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Abstract Wearable devices can be used for monitoring vital physical and physiological signs remotely, as well as for interacting with computers. Widespread adoption of wearables is somewhat hindered by the duration time they can be used without re‐recharging. To ensure uninterrupted operation, these devices need a constant and battery‐less energy supply. Scavenging energy from the wearable's surroundings is, therefore, an essential step towards achieving genuinely autonomous and self‐powered devices. While energy harvesting technologies may not completely eliminate the battery storage unit, they can ensure a maximum duration of use. Piezoelectric energy harvesting is a promising and efficient technique to generate electricity for powering wearable devices in response to body movements. Consequently, we systematically survey the range of technologies used for scavenging energy from the human body, with a particular focus on the upper‐limb area. According to our review and in comparison to other upper limb locations, highest power densities can be achieved from piezoelectric transducers located on the wrist. For short and fast battery charging needs, we therefore review the range of materials, architectures and devices used to scavenge energy from these upper‐limb areas. We provide comparisons as well as recommendations and possible future directions for harvesting energy using this promising technique.

Robotic exoskeletons are active devices that assist or counteract the movements of the body limbs in a variety of tasks, including in industrial environments or rehabilitation processes. With the introduction of textile and soft materials in these devices, the effective motion transmission, mechanical support of the limbs, and resistance to physical disturbances are some of the most desirable structural features. This paper proposes an evaluation protocol and assesses the mechanical support properties of a servo-controlled robotic exoskeleton prototype for rehabilitation in upper limbs. Since this prototype was built from soft materials, it is necessary to evaluate the mechanical behavior in the areas that support the arm. Some of the rehabilitation-supporting movements such as elbow flexion and extension, as well as increased muscle tone (spasticity), are emulated. Measurements are taken using the reference supplied to the system's control stage and then compared with an external high-precision optical tracking system. As a result, it is evidenced that the use of soft materials provides satisfactory outcomes in the motion transfer and support to the limb. In addition, this study lays the groundwork for a future assessment of the prototype in a controlled laboratory environment using human test subjects. [ABSTRACT FROM AUTHOR]

This ergonomic study has focused on the production line workers in food industry because of the presence of repetitive tasks. This study's objective is to understand the working methods and the workers' organization, analyzing repetitive movements of upper limbs, in order to suggest a better distribution of the workload, and reduce the risk of musculoskeletal injury. In total, there are 6 female workers who are exposed to repetitive motions. A time and motion study was carried out, as well as the OCRA (Occupational Repetitive Actions). In conclusion, all repetitive tasks are at Risk (OCRA index> 3.5) according to OCRA index. The main causes include: the worker's position on the line, the frequency of actions per minute, the duration of exposure, the lack of recovery time, among others. [ABSTRACT FROM AUTHOR]

An exoskeleton is an external cast which can be used to maneuver, protect or even provide a greater magnitude of strength to the upper limb allowing for heightened efficiency and performance. The limb may be weakened due to so many diseases or reasons such as paralysis, stroke, muscular atrophy, and different kinds of injuries. Numerous designs and manufactured prototypes of pneumatic exoskeletons have been reviewed--their pros and cons weighed against each other. This paper covers the fundamental concepts of various prototypes that have been designed and developed over the years. The best mechanism has been highlighted, although the design of a fully efficient exoskeleton comes with its set of drawbacks. Types of energy used for the driver unit, types of actuators, materials used, design concepts, and overall weight and manufacturing cost of every prototype has been contrasted with the others to conclude what an ideal exo-skeleton for rehabilitation purposes must look like and the principles and features of the prototype must be decided upon by keeping aesthetics and ergonomics in mind. [ABSTRACT FROM AUTHOR]

BACKGROUND: Treatments for cervical spondylotic amyotrophy are still controversial. For cervical spondylotic amyotrophy patients, conservative treatment can generally stabilize or improve symptoms, but there is no cure. Surgical treatment is recommended for cervical spondylotic amyotrophy with progressive or severe neurological deterioration; however, most clinicians choose surgical methods based on their own clinical experience, and there is no unified standard or industry consensus. The prognosis of different types of cervical spondylotic amyotrophy is significantly different, which may influence the selection of surgical options. OBJECTIVE: To summarize and analyze the pathogenesis, diagnosis, clinical manifestations, types, treatments, and prognosis of cervical spondylotic amyotrophy by reviewing the related researches of cervical spondylotic amyotrophy, in order to provide reference for the selection of clinical treatment and surgical options. METHODS: Articles related to cervical spondylotic amyotrophy published from 1952 to 2020 were retrieved by computer in PubMed, EMbase, Web of Science, CNKI, and WanFang databases. Finally 44 articles that met the inclusion criteria were selected. RESULTS AND CONCLUSION: The clinical manifestations of cervical spondylotic amyotrophy are asymmetry, segmental and other characteristics of upper limb motor weakness accompanied by obvious muscle atrophy, while the lower limbs are not characterized by obvious sensory disturbance or spastic paralysis Clinically, according to the position of muscle atrophy, it is classified into proximal type, distal type and mixed type. This disease needs to be distinguished from motor neuron disease and muscular dystrophy to avoid misdiagnosis and erroneous treatment. The pathogenesis of cervical spondylotic amyotrophy is yet unclear. There are two views on ventral nerve root and spinal anterior horn injury. The latter is recognized by most scholars. The diagnosis of cervical spondylotic amyotrophy is mainly based on clinical symptoms, imaging examinations, and neuroelectrophysiological examinations. Some diseases, such as motor neuron disease, should be excluded in differential diagnosis. Surgical treatment is mainly used for cervical spondylotic amyotrophy. Anterior cervical spine anterior surgery is the first choice, and posterior surgery is preferred for patients with multi-segment cervical posterior longitudinal ligament ossification, anterior decompression impossible or high risk of decompression. Different types of cervical spondylotic amyotrophy patients have different prognostic results after surgery. Prognosis of the proximal type is better than that of the distal type, and prognosis of the mixed type is the worst. Surgery via the anterior cervical approach has better results than that via the posterior cervical approach. [ABSTRACT FROM AUTHOR]

Purpose: The main goal of this study was to evaluate the effectiveness of two different doses of caffeine (3 and 6 mg/kg) to enhance bar velocity during the bench press in women habituated to caffeine. Methods: Twelve recreationally trained women (age: 23.3 ± 0.8 years, body mass: 60.7 ± 5.7 kg, bench press one-repetition maximum (1RM): 44.3 ± 7.8 kg, daily caffeine ingestion: 5.7 ± 2.0 mg/kg/day) participated in a randomized double-blind experimental design. Each participant performed four different experimental sessions: after no supplementation (control, CON), after ingesting 3 and 6 mg/kg of caffeine (CAF-3 and CAF-6, respectively), or after ingesting a placebo (PLAC). In each experimental session, the participants performed 3 sets of 3 repetitions of the bench press exercise at 50% 1RM. Results: A two-way repeated-measures ANOVA with subsequent post hoc analyses indicated significant increases in peak velocity (p < 0.01; ES = 0.91) and mean velocity (p < 0.01; ES = 0.78) after the intake of CAF-6 compared to CON. The study did not show significant differences in bar velocity between CAF-6 and PLAC and between CAF-3 and PLAC. No significant differences in bar velocity were observed between CAF-3 and CAF-6 conditions. Conclusion: These results suggest that 6 mg/kg of caffeine can be an effective dose to improve power-specific training outcomes in women habituated to caffeine. However, the ergogenic effect of 6 mg/kg of caffeine may be derived from a combination of biological effects and expectancy, as this dose was only superior to the control condition with no differences over the placebo. [ABSTRACT FROM AUTHOR]

Many qualitative and quantitative Magnetic Resonance Imaging (MRI) techniques have been applied to evaluate muscle fat degeneration in Duchenne muscular dystrophy (DMD) subjects, but only few studies have focused on the upper limbs. We reviewed the literature in order to evaluate the association between muscle MRI findings and motor function levels in the upper limbs of DMD patients. Ten studies with upper limb muscle MRI data were available. Four explored all upper limb segments, while six explored only the forearm. Functional assessments were performed in nine of the ten studies. All of the studies showed a significant correlation between muscle MRI changes and motor function levels in both ambulant and non-ambulant DMD patients. [ABSTRACT FROM AUTHOR]

Amputee football is gaining popularity worldwide among individuals with disabilities. It has differences compared to normal football, such as, number of players in the field, smaller field dimensions and the usage of crutches while running. Despite the differences with normal football, amputee football requires high levels of flexibility, endurance, power, speed, and agility. Running with crutches is divided into 4 stages and within these 4 stages, an amputee player uses crutches 33% of the time, while 67% of the time uses their foot. Hereby, this study aims to show the relationship between strengthening the upper body to increase the speed of running with crutches during the game of amputee football. A rigorous literature research was conducted based on training and sports performance. The considered databases were PubMed, Research Gate and MEDLINE, where the keywords used were "amputation" "football" "strength" "speed" "crutches". The criteria of the selected studies were the relevance of the article on the selected topic and the time of publication. Studies conducted in this topic conclude that there is a great relation between upper strength and activities performed on amputee football match, such as running. Studies state the usage of latissimus dorsi muscle and shoulder extension movement. This study will be useful to give a clear sighting of the importance of upper limbs training in amputee football players to increase their running speed with crutches. [ABSTRACT FROM AUTHOR]

Abstract Background Work-related musculoskeletal disorders (WMSDs) represent an important socio-economic burden. The current risk assessment and management involved in the ethiopathogenesis of WMSDs is based on observational tools and checklists, which have some limitations in terms of accuracy and reliability. The aim of this study was to assess WMSD prevalence and identify possible correlations with several socio-demographic and work-related variables in a large cohort representative of Italian workers in order to improve our understanding of the WMSD phenomenon. Methods This study includes data from INSuLa, a cross-sectional nationally representative survey of health and safety at work, developed by the Italian Workers’ Compensation Authority. A total of 8000 Italian workers were included. Multivariate logistic regression analyses were performed to evaluate the association of independent variables, such as workers’ perceptions of exposure to biomechanical/ergonomic and video display unit (VDU) risks (Risk Perceived) and the actual risk exposure (Risk Detected) on Back, Lower and Upper limb pain. Socio-demographic, occupational and other health-related variables were included to investigate possible association with musculoskeletal disorders. Results Workers perceiving a significant exposure to biomechanical/ergonomic and VDU risks but not included in a health surveillance program for them (Risk Perceived/No Risk Detected) have had significantly higher odds of reporting musculoskeletal disorders. Regarding the biomechanical/ergonomic risk these workers are in the 19–24 age range (39.9%), transportation, warehousing/information and communication sectors (38.9%) and are employed in companies with more than 250 workers (35.8%). Regarding VDU risk, workers are in the 45–54 age range (24.5%), professional, financial and business services (38.0%) and come from companies with more than 250 employees (25.6%). Conclusions Within the occupational safety and health management systems an appropriate assessment of occupational risk factors correlated to musculoskeletal disorders (mainly biomechanical/ergonomic and VDU) and the correct definition of their exposure levels is essential to adequately prevent the onset of WMSDs. In this regard, our findings provide useful information to design novel approaches, aimed at improving our understanding of emerging risks, identifying gaps in current risk assessment strategies and enhancing workplace interventions are mandatory to improve the occupational risk assessment and management process and therefore implement the subsequent health surveillance systems.

Purpose: This study aimed to clarify how children with congenital limb deficiencies visually attend to their bodies, particularly their limbs and prostheses. Methods: Participants included children with and without congenital limb deficiencies. They were shown photographs of themselves and their visual attention was measured using an eye tracker. Results: Six children with lower limb deficiencies (age [mean ± SD]: 8.8 ± 2.9; 2 girls and 4 boys), six children with upper limb deficiencies (age: 7.0 ± 2.3; 2 girls and 4 boys), and ten control children (age: 7.7 ± 1.9; 5 girls and 5 boys) were included. Children with congenital upper/lower limb deficiencies looked at their upper/lower limbs as often or more than the control children. Prompts to direct their visual attention to their limbs had limited efficacy. Conclusions: To improve the body knowledge of limbs, approaches other than visual recognition prompting, such as improving linguistic understanding, might be considered. [ABSTRACT FROM AUTHOR]

We aimed to analyse cardiac autonomic control by assessing the post-exercise heart rate recovery (HRR) and physical fitness in children and adolescents with spina bifida (SB), compared to participants with typical development. A total of 124 participants, 42 with spina bifida (SB group) and 82 typical developmental controls (CO group) performed the arm cranking exercise test with a gas analysis system. HRR was determined at the first (HRR_1) and second (HRR_2) minute at recovery phase. Data are shown as [mean difference (95% CI)]. The SB group showed reduced HR reserve [14.5 (7.1–22.0) bmp, P<0.01], slower HRR_1 [12.4 (7.4–17.5) bpm, P<0.01] and HRR_2 [16.3 (10.6–21.9) bpm; P<0.01], lower VO2peak [VO2peak relative: 7.3 (4.2–10.3) mL·min−1 ·kg−1 , P<0.01; VO2peak absolute: 0.42 (0.30–0.54) L·min−1 , P<0.01], and lower O2 pulse [2.5 (1.8–3.2) mL·bpm, P<0.01] and ventilatory responses [13.5 (8.8–18.1) L·min−1 , P<0.01] than the CO group. VE/VO2 was not different between groups [−2.82 (−5.77– −0.12); P=0.06], but the VE/VCO2 [−2.59 (−4.40–0.78); P<0.01] and the values of the anaerobic threshold corrected by body mass [−3.2 (−5.8– −0.6) mL·min−1 ·kg−1 , P=0.01] were higher in the SB group than in the CO group. We concluded that children and adolescents with SB have reduced physical fitness and a slower HRR response after maximal effort. [ABSTRACT FROM AUTHOR]

Fear of falling is a critical component in fall prevention approaches; however, it is often overlooked in the majority of fall prevention exercises. Alternative fall prevention approaches that take fear of falling into account are necessary. This article discusses fall prevention activities that are feasible for individuals with limited mobility who have an increased fear of falling. Health care providers should consider the degree to which a patient has a fear of falling and recommend activities that fit most to their patient's comfort level. [ABSTRACT FROM AUTHOR]

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Background: About 1–2% of neonates have congenital anomalies; of these, 10% affect the upper limbs. Congenital anomalies are structural or metabolic defects present at birth. Objective: To review cases seen over a four-year period in a tertiary specialist hospital in Lagos and share our experience. Methodology: Case notes and theatre records of patients with congenital upper limb anomalies were retrieved and relevant data extracted. Data were analyzed with SPSS version 20. Results: 46 patients with 53 diagnoses of upper extremity congenital anomalies: 28 were males and 18 females between 5 weeks and 14 years. 17 patients (37%) presented within the first 12 months of life. Average ages of mothers and fathers were 34.1 and 37 years respectively. 26% of mothers had febrile illnesses and 28.3% used herbal products during the index pregnancies. Swanson’s group 2 was the commonest (58.4). Syndactyly was the commonest descriptive individual diagnosis (49%). Treatments were individualized according to specific diagnosis. Conclusions: Congenital anomalies of the upper extremities present as various diagnostic entities. Syndactyly was the most frequently encountered here

Flexible soft exoskeletons, so-called exosuits, are robotic devices that interact with their users to assist or enhance muscle performance. Their lightweight design and lack of rigid parts allow assisting the user's natural motion without any constraints. They are thereby valuable in carrying out daily labour tasks and performing active stances of rehabilitation. Nonetheless, the usage of these devices in long-term applications demands anatomically adaptive designs and mechanisms to tackle textile artefacts and discrepancies in the human constitution. The soft exoskeleton described in this article is a textile-wearable design that assists shoulder and elbow flexion. The cable-driven actuation is embedded in a jacket by using several textiles and deformable parts. The inconveniences of using textile such as slipping, dampening, and pressure sores are tackled by combining textile layers with force-compliant sewing. The design also includes pieces for cable guidance, anchoring and support. These parts employ different tailoring methods so as to ease fabrication, wearing and cleaning. The motors and electronics, whose design is compatible with textiles too, are placed in a backpack. This configuration reduces forces from loads in motion and weight on the arm. Finally, the last part of the document discusses the preliminary results that have been obtained from four subjects who have worn the device.

Aim of the study: The aim of this study was to analyse pain occurring in double bass players within the upper limb and spine. Materials and methods: Two groups were compared depending on the length of time the instrument was played and the anatomical structures that were subjected to the greatest loads were considered. A group of 50 musicians of different ages from 17 to 31 years old was included in the study. In order to obtain data on the frequency, location and nature of pain, a self-prepared questionnaire was used in electronic form. The survey was designed on the basis of available questionnaires used to study the diseases of instrumentalist musicians (Standardized Nordic questionnaires for the analysis of musculoskeletal symptoms and Evaluation of Performing Artist). Respondents answered questions not only about pain, but also factors that can significantly affect their course. The analysis of lifestyle or level of awareness in the field of occupational hazards and prevention was included in 30 open-ended and closed questions. Results: The results indicate a high percentage of double bass players suffering from pain. The most common pain in the surveyed double bass players it turned out to be pain in the lumbo-sacral segment, shoulder girdle, wrist and hand. The duration of the game had a negative impact on the severity of pain symptoms, which were often accompanied by other symptoms such as pain radiation, loss of concentration, or difficulties in making precise movements. Conclusions: It can be concluded that music work is subject to certain occupational risk and affects on the health of the musicians.

Arthrogryposis multiplex congenita (AMC) has recently drawn substantial attention from researchers and clinicians. New effective surgical and physiotherapeutic methods have been developed to improve the quality of life of patients with AMC. While it is clear that all these interventions should strongly rely on the plastic reorganization of the central nervous system, almost no studies have investigated this topic. The present study demonstrates the feasibility of using magnetoencephalography (MEG) to investigate brain activity in young AMC patients. We also outlined the general challenges and limitations of electrophysiological investigations on patients with arthrogryposis. We conducted MEG recordings using a 306-channel Elekta Neuromag VectorView system during a cued motor task performance in four patients with arthrogryposis, five normally developed children, and five control adults. Following the voice command of the experimenter, each subject was asked to bring their hand toward their mouth to imitate the self-feeding process. Two patients had latissimus dorsi transferred to the biceps brachii position, one patient had a pectoralis major transferred to the biceps brachii position, and one patient had no elbow flexion restoration surgery before the MEG investigation. Three patients who had undergone autotransplantation prior to the MEG investigation demonstrated activation in the sensorimotor area contralateral to the elbow flexion movement similar to the healthy controls. One patient who was recorded before the surgery demonstrated subjectively weak distributed bilateral activation during both left and right elbow flexion. Visual inspection of MEG data suggested that neural activity associated with motor performance was less pronounced and more widely distributed across the cortical areas of patients than of healthy control subjects. In general, our results could serve as a proof of principle in terms of the application of MEG in studies on cortical activity in patients with AMC. Reported trends might be consistent with the idea that prolonged motor deficits are associated with more difficult neuronal recruitment and the spatial heterogeneity of neuronal sources, most likely reflecting compensatory neuronal mechanisms. On the practical side, MEG could be a valuable technique for investigating the neurodynamics of patients with AMC as a function of postoperative abilitation.

Pullover and straight arm pulldown exercises are commonly used in resistance exercise programs to improve sports performance or in physical activity health programs. This study aimed to evaluate the individual electromyographic (EMG) activity of the pectoralis major (clavicular, sternal, and costal portions), latissimus dorsi, anterior deltoid, triceps brachii, and rectus abdominis muscles in a barbell pullover exercise at a 100% biacromial width and a straight arm pulldown exercise at a 100% and 150% biacromial width and to compare the EMG activity in these selected muscles and exercises. Twenty healthy and physically active adults performed a set of eight repetitions of each exercise against 30% of their body mass. The barbell pullover exercise presented a higher EMG activity (p ≤ 0.01) than the straight arm pulldown exercise in both biacromial widths in all evaluated muscles except for the latissimus dorsi and the triceps brachii. These muscles showed the highest EMG activity in the straight arm pulldown exercise at both biacromial widths. In all of the exercises and muscles evaluated, the concentric phase showed a greater EMG activity than the eccentric phase. In conclusion, the barbell pullover exercise can highlight muscle activity in the pectoralis major (mainly in the sternal and lower portions), triceps brachii, and rectus abdominis muscles. However, the straight arm pulldown exercise at 100% and 150% biacromial widths could be a better exercise to stimulate the latissimus dorsi and triceps brachii muscles. Moreover, all exercises showed significantly greater EMG activity (p < 0.001) in the concentric phase than in the eccentric phase for all the evaluated muscles.

Background: Spasticity is a common motor disorder in children with cerebral palsy (CP). Upper limb CP impairment has a significant negative impact on daily activities. Botulinum toxin (BTX-A) injections are widely used to reduce spasticity, but their effectiveness is not well-defined. We performed a systematic review of literature to answer questions about the effectiveness of BTX-A injections in the upper limb in children with CP., Methods: A systematic review of literature was conducted according to PRISMA guidelines. Eligible studies were randomized controlled trials with a high level of evidence on BTX-A upper limb injections in children. The outcomes analyzed included the study population, spasticity, quality of movement, activity limitations, quality of life, pain, appearance and side effects., Results: A total of 24 studies were included. The number of patients included was 1358 with a mean age between 3 and 11years. Improvement after BTX-A injection compared to the control group was observed for spasticity (n=10/19 studies), bimanual activities (Assisting Hand Assessment) (n=3/7), activity limitations (n=6/11), pain (n=2/2) and appearance (n=2/2). No study found an improvement in quality of life. Side effects were described in 16 studies and were moderate in all cases., Conclusion: This review of literature showed that BTX-A injections can improve spasticity and particularly activity limitations when reasonable objectives are established., Level of Evidence: IV, systematic review., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Upper limb motor fatigability is an important debilitating factor for activities of daily living in clinical pediatric populations. However, the reliability of fatigability protocols in these populations is currently unknown. Therefore, the current study investigates test-retest reliability of a static and dynamic motor fatigability protocol for grip and pinch strength in typically developing children (TDC). Eighty-nine TDC (35 boys, 54 girls; mean age 10 years 11 months) used a grip and pinch dynamometer for static (sustained) and dynamic (repeated) contractions during 30s. For static motor fatigability (SFI), mean (Fmean) and SD (Fvar) of force were calculated, and for dynamic motor fatigability, F mean and number of peaks (Npeaks) were calculated. Intraclass correlation coefficients (ICC) were calculated. ICCs of F mean in static and dynamic motor fatigability were high (ICC: 0.94–0.96 and 0.91–0.98). ICCs were moderate to high for F var (ICC: 0.67–0.85). The SFI showed moderate ICCs (ICC: 0.69–0.77). ICCs were moderate to high for N peaks (ICC: 0.78–0.91). Conclusion: The results suggest that static and dynamic motor fatigability in for grip and pinch can be used reliably in TD children aged 6–18 years. What is Known: •Psychometric properties of motor fatigability protocols using grip and pinch in children are lacking. •Motor fatigability in grip and pinch is an important debilitating symptom in multiple neurologic populations. What is New: •Static fatigability can be investigated using a 30-s maximum sustained grip strength protocol in children. •Dynamic fatigability can be investigated using a 30-s maximum repeated grip strength protocol in children. [ABSTRACT FROM AUTHOR]

Wearable devices can be used for monitoring vital physical and physiological signs remotely, as well as for interacting with computers. Widespread adoption of wearables is somewhat hindered by the duration time they can be used without re‐recharging. To ensure uninterrupted operation, these devices need a constant and battery‐less energy supply. Scavenging energy from the wearable's surroundings is, therefore, an essential step towards achieving genuinely autonomous and self‐powered devices. While energy harvesting technologies may not completely eliminate the battery storage unit, they can ensure a maximum duration of use. Piezoelectric energy harvesting is a promising and efficient technique to generate electricity for powering wearable devices in response to body movements. Consequently, we systematically survey the range of technologies used for scavenging energy from the human body, with a particular focus on the upper‐limb area. According to our review and in comparison to other upper limb locations, highest power densities can be achieved from piezoelectric transducers located on the wrist. For short and fast battery charging needs, we therefore review the range of materials, architectures and devices used to scavenge energy from these upper‐limb areas. We provide comparisons as well as recommendations and possible future directions for harvesting energy using this promising technique. [ABSTRACT FROM AUTHOR]

Objective: Musculoskeletal disorders are one of the most important occupational problems especially among nurses. The aim of this study was to investigate the prevalence of musculoskeletal disorders in upper limbs and its associated psychosocial factors in the workplace. Methods: A systematic review was conducted by searching the Medline/PubMed, EMBASE, Scopus, ISI/web of knowledge and Google Scholar databases. The authors classified studies into categories of psychological work stressors and musculoskeletal problems. The statistical analysis was performed using Stata software. Results: We found 1742 articles in our initial search. After reviewing the titles, abstracts and full texts, 66 articles were finally analyzed. Psychosocial factors affecting the prevalence of upper limb musculoskeletal disorders among nurses were identified which included boring work, inadequate staffing, job demands, insufficient support, time pressure, decision latitude, job dissatisfaction, and job stress. There was a significant relationship between these factors and prevalence of musculoskeletal disorders in the wrists, shoulders, neck and shoulders, and wrists and hands. Conclusion: Collectively, the results of this study provide strong evidence of some psychosocial factors affecting the prevalence of upper limb musculoskeletal disorders among nurses. Thus, organizational interventions to minimize these stressors may be promising in reducing one risk factor for the development of nurses' musculoskeletal disorders. These interventions should not only consider the factors of physical ergonomics but also seek to improve the organizational aspects of the workplace. [ABSTRACT FROM AUTHOR]

(1) Background: The increase in the number of bariatric surgery procedures has led plastic surgeons to look for new approaches to improve outcomes of body-contouring surgeries. A major concern in brachioplasty is the scarring process. Here, we propose a novel technique to minimize the incidence of pathological or unsatisfactory scars from brachioplasty. A video of the entire procedure is provided. (2) Methods: From January 2016 to August 2020, we performed the “Jaws” brachioplasty on 16 post-bariatric patients. We evaluated the effectiveness of the technique through pre- and postoperative assessments by patients and surgeons, the Vancouver Scar Scale, and the detection of major and minor complications within 12 months of follow-up. (3) Results: Thirteen patients were female and three were male, with a mean age of 32.5 ± 6.8 years (range: 22–47 years). The BODY-Q© Arms Section scores improved significantly, with no incidence of major or minor complications over 1 year of follow-up, and favorable aesthetic outcomes. (4) Conclusions: We believe that the “Jaws” technique is a valid contribution to post-bariatric surgery, as it aims to solve specific aesthetic problems of scarring from brachioplasty. The small number of patients does not allow the comparison of our original technique to others previously described in the literature.

Objects: To evaluate the feasibility and effectiveness of in-bed wearable elbow robot training for motor recovery in patients with early and late subacute stroke.Methods: Eleven in-patient stroke survivors (male/female: 7/4, age: 50.7 ± 10.6 years, post-stroke duration: 2.6 ± 1.9 months) received 15 sessions of training over about 4 weeks of hospital stay. During each hourly training, participants received passive stretching and active movement training with motivating games using a wearable elbow rehabilitation robot. Isometric maximum muscle strength (MVC) of elbow flexors and extensors was evaluated using the robot at the beginning and end of each training session. Clinical measures including Fugl-Meyer Assessment of upper extremity (FMA-UE), Motricity Index (MI) for upper extremities, Modified Ashworth Scale (MAS) were measured at baseline, after the 4-week training program, and at a 1-month follow-up. The muscle strength recovery curve over the training period was characterized as a logarithmic learning curve with three parameters (i.e., initial muscle strength, rate of improvement, and number of the training session).Results: At the baseline, participants had moderate to severe upper limb motor impairment {FMA-UE [median (interquartile range)]: 28 (18–45)} and mild spasticity in elbow flexors {MAS [median (interquartile range)]: 0 (0–1)}. After about 4 weeks of training, significant improvements were observed in FMA-UE (p = 0.003) and MI (p = 0.005), and the improvements were sustained at the follow-up. The elbow flexors MVC significantly increased by 1.93 Nm (95% CI: 0.93 to 2.93 Nm, p = 0.017) and the elbow extensor MVC increased by 0.68 Nm (95% CI: 0.05 to 1.98 Nm, p = 0.036). Muscle strength recovery curve showed that patients with severe upper limb motor impairment had a greater improvement rate in elbow flexor strength than those with moderate motor impairment.Conclusion: In-bed wearable elbow robotic rehabilitation is feasible and effective in improving biomechanical and clinical outcomes for early and late subacute stroke in-patients. Results from the pilot study suggested that patients with severe upper limb motor impairment may benefit more from the robot training compared to those with moderate impairment.

Objects : To evaluate the feasibility and effectiveness of in-bed wearable elbow robot training for motor recovery in patients with early and late subacute stroke. Methods : Eleven in-patient stroke survivors (male/female: 7/4, age: 50.7 ± 10.6 years, post-stroke duration: 2.6 ± 1.9 months) received 15 sessions of training over about 4 weeks of hospital stay. During each hourly training, participants received passive stretching and active movement training with motivating games using a wearable elbow rehabilitation robot. Isometric maximum muscle strength (MVC) of elbow flexors and extensors was evaluated using the robot at the beginning and end of each training session. Clinical measures including Fugl-Meyer Assessment of upper extremity (FMA-UE), Motricity Index (MI) for upper extremities, Modified Ashworth Scale (MAS) were measured at baseline, after the 4-week training program, and at a 1-month follow-up. The muscle strength recovery curve over the training period was characterized as a logarithmic learning curve with three parameters (i.e., initial muscle strength, rate of improvement, and number of the training session). Results : At the baseline, participants had moderate to severe upper limb motor impairment {FMA-UE [median (interquartile range)]: 28 (18–45)} and mild spasticity in elbow flexors {MAS [median (interquartile range)]: 0 (0–1)}. After about 4 weeks of training, significant improvements were observed in FMA-UE (p = 0.003) and MI (p = 0.005), and the improvements were sustained at the follow-up. The elbow flexors MVC significantly increased by 1.93 Nm (95% CI: 0.93 to 2.93 Nm, p = 0.017) and the elbow extensor MVC increased by 0.68 Nm (95% CI: 0.05 to 1.98 Nm, p = 0.036). Muscle strength recovery curve showed that patients with severe upper limb motor impairment had a greater improvement rate in elbow flexor strength than those with moderate motor impairment. Conclusion : In-bed wearable elbow robotic rehabilitation is feasible and effective in improving biomechanical and clinical outcomes for early and late subacute stroke in-patients. Results from the pilot study suggested that patients with severe upper limb motor impairment may benefit more from the robot training compared to those with moderate impairment. [ABSTRACT FROM AUTHOR]

Robotic exoskeletons are active devices that assist or counteract the movements of the body limbs in a variety of tasks, including in industrial environments or rehabilitation processes. With the introduction of textile and soft materials in these devices, the effective motion transmission, mechanical support of the limbs, and resistance to physical disturbances are some of the most desirable structural features. This paper proposes an evaluation protocol and assesses the mechanical support properties of a servo-controlled robotic exoskeleton prototype for rehabilitation in upper limbs. Since this prototype was built from soft materials, it is necessary to evaluate the mechanical behavior in the areas that support the arm. Some of the rehabilitation-supporting movements such as elbow flexion and extension, as well as increased muscle tone (spasticity), are emulated. Measurements are taken using the reference supplied to the system’s control stage and then compared with an external high-precision optical tracking system. As a result, it is evidenced that the use of soft materials provides satisfactory outcomes in the motion transfer and support to the limb. In addition, this study lays the groundwork for a future assessment of the prototype in a controlled laboratory environment using human test subjects.

ObjectiveTo compare the effect of Whole-Body Vibration Exercise (WBVE) applied in push-up modified and half-squat positions, on handgrip strength (HS) and on the electromyography registry (EMGrms) of the flexor digitorum superficialis muscle (FDSM) of the dominant hand.MethodsNineteen healthy women (age 23.40 ± 4.03 years, bodyweight: 58.89 ± 9.87 kg), performed in a randomized order five different tests: (S1) Control; (S2) Push-up modified; (S3) Push-up placebo; (S4); Half-squatting; (S5) Half-squatting placebo. The HS and the EMGrms were assessed at baseline and immediately after the tests. ANOVA two-way design mixed test, with Tukey post hoc, was used to evaluate the HS, EMGrms and the ratio between EMGrms and HS, i.e., neural ratio (NR). Thus, the lower NR represents the greater neuromuscular modifications. The statistical significance level was set up at p < 0.05.ResultsWBVE on S2 increased HS compared to the stimulus applied to the S4 (p = 0.0001). The increase in HS was associated with a reduction in the EMGrms of the FDSM (p < 0.001) and a lower NR (p < 0.0001), i.e., greater neuromuscular modifications, in the S2 compared to the S4 after the tests.ConclusionThe distance of the stimulus and the positioning on the vibratory platform influence the maximum muscular strength due to neuromuscular modifications of hands in healthy women.

Cervical spinal cord injury is damage to the spinal cord that causes temporary or permanent changes in body functions below the site of the injury. In particular, the impairment of the upper limbs limits the patient's autonomy in the execution of activities of daily living. This paper illustrates the use of a low-cost robot with a virtual reality platform for upper limb rehabilitation of cervical spinal cord injury patients. Vibration and pressure haptic feedback sensations are provided thanks to a custom-made thimble feedback device. The virtual reality platform consists of three different virtual rehabilitation games developed in Unity. They provide the user with the opportunity to interact with the virtual scene using free hands thanks to the data collected by a hand tracking system. During the therapy session, quantitative data about the motor performance are collected. Each virtual reality environment can be modified in settings according to the patients' needs. A proof of concept was performed with both healthy subjects and spinal cord injured patients to evaluate the platform and its usability. The data saved during the sessions are analyzed to validate the importance of haptic feedback and stored both for patients and therapists to control the performance and the recovery process. [ABSTRACT FROM AUTHOR]

Introduction: Parkinson's disease (PD) leads to deficits in upper limb strength and manual dexterity and consequently resulting in functional impairment. Handgrip strength is correlated with the motor symptom severity of the disease, but there is a gap in the literature about the influence of freezing in PD patients. Objective: The objective is to study the correlation between handgrip strength and motor symptom severity considering the freezing phenomenon and to verify variables that can predict Unified Parkinson's Disease Rating Scale (UPDRS) III. Methods: This is a multicenter cross-sectional study in PD. 101 patients were divided into 2 groups: freezing of gait (FOG) (n = 51) and nonfreezing (nFOG) (n = 52). Freezing of Gait Questionnaire (FOGQ); UPDRS II and III sections; Hoehn and Yahr (HY) scale; handgrip dynamometry (HD); 9 Hole Peg Test (9-HPT) were assessed. Results: In both groups, HD was correlated to UPDRS III (nFOG: −0.308; FOG: −0.301), UPDRS total (nFOG: −0.379; FOG: −0.368), UPDRS item 23 (nFOG: −0.404; FOG: −0.605), and UPDRS item 24 (nFOG: −0.405; FOG: −0.515). For the correlation to UPDRS II (0.320) and 9-HPT (−0.323), only nFOG group presented significance. For the UPDRS 25 (−0.437), only FOG group presented statistical significance. The UPDRS III can be predicted by 9-HPT, age, and HY in nFOG patients (Adjusted R2 = 0.416). In FOG group, UPDRS III can be predicted by HD, 9-HPT, age, and HY (Adjusted R2 = 0.491). Conclusion: Handgrip strength showed to be predictive of motor impairment only in the FOG group. Our results showed clinical profile differences of motor symptoms considering freezers and nonfreezers with PD. [ABSTRACT FROM AUTHOR]

The main goal of this study was to evaluate the effectiveness of an acute dose of caffeine (6 mg/kg body mass (b.m.)) on power output and bar velocity during a bench press multiple-set resistance training session in participants with mild daily caffeine consumption (in the range of 1 to 3 mg/kg/b.m). Thirteen recreationally active male participants (age: 21.9 ± 1.2 years, body mass: 74.4 ± 5.3 kg, body mass index: 23.1 ± 1.6 kg/m2, bench press onerepetition maximum (1RM): 79.2 ± 14.9 kg), with daily caffeine ingestion of 1.56 ± 0.56 mg/kg/b.m., participated in the study with a randomized double-blind experimental design. Each participant performed two identical experimental sessions, 60 min after the intake of a placebo (PLAC) or 6 mg/kg/b.m. of caffeine (CAF-6). In each experimental session, participants performed 5 sets of 5 repetitions of the bench press exercise with a load equivalent to 70% 1RM. The eccentric and concentric phases of the bench press exercise were performed at maximal possible velocity in each repetition. Bar velocity was recorded with a linear position transducer and power output was calculated using velocity and load data. A two-way repeated measures ANOVA indicated no significant substance x set interaction for mean power output (MP), mean bar velocity (MV), peak power output (PP) and peak bar velocity (PV). However, there was a significant main effect of substance on MP (p < 0.01; η2 = 0.47) and MV (p < 0.01; η2 =0.45). Post hoc analysis for main effect revealed that MP and MV values in the CAF-6 group were higher than in the PLAC group in all 5 sets of the exercise (p < 0.05). In conclusion, this study demonstrated that an acute dose of caffeine before resistance exercise increased mean power output and mean bar velocity during a multiple-set bench press exercise protocol among mild caffeine users. [ABSTRACT FROM AUTHOR]

Objective: To compare the effect of Whole-Body Vibration Exercise (WBVE) applied in push-up modified and half-squat positions, on handgrip strength (HS) and on the electromyography registry (EMGrms) of the flexor digitorum superficialis muscle (FDSM) of the dominant hand. Methods: Nineteen healthy women (age 23.40 ± 4.03 years, bodyweight: 58.89 ± 9.87 kg), performed in a randomized order five different tests: (S1) Control; (S2) Push-up modified; (S3) Push-up placebo; (S4); Half-squatting; (S5) Half-squatting placebo. The HS and the EMGrms were assessed at baseline and immediately after the tests. ANOVA two-way design mixed test, with Tukey post hoc , was used to evaluate the HS, EMGrms and the ratio between EMGrms and HS, i.e., neural ratio (NR). Thus, the lower NR represents the greater neuromuscular modifications. The statistical significance level was set up at p < 0.05. Results: WBVE on S2 increased HS compared to the stimulus applied to the S4 (p = 0.0001). The increase in HS was associated with a reduction in the EMGrms of the FDSM (p < 0.001) and a lower NR (p < 0.0001), i.e., greater neuromuscular modifications, in the S2 compared to the S4 after the tests. Conclusion: The distance of the stimulus and the positioning on the vibratory platform influence the maximum muscular strength due to neuromuscular modifications of hands in healthy women. [ABSTRACT FROM AUTHOR]

Introdution: Stroke causes several alterations, the more frequent are motor, physical and psychological. Since rehabilitation takes time and can become monotonous, the use of virtual reality can act as a stimulating way to involve the patient in the treatment, seeking to develop its functionality. Objective: The objective of this study was to verify in the available literature the effects of using virtual reality in the treatment of the sequelae of the Stroke, to gain functionality in the upper limbs. Methods: This literature review was based on the PICO strategy, carried out in the databases Lílacs, Pubmed, Scielo and PEDro, using the keywords "physiotherapy AND virtual reality OR exergame OR exergaming AND stroke AND upper limbs". Complete articles were published in English, Portuguese and Spanish, available and dated between 2015 and 2020, excluding those that were review articles, incomplete and that did not address the topic. Results: As a result, the search found 1,035 articles, of which only 14 met the imposed criteria. Most studies have shown that the use of virtual reality through games has proved to be an efficient resource in the functional rehabilitation of patients with stroke. Presenting itself as a competent complementary to physiotherapeutic treatment in improving fine motor skills, motor behavior of the limbs and cognitive performance, these gains directly influenced the gain in functionality of the samples. Conclusion: The use of virtual reality is useful to assist in the treatment and reduction of sequelae in the upper limbs of patients with stroke, as it promotes greater functional gain, range of motion and improves the dexterity of both the most and the least compromised hand. [ABSTRACT FROM AUTHOR]

Many qualitative and quantitative Magnetic Resonance Imaging (MRI) techniques have been applied to evaluate muscle fat degeneration in Duchenne muscular dystrophy (DMD) subjects, but only few studies have focused on the upper limbs. We reviewed the literature in order to evaluate the association between muscle MRI findings and motor function levels in the upper limbs of DMD patients. Ten studies with upper limb muscle MRI data were available. Four explored all upper limb segments, while six explored only the forearm. Functional assessments were performed in nine of the ten studies. All of the studies showed a significant correlation between muscle MRI changes and motor function levels in both ambulant and non-ambulant DMD patients.

Background: First reported by Malherbe in 1880, pilomatricoma is a common benign skin tumor generally believed to occur mainly in children and adolescents. We conducted this study to better define the characteristics of pilomatricoma and compare our findings with current knowledge., Methods: Patients diagnosed pathologically with pilomatricoma from 2016 through 2020 at Nippon Medical School Musashi Kosugi Hospital were included (1,559 patients, 1,590 tumors). Clinicopathological characteristics were analyzed., Results: The male to female ratio was 1:1.6, and the most common tumor site was the upper limbs (33.7%). Preoperative diagnosis was correct in 48.5% of the patients, and their average age at resection was 33.5 years. Resection was carried out in 70% of the patients within 1 year, but time to resection was more than 1 year in the other 30%. Pathologically, squamous stratifying keratinocytes were observed in 41.7% of the patients, cells with a large pale pink cytoplasm in 38.9%, hair papilla-like structures in 33.9%, ossification in 15.7%, trichohyalin granules in 11.9%, and aggregations of follicular germinative cells in 7.8%. Of the chronological and morphological stages proposed by Kaddu (stage 1: early, stage 2: fully developed, stage 3: early regressive, stage 4: late regressive), stage 3 was the most common (70.6%)., Conclusion: Pilomatricoma is more common in females, regardless of ethnicity or age, but the tumor location in the upper limbs commonly observed in Japanese patients may indicate ethnic differences. Pathologically, the fact that cells linked to follicular differentiation are observed suggests that pilomatricoma is a complex panfollicular neoplasm. Time to resection appears to correlate with Kaddu stages. Factors such as age, location, sex, depth, and stage may affect the pathological features of this tumor.

The traditional bionic upper limb structure design is limited by the motion pair and cannot guarantee the flexibility of the mechanical structure. The tensegrity structure has the characteristics of high deformability, strong self-adaptability, and resistance to multi-directional impact. According to the biological characteristics of the upper limbs of the human body, an anatomical study is performed on the upper limb wrist joints that achieve adduction/abduction, flexion/extension, to obtain the relationship between the movements of the related bones and muscles, and to simplify the shape and structure of the wrist. Equivalent mapping of a mechanical model based on two-bar tensile properties. Through the contraction and stretching of the spring, the movement characteristics of the human muscles are realised, and the optimised bionic upper limb wrist tensioning robot without motion pair is further obtained. Adams simulation is used to verify that the bionic tensile wrist can simulate the change movement of the human wrist. The experimental platform was built and a physical prototype was made and the prototype was tested. The results show that the bionic tensile wrist can realise the adaptive motion characteristics of the human wrist well and stably, which proves the validity and feasibility of this design method.

Abstract The characteristic of immersion, involvement and motivation have made serious games an important tool to be used in the medical field. However, there are people that, having some sort of physical disability, are not able to, or do not feel motivated to play. This work presents a strategy to support human- computer interactions for children with a disability in their upper limbs through a wearable device, with the objective of improving access to digital games for the target audience. For the development of this work, the wearable device Myo was used to control a puzzle game as a means of providing the interaction between the individual and the game. In this context, the game is controlled with the movement of the user's upper limb that presents the disability, through the Myo device. For the validation of this research, the game developed was made available for individuals presenting a disability in the upper limbs, from an age range between five and fifteen years old, of the Association of Assistance to the Disabled Child (AACD). Soon, it was noticed that the participants of the research soon could play while utilizing the deficient limb with Myo's support and felt more motivated to play. On the long run, it is expected to contribute to the motivation of patients through technological innovation, so that the process of body consciousness is made more interactive.

Background: This systematic review summarizes the current evidence about the effectiveness of wearable assistive technologies for upper limbs support during activities of daily living for individuals with neuromuscular diseases.Methods: Fourteen studies have been included in the meta-analysis, involving 184 participants. All included studies compared patients ability to perform functional tasks with and without assistive devices.Results: An overall effect size of 1.06 (95% CI = 0.76-1.36, p < 0.00001) was obtained, demonstrating that upper limbs assistive devices significantly improve the performance in activities of daily living in people with neuromuscular diseases. A significant interaction between studies evaluating functional improvement with externally-assessed outcome measures or self-perceived outcome measures has been detected. In particular, the effect size of the sub-group considering self-perceived scales was 1.38 (95% CI = 1.08-1.68), while the effect size of the other group was 0.77 (95% CI = 0.41-1.11), meaning that patients' perceived functional gain is often higher than the functional gain detectable through clinical scales.Conclusion: Overall, the quality of the evidence ranged from low to moderate, due to low number of studies and participants, limitations in the selection of participants and in the blindness of outcome assessors, and risk of publication bias.Significance: A large magnitude effect and a clear dose-response gradient were found, therefore, a strong recommendation, in favor of the use of assistive devices could be suggested.

Abstract Background End-effector robots are commonly used in robot-assisted neuro-rehabilitation therapies for upper limbs where the patient’s hand can be easily attached to a splint. Nevertheless, they are not able to estimate and control the kinematic configuration of the upper limb during the therapy. However, the Range of Motion (ROM) together with the clinical assessment scales offers a comprehensive assessment to the therapist. Our aim is to present a robust and stable kinematic reconstruction algorithm to accurately measure the upper limb joints using only an accelerometer placed onto the upper arm. Methods The proposed algorithm is based on the inverse of the augmented Jaciobian as the algorithm (Papaleo, et al., Med Biol Eng Comput 53(9):815–28, 2015). However, the estimation of the elbow joint location is performed through the computation of the rotation measured by the accelerometer during the arm movement, making the algorithm more robust against shoulder movements. Furthermore, we present a method to compute the initial configuration of the upper limb necessary to start the integration method, a protocol to manually measure the upper arm and forearm lengths, and a shoulder position estimation. An optoelectronic system was used to test the accuracy of the proposed algorithm whilst healthy subjects were performing upper limb movements holding the end effector of the seven Degrees of Freedom (DoF) robot. In addition, the previous and the proposed algorithms were studied during a neuro-rehabilitation therapy assisted by the ‘PUPArm’ planar robot with three post-stroke patients. Results The proposed algorithm reports a Root Mean Square Error (RMSE) of 2.13cm in the elbow joint location and 1.89cm in the wrist joint location with high correlation. These errors lead to a RMSE about 3.5 degrees (mean of the seven joints) with high correlation in all the joints with respect to the real upper limb acquired through the optoelectronic system. Then, the estimation of the upper limb joints through both algorithms reveal an instability on the previous when shoulder movement appear due to the inevitable trunk compensation in post-stroke patients. Conclusions The proposed algorithm is able to accurately estimate the human upper limb joints during a neuro-rehabilitation therapy assisted by end-effector robots. In addition, the implemented protocol can be followed in a clinical environment without optoelectronic systems using only one accelerometer attached in the upper arm. Thus, the ROM can be perfectly determined and could become an objective assessment parameter for a comprehensive assessment.

Abstract Background Stature is one of the important aspects of biological profile for an unknown individual in forensic anthropology. As stature is population-specific, this study was conducted in Hospital Sungai Buloh, Hospital Tapah and Hospital Kampar to develop regression for stature estimation in the Malaysian population. About 90 subjects from 23 to 47 years old were selected for radiography of upper limbs. The standing height of the subject was measured beforehand for each subject. The maximum length of the bones was measured on the x-ray film in cm, and analysis was performed by SPSS version 23. Results Results showed significant correlations between stature and upper limb bones (p 0.05). About eight regression equations were developed, of which three for single bone and one in combination of three bones in males and females. The regression equations with combination of bones showed the highest correlation coefficient (r). However, these regression equations are not suitable yet to be used practically in Malaysian population due to high standard error of estimates. Conclusion In brief, the research study has to be validated with a larger sample size to represent the Malaysian population.

Aim: The current investigation was to examine the intensity of pain in upper limbs experienced by the remote workers. Methods: A questionnaire was developed which includes demographic profile sheet, work profile sheet and upper extremity functional index. These tools were used to gather information from the respondents. Google forms links of the questionnaire were mailed to 500 respondents and of which 198 people have responded. This paper focused on the intensity of pain due to prolonged sitting, working from home without any proper workplace. Result: The pain was common among all the ages of respondents but it was little more in the male and also the pain is present in all the professions. Conclusion: The recent pandemic has put more stress on people regarding work from home, online working while sitting, a little of walking. It has impacted people's physical well-being by developing different type of pain in the body. [ABSTRACT FROM AUTHOR]

Background/Aim: This study aimed to assess the clinical significance of measuring the arm skeletal muscle mass in patients with cirrhosis. Patients and Methods: Using body composition data measured with the bioimpedance analysis (BIA) method, the skeletal muscle mass index (SMI) values of the arm (arm skeletal muscle mass/height²) and leg (leg skeletal mass muscle/height²) were calculated for 353 patients with cirrhosis, and the relationships of these indices to their prognosis were assessed. In addition, overhydration of the upper and lower limbs was compared. Results: Arm SMI was significantly positively associated with the prognosis of patients with cirrhosis (p=0.0002) but leg SMI was not (p=0.0829). The rate of overhydration in the lower limbs was significantly higher than that in the upper limbs (p<0.0001). Conclusion: Arm SMI measured with the BIA method was suggested to be minimally affected by water retention, and might be clinically useful for patients with cirrhosis. [ABSTRACT FROM AUTHOR]