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While past research has largely supported the importance of physical activity for the health of older adults, during the COVID-19 pandemic, older individuals may have reduced their opportunities and levels of physical activity to lower the risk of infection by minimizing outings or interactions with others. Additionally, the adequacy of medical resources in a region is often closely related to factors such as infrastructure and economic resources. Therefore, it is important to consider whether there are differences in health promotion among older adults living in areas with varying levels of medical resources. This study aimed to implement a physical activity program for older adults, selecting Keelung City, Taiwan, as the implementation area, and comparing the differences in implementation effectiveness among administrative districts with different levels of medical resources in the city. The study employed a two-way analysis of variance to examine the differences in the effectiveness of the physical activity program among administrative districts, where the average service population in medical institutions was higher or lower than the city average. The results revealed significant improvements in participants' right-hand grip strength and the number of sit-to-stand repetitions in the overall sample after the program intervention. Moreover, in administrative districts where the average service population in medical institutions was higher than the city average, participants showed greater improvement in grip strength, while in districts where it was lower than the city average, participants demonstrated greater improvement in sit-to-stand repetitions. Future research could draw upon these findings to design physical activity programs tailored to different regions with distinct allocations of medical resources. Tailored program designs considering local medical resources are necessary to optimize effectiveness. Governments and organizations should focus on elderly health, especially in resource-scarce areas, by increasing investment and support for these programs to promote well-being and bridge disparities. [ABSTRACT FROM AUTHOR]

Purpose: Accurate perception of tactile stimuli is essential for performing and learning activities of daily living. Through this scoping review, we sought to summarize existing examination approaches for identifying tactile deficits at the upper extremity in individuals with stroke. The goal was to identify current limitations and future research needs for designing more comprehensive examination tools. Methods: A scoping review was conducted in accordance with the Joanna Briggs Institute methodological framework and the PRISMA for Scoping Reviews (PRISMA-ScR) guidelines. A database search for tactile examination approaches at the upper extremity of individuals with stroke was conducted using Medline (Ovid), The Cochrane Library (Wiley), CINAHL Plus with Full Text (Ebsco), Scopus (Elsevier), PsycInfo (Ebsco), and Proquest Dissertations and Theses Global. Original research and review articles that involved adults (18 years or older) with stroke, and performed tactile examinations at the upper extremity were eligible for inclusion. Data items extracted from the selected articles included: if the examination was behavioral in nature and involved neuroimaging, the extent to which the arm participated during the examination, the number of possible outcomes of the examination, the type(s) of tactile stimulation equipment used, the location(s) along the arm examined, the peripheral nerves targeted for examination, and if any comparison was made with the non-paretic arm or with the arms of individuals who are neurotypical. Results: Twenty-two articles met the inclusion criteria and were accepted in this review. Most examination approaches were behavioral in nature and involved self-reporting of whether a tactile stimulus was felt while the arm remained passive (i.e., no volitional muscle activity). Typically, the number of possible outcomes with these behavioral approaches were limited (2-3), whereas the neuroimaging approaches had many more possible outcomes ( > 15 ). Tactile examinations were conducted mostly at the distal locations along the arm (finger or hand) without targeting any specific peripheral nerve. Although a majority of articles compared paretic and non-paretic arms, most did not compare outcomes to a control group of individuals who are neurotypical. Discussion: Our findings noted that most upper extremity tactile examinations are behavioral approaches, which are subjective in nature, lack adequate resolution, and are insufficient to identify the underlying neural mechanisms of tactile deficits. Also, most examinations are administered at distal locations of the upper extremity when the examinee's arm is relaxed (passive). Further research is needed to develop better tactile examination tools that combine behavioral responses and neurophysiological outcomes, and allow volitional tactile exploration. Approaches that include testing of multiple body locations/nerves along the upper extremity, provide higher resolution of outcomes, and consider normative comparisons with individuals who are neurotypical may provide a more comprehensive understanding of the tactile deficits occurring following a stroke. [ABSTRACT FROM AUTHOR]

Background: Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) is a rare syndrome. The following case shows an atypical course of the disease with successful treatment. In addition, the accompanied review highlights current findings in the pathogenesis and treatment. Clinicians should be aware of the differential diagnosis of RS3PE syndrome. Case presentation: A 67-year-old female patient with recurrent, asymmetric, and painful swelling of both hands with pitting edema, predominantly affecting the dorsal right hand, presented at our in-patient clinic. Over the years of her disease, first diagnosed as rheumatoid arthritis and then psoriatic arthritis, prednisolone treatment had the most favorable effects over various disease-modifying antirheumatic drugs. Subsequent diagnostic evaluation confirmed RS3PE syndrome, a rare inflammatory disorder primarily affecting the elderly population. Manifesting as symmetrical joint inflammation of small joints with pitting edema, RS3PE syndrome typically onsets suddenly and may be accompanied by systemic symptoms like fever, fatigue, and weight loss. Although the precise etiology remains enigmatic, both the innate and the adaptive immune system seem to play a pathogenic role. Treatment is conventionally based on prednisolone, which effectively mitigates symptoms. Ultimately, RS3PE was diagnosed in the context of psoriatic arthritis without dermatological or nail involvement. Given the unusual presentation marked by female gender, asymmetry, and prolonged and extensive disease with various prior treatments and in the context of psoriatic arthritis, a tumor necrosis factor alpha inhibitor was initiated in addition to low-dose prednisolone resulting in clinical remission for the first time. Conclusions: In conclusion, the aforementioned atypical manifestation highlights the significance of including RS3PE syndrome as a potential differential diagnosis, particularly in instances where specific diagnostic criteria for rheumatoid arthritis, polymyalgia rheumatica, or psoriatic arthritis are absent. RS3PE responds well to the administration of prednisolone. In refractory cases, a therapeutic trial with tumor necrosis factor alpha inhibitors can be conducted. [ABSTRACT FROM AUTHOR]

Introduction: About 17–80% stroke survivors experience the deficit of upper limb function, which strongly influences their independence and quality of life. Robot-assisted training and functional electrical stimulation are commonly used interventions in the rehabilitation of hemiplegia upper extremities, while the effect of their combination remains unclear. The aim of this trial is to explore the effect of robot-assisted upper limb training combined with functional electrical stimulation, in terms of neuromuscular rehabilitation, compared with robot-assisted upper limb training alone. Methods: Individuals (n = 60) with the first onset of stroke (more than 1 week and less than 1 year after stroke onset) will be considered in the recruitment of this single-blinded, three-arm randomized controlled trial. Participants will be allocated into three groups (robot-assisted training combined with functional electrical stimulation group, robot-assisted training group, and conventional rehabilitation therapies group) with a ratio of 1:1:1. All interventions will be executed for 45 min per session, one session per day, 5 sessions per week for 6 weeks. The neuromuscular function of the upper limb (Fugl-Meyer Assessment of upper extremity), ability of daily life (modified Barthel Index), pain (visual analogue scale), and quality of life (EQ-5D-5L) will be assessed at the baseline, at the end of this trial and after 3 months follow-up. Two-way repeated measures analysis of variance will be used to compare the outcomes if the data are normally distributed. Simple effects tests will be used for the further exploration of interaction effects by time and group. Scheirer-Ray-Hare test will be used if the data are not satisfied with normal distribution. Discussion: We expect this three-arm randomized controlled trial to explore the effectiveness of robot-assisted training combined with functional electrical stimulation in improving post-stroke upper limb function compared with robot-assisted training alone. Trial registration: Effect of upper limb robot on improving upper limb function after stroke, identifier: ChiCTR2300073279. Registered on 5 July 2023. [ABSTRACT FROM AUTHOR]

This study examined functional trajectories of subjects during the transition phase between ambulatory and non-ambulatory Duchenne muscular dystrophy (DMD) to inform clinical trial designs for new therapeutics. Ambulatory, pulmonary, and upper limb function leading up to loss of ambulation (LoA) and non-ambulatory measures following LoA were quantified; time ordering of pulmonary and upper limb milestones relative to LoA were determined; and the 10-second time threshold for 10-meter walk/run (10MWR) as a marker of approaching LOA was explored. Included in this analysis were 51 subjects aged between 7 and 18 years who experienced LoA during follow-up in the PRO-DMD-01 natural history study. Mean age at LoA was 12.7 (7.1–18.6) years. Mean annual rates of decline in forced vital capacity (FVC) <80%-predicted and performance of upper limb (PUL) 1.2 total score were smaller before than after LoA, but not significantly (FVC %-predicted: 5.6% vs. 10.1%, p = 0.21; PUL 1.2 total score: 2.3 vs. 3.8 units, p = 0.20). More than half of patients experienced clinically significant deficits in FVC %-predicted and PUL 1.2 before experiencing LoA. Among subjects with baseline 10MWR >10 s, those with <1 year to LoA had similar mean ages but significantly worse mean ambulatory function at baseline compared to those with ≥1 year to LoA. Enriching DMD clinical trials for patients with declining pulmonary or upper limb function is achievable without restricting enrollment to non-ambulatory patients. The sequencing of LoA and initial deficits in pulmonary and upper limb function varied across patients and highlights the potential for composite outcomes or multi-outcome trial designs to assess disease-modifying therapies more comprehensively. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to examine the differences in upper limb apraxia assessments and neuropsychological profiles of patients diagnosed with Alzheimer's disease (AD) dementia and mild cognitive impairment (MCI) and healthy controls. Patients and methods: A total of 53 participants were included in the retrospective study, including nine patients with MCI, 23 patients diagnosed with AD, and 21 healthy patients equivalent in age and education level. The participants' data were collected between July 2021 and December 2022. A 12-question mini-test taken from the Test of Upper Limb Apraxia (TULIA) was used in the apraxia evaluation. Individuals' upper limb apraxia evaluations were compared according to diagnostic groups, and their neuropsychological profiles were also examined. Results: Apraxia was found to be associated with impairments in memory retrieval function, executive dysfunction, and decrease in object naming performance. Significant differences were observed between diagnostic groups in both apraxia assessment and neuropsychological tests. Conclusion: The findings indicate that the cognitive profile that emerges with the combined use of upper extremity apraxia assessment and related neuropsychological tests may serve as a marker and guide in the planning and correct execution of treatment in the transition to Alzheimer-type dementia, similar to other neuropsychological tests. [ABSTRACT FROM AUTHOR]

Over the past few years, ARM has been the dominant player in embedded systems and System-on-Chips (SoCs). With the emergence of hardware platforms based on the RISC-V architecture, a practical comparison focusing on their energy efficiency and performance is needed. In this study, our goal is to comprehensively evaluate the energy efficiency and performance of ARM and RISC-V SoCs in three different systems. We will conduct benchmark tests to measure power consumption and overall system performance. The results of our study are valuable to developers and researchers looking for the most appropriate hardware platform for energy-efficient computing applications. Our observations suggest that RISC-V Instruction Set Architecture (ISA) implementations may demonstrate lower average power consumption than ARM, but this does not automatically imply a superior performance per watt ratio for RISC-V. The primary focus of the study is to evaluate and compare these ISA implementations, aiming to identify potential areas for enhancing their energy efficiency. Furthermore, to ensure the practical applicability of our findings, we will use the Computational Fluid Dynamics software OpenFOAM. This step serves to validate the relevance of our results in real-world scenarios. It allows us to fine-tune execution parameters based on the insights gained from our initial study. By doing so, we aim not only to provide meaningful conclusions but also to investigate the transferability of our results to practical applications. Our analysis will also scrutinize the capabilities of these SoCs when handling nonsynthetic software workloads, thereby broadening the scope of our evaluation. [ABSTRACT FROM AUTHOR]

Differential censoring, which refers to censoring imbalance between treatment arms, may bias the interpretation of survival outcomes in clinical trials. In 146 phase III oncology trials with statistically significant time-to-event surrogate primary endpoints, we evaluated the association between differential censoring in the surrogate primary endpoints, control arm adequacy, and the subsequent statistical significance of overall survival results. Twenty-four (16%) trials exhibited differential censoring that favored the control arm, whereas 15 (10%) exhibited differential censoring that favored the experimental arm. Positive overall survival was more common in control arm differential censoring trials (63%) than in trials without differential censoring (37%) or with experimental arm differential censoring (47%; odds ratio = 2.64, 95% confidence interval = 1.10 to 7.20; P  = .04). Control arm differential censoring trials more frequently used suboptimal control arms at 46% compared with 20% without differential censoring and 13% with experimental arm differential censoring (odds ratio = 3.60, 95% confidence interval = 1.29 to 10.0; P  = .007). The presence of control arm differential censoring in trials with surrogate primary endpoints, especially in those with overall survival conversion, may indicate an inadequate control arm and should be examined and explained. [ABSTRACT FROM AUTHOR]

Pneumatic artificial muscle (PAM) has attracted significant attention owing to its safe and compliant physical properties in industrial manipulators, along with advanced service technologies. Since PAM is prone to large deformation problems, actuation control, and dynamic identification is required to perceive considering precise and fast computation. This article presents a methodology for accurate dynamic modeling and analysis of a planar robotic arm in the presence of large deformations caused by the artificial muscle. This novel planar robotic arm with pneumatic actuation and spring loaded in an antagonistic form is designed and fabricated. This article deals with the displacement analysis of a new type of PAM-actuated mechanism for large deformation. The aim is to find an accurate mathematical model of this robotic arm with motion nonlinearity. Since vibration can be generated in the articulating operations according to the dynamic behavior of PAM, a transfer-matrix method is proposed to explore the effect of flexibility undergoing planar flexural deformation. An explanation of the procedure through presenting its general formulation is employed to experiment. The discrete method is analyzed beside the rich datasets generated for actuator identification in the preliminary experimental study. The transfer matrices are determined considering the flexibilities whereas results are verified using MSC.ADAMS©. Experimental validation and numerical modeling confirm that the presented modeling methods help to improve the performance of the pneumatic muscle drives in high-precision manipulators. This study leaves room for further development of this algorithmic framework with a more complicated mechanism with soft pneumatic network actuators for various designs. [ABSTRACT FROM AUTHOR]

Introduction: Stellate ganglion block (SGB) provides diagnostic and therapeutic benefits in pain syndromes in the head, neck, and upper extremity, including complex regional pain syndrome Types I and II, Raynaud's disease, hyperhidrosis, arterial embolism in the region of the arm. Methods: We present a novel ultrasound‐guided supraclavicular stellate ganglion block. Considering the existing anatomical structures of the targeted area. Results and Conclusions: We hope that we can provide fewer complications and additional benefits with this new approach. [ABSTRACT FROM AUTHOR]

Humans possess an incredible capacity for dexterity, but independent finger control is limited. One factor constraining finger independence is the connections between the tendons of the extrinsic finger muscles. The aim of this study was to assess to what extent the linkages between the distal tendons of flexor digitorum profundus (FDP) and those of the flexor digitorum superficialis (FDS) constrain finger independence. Experiments on human fresh frozen cadaveric upper extremities (n = 6) were performed. First, one finger (target) was flexed whereas the other (nontarget) fingers were held in a nearly extended position. The change (Δ) in total flexion angle (∑Θ; i.e., the sum of angles of the different finger joints) of the target finger from the ∑Θ corresponding to the extended position at the start of the movement until the ∑Θ corresponding to the onset of force exertion at the nontarget fingers was assessed. Second, the distribution of force across the four fingers upon loading the tendon of the target finger was assessed for two finger positions (extended, 90° flexion of metacarpal phalangeal joint). For both muscles and for all fingers, the range of independent movement was small (<7°). Δ∑Θ at force onset was lowest for fingers immediately adjacent to the target finger and highest for more distant fingers. For both muscles and for all fingers, some of the target finger force (<14% for FDP, <2% for FDS) was distributed to the nontarget fingers, which increased (up to 58%) only for FDP in response to target finger flexion. We conclude that mechanical connections between the FDP and FDS tendons constrain finger independence. Such constraints become apparent when moving one finger relative to the other fingers. [ABSTRACT FROM AUTHOR]

The purposes for performing negative pressure wound therapy (NPWT) in severe burns are diverse, but few reports comprehensively discussing its indications and methods have been published. We included patients with a ≥30% total burn area. There were 4 patients, and a total of 9 NPWT were performed. The therapy sites were the upper extremity (n = 2), the elbow (n = 1), the dorsum of the hand (n = 5), and the knee (n = 1). The purposes of the therapy were bridge-to-skin grafting (n = 5), dressing the artificial dermis (n = 1), therapy for bolstering the autograft (n = 1), bridge-to-flap surgery (n = 1), and covering the flap (n = 1). The devices used were bedside wall suction (n = 5) and dedicated device (n = 3). Therapy was converted to wall aspiration after use of the dedicated device in 1 case. NPWT is an effective option in severe burn treatment. For each purpose, it is necessary to consider the device used, negative pressure setting, starting date, frequency of dressing changes, and period of therapy. NPWT in severe burns also has the advantage of prioritizing life-prolonging treatment. If strict control of negative pressure is required, a dedicated device should be used rather than wall suction. [ABSTRACT FROM AUTHOR]

Purpose: This systematic review aimed to understand older people's perspectives of associated fear-avoidant beliefs following upper limb fracture. Methods: Published and unpublished literature databases were systematically searched from inception to 1st April 2023. Qualitative studies reporting the perspectives of fear-avoidant beliefs or behaviours in people who had sustained an upper limb fracture were eligible. Data extracted included characteristics of people interviewed, experiences and perceptions of fear, fear of falling, and fear-avoidant beliefs and behaviours. Data were synthesised using a meta-ethnography approach and the GRADE-CERQUAL tool. Results: Eight studies were eligible (n = 150 participants; 109 distal radial/41 humeral fracture). Three overarching themes were identified: (1) type of fear-avoidant experiences, (2) drivers of fear-avoidant beliefs and behaviours, and (3) consequences of fear-avoidant beliefs and behaviours. The themes generated were based on moderate confidence evidence. In summary, whilst some patients initially consider upper limb fractures to be relatively minor injuries, over time, the realisation occurs that they have wide-ranging consequences with longer-term perspectives on recovery. This often occurs following an initial period of reduced fear. Providing education and support immediately post-fracture to prevent or challenge initial health beliefs around fear of falls and fear of movement is imperative to recovery. Conclusions: Fear-avoidant beliefs can impact heavily on certain older people's recovery, as well as their longer-term health and wellbeing. Consideration of fear avoidance and taking steps to mitigate against this in the acute upper limb trauma setting will better serve these patients in their ongoing recovery from injury. [ABSTRACT FROM AUTHOR]

Collision safety is an essential issue for dual-arm nursing-care robots. However, for coordinating operations, there is no suitable method to synchronously avoid collisions between two arms (self-collision) and collisions between an arm and the environment (environment-collision). Therefore, based on the self-motion characteristics of the dual-arm robot's redundant arms, an improved motion controlling algorithm is proposed. This study introduces several key improvements to existing methods. Firstly, the volume of the robotic arms was modeled using a capsule-enveloping method to more accurately reflect their actual structure. Secondly, the gradient projection method was applied in the kinematic analysis to calculate the shortest distances between the left arm, right arm, and the environment, ensuring effective avoidance of the self-collision and environment-collision. Additionally, distance thresholds were introduced to evaluate collision risks, and a velocity weight was used to control the smooth coordinating arm motion. After that, experiments of coordinating obstacle avoidance showed that when the redundant dual-arm robot is holding an object, the coordinating operation was completed while avoiding self-collision and environment-collision. The collision-avoidance method could provide potential benefits for various scenarios, such as medical robots and rehabilitating robots. [ABSTRACT FROM AUTHOR]

In recent years, there has been a notable increase in the clinical adoption of instrumental upper limb kinematic assessment. This trend aligns with the rising prevalence of cerebrovascular impairments, one of the most prevalent neurological disorders. Indeed, there is a growing need for more objective outcomes to facilitate tailored rehabilitation interventions following stroke. Emerging technologies, like head-mounted virtual reality (HMD-VR) platforms, have responded to this demand by integrating diverse tracking methodologies. Specifically, HMD-VR technology enables the comprehensive tracking of body posture, encompassing hand position and gesture, facilitated either through specific tracker placements or via integrated cameras coupled with sophisticated computer graphics algorithms embedded within the helmet. This review aims to present the state-of-the-art applications of HMD-VR platforms for kinematic analysis of the upper limb in post-stroke patients, comparing them with conventional tracking systems. Additionally, we address the potential benefits and challenges associated with these platforms. These systems might represent a promising avenue for safe, cost-effective, and portable objective motor assessment within the field of neurorehabilitation, although other systems, including robots, should be taken into consideration. [ABSTRACT FROM AUTHOR]

As a neurologist who has followed up countless Parkinson's patients over the last 32 years of my fifty-year career; I denied diagnosing myself with Parkinson's disease (PD), although the seldom mild involuntary "twitches" that occurred in the thumb of my right hand over a two-year period, resembled Parkinson's disease tremor. However, when these involuntary contractions became persistent; considering its similarity to characteristic resting tremor in typical PD, the positive effect of dopaminergic medications, the development of levodopa-induced dyskinesias and other non-motor symptoms, it was clear that the PD diagnosis was accurate. This situation naturally caused me anxiety, and for a year and a half, I kept my diagnosis hidden from everyone except a few close relatives. However, with the encouragement of a psychiatrist friend, when I was able to share my condition with my loved ones, I felt a relative reduction in the burden I was carrying and consequently experienced emotional relief. I am still able to carry out my daily activities independently with a rather low dose of medication, and my PD symptoms do not attract noticeable attention. [ABSTRACT FROM AUTHOR]

Spinal muscular atrophy (SMA) is a neuromuscular ailment that leads to the deprivation of motor neurons in the spinal cord, producing denervation and muscle weakness. This case report explains how a patient with type 2 SMA used a therapeutic exercise rehabilitation program in a school environment. Motor functions were assessed by Gross Motor Function Measure-88 (GMFM-88), Manual Muscle Testing (MMT), and Hammersmith Functional Motor Scale (HFMS), which is validated and reliable. This study employed a repeated pre-test post-test measures design. During a year of treatment sessions, the child underwent twice weekly 45-minute physical therapy sessions for 48 weeks. The research was carried out between March 2022 and February 2023. The purpose of the intervention, which comprised a variety of therapeutic workouts, was to enhance physical function and gross motor abilities in an age-appropriate manner. The intervention utilized in this study led to improvements in GMFM-88, HFMS, and MMT total scores. The results of this case study showed that a child with type 2 SMA aged nine had successfully improved their gross motor skills and muscle strength. [ABSTRACT FROM AUTHOR]

Objectives Charaterization of the plasma concentrations of antiretrovirals in a 4-days-a-week maintenance treatment strategy in the ANRS-170-QUATUOR study. Methods Patients were randomized in two groups receiving triple therapy taken 4-days-ON and 3-days-OFF (4/7) or continuous therapy (7/7). Plasma antiretroviral concentrations were monitored during the 'ON-treatment period' (Day 3 or 4 of the 4-day treatment block) and the 'OFF-treatment period' (Day 3 of the 3-day drug cessation) for the 4/7 group, or before the daily drug intake for the 7/7 group, until week-48 (W48). After W48, all patients switched to the 4/7 strategy and were followed until W96. Results W0 measured concentrations were comparable in both groups, except for raltegravir, concentrations of which were higher in the 4/7 group, and were all above the values usually recommended to be effective in therapeutic drug monitoring. Comparison of ON-period median concentrations between the two groups showed a statistical difference for rilpivirine [88 ng/mL (interquartile range (IQR) = 64–112) for 4/7 arm versus 130 ng/mL (82–160) for 7/7 arm, P  < 0.001] and tenofovir [tenofovir disoproxil fumarate: 93 ng/mL (73–135) for 4/7 arm versus 117 ng/mL (83–160) for 7/7 arm, P  < 0.001; tenofovir alafenamide: 11 ng/mL (7–15) for 4/7 arm versus 14 ng/mL (11–18) for 7/7 arm, P  = 0.001]. Median OFF concentrations were significantly lower (P  < 0.001) at the 48 week analysis for all medications except for raltegravir (P  = 0.493) and atazanavir (P  = 0.105), for which the numbers of patients were very small. Conclusions The 4/7-day treatment option led to antiretroviral blood levels close to continuous treatment after the four consecutive days of medication, and to low levels at the end of the non-treatment period. [ABSTRACT FROM AUTHOR]

BACKGROUND: In the last decades, emerging evidence has shown that muscle growth is not homogeneous along a muscle head. This phenomenon is known as regional muscle hypertrophy and has led to several questions regarding the implications it may have for health and sports performance. OBJECTIVE: The aim of this study was to determine whether regional hypertrophy can be predicted by surface electromyography (sEMG). METHODS: 36 participants performed two arm exercises (preacher curls and inclined curls) in a random order to muscle failure at 70% of the 1 RM of the bicep curl exercise. As every participant performed a different number of repetitions, Peak sEMG and the integral of the sEMG of the last 3 repetitions was analyzed an compared to previously performed maximal voluntary isometric contractions (MVIC). RESULTS: The independent sample t -tests showed no significant differences neither in the peak nor in the integral of the sEMG between exercises for any given region. CONCLUSIONS: sEMG cannot be used to predict regional hypertrophy. [ABSTRACT FROM AUTHOR]

Introduction: People living with a painful distal upper limb musculoskeletal disorder (DUL‐MSD) often experience pain, difficulty in doing everyday tasks and a reduced quality of life. Currently, there are challenges in the treatment of DUL‐MSDs, highlighting the need to develop innovative approaches to rehabilitation. A potential solution is to develop and implement a digital self‐management rehabilitation programme focussing on optimising recovery, improving function and reducing pain. Before developing this programme, we aimed to identify the barriers and facilitators to using a digital health intervention (DHI) for self‐management of DUL‐MSDs. Objective: This study aimed to investigate the potential barriers and facilitators to using a DHI with people living with DUL‐MSDs and healthcare professionals (HCPs). Methods: A qualitative exploratory study was carried out with purposely selected participants consisting of 15 participants with DUL‐MSDs and 13 HCPs. Three focus groups (FGs) and four semistructured interviews with DUL‐MSD participants and semistructured interviews with 13 HCPs were conducted. FGs and interviews were digitally recorded, transcribed and analysed using reflexive thematic analysis. Results: To address challenges in the care and management of DUL‐MSDs, both HCPs and people living with a DUL‐MSD welcomed the development of a DHI. This study identified several barriers and facilitators that would influence engagement with a digital intervention. Findings suggest that in developing a DHI, attention needs to be paid to digital design features, usability, tailoring, personalisation and consideration of how well usual care could be replicated digitally without direct HCP involvement. Conclusion: The identified digital design features of importance to participants will inform the design of a digital self‐management rehabilitation programme for people living with DUL‐MSDs. Addressing the barriers and facilitators to engagement with a DHI is essential in ensuring its relevance and acceptability to those who will use it. Patient or Public Contribution: Patient and Public Involvement and Engagement (PPIE) was integral throughout the study. PPIE members contributed to the development and planning of this study, checked and confirmed the relevance of the findings and are involved in the dissemination plans. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the effects of exercises by mechanical hippotherapy devices on postural control, balance, mobility, and Quality of Life in patients with stroke. This was a randomized controlled clinical trial with a total of 30 which were randomly divided into two groups. The participants in the mechanical hippotherapy group (MHG) (n = 15) were given exercises with a mechanical hippotherapy device for 15 min in addition to intensive conventional treatments (45 min), while the control group (CG) (n = 15) received additional 15 min of postural control and balance exercises for five days per week for four consecutive weeks. The primary outcome was The Berg Balance Scale (BBS). Secondary outcomes were the Fugl–Meyer (FM) Rating Scale, Biodex Balance Measurement (BBM), Trunk Impairment Scale (TIS), the Timed Up and Go Test (TUG) and quality of Life Short Form (SF-36). In the MHG, FM-Lower extremity score (−6.4, p = 0.024), FM-Upper extremity score (−12.87, p = 0.013), TIS (−5.87, p = 0.04) and TUG (5.73, p = 0.027) improved statistically significant compared to CG. Exercises using mechanical hippotherapy devices could improve postural control, functional mobility and balance in patients with stroke. It may also improve the quality of life. NCT03528993 NCT03528993 It was concluded from our results that mechanical hippotherapy could be included in the treatment programs of stroke patients. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy and safety of transcranial direct current stimulation in poststroke patients with upper extremity motor dysfunction using a systematic review and meta-analysis. Data Sources: We searched the Web of Science, Cochrane Library, EMBASE, and PubMed for randomized controlled trials investigating the effects of both active and sham stimulation up until January 27, 2024. Review Methods: Efficacy, including the upper extremity Fugl–Meyer Assessment, Action Research Arm Test, Barthel Index, and safety, were assessed. The risk of bias was assessed using the Cochrane Risk of Bias 2 tool and the Physiotherapy Evidence Database Scale. Meta-analysis was performed using the RevMan 5.4 software. Results: Forty-four studies with 1555 participants were included. Transcranial direct current stimulation proved effective in improving upper extremity motor function (standardized mean difference = 0.22, 95% confidence interval: 0.12–0.32, P < 0.001) and Barthel Index (mean difference = 4.65, 95% confidence interval: 2.82–6.49, P < 0.001). Subgroup analysis revealed the highest transcranial direct current stimulation efficacy in patients with subacute stroke. Both anodal and cathodal stimulation were effective against upper extremity motor dysfunction. C3/C4 was the most effective stimulus target. Optimal stimulation parameters included stimulus current densities <0.057 mA/cm2 for 20–30 min and <30 sessions. Adverse effects and dropouts during follow-up showed that transcranial direct current stimulation is safe and feasible. Conclusions: Our findings suggest that both anodal and cathodal stimulation were significantly effective in subacute stroke patients, particularly when preceding other treatments and when C3/C4 is targeted. [ABSTRACT FROM AUTHOR]

Objective. Clinical practice guidelines recommend the radial nerve mechanosensitivity evaluation in patients with lateral epicondylalgia. Despite different positions and sequences having been described, no research analyzed how each variation triggers symptoms associated with lateral epicondylalgia. The aim of this study was to explore the effects of different positions and sequences in the upper limb neural tension test 2b (ULNT2b) in symptom responses in patients with lateral epicondylalgia. Methods. In this observational study, 66 patients underwent 4 test conditions: standard ULNT2b, ULNT2b proximal to distal, ULNT2B with resisted supination, and resisted supination isolated. Paresthesia sensations, symptom reproduction, pain intensity (measured using a visual analog scale), and distribution of painful symptoms data were collected. Results. Significant differences in paresthesia sensations were observed between groups, with significant differences between the standard ULNT2B and other ULNT variations or resisted supination maneuvers. Symptom reproduction also differed significantly across groups, with significant differences between the standard ULNT2B and other ULNT or resisted supination tests. The positive/negative test and percentage of distribution of painful symptoms scores varied significantly across 4 conditions in both lateral and frontal views. Although pain intensity scores during tests were comparable among the tests, distribution of painful symptoms differed significantly. Conclusion. Variations in the ULNT2b test can affect symptom responses in patients with lateral epicondylalgia. The standard ULNT2b test appears more effective at reproducing symptoms, intensity of paresthesia, and distribution of painful symptoms compared to other ULNT variations and the resisted supination test. Impact. ULNT2b sequences have been shown to elicit varying responses concerning paresthesia, replication of familiar symptoms, positive/negative test results, and distribution of painful symptoms. Clinicians should consider specific test variations during the patients' radial nerve mechanosensitivity assessment to identify aggravating factors reproducing recognizable symptoms. A control group of asymptomatic participants and the role of presence of other comorbidities, psychological factors, or the duration of symptoms were not considered in this study and might play an important role influencing the results of the tests. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study is to investigate the effects of Modified‐Constraint Induced Movement Therapy (m‐CIMT) based telerehabilitation on upper extremity motor functions in stroke patients. Methods: Eighteen stroke patients were included and randomly allocated into two groups. The Tele‐CIMT (modified‐constraint induced movement therapy‐based telerehabilitation) (n = 10) group received m‐CIMT based telerehabilitation for 90 min a day, 5 weekdays for 3 weeks at home. Additionally, both the Tele‐CIMT group and the control group (CG) (n = 8) underwent the home exercise program aimed at improving range of motion, active movement, balance, and walking every weekday for 3 weeks at home. The outcome measures were the Stroke Rehabilitation Assessment of Movement Scale (STREAM), Fugl‐Meyer Upper Extremity Motor Evaluation Scale (FM‐UE), Wolf Motor Function Test (WMFT), 9‐Hole Peg Test (9‐HPT), grip strengths, pinch strengths, Motor Activity Log‐28 (MAL‐28), and Functional Independence Measure (FIM). Results: Significant group‐by‐time interactions on STREAM, FM‐UE, WMFT, grip strength, pinch strengths, MAL‐28, and FIM were found to be in favor of the Tele‐CIMT group. Additionally, post hoc analyses revealed that the Tele‐CIMT group significantly improved in terms of these parameters (p >.05). Conclusion: This is the first randomized controlled trial showing that Tele‐CIMT improved upper extremity motor functions and activities of daily living in stroke patients. Tele‐CIMT can help improve the upper extremities in stroke survivors who have difficulties reaching rehabilitation clinics. [ABSTRACT FROM AUTHOR]

Background Several studies show how submuscular breast reconstruction is linked to animation deformity, shoulder dysfunction, and increased postoperative chest pain, when compared to prepectoral breast reconstruction. In solving all these life-impairing side effects, prepectoral implant pocket conversion has shown encouraging results. Objectives The aim of this study was to propose a refinement of the prepectoral implant pocket conversion applied to previously irradiated patients. Methods We conducted a retrospective study on 42 patients who underwent previous nipple- or skin-sparing mastectomy and immediate submuscular reconstruction, followed by radiotherapy. We performed fat grafting sessions as regenerative pretreatment. Six months after the last fat graft, we performed the conversion, with prepectoral placement of micropolyurethane foam–coated implants. We investigated the preconversion and postconversion differences in upper limb range of motion, Upper Extremity Functional Index, and patient satisfaction with the breast and physical well-being of the chest. Results We reported a resolution of animation deformity in 100% of cases. The range of motion and the Upper Extremity Functional Index scores were statistically improved after prepectoral implant pocket conversion. BREAST-Q scores for satisfaction with the breast and physical well-being of the chest were also improved. Conclusions The refined prepectoral implant pocket conversion is a reliable technique for solving animation deformity and improving quality of life in patients previously treated with submuscular reconstruction and radiotherapy. Level of Evidence: 3 [ABSTRACT FROM AUTHOR]

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Background Pediatric, adolescent, and young adult patients with cancer and their caregivers are at high risk of financial toxicity, and few evidence-based oncology financial and legal navigation programs exist to address it. We tested the feasibility, acceptability, and preliminary effectiveness of Financial and Insurance Navigation Assistance, a novel interdisciplinary financial and legal navigation intervention for pediatric, adolescent and young adult patients and their caregivers. Methods We used a single-arm feasibility and acceptability trial design in a pediatric hematology and oncology clinic and collected preintervention and postintervention surveys to assess changes in financial toxicity (3 domains: psychological response/Comprehensive Score for Financial Toxicity [COST], material conditions, and coping behaviors); health-related quality of life (Patient-Reported Outcomes Measurement Information System Physical and Mental Health, Anxiety, Depression, and Parent Proxy scales); and perceived feasibility, acceptability, and appropriateness. Results In total, 45 participants received financial navigation, 6 received legal navigation, and 10 received both. Among 15 adult patients, significant improvements in FACIT-COST (P  = .041) and physical health (P  = .036) were noted. Among 46 caregivers, significant improvements were noted for FACIT-COST (P  < .001), the total financial toxicity score (P  = .001), and the parent proxy global health score (P  = .0037). We were able to secure roughly $335 323 in financial benefits for 48 participants. The intervention was rated highly for feasibility, acceptability, and appropriateness. Conclusions Integrating financial and legal navigation through Financial and Insurance Navigation Assistance was feasible and acceptable and underscores the benefit of a multidisciplinary approach to addressing financial toxicity. ClinicalTrials.gov registration NCT05876325 [ABSTRACT FROM AUTHOR]

Background Surrogate endpoints for overall survival in patients with resectable non–small cell lung cancer receiving neoadjuvant therapy are needed to provide earlier treatment outcome indicators and accelerate drug approval. This study's main objectives were to investigate the association among pathological complete response, major pathological response, event-free survival and overall survival and to determine whether treatment effects on pathological complete response and event-free survival correlate with treatment effects on overall survival. Methods A comprehensive systematic literature review was conducted to identify neoadjuvant studies in resectable non–small cell lung cancer. Analysis at the patient level using frequentist and Bayesian random effects (hazard ratio [HR] for overall survival or event-free survival by pathological complete response or major pathological response status, yes vs no) and at the trial level using weighted least squares regressions (hazard ratio for overall survival or event-free survival vs pathological complete response, by treatment arm) were performed. Results In both meta-analyses, pathological complete response yielded favorable overall survival compared with no pathological complete response (frequentist, 20 studies and 6530 patients: HR = 0.49, 95% confidence interval = 0.42 to 0.57; Bayesian, 19 studies and 5988 patients: HR = 0.48, 95% probability interval = 0.43 to 0.55) and similarly for major pathological response (frequentist, 12 studies and 1193 patients: HR = 0.36, 95% confidence interval = 0.29 to 0.44; Bayesian, 11 studies and 1018 patients: HR = 0.33, 95% probability interval = 0.26 to 0.42). Across subgroups, estimates consistently showed better overall survival or event-free survival in pathological complete response or major pathological response compared with no pathological complete response or no major pathological response. Trial-level analyses showed a moderate to strong correlation between event-free survival and overall survival hazard ratios (R 2 = 0.7159) but did not show a correlation between treatment effects on pathological complete response and overall survival or event-free survival. Conclusion There was a strong and consistent association between pathological response and survival and a moderate to strong correlation between event-free survival and overall survival following neoadjuvant therapy for patients with resectable non–small cell lung cancer. [ABSTRACT FROM AUTHOR]

BACKGROUND: Smartphone usage has increased rapidly in the last decade due to rapid technological advancements. This extensive usage of smartphones led to physiological problems and musculoskeletal disorders (MSD) due to inappropriate postures. OBJECTIVE: Past studies have reported the effects/discomfort of smartphone usage for short periods, ranging from 3–20 min, which does not represent the current era of smartphone dependency (approximately 7-hr/day). METHODS: This study was performed on fifty-four participants aged 20–28 with 1-hr smartphone texting in a sitting posture. Flexion angles, both sides (dominant and non-dominant) muscle activity (maximum voluntary contraction %) at sternocleidomastoid (SCM), upper-trapezius (TRP), extensor digitorum (EDM) and abductor pollicis brevis (APB) muscles, and subjective discomfort were analyzed. RESULTS: After 1-hr smartphone texting, the muscle activity at eight upper extremities: SCM (24.80%), TRP (29.45%), EDM (14.44%) and APB (19.87%) significantly (p < 0.001) increased by 1.5–1.9 times with 27.4±3.18° and 82.94±7.03° head and lower-arm flexion angles, respectively. The mechanical loads on the cervical spine increased by 4.6 times, and subjective discomfort by 3 times. CONCLUSION: Maintaining the same posture for a long duration causes postural stress, muscular imbalances, and discomfort, leading to MSD with increased cervical intervertebral disc pressure. [ABSTRACT FROM AUTHOR]

Inspired by the ideas from the fields of gait rehabilitation, neuroscience, and locomotion biomechanics and energetics, a body of work is reviewed that has led to propose a conceptual framework for novel "self‐assistive" walking devices that could further promote walking recovery from incomplete spinal cord injuries. The underlying rationale is based on a neural coupling mechanism that governs the coordinated movements of the arms and legs during walking, and that the excitability of these neural pathways can be exploited by actively engaging the arms during locomotor training. Self‐assistive treadmill walking rehabilitation devices are envisioned as an approach that would allow an individual to actively use their arms to help the legs during walking. It is hoped that the conceptual framework inspires the design and use of self‐assistive walking devices that are tailored to assist individuals with an incomplete spinal cord injury to regain their functional walking ability. [ABSTRACT FROM AUTHOR]

Aim: This study explores the impact on arteriovenous fistula (AVF) creation and maturation of four methods of heating the scanning environment during ultrasound upper limb mapping, and sonographer perceived useability of the environments. Method: A retrospective audit at Orange and Bathurst hospitals involving patients who underwent ultrasound upper limb mapping (2016–2022). Patients were scanned using warm gel and three additional methods of warming. Two sonographers provided their preference and opinions on each environment. Data on AVF type, brachial artery blood flow (QBRA), AVF maturity status at 3 and 6 months and intervention within this timeframe was retrieved. Data from the three additional heated environments was combined for analysis (heated environments) against the heated gel only environment (gel environment). Results: Eighty‐five patients met selection criteria. There was no significant difference in the proportion of successfully created AVFs between the heated and the gel environments (90% vs. 94%). A greater percentage of AVFs mapped in the heated environments reached maturity without intervention compared to the gel environment (70% vs. 48%, respectively). There was a statistically significant higher QBRA in the AVFs mapped in the heated environments (1.25 L/min) that reached maturity by 3 months without intervention compared to the gel environment (0.95 L/m; p =.008). Sonographers found a warm blanket/electric throw the easiest methods of heating the scanning environment. Conclusion: Using an electric throw and/or a warm blanket during ultrasound upper limb mapping is practical and optimises the scan environment, which provides surgeons with quality information that ultimately improves AVF creation outcomes. [ABSTRACT FROM AUTHOR]

The recent surge in biosignal-based control signifies a profound paradigm shift in biomedical engineering. This innovative approach has injected new life into control theory, ushering in advancements in human-body interaction and control. Surface Electromyography (sEMG) emerges as a pivotal biosignal, attracting considerable attention for its wide-ranging applications across medicine, science, and engineering, particularly in the domain of functional rehabilitation. This study delves into the use of sEMG signals for controlling a robotic arm, with the overarching aim of improving the quality of life for people with disabilities in Vietnam. Raw sEMG signals are acquired via appropriate sensors and subjected to a robust processing methodology involving analog-to-digital conversion, band-pass and low-pass filtering, and envelope detection. To demonstrate the efficacy of the processed sEMG signals, this study introduces a robotic arm model capable of mimicking intricate human finger movements. Employing a fuzzy logic control strategy, the robotic arm demonstrates successful operation in experimental trials, characterized by swift response times, thereby positioning it as a valuable assistive device for people with disabilities. This investigation not only validates the feasibility of sEMG-based control for robotic arms, but also underscores its potential to significantly improve the lives of individuals with disabilities, a demographic that represents a substantial portion (approximately 8%) of the Vietnamese population. [ABSTRACT FROM AUTHOR]

A pre-performance routine (PPR) refers to a set of task-relevant thoughts and actions an athlete systematically engages in prior to performance execution. The aim of this meta-analysis was to determine the effectiveness of the PPR intervention to facilitate sport performance. The meta-analysis included 112 effect sizes from pre–post and experimental designs in low-pressure and pressurised conditions. Extensive PPRs with several preparatory elements as well as specific stand-alone PPRs, such as left-hand dynamic handgrip and quiet eye, were analysed. Three-level random-effects models were used for analysis, utilising Knapp-Hartung adjustments and restricted maximum likelihood estimation. Results showed a significant but small effect of PPRs on sport performance in pre–post designs (SMC = 0.31, 95% CI [0.18, 0.44]) and moderate-to-large effects in experimental designs, both under low-pressure (Hedges' g = 0.64, 95% CI [0.45, 0.83]) and pressurised conditions (Hedges' g = 0.70, 95% CI [0.24, 1.16]). These effects were not moderated by the type of PPR, age, gender, skill level, or intervention characteristics. Overall, the meta-analytic results support the benefits of the PPR intervention in practice regardless of the type of routine. Both extensive and stand-alone PPRs are effective in optimising sport performance. [ABSTRACT FROM AUTHOR]

This paper presents a hybrid adaptive control strategy for upper limb rehabilitation robots using impedance learning. The hybrid adaptation consists of a differential updating mechanism for the estimation of robotic modeling uncertainties and periodic adaptations for the online learning of time-varying impedance. The proposed hybrid adaptive controller guarantees asymptotical control stability and achieves variable impedance regulation for robots without interaction force measurements. According to Lyapunov's theory, we proved that the proposed impedance learning controller guarantees the convergence of tracking errors and ensures the boundedness of the estimation errors of robotic uncertainties and impedance profiles. Simulations and experiments conducted on a parallel robot validated the effectiveness and the superiority of the proposed impedance learning controller in robot-assisted rehabilitation. The proposed hybrid adaptive control has potential applications in rehabilitation, exoskeletons, and some other repetitive interactive tasks. [ABSTRACT FROM AUTHOR]

Objective: The aim of our study was to evaluate the physical performance, balance, gait and activities of daily living (ADL) of older individuals with long COVID syndrome (LCS). Methods: A total of 124 individuals (49% women) with a mean age of 71.8 ± 5.8 years were included in the study. Participants were divided into two groups, older individuals with LCS in the LCS group and older individuals who were not diagnosed with COVID‐19 in the CON (control) group. Physical performance of participants was evaluated with the Alusti Test, balance and gait assessment was evaluated with the Tinetti Balance and Gait Assessment (TBGA), and ADL were evaluated with the Barthel Index (BI). Results: In the evaluations between groups, the mean score of active muscular mobility of right and left upper extremities, transfer supine position to sitting, trunk in sitting position and standing, which are among the subparameters of the Alusti Test, were statistically significantly lower in LCS compared to CON (p <.05). TBGA total score and gait section mean score of TBGA were statistically significantly lower in LCS than in CON (p <.05). There was no significant difference between the groups in the balance section of the TBGA and the mean BI scores (p >.05). Conclusions: It was concluded that physical performance parameters related to active muscular mobility of the upper extremity, transfer supine position to sitting, trunk in sitting position and walking in LCS were negatively affected by the disease, but this did not affect the level of balance and independence in ADL. [ABSTRACT FROM AUTHOR]

Objectives. Shoulder protraction is frequently seen in office workers because of working with excessive trunk flexion for a long time. This study aimed to compare the effectiveness of stabilization exercises (SE) given in addition to office exercises (OE). Methods. Sixty office workers with shoulder protraction were divided into SE + OE (n = 30) and OE (n = 30) groups by stratified random sampling for 8 weeks and followed up for 4 weeks. Shoulder protraction was assessed with a caliper, muscle strength with a hand-held dynamometer, proprioception with an isokinetic dynamometer, vibration sense with a vibrometer and upper extremity functional performance with the closed kinetic chain upper extremity stability test. Results. There were significant improvements in all parameters in the OE + SE group, while increases in the strength of the upper trapezius, pectoralis major and infraspinatus muscles and in upper extremity functional performance were also found in the OE group (p < 0.05). During detraining, shoulder protraction, muscle strength, proprioception and upper extremity performance showed longer-term improvement with SE + OE (p < 0.05). Conclusion. The results obtained with the exercises demonstrate the importance of SE + OE in terms of maintaining proper posture and improving shoulder proprioception, muscle strength and functional performance. [ABSTRACT FROM AUTHOR]

Background: Movement smoothness is a potential kinematic biomarker of upper extremity (UE) movement quality and recovery after stroke; however, the measurement properties of available smoothness metrics have been poorly assessed in this group. We aimed to measure the reliability, responsiveness and construct validity of several smoothness metrics. Methods: This ancillary study of the REM-AVC trial included 31 participants with hemiparesis in the subacute phase of stroke (median time since stroke: 38 days). Assessments performed at inclusion (Day 0, D0) and at the end of a rehabilitation program (Day 30, D30) included the UE Fugl Meyer Assessment (UE-FMA), the Action Research Arm Test (ARAT), and 3D motion analysis of the UE during three reach-to-point movements at a self-selected speed to a target located in front at shoulder height and at 90% of arm length. Four smoothness metrics were computed: a frequency domain smoothness metric, spectral arc length metric (SPARC); and three temporal domain smoothness metrics (TDSM): log dimensionless jerk (LDLJ); number of submovements (nSUB); and normalized average rectified jerk (NARJ). Results: At D30, large clinical and kinematic improvements were observed. Only SPARC and LDLJ had an excellent reliability (intra-class correlation > 0.9) and a low measurement error (coefficient of variation < 10%). SPARC was responsive to changes in movement straightness (rSpearman=0.64) and to a lesser extent to changes in movement duration (rSpearman=0.51) while TDSM were very responsive to changes in movement duration (rSpearman>0.8) and not to changes in movement straightness (non-significant correlations). Most construct validity hypotheses tested were verified except for TDSM with low correlations with clinical metrics at D0 (rSpearman<0.5), ensuing low predictive validity with clinical metrics at D30 (non-significant correlations). Conclusions: Responsiveness and construct validity of TDSM were hindered by movement duration and/or noise-sensitivity. Based on the present results and concordant literature, we recommend using SPARC rather than TDSM in reaching movements of uncontrolled duration in individuals with spastic paresis after stroke. Trial Registration: NCT01383512, https://clinicaltrials.gov/, June 27, 2011. Highlights: Reliability, responsiveness and construct validity of SPARC were satisfactory. Responsiveness and construct validity of LDLJ, NARJ and nSUB were highly related to movement duration. LDLJ had an excellent reliability and a low measurement error, but not NARJ and nSUB. [ABSTRACT FROM AUTHOR]

Background: The most challenging aspect of rehabilitation is the repurposing of residual functional plasticity in stroke patients. To achieve this, numerous plasticity-based clinical rehabilitation programs have been developed. This study aimed to investigate the effects of motor imagery (MI)-based brain–computer interface (BCI) rehabilitation programs on upper extremity hand function in patients with chronic hemiplegia. Design: A 2010 Consolidated Standards for Test Reports (CONSORT)-compliant randomized controlled trial. Methods: Forty-six eligible stroke patients with upper limb motor dysfunction participated in the study, six of whom dropped out. The patients were randomly divided into a BCI group and a control group. The BCI group received BCI therapy and conventional rehabilitation therapy, while the control group received conventional rehabilitation only. The Fugl–Meyer Assessment of the Upper Extremity (FMA-UE) score was used as the primary outcome to evaluate upper extremity motor function. Additionally, functional magnetic resonance imaging (fMRI) scans were performed on all patients before and after treatment, in both the resting and task states. We measured the amplitude of low-frequency fluctuation (ALFF), regional homogeneity (ReHo), z conversion of ALFF (zALFF), and z conversion of ReHo (ReHo) in the resting state. The task state was divided into four tasks: left-hand grasping, right-hand grasping, imagining left-hand grasping, and imagining right-hand grasping. Finally, meaningful differences were assessed using correlation analysis of the clinical assessments and functional measures. Results: A total of 40 patients completed the study, 20 in the BCI group and 20 in the control group. Task-related blood-oxygen-level-dependent (BOLD) analysis showed that when performing the motor grasping task with the affected hand, the BCI group exhibited significant activation in the ipsilateral middle cingulate gyrus, precuneus, inferior parietal gyrus, postcentral gyrus, middle frontal gyrus, superior temporal gyrus, and contralateral middle cingulate gyrus. When imagining a grasping task with the affected hand, the BCI group exhibited greater activation in the ipsilateral superior frontal gyrus (medial) and middle frontal gyrus after treatment. However, the activation of the contralateral superior frontal gyrus decreased in the BCI group relative to the control group. Resting-state fMRI revealed increased zALFF in multiple cerebral regions, including the contralateral precentral gyrus and calcarine and the ipsilateral middle occipital gyrus and cuneus, and decreased zALFF in the ipsilateral superior temporal gyrus in the BCI group relative to the control group. Increased zReHo in the ipsilateral cuneus and contralateral calcarine and decreased zReHo in the contralateral middle temporal gyrus, temporal pole, and superior temporal gyrus were observed post-intervention. According to the subsequent correlation analysis, the increase in the FMA-UE score showed a positive correlation with the mean zALFF of the contralateral precentral gyrus (r = 0.425, P < 0.05), the mean zReHo of the right cuneus (r = 0.399, P < 0.05). Conclusion: In conclusion, BCI therapy is effective and safe for arm rehabilitation after severe poststroke hemiparesis. The correlation of the zALFF of the contralateral precentral gyrus and the zReHo of the ipsilateral cuneus with motor improvements suggested that these values can be used as prognostic measures for BCI-based stroke rehabilitation. We found that motor function was related to visual and spatial processing, suggesting potential avenues for refining treatment strategies for stroke patients. Trial registration: The trial is registered in the Chinese Clinical Trial Registry (number ChiCTR2000034848, registered July 21, 2020). [ABSTRACT FROM AUTHOR]

Background: Stroke frequently gives rise to incapacitating motor impairments in the upper limb. Virtual reality (VR) rehabilitation has exhibited potential for augmenting upper extremity recovery; nonetheless, the optimal techniques for such interventions remain a topic of uncertainty. The present systematic review and meta-analysis were undertaken to comprehensively compare VR-based rehabilitation with conventional occupational therapy across a spectrum of immersion levels and outcome domains. Methods: A systematic search was conducted in PubMed, IEEE, Scopus, Web of Science, and PsycNET databases to identify randomized controlled trials about upper limb rehabilitation in stroke patients utilizing VR interventions. The search encompassed studies published in the English language up to March 2023. The identified studies were stratified into different categories based on the degree of immersion employed: non-immersive, semi-immersive, and fully-immersive settings. Subsequent meta-analyses were executed to assess the impact of VR interventions on various outcome measures. Results: Of the 11,834 studies screened, 55 studies with 2142 patients met the predefined inclusion criteria. VR conferred benefits over conventional therapy for upper limb motor function, functional independence, Quality of life, Spasticity, and dexterity. Fully immersive VR showed the greatest gains in gross motor function, while non-immersive approaches enhanced fine dexterity. Interventions exceeding six weeks elicited superior results, and initiating VR within six months post-stroke optimized outcomes. Conclusions: This systematic review and meta-analysis demonstrates that adjunctive VR-based rehabilitation enhances upper limb motor recovery across multiple functional domains compared to conventional occupational therapy alone after stroke. Optimal paradigms likely integrate VR's immersive capacity with conventional techniques. Trial registration: This systematic review and meta-analysis retrospectively registered in the OSF registry under the identifier [https://doi.org/10.17605/OSF.IO/YK2RJ]. [ABSTRACT FROM AUTHOR]

Background: Failed extubation increases the intensive care unit (ICU) length of stay, hospital length of stay, and financial costs and it reduces the patient's functional ability. Avoiding failed extubation is of utmost importance, therefore predictors for successful extubation are paramount. Objective: To determine if successful extubation in mechanically ventilated patients can be predicted by physiotherapists using upper limb muscle strength and exercise endurance. Methods: Fifty-seven patients from the medical and trauma ICUs of a large academic hospital were eligible for testing. Muscle strength was evaluated using the Oxford grading scale, Medical Research Council score (MRC score), handgrip dynamometer, and maximum inspiratory pressure (MIP). Exercise endurance was tested while the patient was actively riding the MOTOmed® letto2 cycle ergometer for six minutes with the upper limbs. Results: Exercise endurance (time the patient rode actively) (P = 0.005), MRC-score (P = 0.007), and number of days ventilated (P = 0.005) were associated with successful extubation. The handgrip strength (P = 0.061), MIP (P = 0.095), and muscle strength of the sternocleidomastoid (P = 0.053) and trapezius muscles (P = 0.075) were marginally associated with successful extubation. Due to multicollinearity when developing the prediction equation, the final multivariable logistic regression prediction model included only exercise endurance and the number of days ventilated. The newly developed prediction equation conferred a sensitivity of 81.82% and a specificity of 77.14% to predict successful extubation. Conclusion: Successful extubation of mechanically ventilated patients can be predicted by physiotherapists using the newly developed prediction equation consisting of exercise endurance and number of days ventilated. [ABSTRACT FROM AUTHOR]

Background and Aims Few studies have compared arm and ankle blood pressures (BPs) with regard to peripheral artery disease (PAD) and mortality. These relationships were assessed using data from three large prospective clinical trials. Methods Baseline BP indices included arm systolic BP (SBP), diastolic BP (DBP), pulse pressure (arm SBP minus DBP), ankle SBP, ankle–brachial index (ABI, ankle SBP divided by arm SBP), and ankle–pulse pressure difference (APPD, ankle SBP minus arm pulse pressure). These measurements were categorized into four groups using quartiles. The outcomes were PAD (the first occurrence of either peripheral revascularization or lower-limb amputation for vascular disease), the composite of PAD or death, and all-cause death. Results Among 40 747 participants without baseline PAD (age 65.6 years, men 68.3%, diabetes 50.2%) from 53 countries, 1071 (2.6%) developed PAD, and 4955 (12.2%) died during 5 years of follow-up. Incident PAD progressively rose with higher arm BP indices and fell with ankle BP indices. The strongest relationships were noted for ankle BP indices. Compared with people whose ankle BP indices were in the highest fourth, adjusted hazard ratios (95% confidence interval) for each lower fourth were 1.64 (1.31–2.04), 2.59 (2.10–3.20), and 4.23 (3.44–5.21) for ankle SBP; 1.19 (0.95–1.50), 1.66 (1.34–2.05), and 3.34 (2.75–4.06) for ABI; and 1.41 (1.11–1.78), 2.04 (1.64–2.54), and 3.63 (2.96–4.45) for APPD. Similar patterns were observed for mortality. Ankle BP indices provided the highest c -statistics and classification indices in predicting future PAD beyond established risk factors. Conclusions Ankle BP indices including the ankle SBP and the APPD best predicted PAD and mortality. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to compare the effects of four different immobilization methods [single sugar tong splint (SSTS), double sugar tong splint (DSTS), short arm cast (SAC), and long arm cast (LAC)] commonly used for restricting forearm rotation in the upper extremity. Methods: Forty healthy volunteers were included in the study. Dominant extremities were used for measurements. Basal pronation and supination of the forearm were measured with a custom-made goniometer, and the total rotation arc was calculated without any immobilization. Next, the measurements were repeated with the SAC, LAC, SSTS and DSTS. Each measurement was compared to the baseline value, and the percentage of rotation restriction was calculated. Results: The most superior restriction rates were observed for the LAC (p = 0.00). No statistically significant difference was detected between the SSTS and DSTS in terms of the restriction of supination, pronation or the rotation arc (p values, 1.00, 0.18, and 0.50, respectively). Statistically significant differences were not detected between the SAC and the SSTS in any of the three parameters (p values, 0.25; 1.00; 1.00, respectively). When the SAC and DSTS were compared, while there was no significant difference between the two methods in pronation (p = 0.50), a statistically significant difference was detected in supination (p = 0.01) and in the total rotation arc (p = 0.03). Conclusion: The LAC provides superior results in restricting forearm rotation. The SAC and SSTS had similar effects on forearm rotation. The DSTS, which contains, in addition to the SSTS, a sugar tong portion above the elbow, does not provide additional rotational stability. [ABSTRACT FROM AUTHOR]

Myofibromas are rare benign tumors of myofibroblasts, seen more commonly in children. These tumors typically involve soft tissues with a predilection for the head and neck. Malignant neoplasia is often suspected for these rapidly growing tumors in early childhood. Clinical and radiological findings are not typical, and histopathological examination makes the definitive diagnosis. This pathology requires the intervention of a multidisciplinary team and regular follow-up. We report our experience with two children with myofibromas, one in the right arm of a 5-year-old girl and the other in the right axilla of a 9-year-old boy. Tumors were totally resected in both children, who are under follow-up with no adjuvant treatment free of disease after surgery. Myofibroma should be considered in the differential diagnosis of pediatric soft tissue tumors. Surgical resection is sufficient for treatment and patients should be followed regularly for possible recurrences. [ABSTRACT FROM AUTHOR]

Introduction: Water polo upper limb external load monitoring cannot be currently measured accurately because of technological and methodological challenges. This is problematic as large fluctuations in overhead movement volume and intensity may affect performance and alter injury risk. Inertial measurement units (IMU) and machine learning techniques have been shown to accurately classify overhead movements in other sports. We investigated the model accuracy and class precision, sensitivity, and specificity of IMU and machine learning techniques to classify standard overhead drill movements in elite women's water polo. Methods: Ten women's water polo players performed standard drills of swimming, blocking, low-intensity throwing and high-intensity throwing under training conditions. Athletes wore two IMU: one on the upper back and the other on the distal forearm. Each movement was videoed and coded to a standard overhead drill movement. IMU and coded video data were merged to verify the IMU-detected activity classification of each movement to that of the video. Data were partitioned into a training and a test set and used to form a decision tree algorithm. Model accuracy and class precision, sensitivity, and specificity were assessed. Results: IMU resultant acceleration and angular velocity values displayed drill-specific values. A total of 194 activities were identified by the model in the test set, with 8 activities being incorrectly classified. Model accuracy was 95.88%. Percentage class precision, sensitivity, and specificity were as follows: blocking (96.15, 86.21, 99.39), high-intensity throwing (100, 100, 100), low-intensity throwing (93.48,93.48,97.97), and swimming (94.81,98.65,96.67). Conclusions: IMU and machine learning techniques can accurately classify standard overhead drill movements in elite women's water polo. [ABSTRACT FROM AUTHOR]

This paper investigates a method for precise mapping of human arm movements using sEMG signals. A multi-channel approach captures the sEMG signals, which, combined with the accurately calculated joint angles from an Inertial Measurement Unit, allows for action recognition and mapping through deep learning algorithms. Firstly, signal acquisition and processing were carried out, which involved acquiring data from various movements (hand gestures, single-degree-of-freedom joint movements, and continuous joint actions) and sensor placement. Then, interference signals were filtered out through filters, and the signals were preprocessed using normalization and moving averages to obtain sEMG signals with obvious features. Additionally, this paper constructs a hybrid network model, combining Convolutional Neural Networks and Artificial Neural Networks, and employs a multi-feature fusion algorithm to enhance the accuracy of gesture recognition. Furthermore, a nonlinear fitting between sEMG signals and joint angles was established based on a backpropagation neural network, incorporating momentum term and adaptive learning rate adjustments. Finally, based on the gesture recognition and joint angle prediction model, prosthetic arm control experiments were conducted, achieving highly accurate arm movement prediction and execution. This paper not only validates the potential application of sEMG signals in the precise control of robotic arms but also lays a solid foundation for the development of more intuitive and responsive prostheses and assistive devices. [ABSTRACT FROM AUTHOR]

In order to reduce shoulder, upper arm and elbow injury rates in American football, identifying injury risk factors and any underlying associations is needed. No prior study has done such characterization at the high school level. A descriptive epidemiology study was performed using data from the National Athletic Treatment, Injury, and Outcomes Network Surveillance Program (NATION-SP) from the years 2011/12 to 2013/14 on high school football athletes. Four hundred and sixty total injuries were found in the dataset. Acromioclavicular (AC) sprains had the highest incidence of all injuries (0.060 injuries per 1000 exposures). Fractures lead to the greatest time lost (42.24 days). Most injuries occurred in older athletes (juniors and seniors, 30% and 32%, respectively), were related to tackling (31%), and in running back and linebacker positions (15% each). Orthopaedic surgeons and other sports medicine specialists can use these findings to educate players, coaches and families about injury risks and for improving injury prevention guidelines. [ABSTRACT FROM AUTHOR]

Purpose: 3- and 4-part proximal humeral fractures are frequently treated conservatively. This study aims to combine radiographic, and patient reported outcome data to identify factors leading to poor outcomes following conservative treatment. Methods: A retrospective local database analysis identified 3- and 4-part fractures. Radiographic and functional outcomes including Oxford Shoulder Score (OSS), QuickDash (QD), Subjective Shoulder Score (SSV) and VAS pain scores were collected. Results: 104 patients were included at mean follow-up of 55 months. Analysis highlighted significant OSS differences in 3- versus 4-part (p = 0.027), dominant arm injury (p = 0.046), age > 65 (p = 0.006), varus coronal neck-shaft angle < 115 versus 115–155 degrees (p = 0.008), posterior head tilt > 155 degrees (p = 0.005), greater tuberosity (GT) displacement > 5 mm (p = 0.001), GT comminution (p = 0.01), medial calcar hinge displacement > 2 mm (p = 0.032). According to QD scores; age > 65 (p = 0.012), varus neck-shaft angle (p = 0.01), GT displacement > 5 mm (p = 0.001), GT comminution (p = 0.01), medial calcar hinge displacement > 2 mm (p = 0.006). SSV varied significantly with 3- versus 4-part fractures (p = 0.005), age > 65 (p = 0.04), varus neck-shaft angle (p = 0.001), posterior head tilt (p = 0.005), GT displacement > 5 mm (p = 0.001), GT comminution (p = 0.003), and medial calcar hinge displacement > 2 mm (p = 0.001). Conclusion: We highlight risk factors for unfavourable outcomes following conservative management, aiding surgeons in shared decision-making and patient expectation management. [ABSTRACT FROM AUTHOR]

Aims of this study were to investigate if changes in elbow and wrist joints loading and biomechanical characteristics of performance existed as a function of (a) different hand placement and (b) fundamental skills development in female gymnastics. Ten female gymnasts performed 54 successful trials of round-off skills (cartwheel [18], round-off [18], round-off to back handspring [18]), with three different hand positions (parallel, T-shape and reverse). Kinematic and kinetic data were collected for each trial. A two-way repeated measures ANOVA was used to analyse the injury risk factors. Findings of the current study showed that an increase in RO skill difficulty level significantly influences the mechanical load on the upper extremities. With the increase in mechanical load on the upper extremities during the reverse and parallel hand positions, this study suggests that that T-shape hand position should be used as the primary technique for the young female. Differences in vertical velocity from touchdown to take-off between the three hand positions for the RO and RO-BH suggested that the reverse position was less effective for young female gymnasts. The findings of the current study demonstrated no clear performance benefits between hand position selection. [ABSTRACT FROM AUTHOR]

Badminton is the fastest racket sport in the world with smash speeds reaching over 111 m/s (400 kph). This study examined the forehand jump smash in badminton using synchronised force plates and full-body motion capture to quantify relationships to shuttlecock speed through correlations. Nineteen elite male Malaysian badminton players were recorded performing forehand jump smashes with the fastest, most accurate jump smash from each player analysed. The fastest smash by each participant was on average 97 m/s with a peak of 105 m/s. A correlational analysis revealed that a faster smash speed was characterised by a more internally rotated shoulder, a less elevated shoulder, and less extended elbow at contact. The positioning of the arm at contact appears to be critical in developing greater shuttlecock smash speeds. Vertical ground reaction force and rate of force development were not correlated with shuttlecock speed, and further investigation is required as to their importance for performance of the jump smash e.g., greater jump height and shuttle angle. It is recommended that players/coaches focus on not over-extending the elbow or excessively elevating the upper arm at contact when trying to maximise smash speed. [ABSTRACT FROM AUTHOR]

Tracking a moving object with the eyes seems like a simple task but involves areas of prefrontal cortex (PFC) associated with attention, working memory and prediction. Increasing the demand on these processes with secondary tasks can affect eye movements and/or perceptual judgments. This is particularly evident in chronic or acute neurological conditions such as Alzheimer's disease or mild traumatic brain injury. Here, we combined near infrared spectroscopy and video-oculography to examine the effects of concurrent upper limb movement, which provides additional afference and efference that facilitates tracking of a moving object, in a novel dual-task pursuit protocol. We confirmed the expected effects on judgement accuracy in the primary and secondary tasks, as well as a reduction in eye velocity when the moving object was occluded. Although there was limited evidence of oculo-manual facilitation on behavioural measures, performing concurrent upper limb movement did result in lower activity in left medial PFC, as well as a change in PFC network organisation, which was shown by Graph analysis to be locally and globally more efficient. These findings extend upon previous work by showing how PFC is functionally organised to support eye-hand coordination when task demands more closely replicate daily activities. [ABSTRACT FROM AUTHOR]