle recruitment strategies under dual task parameters., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

The musculoskeletal system can move in more ways than are strictly necessary, allowing many tasks to be accomplished with a variety of limb configurations. Why some configurations are preferred has been a focus of motor control research, but most studies have focused on shoulder-elbow or whole arm movements. This study focuses on movements involving forearm pronation-supination (PS), wrist flexion-extension (FE), and wrist radial-ulnar deviation (RUD) and elucidates how these three degrees of freedom (DOF) combine to perform the common task of pointing, which only requires two DOF. Although pointing is more sensitive to FE and RUD than to PS and could be easily accomplished with FE and RUD alone, subjects tend to involve a small amount of PS. However, why we choose this behavior has been unknown and is the focus of this paper. With the use of a second-order model with lumped parameters, we tested a number of plausible control strategies involving minimization of work, potential energy, torque, and path length. None of these control schemes robustly predicted the observed behavior. However, an alternative control scheme, hypothesized to control the DOF that were most important to the task (FE and RUD) and ignore the less important DOF (PS), matched the observed behavior well. In particular, the behavior observed in PS appears to be a mechanical side effect caused by unopposed interaction torques. We conclude that moderately sized pointing movements involving the wrist and forearm are controlled by ignoring forearm rotation even though this strategy does not robustly minimize work, potential energy, torque, or path length. NEW & NOTEWORTHY Many activities require us to point our hands in a given direction using wrist and forearm rotations. Although there are infinitely many ways to do this, we tend to follow a stereotyped pattern. Why we choose this pattern has been unknown and is the focus of this paper. After testing a variety of hypotheses, we conclude that the pattern results from a simplifying strategy in which we focus on wrist rotations and ignore forearm rotation.

In the leg, amplitudes of cutaneous reflexes and reciprocal inhibition are significantly affected by joint and limb position. Comparatively little is known about such modulation in the arm. In this study, amplitudes of reciprocal inhibition (from median nerve stimulation near elbow) and cutaneous reflexes (from median or superficial radial nerve stimulation at the wrist) were measured in forearm muscle extensor carpi radialis with the hand pronated or neutral during graded voluntary activation. Significant correlations with muscle activation were found for reciprocal inhibition and cutaneous reflex amplitudes at both positions. Only cutaneous reflexes from superficial radial nerve were modulated by wrist position. This study reveals that effect of limb position is nerve-specific in cutaneous reflexes and not significant on reciprocal inhibition in the arm. This has implications for measurement and study design in those who have mobility and motor activation challenges (e.g. neurotrauma) that affect hand function., (Copyright © 2018. Published by Elsevier B.V.)

Background: A variety of treatment options suggest that the optimal treatment strategy for lateral elbow tendinopathy (LET) is not known, and further research is needed to discover the most effective treatment for LET. The purpose of the present study was to verify the most effective position of eccentric stretching for the extensor carpi radialis brevis (ECRB) in vivo using ultrasonic shear wave elastography., Methods: A total of 20 healthy males participated in this study. Resting position was defined as 90° elbow flexion and neutral position of the forearm and wrist. Elongation of the ECRB was measured for four stretching maneuvers (forearm supination/pronation and wrist extension/flexion) at two elbow angles (90° flexion and full extension). The shear elastic modulus, used as the index of muscle elongation, was computed using ultrasonic shear wave elastography for the eight aforementioned stretching maneuverangle combinations., Results: The shear elastic modulus was the highest in elbow extension, forearm pronation, and wrist flexion. The shear elastic moduli of wrist flexion with any forearm and elbow position were significantly higher than the resting position. There was no significant difference associated with elbow and forearm positions except for elbow extension, forearm pronation, and wrist flexion positions., Conclusions: This study determined that elbow extension, forearm pronation, and wrist flexion was the most effective eccentric stretching for the ECRB in vivo ., Competing Interests: CONFLICT OF INTEREST: No potential conflict of interest relevant to this article was reported.

We prove the feasibility of decomposing high density surface EMG signals from forearm muscles in non-isometric wrist motor tasks of normally limbed and limb-deficient individuals with the perspective of using the decoded neural information for prosthesis control. For this purpose, we recorded surface EMG signals during motions of three degrees of freedom of the wrist in seven normally limbed subjects and two patients with limb deficiency. The signals were decomposed into individual motor unit activity with a convolutive blind source separation algorithm. On average, for each subject, 16 ± 7 motor units were identified per motor task. The discharge timings of these motor units were estimated with an accuracy > 85%. Moreover, the activity of 6 ± 5 motor units per motor task was consistently detected in all repetitions of the same task. The joint angle at which motor units were first identified was 62.5 ± 26.4% of the range of motion, indicating a prevalence in the identification of high threshold motor units. These findings prove the feasibility of accurate identification of the neural drive to muscles in contractions relevant for myoelectric control, allowing the development of a new generation of myocontrol methods based on motor unit spike trains.

Objectives: Alternative techniques to assess physical exposures, such as prediction models, could facilitate more efficient epidemiological assessments in future large cohort studies examining physical exposures in relation to work-related musculoskeletal symptoms. The aim of this study was to evaluate two types of models that predict arm-wrist-hand physical exposures (i.e. muscle activity, wrist postures and kinematics, and keyboard and mouse forces) during computer use, which only differed with respect to the candidate predicting variables; (i) a full set of predicting variables, including self-reported factors, software-recorded computer usage patterns, and worksite measurements of anthropometrics and workstation set-up (full models); and (ii) a practical set of predicting variables, only including the self-reported factors and software-recorded computer usage patterns, that are relatively easy to assess (practical models)., Methods: Prediction models were build using data from a field study among 117 office workers who were symptom-free at the time of measurement. Arm-wrist-hand physical exposures were measured for approximately two hours while workers performed their own computer work. Each worker's anthropometry and workstation set-up were measured by an experimenter, computer usage patterns were recorded using software and self-reported factors (including individual factors, job characteristics, computer work behaviours, psychosocial factors, workstation set-up characteristics, and leisure-time activities) were collected by an online questionnaire. We determined the predictive quality of the models in terms of R2 and root mean squared (RMS) values and exposure classification agreement to low-, medium-, and high-exposure categories (in the practical model only)., Results: The full models had R2 values that ranged from 0.16 to 0.80, whereas for the practical models values ranged from 0.05 to 0.43. Interquartile ranges were not that different for the two models, indicating that only for some physical exposures the full models performed better. Relative RMS errors ranged between 5% and 19% for the full models, and between 10% and 19% for the practical model. When the predicted physical exposures were classified into low, medium, and high, classification agreement ranged from 26% to 71%., Conclusion: The full prediction models, based on self-reported factors, software-recorded computer usage patterns, and additional measurements of anthropometrics and workstation set-up, show a better predictive quality as compared to the practical models based on self-reported factors and recorded computer usage patterns only. However, predictive quality varied largely across different arm-wrist-hand exposure parameters. Future exploration of the relation between predicted physical exposure and symptoms is therefore only recommended for physical exposures that can be reasonably well predicted., (© The Author 2017. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.)

There is no generally accepted method for measuring manual position control. We developed a method for doing so. We asked university students to hold a handle that had one rotational degree of freedom. The angular position of the handle depended on the degree of pronation-supination of the forearm. The subjects' task was to hold the handle as steadily as possible to keep a needle positioned in a pie-shaped target zone on a computer screen. If the needle remained in the zone for 0.5s, the gain of the feedback loop increased; otherwise the gain decreased or remained at the starting value of 1. Through this adaptive procedure, we estimated the maximum gain that could be achieved at each of the four pronation-supination angles we tested (thumb up, thumb down, thumb in, and thumb out) for each hand. Consistent with previous research on manual control, and so validating our measure, we found that our participants, all of whom were right-handed, were better able to maintain the needle in the target zone when they used the right hand than when they used the left hand and when they used midrange wrist postures (thumb up or in) rather than extreme wrist postures (thumb down or out). The method provides a valid test of manual position control and holds promise for addressing basic-research and practical questions., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Wrist rotations about one wrist axis (e.g. flexion/extension) can affect the strength about another wrist axis (e.g. radial/ulnar deviation). This study used a musculoskeletal model of the distal upper extremity, and an optimization approach, to quantify the interaction effects of wrist flexion/extension (FE), radial/ulnar deviation (RUD) and forearm pronation/supination (PS) on wrist strength. Regression equations were developed to predict the relative changes in strength from the neutral posture, so that the changes in strength, due to complex and interacting wrist and forearm rotation postures, can be incorporated within future ergonomics assessments of wrist strength.

This paper investigates how tennis players control stroke-induced vibration. Its aim is to characterise how a tennis player deals with entering vibration waves or how he/she has the ability to finely adjust them. A specific experimental procedure was designed, based on simultaneously collecting sets of kinematic, vibration and electromyographic data during forehand strokes using various commercial rackets and stroke intensities. Using 14 expert players, a wide range of excitations at spectral and temporal levels were investigated. Energetic and spectral descriptors of stroke-induced vibration occurring at the racket handle and at the player's wrist and elbow were computed. Results indicated that vibrational characteristics are strongly governed by grip force and to a lower extent by the racket properties. Grip force management drives the amount of energy, as well as its distribution, into the forearm. Furthermore, hand-grip can be assimilated to an adaptive filter which can significantly modify the spectral parameters propagating into the player's upper limb. A significant outcome is that these spectral characteristics are as much dependent on the player as on the racket. This contribution opens up new perspectives in equipment manufacture by underlining the need to account for player/racket interaction in the design process.

Recreational tennis players tend to have higher incidence of tennis elbow, and this has been hypothesised to be related to one-handed backhand technique and off-centre ball impacts on the racket face. This study aimed to investigate for a range of participants the effect of off-longitudinal axis and off-lateral axis ball-racket impact locations on racket and forearm joint angle changes immediately following impact in one-handed tennis backhand groundstrokes. Three-dimensional racket and wrist angular kinematic data were recorded for 14 university tennis players each performing 30 "flat" one-handed backhand groundstrokes. Off-longitudinal axis ball-racket impact locations explained over 70% of the variation in racket rotation about the longitudinal axis and wrist flexion/extension angles during the 30 ms immediately following impact. Off-lateral axis ball-racket impact locations had a less clear cut influence on racket and forearm rotations. Specifically off-longitudinal impacts below the longitudinal axis forced the wrist into flexion for all participants with there being between 11° and 32° of forced wrist flexion for an off-longitudinal axis impact that was 1 ball diameter away from the midline. This study has confirmed that off-longitudinal impacts below the longitudinal axis contribute to forced wrist flexion and eccentric stretch of the wrist extensors and there can be large differences in the amount of forced wrist flexion from individual to individual and between strokes with different impact locations.

Reduction of the number of sensors needed to evaluate arm movements, makes a system for the assessment of human body movements more suitable for clinical practice and daily life assessments. In this study, we propose an algorithm to reconstruct lower arm orientation, velocity and position, based on a sensing system which consists of only one inertial measurement unit (IMU) to the forearm. Lower arm movements were reconstructed using a single IMU and assuming that within a measurement there are moments without arm movements. The proposed algorithm, together with a single IMU attached to the forearm, may be used to evaluate lower arm movements during clinical assessments or functional tasks. In this pilot study, reconstructed quantities were compared with an optical reference system. The limits of agreement in the magnitude of the orientation vector and the norm of the velocity vectors are respectively 4.2 deg (normalized, 5.2 percent) and 7.1 cm/s (normalized, 5.8 percent). The limit of agreement of the difference between the reconstructed positions of both sensing systems were relatively greater 7.7 cm (normalized, 16.8 percent).

It is important to estimate the 3 degree-of-freedom (DOF) impedance of human forearm and wrist (i.e., forearm prono-supination, and wrist flexion-extension and radial-ulnar deviation) in motor control and in the diagnosis of altered mechanical resistance following stroke. There is, however, a lack of methods to characterize 3 DOF impedance. Thus, we developed a reliable and accurate impedance estimation method, the distal internal model based impedance control (dIMBIC)-based method, to characterize the 3 DOF impedance, including cross-coupled terms between DOFs, for the first time. Its accuracy and reliability were experimentally validated using a robot with substantial nonlinear joint friction. The 3 DOF human forearm and wrist impedance of eight healthy subjects was reliably characterized, and its linear behavior was verified. Thus, the dIMBIC-based method can provide us with 3 DOF forearm and wrist impedance regardless of nonlinear robot joint friction. It is expected that, with the proposed method, the 3 DOF impedance estimation can promote motor control studies and complement the diagnosis of altered wrist and forearm resistance post-stroke by providing objective impedance estimates, including cross-coupled terms.

The Leap Motion Controller (LMC) is a low-cost, markerless motion capture device that tracks hand, wrist and forearm position. Integration of this technology into healthcare applications has begun to occur rapidly, making validation of the LMC׳s data output an important research goal. Here, we perform a detailed evaluation of the kinematic data output from the LMC, and validate this output against gold-standard, markered motion capture technology. We instructed subjects to perform three clinically-relevant wrist (flexion/extension, radial/ulnar deviation) and forearm (pronation/supination) movements. The movements were simultaneously tracked using both the LMC and a marker-based motion capture system from Motion Analysis Corporation (MAC). Adjusting for known inconsistencies in the LMC sampling frequency, we compared simultaneously acquired LMC and MAC data by performing Pearson׳s correlation (r) and root mean square error (RMSE). Wrist flexion/extension and radial/ulnar deviation showed good overall agreement (r=0.95; RMSE=11.6°, and r=0.92; RMSE=12.4°, respectively) with the MAC system. However, when tracking forearm pronation/supination, there were serious inconsistencies in reported joint angles (r=0.79; RMSE=38.4°). Hand posture significantly influenced the quality of wrist deviation (P<0.005) and forearm supination/pronation (P<0.001), but not wrist flexion/extension (P=0.29). We conclude that the LMC is capable of providing data that are clinically meaningful for wrist flexion/extension, and perhaps wrist deviation. It cannot yet return clinically meaningful data for measuring forearm pronation/supination. Future studies should continue to validate the LMC as updated versions of their software are developed., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Most wrist strength studies evaluate strength about one axis, and postural deviations about that same axis. The purpose of this study was to determine if wrist posture deviations about one axis (e.g. flexion/extension), or two axes (e.g. flexion/extension and pronation/supination), affect the strength about another axis (e.g. ulnar deviation). A custom-built instrumented handle was used to measure maximum static isometric torque exertions at 18 wrist postures (combinations of flexion/extension, radial/ulnar deviation, and pronation/supination). Ulnar deviation torques were highest when the wrist was in neutral. This pattern was not maintained for the other torque directions; the generated torque tended to be highest when the wrist posture was not neutral. The effects were similar for male and female subjects, although male subjects exerted significantly larger torques in all directions. This study illustrates that there is a complex relationship between wrist posture and maximal wrist torques., (Copyright © 2015 Elsevier Ltd and The Ergonomics Society. All rights reserved.)

Objectives: Kinesio tape (KT) is a commonly used intervention in sports. It claims to be able to alter the muscle activity, in terms of both facilitation and inhibition, by certain application methods. This study compared the neuromuscular activity of the wrist extensor muscles and maximal grip strength with facilitatory, inhibitory KT, and tapeless condition in healthy adults who were ignorant about KT. Potential placebo effects were eliminated by deception., Design: Randomized deceptive trial., Methods: 33 participants performed maximal grip assessment in a randomly assigned order of three taping conditions: true facilitatory KT, inhibitory KT, and no tape. The participants were blindfolded during the evaluation. Under the pretense of applying a series of adhesive muscle sensors, KT was applied to their wrist extensor muscles of the dominant forearm in the first two conditions. Within-subject comparisons of normalized root mean square of the wrist extensors electromyographic activity and maximal grip strength were conducted across three taping conditions., Results: 31 out of 33 enlisted participants were confirmed to be ignorant about KT. No significant differences were found in the maximum grip strength (p=0.394), electromyographic activity (p=0.276), and self-perceived performance (p=0.825) between facilitatory KT, inhibitory KT, and tapeless conditions., Conclusions: Neither facilitatory nor inhibitory effects were observed between different application techniques of KT in healthy participants. Clinically, alternative method should be used for muscle activity modulation., (Copyright © 2015 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Context: Lateral epicondylalgia, pain at the lateral elbow, is commonly associated with extensor carpi radialis brevis tendinopathy. The radial head, which abuts the extensor tendons and is elliptical in shape, may affect the extensor tendons during pronation of the forearm. Cadaverous studies have shown that the radial head may act as a cam in pronation, to offer a mechanical advantage to the common extensor tendon and to mitigate load on the origin of the extensor carpi radialis brevis tendon., Objective: To determine the effect of radial-head position on the wrist-extensor tendons in vivo., Design: Repeated-measures design., Setting: Laboratory., Participants: 22 participants (12 male, 2 left-handed)., Main Outcome Measures: Distance (mm) from subcutaneous fascia to radial head measured by ultrasound., Results: The radial head in supination was significantly deeper than either pronation or midprone, indicating a smaller cam effect in supination., Conclusion: The authors recommend that the effect of radial-head position and its relationship to the area of tendon pathology be considered clinically in the rehabilitation of patients suffering from lateral epicondylalgia.

The purpose of this study was to investigate how gripping modulates forearm muscle co-contraction prior to and during sudden wrist perturbations. Ten males performed a sub-maximal gripping task (no grip, 5% and 10% of maximum) while a perturbation forced wrist flexion or extension. Wrist joint angles and activity from 11 muscles were used to determine forearm co-contraction and muscle contributions to wrist joint stiffness. Co-contraction increased in all pairs as grip force increased (from no grip to 10% grip), corresponding to a 36% increase in overall wrist joint stiffness. Inclusion of individual muscle contributions to wrist joint stiffness enhanced the understanding of forearm co-contraction. The extensor carpi radialis longus (ECRL) and brevis had the largest stiffness contributions (34.5 ± 1.3% and 20.5 ± 2.3%, respectively), yet muscle pairs including ECRL produced the lowest co-contraction. The muscles contributing most to wrist stiffness were consistent across conditions (ECRL for extensors; Flexor Digitorum Superficialis for flexors), suggesting enhanced contributions rather than muscular redistribution. This work provides investigation of the neuromuscular response to wrist perturbations and gripping demands by considering both co-contraction and muscle contributions to joint stiffness. Individual muscle stiffness contributions can be used to enhance the understanding of forearm muscle control during complex tasks.

The study of hand and finger movement is an important topic with applications in prosthetics, rehabilitation, and ergonomics. Surface electromyography (sEMG) is the gold standard for the analysis of muscle activation. Previous studies investigated the optimal electrode number and positioning on the forearm to obtain information representative of muscle activation and robust to movements. However, the sEMG spatial distribution on the forearm during hand and finger movements and its changes due to different hand positions has never been quantified. The aim of this work is to quantify 1) the spatial localization of surface EMG activity of distinct forearm muscles during dynamic free movements of wrist and single fingers and 2) the effect of hand position on sEMG activity distribution. The subjects performed cyclic dynamic tasks involving the wrist and the fingers. The wrist tasks and the hand opening/closing task were performed with the hand in prone and neutral positions. A sensorized glove was used for kinematics recording. sEMG signals were acquired from the forearm muscles using a grid of 112 electrodes integrated into a stretchable textile sleeve. The areas of sEMG activity have been identified by a segmentation technique after a data dimensionality reduction step based on Non Negative Matrix Factorization applied to the EMG envelopes. The results show that 1) it is possible to identify distinct areas of sEMG activity on the forearm for different fingers; 2) hand position influences sEMG activity level and spatial distribution. This work gives new quantitative information about sEMG activity distribution on the forearm in healthy subjects and provides a basis for future works on the identification of optimal electrode configuration for sEMG based control of prostheses, exoskeletons, or orthoses. An example of use of this information for the optimization of the detection system for the estimation of joint kinematics from sEMG is reported.

Objective: Previous studies have investigated how tDCS over the primary motor cortex modulates excitability in the intrinsic hand muscles. Here, we tested if tDCS changes corticomotor excitability and/or cortical inhibition when measured in the extensor carpi radialis (ECR) and if these aftereffects can be successfully assessed during controlled muscle contraction., Methods: We implemented a double blind cross-over design in which participants (n = 16) completed two sessions where the aftereffects of 20 min of 1 mA (0.04 mA/cm2) anodal vs sham tDCS were tested in a resting muscle, and two more sessions where the aftereffects of anodal vs sham tDCS were tested in an active muscle., Results: Anodal tDCS increased corticomotor excitability in ECR when aftereffects were measured with a low-level controlled muscle contraction. Furthermore, anodal tDCS decreased short interval intracortical inhibition but only when measured at rest and after non-responders (n = 2) were removed. We found no changes in the cortical silent period., Conclusion: These findings suggest that targeting more proximal muscles in the upper limb with anodal tDCS is achievable and corticomotor excitability can be assessed in the presence of a low-level controlled contraction of the target muscle.

In this paper, we present design, implementation and specifications of the Wrist Gimbal, a three degree-of-freedom (DOF) exoskeleton developed for forearm and wrist rehabilitation. Wrist Gimbal has three active DOF, corresponding to pronation/supination, flexion/extension and adduction/abduction joints. We mainly focused on a robust, safe and practical device design to facilitate clinical implementation, testing and acceptance. Robustness and mechanical rigidity was achieved by implementing two bearing supports for each of the pronation/supination and adduction/abduction axes. Rubber hard stops for each axis, an emergency stop button and software measures ensured safe operation. An arm rest with padding and straps, a handle with adjustable distal distance and height and a large inner volume contribute to ease of use, of patient attachment and to comfort. We present the specifications of Wrist Gimbal in comparison with similar devices in the literature and example data collected from a healthy subject.

Rehabilitation of the distal joints of the upper extremities is crucial to restore the ability to perform activities of daily living to patients with neurological lesions resulting from stroke or spinal cord injury. Robotic rehabilitation has been identified as a promising new solution, however, much of the existing technology in this field is focused on the more proximal joints of the upper arm. A recently presented device, the RiceWrist-S, focuses on the rehabilitation of the forearm and wrist, and has undergone a few important design changes. This paper first addresses the design improvements achieved in the recent design iteration, and then presents the system characterization of the new device. We show that the RiceWrist-S has capabilities beyond other existing devices, and exhibits favorable system characteristics as a rehabilitation device, in particular torque output, range of motion, closed loop position performance, and high spatial resolution.

Purpose: Early motion therapy protocols are desirable to reduce wrist stiffness after carpal injuries and distal radius fractures. Based on our assumption that a reduction in wrist tendon forces will be associated with a reduction in radioulnar carpal joint reaction force, the goal of this study was to determine the forearm position at which the wrist tendon forces required to initiate wrist motion were the least., Methods: We tested 8 fresh-frozen cadaver forearms in a wrist and forearm motion simulator. In each specimen, we generated a wrist flexion-extension motion and a radioulnar deviation motion by pulling on the wrist flexor and extensor tendons with the forearm in supination, pronation, or neutral. We also performed a wrist flexion-extension motion during active forearm rotation. During each motion, we continuously recorded the forces in the 5 wrist tendons. We used repeated-measure analyses of variance to compare tendon forces., Results: During the wrist flexion-extension motion, the summed peak wrist extensor forces were significantly less with the wrist in forearm supination than with the forearm in neutral or during active forearm rotation. For the summed peak wrist flexor forces, flexor tendon forces were significantly less with the forearm in supination compared with active forearm rotation. The extensor carpi radialis longus and flexor carpi ulnaris forces were significantly less in supination than during active forearm motion. During wrist radioulnar deviation motion, peak extensor carpi ulnaris force was significantly less with the forearm in supination than in neutral, and peak flexor carpi radialis force was significantly less with the forearm in supination than in pronation., Conclusions: Peak wrist tendon forces were least in the static forearm supinated position., Clinical Relevance: To reduce deforming forces on a fresh carpal injury or distal radial fracture, active rehabilitation appears to be best initiated with the forearm held in supination., (Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

The primate wrist is an ideal model system for studying the reference frames in which movements are coded within the central nervous system, as a simple rotation of the forearm allows dissociation between extrinsic and body-referenced coordinates. Important information regarding coordinate frame transformations has been obtained using this system, particularly from studies involving extracellular cortical and spinal recordings from monkeys. Because preferred directions of muscle use were reported to rotate by less than half of the joint rotation, the system was considered to dissociate three reference frames: extrinsic (direction of movement in space), muscle (activity of muscles), and joint (angle of the wrist joint). However, given the relatively minor changes in reported muscle biomechanics with human forearm rotation, the reported distinction between joint space and muscle space is surprisingly large. Here, we reassessed patterns of wrist muscle activity with changes in forearm posture in humans, during an isometric force-aiming task with a device that enabled stringent control of the musculoskeletal configuration. Results show that the preferred directions for wrist muscle activation closely follow forearm orientation (i.e., by 88%). Control experiments confirmed this, whether the hand was clamped passively by a device or grasped a handle. Furthermore, the remaining 12% discrepancy between intended changes in wrist orientation and muscle use also occurred for muscle-pulling directions obtained by intramuscular electrical stimulation. The findings prompt reconsideration of data based on the previously reported dissociation between joint space and muscle space and have critical implications for future investigations of sensorimotor transformations and their adaptation using the wrist.

Because wrist rotation dynamics are dominated by stiffness (Charles SK, Hogan N. J Biomech 44: 614-621, 2011), understanding how humans plan and execute coordinated wrist rotations requires knowledge of the stiffness characteristics of the wrist joint. In the past, the passive stiffness of the wrist joint has been measured in 1 degree of freedom (DOF). Although these 1-DOF measurements inform us of the dynamics the neuromuscular system must overcome to rotate the wrist in pure flexion-extension (FE) or pure radial-ulnar deviation (RUD), the wrist rarely rotates in pure FE or RUD. Instead, understanding natural wrist rotations requires knowledge of wrist stiffness in combinations of FE and RUD. The purpose of this report is to present measurements of passive wrist stiffness throughout the space spanned by FE and RUD. Using a rehabilitation robot designed for the wrist and forearm, we measured the passive stiffness of the wrist joint in 10 subjects in FE, RUD, and combinations. For comparison, we measured the passive stiffness of the forearm (in pronation-supination), as well. Our measurements in pure FE and RUD agreed well with previous 1-DOF measurements. We have linearized the 2-DOF stiffness measurements and present them in the form of stiffness ellipses and as stiffness matrices useful for modeling wrist rotation dynamics. We found that passive wrist stiffness was anisotropic, with greater stiffness in RUD than in FE. We also found that passive wrist stiffness did not align with the anatomical axes of the wrist; the major and minor axes of the stiffness ellipse were rotated with respect to the FE and RUD axes by ∼20°. The direction of least stiffness was between ulnar flexion and radial extension, a direction used in many natural movements (known as the "dart-thrower's motion"), suggesting that the nervous system may take advantage of the direction of least stiffness for common wrist rotations.

Human motor cortex is capable of rapid and long-lasting reorganization, evident globally, as shifts in body part representations, and at the level of individual muscles as changes in corticospinal excitability. Representational shifts provide an overview of how various body parts reorganize relative to each other but do not tell us whether all muscles in a given body part reorganize in the same manner and to the same extent. Transcranial magnetic stimulation (TMS) provides information about individual muscles and can therefore inform us about the uniformity of plastic changes within a body part. We used TMS to investigate changes in corticospinal excitability of forearm flexors and extensors after inflation of a tourniquet around the wrist. Motor evoked potential (MEP) amplitudes and input/output (I/O) curves were obtained from wrist flexors and extensors simultaneously before and during block. TMS was delivered to the optimal site for eliciting MEPs in flexors in experiment 1, extensors in experiment 2, and both flexors and extensors in experiment 3. In all experiments flexor MEP amplitude increased during block while extensor MEP amplitude showed no systematic change, and the slope of flexor but not extensor I/O curves increased. Flexor H-reflex amplitude normalized to maximal M wave showed negligible changes during block, suggesting that the increase in corticospinal excitability in the flexors cannot be completely explained by increased excitability at the spinal cord level. These findings show that forearm flexors and extensors differ in their potential for plastic changes, highlight the importance of investigating how experimentally induced plasticity affects anatomically close, but functionally distinct, muscle groups, and suggest that rehabilitation interventions aiming to alter cortical organization should consider the differential sensitivity of various muscle groups to plasticity processes.

We report a case of bilateral reversed palmaris longus muscle (PLM). The muscle was tendinous in its upper portion and muscular in its lower portion in both arms. This rare variation has been mentioned only once in the literature as a surgical finding. According to the literature, a reversed PLM may cause a compartment syndrome in the wrist area, carpal tunnel, and Guyon's syndrome. The described variation is also useful to the hand surgeon as a tendon graft, a tendon for transfer, or as an anatomical landmark for operations at this area.

We investigated the interactive effects of shoulder pain and wrist extensor muscle soreness on surface electromyography (EMG) during computer mouse work. On day one, subjects (N = 12) performed computer work with/without acute muscle pain induced in the trapezius muscle. Subsequently, eccentric exercise was performed to induce delayed onset muscle soreness (DOMS) in wrist extensor muscles. In presence of DOMS on day two, computer work recordings with/without pain were repeated. EMG signals were recorded from the descending part of trapezius bilaterally, flexor carpi ulnaris and extensor carpi radialis brevis. Experimental muscle pain in trapezius led to a decrease in the muscular activity of the wrist extensor (P < 0.02) and decreased the relative rest time in the wrist flexor even in presence of DOMS (P < 0.01). The present result suggests that shoulder pain plays a role in the coordination of wrist flexors and extensors during computer work., (Copyright © 2010 Elsevier Ltd and The Ergonomics Society. All rights reserved.)

This paper presents design, implementation and control of a 3RPS-R exoskeleton, specifically built to impose targeted therapeutic exercises to forearm and wrist. Design of the exoskeleton features enhanced ergonomy, enlarged workspace and optimized device performance when compared to previous versions of the device. Passive velocity field control (PVFC) is implemented at the task space of the manipulator to provide assistance to the patients, such that the exoskeleton follows a desired velocity field asymptotically while maintaining passivity with respect to external applied torque inputs. PVFC is augmented with virtual tunnels and resulting control architecture is integrated into a virtual flight simulator with force-feedback. Experimental results are presented indicating the applicability and effectiveness of using PVFC on 3RPS-R exoskeleton to deliver therapeutic movement exercises., (© 2011 IEEE)

The effectiveness of a robotic training device was evaluated in a 24-year-old male, cervical level four, ASIA Impairment Scale D injury. Robotic training of both upper extremities was provided for three hr/day for ten consecutive sessions using the RiceWrist, an electrically-actuated forearm and wrist haptic exoskeleton device that has been designed for rehabilitation applications. Training involved wrist flexion/extension, radial/ulnar deviation and forearm supination/pronation. Therapy sessions were tailored, based on the patient's movement capabilities for the wrist and forearm, progressed gradually by increasing number of repetitions and resistance. Outcome measures included the ASIA upper-extremity motor score, grip and pinch strength, the Jebsen-Taylor Hand Function test and the Functional Independence Measure. After the training, improvements were observed in pinch strength, and functional tasks. The data from one subject provides valuable information on the feasibility and effectiveness of robotic-assisted training of forearm and hand functions after incomplete spinal cord injury., (© 2011 IEEE)

The purpose of this study was to examine force steadiness in three positions of the forearm in young men and women across a variety of force levels. Eight young men and eight young women performed three maximum voluntary contractions (MVCs) in the neutral, supinated, and pronated forearm positions. Viewing a target line on a computer screen, subjects performed submaximal isometric contractions relative to their own MVC at 2.5, 5, 10, 25, 50, and 75% in each of the three forearm positions. Force steadiness was determined as the coefficient of variation (standard deviation around the mean force). A repeated-measures three-way ANOVA was used to assess the differences in force steadiness between sex, position, and force level. Men were stronger than women in all three forearm positions. Overall, men were steadier than women across all force levels and forearm positions. The neutral and supinated positions were equally strong and steady, and the pronated position was the weakest and least steady position. The forearm was most steady between 25 and 75% MVC, and least steady at the lower force levels. When correlations were run between MVC and coefficient of variation at all force levels and all forearm positions, a strong negative relationship was found (r = -0.49). In conclusion, men were stronger, as well as steadier, than women. The neutral and supinated forearm positions were both stronger and steadier than the pronated position. Results suggest that one of the primary factors influencing sex differences in force steadiness is absolute strength.

Background: Identifying finger and wrist flexion based actions using a single channel surface electromyogram (sEMG) can lead to a number of applications such as sEMG based controllers for near elbow amputees, human computer interface (HCI) devices for elderly and for defence personnel. These are currently infeasible because classification of sEMG is unreliable when the level of muscle contraction is low and there are multiple active muscles. The presence of noise and cross-talk from closely located and simultaneously active muscles is exaggerated when muscles are weakly active such as during sustained wrist and finger flexion. This paper reports the use of fractal properties of sEMG to reliably identify individual wrist and finger flexion, overcoming the earlier shortcomings., Methods: SEMG signal was recorded when the participant maintained pre-specified wrist and finger flexion movements for a period of time. Various established sEMG signal parameters such as root mean square (RMS), Mean absolute value (MAV), Variance (VAR) and Waveform length (WL) and the proposed fractal features: fractal dimension (FD) and maximum fractal length (MFL) were computed. Multi-variant analysis of variance (MANOVA) was conducted to determine the p value, indicative of the significance of the relationships between each of these parameters with the wrist and finger flexions. Classification accuracy was also computed using the trained artificial neural network (ANN) classifier to decode the desired subtle movements., Results: The results indicate that the p value for the proposed feature set consisting of FD and MFL of single channel sEMG was 0.0001 while that of various combinations of the five established features ranged between 0.009 - 0.0172. From the accuracy of classification by the ANN, the average accuracy in identifying the wrist and finger flexions using the proposed feature set of single channel sEMG was 90%, while the average accuracy when using a combination of other features ranged between 58% and 73%., Conclusions: The results show that the MFL and FD of a single channel sEMG recorded from the forearm can be used to accurately identify a set of finger and wrist flexions even when the muscle activity is very weak. A comparison with other features demonstrates that this feature set offers a dramatic improvement in the accuracy of identification of the wrist and finger movements. It is proposed that such a system could be used to control a prosthetic hand or for a human computer interface.

Data for ballistic and visually controlled movement times of different arm components are presented. Ballistic movement times gave strong support to the theoretical model that movement time is linearly related to the square-root of movement amplitude, for all arm components. It was found that there was a significant effect on movement time of the arm component being used. A scaling analysis showed that this time was linearly related to the product of the square-root of amplitude and the one-tenth power of limb mass moment of inertia. This relationship was found to be approximately true in the experiment. For visually controlled movements, movement time showed a significant interaction between Fitts' Index of Difficulty and arm component. The effect of arm component on movement time was stronger in visually controlled movements than in ballistic movements and did not allow the simple modelling in terms of limb mass moment of inertia as was possible with ballistic moves. STATEMENT OF RELEVANCE: Different arm components take different times to move the same distance, dependent on their mass moments of inertia and muscle strength. The work investigated times for finger, wrist, forearm, and full-arm movements that are relevant to tasks such as manual assembly where there are alternative movement methods available for an operator.

The purpose of this study was to compare the discharge characteristics of motor units in the biceps brachii during brief isometric contractions of the elbow flexors as subjects matched either a target force or a target joint angle with the forearm placed in one of two postures. One task required force control to exert a constant force against a rigid restraint (force task), whereas the other task involved position control to maintain a constant elbow angle while supporting an inertial load (position task). The left arm of right-handed subjects was rotated forward so that the upper arm was horizontal and the forearm was vertical. When the elbow flexor muscles were contracted, the wrist exerted a force in a horizontal direction. Subcutaneous electrodes were used to record the discharge of 20 motor units in neutral and supinated forearm postures during both force and position control. Motor unit recruitment thresholds ranged from 1.3 to 37.9% of maximal voluntary contraction force. Discharge rate was similar at the start of the force and position tasks in both the neutral posture (13.1 +/- 0.6 and 12.6 +/- 0.6 pps, P = 0.54) and the supinated posture (14.7 +/- 1.6 and 14.0 +/- 0.9 pps, P = 0.4) and declined during both tasks in the two forearm postures (P < 0.001). Nonetheless, the decrease in discharge rate (P < 0.001), increase in the coefficient of variation for interspike interval (P = 0.04), and increases in the standard deviation of acceleration (P = 0.02) were greatest for the position task in the supinated posture. These findings indicate that the influence of load compliance on the adjustments in motor unit activity during brief isometric contractions with the elbow flexors was modulated by changes in forearm posture.

Transcranial magnetic stimulation was used to study changes in corticospinal excitability during vibration of the flexor and extensor muscles of the wrist in healthy humans. The ratios of muscle stimulation responses to activity levels in these muscles on contraction associated with vibration (the tonic vibratory reflex, TVR) and after vibration of antagonist muscles in isometric conditions (the antagonist vibratory reflex, AVR) were analyzed. The normalized muscle response in the wrist flexors was found to increase by 66% compared with threshold values in the direct vibratory response (TVR), by 75% in the relayed vibratory response (AVR), and by 18% on voluntary contraction. However, increases in the motor response in vibratory responses as compared with those on voluntary contraction did not reach significance, which contrasted with the responses in the forearm flexors. These results are discussed from the point of view that the motor cortex plays different roles in vibratory responses in the distal and proximal muscles.

This study investigated perceived discomfort in an isometric wrist flexion task. Independent variables were wrist flexion/extension (55%, 35% flexion, neutral, 35% and 55% extension ranges of motion (ROM)), forearm rotation (60%, 30% prone, neutral, 30% and 60% supine ROM) and two levels of flexion force (10% and 20% maximum voluntary contraction (MVC)). Discomfort was significantly affected by flexion force, forearm rotation and a two-way interaction of force with forearm rotation (each p < 0.05). High force for 60%ROM forearm pronation and supination resulted in increasingly higher discomfort for these combinations. Flexion forces were set relative to the MVC in each wrist posture and this appears to be important in explaining a lack of significant effect (p = 0.34) for flexion/extension on discomfort. Regression equations predicting discomfort were developed and used to generate iso-discomfort contours, which indicate regions where the risk of injury should be low and others where it is likely to be high. Regression equations predicting discomfort and iso-discomfort contours are presented, which indicate combinations of upper limb postures for which discomfort is predicted to be low, and others where it is likely to be high. These are helpful in the study of limits for risk factors associated with upper limb musculoskeletal injury in industry.

Previous studies using robotic devices that focus on the wrist/fingers following stroke provide an incomplete picture of movement dysfunction because they do not consider the abnormal joint torque coupling that occurs during progressive shoulder abduction loading in the paretic upper limb. This letter introduces a device designed to measure isometric flexion/extension forces generated by the fingers, wrist, and thumb during robot-mediated 3-D dynamic movements of the upper limb. Validation data collected from eight participants with chronic hemiparetic stroke are presented in this paper.

Entrapment neuropathy in the forearm is not uncommon. Surgical interference for nerve decompression should be preceded by accurate diagnosis of the exact cause and site of the nerve entrapment. The aim of the present study was to investigate the prevalence of accessory heads of the flexor pollicis longus and flexor digitorum profundus muscles (FPLah) and (FDPah) in Egyptians and their topographical relationship with both the median nerve and its anterior interosseous branch. A total of 42 upper limbs of embalmed cadavers, 36 from males and 6 from females, were examined to elucidate the prevalence of both the FPLah and the FDPah muscles, their origin, insertion, nerve supply and morphology. The distribution of these two muscles in the right and left male and female upper limbs and their relationship to the anterior interosseous and median nerves were recorded. The total lengths of both accessory muscles and the lengths of their fleshy bellies and tendons were also measured. The FPLah was found to be present more frequently (61.9%) than it was absent, whereas the FDPah was observed in only 14.24% of the specimens examined. The combination of the accessory muscles in the same forearm was noticed in 9.52% of cases. As regards side, the FPLah appeared in 77.7% of the right forearms and in 50% of the left, while the FDPah was found in only 25% of the left forearms. The accessory muscles showed no single morphology, as the FPLah appeared fusiform in 53.8%, slender in 30.8% and voluminous fusiform in 15.4%, while the FDPah was slender in 66.6% and triangular in 33.3% of specimens. The FPLah arose mainly from the under surface of flexor digitorum superficialis, while the FDPah took its origin from the under surface of flexor digitorum superficialis or from the medial epicondyle. The insertion of the FPLah was mainly into the upper third of the FPL tendon, while the FDPah tendon joined the tendons of the flexor digitorum profundus muscle to the index or middle and ring fingers. The FPLah was found between the median nerve anteriorly and the anterior interosseous nerve posteriorly. Both FPLah and FDPah took their nerve supply mainly from the anterior interosseous nerve and, less frequently, from the median nerve. The mean values of the total lengths of FPLah and FDPah were 74.66 mm and 208.33 mm, respectively. Cadaveric dissection in this study confirmed the prevalence of the FPLah and FDPah in Egyptians and demonstrated the relationship of the FPLah to the median nerve and its anterior interosseous branch. These findings may provide the surgeon with information for the differential diagnosis of the causes and sites of anterior interosseous nerve syndrome and entrapment neuropathy of the median nerve in the forearm