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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]

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.

Assembly lines are related to health risks and work-related musculoskeletal disorders (WMSD), particularly of the neck and upper limbs (WULMSD). The assessment of perceived musculoskeletal symptoms is essential to WULMSD prevention, but studies in this field are lacking. A cross sectional survey on assembly line workers (n=270) was performed. The objective of this study was to analyze the frequency and distribution of upper limb musculoskeletal symptoms in assembly line workers. Participants were predominantly men, with ages between 30 and 40 years. Neck and upper limbs pain/discomfort were the most reported symptoms (35.9%), with intensity predominantly moderate or severe. General Health Status and past musculoskeletal injury were the variables more related to the existence of musculoskeletal symptoms; longer working life in the same company, as under 5 years, were related to higher intensity of symptoms. An early identification of musculoskeletal symptoms and health surveillance over time is of most importance to develop WRULMSD prevention measures.

Objective/Background: Occupational therapists usually assess hand function through standardised tests, however, there is no consensus on how the scores assigned to hand dexterity can accurately measure hand function required for daily activities and few studies evaluate the movement patterns of the upper limbs during hand function tests. This study aimed to evaluate the differences in muscle activation patterns during the performance of three hand dexterity tests. Methods: Twenty university students underwent a surface electromyographic (sEMG) assessment of eight upper limb muscles during the performance of the box and blocks test (BBT), nine-hole peg test (9HPT), and functional dexterity test (FDT). The description and comparison of each muscle activity during the test performance, gender differences, and the correlation between individual muscles' sEMG activity were analysed through appropriate statistics. Results: Increased activity of proximal muscles was found during the performance of BBT (p .5; p

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: Digital games are no longer seen as a form of entertainment detrimental to health. They have become an important tool to improve the treatment of patients, ranging from those who are experiencing a serious illness, such as cancer, to those requiring milder procedures such as physiotherapy. However, there are people who are physically disabled and have difficulty playing digital games. In this line of reasoning, this work presents a systematic review on the use of digital games for people with physical disabilities in the upper limbs. The sources of research were the following indexed databases: IEEE Xplore, Portal of Periodicals of the Coordination of Improvement of Personnel of Higher Level (CAPES), PubMed, Scielo, Science Direct, Scopus and Web of Science. It should be noted that the application of Systematic Mapping in the elaboration of a bibliographical review allowed to identify the main gaps for the development of new research, and to redirect to the main publications related to the study. Finally, the results shows that it is an area that is constantly expanding.

Many power-assist wearable exoskeletons have been developed to provide walking support and gait rehabilitation for elderly subjects and gait-disorder patients. Most designers have focused on a direct power-assist to the wearer's lower limbs. However, gait is a coordinated rhythmic movement of four limbs controlled intrinsically by central pattern generators, with the upper limbs playing an important role in walking. Maintaining a normal gait can become difficult as a person ages, because of decreases in limb coordination, stride length, and gait speed. It is known that coordination mechanisms can be governed by the principle of mutual entrainment, in which synchronization develops through the interaction between nonlinear phase oscillators in biological systems. This principle led us to hypothesize that interactive rhythmic stimulation to upper-limb movements might compensate for the age-related decline in coordination, thereby improving the gait in the elderly. To investigate this hypothesis, we developed a gait-assist wearable exoskeleton that employs interactive rhythmic stimulation to the upper limbs. In particular, we investigated the effects on spatial (i.e., hip-swing amplitude) and temporal (i.e., hip-swing period) gait parameters by conducting walking experiments with 12 healthy elderly subjects under one control condition and five upper-limb-assist conditions, where the output motor torque was applied at five different upper-limb swing positions. The results showed a statistically significant increase in the mean hip-swing amplitude, with a mean increment of about 7% between the control and upper-limb-assist conditions. They also showed a statistically significant decrease in the mean hip-swing period, with a mean decrement of about 2.3% between the control and one of the upper-limb-assist conditions. Although the increase in the hip-swing amplitude and the decrease in the hip-swing period were both small, the results indicate the possibility that interactive rhythmic stimulation to the upper limbs might have a positive effect on the gait of the elderly.

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.)

Neuromotor rehabilitation and recovery of upper limb functions are essential to improve the life quality of patients who have suffered injuries or have pathological sequels, where it is desirable to enhance the development of activities of daily living (ADLs). Modern approaches such as robotic-assisted rehabilitation provide decisive factors for effective motor recovery, such as objective assessment of the progress of the patient and the potential for the implementation of personalized training plans. This paper focuses on the design, development, and preliminary testing of a wearable robotic exoskeleton prototype with autonomous Artificial Intelligence-based control, processing, and safety algorithms that are fully embedded in the device. The proposed exoskeleton is a 1-DoF system that allows flexion-extension at the elbow joint, where the chosen materials render it compact. Different operation modes are supported by a hierarchical control strategy, allowing operation in autonomous mode, remote control mode, or in a leader-follower mode. Laboratory tests validate the proper operation of the integrated technologies, highlighting a low latency and reasonable accuracy. The experimental result shows that the device can be suitable for use in providing support for diagnostic and rehabilitation processes of neuromotor functions, although optimizations and rigorous clinical validation are required beforehand.

Purpose: We investigated the effect of ischemic preconditioning (IPC) on performance of a 3 min maximal effort arm ergometer test in young women.Methods: Twenty healthy women (23.1 (SD 3.3) years) performed a 3 min maximal effort arm cycling exercise, preceded by IPC on both arms or SHAM in a counterbalanced randomized crossover design. Both blood flow (via high resolution ultrasound; n = 17) and muscle oxygenation/deoxygenation (via near infrared spectroscopy; n = 5) were measured throughout the IPC/SHAM. Performance and perceptual/physiological (i.e., heart rate, blood lactate, rating of perceived exertion, and triceps brachialis oxygenation) parameters were recorded during the exercise test.Results: Occlusion during IPC completely blocked brachial artery blood flow, decreased oxygenated hemoglobin/myoglobin (Δ[oxy(Hb + Mb)]), and increased deoxygenated Hb/Mb (Δ[deoxy(Hb + Mb)]). There were no differences (P > 0.797) in performance (peak, mean, and end power output) or in any perceptual/physiological variables during the 3 min all-out test between IPC/SHAM. During exercise, Δ[oxy(Hb + Mb)] initially decreased with no differences (P ≥ 0.296) between conditions and returned towards baseline by the completion of the test while Δ[deoxy(Hb + Mb)] increased with no differences between conditions and remained elevated until completion of the test (P ≥ 0.755).Conclusions: We verified the successful application of IPC via blood flow and NIRS measures but found no effects on performance of a 3 min maximal effort arm cranking test in young women. [ABSTRACT FROM AUTHOR]

Background and purpose: Limited research has been dedicated to upper limb (UL) rehabilitation in progressive multiple sclerosis (PMS). The objective in this pilot study was to investigate the effect of task‐oriented UL rehabilitation in PMS and to perform explorative analyses of the magnetic resonance imaging (MRI) correlates of changes in motor performance. Methods: Twenty‐six PMS patients with mild UL impairment were prospectively enrolled and randomized into two groups: an active treatment group (ATG, n = 13) and a passive treatment group (PTG, n = 13). At baseline and after training, patients underwent MRI scans with structural and functional imaging and were evaluated with the action research arm test, the nine‐hole peg test, the ABILHAND scale and the modified fatigue impact scale (MFIS). Measures of motor finger performance were obtained by engineered glove measuring. Results: After rehabilitation, the ATG improved in several finger motor tasks (0.001 ≤ P ≤ 0.03, 0.72 ≤ Cohen's d ≤ 1.22) and showed reduced MFIS scores compared with the PTG (P = 0.03). The ATG showed increased functional connectivity within the cerebellar and thalamic resting state networks compared with the PTG (P < 0.05). Correlations were found between several measures of motor improvement and thalamic and sensorimotor networks (0.87 ≤ r ≤ 0.93, 0.001 ≤ P ≤ 0.03). No changes in cerebral volumes and diffusion tensor imaging derived measures were detected. Conclusions: Progressive multiple sclerosis patients with mild UL dysfunction benefit from task‐oriented UL rehabilitation, which seems to be more efficient than simple passive mobilization. Despite a high burden of disability and brain damage, functional adaptive capacities seem to be preserved, thus providing a rationale for the use of rehabilitative treatments in late PMS. [ABSTRACT FROM AUTHOR]

Study Design: A prospective, within-subject study was conducted.Objective: We aimed to compare the influence of anesthetic fade under maximum stimulation conditions between constant-current and constant-voltage stimulation techniques.Summary Of Background Data: The monitoring of muscle-evoked potentials after electrical stimulation to the brain [Br(E)-MSEP)] is useful for assessing the integrity of spinal cord motor tracts during major spine surgery. Nonetheless, Br(E)-MSEP responses are known to deteriorate over the duration of surgeries performed under general anesthesia. This phenomenon is known as anesthetic fade.Methods: We recruited 117 patients undergoing various spinal surgeries from the cervical to the lumbar level. We excluded 29 cases with insufficient data. The decrease rate of the Br(E)-MSEP amplitude for each muscle was examined. Br(E)-MSEP monitoring with constant-current and constant-voltage stimulations at the C3 and C4 electrode positions was applied. Compound muscle action potentials (CMAPs) were bilaterally recorded from the abductor pollicis brevis, deltoid, abductor hallucis, tibialis anterior, gastrocnemius, and quadriceps muscles. We defined the decrease rate as follows: (initial CMAPs-final CMAPs)/initial CMAPs × 100. Differences in the decrease rate were evaluated between stimulators, limbs (upper vs. lower), and operative time group (lowest quartile vs. highest quartile).Results: The overall decrease rate (across all muscles) increased as the operative time increased, and the rate was higher in the lower limbs than in the upper limbs. In addition, the overall decrease rate was lower with constant-voltage stimulation than with constant-current stimulation. Furthermore, the decrease rate for constant-current stimulation was significantly higher than that for constant-voltage stimulation, regardless of the operative time.Conclusion: The CMAP waveform with constant-voltage stimulation is less susceptible to anesthetic fade than that with constant-current stimulation, even during long surgeries.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

Background: There is growing evidence that arm movements make a substantial and functionally relevant contribution to dynamic balance. Additional insight of the important role of arm movements may be gained by quantifying the effects of arm restriction on the performance of commonly recommended static balance tasks of increasing difficulty.Research Question: The purpose of the present study was to determine whether restricting/permitting arm movements influences postural sway during tasks of various levels of difficulty.Methods: A total of 20 healthy and physically active adults (females; n = 10; age, 20.7 ± 1.3 years) randomly completed (a) quiet standing postural control tasks of increasing difficulty (bipedal, tandem, unipedal) on a fixed and foam surface, and (b) a dynamic postural control task (Y balance test), under two different verbally conveyed instructions of arm position; (1) restricted arm movement and (2) free arm movement. Centre of pressure outcomes measured during quiet standing served as a measure of static balance performance.Results: The results showed that restricting movements of the arms elicited large magnitude (Cohen's d = 0.97 - 1.28) increases in mediolateral postural sway (P < 0.05) but not anteroposterior (P > 0.05) sway. These effects were only observed during challenging (tandem and unipedal) standing balance tasks. Restricting arm movements elicited a marked reduction in the Y Balance reach distance (all directions, P < 0.001, d = -0.53 to -1.15).Significance: The findings from the present study suggest that the contribution of the arms only become relevant when frontal plane balance is challenged. Moreover, the data indicate that arm movements are vital for the control of mediolateral postural sway. [ABSTRACT FROM AUTHOR]

Active computer workstations may help reduce workplace sedentarism. However, their impact on the upper limb musculoskeletal system is unknown. Subjects participated in two 60-min computer laptop-based Bike-and-Type sessions at different cycling intensities (LOW, HIGH). Upper trapezius and wrist extensor muscle blood flow, sensitivity and pain thresholds, and typing performance were measured intermittently. Neck/shoulder discomfort increased over time (p < 0.001), and was higher in the HIGH intensity (p = 0.036). Blood flow to the trapezius (p = 0.041) and wrist (p = 0.021) muscles were higher during HIGH, and wrist blood flow increased over time (p = 0.01). Trapezius sensitivity threshold significantly decreased over time (p = 0.003). There were no effects on pressure pain thresholds (interaction p = 0.091). Average typing speed was greater during HIGH (p = 0.046) and increased over time (p < 0.001). Time spent biking while typing effectively improved performance, which may facilitate muscle regeneration, although effects depend on biking intensity. [ABSTRACT FROM AUTHOR]

This study investigated the effects of upper-body repeated-sprint training in hypoxia vs. in normoxia on world-level male rugby union players' repeated-sprint ability (RSA) during an international competition period. Thirty-six players belonging to an international rugby union male national team performed over a 2-week period four sessions of double poling repeated-sprints (consisting of 3 × eight 10-s sprints with 20-s passive recovery) either in normobaric hypoxia (RSH, simulated altitude 3000 m, n = 18) or in normoxia (RSN, 300 m; n = 18). At pre- and post-training intervention, RSA was evaluated using a double-poling repeated-sprint test (6 × 10-s maximal sprint with 20-s passive recovery) performed in normoxia. Significant interaction effects (P < 0.05) between condition and time were found for RSA-related parameters. Compared to Pre-, peak power significantly improved at post- in RSH (423 ± 52 vs. 465 ± 69 W, P = 0.002, η²=0.12) but not in RSN (395 ± 65 vs. 397 ± 57 W). Averaged mean power was also significantly enhanced from pre- to post-intervention in RSH (351 ± 41 vs. 388 ± 53 W, P < 0.001, η²=0.15), while it remained unchanged in RSN (327 ± 49 vs. 327 ± 43 W). No significant change in sprint decrement (P = 0.151, η² = 0.02) was observed in RSH (−17 ± 2% vs. −16 ± 3%) nor RSN (−17 ± 2% vs. −18 ± 4%). This study showed that only four upper-body RSH sessions were beneficial in enhancing repeated power production in international rugby union players. Although the improvement from RSA to game behaviour remains unclear, this finding appears of practical relevance since only a short preparation window is available prior to international games. [ABSTRACT FROM AUTHOR]

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Background: Functionality in ALS is usually assessed by the revised functional ALS rating scale (ALSFRS-R). The impact of dominant vs. non-dominant side of upper limb (UL) onset on functionality has not been addressed before. Methods: Consecutive patients with clear UL side dominance and followed in our unit were included. We considered three groups accordingly to side-of-onset: right (RUL), left (LUL) and bilateral UL onset forms. Patients were evaluated with ALSFRS-R, including its respiratory (RofALSFRS-R), bulbar (ALSFRSb), UL (ALSFRSul), and lower limb (ALSFRSll) subscores. T-test and X2 assessed differences. Patients were further compared regarding differences in writing (4th question, Q4, in the ALSFRS-R). A p < 0.01 was considered as meaningful. Results: From the 109 patients (75 men; mean onset age 61.36 ± 13.6; mean disease duration 23.1 ± 28.1 months), 65 had RUL, 38 LUL, and 6 bilateral UL onset forms. Right-side dominance was identified in 104. Patients with writing difficulties (87 in 109) had significantly lower ALSFRS-R and ALSFRSul (p < 0.001), presenting more problems in dressing (p < 0.001) and personal hygiene (p = 0.006). RUL patients had significantly lower Q4 scores than LUL (p = 0.002). No other differences were found between these two groups, including ALSFRS-R (p = 0.257) and ALSFRSul (p = 0.051). Functional impact on UL scores was similar between RUL and bilateral onset patients. Q4 scores were negatively influenced by hand-dominance in RUL patients (p = 0.007). Conclusions: ALSFRS-R is an important tool to assess functional UL involvement in ALS. However, it can mislead clinicians when evaluating right-handed patients with initial LUL onset form. Hand dominance should be considered in ALS functional assessment. [ABSTRACT FROM AUTHOR]

The aim of this study was to verify if the mechanical vibration in the exercise of isometric push-up affects the electrical activity of muscles of the upper limbs and the time until the exhaustion. The subjects were 13 experienced strength-training volunteers (25.52 ± 4.44 yrs). The push-up exercise with vibration of 20 Hz (V20) was accomplished until the exhaustion in one day and on another day without vibration (V00). The electromyographic activity (EMG) of the triceps brachii (TRB) and pectoralis (PT) was measured. There was no difference in the exercise duration between V20 and V00 (P = 0.954), but in the analysis of the complete signal, the Root Mean Square (RMS) of the TRB and PT was higher in V20 compared to V00 (P = 0.015, P = 0.018, respectively) and the Median Frequency (FMA) of the EMG was not different between the situations. The partial analysis of the EMG signal showed that in both muscles RMS was bigger in the 10 last sec (10f) and the FMA significantly lower in 10f compared to initial 10 sec. The findings indicate that the frequency vibration of 20 Hz increased the electrical activity of the upper limb muscles, but did not change the performance of strength resistance. [ABSTRACT FROM AUTHOR]

Transcutaneous and epidural electrical spinal cord stimulation techniques are becoming more valuable as electrophysiological and clinical tools. Recently, remarkable recovery of the upper limb sensorimotor function during cervical spinal stimulation was demonstrated. In the present study, we sought to elucidate the neural mechanisms underlying the effects of transcutaneous spinal cord stimulation (tSCS) of the cervical spine. We hypothesized that cervical tSCS can be used to selectively activate the sensory route entering the spinal cord and transsynaptically converge on upper limb motor pools. To test this hypothesis, we applied cervical tSCS using paired stimuli (homosynaptic depression) and during passive muscle stretching of the wrist flexor (presynaptic inhibition via Ia afferents), voluntary hand muscle contraction (descending facilitation of motoneuron pool), and muscletendon vibration of the wrist (presynaptic inhibition via afferent occlusion). Our results demonstrate significant inhibition of the second evoked response during paired stimulus delivery, inhibition of responses during passive muscle stretching and muscle-tendon vibration, and facilitation during voluntary muscle contraction, which share similarities with responses evoked during lumbosacral tSCS. These results indicate that the route of the stimulation current transmission passes via afferents in the dorsal roots through the spinal cord to activate the motor pools and potentially interneuronal networks projecting to upper limb muscles. Using a novel stimulation paradigm, our study is the first to present evidence of the sensory neuronal pathway of the cervical tSCS propagation. Overall, our work demonstrates the utility and sensitivity of cervical tSCS to engage the sensory pathway projecting to the upper limbs. [ABSTRACT FROM AUTHOR]

Spinal cord injury (SCI) derives in loss of bone mineral content (BMC) and bone mineral density (BMD). However, physical activity is an important determinant in bone mass acquisition, which is partially mediated through the lean mass (LM). The aim was to examine the effect of cardiorespiratory fitness (CRF) on BMD and BMC arms of adult males with SCI and able-bodied controls using the arm LM as a mediator variable. Thirty able-bodied men and thirty men with SCI participated. BMC and BMD were analysed by DXA, and indirect calorimetry was used to calculate VO2peak during a progressive arm-cranking test. When groups were divided by the amount of LM, the subgroup with highest LM had significantly higher arm BMC compared to the lowest LM subgroup (p ≤ 0.05) in both SCI and able-bodied groups. Moreover, same differences were found when confidence intervals were analysed. Only in the SCI group, arm LM mediated the relationship between bone mass and CRF at 30.9%, as indicated by the Sobel test (z = 2.17 and z = 2.04 for BMC and BMD, respectively). In conclusion, LM mediates the indirect association between CRF and bone health, specifically in the arms. This finding highlights the importance of having an adequate CRF for the maintenance of good bone health in SCI men. [ABSTRACT FROM AUTHOR]

Electroencephalography neurofeedback (EEG-NFB) training can induce changes in the power of targeted EEG bands. The objective of this study is to enhance and evaluate the specific changes of EEG power spectral density that the brain-machine interface (BMI) users can reliably generate for power augmentation through EEG-NFB training. First, we constructed an EEG-NFB training system for power augmentation. Then, three subjects were assigned to three NFB training stages, based on a 6-day consecutive training session as one stage. The subjects received real-time feedback from their EEG signals by a robotic arm while conducting flexion and extension movement with their elbow and shoulder joints, respectively. EEG signals were compared with each NFB training stage. The training results showed that EEG beta (12–40 Hz) power increased after the NFB training for both the elbow and the shoulder joints’ movements. EEG beta power showed sustained improvements during the 3-stage training, which revealed that even the short-term training could improve EEG signals significantly. Moreover, the training effect of the shoulder joints was more obvious than that of the elbow joints. These results suggest that NFB training can improve EEG signals and clarify the specific EEG changes during the movement. Our results may even provide insights into how the neural effects of NFB can be better applied to the BMI power augmentation system and improve the performance of healthy individuals.

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.

Processing and control systems based on artificial intelligence (AI) have progressively improved mobile robotic exoskeletons used in upper-limb motor rehabilitation. This systematic review presents the advances and trends of those technologies. A literature search was performed in Scopus, IEEE Xplore, Web of Science, and PubMed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology with three main inclusion criteria: (a) motor or neuromotor rehabilitation for upper limbs, (b) mobile robotic exoskeletons, and (c) AI. The period under investigation spanned from 2016 to 2020, resulting in 30 articles that met the criteria. The literature showed the use of artificial neural networks (40%), adaptive algorithms (20%), and other mixed AI techniques (40%). Additionally, it was found that in only 16% of the articles, developments focused on neuromotor rehabilitation. The main trend in the research is the development of wearable robotic exoskeletons (53%) and the fusion of data collected from multiple sensors that enrich the training of intelligent algorithms. There is a latent need to develop more reliable systems through clinical validation and improvement of technical characteristics, such as weight/dimensions of devices, in order to have positive impacts on the rehabilitation process and improve the interactions among patients, teams of health professionals, and technology.

Abstract Background Several recent studies have described the presence of musculoskeletal complaints, presenting evidence that multisite musculoskeletal pain (MP) is more often present than single-site musculoskeletal pain. However, less is known about determinants of this multimorbidity, particularly, concerning the role of occupational factors and, mainly, what determines single or multisite pain. This study described the associations between pain in different body sites and investigated related factors to MP in workers from Brazil. Methods A total of 1070 workers (228 women and 842 men), from urban cleaning services and from shoe manufacturers, participated in this cross sectional study (response 97 %). Interviewer-administered questionnaire included sociodemographic factors, physical and psychosocial work demands, leisure-time activities and musculoskeletal pain which was presence of pain in previous seven days, considering eight body sites and MP, the sum score of all painful sites, varying 0–8. A factor analysis was performed that captured the nine variables of physical exposure into two latent factors. Associations of pain between different body sites were assessed. Cox regression analyses, presenting the prevalence ratio (PR), showed the related factors to MP. Results In the previous seven days, 30 % of workers had MP. For all body sites, comorbidity ranged from 72 % to 91 %. Having pain in one body site is associated with pain in other site and the associations between proximal sites were stronger than between more distal sites. High exposure to manual material handling and awkward postures (PR = 1.5, 95 % CI 1.1–2.0), job strain (PR = 1.2, 95 % CI 1.0–1.6), and low social support (PR = 1.3, 95 % CI 1.0–1.7) and being woman (PR = 1.7, 95 % CI 1.3–2.3) were associated with MP. Risk factors for single–site pain and for subsequent musculoskeletal comorbidity were very similar, suggesting an additive effect of risk factors. Conclusions Most workers reported MP that was associated with several work-related factors. The findings support the idea that multisite pain is a continuum of single-site pain, maintained by exposure to several risk factors, rather than the result of a specific risk factor that initiates the multisite pain but not single-site pain. Workplace interventions are needed to decrease the number of pain sites, in order to improve the worker’s health.

The use of videogames and motion capture systems in rehabilitation contributes to the recovery of the patient. This systematic review aimed to explore the works related to these technologies. The PRISMA method (Preferred Reporting Items for Systematic reviews and Meta-Analyses) was used to search the databases Scopus, PubMed, IEEE Xplore, and Web of Science, taking into consideration four aspects: physical rehabilitation, the use of videogames, motion capture technologies, and upper limb rehabilitation. The literature selection was limited to open access works published between 2015 and 2020, obtaining 19 articles that met the inclusion criteria. The works reported the use of inertial measurement units (37%), a Kinect sensor (48%), and other technologies (15%). It was identified that 26% used commercial products, while 74% were developed independently. Another finding was that 47% of the works focus on post-stroke motor recovery. Finally, diverse studies sought to support physical rehabilitation using motion capture systems incorporating inertial units, which offer precision and accessibility at a low cost. There is a clear need to continue generating proposals that confront the challenges of rehabilitation with technologies which offer precision and healthcare coverage, and which, additionally, integrate elements that foster the patient’s motivation and participation.

Motor-cognitive dual tasks have been intensely studied and it has been demonstrated that even well practiced movements like walking show signs of interference when performed concurrently with a challenging cognitive task. Typically walking speed is reduced, at least in elderly persons. In contrast to these findings, some authors report an increased movement frequency under dual-task conditions, which they call hastening. A tentative explanation has been proposed, assuming that the respective movements are governed by an automatic control regime. Though, under single-task conditions, these automatic processes are supervised by “higher-order” cognitive control processes. However, when a concurrent cognitive task binds all cognitive resources, the automatic process is freed from the detrimental effect of cognitive surveillance, allowing higher movement frequencies. Fast rhythmic movements (>1 Hz) should more likely be governed by such an automatic process than low frequency discrete repetitive movements. Fifteen subjects performed two repetitive movements under single and dual-task condition, that is, in combination with a mental calculation task. According to the expectations derived from the explanatory concept, we found an increased movement frequency under dual-task conditions only for the fast rhythmic movement (paddleball task) but not for the slower discrete repetitive task (pegboard task). fNIRS measurements of prefrontal cortical load confirmed the idea of an automatic processing in the paddleball task, whereas the pegboard task seems to be more controlled by processes interfering with the calculation related processing.

In this article, we present a case study involving a patient with spinal cord injury (SCI), resulting in tetraplegia and subsequent loss of upper limb function. The subject of our study was a 23-year-old woman with incomplete tetraplegia stemming from a cervical spinal cord injury. Our primary objective was to enhance hand function and grip strength. Throughout the intervention, we observed substantial enhancements in hand function, range of motion, and muscle power. Notably, the patient exhibited a favorable response to the therapy, demonstrating commendable adherence and active participation. To create an optimal training environment tailored to the patient's needs, we employed the Unity 3D game engine in conjunction with a Leap Motion controller sensor. This combination facilitated the development of a semi-immersive virtual training environment. The utilization of this technology aimed to simulate a conducive training atmosphere for the rehabilitation of hand function. Based on our study outcomes, we advocate for the incorporation of leap motion-related exercises in the treatment of hand functional loss and weakness. The promising results observed in this case study prompt the recommendation for further large-scale studies to validate and substantiate our findings. Such investigations would contribute to the establishment of evidence-based practices and enhance the understanding of the efficacy of Leap Motion technology in addressing upper limb impairments associated with spinal cord injuries., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Al Nattah et al.)

This paper presents a novel kinematic reconstruction of the human arm chain with five degrees of freedom and the estimation of the shoulder location during rehabilitation therapy assisted by end-effector robotic devices. This algorithm is based on the pseudoinverse of the Jacobian through the acceleration of the upper arm, measured using an accelerometer, and the orientation of the shoulder, estimated with a magnetic angular rate and gravity (MARG) device. The results show a high accuracy in terms of arm joints and shoulder movement with respect to the real arm measured through an optoelectronic system. Furthermore, the range of motion (ROM) of 50 healthy subjects is studied from two different trials, one trying to avoid shoulder movements and the second one forcing them. Moreover, the shoulder movement in the second trial is also estimated accurately. Besides the fact that the posture of the patient can be corrected during the exercise, the therapist could use the presented algorithm as an objective assessment tool. In conclusion, the joints’ estimation enables a better adjustment of the therapy, taking into account the needs of the patient, and consequently, the arm motion improves faster.

Background: Shoulder injuries are substantial problems in overhead athletes, and more studies are necessary to deepen the knowledge on this type of injury. The objective of this study was to compare the overall function and performance of female overhead athletes with and without a previous history of shoulder injuries., Methods: In this cross-sectional study, female overhead athletes with and without a previous shoulder injury were included. Muscular impairment, the stability of the shoulder, strength, scapular dyskinesia, functionality and sports performance were evaluated. A total of 50 females were included., Results: There were significant differences in strength ( p = 0.046) and stability ( p = 0.039) between groups, with a poorer score in the group with a history of shoulder injury. Regarding scapular dyskinesia, significant differences were also observed between groups ( p = 0.048), with higher levels of dyskinesia in the group with previous shoulder injury. Also, muscular impairment showed significant differences between groups for the three muscles evaluated ( p < 0.005). Additionally, the group without a previous shoulder injury presented with a significantly greater score in functionality ( p = 0.046) and sports performance ( p = 0.004)., Conclusion: In conclusion, previous shoulder injuries are an important factor to take into account in female overhead athletes. Players with a history of shoulder injury present clinical impairments during the game, leading to poorer functional status and performance in sport.

The aim of this study is to assess quantitatively the effects of a computer-assisted system (ARMEO Spring system) to improve upper extremity function in hemiplegic children due to Cerebral Palsy (CP), by means of clinical-functional scales and upper limb kinematics. Twenty-one children with hemiplegia were clinically assessed with Quality of Upper Extremities Skills Test and Melbourne Assessment and instrumentally by 3D movement analysis during reaching task. Data were collected before and after 4 weeks of treatment with the ARMEO Spring system. A control group of 15 healthy children was included as reference. After the ARMEO Spring training, the clinical scores improved significantly. In terms of kinematics, the affected limbs improved in terms of the movement duration and velocity, smoothness (Average Jerk) and Number of Movement Unit parameters. From these results, the ARMEO Spring training seems to be a promising intervention for improving upper limb function in hemiplegic children. [ABSTRACT FROM AUTHOR]

Background: Limb amputation can be defined as a procedure that consists of separating a limb or a segment of a limb from the body. Objectives: To describe the profile of limb amputation procedures performed at a large hospital run by the state of Pernambuco (Brazil). Methods: Cross-sectional descriptive and retrospective study conducted at a large hospital in the city of Recife, PE. Data were collected from the records of patients who underwent amputations during 2017. Records from patients who had had a limb amputation during 2017 were included, unless data were illegible or missing. Results: A total of 328 procedures were performed on 274 patients, the majority of whom were male (57.7%). There was a predominance of lower limb amputations (64.2%), of non-traumatic causes (86.5%), and urgent treatment (96.4%). The majority of patients who underwent amputations remained in hospital for 11 to 25 days (32.1%). The study found that the majority of amputees were discharged (69.7%), although a proportion died. Deaths of lower limb amputees were primarily among elderly women in the age range of 60 to 90 years (76%), females (55%), and patients subjected to a single amputation (91%). Conclusions: The data observed in this study are alarming, particularly considering that many of these amputations could have been avoided, since they were caused by complications of diseases that can be prevented and controlled at healthcare services of a lower level of complexity and at a relatively low cost. [ABSTRACT FROM AUTHOR]

Background: An engineered glove measuring finger motor performance previously showed ability to discriminate early‐stage multiple sclerosis (MS) patients from healthy controls (HCs). Radiologically isolated syndrome (RIS) classifies asymptomatic subjects with brain magnetic resonance imaging (MRI) abnormalities suggestive of multiple sclerosis. Methods: Seventeen asymptomatic subjects with RIS and 17 HCs were assessed. They performed finger‐to‐thumb opposition sequences at their maximal velocity, metronome‐paced bimanual movements and conventional and diffusion tensor MRI. Results: Subjects with RIS showed lower (P = 0.005) maximal velocity and higher (P = 0.006) bimanual coordination impairment than HCs. In RIS, bimanual coordination correlated with T2‐lesion volume, fractional anisotropy and radial diffusivity in the white matter. Conclusions: These findings point out the relevance of fine hand measures as a robust marker of subclinical disability. [ABSTRACT FROM AUTHOR]

Purpose: This study was conducted to test the effects of conscious abdominal contraction on electromyographic activity of the periscapular muscles during two isometric exercises. Methods: Eighteen subjects participated in the study. Electromyographic signals of the upper, middle and lower trapezius, upper and lower portion of the anterior serratus, external and internal oblique were obtained during two variations of isometric exercises (bilateral and 3-point push-ups) with and without conscious contraction. Two-way ANOVA was used to detect differences during the exercises and conscious abdominal contraction. Relationships between the abdominal and periscapular muscles was checked by Pearson correlation. Key Results: Conscious abdominal contraction increased the activity of anterior serratus in both exercises. The trapezius muscle was not influenced by the exercises. All the analyzed muscles showed higher activity during the 3-point exercise without conscious abdominal contraction. The conscious abdominal contraction only provided an increase in trapezius activity during the bilateral exercise. Positive correlations were observed between activity of the external oblique muscle with upper and lower anterior serratus in both exercises. Conclusion: Conscious abdominal contraction is effective to increase serratus activity. Regarding the trapezius muscles, conscious abdominal contraction increase muscular activity when combined with the bilateral push-up exercise, but the activity with the 3-point exercise was not significant. [ABSTRACT FROM AUTHOR]

We studied the short-latency (SL) effects of postural perturbations produced by impulses applied over the spine of the C7 vertebra or the sternum (“axial impulses”) in 12 healthy subjects. EMG recordings were made bilaterally from the triceps brachii, biceps brachii, soleus, and tibialis anterior muscles, and unilaterally from the deltoid, forearm flexors, forearm extensors, and first dorsal interosseous (FDI) muscles. Sternal impulses evoked short-latency responses in the biceps when subjects leaned posteriorly to support approximately 12% of their body weight with the arms, but these responses were only modestly larger than for isometric contraction of the arms (26.3 vs. 14.7%). In contrast, clear excitatory responses could be evoked in the deltoid, triceps, forearm muscles, and FDI when leaning anteriorly to support similar amounts of body weight. These responses were significantly larger than during isometric contraction. The deltoid (42.5%) and triceps (44.7%) had the largest responses in supported anterior lean and onset latencies increased distally in this condition (mean 31.8 ms in deltoid to 53.7 ms in FDI). There was a disproportionate delay between the forearm muscles and FDI. For both directions of lean, postural reflex responses normally present in the legs were severely attenuated. SL upper limb excitatory responses were bigger in proximal muscles as well as larger and more widespread for anterior axial perturbations compared to posterior axial perturbations when using the arms to support body weight. Our findings also provide further evidence of a role for reticulospinal pathways in mediating these rapid postural responses to accelerations of the trunk. [ABSTRACT FROM AUTHOR]

THE IMPORTANCE OF ARM ACTION DURING SPRINT RUNNING HAS BEEN AN ONGOING DISCUSSION AMONG PRACTITIONERS. ALTHOUGH SOME COACHES BELIEVE THAT THE ARMS SERVE TO MERELY PROVIDE BALANCE TO THE ROTARY MOMENTUM OF THE LEGS, OTHERS BELIEVE THAT THE ARMS ARE VITAL TO SPRINT RUNNING PERFORMANCE AND CONTRIBUTE TO PROPULSIVE FORCES. ALTHOUGH A LARGE BODY OF RESEARCH HAS BEEN UNDERTAKEN INTO THE EFFECTS OF LEG KINEMATICS AND KINETICS ON SPRINT RUNNING PERFORMANCE, THE ROLE OF ARM ACTION REMAINS AMBIGUOUS AND UNDERINVESTIGATED. THEREFORE, THE PURPOSE OF THIS REVIEW IS TO IMPROVE UNDERSTANDING RELATED TO ARM MECHANICS DURING SPRINT RUNNING AND PROVIDE PRACTICAL CONTEXT GUIDELINES. [ABSTRACT FROM AUTHOR]

Upper limb work-related musculoskeletal disorders have a 12-month prevalence ranging from 12 to 41% worldwide and can be partly caused by handling low loads at high frequency. The association between the myoelectric manifestation of elbow flexor muscle fatigue and occupational physical demand has never been investigated. It was hypothesized that an elbow flexor muscle fatigue index could be a valid risk indicator in handling low loads at high frequency. This study aims to measure the myoelectric manifestation of muscle fatigue of the three elbow flexor muscles during the execution of the work tasks in different risk conditions. Fifteen right-handed healthy adults were screened using a movement analysis laboratory consisting of optoelectronic, dynamometer and surface electromyographic systems. The main result indicates that the fatigue index calculated from the brachioradialis is sensitive to the interaction among risk classes, session and gender, and above all it is sensitive to the risk classes. [ABSTRACT FROM AUTHOR]

Background In clinical routine, upper limb motor disorders of people with Parkinson's disease are commonly assessed using scale- or timed tests, but such tools are not fully suitable for providing detailed information about their type and magnitude. To partly overcome these limitations, the present study aims to quantitatively investigate upper limb functional impairments through quantitative analysis of the “hand-to-mouth” task. Methods Twenty-five individuals with Parkinson's disease and 20 age-matched healthy individuals underwent a kinematic analysis of the hand-to-mouth task from which spatio-temporal and kinematic measures, including summary measures (Arm Variable Score and Arm Profile Score), were calculated and correlated with clinical scores (Hoehn & Yahr, H&Y and the Unified Parkinson Disease Rating Scale, UPDRS). Findings The “hand-to-mouth” movement is significantly altered in individuals with Parkinson's disease, especially in terms of reduced velocity, reduced range of motion of elbow flexion-extension and deviation from a physiologic pattern (Arm Profile Score 12.8° vs. 10.1° of unaffected, P  = 0.002). Significant moderate correlations were found between movement duration and UPDRS-III (rho = 0.478, P  = 0.001) and between the Arm Profile Score and H&Y (rho = 0.481, P  = 0.024) and UPDRS-III (rho = 0.326, P  = 0.001). Interpretation On the basis of such findings, we can state that the kinematic analysis of “hand-to-mouth” movement, and in particular the summary indexes, are suitable for easily representing upper limb movement alterations in people with Parkinson's disease, thus allowing the monitoring either of disease progression or effectiveness of pharmacologic and rehabilitative treatments. [ABSTRACT FROM AUTHOR]

Background: The study aims to determine the effectiveness of robot-assisted training in the recovery of stroke-affected arms using an exoskeleton robot Armeo Spring.Objective: To identify the effect of robot training on functional recovery of the arm.Methods: A total of 34 stroke patients were divided into either an experimental group (EG; n= 17) or a control group (n= 17). EG was also trained to use the Armeo Spring during occupational therapy. Both groups were clinically assessed before and after treatment. Statistical comparison methods (i.e. one-tailed t-tests for differences between two independent means and the simplest test) were conducted to compare motor recovery using robot-assisted training or conventional therapy.Results: Patients assigned to the EG showed a statistically significant improvement in upper extremity motor function when compared to the CG by FIM (P< 0.05) and ACER (P< 0.05). The calculated treatment effect in the EG and CG was meaningful for shoulder and elbow kinematic parameters.Conclusions: The findings show the benefits of robot therapy in two areas of functional recovery. Task-oriented robotic training in rehabilitation setting facilitates recovery not only of the motor function of the paretic arm but also of the cognitive abilities in stroke patients. [ABSTRACT FROM AUTHOR]

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