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Upper extremity limb loss: functional restoration from prosthesis and targeted reinnervation to transplantation.
For several decades, prosthetic use was the only option to restore function after upper extremity amputation. Recent years have seen advances in the field of prosthetics. Such advances include prosthetic design and function, activity-specific devices, improved aesthetics, and adjunctive surgical procedures to improve both form and function. Targeted reinnervation is one exciting advance that allows for more facile and more intuitive function with prosthetics following proximal amputation. Another remarkable advance that holds great promise in nearly all fields of medicine is the transplantation of composite tissue, such as hand and face transplantation. Hand transplantation holds promise as the ultimate restorative procedure that can provide form, function, and sensation. However, this procedure still comes with a substantial cost in terms of the rehabilitation and toxic immunosuppression and should be limited to carefully selected patients who have failed prosthetic reconstruction. Hand transplantation and prosthetic reconstruction should not be viewed as competing options. Rather, they are two treatment options with different risk/benefit profiles and different indications and, hence vastly different implications. PMID:24397947
Carlsen, Brian T; Prigge, Pat; Peterson, Jennifer
Muscles of the Upper Extremity
... Citation Help Home £ Cancer Registration & Surveillance Modules £ Anatomy & Physiology £ Muscular System £ Muscle Groups £ Upper Extremity Cancer Registration & Surveillance Modules Anatomy & Physiology Intro to the Human Body Body Functions & Life ...
Uncommon upper extremity compression neuropathies.
Hand surgeons routinely treat carpal and cubital tunnel syndromes, which are the most common upper extremity nerve compression syndromes. However, more infrequent nerve compression syndromes of the upper extremity may be encountered. Because they are unusual, the diagnosis of these nerve compression syndromes is often missed or delayed. This article reviews the causes, proposed treatments, and surgical outcomes for syndromes involving compression of the posterior interosseous nerve, the superficial branch of the radial nerve, the ulnar nerve at the wrist, and the median nerve proximal to the wrist. PMID:23895725
Knutsen, Elisa J; Calfee, Ryan P
Innovations in prosthetic interfaces for the upper extremity.
Advancements in modern robotic technology have led to the development of highly sophisticated upper extremity prosthetic limbs. High-fidelity volitional control of these devices is dependent on the critical interface between the patient and the mechanical prosthesis. Recent innovations in prosthetic interfaces have focused on several control strategies. Targeted muscle reinnervation is currently the most immediately applicable prosthetic control strategy and is particularly indicated in proximal upper extremity amputations. Investigation into various brain interfaces has allowed acquisition of neuroelectric signals directly or indirectly from the central nervous system for prosthetic control. Peripheral nerve interfaces permit signal transduction from both motor and sensory nerves with a higher degree of selectivity. This article reviews the current developments in each of these interface systems and discusses the potential of these approaches to facilitate motor control and sensory feedback in upper extremity neuroprosthetic devices. PMID:24281580
Kung, Theodore A; Bueno, Reuben A; Alkhalefah, Ghadah K; Langhals, Nicholas B; Urbanchek, Melanie G; Cederna, Paul S
Physical examination of upper extremity compressive neuropathies.
A thorough history and physical examination are vital to the assessment of upper extremity compressive neuropathies. This article summarizes relevant anatomy and physical examination findings associated with upper extremity compressive neuropathies. PMID:23026457
Popinchalk, Samuel P; Schaffer, Alyssa A
Advances in upper extremity prosthetics.
Until recently, upper extremity prostheses had changed little since World War II. In 2006, the Defense Advanced Research Projects Agency responded to an increasing number of military amputees with the Revolutionizing Prosthetics program. The program has yielded several breakthroughs both in the engineering of new prosthetic arms and in the control of those arms. Direct brain-wave control of a limb with 22¯ of freedom may be within reach. In the meantime, advances such as individually powered digits have opened the door to multifunctional full and partial hand prostheses. Restoring sensation to the prosthetic limb remains a major challenge to full integration of the limb into a patient's self-image. PMID:23101609
Zlotolow, Dan A; Kozin, Scott H
Principles of Reconstruction of the Upper Extremities
Successful surgical reconstruction of the upper extremities paralyzed by poliomyelitis depends largely on the careful analysis of the individual problem and replacement of critical motions of the upper extremity. These replacements or substitutions may be gained by muscle transposition, tendon transplantation, tenodesis, bone block, or arthrodesis.
Schottstaedt, Edwin R.; Larsen, Loren J.; Bost, Frederic C.
Distal upper extremity motion during keyboarding
Abnormal computer keyboard typing patterns have been associated with musculoskeletal disorders of the upper extremities. Threshold values for quantifying abnormal distal upper extremity function during typing have been established to identify typing behaviors that may place the computer user at risk for developing an injury. In this paper, the joint displacements of repeated typing tasks were normalized using previously collected
E. J. Bill; D. R. Peterson
Thoracoscopic removal of dental prosthesis impacted in the upper thoracic esophagus
Dental appliances are the most common cause of accidental foreign body esophageal impaction, especially in the elderly population with decreased oral sensory perception. A 47-year-old man with history of oligophrenia and recurrent epileptic seizures was referred to our hospital following dislocation and ingestion of his upper dental prosthesis. Endoscopic removal and clipping of an esophageal tear had been unsuccessfully attempted. A chest CT scan confirmed entrapment of the dental prosthesis in the upper thoracic esophagus, the presence of pneumomediastinum, and the close proximity of one of the metal clasps of the prosthesis to the left subclavian artery. A video-assisted right thoracoscopy in the left lateral decubitus position was performed and the foreign body was successfully removed. The patient was then allowed to wear the retrieved prosthesis after dentistry consultation and repair of the wire clasps by a dental technician. At the 6-month follow-up visit the patient was doing very well without any trouble in swallowing.
Traumatic and trauma-related amputations: Part II: Upper extremity and future directions.
Trauma is the most common reason for amputation of the upper extremity. The morphologic and functional distinctions between the upper and lower extremities render the surgical techniques and decision-making different in many key respects. Acceptance of the prosthesis and the outcomes are improved by performing a transradial rather than a more proximal amputation. Substantial efforts, including free tissue transfers when necessary, should be made to salvage the elbow. Careful management of the peripheral nerves is critical to minimize painful neuroma formation while preserving options for possible future utilization in targeted muscle reinnervation and use of a myoelectric prosthesis. Rapid developments with targeted muscle reinnervation, myoelectric prostheses, and composite tissue allotransplantation may dramatically alter surgical treatment algorithms in the near future for patients with severe upper-extremity trauma. PMID:21159994
Tintle, Scott M; Baechler, Martin F; Nanos, George P; Forsberg, Jonathan A; Potter, Benjamin K
Research, design & development project Myoelectric Prosthesis of Upper Limb
NASA Astrophysics Data System (ADS)
A Research Design and Development Project was developed of a myoelectric prosthesis for a pediatric patient presenting congenital amputation of the left forearm below the elbow. A multidisciplinary work-team was formed for this goal, in order to solve the several (/various) aspects regarding this project (mechanical, ergonomics, electronics, physical). The prosthesis as an electromechanical device was divided in several blocks, trying to achieve a focused development for each stage, acording to requisites. A mechanical prototype of the prothesis was designed and built along with the circuitry needed for EMG aquisition, control logic and drivers. Having acomplished the previuos stages, the project is now dealing with the definitions of the interface between the prosthesis and the patient, with promising perspectives.
Galiano, L.; Montaner, E.; Flecha, A.
Prospective Study of Upper Extremity Musculoskeletal Disorders.
National Technical Information Service (NTIS)
This epidemiologic study of upper extremity musculoskeletal disorders in manufacturing and health care industries collected individual demographic, health, psychosocial, work organizational and physical load exposure information among 733 permanent full-t...
B. Silverstein C. Smith D. Bonauto J. Fan N. Howard P. Spielholz S. Bao
Problems of the upper extremity in gymnastics.
The majority of upper extremity problems experienced by gymnasts are not considered injuries but are regarded as consequences of the sport. Treatment of these problems should include treatment of not only the injury but also the cause. This requires the cooperation of the gymnast, his or her coach, and a physician familiar with the demands placed upon the upper extremity in gymnastics. The level of a gymnast's capabilities must be recognized. Improper techniques must be corrected. Emphasis must be placed on rehabilitation for shoulder problems and strengthening exercises for the elbow and wrist in attempt to decrease the symptoms from repeated forced extension. In the words of Peter Kormann, an Olympic medalist in gymnastics, "All gymnasts work out and compete with ongoing problems in their upper extremities. These problems are only considered serious injuries when the gymnast can no longer compete." PMID:3967313
Aronen, J G
Experimental development of a sensory control system for an upper limb myoelectric prosthesis with cosmetic covering.
A sensory control system based on the force-sensing resistor (FSR) for an upper limb prosthesis has been designed for application to a commercial prosthetic hand of proven reliability. In particular, FSR sensors have been used to control the strength of the grip on objects. Moreover, the problem of the object possibly slipping from the grip has been addressed by a system based on an optical sensor for detecting movement. Tests on different everyday objects have shown the feasibility of the above approach, given the constraints of the limited dimensions of the prosthesis and the presence of a cosmetic glove. PMID:9505249
Tura, A; Lamberti, C; Davalli, A; Sacchetti, R
Proposal of the movement trajectories for a superior extremity, to build the movement regulator of a trans-humeral prosthesis
Abstr~~t - This work obtains the patterns of movement trajectories during daily tasks of a right superior extremity, these patterns will be used to reproduce the movement in a Trans-Humeral prosthesis. In this way the movements of the prosthesis will come near to the natural movements of the superior extremity. The trajectories are obtained using three fluorescent spherical markers placed
Gilberto Diaz; Lorenzo Leija; R. Munoz; Arturo Vera
Upper extremity neuromuscular injuries in athletes.
Upper extremity muscle and nerve injuries in athletes are important causes of lost playing time and suboptimal performance. Although most muscle injuries are self-limited, imaging may be indicated in select situations for diagnostic and prognostic purposes, to investigate potential complications of injury, and for instituting prompt therapy to hasten recovery. MRI is particularly sensitive to soft tissue abnormalities seen in muscle injury, and it can reliably diagnose and stage direct injuries such as contusions and lacerations, and indirect injuries such as strains, delayed-onset muscle soreness, and exertional compartment syndrome. Upper extremity peripheral nerve injuries may be compressive or noncompressive in etiology, with certain sports and activities rendering particular nerves vulnerable to characteristic injuries. Initial evaluation includes a complete history, physical examination, and electrodiagnostic studies. MRI and ultrasound assessment of the nerves, surrounding tissues, and innervated muscles can provide localizing, diagnostic, and prognostic information that complements clinical and electrodiagnostic testing. PMID:23047279
Demertzis, Jennifer L; Rubin, David A
Controlling a multi-degree of freedom upper limb prosthesis using foot controls: user experience.
Abstract Purpose: The DEKA Arm, a pre-commercial upper limb prosthesis, funded by the DARPA Revolutionizing Prosthetics Program, offers increased degrees of freedom while requiring a large number of user control inputs to operate. To address this challenge, DEKA developed prototype foot controls. Although the concept of utilizing foot controls to operate an upper limb prosthesis has been discussed for decades, only small-sized studies have been performed and no commercial product exists. The purpose of this paper is to report amputee user perspectives on using three different iterations of foot controls to operate the DEKA Arm. Method: Qualitative data was collected from 36 subjects as part of the Department of Veterans Affairs (VA) Study to Optimize the DEKA Arm through surveys, interviews, audio memos, and videotaped sessions. Three major, interrelated themes were identified using the constant comparative method: attitudes towards foot controls, psychomotor learning and physical experience of using foot controls. Results: Feedback about foot controls was generally positive for all iterations. The final version of foot controls was viewed most favorably. Conclusions: Our findings indicate that foot controls are a viable control option that can enable control of a multifunction upper limb prosthesis (the DEKA Arm). Implications for Rehabilitation Multifunction upper limb prostheses require many user control inputs to operate. Foot controls offer additional control input options for such advanced devices, yet have had minimal study. This study found that foot controls were a viable option for controlling multifunction upper limb prostheses. Most of the 36 subjects in this study were willing to adopt foot controls to control the multiple degrees of freedom of the DEKA Arm. With training and practice, all users were able to develop the psychomotor skills needed to successfully operate food controls. Some had initial difficulty, but acclimated over time. PMID:23902465
Resnik, Linda; Klinger, Shana Lieberman; Etter, Katherine; Fantini, Christopher
Synovial chondromatosis of the upper extremity.
Synovial chondromatosis is a rare, benign, proliferative cartilaginous lesion arising from the synovial tissue or bursal lining of or near joints. This disease process can be classified into intra-articular and extra-articular, or tenosynovial, subtypes. Diagnosis can often be delayed due to the rarity of the disease and its nonspecific symptoms of pain, reduced range of motion, or swelling. This article reviews the literature and describes the classification, clinical course, demographics, diagnosis, histology, and treatment of synovial chondromatosis and tenosynovial chondromatosis in the upper extremity. PMID:23474166
Ho, Yvette Y; Choueka, Jack
Nerve glue for upper extremity reconstruction.
Nerve glue is an attractive alternative to sutures to improve the results of nerve repair. Improved axon alignment, reduced scar and inflammation, greater and faster reinnervation, and better functional results have been reported with the use of nerve glue. The different types of nerve glue and the evidence to support or oppose their use are reviewed. Although the ideal nerve glue has yet to be developed, fibrin sealants can be used as nerve glue in select clinical situations. Technology to allow suture-free nerve repair is one development that can potentially improve functional nerve recovery and the outcomes of upper extremity reconstruction. PMID:23101603
Tse, Raymond; Ko, Jason H
Compartment syndromes of the upper extremity.
Upper extremity compartment syndromes are difficult conditions that are manifest in a myriad of ways. Careful attention to the details of the history and physical examination can assist in the development of a useful working diagnosis. Testing ITPs is the best method available to help confirm the diagnosis. Prompt fasciotomy is effective for diminishing compartment pressure and limiting additional tissue necrosis due to pressure elevation. Unfortunately, a number of characteristics specific to compartment syndrome affect ultimate outcome. Other variables, such as the amount of muscle damage from the initial injury, problems originating from any associated fracture, and soft tissue injury, also significantly affect overall patient outcome. PMID:12141186
Seiler, J G; Casey, P J; Binford, S H
A Survey on Activities of Daily Living and Occupations of Upper Extremity Amputees
Objective To assess prosthetic use by upper extremity amputees, and their difficulties with prostheses in activities of daily living and occupations. Method This study is based on a survey of 307 subjects, who were using prostheses manufactured in the Center of Prosthetics and Orthotics. The survey questionnaire included items about general demographic characteristics, side and level of amputation, type of prosthesis and its use, and difficulties in the activities of daily living, employment and driving. Results The most common type of prosthesis was the cosmetic hand type (80.2%). There were no statistically significant correlations between satisfaction with prosthesis and the amputation level or type of prosthesis. The most common difficulties in daily living activities experienced by amputees were lacing shoes, removing bottle-tops with a bottle opener, and using scissors. Only 7.3% of amputees received rehabilitation services. Less than half of the amputees (44.7%) used their prostheses for eight or more hours a day, and 76.9% used their prostheses for regular or irregular cosmetic purposes. After amputation, most of the respondents (69.0%) became unemployed or changed workplaces. Conclusion In our study, respondents preferred cosmetic usage to functional usage. Only 30.0% of respondents reported satisfaction with their prostheses. Many of the amputees had difficulties in complex tasks and either changed jobs or became unemployed. Clerical workers were the occupation group, which was most likely to return to work. The development of a more functional prosthetic hand and additional rehabilitation services are required.
Jang, Chul Ho; Yang, Hea Eun; Lee, Seon Yeong; Kwon, Ji Won; Yun, Bong Duck; Choi, Jae Yung; Kim, Seon Nyeo; Jeong, Hae Won
Upper extremity lymphedema index: a simple method for severity evaluation of upper extremity lymphedema.
Measurement of the circumference is the most commonly employed method for evaluating extremity lymphedema. However, comparison between different patients is difficult with this measurement. To resolve this problem, we have formulated a new index, upper extremity lymphedema (UEL) index, which can be easily obtained from measurements of the body. We evaluated correlation between UEL index and clinical stage in patients with UEL. The UEL indices were significantly correlated with clinical stages and could be used as a severity scale. The lower extremity lymphedema index makes objective assessment of the severity of lymphedema through a numerical rating, regardless of the body type. This numerical rating makes the index useful for evaluation of lymphedema severities between different cases. PMID:21734534
Yamamoto, Takumi; Yamamoto, Nana; Hara, Hisako; Mihara, Makoto; Narushima, Mitsunaga; Koshima, Isao
Upper extremity composite tissue allotransplantation imaging.
Objective: Upper extremity (UE) transplantation is the most commonly performed composite tissue allotransplantation worldwide. However, there is a lack of imaging standards for pre- and posttransplant evaluation. This study highlights the protocols and findings of UE allotransplantation toward standardization and implementation for clinical trials. Methods: Multimodality imaging protocols for a unilateral hand transplant candidate and a bilateral mid-forearm level UE transplant recipient include radiography, computed tomography (CT), magnetic resonance (MR) imaging, catheter angiography, and vascular ultrasonography. Pre- and posttransplant findings, including dynamic CT and MR performed for assessment of motor activity of transplanted hands, are assessed, and image quality of vessels and bones on CT and MR evaluated. Results: Preoperative imaging demonstrates extensive skeletal deformity and variation in vascular anatomy and vessel patency. Posttransplant images confirm bony union in anatomical alignment and patency of vascular anastomoses. Mild differences in rate of vascular enhancement and extent of vascular networks are noted between the 2 transplanted limbs. Dynamic CT and MR demonstrate a 15¯ to 30¯ range of motion at metacarpophalangeal joints and 90¯ to 110¯ at proximal interphalangeal joints of both transplanted hands at 8 months posttransplant. Image quality was slightly better for CT than for MR in the first subject, while MR was slightly better in the second subject. Conclusion: Advanced vascular and musculoskeletal imaging play an important role in surgical planning and can provide novel posttransplantation data to monitor the success of the procedure. Implementation of more standardized protocols should enable a more comprehensive assessment to evaluate the efficacy in clinical trials. PMID:23943677
George, Elizabeth; Mitsouras, Dimitrios; Kumamaru, Kanako K; Shah, Nehal; Smith, Stacy E; Schultz, Kurt; Deaver, Pamela M; Mullen, Katherine M; Steigner, Michael L; Gravereaux, Edwin C; Demehri, Shadpour; Bueno, Ericka M; Talbot, Simon G; Pomahac, Bohdan; Rybicki, Frank J
Requirements for upper extremity motions during activities of daily living
Background. Functioning of the upper extremity after implantation of an endoprosthesis remains limited despite the achieved pain relief. Upper extremity kinematics can give insight into function after shoulder arthroplasty. Data on ranges of motion related to the performance of a selection of activities of daily living can aid the clinician in evaluating the outcome of the shoulder and elbow arthroplasties.Methods.
D. J. Magermans; E. K. J. Chadwick; H. E. J. Veeger
Multicomponent Intervention for Work-Related Upper Extremity Disorders
Although several multidimensional models have emerged to explain the development, exacerbation and maintenance of work-related upper extremity disorders and disability, there is a paucity of data on the application of these models for the development of worksite-based prevention and management programs. Sign language interpreting is an occupation associated with increased risk for upper extremity symptoms. Ergonomic, work organization, work style,
Michael Feuerstein; Liza Marshall; William S. Shaw; Lolita M. Burrell
Prosthesis for a Forequarter Amputee-Laboratory Evaluation.
National Technical Information Service (NTIS)
An upper extremity prosthesis for a forequarter amputee was laboratory evaluated. The evaluation consisted of an observation of the functional characteristics with emphasis on cable force and excursion levels, battery life, and cyclic tests. The results o...
J. W. Hodge
Exercise-Induced Deep Vein Thrombosis of the Upper Extremity
Upper-extremity deep venous thrombosis (UEDVT) is an increasingly important clinical problem in children. These events are classified as primary or secondary, with the latter being the most common and usually associated with the presence of a central venous line. Among primary UEDVT, the so-called Paget-Schroetter syndrome, effort-related or exercise-induced upper-extremity thrombotic event represents an extremely rare finding that has never
Leonardo R. BrandÐo; Suzan Williams; Walter H. A. Kahr; Clodagh Ryan; Michael Temple; Anthony K.C. Chan
High-resolution magnetic resonance neurography in upper extremity neuropathy.
The most common sites of nerve entrapment are in the upper extremity, commonly diagnosed based on clinical findings and electrophysiologic studies. Cross-sectional imaging modalities, such as ultrasonography and magnetic resonance (MR) imaging, have been used to enhance diagnostic accuracy and provide anatomic mapping of abnormalities. MR neurography offers multiplanar high-resolution imaging of upper extremity nerves as well as adjacent soft tissues, and provides an objective assessment of the neuromuscular anatomy and related abnormalities. This article reviews the normal 3-T MR neurographic appearance of the upper extremity nerves, and abnormal findings related to injury, entrapment, and other pathologic conditions. PMID:24210316
Chalian, Majid; Behzadi, Ashkan Heshmatzadeh; Williams, Eric H; Shores, Jaimie T; Chhabra, Avneesh
VIDEO: Common Upper Extremity Injections Utilizing Musculoskeletal Ultrasound.
OBJECTIVE. The purpose of this video article is to demonstrate the use of ultrasound for upper extremity musculoskeletal injections, covering general guidelines, preprocedure planning, needle selection, and basic technique. Several different upper-extremity injections are shown, including joint injections and aspirations, tendon sheath and bursal injections, and percutaneous treatment of calcific tendinitis. CONCLUSION. Musculoskeletal ultrasound is well suited for imaging-guided injections of the upper extremities. It is readily available, allows for high-resolution real-time imaging of the soft tissues and joints, and is adaptable for patient comfort and positioning. After viewing this video article, the observer should have an understanding of the applications for ultrasound in upper-extremity musculoskeletal interventions and should be able to apply that knowledge to advance their clinical practice. PMID:24951210
Scher, Courtney E; Siegal, Daniel S
Skin Cancer of the Hand and Upper Extremity
... A-Z Hand Anatomy Find a Hand Surgeon Skin Cancer of the Hand and Upper Extremity Email to ... to name and customize your collection. Register DESCRIPTION Skin cancer is a change in some of the cells ...
[Biomechanical analysis of the functioning of resection prosthesis for upper jaw].
The thesis presents the main design cases, the possible functioning of resection prosthesis. The influence of the main parameters of hinge resection prosthesis in the moving up - down on efforts to support elements (teeth and implants) and the mucosal of the sky. Suitable for use in the clinic during the initial installation and regulation of the prosthesis by moving down to ensure good contact between the lower stop and the rod spring pin, which eliminates a feeling of "balancing" the prosthesis, and hence a feeling of discomfort for the patient. It is the proved that a significant decrease in "wrenching" the supporting teeth (implants) Moments of the can be achieved by placing additional support in the area of resection of the sky or on the edge of the healthy part of it. PMID:24323959
Levandovski?, R A
[Congenital partial gigantism of the upper extremities in children].
Angio-and phlebography, as well as pathomorphological studies were made on epiphyseal cartilaginous plate, diaphyseal bone tissue and skin of patients with partial gigantism of upper extremities. Significant developmental anomalies were found in the formation of palmar arches and digital arteries, as well as hypoplasia and aplasia of deep brachial and antebrachial veins. Light and electron microscopy revealed epiphyseal plate dystrophy and dysplasia, tubular bone osteoporosis, subcutaneous fat hyperplasia. The data obtained suggest a pathogenetic relationship between the vascular formation and the development of some malformations and growth abnormalities of upper extremities. PMID:3778237
Pavlova, M N; Beliaeva, A A; Gusev, B V
Associations between childhood obesity and upper and lower extremity injuries
Objectives To estimate the overall and age-specific associations between obesity and extremity musculoskeletal injuries and pain in children. Methods This cross-sectional study used information from electronic medical records of 913 178 patients aged 219 years enrolled in an integrated health plan in the period 20072009. Children were classified as underweight, normal weight, overweight, or moderately/extremely obese and, using multivariable logistic regression methods, the associations between weight class and diagnosis of upper or lower extremity fractures, sprains, dislocations and pain were calculated. Results Overweight (OR 1.18, 95% CI 1.15 to 1.20), moderately obese (OR 1.24, 95% CI 1.20 to 1.27) and extremely obese (OR 1.34, 95% CI 1.30 to 1.39) children had statistically significantly higher odds of lower extremity injuries/pain compared to normal weight, adjusted for sex, age, race/ethnicity and insurance status. Age-stratified analyses yielded similar results. No consistent association was observed between body mass index and injuries/pain of the upper extremities. Conclusions Greater body mass index is associated with increased odds of lower extremity injuries and pain issues. Because the benefits of physical activity may still outweigh the risk of injury, attention should be paid to injury prevention strategies for these children at greater risk for lower extremity injuries.
Adams, Annette L; Kessler, Jeffrey I; Deramerian, Krikor; Smith, Ning; Black, Mary Helen; Porter, Amy H; Jacobsen, Steven J; Koebnick, Corinna
Portable Upper Extremity Robotics is as Efficacious as Upper Extremity Rehabilitative Therapy: A Randomized Controlled Pilot Trial
Objective To compare the efficacy of a repetitive task specific practice regimen integrating a portable, electromyography-controlled brace called the Myomo versus usual care repetitive task specific practice in subjects with chronic, moderate upper extremity impairment. Subjects 16 subjects (7 males; mean age = 57.0 Ý 11.02 years; mean time post stroke = 75.0 Ý 87.63 months; 5 left-sided strokes) exhibiting chronic, stable, moderate upper extremity impairment. Interventions Subjects were administered repetitive task specific practice in which they participated in valued, functional tasks using their paretic upper extremities. Both groups were supervised by a therapist and were administered therapy targeting their paretic upper extremities that was 30-minutes in duration, occurring 3 days/week for 8 weeks. However, one group participated in repetitive task specific practice entirely while wearing the portable robotic while the other performed the same activity regimen manually.. Main Outcome Measures The upper extremity Fugl-Meyer, Canadian Occupational Performance measure and Stroke Impact Scale were administered on two occasions before intervention and once after intervention. Results After intervention, groups exhibited nearly-identical Fugl-Meyer score increases of ? 2.1 points; the group using robotics exhibited larger score changes on all but one of the Canadian occupational performance measure and Stroke Impact Scale subscales, including a 12.5-point increase on the Stroke Impact Scale recovery subscale. Conclusions Findings suggest that therapist-supervised repetitive task specific practice integrating robotics is as efficacious as manual in subjects with moderate upper extremity impairment.
Page, Stephen J.; Hill, Valerie; White, Susan
Exercise-Induced Deep Vein Thrombosis of the Upper Extremity
Paget-Schroetter syndrome or effort-related upper extremity deep vein thrombosis is a rare condition that usually afflicts young healthy individuals, most commonly males. The cause is multifactorial but almost always involves extrinsic compression of the subclavian vein at the thoracic inlet, causing venous stenosis from repetitive trauma. The diagnosis of this condition may be difficult, and its delay may contribute to
Leonardo R. BrandÐo; Suzan Williams; Walter H. A. Kahr; Clodagh Ryan; Michael Temple; Anthony K.C. Chan
VDT ergonomics: upper extremity assessment requires a holistic approach.
Repetitive strain injuries (RSI) of the hand and upper extremity have been linked to video display terminals (VDT). The incidence of RSI has increased with the proliferation of computer use in the workplace and at home. A holistic approach to dealing with upper extremity RSI begins with the seated position. Simple adjustments made here can correct much of the poor positioning of the shoulders, arms, and hands. The rest of the workstation can then be designed around the correctly seated VDT user. In addition to being instructed in appropriate seating and posture, the VDT user must also learn proper keyboard technique, work pacing and rotation, and exercises to stretch shortened muscles and strengthen overstretched muscles. A checklist to review the basic components of a VDT ergonomic analysis has been developed. PMID:24441777
Drake, M R; Ferraro, M C
Upper extremity venous aneurysm as a source of pulmonary emboli.
Spontaneous venous aneurysms of the upper extremities and neck are rare and typically asymptomatic. We present the first reported case of a symptomatic, primary upper extremity venous aneurysm in a patient who initially presented with pulmonary emboli. A 22-year-old patient was admitted with chest pain, dyspnea, and a right axillary mass. Computed tomography revealed diffuse, bilateral pulmonary emboli in addition to a thrombosed axillary vein. Venography confirmed the diagnosis, and also revealed a subclavian vein stenosis at the crossing of the first rib. Pharmacomechanical thrombolysis, catheter-directed thrombolysis, and venoplasty were performed with adequate flow restoration, also revealing the presence of a previously thrombosed proximal brachial/distal axillary venous aneurysm. Hematologic testing showed a positive and persistent lupus anticoagulant. The patient declined surgical reconstruction and opted for long-term anticoagulation. At 24 months, the patient continued to remain symptom-free. PMID:23380560
Wallace, Justin R; Baril, Donald T; Chaer, Rabih A
A review of bilateral training for upper extremity hemiparesis.
Upper extremity hemiparesis is the most common post-stroke disability. Longitudinal studies have indicated that 30-66% of stroke survivors do not have full arm function 6 months post-stroke. The current gold standard for treatment of mild post-stroke upper limb impairment is constraint-induced therapy but, because of the inclusion criteria, alternative treatments are needed which target more impaired subjects. Bilateral arm training has been investigated as a potential rehabilitation intervention. Bilateral arm training encompasses a number of methods including: (1) bilateral isokinematic training; (2) mirror therapy using bilateral training; (3) device-driven bilateral training; and (4) bilateral motor priming. Neural mechanisms mediating bilateral training are first reviewed. The key bilateral training studies that have demonstrated evidence of efficacy will then be discussed. Finally, conclusions are drawn concerning clinical implications based on the reviewed literature. PMID:19517519
Stoykov, Mary Ellen; Corcos, Daniel M
Use of "spare parts" in mutilated upper extremity injuries.
Management and treatment of complex mutilated upper extremity injuries often can be challenging and at times seemingly formidable. A reconstructive surgeon's ability to mobilize, transpose, and transfer tissues has allowed not only closure of complex wounds but also restoration of function and form. Use of "spare parts" from an otherwise unsalvageable limb represents the ultimate form of reconstruction that probes the creative mind and challenges the reconstructive knowledge of the surgeon. In this article, the authors review and discuss the use of various "spare parts" in the treatment of mutilating hand injuries. PMID:12683448
Brown, Richard E; Wu, Tzu-Ying Tammy
Sensitivity and specificity of upper extremity movements decoded from electrocorticogram.
Electrocorticogram (ECoG)-based brain computer interfaces (BCI) can potentially be used for control of arm prostheses. Restoring independent function to BCI users with such a system will likely require control of many degrees-of-freedom (DOF). However, our ability to decode many-DOF arm movements from ECoG signals has not been thoroughly tested. To this end, we conducted a comprehensive study of the ECoG signals underlying 6 elementary upper extremity movements. Two subjects undergoing ECoG electrode grid implantation for epilepsy surgery evaluation participated in the study. For each task, their data were analyzed to design a decoding model to classify ECoG as idling or movement. The decoding models were found to be highly sensitive in detecting movement, but not specific in distinguishing between different movement types. Since sensitivity and specificity must be traded-off, these results imply that conventional ECoG grids may not provide sufficient resolution for decoding many-DOF upper extremity movements. PMID:24111011
Do, An H; Wang, Po T; King, Christine E; Schombs, Andrew; Lin, Jack J; Sazgar, Mona; Hsu, Frank P K; Shaw, Susan J; Millett, David E; Liu, Charles Y; Szymanska, Agnieszka A; Chui, Luis A; Nenadic, Zoran
Effect of whole body vibration applied on upper extremity muscles.
The acute residual effect of whole body vibration (WBV) on upper extremity muscles and testosterone secretion was studied. Eight highly (G1), nine moderately trained gymnasts (G2) and seven physically active persons (CG) were recruited for the investigation. The intervention occurred in push-up position with the elbow flexed at 90¯. G1 and G2 received 30 s, 30 Hz and 6 mm amplitude vibration repeated five times. Subjects were tested before and after one and ten minutes intervention in push-up movement. Contact time (Tc), fly time (Tf), TF/Tc ratio and impulse was measured from the ground reaction force-time curves recorded during self-selected (SSRM) and full range of motion (FRM). Testosterone level in urine was also determined. Tf increased significantly in SSRM for G1 and decreased in SSRM and FRM for G2. Tf/Tc ratio in FRM and impulse in SSRM increased significantly for G1 only. No significant alteration in testosterone level was observed. We concluded that WBV is a reasonable training modality for influencing dynamic work of upper extremity muscle, but the reaction to WBV is training and individual dependent. It seems that WBV do not influence dynamic work through increased testosterone secretion because of the relatively low mass of the involved muscles. PMID:23232701
Gyulai, G; RÃcz, L; Di Giminiani, R; Tihanyi, Jµzsef
Salvage of the upper extremity in cases of tumorous destruction of the proximal humerus.
Malignant bone tumours or metastasis of the upper humerus may cause significant loss of function especially in those patients with resectional arthroplasty of the shoulder. One method for achieving functional reconstruction of the humerus concerned is replacement with a modular endoprosthesis. Little is known about clinical and radiological results in these rare circumstances. Between 1993 and 1997 we treated 21 patients (22 shoulders) with enlarged osteolytic destructions of the proximal humerus caused by metastatic spread or primary malignant tumours. Patients with additional involvement of the glenoid were excluded from this study. The average follow-up was 3.9 years. Every 3 months all patients were followed-up clinically and radiographically. Prior to surgery, diagnosis was established by incisional biopsy and the outcome determined the therapeutic algorithm (radiotherapy, chemotherapy, surgery). In most cases of metastatic lesions, surgery was the first treatment. According to the regional spread of the tumour, various amount of bone and soft tissues had to be removed. The distal stem of the prosthesis was inserted in a cementless way and secured to bone with two interlocking screws. The length of the diaphyseal part depended on the site of osteotomy. Soft-tissue coverage of the large implant was achieved in all patients. Early complications were lymphogenic oedema and superficial wound dehiscence. One patient developed a deep infection, which had to be managed surgically. According to the functional rating system of the Musculoskeletal Tumour Society for the upper extremity the overall results were inversely proportional to the extent of resection. None of our patients achieved unrestricted motion of the shoulder concerned. The most important finding was a proximal migration of the prosthesis causing a painful subacromial impingement, mainly a consequence of the resection of the deltoid muscle and the rotator cuff. In summary, a modular endoprosthesis cannot be recommended generally as the method of choice. If the muscular balance of the shoulder is too weak to act as a joint centralizer the endoprosthesis has no advantage over a simple diaphyseal spacer. PMID:10870644
Fuhrmann, R A; Roth, A; Venbrocks, R A
Deep venous thrombosis of the upper extremity. A review.
Upper extremity deep venous thrombosis (UEDVT) occurs either spontaneously, as a consequence of strenuous upper limb activity (also known as the Paget-Schroetter syndrome) or secondary to an underlying cause. Primary and secondary UEDVT differs in long-term sequelae and mortality. This review will focus on the clinical presentation, risk factors, diagnosis, and treatment strategies of UEDVT. In the period from January to October 2012 an electronic literature search was performed in the PubMed/MEDLINE database, and 27 publications were included. Clinical presentation: swelling, pain and functional impairment are typical symptoms of UEDVT, although completely asymptomatic cases have been described. However life-threatening, massive pulmonary embolism (PE) can also be a sign of UEDVT. Risk factors: for the primary condition anatomical abnormalities (Thoracic Outlet Syndrome, TOS) may dispose to the condition. Malignancy and therapeutic interventions are major risk factors for the secondary deep vein thrombosis in combination with the patient's characteristics, comorbidities and prior history of deep vein thrombosis. Complications: recurrent deep venous thrombosis, pulmonary embolism and Post Thrombotic Syndrome (PTS) are the major complications after UEDVT. PTS is a chronic condition leading to significant functional disability and impaired quality of life. Diagnosis: compression ultrasonography is noninvasive and the most frequently used objective test with a high accuracy in experienced hands. Treatment modalities and strategies: the treatment modalities include anticoagulation therapy, catheter-directed thrombolysis, surgical decompression, percutaneous transluminal angioplasty and stenting and they may be combined. However, the optimal treatment and timing of treatment remains controversial. Early diagnosis and treatment is essential to prevent PTS in primary UEDVT; however, there is no consensus on which treatment is the best. Anticoagulation is still considered the treatment of choice for at least 3-6 months, until Randomized Controlled Trials may have demonstrated otherwise. PMID:23903301
Klitfod, L; Broholm, R; Baekgaard, N
Upper extremity activity in adults: Referent values using accelerometry
The goal of physical rehabilitation following upper extremity (UE) impairment is functional restoration of the UE for use in daily activities. Because capacity for UE function may not translate into real-world activity, it is important that assessment of real-world UE activity be used in conjunction with clinical measures of capacity. Accelerometry can be used to quantify duration of UE activity outside of the clinic. The purpose of this study was to characterize hours of UE activity and potential modifying factors of UE activity (sedentary activity, cognitive impairment, depressive symptomatology, additive effects of comorbidities, cohabitation status, and age). Seventy-four community dwelling adults wore accelerometers on bilateral wrists for 25 hours and provided information on modifying factors. Mean hours of dominant UE activity was 9.1 Ý 1.9 hours and the ratio of activity between the non-dominant and dominant UEs was 0.95 Ý 0.06. Decreased hours of dominant UE activity was associated with increased time spent in sedentary activity. No other factors were associated with hours of dominant UE activity. These data can be used to help clinicians establish outcome goals for patients, given pre-impairment level of sedentary activity, and to track progress during rehabilitation of the UEs.
Bailey, Ryan R.; Lang, Catherine E.
Effect of upper extremity exercise in people with COPD
Background Exercise for people with COPD has focused on leg training, such as walking and cycling. The role and effectiveness of arm training has not been investigated in detail. This review was undertaken to examine the literature for the effectiveness of upper extremity exercise on arm exercise capacity and arm strength in people with COPD. Methods Trials relating to arm endurance and strength training in COPD were located by searching electronic databases and screening the reference lists of pertinent articles. Where possible, effect sizes and 95% CI were determined and meta-analysis used. Results The search strategy yielded 24 articles. Unsupported arm training improved arm endurance capacity (standard mean difference [SMD] =1.25; 95% CI=0.16 to 2.66) and was the optimal mode of arm endurance training. Combined unsupported and supported arm training was also found to have a large positive effect on peak arm exercise capacity (SMD=1.27; 95% CI=0.59 to 1.94). In addition arm strength training produced moderate improvements in arm strength (SMD=0.46; 95% CI=0.10 to 0.81). Conclusion This review suggests that in the short term, arm endurance training improves arm exercise capacity and arm strength training improves arm strength. Further research is required, in people with COPD, to investigate the long-term effects of arm training.
Kathiresan, Ganesan; Jeyaraman, Senthil Kumar; Jaganathan, Jayachandran
Using virtual reality environment to facilitate training with advanced upper-limb prosthesis.
Technological advances in upper-limb prosthetic design offer dramatically increased possibilities for powered movement. The DEKA Arm system allows users 10 powered degrees of movement. Learning to control these movements by utilizing a set of motions that, in most instances, differ from those used to obtain the desired action prior to amputation is a challenge for users. In the Department of Veterans Affairs "Study to Optimize the DEKA Arm," we attempted to facilitate motor learning by using a virtual reality environment (VRE) program. This VRE program allows users to practice controlling an avatar using the controls designed to operate the DEKA Arm in the real world. In this article, we provide highlights from our experiences implementing VRE in training amputees to use the full DEKA Arm. This article discusses the use of VRE in amputee rehabilitation, describes the VRE system used with the DEKA Arm, describes VRE training, provides qualitative data from a case study of a subject, and provides recommendations for future research and implementation of VRE in amputee rehabilitation. Our experience has led us to believe that training with VRE is particularly valuable for upper-limb amputees who must master a large number of controls and for those amputees who need a structured learning environment because of cognitive deficits. PMID:21938657
Resnik, Linda; Etter, Katherine; Klinger, Shana Lieberman; Kambe, Charles
Electromyogram whitening for improved classification accuracy in upper limb prosthesis control.
Time and frequency domain features of the surface electromyogram (EMG) signal acquired from multiple channels have frequently been investigated for use in controlling upper-limb prostheses. A common control method is EMG-based motion classification. We propose the use of EMG signal whitening as a preprocessing step in EMG-based motion classification. Whitening decorrelates the EMG signal and has been shown to be advantageous in other EMG applications including EMG amplitude estimation and EMG-force processing. In a study of ten intact subjects and five amputees with up to 11 motion classes and ten electrode channels, we found that the coefficient of variation of time domain features (mean absolute value, average signal length and normalized zero crossing rate) was significantly reduced due to whitening. When using these features along with autoregressive power spectrum coefficients, whitening added approximately five percentage points to classification accuracy when small window lengths were considered. PMID:23475374
Liu, Lukai; Liu, Pu; Clancy, Edward A; Scheme, Erik; Englehart
Proximal venous outflow obstruction in patients with upper extremity arteriovenous dialysis access
To evaluate the impact of central venous obstruction on upper extremity hemodialysis access failure, we retrospectively analyzed our recent experience in managing this problem. We reviewed 158 upper extremity hemodialysis access procedures performed in 122 patients during a 1-year period. Fourteen (11.5%) patients had central vein obstruction as the cause of severe arm swelling, graft thrombosis, or graft malfunction. All
Enrique Criado; William A. Marston; Paul F. Jaques; Matthew A. Mauro; Blair A. Keagy
Ergonomic stressors and upper extremity disorders in vehicle manufacturing: cross sectional exposure-response trends
OBJECTIVE: To evaluate the association between upper extremity soft tissue disorders and exposure to preventable ergonomic stressors in vehicle manufacturing operations. METHODS: A cross sectional study was conducted in one vehicle stamping plant and one engine assembly plant. A standardised physical examination of the upper extremities was performed on all subjects. An interviewer administered questionnaire obtained data on demographics, work
L. Punnett
An invisible disability: Qualitative research on upper extremity disorders in a university community
Objectives. To understand how upper extremity disorders related to computer use affect graduate and undergraduate university students; and, to develop hypotheses for prevention and management of these disorders. Methods. Focus group discussions concerning upper extremity disorders were conducted among sixteen symptomatic undergrad- uate and graduate students at a private university in the US. Discussions were tape recorded, transcribed, coded for
Marissa C. Cort; Benjamin C. Amick; Jeffrey N. Katzd; Robert Brigham
Is Workstyle a Mediating Factor for Pain in the Upper Extremity Over Time?
Introduction Upper extremity musculoskeletal disorders influence workers quality of life. Workstyle may be one factor to deal with in workers with pain in the upper extremity. The objective of this study was to determine if workstyle is a mediating factor for upper extremity pain in a changing work environment of office workers over time. Methods Office workers with upper extremity pain filled out a Workstyle questionnaire (WSF) at baseline (n = 110). After 8 and 12 months follow-up assessment took place. Participants were divided into a good and an adverse workstyle group at baseline. The presence of upper extremity pain in both groups was calculated and relative risks were determined. Chi-square tests were used. Results Eight months after baseline, 80% of the adverse and 45% of the good workstyle group reported pain. The relative risk (RR) of having upper extremity pain for the adverse compared to the good workstyle group was 1.8 (95% CI 1.082.86) (P = 0.055). Twelve months after baseline, upper extremity pain was more often presented in the adverse workstyle compared to the good workstyle group (RR = 3.0, (95% CI 1.765.11), P = 0.003). Twelve months after baseline, 100% of the adverse workstyle group and 33% of the good workstyle group reported pain in the upper extremity. Conclusion Workstyle seems to be a mediating factor for upper extremity pain in office workers in a changing work environment. It is recommended to assess workstyle among office workers with upper extremity pain, and to include workstyle behaviour in treatments.
Meijer, Eline M.; Frings-Dresen, Monique H. W.
Acute and chronic rejection in upper extremity transplantation: what have we learned?
To date, 78 upper extremity transplants have been performed in 55 recipients around the world. The purpose of this article is to provide an overview of acute and chronic rejection (CR) and to summarize collective insights in upper extremity transplantation. To date, almost all patients experienced AR that is pathophysiologically similar to that in solid organs. The spectre of chronic rejection is just emerging. Upper extremity transplantation has significant potential as a reconstructive option only if efforts are invested in strategies to reduce risks of prolonged immunosuppression and in approaches to better diagnose, monitor and treat AR and CR. PMID:22051389
Gorantla, Vijay S; Demetris, Anthony J
Comparison of the Effects of Walking with and without Nordic Pole on Upper Extremity and Lower Extremity Muscle Activation
[Purpose] The aim of this study was to assess the effect of Nordic pole walking on the electromyographic activities of upper extremity and lower extremity muscles. [Subjects and Methods] The subjects were randomly divided into two groups as follows: without Nordic pole walking group (n=13) and with Nordic pole walking group (n=13). The EMG data were collected by measurement while the subjects walking on a treadmill for 30 minutes by measuring from one heel strike to the next. [Results] Both the average values and maximum values of the muscle activity of the upper extremity increased in both the group that used Nordic poles and the group that did not use Nordic poles, and the values showed statistically significant differences. There was an increase in the average value for muscle activity of the latissimus dorsi, but the difference was not statistically significant, although there was a statistically significant increase in its maximum value. The average and maximum values for muscle activity of the lower extremity did not show large differences in either group, and the values did not show any statistically significant differences. [Conclusion] The use of Nordic poles by increased muscle activity of the upper extremity compared with regular walking but did not affect the lower extremity.
Shim, Je-myung; Kwon, Hae-yeon; Kim, Ha-roo; Kim, Bo-in; Jung, Ju-hyeon
Identification of Injury Mechanisms Resulting in Injuries to the Upper Extremities in Frontal Crashes.
National Technical Information Service (NTIS)
This research study builds on previous research findings concerning upper-extremity/ airbag-interaction, and the use of average distal forearm speed (ADFS) model to predict direct-loading forearm fractures using static-deployment testing of steering wheel...
W. N. Hardy L. W. Schneider
Upper Extremity Prosthetics Research. Human Tracking. Sensory Motor Control. Myoelectric Control.
National Technical Information Service (NTIS)
CONTENTS: Upper extremity prosthetics research: Experimental investigation of the Heidelberg Pneumatic Arm; experimental investigation of the Northwestern Attitudinal Controlled Elbow; experimental investigation of the French Electric Hand; exploration of...
J. Lyman
Upper Extremity Prosthetics Research, Human Tracking, Sensory Motor Control, and Myoelectric Control.
National Technical Information Service (NTIS)
Contents: I. Upper Extremity Prosthetics Research: Needs analysis for development of externally-powered prostheses design specification; Analysis of existing externally-powered prostheses and development of advanced design specification; Current status of...
Giant lipomas of the upper extremity: Case reports and a literature review
Giant fibrolipomas involving the upper extremities are rare tumours. These large masses grow slowly and produce symptoms due to their size, location and compression of adjacent structures. Surgical excision usually leads to complete recovery from symptoms.
Balakrishnan, Chenicheri; Nanavati, Dhiren; Balakrishnan, Anila; Pane, Thomas
Regional anesthesia procedures for shoulder and upper arm surgery upper extremity update--2005 to present.
This review of the literature since 2005 assesses developments of RA techniques commonly used for shoulder surgery, and their effectiveness for postoperative analgesia. Advantages of regional techniques include site-specific anesthesia and decreased postoperative opioid use. For shoulder surgeries, the ISB provides effective analgesia with minimal complications, whereas the impacts of IA single-injections remain unclear. When combined with GA, ISB can be used in lower volumes and reducing the complications for shoulder and proximal upper extremity. USG ISB and SCB are both effective and safe for shoulder surgery with a low incidence of complications, especially PONS.53 When compared with intravenous patient-controlled opioid analgesia, a perineural LA infusion using a disposable pump with patient-controlled LA bolus function has led to better pain relief and functional recovery while decreasing the need for rescue analgesics and the number of adverse events after ambulatory orthopedic surgery. The most remarkable advance in RA in the past 5 years is the increased usage of USG. Although there are no large-scale prospective studies to show the safety, efficacy, and success and complication rates for USG blocks, USG RA theoretically could have less risk for neurologic symptoms, except for those induced by LA (less likely perineurally, much more likely intraneurally). The next "quantum leap" lies in reducing LA concentrations and augmenting anesthetic-analgesic effects with perineural additives (including clonidine, buprenorphine, and likely low-dose dexamethasone). Since 2005, perineural catheters have been an analgesic option that offers improved pain relief among other benefits, and are now being used at home. It is clear that patients benefit greatly from a single injection and continuous nerve block for postoperative pain management,but the financial and logistical aspects need to be resolved, not to mention the phrenic hemiparesis coin toss. Whether combined perineural analgesic adjuvants prolong low-concentration LA nerve blocks sufficiently to render brachial plexus catheters as unnecessary would certainly represent another quantum leap. PMID:22227421
Sripada, Ramprasad; Bowens, Clifford
In performing amputations the surgeon must bear in mind the biomechanical and other constraints of the prosthesis likely to be fitted and, so far as possible, should fashion the stump accordingly. The various types of prosthesis and their features are discussed in relation to amputations of the lower and upper limbs at all levels.
Day, H. J.
Miyaguchi, K and Demura, S. Gender difference in ability using the stretch-shortening cycle in the upper extremities. J Strength Cond Res 23(1): 231-236, 2009A gender difference in ability using the stretch-shortening cycle (SSC ability) in the upper extremities has not been studied in detail. This study aimed to devise an index to evaluate SSC ability during powerful elbow flexion and
Prevalence of Upper Extremity Symptoms and Disorders among Dental and Dental Hygiene Students
CONTEXT: Upper extremity musculoskeletal disorders are common among dental professionals. The natural history of these disorders is not well-understood. These disorders are more common in older workers, but the prevalence among younger workers has not been well-studied. OBJECTIVE: The objective of this study was to determine if dental\\/dental hygiene students had a similar prevalence of upper extremity musculoskeletal disorders compared
Robert A. Werner; Alfred Franzblau; Nancy Gell; Curt Hamann; Pamela A. Rodgers; Timothy J. Caruso; Frank Perry; Courtney Lamb; Shirley Beaver; David Hinkamp; Kathy Eklund; Christine P. Klausner
The Influence of Altering Push Force Effectiveness on Upper Extremity Demand during Wheelchair Propulsion
Manual wheelchair propulsion has been linked to a high incidence of overuse injury and pain in the upper extremity, which may be caused by the high load requirements and low mechanical efficiency of the task. Previous studies have suggested that poor mechanical efficiency may be due to a low effective handrim force (i.e. applied force that is not directed tangential to the handrim). As a result, studies attempting to reduce upper extremity demand have used various measures of force effectiveness (e.g. fraction effective force, FEF) as a guide for modifying propulsion technique, developing rehabilitation programs and configuring wheelchairs. However, the relationship between FEF and upper extremity demand is not well understood. The purpose of this study was to use forward dynamics simulations of wheelchair propulsion to determine the influence of FEF on upper extremity demand by quantifying individual muscle stress, work and handrim force contributions at different values of FEF. Simulations maximizing and minimizing FEF resulted in higher average muscle stresses (23% and 112%) and total muscle work (28% and 71%) compared to a nominal FEF simulation. The maximal FEF simulation also shifted muscle use from muscles crossing the elbow to those at the shoulder (e.g. rotator cuff muscles), placing greater demand on shoulder muscles during propulsion. The optimal FEF value appears to represent a balance between increasing push force effectiveness to increase mechanical efficiency and minimizing upper extremity demand. Thus, care should be taken in using force effectiveness as a metric to reduce upper extremity demand.
Rankin, Jeffery W.; Kwarciak, Andrew M.; Richter, W. Mark; Neptune, Richard R.
Gastric Somatostatinoma: An Extremely Rare Cause of Upper Gastrointestinal Bleeding
A 49-year-old woman presented with chronic abdominal discomfort, significant weight loss, and chronic intermittent diarrhea. She suddenly developed massive upper gastrointestinal bleeding and was referred for further treatment. Endoscopy indicated a large mass in the upper gastric body with antral and duodenal bulb involvement. Endosonography showed a large well-defined isoechoic gastric subepithelial mass with multiple intra-abdominal and peripancreatic lymphadenopathy, suspected to be malignant on the basis of fine needle aspiration cytology. The tumor was surgically removed, and histopathology showed typical characteristics of a neuroendocrine tumor. On the basis of immunohistochemical staining, somatostatinoma, a rare neuroendocrine tumor, was diagnosed. Gastrointestinal bleeding is a rare presentation and the stomach is an uncommon tumor location.
Aswakul, Pitulak; Deesomsak, Morakod; Pongpaibul, Ananya
High-voltage electrical burn injuries: functional upper extremity assessment.
High-voltage electric injuries have many manifestations, and an important complication is the damage of the central/peripheral nervous system. The purpose of this work was to assess the upper limb dysfunction in patients injured by high-voltage current. The evaluation consisted of analysis of patients' records, cutaneous-sensibility threshold, handgrip and pinch strength and a specific questionnaire about upper limb dysfunctions (DASH) in 18 subjects. All subjects were men; the average age at the time of the injury was 38 years. Of these, 72% changed job/retired after the injury. The current entrance was the hand in 94% and grounding in the lower limb in 78%. The average burned surface area (BSA) was 8.6%. The handgrip strength of the injured limb was reduced (p<0.05) and so also that of the three pinch types. The relationship between the handgrip strength and the DASH was statistically significant (p<0.001) as well as the relationship between the three pinch types (p
Mazzetto-Betti, K C; Amãncio, A C G; Farina, J A; Barros, M E P M; Fonseca, M C R
Upper extremity cumulative trauma disorder and return to work assessment.
Evaluation of the patient with upper limb cumulative trauma disorder (CTD) requires use of both qualitative and quantitative measures. The clinical evaluations are reviewed, which include tests for range of motion, strength, limb size, sensation, and dexterity. Essential observations for identifying and describing the presentation of posture, symptoms, and painful events are illustrated for qualitative descriptions related to work activities and activities of daily living (ADL). Therapeutic intervention is described in two sequential stages: calming of symptoms and then control of symptoms. PMID:24441776
Bear-Lehman, J
Incidence and prevalence of complaints of the neck and upper extremity in general practice
Objective: To study the incidence and prevalence of neck and upper extremity musculoskeletal complaints in Dutch general practice. Methods: Data were obtained from the second Dutch national survey of general practice. In all, 195 general practitioners (GPs) from 104 practices across the Netherlands recorded all contacts with patients during 12 consecutive months. Incidence densities and consultation rates were calculated. Results: The total number of contacts during the registration period of one year was 1 524 470. The most commonly reported complaint was neck symptoms (incidence 23.1 per 1000 person-years), followed by shoulder symptoms (incidence 19.0 per 1000 person-years). Sixty six GP consultations per 1000 person-years were attributable to a new complaint or new episode of complaint of the neck or upper extremity (incidence density). In all, the GPs were consulted 147 times per 1000 registered persons for complaints of the neck or upper extremity. For most complaints the incidence densities and consultation rates were higher for women than for men. Conclusions: Neck and upper extremity symptoms are common in Dutch general practice. The GP is consulted approximately seven times each week for a complaint relating to the neck or upper extremity; of these, three are new complaints or new episodes. Attention should be paid to training GPs to deal with neck and upper limb complaints, and to research on the prognosis and treatment of these common complaints in primary care.
Bot, S; van der Waal, J M; Terwee, C; van der Windt, D A W M; Schellevis, F; Bouter, L; Dekker, J
Chronic Brachial Plexopathies and Upper Extremity Proprioception and Strength
Brachial plexopathies, where traction or compressive forces disrupt motor and sensory nerve conduction, are the most common nerve injuries in collision sports. Athletes frequently do not report these episodes, however, predisposing the brachial plexus to recurrent trauma. The purpose of this study was to identify how multiple injuries to the brachial plexus affects shoulder strength and proprioception. Ten male intercollegiate football players with at least three unilateral episodes of brachial plexopathies were tested an average of 10 weeks after the most recent episode. The uninvolved shoulder was used as the control. Isometric peak torque was assessed for shoulder abduction, external rotation, and elbow flexion. Proprioception was measured under two conditions: threshold to detection of passive motion and reproduction of passive positioning. Dependent t tests revealed significant mean differences (p < .05) between the involved and uninvolved extremity for abduction peak torque, overall mean peak torque, and one out of four conditions of threshold to detection of passive motion conditions. This was in the neutral position moving into external rotation. In addition, subjects with greater numbers of episodes exhibited larger strength deficits. The results of this study emphasize the need for timely re-evaluation of athletes with chronic brachial plexopathies. ImagesFig 2.Fig 3.Fig 4.Fig 5.
Swanik, C. Buz; Henry, Tim J.; Lephart, Scott M.
Electromyographic muscle activity in curl-up exercises with different positions of upper and lower extremities.
The purpose of the study was to evaluate the electromyographic (EMG) activity of muscles in curl-up exercises depending on the position of the upper and lower extremities. From the perspective of biomechanics, different positions of the extremities result in shifting the center of gravity and changing muscular loads in abdominal strength exercises. The subjects of the research were 3 healthy students (body mass 53-56 kg and height 163-165 cm) with no history of low back pain or abdominal surgery. Subjects completed 18 trials for each of the 9 exercises (static curl-up with 3 positions of the upper and 3 position of the lower extremities). The same experiment with the same subjects was conducted on the next day. The EMG activity of rectus abdominis (RA), erector spinae (ES), and quadriceps femoris-long head (rectus femoris [RF]) was examined during the exercises. The surface electrical activity was recorded for the right and left sides of each muscle. The raw data for each muscle were rectified and integrated. The statistical analysis showed that changing the position of upper extremities in the examined exercises affects the EMG activity of RA and ES but does not significantly affect the EMG activity of RF. Additionally, it was found that curl-up exercises with the upper extremities extended behind the head and the lower extremities flexed at 90¯ in the hip and knee joints involve RA with the greatest intensity, whereas curl-up exercises with the upper extremities extended along the trunk and the lower extremities flexed at 90¯ in the hip and knee joints involve RA with the lowest intensity. PMID:20940638
Rutkowska-Kucharska, Alicja; Szpala, Agnieszka
Understanding the importance of natural neuromotor strategy in upper extremity neuroprosthetic control.
A key challenge in upper extremity neuroprosthetics is variable levels of skill and inconsistent functional recovery. We examine the feasibility and benefits of using natural neuromotor strategies through the design and development of a proof-of-concept model for a feed-forward upper extremity neuroprosthetic controller. Developed using Artificial Neural Networks, the model is able to extract and classify neural correlates of movement intention from multiple brain regions that correspond to functional movements. This is unique compared to contemporary controllers that record from limited physiological sources or require learning of new strategies. Functional MRI (fMRI) data from healthy subjects (N = 13) were used to develop the model, and a separate group (N = 4) of subjects were used for validation. Results indicate that the model is able to accurately (81%) predict hand movement strictly from the neural correlates of movement intention. Information from this study is applicable to the development of upper extremity technology aided interventions. PMID:24589839
Nathan, Dominic E; Prost, Robert W; Guastello, Stephen J; Jeutter, Dean C
Exploring expectations for upper extremity motor treatment in people after stroke: A secondary analysis
Objective Our purpose was to explore expectations for outcomes during a research intervention for people with stroke. Methods Twelve people with chronic stroke participated in this secondary analysis from a pilot trial of a high repetition, task-specific, upper extremity intervention. First, we examined relationships between individual expectancy and session-by-session achievement of high numbers of repetitions. Second, we examined the relationship between expectancy for the intervention as a whole and improvements in upper extremity motor function. Spearman rank correlation coefficients were used to evaluate the relationships. Results Correlations between individual expectancy and session-by-session achievement ranged from 0.0 to 0.84. Expectancy for improvement from the intervention was good (ave. = 7/10), but had a low correlation (0.17) with actual improvement. Conclusions Individual expectancy ratings were inconsistently related to session-by-session achievement. Expectancy for the invention as a whole was not related to improvement in upper extremity motor function.
Prager, Eliza M.; Birkenmeier, Rebecca L.; Lang PT, Catherine E.
Neurodevelopmental therapy and upper-extremity inhibitive casting for children with cerebral palsy.
The purpose of this research was to study the effect of intensive neurodevelopmental therapy (NDT) and upper-extremity inhibitive casting, separately or in combination, on hand function, quality of upper-extremity movement and range of motion of 73 children with spastic cerebral palsy aged 18 months to eight years. There was no significant difference between intensive or regular therapy and casting or no casting for hand function, between intensive and regular NDT, or between intensive NDT plus casting and the other groups for quality of movement and range of motion. Casting led to increased quality of movement and wrist extension after six months. Casting with NDT improved the quality of upper-extremity movement and range of motion. There appear to be no immediate benefits from intensive therapy alone. PMID:2065824
Law, M; Cadman, D; Rosenbaum, P; Walter, S; Russell, D; DeMatteo, C
[Muscle anomalies of the upper extremity as an atavistic cause of peripheral nerve disorder].
We report on 2 patients with anomalous muscles of the upper extremity causing symptoms of peripheral nerve entrapment. Our first case clinically showed a lesion of the R. dorsalis manus of nervus ulnaris produced by an accessory muscle belly at the dorsum of the hand to be identified as an extensor indicis brevis muscle. The second case presented a carpal-tunnel-syndrome, tunnel into the palm. Phylogenetically and ontogenetically these muscles are classified as atavistic. We demonstrate the homologies of the upper extremity of fishes, amphibians, reptiles, lower mammals and man, which show an upward migration of the muscle masses from the hand to the forearm. By that means the upper extremity gains additionally to the power of the reptiles paw the functionality and free motility of the human hand. PMID:8396294
Kraus, E; Sch—n, R; Boller, O; Nabavi, A
Specialized connective tissue: bone, the structural framework of the upper extremity.
Bone is a connective tissue containing cells, fibers, and ground substance. There are many functions in the body in which the bone participates, such as storing minerals, providing internal support, protecting vital organs, enabling movement, and providing attachment sites for muscles and tendons. Bone is unique because its collagen framework absorbs energy, whereas the mineral encased within the matrix allows bone to resist deformation. This article provides an overview of the structure and function of bone tissue from a macroscopic to microscopic level and discusses the physiological processes contributing to upper extremity bone health. It concludes by discussing common conditions influencing upper extremity bone health. PMID:22047807
Weatherholt, Alyssa M; Fuchs, Robyn K; Warden, Stuart J
The Effects of Active Scapular Protraction on the Muscle Activation and Function of the Upper Extremity
[Purpose] The purpose of this study was to determine the effects of adjusting the scapula into its ideal position through active scapular protraction on the muscle activation and function of the upper extremity. [Subjects] Twenty female college students aged 1921 without any physical or functional disability were the subjects of this study. They had no history of injury to their upper extremities or hands. [Methods] After the initial measurements the experimental group was asked to perform active scapular protraction; then, their grip strength and muscle activation were measured again. Every action was maintained for 5 seconds and repeated 3 times. The mean values of the measurements were analyzed. A resting of 1 minute was given between each action. [Results] The results revealed a significant change in the experimental groups grip strength after active scapular protraction had been performed. The surrounding muscles of the scapula, such as the serratus anterior, upper trapezius, flexor carpi ulnaris, flexor carpi radialis and palmaris longus, showed significant changes in muscle activation after active scapular protraction. The muscles of the upper extremity also showed significant changes after active scapular protraction. [Conclusion] The adjustment of scapula into its ideal position through active scapular protraction increased the activations of the muscles surrounding the shoulder joint and improved the function of the upper extremity.
Yang, Jeongok; Lee, Joongsook; Lee, Bomjin; Jeon, Sora; Han, Bobae; Han, Dongwook
Subcutaneous abscess formation in the upper extremity caused by toxigenic Corynebacterium ulcerans.
Corynebacterium ulcerans is attracting attention as an emerging zoonosis that causes lymphadenitis, dermatitis and respiratory infections. We report here what appears to be the first case of subcutaneous abscess formation in the upper extremity due to toxigenic C. ulcerans in Japan. Awareness of the fact that C. ulcerans can cause a subcutaneous, elastic-hard, less-mobile mass with heat, redness and pain in the extremities is important for differential diagnosis. PMID:23222862
Urakawa, Takaaki; Seto, Junji; Yamamoto, Akihiko; Nakajima, Tomoko; Goto, Shinichi
The Effect of Upper Extremity Fatigue on Grip Strength and Passing Accuracy in Junior Basketball Players
Fatigue is an unavoidable part of a basketball game, which may affect an athletes performance. The aim of this study was to investigate the effect of upper extremity fatigue on grip strength and passing accuracy in basketball, and ascertain if the effects of different fatigue protocols on grip strength and passing accuracy are the same. Twenty-four juniors under 18 years old (age: 16.75 Ý 0.62 years; body height: 184.5 Ý 3.31 cm; body mass: 77.25 Ý 3.22 kg) volunteered to participate in the study, and were divided into two groups. After a warm-up, both groups performed the basketball passing test and grip strength was recorded for each group under three different testing conditions: rest, 70% and 90% exercise intensity. The protocol used for the first group was the chest press, and for the second group the wrist curls. Results show that after the upper extremity fatigue protocol all parameters of the study (grip strength and passing accuracy) showed a significant decrease, and there was no significant difference between both groups regarding grip strength and passing accuracy. The study suggested that in order to avoid upper extremity fatigue, basketball trainers and coaches need to include upper extremity conditioning exercises into their training sessions.
Ahmed, Taghread
Development of an interactive upper extremity gestural robotic feedback system: from bench to reality.
Development of an interactive system to treat patients with movement impairments of the upper extremity is described. Gestures and movement of patients as instructed by therapists are detected by accelerometers and feedback is provided directly to the patient via a robot. PMID:19964144
Wood, Krista A; Lathan, Corinna E; Kaufman, Kenton R
Brief Assessment of Motor Function: Content Validity and Reliability of the Upper Extremity Gross Motor Scale
ERIC Educational Resources Information Center
Content validity and reliability of the Brief Assessment of Motor Function (BAMF) Upper Extremity Gross Motor Scale (UEGMS) were evaluated in this prospective, descriptive study. The UEGMS is one of five BAMF ordinal scales designed for quick documentation of gross, fine, and oral motor skill levels. Designed to be independent of age and
Cintas, Holly Lea; Parks, Rebecca; Don, Sarah; Gerber, Lynn
Nerve compression syndromes of the upper extremity: diagnosis, treatment, and rehabilitation.
Nerve compression syndromes of the upper extremity, including carpal tunnel syndrome, cubital tunnel syndrome, posterior interosseous syndrome and radial tunnel syndrome, are common in the general population. Diagnosis is made based on patient complaint and history as well as specific exam and study findings. Treatment options include various operative and nonoperative modalities, both of which include aspects of hand therapy and rehabilitation. PMID:23641462
Mansuripur, P Kaveh; Deren, Matthew E; Kamal, Robin
The purpose of this study was to examine reaction forces transmitted to the upper extremities of high- level gymnasts during the round-off phase of the Yurchenko vault. A secondary purpose of this study was to compare reaction forces during the Yurchenko vault to reaction forces observed in a tumbling pass during the floor exercise. Ten high-level, female gymnasts volunteered to
Matthew Kirk Seeley; Eadric Bressel
An evolutionary perspective on the history of flap reconstruction in the upper extremity.
Examining the evolution of flap reconstruction of the upper extremity is similar to studying the evolution of biological species. This analogy provides a perspective to appreciate the contributing factors that led to the development of the current arsenal of techniques. It shows the trajectory for the future and provides a glimpse of the factors that that will be influential in the future. PMID:24731604
Fang, Frank; Chung, Kevin C
Weak Grip Strength Does not Predict Upper Extremity Musculoskeletal Symptoms or Injuries Among New Workers.
Purpose Grip strength is often tested during post-offer pre-placement screening for workers in hand-intensive jobs. The purpose of this study was to evaluate the association between grip strength and upper extremity symptoms, work disability, and upper extremity musculoskeletal disorders (UE MSDs) in a group of workers newly employed in both high and low hand intensive work. Methods 1,107 recently-hired workers completed physical examinations including grip strength measurements. Repeated surveys obtained over 3 years described the presence of upper extremity symptoms, report of physician-diagnosed musculoskeletal disorders (MSDs), and job titles. Baseline measured grip values were used in analytic models as continuous and categorized values to predict upper extremity symptoms, work disability, or UE MSD diagnosis. Results Twenty-six percent of males and 20 % of females had low baseline hand strength compared to normative data. Multivariate logistic regression analyses showed no consistent associations between grip strength and three health outcomes (UE symptoms, work disability, and MSDs) in this young cohort (mean age 30 years). Past MSD and work type were significant predictors of these outcomes. Conclusions Physical hand strength testing was not useful for identifying workers at risk for developing UE MSDs, and may be an inappropriate measure for post-offer job screens. PMID:23857165
Dale, Ann Marie; Addison, Lesley; Lester, Josh; Kaskutas, Vicki; Evanoff, Bradley
Vascularized Nerve Grafts and Vascularized Fascia for Upper Extremity Nerve Reconstruction
Since 1976, experimental and clinical studies have suggested the superiority of vascularized nerve grafts. In this study, a 27-year experience of the senior author is presented regarding vascularized nerve grafts and fascia for complex upper extremity nerve reconstruction. The factors influencing outcomes as well as a comparison with conventional nerve grafts is presented. Since 1981, 21 vascularized nerve grafts, other than vascularized ulnar nerve, were used for reconstruction of nerve injuries in the upper extremity. Indications were prolonged denervation time, failure of the previously used conventional nerve grafts, and excessive scar in the recipient site. Injury was in the hand/wrist area (n?=?5), in the forearm (n?=?4), in the elbow (n?=?2), in the arm (n?=?4), or in the plexus (n?=?6). Vascularized sural (n?=?9), saphenous (n?=?8), superficial radial (n?=?3), and peroneal (superficial and deep) nerves were used. The mean follow-up was 31.4 months. Vascularized nerve grafts for upper extremity injuries provided good to excellent sensory return in severely scarred upper extremities in patients in whom conventional nerve grafts had failed. They have also provided relief of causalgia after painful neuroma resection and motor function recovery in selective cases even for above the elbow injuries. Small diameter vascularized nerve grafts should be considered for bridging long nerve gaps in regions of excessive scar or for reconstructions where conventional nerve grafts have failed.
Kostopoulos, Vasileios K.
An ergonomic evaluation of surgeons axial skeletal and upper extremity movements during laparoscopic and open surgery
Background: Many surgeons have complained of fatigue and musculoskeletal pain after laparoscopic surgery. We evaluated differences in surgeons axial skeletal and upper extremity movements during laparoscopic and open operations.Methods: Five surgeons were videotaped performing 16 operations (8 laparoscopic and 8 open) to record their neck, trunk, shoulder, elbow, and wrist movements during the first hour of surgery. We also compared
Ninh T Nguyen; Hung S Ho; Warren D Smith; Constantine Philipps; Clare Lewis; Rodel M De Vera; Ramon Berguer
Validation of Upper Extremity Post-Thrombotic Syndrome Outcome Measurement in Children
Using the Manco-Johnson instrument in a derivation cohort of 107 children with/without central venous catheters, upper extremity (UE) physical findings of post-thrombotic syndrome were absent and pain score was zero in all but one child. Inter-rater reliability in an independent validation cohort (n=38) of children with/without UE DVT was 97-100%.
Goldenberg, Neil A.; Pounder, Elizabeth; Knapp-Clevenger, R.; Manco-Johnson, Marilyn J.
Construct Validity of the Quality of Upper Extremity Skills Test for Children with Cerebral Palsy
ERIC Educational Resources Information Center
Aim: The aim of the study was to investigate the construct validity of the Quality of Upper Extremity Skills Test (QUEST) in children with cerebral palsy (CP). Method: A total of 170 QUEST assessments from a convenience sample of 94 children with CP involved in clinical and research treatment programmes (54 males, 40 females; mean age 6y 10mo, SD
Thorley, Megan; Lannin, Natasha; Cusick, Anne; Novak, Iona; Boyd, Roslyn
The effects of airbag deployment on severe upper extremity injuries in frontal automobile crashes
The purpose of this study was to investigate severe upper extremity injuries resulting from frontal automobile crashes and to determine the effects of frontal airbags. The National Automotive Sampling System database files from 1993 to 2000 were examined in a study that included 25,464 individual cases that occurred in the United States. An analysis of the cases indicated that occupants
M. Virginia Jernigan; Stefan M. Duma
Musculotendon Lengths and Moment Arms for a Three-Dimensional Upper-Extremity Model
Generating muscle-driven forward dynamics simulations of human movement using detailed musculoskeletal models can be computationally expensive. This is due in part to the time required to calculate musculotendon geometry (e.g., musculotendon lengths and moment arms), which is necessary to determine and apply individual musculotendon forces during the simulation. Modeling upper-extremity musculotendon geometry can be especially challenging due to the large number of multi-articular muscles and complex muscle paths. To accurately represent this geometry, wrapping surface algorithms and/or other computationally expensive techniques (e.g., phantom segments) are used. This paper provides a set of computationally efficient polynomial regression equations that estimate musculotendon length and moment arms for thirty-two (32) upper-extremity musculotendon actuators representing the major muscles crossing the shoulder, elbow and wrist joints. Equations were developed using a least squares fitting technique based on geometry values obtained from a validated public-domain upper-extremity musculoskeletal model that used wrapping surface elements (Holzbaur et al., 2005). In general, the regression equations fit well the original model values, with an average root mean square difference for all musculotendon actuators over the represented joint space of 0.39 mm (1.1% of peak value). In addition, the equations reduced the computational time required to simulate a representative upper-extremity movement (i.e., wheelchair propulsion) by more than two orders of magnitude (315 versus 2.3 seconds). Thus, these equations can assist in generating computationally efficient forward dynamics simulations of a wide range of upper-extremity movement tasks.
Rankin, Jeffery W.; Neptune, Richard R.
NASA Technical Reports Server (NTRS)
A coupling for use in an apparatus for connecting a prosthesis to the bone of a stump of an amputated limb is described which permits a bio-compatible carbon sleeve forming a part of the prosthesis connector to float so as to prevent disturbing the skin seal around the carbon sleeve. The coupling includes a flexible member interposed between a socket that is inserted within an intermedullary cavity of the bone and the sleeve. A lock pin is carried by the prosthesis and has a stem portion which is adapted to be coaxially disposed and slideably within the tubular female socket for securing the prosthesis to the stump. The skin around the percutaneous carbon sleeve is able to move as a result of the flexing coupling so as to reduce stresses caused by changes in the stump shape and/or movement between the bone and the flesh portion of the stump.
Reswick, J. B.; Mooney, V.; Bright, C. W.; Owens, L. J. (inventors)
Free style perforator based propeller flaps: Simple solutions for upper extremity reconstruction!
Background: The introduction of perforator flaps by Koshima et al. was met with much animosity in the plastic surgery fraternity. The safety concerns of these flaps following the intentional twist of the perforators have prevented widespread adoption of this technique. Use of perforator based propeller flaps in the lower extremity is gradually on the rise, but their use in upper extremity reconstruction is infrequently reported, especially in the Indian subcontinent. Materials and Methods: We present a retrospective series of 63 free style perforator flaps used for soft tissue reconstruction of the upper extremity from November 2008 to June 2013. Flaps were performed by a single surgeon for various locations and indications over the upper extremity. Patient demographics, surgical indication, defect features, complications and clinical outcome are evaluated and presented as an uncontrolled case series. Results: 63 free style perforator based propeller flaps were used for soft tissue reconstruction of 62 patients for the upper extremity from November 2008 to June 2013. Of the 63 flaps, 31 flaps were performed for trauma, 30 for post burn sequel, and two for post snake bite defects. We encountered flap necrosis in 8 flaps, of which there was complete necrosis in 4 flaps, and partial necrosis in four flaps. Of these 8 flaps, 7 needed a secondary procedure, and one healed secondarily. Although we had a failure rate of 12-13%, most of our failures were in the early part of the series indicative of a learning curve associated with the flap. Conclusion: Free style perforator based propeller flaps are a reliable option for coverage of small to moderate sized defects. Level of Evidence: Therapeutic IV.
Panse, Nikhil; Sahasrabudhe, Parag
Content Range and Precision of a Computer Adaptive Test of Upper Extremity Function for Children with Cerebral Palsy
ERIC Educational Resources Information Center
This article reports on the content range and measurement precision of an upper extremity (UE) computer adaptive testing (CAT) platform of physical function in children with cerebral palsy. Upper extremity items representing skills of all abilities were administered to 305 parents. These responses were compared with two traditional standardized
Montpetit, Kathleen; Haley, Stephen; Bilodeau, Nathalie; Ni, Pengsheng; Tian, Feng; Gorton, George, III; Mulcahey, M. J.
Upper extremity transplantation: current concepts and challenges in an emerging field.
Loss of an isolated upper limb is an emotionally and physically devastating event that results in significant impairment. Patients who lose both upper extremities experience profound disability that affects nearly every aspect of their lives. While prosthetics and surgery can eventually provide the single limb amputee with a suitable assisting hand, limited utility, minimal haptic feedback, weight, and discomfort are persistent problems with these techniques that contribute to high rates of prosthetic rejection. Moreover, despite ongoing advances in prosthetic technology, bilateral amputees continue to experience high levels of dependency, disability, and distress. Hand and upper extremity transplantation holds several advantages over prosthetic rehabilitation. The missing limb is replaced with one of similar skin color and size. Sensibility, voluntary motor control, and proprioception are restored to a greater degree, and afford better dexterity and function than prosthetics. The main shortcomings of transplantation include the hazards of immunosuppression, the complications of rejection and its treatment, and high cost. Hand and upper limb transplantation represents the most commonly performed surgery in the growing field of Vascularized Composite Allotransplantation (VCA). As upper limb transplantation and VCA have become more widespread, several important challenges and controversies have emerged. These include: refining indications for transplantation, optimizing immunosuppression, establishing reliable criteria for monitoring, diagnosing, and treating rejection, and standardizing outcome measures. This article will summarize the historical background of hand transplantation and review the current literature and concepts surrounding it. PMID:24241894
Elliott, River M; Tintle, Scott M; Levin, L Scott
Upper extremity impairments in women with or without lymphedema following breast cancer treatment
Introduction Breast-cancer-related lymphedema affects ?25% of breast cancer (BC) survivors and may impact use of the upper limb during\\u000a activity. The purpose of this study is to compare upper extremity (UE) impairment and activity between women with and without\\u000a lymphedema after BC treatment.\\u000a \\u000a \\u000a \\u000a \\u000a Methods 144 women post BC treatment completed demographic, symptom, and Disability of Arm-Shoulder-Hand (DASH) questionnaires. Objective\\u000a measures included Purdue
Betty Smoot; Josephine Wong; Bruce Cooper; Linda Wanek; Kimberly Topp; Nancy Byl; Marylin Dodd
Recurrent lipoblastoma of upper extremity in a 9-year-old boy.
Lipoblastoma is a benign soft-tissue tumour of infancy and early childhood. The location of the tumour varies from that of the extremities, trunk, retroperitoneum, mediastinal, inguinal and scrotal regions. The most common symptoms are painless mass with or without increasing size. Complete surgical excision is the gold standard for managing this entity. Though rare, the recurrence occurs usually because of incomplete excision. We report a case of recurrent lipoblastoma of the upper extremity in a 9-year-old boy. PMID:24713710
Panda, Shasanka Shekhar; Bajpai, Minu; Singh, Amit
Complications in the upper extremity following intra-arterial drug abuse.
A retrospective study of drug abuse patients who developed arterial and venous complications in the upper extremity during 2002-2006 was performed. Twenty-two patients were admitted to hospital on 24 occasions over this period for treatment by our hand clinic. The drug most frequently causing complications was midazolam. The predominant clinical findings were increasing pain and loss of sensitivity in the hand, followed by oedema, cyanosis and marbling of the skin. Treatments included brachial block anaesthesia, low molecular weight heparin, embolectomy and fasciotomies. Despite these measures, amputations, mainly of the fingertips, were necessary in 15 patients. Complications in the upper extremity after self-injection by drug addicts are increasing; information and preventive procedures to minimize these complications are important and demanding tasks for health care bodies. PMID:20237182
Lindfors, N C; Vilpponen, L; Raatikainen, T
[Diagnostics and correction of vascular disorders in upper extremity muscular transplants].
The features of clinical presentation, diagnosis and treatment of the acute circulatory disorders of muscular transplants in 7 patients after 59 transplantations of revascularized and reinnervated muscle grafts in severe consequences of upper extremities injuries were presented in the article. Tissue complex on pedicle were transplanted to upper extremity in Volkmann contracture (n=47), in consequences of the gunshot wound (n=7) and electric trauma (n=5). Signs of circulatory disorders of the transplanted tissue complex were registered shortly after the operation in 7 patients. Diagnosis was based on the findings of visual and ultrasound investigations. In all cases of circulatory disorders disorders patients were reoperated within 24 hours. Arterial thrombosis occurred in 3 cases and venous - in 2. The cause of impaired venous outflow was a hematoma in 2 cases. Repeated reconstruction of anastomoses with wound drainage in 5 cases led to restoration of blood circulation in transplants. Reoperation was not successful in 2 cases with developing transplant necrosis. PMID:23887262
Malikov, M Kh; Kurbanov, U A; Karimzade, G D
Association between Back, Neck, and Upper Extremity Musculoskeletal Pain and the Individual Body Armor
The purpose of this study was to investigate the relationship between back, neck, and upper extremity (UE) musculoskeletal pain and the wear of individual body armor, physical training (PT), and work tasks. We conducted a cross-sectional randomized-survey design in which 1,187 surveys were distributed to U.S. Soldiers in Iraq; 863 were completed. The survey was a three-page questionnaire covering demographics,
Mary Lim Reed; M FARGO; T BRININGER; M LIMREED
Understanding neuromotor strategy during functional upper extremity tasks using symbolic dynamics.
The ability to model and quantify brain activation patterns that pertain to natural neuromotor strategy of the upper extremities during functional task performance is critical to the development of therapeutic interventions such as neuroprosthetic devices. The mechanisms of information flow, activation sequence and patterns, and the interaction between anatomical regions of the brain that are specific to movement planning, intention and execution of voluntary upper extremity motor tasks were investigated here. This paper presents a novel method using symbolic dynamics (orbital decomposition) and nonlinear dynamic tools of entropy, self-organization and chaos to describe the underlying structure of activation shifts in regions of the brain that are involved with the cognitive aspects of functional upper extremity task performance. Several questions were addressed: (a) How is it possible to distinguish deterministic or causal patterns of activity in brain fMRI from those that are really random or non-contributory to the neuromotor control process? (b) Can the complexity of activation patterns over time be quantified? (c) What are the optimal ways of organizing fMRI data to preserve patterns of activation, activation levels, and extract meaningful temporal patterns as they evolve over time? Analysis was performed using data from a custom developed time resolved fMRI paradigm involving human subjects (N=18) who performed functional upper extremity motor tasks with varying time delays between the onset of intention and onset of actual movements. The results indicate that there is structure in the data that can be quantified through entropy and dimensional complexity metrics and statistical inference, and furthermore, orbital decomposition is sensitive in capturing the transition of states that correlate with the cognitive aspects of functional task performance. PMID:22196111
Nathan, Dominic E; Guastello, Stephen J; Prost, Robert W; Jeutter, Dean C
Cognitive-Behavior Therapy in the Management of Upper Extremity Cumulative Trauma Disorder
Cognitive-behavioral techniques have a great deal to offer in the prevention and remediation of upper extremity cumulative trauma disorder (CTD) in the workplace In relation to prevention, cognitive-behavioral methods offer promise as adjuncts to educational programs and ergonomic practices that aim to increase workers' use of safe work postures, movements, and procedures. Cognitive-behavior therapy (CBT) is also an important component
Susan H. Spence
Delayed-onset muscle soreness and motor performance of the upper extremity
. The purpose of this study was to examine the effects of delayed-onset muscle soreness after a strength-training session on\\u000a the motor performance of the upper extremities, including the reaction time, speed of movement, tapping speed and coordination.\\u000a In addition, muscle strength, electromyographic (EMG) activity, creatine kinase (CK) and soreness responses were measured.\\u000a The study was a randomised cross-over intervention
Kari Kauranen; Pertti Siira; Heikki Vanharanta
Upper extremity skeletal muscle mass: Potential of measurement with single frequency bioimpedance analysis
This study examined the potential of single frequency (50 kHz) BIA for estimation of upper extremity skeletal muscle (SM) mass. Subjects (n = 50) were weight stable adults varying in age (X Ý SD, 51.6 Ý 17 yr) and body mass index (27.2 Ý 5.9 kg\\/m2). Determinants of arm to arm impedance index (length L; L2\\/Z) were examined using multiple
Steven B. Heymsfield; Dympna Gallagher; Jill Grammes; Christopher Nuþez; Zimian Wang; Angelo Pietrobelli
A checklist for evaluating ergonomic risk factors associated with upper extremity cumulative trauma disorders
A two-page checklist for determining the presence of ergonomic risk factors associated with the development of upper extremity cumulative trauma disorders (e.g., repetitiveness, local mechanical contact stresses, forceful manual exertions, awkward postures, and hand tool usage) was developed and evaluated as part of a joint labour-management ergonomics intervention programme. This checklist was used by plant personnel at four work sites
Reliability and Validity of the Kinematic Dystonia Measure for Children With Upper Extremity Dystonia
This study was conducted to determine the test-retest reliability and construct validity of the Kinematic Dystonia Measure, a quantitative measure of upper extremity dystonia. To determine the effectiveness of various treatments, reliable and valid measures of dystonia are required. Test-retest reliability of the Kinematic Dystonia Measure using the intraclass correlation coefficient was excellent for the hand-tapping task (0.95) and substantial
Anne Kawamura; Sue Klejman; Darcy Fehlings
A reassessment of the role of the radial forearm flap in upper extremity reconstruction.
Our understanding of the hemodynamic consequences of radial artery harvest to the upper extremity has changed our considerations when approaching soft tissue defects of the hand. A critical assessment of the donor site morbidity of radial forearm (and radial artery) harvest is necessary to discern the role this flap should have in our current and future reconstructive armamentarium. A review of the available data and discussion of its implications is provided. PMID:21621927
Higgins, James P
Evaluation and management of chronic work-related musculoskeletal disorders of the distal upper extremity
This clinical review will describe the epidemiology, clinical presentation, and manage- ment of the following work-related musculoskeletal disorders (WMSDs) of the distal upper extremity: deQuervain's disease, extensor and flexor forearm tendinitis\\/tendinosis, lateral and medial epicondylitis, cubital tunnel syndrome, and hand-arm vibration syndrome (HAVS). These conditions were selected for review either because they were among the most common WMSDs among patients
George Piligian; Robin Herbert; Michael Hearns; Jonathan Dropkin; Paul Landsbergis; Martin Cherniack
Allograft Reconstruction for the Treatment of Musculoskeletal Tumors of the Upper Extremity
In comparison with the lower extremity, there is relatively paucity literature reporting survival and clinical results of allograft reconstructions after excision of a bone tumor of the upper extremity. We analyze the survival of allograft reconstructions in the upper extremity and analyze the final functional score according to anatomical site and type of reconstruction. A consecutive series of 70 allograft reconstruction in the upper limb with a mean followup of 5 years was analyzed, 38 osteoarticular allografts, 24 allograft-prosthetic composites, and 8 intercalary allografts. Kaplan-Meier survival analysis of the allografts was performed, with implant revision for any cause and amputation used as the end points. The function evaluation was performed using MSTS functional score. Sixteen patients (23%) had revision surgery for 5 factures, 2 infections, 5 allograft resorptions, and 2 local recurrences. Allograft survival at five years was 79% and 69% at ten years. In the group of patients treated with an osteoarticular allograft the articular surface survival was 90% at five years and 54% at ten years. The limb salvage rate was 98% at five and 10 years. We conclude that articular deterioration and fracture were the most frequent mode of failure in proximal humeral osteoarticular reconstructions and allograft resorption in elbow reconstructions. The best functional score was observed in the intercalary humeral allograft.
Aponte-Tinao, Luis A.; Ayerza, Miguel A.; Muscolo, D. Luis; Farfalli, German L.
Interventions for the prevention and management of neck/upper extremity musculoskeletal conditions: a systematic review
Considered from medical, social or economic perspectives, the cost of musculoskeletal injuries experienced in the workplace is substantial, and there is a need to identify the most efficacious interventions for their effective prevention, management and rehabilitation. Previous reviews have highlighted the limited number of studies that focus on upper extremity intervention programmes. The aim of this study was to evaluate the findings of primary, secondary and/or tertiary intervention studies for neck/upper extremity conditions undertaken between 1999 and 2004 and to compare these results with those of previous reviews. Relevant studies were retrieved through the use of a systematic approach to literature searching and evaluated using a standardised tool. Evidence was then classified according to a pattern of evidence approach. Studies were categorised into subgroups depending on the type of intervention: mechanical exposure interventions; production systems/organisational culture interventions and modifier interventions. 31 intervention studies met the inclusion criteria. The findings provided evidence to support the use of some mechanical and modifier interventions as approaches for preventing and managing neck/upper extremity musculoskeletal conditions and fibromyalgia. Evidence to support the benefits of production systems/organisational culture interventions was found to be lacking. This review identified no single?dimensional or multi?dimensional strategy for intervention that was considered effective across occupational settings. There is limited information to support the establishment of evidence?based guidelines applicable to a number of industrial sectors.
Boocock, M G; McNair, P J; Larmer, P J; Armstrong, B; Collier, J; Simmonds, M; Garrett, N
Kinetics of the upper extremity in the open and square stance tennis forehand.
Seven right-handed teaching professionals and eight intermediate tennis players were filmed using two high-speed cameras (100 Hz) as they performed open and square stance forehand drives. Three-dimensional coordinates (3D) were reconstructed using the DLT method. A three-segment rigid body model of the racket and upper extremity was used to calculate the kinetics of the wrist, elbow, and shoulder joints up to impact. The open stance created lower resultant velocities of the racket at impact (21.2 and 15.8 m/s) than the square stance (22.3 and 16.4 m/s) for professional and intermediate subjects, respectively. The largest components of the resultant joint torques were generated by the shoulder horizontal adductors, followed by elbow varus torques, and shoulder internal rotation torques. Torques were similar across stance and skill level except for significantly (p < 0.05) greater peak shoulder internal rotation torques in the square compared to the open stance, greater peak wrist flexion torques in the intermediate compared to the professionals, and greater peak wrist flexion torques in the square stance compared to the open stance. The data did not support the hypothesis that the open stance technique creates greater loading throughout the upper extremity than the square stance technique. Peak upper extremity torques were similar to peak torques reported for baseball pitching and represent loads that could contribute to strength imbalances and overuse injuries. PMID:12801214
Bahamonde, R E; Knudson, D
Playing Piano Can Improve Upper Extremity Function after Stroke: Case Studies
Music-supported therapy (MST) is an innovative approach that was shown to improve manual dexterity in acute stroke survivors. The feasibility of such intervention in chronic stroke survivors and its longer-term benefits, however, remain unknown. The objective of this pilot study was to estimate the short- and long-term effects of a 3-week piano training program on upper extremity function in persons with chronic stroke. A multiple pre-post sequential design was used, with measurements taken at baseline (week0, week3), prior to (week6) and after the intervention (week9), and at 3-week follow-up (week12). Three persons with stroke participated in the 3-week piano training program that combined structured piano lessons to home practice program. The songs, played on an electronic keyboard, involved all 5 digits of the affected hand and were displayed using a user-friendly MIDI program. After intervention, all the three participants showed improvements in their fine (nine hole peg test) and gross (box and block test) manual dexterity, as well as in the functional use of the upper extremity (Jebsen hand function test). Improvements were maintained at follow-up. These preliminary results support the feasibility of using an MST approach that combines structured lessons to home practice to improve upper extremity function in chronic stroke.
Villeneuve, Myriam; Lamontagne, Anouk
Lower and upper extremity loading in nordic walking in comparison with walking and running.
Nordic walking (NW) was compared with walking (W) and running (R) with respect to upper and lower limb injury risks. 24 NW-instructors performed W, NW, and R trials on a runway covered with artificial turf at controlled speeds. Foot pronation and ground reaction forces were measured as well as shock wave transmission to the right wrist. Comparison of NW and W shows similar results for all of the four chosen velocities (5 km/h, 7 km/h, 8 km/h, 8.5 km/h). Except for the 2nd peak of the vertical ground reaction force, NW results in higher loading rates and horizontal forces as well as higher pronation and pronation velocity values as compared with W. Wrist acceleration values up to 7.6 times gravitational acceleration were recorded in NW. Compared with R at the same speeds (8 km/h and 8.5 km/h), NW can be recommended as low impact sport with 36% lower loading rates and 59% lower pronation velocities. However, the high wrist accelerations in NW reveal that the upper extremities are exposed to considerable repetitive shocks, which may cause overuse injuries of the upper extremities. Thus, additional preventive exercises for the upper limb muscles are recommended as well as using shock absorbing walking poles. PMID:21451179
Hagen, Marco; Hennig, Ewald M; Stieldorf, Peter
Emergent Thrombectomy in a Neonate with an Upper Extremity Arterial Thrombus
Case?This case report is of a 39 4/7weeks infant who presented at the time of birth with an immobile, cyanotic right upper extremity consistent with ischemia but without evidence of gangrene. Doppler examination identified pulses in the axillary but not the brachial or radial arteries. Extremity arterial ultrasound confirmed the diagnosis of an arterial thrombosis extending from the right axillary artery to the brachial artery bifurcation. An emergent balloon thrombectomy was performed successfully with immediate return of blood flow. Intraoperative ultrasound demonstrated patent axillary and brachial arteries with forward flow. A retroperitoneal ultrasound and limited hypercoagulable workup failed to identify a source of the arterial thrombus. The infant had normal return of function without residual limb effects. Conclusion?Emergent balloon thrombectomy should be heavily considered in neonates with an extremity arterial thrombosis of undeterminable duration both for limb salvage, preserve function, and to prevent long-term growth discordance.
Ulrich, Timothy J. B.; Ellsworth, Marc A.; Lang, Tara R.
Factors Affecting Outcomes in Patients Treated Surgically for Upper Extremity Tumors and Tumor-Like Lesions
There is little data available regarding outcomes of patients who have undergone surgery for tumors of the upper extremity. Functional data after surgery for upper extremity tumors would aid in guiding patient expectations in the peri-operative period. The purpose of this study was to identify patient, tumor, and surgery-related characteristics associated with patient-reported physical and emo-tional function before and after surgery for tumors of the upper extremity. Pre- and post-operative mental and physical Medical Outcomes Study Short Form 36 (SF-36) scores were collected from 79 patients with benign and malignant neoplasms of the upper extremity. A retrospective chart review was performed to ascertain whether tumor behavior, type, location, patient sex, age, surgical specimen size, or type of surgery were correlated with differing outcomes. Our outcome measure was patient-reported physi-cal and mental score (SF-36) at less than one year, one to two years, and greater than two years post-operatively. We found that patients with tumors proximal to the elbow and patients with right-sided tumors had statistically significantly lower post-operative physical scores at minimum two-year follow-up (p=0.02). Additionally, lower physical scores were associated with age greater than 50 (p=0.03) and tumor resection rather than curettage (p=0.01). The subset of patients with hereditary multiple exostoses had significantly lower post-operative physical scores than other patient sub-populations. There was no difference in physical function after surgery between patients with benign and malig-nant tumors, patients with tumors larger than 5 cm and less than 5 cm in greatest dimension, and patients with bone versus soft tissue tumors. Inter-estingly, we found that there was no difference in mental function scores between any comparisons. Our results suggest that patient age, tumor location, and type of surgery are correlated with patient-reported physical function following sur-gery. These findings could be helpful in counsel-ing patients undergoing surgery for tumors of the upper extremity.
Otero, Jesse E; Graves, Christopher M; TeKippe, Ashley; Buckwalter, Joseph A; Miller, Benjamin J
Recovery of Upper Extremity Sensorimotor System Acuity in Baseball Athletes After a Throwing-Fatigue Protocol
Context: Research indicates that upper extremity fatigue hampers sensorimotor system acuity. However, no investigators have observed recovery of upper extremity acuity after fatigue. Objective: To observe recovery of active position reproduction acuity in overhead throwers after a throwing-fatigue protocol. Design: Single-session, repeated-measures design. Setting: University musculoskeletal laboratory. Patients or Other Participants: Sixteen healthy collegiate baseball players (age = 21.0 Ý 1.6 years, height = 175.8 Ý 10.2 cm, mass = 82.8 Ý 4.3 kg). Intervention(s): Subjects threw a baseball with maximum velocity (every 5 seconds) from a single knee. Every 20 throws, subjects rated their upper extremity exertion on a Borg scale until reporting a level of more than 14. Main Outcome Measure(s): We used an electromagnetic tracking system to measure active multijoint position reproduction acuity at 5 intervals: prefatigue; immediately postfatigue; and after 4, 7, and 10 minutes of recovery. Blindfolded subjects reproduced their arm-cocked and ball-release positions. Dependent variables were 3-dimensional variable errors of scapulothoracic, glenohumeral, elbow, and wrist joints; endpoint (ie, hand) position error represented overall upper extremity acuity. The independent variable was time (measured prefatigue and at 4 postfatigue intervals). Results: Fatigue significantly affected acuity of scapulothoracic, glenohumeral, and elbow joints and endpoint error for both positions (P < .001). Fatigue significantly affected wrist acuity only for ball release (P < .001). For arm-cocked reproduction, each measure of acuity, except that of the glenohumeral joint, recovered by 7 minutes; for ball release, each measure of acuity recovered within 4 minutes (P > .05). Conclusions: The sensorimotor system deficits that we observed after fatigue recovered within 7 minutes in most upper extremity joints. Glenohumeral arm-cocked position reproduction acuity failed to recover within 10 minutes. Research indicates that overhead throwers are vulnerable in this position to the capsulolabral injuries commonly observed in throwing athletes. Future researchers should explore this relationship and the effectiveness of exercises aimed at enhancing sensorimotor system acuity and endurance.
Tripp, Brady L; Yochem, Eric M; Uhl, Timothy L
Role of Anomalous States of Upper Tropospheric Circulation on Extremely Dry and Wet Summer Monsoon Events
NASA Astrophysics Data System (ADS)
Seasonal changes in wind pattern, monsoon, sometimes result in severe droughts and intense flooding in many parts of the world including South Asian countries like Pakistan. The livelihood of a vast population in Pakistan depends on agriculture and land use is strongly influenced by water-based ecosystems that depend on the monsoon rains. Furthermore, climate change studies undertaken so far reveal that action is essential in order to prevent long term damage to water cycle and thus of great concern to the community and stakeholders. Pakistan Summer Monsoon (PSM) is affected by both the disturbances from the tropical and the extratropical regions; however there is lack of understanding of physical mechanisms of PSM compared to other regional studies i.e. Indian Summer Monsoon (ISM) and South-East Asian Monsoon (SEAM). In our study, we applied heat and vorticity budgets, and wave train analysis to reveal the mechanisms of the extremely dry and wet PSM events associated with the anomalous upper tropospheric conditions. We found that the extremely dry (wet) PSM events were closely related with the anomalous cyclonic (anticyclonic) upper-tropospheric circulation around northwest of Pakistan, and mid-upper tropospheric cooling (warming) anomaly around Pakistan and to its north/northwest. We also found in addition to Rossby wave response due to the suppressed (enhanced) convective activities around monsoon regions, the midlatitude wave energy propagation emanating around cyclonic/anticyclonic anomaly around northwestern Atlantic, northeastern Atlantic, Europe or Mediterranean regions induced/reinforced/maintained the anomalous upper tropospheric cyclonic (anticyclonic) circulation around northwest of Pakistan during extremely dry (wet) PSM events. Therefore, devastating drought (flood) events over the PSM region resulting from weak (strong) convection anomalies are induced by both the tropical and extratropical processes.
Ahmad, S.; Koike, T.; Nishii, K.; Shrestha, M.
Identifying sources of temporal variability in hydrological extremes of the upper Blue Nile basin
NASA Astrophysics Data System (ADS)
It is known that changes in catchment runoff variability are a function of changes in climate as well as catchment behavior. For proper management of a certain watershed it is important to have a good understanding of the main causes of variability. Specifically, changes in extreme conditions of water resources are imperative as their consequences are far reaching. This paper attempts to identify the cause of hydrological extremes variability in the upper Blue Nile basin of Ethiopia. A method is proposed to utilize conceptual hydrological models to simulate long term (41 years) hydro-meteorological data and analyse the outputs using the Quantile Perturbation Method (QPM) specially designed for investigation of the temporal variability of extreme values in time series over multi-annual to (multi-)decadal time scales. Two conceptual hydrological models were calibrated and evaluated for their performance to simulate extreme high flows and changes in these flows for corresponding changes in rainfall conditions. The temporal variability results show similar patterns for simulated and observed extreme flows. This indicates the major influence of climate variability in extreme flows as demonstrated by the rainfall input in the models. There is no discernible change in the catchment response, e.g. quick runoff coefficient as a function of soil saturation state, between periods of the 1960-1970s, the 1980s and the 1990-2000s, which are attributed to land policy changes. This shows the influence of changes in catchment characteristics is minimal. (Multi-)decadal climate variability is identified as the main cause of temporal variation in hydrological extremes of the Blue Nile basin.
Taye, Meron Teferi; Willems, Patrick
A Novel Arm Sleeve for Upper Extremity Lymphedema: A Pilot Study
Objective: To investigate the safety and efficacy of a novel arm sleeve composed of a conventional arm sleeve extending to a wider area of the body. Materials and Methods: Five subjects with post-mastectomy upper extremity lymphedema, who had already been using their own arm sleeve, used a brand-new conventional arm sleeve for 2 weeks, followed by a novel arm sleeve for 2 weeks. The adverse events, arm-related symptoms, interface pressures, and subcutaneous fluid distributions observed by magnetic resonance imaging (MRI) were assessed. Results: The use of the novel arm sleeve resulted in a graduated compression extending to the shoulder (forearm, 21.8 Ý 3.7 mmHg; upper arm, 15.2 Ý 3.3 mmHg; shoulder, 8.8 Ý 3.1 mmHg). By eliminating the wring seen in the conventional arm sleeve, the disturbed proximal diffusion of the subcutaneous fluid and venous occlusion were successfully avoided, as confirmed by MRI. No adverse event or worsening of arm-related symptoms was reported. Conclusion: The novel arm sleeve seemed to provide graduated compression to a wider area, allowing improved subcutaneous fluid and venous drainage without any adverse events. Therefore, the novel arm sleeve may be recommended as a compression therapy option for upper extremity lymphedema.
Effects of velocity on upper to lower extremity muscular work and power output ratios of intercollegiate athletes
OBJECTIVES: Peak torque expresses a point output which may, but does not always, correlate well with full range output measures such as work or power, particularly in a rehabilitating muscle. This study evaluates isokinetic performance variables, particularly (a) flexor to extensor work and power output ratios of upper and lower extremities and (b) overall upper to lower extremity work and power ratios, in intercollegiate athletes. The purpose was to ascertain how speeds of 30 and 180 degrees/s influence agonist to antagonist ratios for torque, work, and power and to determine the effects of these speeds on upper to lower limb flexor (F), extensor (E), and combined (F + E) ratios, as a guide to rehabilitation protocols and outcomes after injury. METHODS: Twenty seven athletic men without upper or lower extremity clinical histories were tested isokinetically at slow and moderately fast speeds likely to be encountered in early stages of rehabilitation after injury. Seated knee extensor and flexor outputs, particularly work and power, were investigated, as were full range elbow extensor and flexor outputs. The subjects were morphologically similar in linearity and muscularity (coefficient of variation 4.17%) so that standardisation of isokinetic outputs to body mass effectively normalised for strength differences due to body size. Peak torque (N.m/kg), total work (J/kg), and average power (W/kg) for elbow and knee flexions and extensions were measured on a Cybex 6000 isokinetic dynamometer. With respect to the raw data, the four test conditions (F at 30 degrees/s; E at 30 degrees/s; F at 180 degrees/s; E at 180 degrees/s) were analysed by one way analysis of variance. Reciprocal (agonist to antagonist) F to E ratios of the upper and lower extremities were calculated, as were upper to lower extremity flexor, extensor, and combined (F + E) ratios. Speed related differences between the derived ratios were analysed by Student's t tests (related samples). RESULTS: At the speeds tested all torque responses exhibited velocity related decrements at rates that kept flexor to extensor ratios and upper to lower extremity ratios constant (p > 0.05) for work and power. All upper extremity relative torque, work, and power flexion responses were equal to extension responses (p > 0.05) regardless of speed. Conversely, all lower extremity relative measures of torque, work, and power of flexors were significantly lower than extensor responses. In the case of both upper and lower extremities, work and power F to E ratios were unaffected by speed. Moreover, increasing speed from 30 to 180 degrees/s had no effect on upper to lower extremity work and power ratios, whether for flexion, extension, or flexion and extension combined. CONCLUSIONS: Peak torque responses may not adequately reflect tension development through an extensive range of motion. Total work produced and mean power generated, on the other hand, are highly relevant measures of performance, and these, expressed as F to E ratios, are unaffected by speeds of 30 and 180 degrees/s, whether for upper or lower extremities or for upper to lower extremities. In this sample, regardless of speed, the upper extremity produced 55% of the work and 39% of the power of the lower extremity, when flexor and extensor outputs were combined. Injured athletes are, in the early stages of function restoration, often not able to exert tension at fast speeds. An understanding of upper to lower extremity muscular work and power ratios has important implications for muscle strengthening after injury. Knowledge of normal upper to lower extremity work and power output ratios at slow to moderately fast isokinetic speeds is particularly useful in cases of bilateral upper (or lower) extremity rehabilitation, when the performance of a contralateral limb cannot be used as a yardstick. ???
Charteris, J.
Feasibility of Gestural Feedback Treatment for Upper Extremity Movement in Children With Cerebral Palsy
External feedback of performance is an important component of therapy, especially for children with impairments due to cerebral palsy because they lack intrinsic experience of good movements to compare effort and determine performance outcomes. A robotic therapy system was developed to provide feedback for specific upper extremity movements (gestures) which are therapeutically desirable. The purpose of this study was to compare changes in forearm supination/pronation or wrist extension/flexion motion following conventional therapy and gestural robotic feedback therapy intervention. Six subjects with cerebral palsy (ages 518, GMFCS level IVthree subjects, level IIIone subject, and level Itwo subjects) participated in a blinded crossover design study of conventional and robotic feedback therapy targeting either forearm supination or wrist extension. Functional upper extremity motion at baseline and following conventional and robotic feedback therapy interventions were obtained using a motion capture system by personnel blinded to the intervention order. All activities were approved by IRB. Use of the robotic feedback system did result in slightly increased movement in the targeted gesture without change in un-targeted motions. Data also suggest a decrease in both agonist and antagonist motion following conventional therapy intervention. Results suggest improved motion when robotic feedback therapy intervention precedes conventional therapy intervention. Robotic feedback therapy is no different than conventional therapy to improve supination or wrist extension function in upper extremity impairments of children with cerebral palsy when changes were considered as aggregate data. In this very small group of diverse patients, individual subject results suggested that intervention order could be responsible for obscuring differences due to intervention type. Outcomes from several individual subjects suggest that results could be different given a more homogeneous group of subjects which future studies should be considered to ultimately determine efficacy of the robotic feedback therapy. Future studies should also address efficacy in other neuromuscular patient populations.
Wood, Krista Coleman; Lathan, Corinna E.; Kaufman, Kenton R.
Feasibility of gestural feedback treatment for upper extremity movement in children with cerebral palsy.
External feedback of performance is an important component of therapy, especially for children with impairments due to cerebral palsy because they lack intrinsic experience of "good movements" to compare effort and determine performance outcomes. A robotic therapy system was developed to provide feedback for specific upper extremity movements (gestures) which are therapeutically desirable. The purpose of this study was to compare changes in forearm supination/pronation or wrist extension/flexion motion following conventional therapy and gestural robotic feedback therapy intervention. Six subjects with cerebral palsy (ages 5-18, GMFCS level IV--three subjects, level III--one subject, and level I--two subjects) participated in a blinded crossover design study of conventional and robotic feedback therapy targeting either forearm supination or wrist extension. Functional upper extremity motion at baseline and following conventional and robotic feedback therapy interventions were obtained using a motion capture system by personnel blinded to the intervention order. All activities were approved by IRB. Use of the robotic feedback system did result in slightly increased movement in the targeted gesture without change in untargeted motions. Data also suggest a decrease in both agonist and antagonist motion following conventional therapy intervention. Results suggest improved motion when robotic feedback therapy intervention precedes conventional therapy intervention. Robotic feedback therapy is no different than conventional therapy to improve supination or wrist extension function in upper extremity impairments of children with cerebral palsy when changes were considered as aggregate data. In this very small group of diverse patients, individual subject results suggested that intervention order could be responsible for obscuring differences due to intervention type. Outcomes from several individual subjects suggest that results could be different given a more homogeneous group of subjects which future studies should be considered to ultimately determine efficacy of the robotic feedback therapy. Future studies should also address efficacy in other neuromuscular patient populations. PMID:23193461
Wood, Krista Coleman; Lathan, Corinna E; Kaufman, Kenton R
Upper extremity rehabilitation of stroke: Facilitation of corticospinal excitability using virtual mirror paradigm
Background Several experimental studies in stroke patients suggest that mirror therapy and various virtual reality programs facilitate motor rehabilitation. However, the underlying mechanisms for these therapeutic effects have not been previously described. Objectives We attempted to delineate the changes in corticospinal excitability when individuals were asked to exercise their upper extremity using a real mirror and virtual mirror. Moreover, we attempted to delineate the role of visual modulation within the virtual environment that affected corticospinal excitability in healthy subjects and stroke patients. Methods A total of 18 healthy subjects and 18 hemiplegic patients were enrolled into the study. Motor evoked potential (MEP)s from transcranial magnetic stimulation were recorded in the flexor carpi radialis of the non-dominant or affected upper extremity using three different conditions: (A) relaxation; (B) real mirror; and (C) virtual mirror. Moreover, we compared the MEPs from the virtual mirror paradigm using continuous visual feedback or intermittent visual feedback. Results The rates of amplitude increment and latency decrement of MEPs in both groups were higher during the virtual mirror task than during the real mirror. In healthy subjects and stroke patients, the virtual mirror task with intermittent visual feedback significantly facilitated corticospinal excitability of MEPs compared with continuous visual feedback. Conclusion Corticospinal excitability was facilitated to a greater extent in the virtual mirror paradigm than in the real mirror and in intermittent visual feedback than in the continuous visual feedback, in both groups. This provides neurophysiological evidence supporting the application of the virtual mirror paradigm using various visual modulation technologies to upper extremity rehabilitation in stroke patients.
Validity of the Dictionary of Occupational Titles for Assessing Upper Extremity Work Demands
Objectives The Dictionary of Occupational Titles (DOT) is used in vocational rehabilitation to guide decisions about the ability of a person with activity limitations to perform activities at work. The DOT has categorized physical work demands in five categories. The validity of this categorization is unknown. Aim of this study was to investigate whether the DOT could be used validly to guide decisions for patients with injuries to the upper extremities. Four hypotheses were tested. Methods A database including 701 healthy workers was used. All subjects filled out the Dutch Musculoskeletal Questionnaire, from which an Upper Extremity Work Demands score (UEWD) was derived. First, relation between the DOT-categories and UEWD-score was analysed using Spearman correlations. Second, variance of the UEWD-score in occupational groups was tested by visually inspecting boxplots and assessing kurtosis of the distribution. Third, it was investigated whether occupations classified in one DOT-category, could significantly differ on UEWD-scores. Fourth, it was investigated whether occupations in different DOT-categories could have similar UEWD-scores using Mann Whitney U-tests (MWU). Results Relation between the DOT-categories and the UEWD-score was weak (rsp?=?0.40; p<.01). Overlap between categories was found. Kurtosis exceeded Ý1.0 in 3 occupational groups, indicating large variance. UEWD-scores were significantly different within one DOT-category (MWU?=?1.500; p<.001). UEWD scores between DOT-categories were not significantly different (MWU?=?203.000; p?=?.49). Conclusion All four hypotheses could not be rejected. The DOT appears to be invalid for assessing upper extremity work demands.
Opsteegh, Lonneke; Soer, Remko; Reinders-Messelink, Heleen A.; Reneman, Michiel F.; van der Sluis, Corry K.
Face, upper extremity, and concomitant transplantation: potential concerns and challenges ahead.
From its origination involving successful rat hind-limb allograft studies using cyclosporine, face and upper extremity composite tissue allotransplantation has since developed into an exciting and promising subset of reconstructive transplant surgery. Current surgical technique involving composite tissue allotransplantation has allowed optimal outcomes in patients with massive facial and/or upper extremity defects; however, with its coexisting immunologic barrier, obligatory lifelong immunosuppression commits each patient to a daily risk of transplant-related complications with many unanswered questions. Since 1998, nearly 50 hand transplantations in 40 patients have been performed around the world at various levels ranging from wrist level to shoulder level. However, the risk-to-benefit ratio remains controversial in bilateral versus unilateral transplantation and has yet to be determined. From recent experience, the two most important determinants of the success of each patient's upper extremity transplant are patient compliance and intense rehabilitation. A total of nine face transplants have been performed since 2005. Multiple aesthetic subunits (i.e., nose, lips, eyelids) with or without underlying craniofacial skeletal defects (i.e., maxilla, mandible) have been successfully restored, thereby providing restoration of vital facial functions (i.e., smiling) in an unprecedented manner. As of today, face transplantation carries an estimated 2-year mortality of 20 percent. Concomitant composite tissue allotransplantation, which involves a variable combination of allograft subtypes, has been performed in two of the nine face transplant patients. These have included simultaneous bilateral hand transplants and tongue with mandible. Future study is warranted to investigate the potential advantages and disadvantages of using this approach versus a staged approach for reconstruction. PMID:20595877
Siemionow, Maria Z; Zor, Fatih; Gordon, Chad R
Upper extremity disorders in a pork processing plant: relationships between job risk factors and morbidity.
Thirty-two jobs at a pork processing plant were semi-quantitatively analyzed in terms of their ergonomic characteristics, then classified as "hazardous" or "safe" in terms of potential risk for elbow or hand/wrist disorders. The spectrum, number, and incidence of such disorders occurring during the preceding 20 months were then compared to the job analyses and hazard classifications. There were 104 disorders associated with 15 job categories. The disorders included epicondylitis (24), nonspecific hand/wrist pain (41), carpal tunnel syndrome (CTS) (21), trigger finger (12), trigger thumb (3), and De-Quervain's tenosynovitis (3). The strength demands of the jobs associated with morbidity were significantly greater than those of jobs without morbidity. Differences in wrist posture were less significant. Type of grasp and repetitiveness were not significantly different. Practically all morbidity (96%) was associated with the hazardous job categories and occurred with a characteristic pattern of co-morbidity. The hazard classification scheme correctly predicted risk of upper extremity morbidity for 13 (87%) of the 15 job categories associated with morbidity and correctly predicted a lack of risk of morbidity for 16 (94%) of the 17 job categories not associated with morbidity. Significantly elevated relative risks were observed for any upper extremity disorder (11.4), any disorder excluding CTS (39.4), all specific disorders (6.9), and all specific disorders excluding CTS (19.4). The relative risk for CTS was 2.8 and not statistically significant. The results of this study provide additional epidemiological evidence that upper extremity musculotendinous disorders and some cases of CTS may be causally associated with work. The exertional demands of a task best explained the occurrence of morbidity. PMID:7942507
Moore, J S; Garg, A
Preconditioning electromyographic data for an upper extremity model using neural networks
NASA Technical Reports Server (NTRS)
A back propagation neural network has been employed to precondition the electromyographic signal (EMG) that drives a computational model of the human upper extremity. This model is used to determine the complex relationship between EMG and muscle activation, and generates an optimal muscle activation scheme that simulates the actual activation. While the experimental and model predicted results of the ballistic muscle movement are very similar, the activation function between the start and the finish is not. This neural network preconditions the signal in an attempt to more closely model the actual activation function over the entire course of the muscle movement.
Roberson, D. J.; Fernjallah, M.; Barr, R. E.; Gonzalez, R. V.
fMRI assessment of upper extremity related brain activation with an MRI-compatible manipulandum
Purpose Longitudinal studies to evaluate the effect of rehabilitative therapies require an objective, reproducible and quantitative\\u000a means for testing function in vivo. An fMRI assessment tool for upper extremity related brain activation using an MRI-compatible\\u000a manipulandum was developed and tested for use in neurorehabilitation research.\\u000a \\u000a \\u000a \\u000a \\u000a Methods Fifteen healthy, right-handed subjects participated in two fMRI sessions, which were three to four weeks apart.
Ningbo Yu; Natalia EstÕvez; Marie-Claude Hepp-Reymond; Spyros S. Kollias; Robert Riener
A telescope for observation from space of extreme lightnings in the upper atmosphere
NASA Astrophysics Data System (ADS)
A new type of telescope with a wide field-of-view and functions of fast zoom-in has been introduced. Two kinds of MEMS (Micro-Electro-Mechanical Systems) micromirrors, digital and analog, are used for reflectors of the telescope, placed at different focal lengths. We apply this technology to the observation from space of TLE (Transient Luminous Events), extremely large transient sparks occurring at the upper atmosphere. TLE are one type of important backgrounds to be understood for future space observation of UHECR (Ultra-High Energy Cosmic Rays). The launch of the payload carried by a Russian microsatellite is foreseen in the middle of 2008.
Nam, S.; Artikova, S.; Chung, T.; Garipov, G.; Jeon, J. A.; Jeong, S.; Jin, J. Y.; Khrenov, B. A.; Kim, J. E.; Kim, M.; Kim, Y. K.; Klimov, P.; Lee, J.; Lee, H. Y.; Na, G. W.; Oh, S. J.; Panasyuk, M.; Park, I. H.; Park, J. H.; Park, Y.-S.; Yoo, B. W.; Yoo, H. J.
[Dynamics of restoration of the motor and sensory functions of the upper extremity after suturing].
In 46 patients 63 nerves of upper extremities were sutured and clinico-electroneuromyographic investigations performed. The restitution of motor and sensory functions ran slowly over 7 to 36 months depending on the level injured. Full restoration of motor functions surpassed the restoration of sensory functions in the autonomic zone of the nerve lesioned. Electroneuromyographic investigation showed that clinical healing provides no real indices of the final nerve regeneration as the nervous condition velocity remained altered. This allows recommending nonsurgical treatment for several months after surgery under electroneuromyographic control. PMID:2665400
Kankava, D M; Baratashvili, N N; Kvirkveliia, N B
Acquired microcystic lymphatic malformation of the distal upper extremity mimicking verrucae vulgaris.
An 18-year-old African American male with a history of congenital lymphedema of the right upper extremity presented for evaluation of multiple verrucous lesions on his right hand. Clusters of 2 to 4-mm dome-shaped vesicles were intermixed with scattered verrucous papules on the right forearm and the dorsal and palmar aspects of the hand. Histopathology of one the verrucous lesions showed well-circumscribed areas of dilated lymphatic vascular channels with lymph in the lumen. The patient was diagnosed with microcystic lymphatic malformation, verrucous type. This article reviews the literature regarding reports of this variant of microcystic lymphatic malformation in the pediatric population. PMID:23876174
Wang, Stephanie; Krulig, Eliana; Hernandez, Claudia
Delayed onset of Brown-Sequard syndrome involving upper extremity pain.
Report of a case: A 60-year-old white male with a history of C3-C4 spinal cord injury with subsequent C3-C4 fusion complained of right upper extremity painful spasms of 2 years duration with associated hyperspasticity, motor weakness and poor positional and vibrational sense. The patient was diagnosed with Brown-Sequard syndrome (BSS) and treated with botulinum toxin type A injections distributed into the affected muscle groups that provided substantial and lasting relief. This case is unique in that the patient's trauma occurred 28 years before the development of the BSS suggesting a slow evolution of the condition. PMID:19210635
Tang, Nelson; Stickevers, Susan; Awan, Gulle
An evaluation of botulinum-A toxin injections to improve upper extremity function in children with hemiplegic cerebral palsy
Objective: In a randomized, controlled, single-blind trial, to test the hypothesis that botulinum-A toxin (BTA) injections into the upper extremity of children with spastic hemiplegia improve upper extremity function. Study design: Thirty children with hemiplegia, aged 2.5 to 10 years, were randomly assigned to receive: (1) a BTA injection into 1 or more of 3 muscle groups (biceps, volar forearm
Darcy Fehlings; Mercer Rang; Janet Glazier; Catherine Steele
The effect of the action observation physical training on the upper extremity function in children with cerebral palsy
The purpose this study was to investigate the effect of action observation physical training (AOPT) on the functioning of the upper extremities in children with cerebral palsy (CP), using an evaluation framework based on that of the International Classification of Functioning, Disability and Health (ICF). The subjects were divided into an AOPT group and a physical training (PT) group. AOPT group practiced repeatedly the actions they observed on video clips, in which normal child performed an action with their upper extremities. PT group performed the same actions as the AOPT group did after observing landscape photographs. The subjects participated in twelve 30-min sessions, 3 days a week, for 4 weeks. Evaluation of upper extremity function using the following: the power of grasp and Modified Ashworth Scale for body functions and structures, a Box and Block test, an ABILHAND-Kids questionnaire, and the WeeFIM scale for activity and participation. Measurements were performed before and after the training, and 2 weeks after the end of training. The results of this study showed that, in comparison with the PT group, the functioning of the upper extremities in the AOPT group was significantly improved in body functions and activity and participation according to the ICF framework. This study demonstrates that AOPT has a positive influence on the functioning of the upper extremities in children with CP. It is suggested that this alternative approach for functioning of the upper extremities could be an effective method for rehabilitation in children with CP.
Kim, Jin-young; Kim, Jong-man; Ko, Eun-young
Occupational Upper Extremity Symptoms in Sign Language Interpreters: Prevalence and Correlates of Pain, Function, and Work Disability
The interactive role of work demands, occupational stressors, and ergonomic risk factors in work-related upper extremity (UE) disorders remains unclear. Professional sign language interpreting, which involves exposure of the upper limbs to a combination of potential ergonomic and psychosocial stressors represents a unique occupational group to investigate the multivariate nature of UE disorders. The present study reports data on the
Michael Feuerstein; Ann Marie Carosella; Lolita M. Burrell; Liza Marshall; James Decaro
Biomechanic Evaluation of Upper-Extremity Symmetry Manual Wheelchair Propulsion Over Varied Terrain
Objective To evaluate upper-extremity symmetry during wheelchair propulsion across multiple terrain surfaces. Design Case series. Setting A biomechanics laboratory and the community. Participants Manual wheelchair users (N=12). Interventions Not applicable. Main Outcome Measures Symmetry indexes for the propulsion moment, total force, tangential force, fractional effective force, time-to-peak propulsion moment, work, length of push cycle, and power during wheelchair propulsion over outdoor and indoor community conditions, and in conditions. Results Upper-extremity asymmetry was present within each condition. There were no differences in the magnitude of asymmetry when comparing laboratory with indoor community conditions. Outdoor community wheelchair propulsion asymmetry was significantly greater than asymmetry measured during laboratory conditions. Conclusions Investigators should be aware that manual wheelchair propulsion is an asymmetrical act, which may influence interpretation when data is collected from a single limb or averaged for both limbs. The greater asymmetry identified during outdoor versus laboratory conditions the emphasizes need to evaluate wheelchair biomechanics in the users natural environment.
Hurd, Wendy J.; Morrow, Melissa M.; Kaufman, Kenton R.; An, Kai-Nan
Wartime upper extremity injuries: Experience from the Kabul International Airport combat support hospital.
Few epidemiologic studies have been published about the surgical management of wartime upper extremity injuries (UEIs). The purpose of the present report was to analyze upper extremity combat-related injuries (CRIs) and non-combat related injuries (NCRIs) treated in the Kabul International Airport Combat Support Hospital. A retrospective study was conducted using the French surgical database OpEX (French military health service) from June 2009 to January 2013. During this period, 491 patients with a mean age of 28.7Ý13years were operated on because of an UEI. Among them, 244 (49.7%) sustained CRIs and 247 (50.3%) sustained NCRIs. A total number of 558 UEIs were analyzed. Multiple UEIs and associated injuries were significantly more common in the CRIs group. Debridement was the most common procedure in both groups. External fixator application, delayed primary closure and flap coverage were predominant in the CRIs group, as well as internal fracture fixation and tendon repair in the NCRIs group. The overall number of surgical episodes was significantly higher in the CRIs group. Due to the high frequency of UEIs in the theatres of operations, deployed orthopedic surgeons should be trained in basic hand surgery. Although the principles of CRIs treatment are well established, management of hand NCRIs remains controversial in this setting. PMID:24857707
Mathieu, L; Bertani, A; Gaillard, C; Ollat, D; Rigal, S; RongiÕras, F
Upper Extremity Freezing and Dyscoordination in Parkinson's Disease: Effects of Amplitude and Cadence Manipulations
Purpose. Motor freezing, the inability to produce effective movement, is associated with decreasing amplitude, hastening of movement, and poor coordination. We investigated how manipulations of movement amplitude and cadence affect upper extremity (UE) coordination as measured by the phase coordination index (PCI)only previously measured in gaitand freezing of the upper extremity (FO-UE) in people with Parkinson's disease (PD) who experience freezing of gait (PD?+?FOG), do not experience FOG (PD-FOG), and healthy controls. Methods. Twenty-seven participants with PD and 18 healthy older adults made alternating bimanual movements between targets under four conditions: Baseline; Fast; Small; SmallFast. Kinematic data were recorded and analyzed for PCI and FO-UE events. PCI and FO-UE were compared across groups and conditions. Correlations between UE PCI, gait PCI, FO-UE, and Freezing of Gait Questionnaire (FOG-Q) were determined. Results. PD?+?FOG had poorer coordination than healthy old during SmallFast. UE coordination correlated with number of FO-UE episodes in two conditions and FOG-Q score in one. No differences existed between PD?/+FOG in coordination or number of FO-UE episodes. Conclusions. Dyscoordination and FO-UE can be elicited by manipulating cadence and amplitude of an alternating bimanual task. It remains unclear whether FO-UE and FOG share common mechanisms.
Williams, April J.; Peterson, Daniel S.; Ionno, Michele; Pickett, Kristen A.; Earhart, Gammon M.
Assessing agreement of self-reported and observed physical exposures of the upper extremity
Assessment of workplace physical exposures by self-reported questionnaires has logistical advantages in population studies but is subject to exposure misclassification. This study measured agreement between eight self-reported and observer-rated physical exposures to the hands and wrists, and evaluated predictors of inter-method agreement. Workers (n=341) from three occupational categories (clerical/technical, construction, and service) completed self-administered questionnaires and worksite assessments. Analyses compared self-reported and observed ratings using a weighted kappa coefficient. Personal and psychosocial factors, presence of upper extremity symptoms and job type were evaluated as predictors of agreement. Weighted kappa values were substantial for lifting (0.67) and holding vibrating tools (0.61), moderate for forceful grip (0.58) and fair to poor for all other exposures. Upper extremity symptoms did not predict greater disagreement between self-reported and observed exposures. Occupational category was the only significant predictor of inter-method agreement. Self-reported exposures may provide a useful estimate of some work exposures for population studies.
Dale, Ann Marie; Strickland, Jaime; Gardner, Bethany; Symanzik, Jurgen; Evanoff, Bradley
Changes in bone density and geometry of the upper extremities after stroke: a case report.
Purpose: The purpose of this study was to examine changes in bone density and geometry of the forearm region and motor function of the paretic upper extremity in a person with subacute stroke. Client Description: The participant was a 48-year-old man with right hemiparesis. Intervention: Not applicable. Measures and Outcomes: The assessment of upper-extremity (UE) function and bone imaging took place at 3 months and 12 months after stroke. The participant had moderate motor impairment and severe disuse of the paretic UE 3 months after stroke. During the follow-up period, no substantial change in paretic UE function was observed. At the 12 month follow-up, the areal bone mineral density (aBMD) of the ultradistal and mid-regions of the paretic forearm, as measured by dual-energy X-ray absorptiometry, sustained a significant reduction of 7.9% and 5.9%, respectively. The non-paretic side, in contrast, had a significant 4.0% increase in aBMD of the mid-forearm and a 2.8% increase in aBMD of the total forearm. Significant findings from peripheral quantitative computed tomography were a reduction in total volumetric bone mineral density (-12.1%) and bone strength index (-20.6%) in the radius distal epiphysis on the paretic side and an increase in cortical bone mineral content (2.0%) and bone strength index (7.6%) in the radius diaphysis on the non-paretic side. Implications: After a stroke that resulted in moderate to severe UE impairment, a significant decline in bone mineral density was identified in various skeletal sites in the forearm region as the participant entered the subacute and chronic stages of recovery. The results point to the potential importance of early rehabilitative intervention in preventing unfavourable bone changes in the paretic upper limb among individuals with stroke. PMID:23277690
Pang, Marco Y C; Yang, Feigo Z H; Lau, Ricky W K; Cheng, Ada Q; Li, Leonard S W; Zhang, Ming
Retinal prosthesis has been translated from the laboratory to the clinic over the past two decades. Currently, two devices have regulatory approval for the treatment of retinitis pigmentosa. These devices provide partial sight restoration and patients use this improved vision in their everyday lives. Improved mobility and object detection are some of the more notable findings from the clinical trials. However, significant vision restoration will require both better technology and improved understanding of the interaction between electrical stimulation and the retina. This paper reviews the recent clinical trials and highlights technology breakthroughs that will contribute to next generation of retinal prostheses. PMID:24710817
Weiland, James D; Humayun, Mark S
Epidemiology of musculoskeletal upper extremity ambulatory surgery in the United States
Background Musculoskeletal disorders of the upper extremity are common reasons for patients to seek care and undergo ambulatory surgery. The objective of our study was to assess the overall and age-adjusted utilization rates of rotator cuff repair, shoulder arthroscopy performed for indications other than rotator cuff repair, carpal tunnel release, and wrist arthroscopy performed for indications other than carpal tunnel release in the United States. We also compared demographics, indications, and operating room time for these procedures. Methods We used the 2006 National Survey of Ambulatory Surgery to estimate the number of procedures of interest performed in the United States in 2006. We combined these data with population size estimates from the 2006 U.S. Census Bureau to calculate rates per 10,000 persons. Results An estimated 272,148 (95% confidence intervals (CI)?=?218,994, 325,302) rotator cuff repairs, 257,541 (95% CI?=?185,268, 329,814) shoulder arthroscopies excluding those for cuff repairs, 576,924 (95% CI?=?459,239, 694,609) carpal tunnel releases, and 25,250 (95% CI?=?17,304, 33,196) wrist arthroscopies excluding those for carpal tunnel release were performed. Overall, carpal tunnel release had the highest utilization rate (37.3 per 10,000 persons in persons of age 4564 years; 38.7 per 10,000 persons in 6574 year olds, and; 44.2 per 10,000 persons in the age-group 75 years and older). Among those undergoing rotator cuff repairs, those in the age-group 6574 had the highest utilization (28.3 per 10,000 persons). The most common indications for non-cuff repair related shoulder arthroscopy were impingement syndrome, periarthritis, bursitis, and instability/SLAP tears. Non-carpal tunnel release related wrist arthroscopy was most commonly performed for ligament sprains and diagnostic arthroscopies for pain and articular cartilage disorders. Conclusions Our data shows substantial age and demographic differences in the utilization of these commonly performed upper extremity ambulatory procedures. While over one million upper extremity procedures of interest were performed, evidence-based clinical indications for these procedures remain poorly defined.
Concurrent neuromechanical and functional gains following upper-extremity power training post-stroke
Background Repetitive task practice is argued to drive neural plasticity following stroke. However, current evidence reveals that hemiparetic weakness impairs the capacity to perform, and practice, movements appropriately. Here we investigated how power training (i.e., high-intensity, dynamic resistance training) affects recovery of upper-extremity motor function post-stroke. We hypothesized that power training, as a component of upper-extremity rehabilitation, would promote greater functional gains than functional task practice without deleterious consequences. Method Nineteen chronic hemiparetic individuals were studied using a crossover design. All participants received both functional task practice (FTP) and HYBRID (combined FTP and power training) in random order. Blinded evaluations performed at baseline, following each intervention block and 6-months post-intervention included: Wolf Motor Function Test (WMFT-FAS, Primary Outcome), upper-extremity Fugl-Meyer Motor Assessment, Ashworth Scale, and Functional Independence Measure. Neuromechanical function was evaluated using isometric and dynamic joint torques and concurrent agonist EMG. Biceps stretch reflex responses were evaluated using passive elbow stretches ranging from 60 to 180¤/s and determining: EMG onset position threshold, burst duration, burst intensity and passive torque at each speed. Results Primary outcome: Improvements in WMFT-FAS were significantly greater following HYBRID vs. FTP (p?=?.049), regardless of treatment order. These functional improvements were retained 6-months post-intervention (p?=?.03). Secondary outcomes: A greater proportion of participants achieved minimally important differences (MID) following HYBRID vs. FTP (p?=?.03). MIDs were retained 6-months post-intervention. Ashworth scores were unchanged (p?>?.05). Increased maximal isometric joint torque, agonist EMG and peak power were significantly greater following HYBRID vs. FTP (p < .05) and effects were retained 6-months post-intervention (ps?.05). EMG position threshold and burst duration were significantly reduced at fast speeds (?120¤/s) (ps < 0.05) and passive torque was reduced post-washout (p < .05) following HYBRID. Conclusions Functional and neuromechanical gains were greater following HYBRID vs. FPT. Improved stretch reflex modulation and increased neuromuscular activation indicate potent neural adaptations. Importantly, no deleterious consequences, including exacerbation of spasticity or musculoskeletal complaints, were associated with HYBRID. These results contribute to an evolving body of contemporary evidence regarding the efficacy of high-intensity training in neurorehabilitation and the physiological mechanisms that mediate neural recovery.
Incidence, epidemiology, and operative outcome of replantation or revascularisation of injury to the upper extremity.
We retrospectively studied the epidemiology of adult patients admitted for possible replantation or revascularisation of an injured upper extremity during the period June 2003 to May 2008. A total of 121 patients were admitted (71 graded severe), mean 24 (14 graded severe), being admitted each year. The annual rate of amputation injuries in the referral area of 1.5 million was 1.5/100 000 and for severe amputation injuries 0.9/100 000. Most injuries occurred in patients aged 41-50. Fifty-eight patients had the accident during working hours (36 severe), and 62 during leisure time (34 severe). The survival rate for subtotal amputations was 77% and for total amputations 55%. Of 15 further vascularisation procedures, two succeeded at the metacarpal level. Most of the accidents occurred during wood-processing with circular saws or powered wood splitters. More efforts should focus on preventing such injuries. PMID:20158426
Lindfors, Nina; Raatikainen, Timo
US-guided injection of the upper and lower extremity joints.
There is a growing interest in the application of ultrasound (US) guidance for diagnostic and therapeutic joint injections. US provides direct visualization of soft tissues and the outer borders of bony structures. With real-time needle guidance the success rate of intra-articular injections improves and iatrogenic damage to anatomic structures can be avoided. An US machine is more readily available, transferrable and more affordable than a fluoroscopy machine or CT scanner and lacks the risk of radiation. These factors make US a valuable alternative to procedures performed either blind or under fluoroscopic or CT guidance. This article focuses on the rationale for injections in the upper and lower extremity joints and describes and illustrates the different US-guided injection techniques. PMID:22130195
Collins, James M P; Smithuis, Robin; Rutten, Matthieu J C M
[The compartment syndrome in injuries of the upper extremity in children].
In the Centre for Child Traumatology in Brno the authors followed up during the last 10 years 22 patients with suspected compartment syndrome of the upper extremity. Incisions of intrafascial spaces were made in 12 patients-9x on the forearm and 3x on the hand. Another 10 patients had conservative treatment. The therapeutic results are with the exception of one female patient with developed Volkmann's contracture very satisfactory, the sequelae are only cosmetic. Compartment syndrome is a serious acute condition in child traumatology. Permanent sequelae of this syndrome can be prevented above all by early diagnosis and adequate therapy. It is therefore important to consider the possible development of this serious complication. PMID:10377771
GÃl, P; Melichar, I
Limited surgical treatment of suspected necrotizing fasciitis of the upper extremity with a benign clinical presentation
Necrotizing fasciitis is a rapidly evolving, potentially fatal infection. Current recommendations advocate antibiotic administration and early aggressive surgical debridement. Aggressive surgery is associated with significant morbidity, leaving patients with substantial tissue loss and complex wounds. A case of suspected necrotizing fasciitis treated with minimal surgery is described. A previously healthy 48-year-old man presented with increased erythema, swelling and blistering of his left upper extremity. Despite a benign systemic clinical presentation, the hand and forearm were suspicious for necrotizing fasciitis, prompting surgical treatment. Surgical exploration found a significant amount of intradermal and subdermal clear fluid. It was decided to limit the amount of debridement. The diagnosis was Wells syndrome, eosinophilic cellulitis. Treated with steroids, the wounds healed uneventfully. It is important to consider the complete clinical picture before aggressive surgical treatment. A negative history for diabetes, atypical clinical presentation and benign operative findings are suggestive of a more benign diagnosis.
Gander, Brian; Kaye, Marc; Wollstein, Ronit
Time Series Analysis of Spontaneous Upper-Extremity Movements of Premature Infants With Brain Injuries
Background and Purpose: Comparisons of spontaneous movements of premature infants with brain injuries and those without brain injuries can provide insights into normal and abnormal processes in the ontogeny of motor development. In this study, the characteristics of spontaneous upper-extremity movements of premature infants with brain injuries and those without brain injuries were examined with time series analysis. Subjects: Participants were 7 premature infants with brain injuries and 7 matched, low-risk, premature infants at the age of 1 month after term. Methods: A triaxial accelerometer was used to measure upper-extremity limb acceleration in 3-dimensional space. Acceleration signals were recorded from the right wrist when the infant was in an active, alert state and lying in the supine position. The recording time was 200 seconds. The acceleration signal was sampled at a rate of 200 Hz. The acceleration time series data were analyzed by nonlinear analysis as well as linear analysis. Results: The nonlinear time series analysis indicated that spontaneous movements of premature infants have nonlinear, chaotic, dynamic characteristics. The movements of the infants with brain injuries were characterized by larger dimensionality, and they were more unstable and unpredictable than those of infants without brain injuries. Discussion and Conclusion: As determined by nonlinear analysis, the spontaneous movements of the premature infants with brain injuries had the characteristics of increased disorganization compared with those of the infants without brain injuries. Infants with brain injuries may manifest problems with self-organization as a function of the coordination of subsystems. Physical therapists should be able to support interactions among the subsystems and promote self-organization of motor learning through the individualized provision of various sensorimotor experiences for infants.
Ohgi, Shohei; Morita, Satoru; Loo, Kek Khee; Mizuike, Chihiro
Catheter-Directed Thrombolysis for Treatment of Deep Venous Thrombosis in the Upper Extremities
Traditional anticoagulant treatment of deep venous thrombosis (DVT) in the upper extremities (UEDVT) is associated with a relatively high incidence of postthrombotic syndrome (PTS). Catheter-directed thrombolysis (CDT) for UEDVT would provide efficient thrombolysis with less subsequent PTS than during traditional anticoagulation. Primary efficacy, complications, and long-term results after CDT are reported in a retrospective cohort (2002-2007) of patients (n = 30) with DVT in the upper extremities. PTS was assessed by a modified Villalta scale. UEDVT was unprovoked in 11 (37%) cases and effort related in 9 (30%) cases. The median duration of symptoms prior to CDT was 7.0 days (range, 1-30); median duration of thrombolysis treatment, 70 h (range, 24-264 h); and the median amount of rt-PA infused during CDT, 52 mg (range, 19-225 mg). Major bleeding was registered in three (9%) patients, and CDT was stopped prematurely in three patients due to local hematoma. No intracerebral bleeding, clinical pulmonary embolism, or deaths occurred during treatment. Grade II (>50%) or III (>90%) lysis was present in 29 patients (97%) at the end of CDT. Bleeding complications increased by each day of delay from the debut of symptoms to the start of treatment (OR, 1.20; 95% CI, 1.01-1.42). At follow-up (n = 29; median, 21 months; range, 5-58 months), 11 (38%) patients had occluded veins, whereas 18 (62%) had patent veins. However, stenosis of varying severity was present in eight of those with a patent vein. No patients had severe PTS, whereas six (21%) experienced mild PTS. In conclusion, our retrospective cohort study of patients with UEDVT showed that treatment restored venous drainage, with a subsequent low frequency of mild PTS at follow-up. Early intervention with CDT prevented bleeding complications.
Vik, Anders, E-mail: firstname.lastname@example.com [University Hospital of North Norway, Department of Medicine (Norway); Holme, Pal Andre [Rikshospitalet University Hospital, Division of Haematology, Medical Department (Norway); Singh, Kulbir [University Hospital of North Norway, Department of Radiology (Norway); Dorenberg, Eric [Rikshospitalet University Hospital, Department of Radiology (Norway); Nordhus, Kare Christian; Kumar, Satish [University Hospital of North Norway, Department of Radiology (Norway); Hansen, John-Bjarne [University Hospital of North Norway, Department of Medicine (Norway)
The influences of obesity and age on functional performance during intermittent upper extremity tasks.
In this study, the main and interactive effects of obesity and age on functional performance were assessed during intermittent exertions involving the upper extremity. The prevalence of obesity has doubled over the past 30 years and this increase is associated with higher health care costs, rates of workplace injury, and lost workdays. Obesity and aging can modify job demands and affect worker capacity in terms of muscular and psychomotor function. However, there is a lack of empirical studies quantifying the work-relevant (or ergonomic) impacts related to task demands, capacities, and their potential imbalance. Eight obese and eight non-obese participants from each of two age groups (18-25 and 50-65 years) completed three endurance tasks involving fixed levels of task demands: hand grip, shoulder flexion, and a simulated assembly task using the upper extremity. Measures of functional performance including endurance, discomfort, motor control, and task performance were recorded for each of the task conditions. Endurance times were ?60% longer for the non-obese group, and older participants had longer endurance times; however there was no evidence of interactive effects of obesity and age. Obesity also impaired functional performance, as indicated by higher rates of strength loss, increases in discomfort, and declines in task performance. These observed impairments may reflect underlying physiological differences among individuals who are obese, but that are independent of age. Obesity-related impairments may have implications for the design of work duration and demand level to prevent fatigue development for workers who are obese. PMID:24484265
Cavuoto, Lora A; Nussbaum, Maury A
Biomechanical model for evaluation of pediatric upper extremity joint dynamics during wheelchair mobility.
Pediatric manual wheelchair users (MWU) require high joint demands on their upper extremity (UE) during wheelchair mobility, leading them to be at risk of developing pain and pathology. Studies have examined UE biomechanics during wheelchair mobility in the adult population; however, current methods for evaluating UE joint dynamics of pediatric MWU are limited. An inverse dynamics model is proposed to characterize three-dimensional UE joint kinematics and kinetics during pediatric wheelchair mobility using a SmartWheel instrumented handrim system. The bilateral model comprises thorax, clavicle, scapula, upper arm, forearm, and hand segments and includes the sternoclavicular, acromioclavicular, glenohumeral, elbow and wrist joints. A single 17 year-old male with a C7 spinal cord injury (SCI) was evaluated while propelling his wheelchair across a 15-meter walkway. The subject exhibited wrist extension angles up to 60¯, large elbow ranges of motion and peak glenohumeral joint forces up to 10% body weight. Statistically significant asymmetry of the wrist, elbow, glenohumeral and acromioclavicular joints was detected by the model. As demonstrated, the custom bilateral UE pediatric model may provide considerable quantitative insight into UE joint dynamics to improve wheelchair prescription, training, rehabilitation and long-term care of children with orthopedic disabilities. Further research is warranted to evaluate pediatric wheelchair mobility in a larger population of children with SCI to investigate correlations to pain, function and transitional changes to adulthood. PMID:24309622
Schnorenberg, Alyssa J; Slavens, Brooke A; Wang, Mei; Vogel, Lawrence C; Smith, Peter A; Harris, Gerald F
Upper extremity kinematic and kinetic adaptations during a fatiguing repetitive task.
Repetitive low-force contractions are common in the workplace and yet can lead to muscle fatigue and work-related musculoskeletal disorders. The current study aimed to investigate potential motion adaptations during a simulated repetitive light assembly work task designed to fatigue the shoulder region, focusing on changes over time and age-related group differences. Ten younger and ten older participants performed four 20-min task sessions separated by short breaks. Mean and variability of joint angles and scapular elevation, joint net moments for the shoulder, elbow, and wrist were calculated from upper extremity kinematics recorded by a motion tracking system. Results showed that joint angle and joint torque decreased across sessions and across multiple joints and segments. Increased kinematic variability over time was observed in the shoulder joint; however, decreased kinematic variability over time was seen in the more distal part of the upper limb. The changes of motion adaptations were sensitive to the task-break schedule. The results suggested that kinematic and kinetic adaptations occurred to reduce the biomechanical loading on the fatigued shoulder region. In addition, the kinematic and kinetic responses at the elbow and wrist joints also changed, possibly to compensate for the increased variability caused by the shoulder joint while still maintaining task requirements. These motion strategies in responses to muscle fatigue were similar between two age groups although the older group showed more effort in adaptation than the younger in terms of magnitude and affected body parts. PMID:24642235
Qin, Jin; Lin, Jia-Hua; Faber, Gert S; Buchholz, Bryan; Xu, Xu
Biomechanical Model for Evaluation of Pediatric Upper Extremity Joint Dynamics during Wheelchair Mobility
Pediatric manual wheelchair users (MWU) require high joint demands on their upper extremity (UE) during wheelchair mobility, leading them to be at risk of developing pain and pathology. Studies have examined UE biomechanics during wheelchair mobility in the adult population; however, current methods for evaluating UE joint dynamics of pediatric MWU are limited. An inverse dynamics model is proposed to characterize three-dimensional UE joint kinematics and kinetics during pediatric wheelchair mobility using a SmartWheel instrumented handrim system. The bilateral model comprises thorax, clavicle, scapula, upper arm, forearm, and hand segments and includes the sternoclavicular, acromioclavicular, glenohumeral, elbow and wrist joints. A single 17 year-old male with a C7 spinal cord injury (SCI) was evaluated while propelling his wheelchair across a 15-meter walkway. The subject exhibited wrist extension angles up to 60¯, large elbow ranges of motion and peak glenohumeral joint forces up to 10% body weight. Statistically significant asymmetry of the wrist, elbow, glenohumeral and acromioclavicular joints was detected by the model. As demonstrated, the custom bilateral UE pediatric model may provide considerable quantitative insight into UE joint dynamics to improve wheelchair prescription, training, rehabilitation and long-term care of children with orthopaedic disabilities. Further research is warranted to evaluate pediatric wheelchair mobility in a larger population of children with SCI to investigate correlations to pain, function and transitional changes to adulthood.
Schnorenberg, Alyssa J.; Slavens, Brooke A.; Wang, Mei; Vogel, Lawrence; Smith, Peter; Harris, Gerald F.
Position-dependent torque coupling and associated muscle activation in the hemiparetic upper extremity
Previous studies have demonstrated abnormal joint torque coupling and associated muscle coactivations of the upper extremity in individuals with unilateral stroke. We investigated the effect of upper limb configuration on the expression of the well-documented patterns of shoulder abduction/elbow flexion and shoulder adduction/elbow extension. Maximal isometric shoulder and elbow torques were measured in stroke subjects in four different arm configurations. Additionally, an isometric combined torque task was completed where subjects were required to maintain various levels of shoulder abduction/adduction torque while attempting to maximize elbow flexion or extension torque. The dominant abduction/elbow flexion pattern was insensitive to changes in limb configuration while the elbow extension component of the adduction/extension pattern changed to elbow flexion at smaller shoulder abduction angles. This effect was not present in control subjects without stroke. The reversal of the torque-coupling pattern could not be explained by mechanical factors such as muscle length changes or muscle strength imbalances across the elbow joint. Potential neural mechanisms underlying the sensitivity of the adduction/elbow extension pattern to different somatosensory input resultant from changes in limb configuration are discussed along with the implications for future research.
Ellis, Michael D.; Acosta, Ana Maria; Yao, Jun
Upper extremity deep vein thrombosis presenting to a chiropractic clinic: a description of 2 cases
Objective The purpose of this case series is to describe the presentation of 2 patients who presented to a chiropractic teaching clinic with Paget-Schroetter syndrome (PSS) and to discuss the potential role for conservative therapy in the management of symptoms. Clinical Features Two patients presented with a vascular and muscular findings suggesting activity-related upper extremity deep vein thrombosis. One patient presented with recent onset of symptoms (pain in the neck with a pinched nerve sensation in the left upper trapezius); and the other presented with chronic, low-grade neck pain of 1 year's duration. Intervention and Outcome The initial treatment approach for the patient with acute symptoms included soft tissue therapy. During the second appointment, he was immediately referred for medical evaluation and management because of worsening symptoms. He was diagnosed with thrombus in the left brachial vein, started immediately on a thrombolytic agent, and referred to a thrombosis clinic. Treatment for the second patient with chronic symptoms included soft tissue therapy, spinal manipulative therapy, and active care. Two months after 3 treatments, she reported improved symptoms. She remains under supportive care and has reported continued relief of her symptoms. Conclusion Although a rare condition, PSS has the potential to result in significant morbidity and potentially fatal complications; thus, it is critical that practitioners recognize the signs and symptoms to facilitate appropriate and timely referrals. Clinicians should be aware of the presentation and proposed pathogenesis of PSS, and consider this diagnosis in patients with unilateral upper limb and/or neck pain.
Stainsby, Brynne E.; Muir, Bradley J.; Miners, Andrew L.
Omental Free-tissue Transfer for Coverage of Complex Upper Extremity and Hand DefectsThe Forgotten Flap
Free omental tissue transfer is a versatile reconstructive option for trunk, head and neck, and extremity reconstruction.\\u000a Its utility is due to the length and caliber of the vascular pedicle and the malleability and surface area of the flap. We\\u000a report our experience with omental free flap coverage of complex upper-extremity defects. A retrospective analysis of eight\\u000a omental free-tissue transfers
Iris A. Seitz; Craig S. Williams; Thomas A. Wiedrich; Ginard Henry; John G. Seiler; Loren S. Schechter
Risk factors for upper-extremity musculoskeletal disorders in the working population
SUMMARY Objective The study aimed to assess the relative importance of personal and occupational risk factors for upper-extremity musculoskeletal disorders (UEMSDs) in the working population. Methods A total of 3,710 workers (58% of men) participating in a surveillance program of MSDs in a French region in 20022005 were included. UEMSDs were diagnosed by 83 trained occupational physicians performing a standardized physical examination. Personal factors and work exposure were assessed by a self-administered questionnaire. Statistical associations between MSDs, personal and occupational factors were analyzed using logistic regression modeling. Results A total of 472 workers suffered from at least one UEMSD. The risk of UEMSDs increased with age for both genders (P<0.001) (O.R. up to 4.9 in men and 5.0 and in women) and in cases of prior history of UEMSDs (OR 3.1 and 5.0, P<0.001). In men, UEMSDs were associated with obesity (OR 2.2, P=0.014), high level of physical demand (OR 2.0, P<0.001), high repetitiveness of the task (OR 1.5, P=0.027), postures with the arms at or above shoulder level (OR 1.7, P=0.009) or with full elbow flexion (OR 1.6, P=0.006), and high psychological demand (O.R. 1.5, P=0.005). In women, UEMSDs were associated with diabetes mellitus (O.R. 4.9, P=0.001), postures with extreme wrist bending (OR 2.0, P<0.001), use of vibrating hand tools (O.R. 2.2, P=0.025) and low level of decision authority (OR 1.4, P=0.042). Conclusion The study showed that personal and work-related physical and psychosocial factors were strongly associated with clinically-diagnosed UEMSDs.
Roquelaure, Yves; Ha, Catherine; Rouillon, Clarisse; Fouquet, Natacha; Leclerc, Annette; Descatha, Alexis; Touranchet, Annie; Goldberg, Marcel; Imbernon, Ellen
Painful knee prosthesis: surgical approach
Summary There are many conditions that may be responsible of a painful knee prosthesis. The possible causes are not always easily diagnosed. Common causes of prosthetic failure, such as aseptic loosening, infection, instability, progressive patellar arthropathy and recurrent synovitis are associated with clearly defined radiographic and/or clinical evidence. Prosthetic infection should always be considered first until any other cause has been demonstrated. In the presence of an infected prosthesis we carry out a two-step revision. Aseptic loosening needs implant revision more often with increasing prosthesis stability. Varus-valgus, anteroposterior, global and patello-femoral instability are failures often due to technical errors; superstabilized or constrained implants are needed depending on the instability entity. In presence of patello-femoral pain it is necessary to evaluate the stability of the patellar component and any alterations in its motion. Patellar progressive arthropathy can often cause late-onset knee pain; in this case patella resurfacing is needed. Altered patellar tracking, may need a lateral release but in some cases is related to misalignment of the components and the revision procedure is mandatory. Nevertheless, the diagnosis and treatment of a painful knee prosthesis can be extremely difficult if there is no clear evidence of any of the most common causes of failure. Referred pain, ligament and tendon dysfunction, cutaneous neuromas, synovitis, a patellar clunk have to be diagnosed and treated. A possible aetiological understimated factor is painful knee prosthesis due to metals sensibilization, in particular to nickel. In this event the quantity of nickel in the revision prosthesis must be minimal.
Villano, Marco; Carulli, Christian; Puccini, Serena; Soderi, Stefano; Innocenti, Massimo
To Constrain or Not to Constrain, and Other Stories of Intensive Upper Extremity Training for Children with Unilateral Cerebral Palsy
ERIC Educational Resources Information Center
Impaired hand function is among the most functionally disabling symptoms of unilateral cerebral palsy. Evidence-based treatment approaches are generally lacking. However, recent approaches providing intensive upper extremity training appear promising. In this review, we first describe two such approaches, constraint-induced movement therapy (CIMT)
Gordon, Andrew M.
The impact of seating and positioning on the development of repetitive strain injuries of the upper extremity in wheelchair athletes.
The population of people who use wheelchairs has been increasing due to technological advances. With this increase, there has also been an increase in participation in wheelchair sports. The incidence of upper extremity injury in wheelchair users has been reported to be between 31 and 73% [2,13,23,26,29]. Wheelchair athletes may be at an increased risk for upper extremity injury due to increased upper extremity use with sport. The purpose of this paper is to ascertain whether proper seating and positioning have an impact on the prevention of repetitive strain injuries (RSI) of the soft tissues, including peripheral nerve entrapments and muscle injury, of the upper extremity in wheelchair athletes. A review of current research on wheelchair propulsion and RSI revealed several hazards for wheelchair athletes to develop RSI's. These include duration of impairment, muscle imbalance, awkward positioning, inadequate rest breaks, repetition of muscle use in daily activities and in sport participation, the degree of force needed for propulsion, and fatigue. Current research does not provide conclusive information on optimal seating. Suggestions of preventative measures are given including suggestions with regard to positioning in the wheelchair. PMID:12441510
Stankovits, Sharon
Neuromuscular Electrical Stimulation and Dynamic Bracing as a Treatment for Upper-Extremity Spasticity in Children with Cerebral Palsy
We have investigated a therapeutic regimen using neuromuscular electrical stimulation (NMES) and dynamic bracing to assess their effectiveness in reducing upper-extremity spasticity in children with cerebral palsy. Nineteen patients between 4 and 21 years of age with documented diagnoses of spastic cerebral palsy were treated. The patients included in the study followed a regimen of two 30-minute sessions of NMES
We have investigated a therapeutic regimen using neuromuscular electrical stimulation (NMES) and dynamic bracing to assess their effectiveness in reducing upper-extremity spasticity in children with cerebral palsy. Nineteen patients between 4 and 21 years of age with documented diagnoses of spastic cerebral palsy were treated. The patients included in the study followed a regimen of two 30-minute sessions of NMES
Reliability of the Quality of Upper Extremity Skills Test for Children with Cerebral Palsy Aged 2 to 12 Years
ERIC Educational Resources Information Center
Aim: To investigate reliability of the Quality of Upper Extremity Skills Test (QUEST) scores for children with cerebral palsy (CP) aged 2-12 years. Method: Thirty-one QUESTs from 24 children with CP were rated once by two raters and twice by one rater. Internal consistency of total scores, inter- and intra-rater reliability findings for total,
Thorley, Megan; Lannin, Natasha; Cusick, Anne; Novak, Iona; Boyd, Roslyn
Acute Bouts of Assisted Cycling Improves Cognitive and Upper Extremity Movement Functions in Adolescents with Down Syndrome
ERIC Educational Resources Information Center
The aim of this study was to examine the effectiveness of 2 modes of exercise on cognitive and upper extremity movement functioning in adolescents with Down syndrome (DS). Nine participants randomly completed 3 interventions over 3 consecutive weeks. The interventions were: (a) voluntary cycling (VC), in which participants cycled at their
Ringenbach, Shannon D. R; Albert, Andrew R.; Chen, Chih-Chia; Alberts, Jay L.
clinical ergonomic job analysis and consultation: Facilitating work reentry in a case with upper extremity cumulative trauma-related disability
The management of work-related recurrent and chronic upper extremity cumulative trauma disorders (UECTDs) represents a challenge particularly when return to work is a treatment goal. Many of these work-related UECTDs may be the consequence of exposure to such physical stressors as repetition, excessive force, awkward and sustained posture in addition to psychosocial stressors in the workplace. Pain and associated disability
Paul F. Hickey; Michael Feuerstein I
Minimal Depression: How Does It Relate to Upper-Extremity Impairment and Function in Stroke?
OBJECTIVE. We sought to determine the association between minimal depression, upper-extremity (UE) impairment, and UE motor function in a cohort of participants with subacute stroke. METHOD. We conducted a retrospective, secondary analysis of an interventional study. Correlational analyses were performed using the following outcome measures: the UE section of the Fugl-Meyer Assessment (FM), the functional ability section of the Arm Motor Ability Test (AMAT), and the Beck Depression Inventory (BDIII). RESULTS. We found a negative correlation between BDIII and both the FM (?.120, p = .196) and the AMAT (?.110, p = .275); however, this correlation was not statistically significant. Women exhibited higher depression scores (8.75 Ý 0.78) than men (6.29 Ý 0.46; p = .008). CONCLUSION. Low levels of depression are not associated with UE motor impairment and function in people with minimal to moderate UE disability levels. Poststroke depression occurs more frequently in women, warranting additional research on sex-specific differences. Given the proliferation of UE therapies targeting this group, this information is important for effective therapy planning and implementation.
Weaver, Lindy L.; Sheffler, Lynne; Chae, John
Incidence and prevalence of upper-extremity musculoskeletal disorders. A systematic appraisal of the literature
Background A systematic appraisal of the worldwide incidence and prevalence rates of UEDs available in scientific literature was executed to gauge the range of these estimates in various countries and to determine whether the rates are increasing in time. Methods Studies that recruited at least 500 people, collected data by using questionnaires, interviews and/or physical examinations, and reported incidence or prevalence rates of the whole upper-extremity including neck, were included. Results No studies were found with regard to the incidence of UEDs and 13 studies that reported prevalence rates of UEDs were included. The point prevalence ranged from 1.653%; the 12-months prevalence ranged from 2.341%. One study reported on the lifetime prevalence (29%). We did not find evidence of a clear increasing or decreasing pattern over time. The case definitions for UEDs used in the studies, differed enormously. Therefore, it was not possible to pool the data. Conclusion There are substantial differences in reported prevalence rates on UEDs. Main reason for this is the absence of a universally accepted way of labelling or defining UEDs. If we want to make progress in this field, the first requirement is to agree on unambiguous terminology and classification of EUDs.
Huisstede, Bionka MA; Bierma-Zeinstra, Sita MA; Koes, Bart W; Verhaar, Jan AN
Solitary necrobiotic xanthogranuloma of an upper extremity in association with multiple myeloma.
Necrobiotic xanthogranuloma (NXG) is an uncommon granulomatous disorder of unknown pathogenesis that often presents with yellowish plaques in a periorbital distribution. While a majority of cases are associated with an underlying paraproteinemia of the IgG kappa type, a much smaller number are found to be associated with an underlying multiple myeloma. We present a case of a 78-year-old male with an isolated lesion of NXG on his right upper extremity. Following his diagnosis of NXG, further investigation for underlying systemic disorders with serum immunofixation revealed a monoclonal IgG kappa immunoglobulin with an M-spike of 1.2 g/dL. A PET-CT demonstrated bone destruction in the left proximal fifth rib, left scapula, the anterior lumbar I (L1) vertebrae, the left lumbar III (L3) vertebrae posterior elements and possibly left sacrum. A bone marrow biopsy revealed 18 % plasma cells. With these findings he was diagnosed with stage I multiple myeloma. Though clinically unimpressive and atypical in location for NXG, early biopsy and diagnosis of this solitary lesion led to the discovery of his hematopoietic disorder.
J Drugs Dermatol. 2014;13(5):598-600. PMID:24809886
Bain Iii, E Eugene; Meehan, Shane A; Hale, Elizabeth K
Management of disorders of the rotator cuff: proceedings of the ISAKOS upper extremity committee consensus meeting.
The goal of this article is to consolidate the International Society of Arthroscopy, Knee Surgery & Orthopaedic Sports Medicine (ISAKOS) Upper Extremity Committee's (UEC's) current knowledge on rotator cuff disease and management, as well as highlight key unresolved issues. The rotator cuff is an anatomically complex structure important for providing glenohumeral function and stability as part of a closed chain system. Current consensus suggests rotator cuff injuries are most accurately diagnosed, at levels similar to diagnosis by magnetic resonance imaging, with a combination of cuff- and impingement-specific clinical tests. Updates in the understanding of acromion morphology, the insertional anatomy of the rotator cuff, and the role of suprascapular nerve release may require changes to current classification systems and surgical strategies. Although initial management focuses on nonoperative protocols, discussion continues on whether surgery for isolated impingement is clinically more beneficial than rehabilitation. However, clear indications have yet to be established for the use of single- versus double-row repair because evidence confirms neither is clinically efficacious than the other. Biceps tenodesis, however, in non-isolated cuff tears has proven more successful in addressing the etiology of shoulder pain and yields improved outcomes over tenotomy. Data reviewing the benefits of tendon transfers, shoulder prostheses, and mechanical scaffolds, as well as new research on the potential benefit of platelet-rich plasma, pluripotential stem cells, and gene therapies, will also be presented. PMID:24041864
Arce, Guillermo; Bak, Klaus; Bain, Gregory; Calvo, Emilio; Ejnisman, Benno; Di Giacomo, Giovanni; Gutierrez, Vicente; Guttmann, Dan; Itoi, Eiji; Ben Kibler, W; Ludvigsen, Tom; Mazzocca, Augustus; de Castro Pochini, Alberto; Savoie, Felix; Sugaya, Hiroyuki; Uribe, John; Vergara, Francisco; Willems, Jaap; Yoo, Yon Sik; McNeil, John W; Provencher, Matthew T
Clinical orthopedic examination findings in the upper extremity: correlation with imaging studies and diagnostic efficacy.
Different orthopedic tests are used to evaluate internal derangements of joints. Radiologic examinations like magnetic resonance (MR) imaging are ordered on the basis of results of these tests to narrow the clinical diagnosis and formulate a treatment plan. Although these tests are clinically useful, the test terminology can be confusing and the significance of the tests not clearly understood. This article helps explain the clinical jargon of tests performed for the major joints of the upper extremity and their proper use and diagnostic value in conjunction with MR imaging. The article presents a structured algorithmic approach to explain the tests. For each joint, a hierarchy of clinical tests is performed, starting with general observation and range of motion, followed by more specific tests tailored to evaluate individual or grouped anatomic structures. MR imaging findings and clinical tests complement each other in making a final diagnosis. However, because of the varied sensitivity and specificity of the clinical tests and MR imaging, it is important to be familiar with their diagnostic value before making clinical decisions. Knowledge of clinical jargon and the proper use and diagnostic value of orthopedic tests can aid in interpretation of radiologic images by focusing search patterns, thus allowing comprehensive evaluation and optimized reporting. It also enhances communication with the orthopedist, thereby helping maintain continuity of care. Online supplemental material is available for this article. PMID:24617698
Pandey, Tarun; Slaughter, Aubrey J; Reynolds, Kirk A; Jambhekar, Kedar; David, Ryan M; Hasan, S Ashfaq
Preparatory band specific premotor cortical activity differentiates upper and lower extremity movement
Event related desynchronization (ERD) allows evaluation of brain signals in multiple frequency dimensions. The purpose of this study was to determine left hemispheric non-primary motor cortex differences at varying frequencies of premovement ERD for similar movements by end-effectors of the upper and lower extremities. We recorded 32-channel electroencephalography (EEG) while subjects performed self-paced right ankle dorsiflexion and wrist extension. Electromyography (EMG) was recorded over the tibialis anterior and extensor carpi ulnaris. EEG was analyzed for premovement ERD within the alpha (812 Hz), low beta (1318 Hz) and high beta (1822 Hz) frequencies over the premotor, motor, and sensory areas of the left and mesial cortex from ?1.5 to 0 s before movement. Within the alpha and high beta bands, wrist movements showed limited topography, but greater ERD over posterior premotor cortex areas. Alpha ERD was also significantly greater over the lateral motor cortex for wrist movements. In the low beta band, wrist movements provided extensive ERD differences to include the left motor and mesial/lateral premotor areas, whereas ankle movements showed only limited ERD activity. Overall, alpha and high beta activity demonstrated distinctions that are consistent with mapping of wrist and ankle representations over the sensorimotor strip, whereas the low beta representation demonstrated the clearest distinctions between the limbs over widespread brain areas, particularly the lateral premotor cortex. This suggests limited leg premovement activity at the dorsolateral premotor cortex. Low beta ERD may be reflect joint or limb specific preparatory activity in the premotor area. Further work is required to better evaluate the extent of this low beta activity for multiple comparative joints.
Carpenter, Mackenzie; Mizelle, J. C.; Forrester, Larry
Quantitative examination of upper and lower extremity muscle activation during common shoulder rehabilitation exercises using the Bodyblade.
The kinetic chain approach to shoulder rehabilitation has become a standard of care within sports medicine. Attempting to incorporate the kinetic chain method of proximal stability for distal mobility requires a stable base of not only the lower extremity but also the upper extremity. Therefore, it was the purpose of this study to quantify muscle activation of the upper and lower extremity during common shoulder rehabilitation exercises using the Bodyblade. An observational descriptive study design was used. Thirty healthy collegiate graduate students (age: 23.5 Ý 1.34 years; height: 174.4 Ý 11.0 cm; weight: 76.6 Ý 16.9 kg), regardless of gender, consented to participate. The independent variables were the 2 observational categories of exercise and muscle. The dependent variable was considered muscle activation as presented as percent maximum voluntary isometric contraction. Results revealed moderate to moderately strong activation of both the musculature of the upper and lower extremity while performing the shoulder rehabilitation exercises. The findings of this study demonstrate that any of these exercises may be incorporated into a shoulder rehabilitation program. The muscle activations described in this study are beneficial in choosing appropriate exercises to perform during shoulder rehabilitation. Information from this study can be applied to the kinetic chain approach to shoulder rehabilitation where focus is on the movement pattern. The Bodyblade is a unique rehabilitation tool because a variety of kinetic chain movement pattern exercises allow for scapular control via muscle activation about the hip and shoulder. PMID:23238096
Oliver, Gretchen D; Sola, Mike; Dougherty, Chris; Huddleston, Sean
Reliability of the Quality of Upper Extremity Skills Test for Children with Cerebral Palsy Aged 2 to 12 Years
Aim: To investigate reliability of the Quality of Upper Extremity Skills Test (QUEST) scores for children with cerebral palsy (CP) aged 212 years.\\u000aMethod: Thirty-one QUESTs from 24 children with CP were rated once by two raters and twice by one rater. Internal consistency of total scores, inter- and intra-rater reliability findings for total, domain, and item scores were calculated.
Megan Thorley; Natasha Lannin; Anne Cusick; Iona Novak; Roslyn Boyd
A Randomized Controlled Trial Comparing Botulinum Toxin A Dosage in the Upper Extremity of Children with Spasticity
ERIC Educational Resources Information Center
This study compared the effects of low and high doses of botulinum toxin A (BTX-A) to improve upper extremity function. Thirty-nine children (22 males, 17 females) with a mean age of 6 years 2 months (SD 2y 9mo) diagnosed with spastic hemiplegia or triplegia were enrolled into this double-blind, randomized controlled trial. The high-dose group
Kawamura, Anne; Campbell, Kent; Lam-Damji, Sophie; Fehlings, Darcy
Short-Term Change of Handgrip Strength After Trigger Point Injection in Women With Muscular Pain in the Upper Extremities
Objective To determine overall handgrip strength (HGS), we assessed the short-term change of HGS after trigger point injection (TPI) in women with muscular pain in the upper extremities by comparison with established pain scales. Methods The study enrolled 50 female patients (FMS with MPS group: 29 patients with combined fibromyalgia [FMS] and myofascial pain syndrome [MPS]; MPS group: 21 patients with MPS) who presented with muscular pain in the upper extremities at Konyang University Hospital. In addition, a total of 9 healthy women (control group) were prospectively enrolled in the study. We surveyed the three groups using the following established pain scales: the Fibromyalgia Impact Questionnaire (FIQ), the 36-Item Short Form Health Survey (SF-36), and the Short Form McGill Pain Questionnaire (MPQ). HGS was measured in both hands of study participants using a handgrip dynamometer. We performed TPI (0.5% lidocaine, total 10 mL, injected at the pain site of upper extremities). After 20 minutes, we remeasured the patient's HGS and MPQ score. Results ANOVA analysis was conducted among groups. Based on Tukey multiple comparison test, the majority of FIQ and SF-36 subscales, total FIQ and SF-36 scores, MPQ and HGS were significantly different between FMS with MPS and the other groups. There was no statistically significant difference between MPS and control groups. Higher HGS was positively associated with enhanced physical function, negatively associated with total FIQ and MPQ scores, and positively associated with the total SF-36 score calculated using Spearman correlation. Post-TPI MPQ decreased and HGS increased. In patient groups, a negative correlation was found between MPQ and HGS. Conclusion The HGS test might potentially be a complementary tool in assessing the short-term treatment effects of women with muscular pain in the upper extremities.
Lee, Soo Jin; Ahn, Dong Heun; Jung, Ji Hun; Kim, Yong Rok
[Recovery of voluntary motion in the upper extremity following hemiplegia in patients with cerebrovascular accident. Prognostic evaluation].
The study aims the registration and anlaysis of the main facts which occur during recovery of the voluntary movements in the upper extremity, in patients with hemiplegia following cerebrovascular accident, and it also intends to evaluate the prognosis. Of particular interest was the comparative recognition of the spontaneous recovery of voluntary motricity in different segments of the upper extremity in 88 patients, not previously selected, with hemiplegia after cerebrovascular accident, admitted to the hospital at the acute stage. Of the 88 hemiplegic patients studied whose further evolution has been fairly followed 56 cases (group 1) experienced clinical improvement, either with partial or total remission of neurological manifestations and complete recovery of all voluntary movements in the different upper extremity joints, while 32 patients (group 2) with persistent neurological symptoms, particularly spasticity, showed a slighter clinical improvement, as well as only partial recovery of upper extremity movements. The clinical quantification of neurological signs applied in this study, has made possible to report the main significant changes developed during the 88 patients recovery. This criteria has allowed to emphasize the degree of the spontaneous remission of symptoms and the determination of the critical level of stabilization "plateau". The analysis of the data supplied by the two groups led to the following conclusions: a) the critical level of remission of symptoms and the spontaneous recovery of voluntary movements ocurred around the 70th day after the installation of hemiplegia; b) the 256 average score acquired 70 days after the onset of the hemiplegia represents the critical level stabilization (plateau); c) although the presence of early initial movements, immediately after the installation of hemiplegia, is a valuable data for the prognosis, the characterization of early movement patterns is of most important meaning; d) patients with hemiplegia after cerebrovascular acident who present the thumb flexion-extension and opposition movements showed a better prognosis than those whose initial movements were represented by the elbow flexion and/or arm flexion-adduction. PMID:1275794
Anghinah, A
Associations of metabolic factors and adipokines with pain in incipient upper extremity soft tissue disorders: a cross-sectional study
Objectives Earlier studies have suggested associations between metabolic factors and musculoskeletal pain or disorders. We studied the associations of obesity, lipids, other features of the metabolic syndrome and adipokines (adiponectin, leptin, resistin, visfatin) with upper extremity pain in a clinical population with incipient upper extremity soft tissue disorders (UESTDs). Design A cross-sectional study. Setting Primary healthcare (occupational health service) with further examinations at a research institute. Participants Patients (N=163, 86% were women) seeking medical advice in the occupational health service due to incipient upper extremity symptoms with symptom duration of <1?month were referred for consultation to the Finnish Institute of Occupational Health from Spring 2006 to Fall 2008. We included all actively working subjects meeting diagnostic criteria based on physical examination. We excluded subjects meeting predetermined conditions. Outcome measure Pain intensity was assessed with visual analogue scale and dichotomised at the highest tertile (cut-point 60). Results Obesity (adjusted OR for high waist circumference 2.9, 95% CI 1.1 to 7.3), high-density lipoprotein cholesterol (OR 3.9, 95% CI 1.4 to 10.1 for low level) and triglycerides (OR 2.6, 95% CI 1.0 to 6.8 for high level) were associated with pain intensity. Of four adipokines studied, only visfatin was associated with upper extremity pain (adjusted OR 1.4, 95% CI 1.0 to 2.1 for 1SD increase in level). Conclusions Abdominal obesity and lipids may have an impact on pain intensity in UESTDs. They may intensify pain through proinflammatory pain-modifying molecular pathways or by causing soft tissue pathology and dysfunction of their supplying arteries. Of four adipokines studied only one (visfatin) was associated with pain intensity. In the future, further studies are required to better understand the relationship between metabolic factors and UESTDs.
Rechardt, Martti; Shiri, Rahman; Lindholm, Harri; Karppinen, Jaro; Viikari-Juntura, Eira
Reliability and Validity of the Upper-Extremity Motor Activity Log14 for Measuring Real-World Arm Use
Background and PurposeIn research on Constraint-Induced Movement (CI) therapy, a structured interview, the Motor Activity Log (MAL), is used to assess how stroke survivors use their more-impaired arm outside the laboratory. This article examines the psychometrics of the 14-item version of this instrument in 2 chronic stroke samples with mild-to-moderate upper-extremity hemiparesis. MethodsParticipants (n41) in the first study completed MALs
Gitendra Uswatte; Edward Taub; David Morris; Mary Vignolo; Karen McCulloch
Age Differences in Energy Absorption in the Upper Extremity During a Descent Movement: Implications for Arresting a Fall
Background Falls are the number one cause of unintentional injury in older adults. The protective response of breaking the fall with the outstretched hand is often essential for avoiding injury to the hip and head. In this study, we compared the ability of young and older women to absorb the impact energy of a fall in the outstretched arms. Methods Twenty young (mean age = 21 years) and 20 older (M = 78 years) women were instructed to slowly lower their body weight, similar to the descent phase of a push-up, from body lean angles ranging from 15¯ to 90¯. Measures were acquired of peak upper extremity energy absorption, arm deflection, and hand contact force. Results On average, older women were able to absorb 45% less energy in the dominant arm than young women (1.7 Ý 0.5% vs 3.1 Ý 0.4% of their body weight æ body height; p < .001). These results suggest that, even when both arms participate equally, the average energy content of a forward fall exceeds by 5-fold the average energy that our older participants could absorb and exceeds by 2.7-fold the average energy that young participants could absorb. Conclusions During a descent movement that simulates fall arrest, the energy-absorbing capacity of the upper extremities in older women is nearly half that of young women. Absorbing the full energy of a fall in the upper extremities is a challenging task even for healthy young women. Strengthening of upper extremity muscles should enhance this ability and presumably reduce the risk for injury to the hip and head during a fall.
Stotz, Paula J.; Normandin, Sarah C.; Robinovitch, Stephen N.
Surgical management of a high-flow arteriovenous malformation of the upper extremity producing severe hemodynamic impairment
Peripheral arteriovenous (AV) malformations may present with a plethora of clinical symptoms such as paradoxical emboli, severe hypertension, nerve palsies or pain syndromes. Hemodynamically compromising lesions of the limbs are rare and involve high-flow AV fistulae with marked arteriovenous shunting. A female patient with a high-flow arteriovenous malformation of the left upper-extremity is presented. Preoperative assessment by magnetic resonance imaging
E. Polykandriotis; C. B—hner; R. Hess; U. Kneser; H. Seyhan; B. Loos; A. Bach; J. Kopp; R. E. Horch
A randomized controlled trial comparing botulinum toxin A dosage in the upper extremity of children with spasticity.
This study compared the effects of low and high doses of botulinum toxin A (BTX-A) to improve upper extremity function. Thirty-nine children (22 males, 17 females) with a mean age of 6 years 2 months (SD 2y 9mo) diagnosed with spastic hemiplegia or triplegia were enrolled into this double-blind, randomized controlled trial. The high-dose group received BTX-A in the following doses: biceps 2U/kg, brachioradialis 1.5U/kg, common flexor origin 3U/kg, pronator teres 1.5U/kg, and adductor/opponens pollicis 0.6U/kg to a maximum of 20U. The low-dose group received 50% of this dosage. Outcomes were measured at baseline and at 1 and 3 months after injection, and results were analyzed with a repeated-measures analysis of variance. There was no significant difference between the low-dose and high-dose groups in upper extremity function over the 3-month period as measured by the Quality of Upper Extremity Skills Test (F[1,37]=0.18, p=0.68). There was no difference between the groups in the Pediatric Evaluation of Disability Inventory Self Care Domain (F[1,37]=0.05, p=0.83). Although grip strength decreased over the 3-month period, there was no difference between groups (F[1,32]=0.45, p=0.51). These findings indicate that there is no difference in hand and arm function between a low dose and a high dose of BTX-A at 1 and 3 months after injection. This information can be used to guide dosage of BTX-A for the management of upper extremity spasticity in children. PMID:17489805
Kawamura, Anne; Campbell, Kent; Lam-Damji, Sophie; Fehlings, Darcy
Manual segmentation of DXA scan images results in reliable upper and lower extremity soft and rigid tissue mass estimates.
Quantification of segment soft and rigid tissue masses in living people is important for a variety of clinical and biomechanical research applications including wobbling mass modeling. Although Dual-energy X-ray Absorptiometry (DXA) is widely accepted as a valid method for this purpose, the reliability of manual segmentation from DXA scans using custom regions of interest (ROIs) has not been evaluated to date. Upper and lower extremity images of 100 healthy adults who underwent a full body DXA scan in the supine position were manually segmented by 3 measurers independently using custom ROIs. Actual tissue masses (fat mass, lean mass, bone mineral content) of the arm, arm with shoulder, forearm, forearm and hand, thigh, leg, and leg and foot segments were quantified bilaterally from the ROIs. There were significant differences between-measurers, however, percentage errors were relatively small overall (<1-5.98%). Intraclass correlation coefficients (ICCs) were very high between and within-measurers, ranging from 0.990 to 0.999 and 0.990 to 1.00 for the upper and lower extremities, respectively, suggesting excellent reliability. Between and within-measurer errors were comparable in general, and differences between the tissue types were small on average (maximum of 42 and 53g for upper and lower extremities, respectively). These results suggest that manual segmentation of DXA images using ROIs is a reliable method of estimating soft and rigid tissues in living people. PMID:19356763
Burkhart, Timothy A; Arthurs, Katherine L; Andrews, David M
Axillary nerve block in comparison with intravenous midazolam/fentanyl for painless reduction of upper extremity fractures.
The painful nature of fractures has made it inevitable to use various anesthetic techniques to reduce or immobilize fractured parts. In the present study, axillary nerve block was compared with intravenous midazolam/fentanyl to induce anesthesia for Painless Reduction of Upper Extremity Fractures. The subjects in the present clinical trial consisted of 60 patients with upper extremity fractures. They were randomly divided into two equal groups of intravenous sedation (IVS) with midazolam/fentanyl and axillary nerve block (ANB). Rate of anesthesia induction, recovery time, and pain intensities at baseline, during the procedure and at the end of the procedure were recorded in both groups. Data was analyzed and compared between the two groups with SPSS 18 statistical software using appropriate tests. Demographic data, vital signs and means of pain intensities at the beginning of the procedure were equal in the two groups. In the IVS group, the overall duration of the procedure was shorter with more rapid onset of anesthesia (P<0.05). In contrast, the recovery time was much shorter in the ANB group (P<0.001). No life or organ threatening complications were observed in the two groups. Axillary nerve block can be considered an appropriate substitute for intravenous sedation in painful procedures of the upper extremity. PMID:24659069
Alimohammadi, Hossein; Azizi, Mohammad-Reza; Safari, Saeed; Amini, Afshin; Kariman, Hamid; Hatamabadi, Hamid Reza
mHealth application for upper extremity range of motion and reachable workspace.
We present mobile health (mHealth) applications utilizing embedded phone sensors as an angle-measuring device for upper-limb range of motion (ROM) and estimation of reachable workspace to assist in evaluation of upper limb functional capacity. Our results show that the phone can record accurate measurements, as well as provide additional functionalities for clinicians. PMID:23400206
Yan, Posu; Kurillo, Gregorij; Bajcsy, Ruzena; Abresch, R Ted; Nicorici, Alina; Johnson, Linda; Han, Jay J
Upper extremity interaction with a helicopter side airbag: injury criteria for dynamic hyperextension of the female elbow joint.
This paper describes a three part analysis to characterize the interaction between the female upper extremity and a helicopter cockpit side airbag system and to develop dynamic hyperextension injury criteria for the female elbow joint. Part I involved a series of 10 experiments with an original Army Black Hawk helicopter side airbag. A 5(th) percentile female Hybrid III instrumented upper extremity was used to demonstrate side airbag upper extremity loading. Two out of the 10 tests resulted in high elbow bending moments of 128 Nm and 144 Nm. Part II included dynamic hyperextension tests on 24 female cadaver elbow joints. The energy source was a drop tower utilizing a three-point bending configuration to apply elbow bending moments matching the previously conducted side airbag tests. Post-test necropsy showed that 16 of the 24 elbow joint tests resulted in injuries. Injury severity ranged from minor cartilage damage to more moderate joint dislocations and severe transverse fractures of the distal humerus. Peak elbow bending moments ranged from 42.4 Nm to 146.3 Nm. Peak bending moment proved to be a significant indicator of any elbow injury (p = 0.02) as well as elbow joint dislocation (p = 0.01). Logistic regression analyses were used to develop single and multiple variate injury risk functions. Using peak moment data for the entire test population, a 50% risk of obtaining any elbow injury was found at 56 Nm while a 50% risk of sustaining an elbow joint dislocation was found at 93 Nm for the female population. These results indicate that the peak elbow bending moments achieved in Part I are associated with a greater than 90% risk for elbow injury. Subsequently, the airbag was re-designed in an effort to mitigate this as well as the other upper extremity injury risks. Part III assessed the redesigned side airbag module to ensure injury risks had been reduced prior to implementing the new system. To facilitate this, 12 redesigned side airbag deployments were conducted using the same procedures as Part I. Results indicate that the re-designed side airbag has effectively mitigated elbow injury risks induced by the original side airbag design. It is anticipated that this study will provide researchers with additional injury criteria for assessing upper extremity injury risk caused by both military and automotive side airbag deployments. PMID:17230265
Duma, Stefan M; Hansen, Gail A; Kennedy, Eric A; Rath, Amber L; McNally, Craig; Kemper, Andrew R; Smith, Eric P; Brolinson, P Gunnar; Stitzel, Joel D; Davis, Martin B; Bass, Cameron R; Brozoski, Frederick T; McEntire, B Joseph; Alem, Nabih M; Crowley, John S
Surgical Extirpation of Glomus Tumor from Rare Localization on the Upper Extremity
Objective. To report on a very rare case of a glomus tumor manifested on the upper arm in a healthy young male patient. Case Presentation and Intervention. A 22-year-old male patient presented with bluish multifocal venous malformation on the left upper arm and was admitted for venous malformation excision. Pain, discomfort, and upper arm paraesthesia had been present for almost 6 years. Ultrasonography revealed septet tumor without blood flow in the subcutaneous region of anterior aspect of the upper arm. A multifocal venous malformation approximately 510?mm in diameter was excised. Histological examination showed dilated vascular area with proliferated glomus cells with round nucleus in the wall of dilated vascular structures. Based on histological examination, the final diagnosis was made as glomangioma. Conclusion. Histological examination is the only method that can establish final diagnosis. Currently, the only available treatment for this type of tumor is surgical excision.
Hruby, Jan; Novotny, Robert; Spacek, Miroslav; Mitas, Petr; Hlubocky, Jaroslav; Janak, David; Povysil, Ctibor; Lindner, Jaroslav
Thrombosed hemodialysis access as an unusual source of emboli in the upper extremity of a kidney transplant recipient.
Arteriovenous fistula (AVF) is no longer used in kidney transplant recipients. However, there is no consensus regarding whether or not to ligate a well-functioning AVF after successful kidney transplantation, particularly in patients with well and stably functioning kidney transplants. Most AVFs without complications are left in situ and more than one-third of native AVFs close spontaneously. The currently accepted policy toward thrombosed AVFs is retention within the patient's extremity without treatment. These thrombosed AVFs seldom cause serious problems. However, when combined with aneurysmal dilatation of the proximal vein adjacent to the arterial anastomotic area, the AVF could act as the source of distal arterial emboli. This is very similar clinical scenario to that observed in embolization from a peripheral arterial aneurysm. Here we describe a case report of upper extremity ischemia following massage of a thrombosed aneurysmal AVF. The patient was successfully treated with a combination of catheter-directed thromboaspiration, thrombolysis, and surgical repair of the thrombosed AVF. To the best of our knowledge, this is the first report of upper extremity embolism after massage of a thrombosed aneurysmal AVF involving this combined treatment. PMID:24274072
Kim, Mi-Hyeong; Hwang, Jeong Kye; Chun, Ho Jong; Moon, In Sung; Kim, Ji Il
Multiple variations of the arterial pattern in upper extremities: A case report and embryological pathogenesis.
During a routine dissection at the Department of Anatomy, Collegium Medicum, Jagiellonian University, one cadaver was found to have multiple variations of the arteries of the upper limbs. The variations pertained to the course of the brachial artery as well as to its distribution. An unusual formation of the superficial palmar arch was observed in both upper limbs. The anatomical peculiarities encountered included: in the left upper limb-the brachioradial artery, which formed the superficial palmar arch by turning to the palmar side of the hand and connecting with the ulnar artery and in the right upper limb-a subscapular-circumflex humeral-deep brachial trunk that correlated with a high division of the brachial artery (in the upper third of the biceps brachii muscle), a large anastomosis between the radial and the ulnar artery, the presence of a persistent median artery, and the unusual formation of the superficial palmar arch, which was created by the median, ulnar, and radial arteries. In this report, we will trace the path of the axillary artery and its branches in detail and emphasize its embryological significance. PMID:23037918
Klimek-Piotrowska, Wies?awa; Pacholczak, Renata; Walocha, Jerzy
[Sport performance with a prosthesis].
Technology is a contributory factor to sporting success in many Paralympic sports. This article is about upper and lower limb prostheses that are used in sports. The characteristics of lower limb prosthesis can be modified to respond to predictable leg movements such as with running. Conventional mechanical lower limb prostheses do not respond well to unexpected movements. There are upper limb prostheses that have been adapted for a broad range of sports including fishing, cycling, kayaking, skiing, baseball and even mountain climbing. Techniques are being developed that enable a more natural movement of the prosthesis to occur, such as targeted muscle reinnervation. These techniques are currently still in the experimental stage. The training schedule of the sportsperson must be balanced against his or her tolerance level to avoid mechanical overstrain, not only around the stump but also on the unaffected side. Lower limb prostheses that lead to top sporting successes, such as with running, have resulted in discussions about distorted competition. No upper limb prostheses have led to similar discussions. PMID:24382045
van Keeken, Helco; Bongers, Raoul M; Dekker, Rienk; van der Woude, Luc H V
On the Dynamics of Extreme Meteorological Droughts during Pakistan Summer Monsoon by Focusing the Anomalous States of Upper Troposphere
NASA Astrophysics Data System (ADS)
The lack of summer monsoon sometimes brings severe droughts in many parts of the world including South Asian countries like Pakistan. Human life and economy in Pakistan considerably depends on the summer monsoon. So, an essential question arises "how can we contribute better to manage the water resources during drought conditions for the societal needs". To address the concern as a hydrologist, we need to develop a basis of the scientific understanding of the different contrast of the climatology during extremely dry rainfall events over Pakistan region. However, compared to other regional studies i.e. Indian Summer Monsoon (ISM) and South-East Asian Monsoon (SEAM), the basis of the thermodynamical structure and the processes associated with upper tropospheric conditions during the climatological mean Pakistan Summer Monsoon (PSM) and its extreme events have not been addressed deeply yet and need to be investigated, because it is immensely vital for the hydrologist as a first step to develop the basis of scientific understanding. By data analysis, an attempt has been made to accomplish this objective. Firstly, the climatological tropospheric conditions and the associated processes from pre-monsoon phase to the PSM mature phase are investigated. During the PSM mature phase (mid July), the climatological-mean structure of the atmosphere favors convective activity compared to the pre-monsoon phase (late June) with weakening of the subsidence in the upper troposphere and also with increasing of incoming moisture flux in the lower troposphere from Arabian Sea and Bay of Bengal around Pakistan. Specifically, in the upper troposphere, the upper-level subsidence and convergence observed over Pakistan during pre-monsoon phase shifts and reallocates to the northwest of Pakistan during mature phase, which results in weakening of the subsidence just over Pakistan, and then the PSM mature phase initiated. Secondly, comparing the PSM mature phase climatological mean characteristics, the characteristics of the extremely dry PSM events are investigated by focusing their common anomalous tropospheric conditions observed during the period 1979-2008. We found that the extremely dry PSM events were closely related with the anomalous state of upper tropospheric cyclonic circulation northwest of Pakistan and the associated cold temperature anomaly around Pakistan. This anomalous state of upper tropospheric cyclonic circulation is accompanied with the anomalous upper level convergence around Pakistan, which anomalously weakens the climatological mean PSM trough to suppress the PSM activities. We found two possibilities i.e. Matsuno-Gill type atmospheric response from the tropics and/or the Rossby wave train along the Asian Jet to trigger, reinforce, and maintain the upper-tropospheric cyclonic circulation. In summary, the strong convection anomalies resulting in severe drought events over the PSM region are suggested to be induced by both the tropical and extratropical processes. However what (i.e. source) triggers the circulation anomaly from the tropics and/or extratropics is unknown at the moment, which needs further investigations to reach a definite conclusion. Further, if hydrologist gets a prediction signal in advance, the integrated water resources management (IWRM) will be much more effective for the region.
Ahmad, S.; Koike, T.; Nishii, K.
Solitary infantile myofibromatosis in the bones of the upper extremities: Two rare cases and a review of the literature
Infantile myofibromatosis (IM) is the most common fibrous tumor of infancy. IM may arise in a solitary or multicentric form, with similar histopathological findings, however, the clinical features and prognoses may vary. The solitary form tends to occur predominantly in males and is typically observed in the dermis, subcutis or deep soft tissues. The reported incidence of solitary osseous myofibromatosis is rare. Furthermore, the majority of solitary IM cases of the bone occur in the craniofacial bones, while the occurrence of solitary osseous myofibromatosis on the extremities has been sporadically reported. The present study describes two cases of solitary IM involving the bones of the upper extremities in females who were over two years old. The cases show unusual symptom presentation and the tumor origin is in a rarely observed location. The study discusses the clinical, radiological and pathological features, in addition to the previously described etiology, prognosis and treatment options for this condition.
Modulation of upper extremity motor evoked potentials by cutaneous afferents in humans
The excitability of motoneurons controlling upper limb muscles in humans may vary with cutaneous nerve stimulation. We investigated the effect of noxious and non-noxious conditioning stimuli applied to right and left digit II and right digit V on motor evoked potentials (MEPs) recorded from right thenar eminence, abductor digiti minimi, biceps and triceps brachii muscles in twelve healthy subjects. Transcranial
Markus Kofler; Peter Fuhr; A. Arturo Leis; Franz X Glocker; Martina F Kronenberg; J—rg Wissel; Ivana Stetkarova
Clinical effect of radiation synovectomy of the upper extremity joints: a randomised, double-blind, placebo-controlled study
Purpose To compare the clinical efficacy of radiosynoviorthesis (RSO) with intra-articular radionuclide plus glucocorticoid (GC) injection\\u000a (group A) with that of placebo plus GC injection (group B) for the treatment of persistent synovitis in joints of the upper\\u000a extremity.\\u000a \\u000a \\u000a \\u000a Methods At baseline and at 6 and 12 months after intra-articular injection, six clinical parameters were scored. Changes in clinical\\u000a values over time were
F. M. van der Zant; Z. N. Jahangier; J. D. Moolenburgh; W. A. A. Swen; R. O. Boer; J. W. G. Jacobs
The patient-based outcome of upper-extremity surgeries using the DASH questionnaire and the effect of disease activity of the patients with rheumatoid arthritis
The Disabilities of the Arm, Shoulder and Hand (DASH) is a standardized patient-based outcome measure, which assesses integrated\\u000a upper-extremity disorders. The objectives of this study were to investigate subjective outcome after upper-extremity surgeries\\u000a for the patients with rheumatoid arthritis (RA) using the DASH questionnaire (Japanese version) and to investigate the influence\\u000a of disease activity on the surgical outcome using the
Hajime Ishikawa; Akira Murasawa; Kiyoshi Nakazono; Asami Abe; Hiroshi Otani; Tahahiro Netsu; Takehito Sakai; Hiroe Sato
Thoughts on the management of amputation and amputation-like injuries in the upper extremities
Summary \\u000a Between 1982 and 1993, 65 amputation and amputation-like injuries in the upper arm (n = 18), proximal and middle forearm (n = 32) and distal forearm and wrist level (n = 15) were treated in our institution. The overall survival rate in our series was 92.3 % (60\\/65). In 3 of 65 cases early\\u000a secondary amputation because of vascular
R. Hierner; A. Berger; P. Brenner
Salvage of the upper extremity in cases of tumorous destruction of the proximal humerus
Malignant bone tumours or metastasis of the upper humerus may cause significant loss of function especially in those patients\\u000a with resectional arthroplasty of the shoulder. One method for achieving functional reconstruction of the humerus concerned\\u000a is replacement with a modular endoprosthesis. Little is known about clinical and radiologicial results in these rare circumstances.\\u000a Between 1993 and 1997 we treated 21
RenÕe A. Fuhrmann; Andreas Roth; Rolf A. Venbrocks
Understanding Work-Related Upper Extremity Disorders: Clinical Findings in 485 Computer Users, Musicians, and Others
Four hundred eighty five patients whose chief complaints were work related pain and other symptoms received a comprehensive upper-body clinical evaluation to determine the extent of their illness. The group had a mean age of 38.5 years. Sixty-three percent of patients were females. Seventy percent were computer users, 28% were musicians, and 2% were others engaged in repetitive work. The
Emil F. Pascarelli; Yu-Pin Hsu
EMG-based Control for a C5\\/C6 Spinal Cord Injury Upper Extremity Neuroprosthesis
The goal of this project is to enhance the benefits of functional electrical stimulation (FES) for individuals with cervical mid-level spinal cord injury (C5-C6 SCI) by providing upper arm function that complements the hand function provided by current FES systems. As a result of stimulation to selected shoulder and elbow muscles, individuals are able to increase their range of motion,
Juan Gabriel Hincapie; Robert F Kirsch
Contralaterally Controlled Functional Electrical Stimulation for Upper Extremity Hemiplegia: An Early-Phase Randomized Clinical Trial in Subacute Stroke Patients
Background Contralaterally controlled functional electrical stimulation (CCFES) is an experimental treatment intended to improve hand function after stroke. Objective To compare the effects of 6 weeks of CCFES vs. cyclic neuromuscular electrical stimulation (NMES) on upper extremity impairment and activity limitation in patients ? 6 months poststroke. Methods Twenty-one participants were randomized to CCFES or cyclic NMES. Treatment for both groups consisted of daily stimulation-assisted repetitive hand-opening exercise at home plus twice-weekly lab sessions of functional task practice. Assessments were made at pretreatment and posttreatment and at 1 month and 3 months posttreatment. They included maximum voluntary finger extension angle, finger movement tracking error, upper extremity Fugl-Meyer score, Box and Blocks test, and Arm Motor Abilities Test. Treatment effects were estimated using a 2-factor repeated measures analysis of variance with the value of the baseline measure as a covariate. Results Seventeen patients completed the treatment phase (9 CCFES, 8 cyclic NMES). At all post-treatment time points, CCFES produced larger improvements than cyclic NMES on every outcome measure. Maximum voluntary finger extension showed the largest treatment effect, with a mean group difference across the posttreatment time points of 28¯ more finger extension for CCFES. Conclusions The results favor CCFES over cyclic NMES though the small sample size limits the statistical power of the study. The effect size estimates from this study will be used to power a larger trial.
Knutson, Jayme S.; Harley, Mary Y.; Hisel, Terri Z.; Hogan, Shannon D.; Maloney, Margaret M.; Chae, John
The Role of Imaging in Patient Selection, Preoperative Planning, and Postoperative Monitoring in Human Upper Extremity Allotransplantation
Objective. To describe the role of imaging in vascular composite allotransplantation based on one institution's experience with upper extremity allotransplant patients. Methods. The institutional review board approved this review of HIPAA-compliant patient data without the need for individual consent. A retrospective review was performed of imaging from 2008 to 2011 on individuals undergoing upper extremity transplantation. This demonstrated that, of the 19 patients initially considered, 5 patients with a mean age of 37 underwent transplantation. Reports were correlated clinically to delineate which preoperative factors lead to patient selection versus disqualification and what concerns dictated postoperative imaging. Findings were subdivided into musculoskeletal and vascular imaging criterion. Results. Within the screening phase, musculoskeletal exclusion criterion included severe shoulder arthropathy, poor native bone integrity, and marked muscular atrophy. Vascular exclusion criterion included loss of sufficient arterial or venous supply and significant distortion of the native vascular architecture. Postoperative imaging was used to document healing and hardware integrity. Postsurgical angiography and ultrasound were used to monitor for endothelial proliferation or thrombosis as signs of rejection and vascular complication. Conclusion. Multimodality imaging is an integral component of vascular composite allotransplantation surgical planning and surveillance to maximize returning form and functionality while minimizing possible complications.
Roth, Eira S.; Buck, David G.; Gorantla, Vijay S.; Losee, Joseph E.; Foust, Daniel E.; Britton, Cynthia A.
The Vascularized Fibular Graft in the Pediatric Upper Extremity: A Durable, Biological Solution to Large Oncologic Defects
Skeletal reconstruction after large tumor resection is challenging. The free vascularized fibular graft (FVFG) offers the potential for rapid autograft incorporation as well as growing physeal transfer in pediatric patients. We retrospectively reviewed eleven pediatric patients treated with FVFG reconstructions of the upper extremity after tumor resection. Eight male and three female patients were identified, including four who underwent epiphyseal transfer. All eleven patients retained a functional salvaged limb. Nonunion and graft fracture were the most common complications relating to graft site (27%). Peroneal nerve palsy occurred in 4/11 patients, all of whom received epiphyseal transfer. Patients receiving epiphyseal transplant had a mean annual growth of 1.7?cm/year. Mean graft hypertrophy index increased by more than 10% in all cases. Although a high complication rate may be anticipated, the free vascularized fibula may be used to reconstruct large skeletal defects in the pediatric upper extremity after oncologic resection. Transferring the vascularized physis is a viable option when longitudinal growth is desired.
Zelenski, Nicki; Brigman, Brian E.; Levin, L. Scott; Erdmann, Detlev; Eward, William C.
Amputation and prosthesis implantation shape body and peripersonal space representations.
Little is known about whether and how multimodal representations of the body (BRs) and of the space around the body (Peripersonal Space, PPS) adapt to amputation and prosthesis implantation. In order to investigate this issue, we tested BR in a group of upper limb amputees by means of a tactile distance perception task and PPS by means of an audio-tactile interaction task. Subjects performed the tasks with stimulation either on the healthy limb or the stump of the amputated limb, while wearing or not wearing their prosthesis. When patients performed the tasks on the amputated limb, without the prosthesis, the perception of arm length shrank, with a concurrent shift of PPS boundaries towards the stump. Conversely, wearing the prosthesis increased the perceived length of the stump and extended the PPS boundaries so as to include the prosthetic hand, such that the prosthesis partially replaced the missing limb. PMID:24088746
Canzoneri, Elisa; Marzolla, Marilena; Amoresano, Amedeo; Verni, Gennaro; Serino, Andrea
Omental free-tissue transfer for coverage of complex upper extremity and hand defects--the forgotten flap.
Free omental tissue transfer is a versatile reconstructive option for trunk, head and neck, and extremity reconstruction. Its utility is due to the length and caliber of the vascular pedicle and the malleability and surface area of the flap. We report our experience with omental free flap coverage of complex upper-extremity defects. A retrospective analysis of eight omental free-tissue transfers in seven patients with complex upper-extremity defects between 1999 and 2008 was performed. Indications, operative technique, and outcome were evaluated. Patient age ranged from 12 to 59 years with five male and two female patients. Indications included tissue defects due to crush-degloving injuries, pitbull mauling, or necrotizing soft tissue infection. All patients had prior operations including: revascularization, debridement, tendon repair, skin grafts, and/or fixation of associated fractures. One patient sustained severe bilateral crush-degloving injuries requiring free omental hemiflap coverage of both hands. The mean defect size was 291 cm(2) with all patients achieving complete wound coverage. No flap loss or major complications were noted. Laparoscopic-assisted omental free flap harvest was performed in conjunction with the general surgery team in three cases. Mean follow-up was 2 years. The omental free flap is a valuable, often overlooked reconstructive option. The long vascular pedicle and large amount of pliable, well-vascularized tissue allow the flap to be aggressively contoured to meet the needs of complex three-dimensional defects. In addition, laparoscopic-assisted harvest may aid with flap dissection and may result in reduced donor-site morbidity. PMID:19319608
Seitz, Iris A; Williams, Craig S; Wiedrich, Thomas A; Henry, Ginard; Seiler, John G; Schechter, Loren S
Catheter-Directed Thrombolysis with Percutaneous Rheolytic Thrombectomy Versus Thrombolysis Alone in Upper and Lower Extremity Deep Vein Thrombosis
Purpose. To compare the efficacy of catheter-directed thrombolysis (CDT) alone versus CDT with rheolytic percutaneous mechanical thrombectomy (PMT) for upper and lower extremity deep vein thrombosis (DVT). Methods. A retrospective cohort of consecutive patients with acute iliofemoral or brachiosubclavian DVT treated with urokinase CDT was identified, and a chart review was conducted. Demographic characteristics, treatment duration, total lytic dose, clot lysis rates and complications were compared in patients treated with urokinase CDT alone or combined CDT and rheolytic PMT. Results. Forty limbs in 36 patients were treated with urokinase CDT alone. Twenty-seven limbs in 21 patients were treated with urokinase CDT and rheolytic PMT. The mean treatment duration for urokinase CDT alone was 48.0 {+-} 27.1 hr compared with 26.3 {+-} 16.6 hr for urokinase CDT and rheolytic PMT (p = 0.0004). The mean urokinase dose required for CDT alone was 5.6 {+-} 5.3 million units compared with 2.7 {+-} 1.8 million units for urokinase CDT with rheolytic PMT (p = 0.008). Complete clot lysis was achieved in 73% (29/40) of DVT treated with urokinase CDT alone compared with 82% (22/27) treated with urokinase CDT with rheolytic PMT. Conclusion. Percutaneous CDT with rheolytic PMT is as effective as CDT alone for acute proximal extremity DVT but requires significantly shorter treatment duration and lower lytic doses. Randomized studies to confirm the benefits of pharmacomechanical thrombolysis in the treatment of acute proximal extremity DVT are warranted.
Kim, Hyun S., E-mail: firstname.lastname@example.com; Patra, Ajanta; Paxton, Ben E.; Khan, Jawad [Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiological Science (United States); Streiff, Michael B. [Johns Hopkins University School of Medicine, Department of Medicine (United States)
Custom-made ocular prosthesis.
An ocular defect may affect a patient psychologically. An ocular prosthesis is given to uplift the patient psychologically and improve the confidence. Ocular prosthesis can be custom made or a stock shell. To improve the comfort and matching of the prosthesis with that of the adjacent natural eye an custom made ocular prosthesis is preferred. Different techniques are available to fabricate a custom ocular prosthesis, here we have used paper iris disk technique. PMID:23066246
Gunaseelaraj, Rajkumar; Karthikeyan, Suma; Kumar, Mohan N; Balamurugan, T; Jagadeeshwaran, A R
Superconductivity with extremely large upper critical fields in Nb2Pd0.81S5.
Here, we report the discovery of superconductivity in a new transition metal-chalcogenide compound, i.e. Nb2Pd0.81S5, with a transition temperature Tc is approximately equal to 6.6 K. Despite its relatively low Tc, it displays remarkably high and anisotropic superconducting upper critical fields, e.g. ?0Hc2 (T ? 0 K) > 37 T for fields applied along the crystallographic b-axis. For a field applied perpendicularly to the b-axis, ?0Hc2 shows a linear dependence in temperature which coupled to a temperature-dependent anisotropy of the upper critical fields, suggests that Nb2Pd0.81S5 is a multi-band superconductor. This is consistent with band structure calculations which reveal nearly cylindrical and quasi-one-dimensional Fermi surface sheets having hole and electron character, respectively. The static spin susceptibility as calculated through the random phase approximation, reveals strong peaks suggesting proximity to a magnetic state and therefore the possibility of unconventional superconductivity. PMID:23486091
Zhang, Q; Li, G; Rhodes, D; Kiswandhi, A; Besara, T; Zeng, B; Sun, J; Siegrist, T; Johannes, M D; Balicas, L
Superconductivity with extremely large upper critical fields in Nb2Pd0.81S5
Here, we report the discovery of superconductivity in a new transition metal-chalcogenide compound, i.e. Nb2Pd0.81S5, with a transition temperature Tc ? 6.6?K. Despite its relatively low Tc, it displays remarkably high and anisotropic superconducting upper critical fields, e.g. ?0Hc2 (T ? 0?K) > 37?T for fields applied along the crystallographic b-axis. For a field applied perpendicularly to the b-axis, ?0Hc2 shows a linear dependence in temperature which coupled to a temperature-dependent anisotropy of the upper critical fields, suggests that Nb2Pd0.81S5 is a multi-band superconductor. This is consistent with band structure calculations which reveal nearly cylindrical and quasi-one-dimensional Fermi surface sheets having hole and electron character, respectively. The static spin susceptibility as calculated through the random phase approximation, reveals strong peaks suggesting proximity to a magnetic state and therefore the possibility of unconventional superconductivity.
Zhang, Q.; Li, G.; Rhodes, D.; Kiswandhi, A.; Besara, T.; Zeng, B.; Sun, J.; Siegrist, T.; Johannes, M. D.; Balicas, L.
Superconductivity with extremely large upper critical fields in Nb2Pd0.81S5
NASA Astrophysics Data System (ADS)
Here, we report the discovery of superconductivity in a new transition metal-chalcogenide compound, i.e. Nb2Pd0.81S5, with a transition temperature Tc 6.6 K. Despite its relatively low Tc, it displays remarkably high and anisotropic superconducting upper critical fields, e.g. ?0Hc2 (T -> 0 K) 37 T for fields applied along the crystallographic b-axis. This value is considerably larger than the value reported for the technologically relevant Nb3Sn compound (?0Hc2 30 T, with Tc= 18 K)^1,2. Its ratio of ?0Hc2 (T -> 0 K) to Tc, is also larger than those of the new Fe based superconductors, e.g. ?-FeSe (20 T/8.7 K)^3, Ba1-xKxFe2As2 ( 70 T/28 K)^4, and even higher than the reported ratio for the Chevrel-phase PbMo6S8(60T/13.3 K)^5 compound. For a field applied perpendicularly to the b-axis, ?0Hc2 shows a linear dependence in temperature which coupled to a temperature-dependent anisotropy of the upper critical fields, suggests that Nb2Pd0.81S5 is a multi-band superconductor. This is confirmed by band structure calculations which reveal nearly cylindrical and quasi-one-dimensional Fermi surface sheets having hole and electron character, respectively.
Run Zhang, Qiu; Li, Gang; Rhodes, Daniel; Kiswandhi, Andhika; Basara, Tiglet; Sung, J.; Siegrist, Theo; Johannes, Michelle; Balicas, Luis
Targeted muscle reinnervation in the initial management of traumatic upper extremity amputation injury.
Targeted muscle reinnervation (TMR) was initially designed to provide cortical control of upper limb prostheses through a series of novel nerve transfers. Early experience has suggested that TMR may also inhibit symptomatic neuroma formation. We present the first report of TMR performed at the time of a traumatic shoulder disarticulation. The procedure was done to prevent painful neuroma pain and allow for myoelecteric prosthetic use in the future. Eight months post-operatively, the patient demonstrates multiple successful nerve transfers and exhibits no evidence of neuroma pain on clinical exam. Using the Patient Reported Outcomes Measurement Information System (PROMIS), the patient demonstrates minimal pain interference or pain behavior. Targeted muscle reinnervation may be considered in the acute trauma setting to prevent neuroma pain and to prepare patients for myoelectric prostheses in the future. PMID:24839430
Cheesborough, Jennifer E; Souza, Jason M; Dumanian, Gregory A; Bueno, Reuben A
An improved nipple prosthesis.
A nipple-areola reconstruction of prosthesis completes the process of breast reconstruction. Reconstructions are technically difficult and have poor long-term results, whereas commercial nipple prostheses are unsatisfactory in matching the normal colour and shape. We describe a simple technique for the manufacture of a custom made nipple-areola prosthesis. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6
Sainsbury, R.; Walker, V. A.; Smith, P. M.
[Dosimetric influence of hip prosthesis during radiotherapeutic treatement].
As the population become aged, many patients with hip prosthesis are treated for a pelvic cancer. The recommended ballistic must avoid to pass in the prosthesis, but sometimes it is inevitable. So it is essential to quantify with accuracy the dose modifications linked to the presence of metallic implant. The aim of this study is to analyze by Monte Carlo method these modifications in simple and complex models (anthropomorphic phantom) which take into account the geometry and the composition of the prosthesis and its coatings. Then, this methodology was used to study the behaviour of a treatment planning system in theses extreme conditions. PMID:18248832
Gschwind, R; Buffard, E; Masset, H; David, C; Makovicka, L
In-flight estimation of gyro noise on the Upper Atmosphere Research Satellite (UARS) and Extreme Ultraviolet Explorer (EUVE) missions
NASA Technical Reports Server (NTRS)
This paper characterizes the low-frequency noise response of the Teledyne dry rotor inertial reference unit (DRIRU) gyroscopes on the Upper Atmosphere Research Satellite (UARS) and the Extreme Ultraviolet Explorer (EUVE). The accuracy of spacecraft attitude estimation algorithms that use gyro data for propagating the spacecraft attitude is sensitive to gyro noise. EUVE gyro data were processed to validate a single-axis gyro noise model, which is used onboard various spacecraft. The paper addresses the potential impact of temperature effects on the gyro noise model and the overall impact on attitude determination accuracy. The power spectral density (PSD) of the gyro noise is estimated from UARS in-flight data by Fast Fourier Transform (FFT). The role of actuator dynamics on the PSD function is also discussed.
Lee, M.; Crouse, P.; Harman, R.; Leid, Terry; Davis, W.; Underwood, S.
Acute bouts of assisted cycling improves cognitive and upper extremity movement functions in adolescents with down syndrome.
Abstract The aim of this study was to examine the effectiveness of 2 modes of exercise on cognitive and upper extremity movement functioning in adolescents with Down syndrome (DS). Nine participants randomly completed 3 interventions over 3 consecutive weeks. The interventions were: (a) voluntary cycling (VC), in which participants cycled at their self-selected pedaling rate; (b) assisted cycling (AC), in which the participants' voluntary pedaling rates were augmented with a motor to ensure the maintenance of 80 rpm; and (c) no cycling (NC), in which the participants sat and listened to music. Manual dexterity improved after AC, but not after VC or NC. Measures of cognitive function, including reaction time and cognitive planning, also improved after AC, but not after the other interventions. Future research will try to uncover the mechanisms involved in the behavioral improvements found after an acute bout of assisted cycling in adolescents with DS. PMID:24725111
Ringenbach, Shannon D R; Albert, Andrew R; Chen, Chih-Chia Jj; Alberts, Jay L
Relationship between gluteal muscle activation and upper extremity kinematics and kinetics in softball position players.
As the biomechanical literature concerning softball pitching is evolving, there are no data to support the mechanics of softball position players. Pitching literature supports the whole kinetic chain approach including the lower extremity in proper throwing mechanics. The purpose of this project was to examine the gluteal muscle group activation patterns and their relationship with shoulder and elbow kinematics and kinetics during the overhead throwing motion of softball position players. Eighteen Division I National Collegiate Athletic Association softball players (19.2 Ý 1.0 years; 68.9 Ý 8.7 kg; 168.6 Ý 6.6 cm) who were listed on the active playing roster volunteered. Electromyographic, kinematic, and kinetic data were collected while players caught a simulated hit or pitched ball and perform their position throw. Pearson correlation revealed a significant negative correlation between non-throwing gluteus maximus during the phase of maximum external rotation to maximum internal rotation (MIR) and elbow moments at ball release (r = -0.52). While at ball release, trunk flexion and rotation both had a positive relationship with shoulder moments at MIR (r = 0.69, r = 0.82, respectively) suggesting that the kinematic actions of the pelvis and trunk are strongly related to the actions of the shoulder during throwing. PMID:23519517
Oliver, Gretchen D
Peripheral paresis of upper extremity nerves following supracondylar fracture of the humerus in children.
The authors observed a lesion of the peripheral nerves in 13 of 401 children with supracondylar humerus fractures (3.2%). Most frequently, the radial nerve was injured. All patients with neural lesions healed spontaneously, a surgical revision of the nerve was not necessary. The authors' opinion is that neural lesions accompanying supracondylar fractures can be treated conservatively. Exceptions are clear indications for surgical revision, as persisting ischaemia of the forearm or extensive open fractures. When treating conservatively, it is necessary to make a thorough clinical and EMG investigation to set exactly the diagnosis of the neural lesion immediately after removing the plaster cast (mostly 3 weeks after the injury). This investigation is to be repeated regularly, as the reinervation dynamics of the affected region is to be followed up. At the same time it is advantageous to perform electrostimulation until reinervation potentials appear, vitaminotherapy and intensive active exercise with the involved extremity. If no signs of reinvertion in the affected area appear within 6 months, a surgical revision of the nerve is to be considered. PMID:2520154
HavrÃnek, P; VÕle, F; HÃjkovÃ, H; ZwingerovÃ, H
Effects of Bilateral Passive Range of Motion Exercise on the Function of Upper Extremities and Activities of Daily Living in Patients with Acute Stroke
[Purpose] To evaluate the effects of early passive range of motion exercise on the function of upper extremities and activities of daily living in patients with acute stroke. [Methods] A total of 37 patients with acute stroke in intensive care units, were assigned to the experimental group (n=19) and control group (n=18). The experimental group performed passive range of motion exercise twice a day, for 4 weeks, immediately after a pretest; the patients in the control group performed the range of motion exercise in the same manner for 2 weeks beginning 2 weeks after the pretest. The functions of upper extremities (edema, range of motion), manual function, and activities of daily living of both groups were measured before and at four weeks after the intervention. [Results] The experimental group showed a significant decrease in the edema of upper extremities compared with the control group. It also showed a significant increase in the range of motion, function of upper extremities, and the activities of daily living compared to the control group. [Conclusion] Passive range of motion exercise in the early stage can improve the function of upper extremities and activities of daily living in patients with acute stroke.
Kim, Hyun Ju; Lee, Yaelim; Sohng, Kyeong-Yae
A pilot study evaluating use of a computer-assisted neurorehabilitation platform for upper-extremity stroke assessment
Background There is a need to develop cost-effective, sensitive stroke assessment instruments. One approach is examining kinematic measures derived from goal-directed tasks, which can potentially be sensitive to the subtle changes in the stroke rehabilitation process. This paper presents the findings from a pilot study that uses a computer-assisted neurorehabilitation platform, interfaced with a conventional force-reflecting joystick, to examine the assessment capability of the system by various types of goal-directed tasks. Methods Both stroke subjects with hemiparesis and able-bodied subjects used the force-reflecting joystick to complete a suite of goal-directed tasks under various task settings. Kinematic metrics, developed for specific types of goal-directed tasks, were used to assess various aspects of upper-extremity motor performance across subjects. Results A number of metrics based on kinematic performance were able to differentiate subjects with different impairment levels, with metrics associated with accuracy, steadiness and speed consistency showing the best capability. Significant differences were also shown on these metrics between various force field settings. Conclusion The results support the potential of using UniTherapy software with a conventional joystick system as an upper-extremity assessment instrument. We demonstrated the ability of using various types of goal-directed tasks to distinguish between subjects with different impairment levels. In addition, we were able to show that different force fields have a significant effect on the performance across subjects with different impairment levels in the trajectory tracking task. These results provide motivation for studies with a larger sample size that can more completely span the impairment space, and can use insights presented here to refine considerations of various task settings so as to generalize and extend our conclusions.
Feng, Xin; Winters, Jack M
clinical ergonomic job analysis and consultation: Facilitating work reentry in a case with upper extremity cumulative trauma-related disability.
The management of work-related recurrent and chronic upper extremity cumulative trauma disorders (UECTDs) represents a challenge particularly when return to work is a treatment goal. Many of these work-related UECTDs may be the consequence of exposure to such physical stressors as repetition, excessive force, awkward and sustained posture in addition to psychosocial stressors in the workplace. Pain and associated disability can be exacerbated by these ergonomic and psychosocial stressors. The application of ergonomic principles and techniques in the context of clinical management of UECTDs may assist in efforts to return the injured worker to work and reduce the likelihood of increased symptoms, discomfort, and disability. This paper presents a case of a 43-year-old dental hygientist unable to work for a period of 2 months due to recurrent episodes of pain in the neck, right shoulder, and arm radiating to the right thumb experienced episodically over a 10-year duration. The case is presented to illustrate the application of ergonomic principles and techniques in the clinical management of a chronic episodic UECTD. The implementation of an ergonomic job analysis and subsequent ergonomic interventions at the workplace that occurred in conjunction with rehabilitation was associated with anecdotal improvements in pain, function, and comfort levels upon returning to work. While the case highlights the potential utility of ergonomics in the management of an occupational musculoskeletal upper extremity disorder, the need for reliable, valid, cost effective, and time efficient methods to assess ergonomic exposure within a clinical context remain to be developed. PMID:24243349
Hickey, P F; Feuerstein, M
Semiconstrained Distal Radioulnar Joint Prosthesis
Distal radioulnar joint (DRUJ) problems can occur as a result of joint instability, abutment, or incongruity. The DRUJ is a weight-bearing joint; the ulnar head is frequently excised either totally or partially, and in some cases it is fused, because of degenerative, rheumatoid, or posttraumatic arthritis. Articles about these procedures report the ability to pronate and supinate, but they rarely discuss grip strength, and even less do they address lifting capacity. We report the long term results of the first 35 patients who underwent total DRUJ arthroplasty with the Aptis DRUJ prosthesis after 5 years follow-up. Surgical indications were all causes of dysfunctional DRUJ (degenerative, posttraumatic, autoimmune, congenital). We recorded data for patient demographics, range of motion (ROM), strength, and lifting capacity of the operated and of the nonoperated extremity. Pain and functional assessments were also recorded. The Aptis DRUJ prosthesis, a bipolar self-stabilizing DRUJ endoprosthesis that restores forearm function, consists of a semiconstained and modular implant designed to replace the function of the ulnar head, the sigmoid notch of the radius, and the triangular fibrocartilage ligaments. The surgical technique is presented in detail. The majority of the patients regained adequate ROM and improved their strength and lifting capacity to the operated side. Pain and activities of daily living were improved. Twelve patients experienced complications, most commonly being extensor carpi ulnaris (ECU) tendinitis, ectopic bone formation, bone resorption with stem loosening, low-grade infection, and need for ball replacement. The Aptis total DRUJ replacement prosthesis is an alternative to salvage procedures that enables a full range of motion as well as the ability to grip and lift weights encountered in daily living activities.
Savvidou, Christiana; Murphy, Erin; Mailhot, Emilie; Jacob, Shushan; Scheker, Luis R.
Symptomatic upper-extremity deep venous thrombosis after pacemaker placement in a pediatric patient: how to treat?
Symptomatic upper-extremity deep venous thrombosis (UEDVT) after pacemaker placement in adults has been reported, but the occurrence of UEDVT in pediatric patients is poorly defined, and no treatment guidelines exist. This report describes a 14-year old girl with a history of complete atrioventricular block who experienced a symptomatic UEDVT 8 months after placement of a transvenous pacemaker. The girl was treated initially with anticoagulation including subcutaneous enoxaparin and a heparin drip, which did not resolve the venous obstruction. In the interventional laboratory, a venogram demonstrated complete obstruction of the left subclavian vein, which was treated successfully with catheter-directed alteplase, direct thrombus removal by manual suctioning, and balloon angioplasty. Warfarin therapy was continued for an additional 6 months, with follow-up venous ultrasounds demonstrating left subclavian vein patency. Soon after completing warfarin therapy, the girl presented with minimal edema of her left distal extremity and was thought to have post-thrombotic syndrome, which resolved quickly. She continued to receive aspirin therapy, with no recurrence of symptoms. In conclusion, symptomatic UEDVT after pacemaker placement in a pediatric patient can be treated successfully with both anticoagulation and interventional therapies. Further studies are needed to evaluate the incidence of thrombus formation among children with transvenous pacemaker placement together with the development of guidelines based on the safety and effectiveness of differing treatments. PMID:22618585
Spar, David S; Anderson, Jeffrey B; Palumbo, Joseph S; Kukreja, Kamlesh U; Czosek, Richard J
The aesthetic hand prosthesis.
The high-quality aesthetic prosthesis can be equally helpful to those with acquired amputation and to those whose loss is due to agenesis. Restoring near-normal appearance improves patients' function in a global sense, enabling them to better utilize what they have in the complex socioeconomic environment of today's mobile society. The aesthetic prosthesis often also gives some prehensile assistance, providing an opposition part for remaining digits or thumb. The needs of each patient must be carefully considered, and the prosthesis must conform to the high standards of quality outlined. Its use is primarily for the unilateral amputee who is making a good adjustment to the loss with realistic expectations. PMID:7322522
Pillet, J
Computer game-based upper extremity training in the home environment in stroke persons: a single subject design
Background The objective of the present study was to assess whether computer game-based training in the home setting in the late phase after stroke could improve upper extremity motor function. Methods Twelve subjects with prior stroke were recruited; 11 completed the study. Design The study had a single subject design; there was a baseline test (A1), a during intervention test (B) once a week, a post-test (A2) measured directly after the treatment phase, plus a follow-up (C) 1618 weeks after the treatment phase. Information on motor function (Fugl-Meyer), grip force (GrippitR) and arm function in activity (ARAT, ABILHAND) was gathered at A1, A2 and C. During B, only Fugl-Meyer and ARAT were measured. The intervention comprised five weeks of game-based computer training in the home environment. All games were designed to be controlled by either the affected arm alone or by both arms. Conventional formulae were used to calculate the mean, median and standard deviations. Wilcoxons signed rank test was used for tests of dependent samples. Continuous data were analyzed by methods for repeated measures and ordinal data were analyzed by methods for ordered multinomial data using cumulative logistic models. A p-value of?0.05 was considered statistically significant. Results Six females and five males, participated in the study with an average age of 58 years (range 2666). FMA-UE A-D (motor function), ARAT, the maximal grip force and the mean grip force on the affected side show significant improvements at post-test and follow-up compared to baseline. No significant correlation was found between the amount of game time and changes in the outcomes investigated in this study. Conclusion The results indicate that computer game-based training could be a promising approach to improve upper extremity function in the late phase after stroke, since in this study, changes were achieved in motor function and activity capacity.
Modified graded motor imagery for complex regional pain syndrome type 1 of the upper extremity in the acute phase: a patient series.
Complex regional pain syndrome (CRPS) is a pathologic condition in which the painful experience is disproportionate in time and intensity in comparison with the inciting event. At present, the pathophysiology of CRPS is not well understood. Several studies have indicated that cortical reorganization plays a role in the persistence of the symptoms. A new promising approach, graded motor imagery (GMI), seems to be effective, but there are limited data for the CRPS-1 upper extremity population. The aim of this study was to demonstrate the effectiveness of a modified GMI (mGMI) protocol based on the work of Moseley to reduce pain and enhance functional capacities for a population with nonchronic CRPS-1 of the upper extremity. The following outcome measures were used to assess the clinical effectiveness: pain (short form of the McGill Pain Questionnaire), grip force (Martin vigorimeter), perception of upper extremity function (Disabilities of the Arm, Shoulder and Hand Questionnaire), and patient's global impression of change. All outcomes at T4 were compared with the baseline data (T0) using the Mann-Whitney test and the ? test (nonparametric tests). Seven patients were recruited for the study. At the end of the mGMI (T4), we obtained significant results for the decrease in the pain experienced in the last 7 days (visual analog scale; P=0.046), improvement in the affected extremity grip force (P=0.042), and the patient's global impression of change (P=0.015). However, the data of the perception of upper extremity function (Disabilities of the Arm, Shoulder and Hand Questionnaire) were not clinically or statistically significant. Our results indicate that this mGMI protocol seems to be a promising therapeutic modality to reduce pain. However, more investigations are needed to determine whether mGMI has a significant impact on upper extremity function. PMID:22436440
Lagueux, Emilie; Charest, Joelle; LefranÓois-Caron, Eve; Mauger, Marie-Eve; Mercier, Emilie; Savard, Kim; Tousignant-Laflamme, Yannick
The patient-based outcome of upper-extremity surgeries using the DASH questionnaire and the effect of disease activity of the patients with rheumatoid arthritis.
The Disabilities of the Arm, Shoulder and Hand (DASH) is a standardized patient-based outcome measure, which assesses integrated upper-extremity disorders. The objectives of this study were to investigate subjective outcome after upper-extremity surgeries for the patients with rheumatoid arthritis (RA) using the DASH questionnaire (Japanese version) and to investigate the influence of disease activity on the surgical outcome using the Disease Activity Score (DAS) 28-CRP(4). Approximately 127 surgical procedures for the upper extremities in 127 patients with RA were recruited in this study. Surgeries were performed in 4 shoulders, 35 elbows, 60 wrists and 28 hands. The DASH score (disability/symptom score) was investigated just before surgery and at follow-up. The mean follow-up period after the surgery was 15 months on average (range, 6 to 24 months). The preoperative DASH score (disability/symptom score) 50 +/- 23 (mean +/- SD) decreased significantly to 38 +/- 23 at the follow-up (n = 127, p < 0.01). Standardized response mean and effect size revealed a medium effect of -0.6 and -0.5. Patients with various degrees of disease activity improved and the improvements per se were comparable of preoperative disease activity and postoperative response to medical treatment. A favorable subjective outcome of rheumatoid upper-extremity surgeries can be anticipated under the good control of disease activity. PMID:18214571
Ishikawa, Hajime; Murasawa, Akira; Nakazono, Kiyoshi; Abe, Asami; Otani, Hiroshi; Netsu, Tahahiro; Sakai, Takehito; Sato, Hiroe
A study on the prevalence of upper extremity repetitive strain injuries among the handloom weavers of West Bengal.
Handloom is one of the oldest cottage industries in India, particularly in West Bengal, where a considerable number of rural people are engaged in weaving. Purposes of the present investigation were to clarify the prevalence of repetitive strain injuries in upper extremities among the handloom weavers and to identify the risk factors leading to its development. Fifty male handloom weavers were randomly selected from the population. A questionnaire (Kourinka et al., 1987) method including Borg scale assessment of pain, checklist analyses of the work, and time-motion studies for analyzing the repetitiveness/non-repetitiveness of the job were implemented. The time-motion analyses demonstrated that weaving occupied over 50% of the work cycle time for majority of subjects, and thus could be regarded as a repetitive activity. Statistical analyses revealed a highly significant correlation between the intensity of pain feeling and the repetitiveness on one hand, and the year of experience as a weaver on the other. By contrast, no significant relationship was observed between chronological ages of weavers and the pain intensity. These results suggested that highly repetitive works engaged for a long time could increase the intensity of the pain felt and would lead to repetitive strain injuries. PMID:15176126
Banerjee, Prasun; Gangopadhyay, Somnath
Transfer of training between distinct motor tasks after stroke: Implications for task- specific approaches to upper extremity neurorehabilitation
Background Although task-specific training is emerging as a viable approach for recovering motor function after stroke, there is little evidence for whether the effects of such training transfer to other functional motor tasks not directly practiced in therapy. Objective The purpose of the current study was to test whether training on one motor task would transfer to untrained tasks that were either spatiotemporally similar or different in individuals with chronic hemiparesis post-stroke. Methods Eleven participants with chronic mild-to-moderate hemiparesis following stroke completed five days of supervised massed practice of a feeding task with their affected side. Performance on the feeding task, along with two other untrained functional upper extremity motor tasks (sorting, dressing) was assessed before and after training. Results Performance of all three tasks improved significantly after training exclusively on one motor task. The amount of improvement in the untrained tasks was comparable, and was not dependent on the degree of similarity to the trained task. Conclusions Because the number and type of tasks that can be practiced are often limited within standard stroke rehabilitation, results from this study will be useful for designing task-specific training plans to maximize therapy benefits.
Schaefer, Sydney Y.; Patterson, Chavelle B.; Lang, Catherine E.
Gangrene of the upper extremity following intra-arterial injection of drugs. A case report and review of the literature.
A case of inadvertent intra-arterial self-injection of crushed codeine tablets in an 37-year-old man, resulting in gangrene of an upper extremity, is presented. The problem studied was whether the gangrene was caused by the codeine or by one of the excipients found in the tablets. The cause of the gangrene was investigated in an experimental study. Each of the components of the tablet (codeine, lactose, gelatin, carboxymethyl cellulose, calcium stearate, talc, and microcrystalline cellulose) was injected into the femoral arteries of dogs. The results of the study clearly demonstrate that the unique component producing the gangrene was the micro-crystalline cellulose, while the injection of pure codeine was harmless. To date, the only reported deleterious effects of intravascular injection of micro-crystalline cellulose have been pulmonary embolism and granulomatosis. Some examples of drugs that include microcrystalline cellulose are methadone, methaqualone, oxcycodone, acetaminophen, aspirin with codeine, propoxyphene napsylate, meprobamate, and phenobarbital. Recently, the vulnerability of drug addicts who habitually inject drugs into veins to the accidental injection of an artery has been noted, and it seems likely that in the future the problem of intra-arterial injection will increase in severity. The literature of the last 40 years is reviewed, and a list of drugs known to have produced gangrene when injected intra-arterially is cited. PMID:6380862
Goldberg, I; Bahar, A; Yosipovitch, Z
Clinical evaluation of motion and position sense in the upper extremities of the elderly using motion analysis system
The purpose of this study was to measure kinesthetic accuracy in healthy older adults by using arm position and motion matching tests. We investigated the effect of task type, joint angle, and matching arm results on kinesthetic accuracy in the upper extremities of 17 healthy right-handed older adults. Blinded subjects were asked to match positions and motions at four reference joint angles: 1) shoulder flexion, 0¯60¯; 2) elbow flexion, 90¯135¯; 3) wrist extension, 0¯50¯ in the sagittal plane; and 4) shoulder abduction, 0¯60¯ in the frontal plane. The absolute difference in angular displacement between the reference and matching arms was calculated to determine kinesthetic accuracy. Results showed that subjects were more accurate at matching motion than position tasks (P=0.03). Shoulder and elbow joints were more sensitive than wrist joints in perceiving passive positions and motions (P<0.05). The effect of the matching arm was found only when matching the joint angles of shoulder abduction and wrist extension (P<0.01). These results are comparable to findings of other studies that used machine-generated kinesthetic stimuli. The manual measurement of kinesthetic accuracy could be effective as a preliminary screening tool for therapists in clinical settings.
Li, Kuan-yi; Wu, Yi-hui
A standard set of upper extremity tasks for evaluating rehabilitation interventions for individuals with complete arm paralysis
We have developed a set of upper extremity functional tasks to guide the design and test the performance of rehabilitation technologies that restore arm motion in people with high tetraplegia. Our goal was to develop a short set of tasks that would be representative of a much larger set of activities of daily living while also being feasible for a unilateral user of an implanted Functional Electrical Stimulation (FES) system. To compile this list of tasks, we reviewed existing clinical outcome measures related to arm and hand function, and were further informed by surveys of patient desires. We ultimately selected a set of five tasks that captured the most common components of movement seen in these tasks, making them highly relevant for assessing FES-restored unilateral arm function in individuals with high cervical spinal cord injury (SCI). The tasks are intended to be used when setting design specifications and for evaluation and standardization of rehabilitation technologies under development. While not unique, this set of tasks will provide a common basis for comparing different interventions (e.g., FES, powered orthoses, robotic assistants) and testing different user command interfaces (e.g., sip-and-puff, head joysticks, brain-computer interfaces).
Cornwell, Andrew S.; Liao, James Y.; Bryden, Anne M.; Kirsch, Robert F.
Nosology of juvenile muscular atrophy of distal upper extremity: from monomelic amyotrophy to Hirayama disease--Indian perspective.
Since its original description by Keizo Hirayama in 1959, "juvenile muscular atrophy of the unilateral upper extremity" has been described under many nomenclatures from the east. Hirayama disease (HD), also interchangeably referred to as monomelic amyotrophy, has been more frequently recognised in the west only in the last two decades. HD presents in adolescence and young adulthood with insidious onset unilateral or bilateral asymmetric atrophy of hand and forearm with sparing of brachioradialis giving the characteristic appearance of oblique amyotrophy. Symmetrically bilateral disease has also been recognized. Believed to be a cervical flexion myelopathy, HD differs from motor neuron diseases because of its nonprogressive course and pathologic findings of chronic microcirculatory changes in the lower cervical cord. Electromyography shows features of acute and/or chronic denervation in C7, C8, and T1 myotomes in clinically affected limb and sometimes also in clinically unaffected contralateral limb. Dynamic forward displacement of dura in flexion causes asymmetric flattening of lower cervical cord. While dynamic contrast magnetic resonance imaging is diagnostic, routine study has high predictive value. There is a need to lump all the nomenclatures under the rubric of HD as prognosis in this condition is benign and prompt diagnosis is important to institute early collar therapy. PMID:24063005
Hassan, Kaukab Maqbool; Sahni, Hirdesh
Cutting balloon angioplasty for in-stent restenosis of the aortic coarctation in a young boy presenting with systemic hypertension of the upper extremities.
An 8.25-year-old boy was incidentally found to have systemic hypertension of the upper extremities. Blood pressures of the upper extremities were 142-150/86-98 mmHg, and those of the lower extremities 110-116/60-66 mmHg. Doppler echocardiography showed in-stent restenosis of the aortic coarctation. Traditional high-pressure balloon angioplasty failed to dilate this inveterate in-stent restenosis. Instead, a cutting balloon angioplasty was performed. The lumen was dilated from 4.80 mm to 7.89 mm. The pressure gradient dropped from 32 mmHg to 9 mmHg. Blood pressures of the upper extremities were 112-116/76-78 mmHg, and those of the lower extremities 100-104/70-72 mmHg. This paper highlights that a cutting balloon angioplasty can serve as a juste milieu to relieve in-stent restenosis of the aortic coarctation when traditional high-pressure balloon angioplasty is debatable. PMID:24579444
Lee, Meng-Luen
Brunnstrom recovery stage and motricity index for the evaluation of upper extremity in stroke: analysis for correlation and responsiveness.
The aim of this study was to find out first whether Brunnstrom recovery stage (BRS) and motricity index (MI) were correlated with each other and second to observe whether the two assessment tools were sensitive to changes regarding the rehabilitation outcome. Forty-six stroke patients who were admitted to the Stroke Rehabilitation Unit at our Rehabilitation Centre were recruited. All measurements were made within the first 72 h of admission and on the last day of discharge. A physiotherapist performed all MI evaluations and a physiatrist blind to the results performed all BRS evaluations. Both upper extremity (UE) and hand BRS scores were found to be positively correlated with those of UE-MI; moreover, correlations between the discharge values were stronger than those between the admission values. The responsiveness of both the total scores of the BRS and UE-MI were strong (effect size d = 0.97, Wilcoxon Z=5.33, P<0.001 for the UE-BRS; d=0.81, Z=5.09, P<0.001 for the hand BRS; d=0.91, Z=5.45, P<0.001 for the UE-MI). BRS and MI scores were found to be increased on discharge when compared with those of admission and the differences in between were statistically significant (P<0.001). BRS and MI seem to be well correlated and responsive concerning the evaluation of UEs in early stage stroke patients. Being convenient tests, they may easily be applied repetitively for close follow-up during rehabilitation. PMID:19339892
Safaz, Ismail; Yilmaz, Bilge; Ya?ar, Evren; Alaca, Rdvan
Upper Extremity Venous Thrombosis in Patients With Cancer With Peripherally Inserted Central Venous Catheters: A Retrospective Analysis of Risk Factors
Purpose: Peripherally inserted central catheters (PICCs) are often used in place of mediport catheters because of cost and lack of operating room time and to prevent delays in therapy. One common complication associated with their use is upper extremity venous thrombosis (UEVT). The purpose of this study was to ascertain risk factors associated with an increased risk of PICC-associated UEVT in patients with cancer. Methods: Retrospective analysis identified 237 patients with cancer who received PICCs at the Dallas Veterans Affairs Medical Center from 2006 to 2009. We analyzed many risk factors, including PICC infection (PI), use of erythropoiesis-stimulating agents (ESAs), antiplatelet agents (APAs), treatment dose anticoagulation (TDA), and bevacizumab. Results: Of 237 patients, 36 (15%) were found to have UEVT. Stepwise logistic regression analysis showed risk factors positively associated with UEVT were use of ESAs (odds ratio [OR], 10.66; 95% CI, 2.25 to 50.49), hospitalization (OR, 2.38; 95% CI, 1.05 to 5.39), PI (OR, 2.46; 95% CI, 1.03 to 5.86), and TDA (OR, 8.34; 95% CI, 2.98 to 23.33), whereas patients receiving APAs had a lower risk of UEVT (OR, 0.25; 95% CI, 0.07 to 0.92). Conclusion: Specific factors significantly increase the risk of UEVT in patients with cancer with PICCs, whereas use of APAs seems to have a protective effect against UEVT. These results may aid in the development of a predictive model for identifying patients at high risk of UEVT who may benefit from APAs, as well as in determining preventive strategies for reducing the risk of PICC-associated UEVT.
Ahn, Daniel H.; Illum, Henrik Bo; Wang, David H.; Sharma, Anant; Dowell, Jonathan E.
Simulation of Upper Limb Movements
NASA Astrophysics Data System (ADS)
The paper deals with controlling an upper limb prosthesis based on the measurement of myoelectric signals (MES) while drinking. MES signals have been measured on healthy limbs to obtain the same response for the prosthesis. To simulate the drinking motion of a healthy upper limb, the program ADAMS was used, with all degrees of freedom and a hand after trans-radial amputation with an existing hand prosthesis. Modification of the simulation has the exact same logic of control, where the muscle does not have to be strenuous all the time, but it is the impulse of the muscle which drives the motor even though the impulse disappears and passed away.
Uher?Úk, Filip; Hu?ko, Branislav
Implant-retained auricular prosthesis.
Auricular defects may result from congenital malformations, injuries from motor vehicle crashes, trauma, or tumor resections. An auricular prosthesis was fabricated for a patient who had an injury from a motor vehicle crash. Extraoral implants and bar-and-clip retention for the proper connection of the auricular prosthesis to implant were used. This prosthesis was acceptable to the patient because of excellent support, retentive abilities, and the patient's appearance. PMID:21119423
Demir, Necla; Malkoc, Meral Arslan; Ozturk, A Nilgun; Tosun, Zekeriya
NASA Astrophysics Data System (ADS)
This research involves development and testing of a tactile control prosthesis to aid human operators in control of dynamic vehicles. Specifically, this work includes development and demonstration of a torso mounted tactile drift display that allowed helicopter pilots to hover a Blackhawk helicopter with degraded vision (equivalent to 20/200 acuity), a NASA sponsored pilot-in-the-loop simulator study for a hover display and development and analysis of a tactile control prosthesis to help pilots correctly control an airplane experiencing an engine failure on takeoff. Results of a ten-subject experiment indicate that use of a tactile display in conjunction with a visual display reduces operator delay by 65 msec (SD of 28 msec), (P < 0.001) without a significant increase in error rate. In the pilot-in-the-loop simulation experiment pilots hovered a simulated helicopter better under increased workload conditions with the tactile control prosthesis than without it. The increased workload consisted of an addition drill in which the subject had to agree or disagree with a computer generated sum. Pilots were able to hover more precisely with the tactile display (mean of 5.19, SD of 2.57 feet) than without (mean of 6.39 and SD of 3.31 feet) especially when the secondary task was required (P < 0.001). Although learning effects were exhibited throughout the trials (P < 0.001), the tactile display was of greater benefit in higher workload conditions.
Perry, James Franklin
Musculoskeletal symptoms of the upper extremities and the neck: A cross-sectional study on prevalence and symptom-predicting factors at visual display terminal (VDT) workstations
Background The aim of this study was to determine the prevalence and the predictors of musculoskeletal symptoms in the upper extremities and neck at visual display terminal (VDT) workstations. Methods In a cross-sectional study 1,065 employees working at VDT > 1 h/d completed a standardised questionnaire. Workstation conditions were documented in a standardised checklist, and a subgroup of 82 employees underwent a physical examination. Results Using the Nordic Questionnaire, the 12-month prevalence of symptoms of the neck, shoulder region, hand/wrist, or elbow/lower arm was 55%, 38%, 21%, and 15% respectively. The duration of VDT work had a significant impact on the frequency of neck symptoms in employees performing such work > 6 h/d. Conclusion With regard to musculoskeletal symptoms of the upper extremities, preventive measures at VDT workstations should be focused on neck and shoulder symptoms (e.g. ergonomic measures, breaks to avoid sitting over long periods).
Klussmann, Andre; Gebhardt, Hansjuergen; Liebers, Falk; Rieger, Monika A
Angelchik prosthesis revisited.
There are few long-term follow-up reports of the Angelchik prosthesis (AP). We report the longest follow-up series (66-192 months, average 145 months) to date. Between October 1983 and January 1994, 65 patients (45 men and 20 women) aged between 29 and 84 years (mean 52 years) had an AP inserted for gastro-oesophageal reflux (GOR) with or without hiatus hernia (HH). Clinical, radiological, endoscopy, and operative details were reviewed. Postoperative complications, investigations, and follow-up details were critically analyzed. All living patients (n = 53) with an AP in situ were interviewed and symptomatic assessment was carried out using a modified Visick system (I-IV). The average duration of the GOR symptoms before the operation was 5.7 years (range 10 months to 20 years). The average hospital stay was 8 days (range 5-15 days). Postoperatively, five patients developed chest infection/atelectasis, four had superficial wound infection, two had deep vein thrombosis (one with pulmonary embolism), one had urinary retention, and four developed an incisional hernia. Six patients (three with an AP in situ) died of other medical conditions. Ten (15%) patients had removal of the prosthesis. Eight (12%) and 11 (17%) had transient and persistent dysphagia, respectively. Thirteen (20%) and five (8%) patients had distal slippage and proximal migration of the prosthesis, respectively. One patient had erosion of the AP into the stomach, while in another patient, the straps of the prosthesis ruptured. Of the 53 living patients with an AP in situ, 28 (53%) were Visick I, 11 (20%) were Visick II, 11 (20%) were Visick III, and 3 (7%) were Visick IV. We conclude that the AP has poor long-term results, with only 66% attaining Visick I and II, and a prosthesis removal rate of 15% (10/65). Patients with preoperative dysphagia, hypothyroidism, and diabetes tend to do worse with an AP. Obese patients and those with failed previous fundoplication seemed to fare well with an AP. In view of poor long-term results and high incidence of complications as compared to other conventional operations for GOR, we cannot recommend the continued use of the AP. PMID:11898046
Varshney, Subodh; Kelly, John J; Branagan, Graham; Somers, Shaw S; Kelly, J M
Musculoskeletal symptoms of the upper extremities and the neck: A cross-sectional study on prevalence and symptom-predicting factors at visual display terminal (VDT) workstations
BACKGROUND: The aim of this study was to determine the prevalence and the predictors of musculoskeletal symptoms in the upper extremities and neck at visual display terminal (VDT) workstations. METHODS: In a cross-sectional study 1,065 employees working at VDT > 1 h\\/d completed a standardised questionnaire. Workstation conditions were documented in a standardised checklist, and a subgroup of 82 employees
AndrÕ Klussmann; Hansjuergen Gebhardt; Falk Liebers; Monika A Rieger
Efficacy of recombinant human ?- L -iduronidase (laronidase) on restricted range of motion of upper extremities in mucopolysaccharidosis type I patients
The aims of the study were to assess the effectiveness of enzyme replacement therapy (ERT) with laronidase on the range of\\u000a motion (ROM) of upper extremities and influence on activities of daily living (ADLs) of patients with mucopolysaccharidosis\\u000a type I (MPS I). The ROM of 17 patients with MPS I was followed from the first year of life until the introduction of ERT
Anna Tylki-Szymanska; Jolanta Marucha; Agnieszka Jurecka; Malgorzata Syczewska; Barbara Czartoryska
Ureteral replacement with a new prosthesis.
A new flexible silicone ureteral prosthesis has been developed and implanted by a new technique in 20 miniature pigs. The improved implantation technique and the results are described. All prostheses remained firmly attached in their position and drained the upper urine collecting system adequately during an observation period up to 12 mos. Leakage, incrustation, dislocation or rejection did not occur. The promising results encouraged us to continue our investigations to get long term experience for clinical trial in human patients for whom nephrostomy is the alternative. PMID:160647
Schreiber, B; Homann, W; Mlynek, M; Mellin, P
Flail chest stabilization with palacos prosthesis.
The approach and management of patients with post-traumatic flail chest continue to be a controversial issue. A method of surgical stabilization of flail chest using palacos, a cement-like material is described. A ready-made prosthesis is placed on the external side of the ribs vertically bridging the flailed chest segment, and fixed to the first upper and first lower intact rib as well as to the mobile segments of the affected ribs. Surgical fixation was carried out in 56 patients. The results proved the method to be a simple and effective procedure. PMID:11505635
Glavas, M; Altarac, S; Vukas, D; Ivanci?, A; Drazini?, I; Gusi?, N; Celovi?, R; Mirkovi?, I
One-Stage Repair With a New Integrated Stent-Dacron Prosthesis for Type B Aortic Dissection
he one-stage repair was performed through a partial upper sternotomy and under moderate hypother- mia and circulatory arrest. The distal aortic arch was opened and the endovascular part of the prosthesis was deployed. The Dacron soft part of the prosthesis (Jotech, Hechingen, Germany) was sutured distally to the ostium of the left subclavian artery. Perioperative angiography demonstrated a well deployed
Aristotelis Panos; Spyros Kalakonas; Elefterios Chouliaras; Gregory Khatchatourov
An attempt to dendroclimatic reconstruction of winter temperature based on multispecies tree-ring widths and extreme years chronologies (example of Upper Silesia, Southern Poland)
NASA Astrophysics Data System (ADS)
This study aims at investigating pre-instrumental tree-ring based winter thermal conditions from Upper Silesia, southern Poland. The Scots pine, pedunculate oak and sessile oak ring widths and the extreme index were used to reconstruct winter mean temperature back to A.D. 1770. The climate response analysis showed that the pine is the most sensitive to February (0.36) and March (0.41) temperature, the oaks were found to be sensitive to the previous December (0.27) and January (0.23) temperature. It was found out that the combination of temperature sensitive species and an additional extreme index in regression can improve the reconstruction, with an emphasis on more reliable reconstruction of extreme values. The elimination of variance reduction and precise reconstruction of actual values of temperature is possible by scaling. The obtained calibration/verification results suggest that, through the application of the long-term composite chronologies a detailed study of the climate variability in Upper Silesia in past centuries can be provided.
Opa?a, Magdalena; Mendecki, Maciej J.
A self-contained, mechanomyography-driven externally powered prosthesis.
The measurement of the low-frequency (5-50 Hz) "sounds" or vibrations produced by contracting muscles is termed mechanomyography (MMG). As a control signal for powered prostheses, MMG offers several advantages over conventional myoelectric control, including, nonspecific sensor placement, distal signal measurement, robustness to changing skin impedance, and reduced sensor costs. The objectives of this study were to demonstrate 2-function prosthesis control based on a triplet of distally recorded, normalized root mean square MMG signals and to identify necessary future research toward full clinical implementation of MMG signals in upper-limb externally powered prostheses. A novel self-contained MMG-driven prosthesis for below-elbow amputees was designed, implemented, and preliminarily tested on 2 subjects. This prosthesis was composed of specialized software and hardware modules that emulate a 2-site electromyography sensing system. Although the use of MMG signals for prosthesis control has been shown previously, we report, for the first time, successful control within a self-contained unit in unconstrained environments. Specifically, essential requirements for practical use, such as standardized sensor attachment, basic noise elimination, and miniaturization of the system, have been achieved. Both subjects were able to voluntarily open and close the prosthesis hand with no significant delays from intention to action (approximately 120 ms). Quantitative analyses revealed 88% and 71% control accuracy for subjects 1 and 2, respectively. PMID:16213256
Silva, Jorge; Heim, Winfried; Chau, Tom
50 years ago, prosthetic replacement of the hip joint ushered in a new epoch in orthopaedics. Total hip replacement made it possible to remove a severely diseased, painful hip and restore normal function and a normal quality of life to the afflicted patient. The early results of total hip replacement are almost all spectacular and hip replacement has become the most successful type of orthopaedic surgery. These good results using an approach that was technically relatively simple resulted in a temptation to implant prosthetic hip joints with ever increasing frequency in ever younger patients. This led to the emergence of new problems, which were not so clearly recognised at the outset: it emerged that the stability of prosthetic hip joints was of limited duration. This had the following consequence: If a total hip prosthesis is implanted in an elderly person whose remaining life-expectancy is shorter than the longevity of the prosthesis, hip replacement is a life-long solution. We can therefore say that, for a patient who has only 10 to 15 years left to live, their hip problem is solved by total hip replacement. For young people, who still have a long life expectancy in front of them, it is different. They will experience failure of the artificial joint and require further surgery. The commonest and most important type of failure in total hip prostheses is aseptic loosening, which is associated with resorption of bone at the site of the prosthesis. The cause of this phenomenon has only gradually been recognised in the course of the years. Initially, the unanimous opinion was that the methacrylate cement, used to fix the components of the prosthesis in the bone, was the definitive cause of aseptic loosening because fissures and fractures of the cement were almost always found during surgical revision of loosened joints. There was talk of "cement disease" and great efforts were made to improve the quality of the cement and the cementing technique. Moreover, even today, there is no established answer to the question whether, over the course of many years, cement ages and becomes friable, a process that may have major implications for young patients. For this reason, ways of reliably fixing the prosthesis in the bone without methacrylate cement were also explored at the same time. Valuable pioneering work in this field was carried out with uncemented dental implants made of titanium and with a roughened surface. With these implants, the phenomenon of osseointegration, i.e. the deposition of bone directly on the roughened metal surface without any intervening connective tissue, was observed. This phenomenon has also been utilised successfully in hip prostheses: if artificial hips made of titanium alloy with a coarse-blasted surface and with a high primary mechanical stability are placed in the bone, osseointegration also occurs. In parallel with this development, Willert, from G—ttingen, identified the most important cause of loosening of the prosthesis: he established that, when an artificial joint articulates, very fine particles of polyethylene are eroded from the prosthetic cup when the surfaces of the joint glide over one another and that these are only partially removed by the lymphatic system. A large proportion of the particles accumulates in the artificial joint and in the gap between the prosthesis and the bone, giving rise to foreign body granulomata, which resorb bone thus leading to loosening. The number of eroded particles is considerable. In 1998, Patricia Campbell, from Los Angeles, showed that 470,000 particles per step were produced from an articulation between a metal head and a polyethylene cup. This huge number gives an indication how small these particles are, since the linear erosion of the polyethylene surface only amounts to about 0.1 to 0.2 mm a year. This relatively recent recognition of "particle disease" has led to the investigation of other materials, which produce fewer erosion particles, for artificial joint articulations. Three possible options are available today, but it
Wagner, H; Wagner, M
A Study on Extremely Dry and Wet Summer Monsoon in Pakistan by Focusing on the Anomalous States of the Upper Troposphere
NASA Astrophysics Data System (ADS)
Seasonally-changes in wind pattern, monsoon, sometimes results in severe droughts and intense flooding in many parts of the world including South Asian countries like Pakistan. The livelihood of a vast population in Pakistan depends on agriculture and land use is strongly influenced by water-based ecosystems that depend on the monsoon rains. Furthermore, climate change studies undertaken so far reveal that action is essential in order to prevent long term damage to water cycle and thus of great concern to the community and stakeholders. Pakistan Summer Monsoon (PSM) is generally affected by both the disturbances from the tropical and the extratropical regions; however there is lack of understanding of physical mechanisms of PSM compared to other regional studies i.e. Indian Summer Monsoon (ISM) and South-East Asian Monsoon (SEAM). In our study, we applied heat and vorticity budgets and wave train analysis to reveal the mechanisms of the extremely dry and wet PSM events associated with the anomalous upper tropospheric circulation. We found that the extremely dry (wet) PSM events are closely related with the strengthening(weakening) of the upper-tropospheric central Asian high. We also found that in addition to Rossby-wave (Matsuno-Gill) type atmospheric response, the Rossby wave train along the Asian Jet originating from northwestern Europe or North Atlantic Ocean strengthened(weakened) the upper-tropospheric central Asian high. Therefore strong convection anomalies resulting in severe flooding (drought) events over the PSM region are induced by both the tropical and extratropical processes. Key Words: Pakistan, Extremes Monsoon Events, Physical Processes, Heat Budget, Vorticity, Wave Train
Ahmad, S.; Koike, T.; Nishii, K.
Effect of electrical stimulation therapy on upper extremity functional recovery and cerebral cortical changes in patients with chronic hemiplegia.
Hemiplegia is a common sequel of stroke and assisted living care is needed in many cases. The purpose of this study was to evaluate the effect of using surface electrode stimulation device in rehabilitation, in terms of functional improvement in upper limb and the changes in brain activation related to central nervous system reconstruction. Five patients with chronic hemiplegia received electrical stimulation therapy using the orthosis-type surface electrode stimulation device for 12 weeks. Training time was 30 min/day for the first weeks, and increased 30 min/day in every 4 weeks. Upper limb outcome measures included Brunnstrom stage, range of motion, Fugl-Meyer assessment and manual function test. Brain activation was measured using functional MRI. After therapy with therapeutic electrical stimulation (TES) for 12 weeks upper limb function improved in all cases. The results of brain activation showed two patterns. In the first, the stimulation produced an activity in the bilateral somatosensory cortices (SMC), which was seen to continue over time. The second, activation was bilateral and extensive before stimulation, but localized to the SMC after intervention. Treatment with TES using an orthosis-type electrode stimulation device improves upper limb function in chronic hemiplegia patients. The present findings suggest that there are not only efferent but also afferent effects that may promote central nervous system remodeling. PMID:22572383
Sasaki, Kana; Matsunaga, Toshiki; Tomite, Takenori; Yoshikawa, Takayuki; Shimada, Yoichi
Self-Reported Musculoskeletal Disorders of the Distal Upper Extremities and the Neck in German Veterinarians: A Cross-Sectional Study
Background Veterinary work is a physically demanding profession and entails the risk of injuries and diseases of the musculoskeletal system, particularly in the upper body. The prevalence of musculoskeletal disorders (MSD), the consequences and work-related accidents in German veterinarians were investigated. Work-related and individual factors associated with MSD of upper extremities and the neck were analyzed. Methods In 2011, a self-reporting Standardized Nordic Questionnaire was mailed to registered veterinarians in seven federal medical associations in Germany. A total of 3174 (38.4%) veterinarians responded. Logistic regression analysis was used to determine the association between risk factors and MSD-related impairment of daily activities. Results MSD in the neck (66.6%) and shoulder (60.5%) were more prevalent than in the hand (34.5%) or elbow (24.5%). Normal activities were affected in 28.7% (neck), 29.5% (shoulder), 19.4% (hand) and 14% (elbow) of the respondents. MSD in the upper body occurred significantly more often in large animal practitioners. Accidents that resulted in MSD were most frequently reported in the hand/wrist (14.3%) or in the shoulder (10.8%). The majority of all accidents in the distal upper extremities were caused by animals than by other factors (19% vs. 9.2%). For each area of the body, a specific set of individual and work-related factors contributed significantly to severe MSD: Older age, gender, previous injuries, BMI, practice type, veterinary procedures such as dentistry, rectal procedures and obstetric procedures as well as high demands and personal burnout. Conclusion From the perspective of occupational health and safety, it seems to be necessary to improve accident prevention and to optimize the ergonomics of specific tasks. Our data suggest the need for target group-specific preventive measures that also focus on the psychological factors at work.
Kozak, Agnessa; Schedlbauer, Grita; Peters, Claudia; Nienhaus, Albert
A 100-year extreme snow-avalanche record based on tree-ring research in upper B½dalen, inner Nordfjord, western Norway
NASA Astrophysics Data System (ADS)
This paper analyses with the help of tree-ring studies the recurrence of extreme snow avalanches in a path situated in the upper B½dalen valley and originating from an outlet glacier of the Jostedalsbreen ice cap. By analysing tree-ring patterns of 91 trees, four extreme snow-avalanche events, extending over the entire valley floor and up to a distance of 800 m from the foot of the slope, are clearly highlighted during the 20th century and at the beginning of the 21st century. Return periods of 15 to 20 years for the most extreme events are extracted from the analyses, and recurrence intervals of 10 to 15 years for avalanches presenting distinct deposition lobes uphill of the distal torrent. Results obtained by tree-ring analyses are successfully compared with available documents at different spatial and temporal scales. Rock-face snow-avalanche occurrences in the area, of small to medium size, are associated with heavy wintry precipitation combined with strong winds. However this normal situation is not valid for extreme snow avalanches crossing the path investigated in the paper, which result from the outlet glacier located in the starting zone; this glacier commands spatial and inter-annual variations of snow accumulation in the departure zone.
Decaulne, Armelle; Eggertsson, Ælafur; Laute, Katja; Beylich, Achim A.
Photovoltaic retinal prosthesis
NASA Astrophysics Data System (ADS)
Electronic retinal prostheses seek to restore sight to patients suffering from retinal degenerative disorders. Implanted electrode arrays apply patterned electrical stimulation to surviving retinal neurons, producing visual sensations. All current designs employ inductively coupled coils to transmit power and/or data to the implant. We present here the design and initial testing of a photovoltaic retinal prosthesis fabricated with a pixel density of up to 177 pixels/mm2. Photodiodes within each pixel of the subretinal array directly convert light to stimulation current, avoiding the use of bulky coil implants, decoding electronics, and wiring, and thereby reducing surgical complexity. A goggles-mounted camera captures the visual scene and transmits the data stream to a pocket processor. The resulting images are projected into the eyes by video goggles using pulsed, near infrared (~900 nm) light. Prostheses with three pixel densities (15, 55, and 177 pix/mm2) are being fabricated, and tests indicate a charge injection limit of 1.62 mC/cm2 at 25Hz. In vitro tests of the photovoltaic retinal stimulation using a 512-element microelectrode array have recorded stimulated spikes from the ganglion cells, with latencies in the 1-100ms range, and with peak irradiance stimulation thresholds varying from 0.1 to 1 mW/mm2. With 1ms pulses at 25Hz the average irradiance is more than 100 times below the IR retinal safety limit. Elicited retinal response disappeared upon the addition of synaptic blockers, indicating that the inner retina is stimulated rather than the ganglion cells directly, and raising hopes that the prosthesis will preserve some of the retina's natural signal processing.
Loudin, James; Mathieson, Keith; Kamins, Ted; Wang, Lele; Galambos, Ludwig; Huie, Philip; Sher, Alexander; Harris, James; Palanker, Daniel
Experimental Brain Prosthesis for Stroke.
National Technical Information Service (NTIS)
Electrical control of motor behavior by programmed electrical stimulation of the brain has been described. Such programmed brain stimulation is referred to as a 'brain prosthesis,' meaning, in effect, 'artificial brain.' Areas in the brain which related t...
L. R. Pinneo J. N. Kaplan E. A. Elpel P. C. Reynolds J. H. Glick
... decrease the size of the socket and or frame without rebuilding the whole prosthesis. In addition, if ... which consists of a flexible socket, a rigid frame and/or a socket interface, should be replaced ...
3. Brain Millfield MD Timothy E. Morey focuser inking 2003 conducted randomized double blinded controlled study continuous infer-clavicular infusion Gleneden ropivacaine ropivacaine alone 34 patients undergoing moderately painful upper extremity orthopedic surgeries concluded adding 1mcg per ml Gleneden ropivacaine continuous per-neural infusion AND -provide OR clinically OR relevant OR improvement OR analgesia OR sleep OR quality OR analgesic OR requirements OR ambulatory OR patients OR moderately OR painful OR upper OR extremity OR surgeries
Did you mean: 3. Brain Millfield MD Timothy E. Morey focuser inking 2003 conducted randomized double blinded controlled study continuous infer-clavicular infusion Gleneden ropivacaine ropivacaine alone 34 patients undergoing moderately painful upper extremity orthopedic surgeries concluded adding 1mcg per ml Gleneden ropivacaine continuous per-neural infusion AND -provide OR clinically OR relevant OR improvement OR analgesia OR sleep OR quality OR analgesic OR requirements OR ambulatory OR patients OR moderately OR painful OR upper OR extremity OR surgeries ?
FES of lower extremities: Comparison of rehabilitation strategies and stimulation equipment in patients with upper \\/ lower motor neuron lesion
http:\\/\\/www.meduniwien.ac.at\\/zbmtp\\/bmt\\/ Abstract Functional Electrical Stimulation (FES) of lower extremities in patients suffering from paraplegia can be used to restore standing up from the wheelchair, standing, walking \\/ stepping and sitting down. Usually only patients with an intact lower motor neuron (spastic paraplegia) can benefit while patients with flaccid paralysis are excluded due to the inexistent or very weak force response
Bijak M; Hofer C; Rakos M; Kern H; Mayr W
[Fracture of macroporous hydroxyapatite prosthesis].
Different prosthesis implants are offered to perform a cranioplasty after a decompressive craniectomy when autologous bone graft cannot be used. The authors report the case of a 25-year-old man who benefited a unilateral decompressive craniectomy after a severe head trauma. Seven months later, a cranioplasty using custom macroporous hydroxyapatite prosthesis was performed. The postoperative course was marked by a generalized seizure leading to a traumatic head injury. The CT-scan showed a comminutive fracture of the prosthesis and an extradural hematoma. The patient underwent a removal of the fractured prosthesis and an evacuation of the extradural clot. The postoperative course was uneventful with a Glasgow outcome scale score at 5. A second cranioplasty using a polyether ether ketone (PEEK) implant was performed. Among cranioplasty prosthesis solutions, hydroxyapatite implants seem to have similar property to the bone. However, its weak mechanic resistance is an actual problem in patients susceptible to present generalized seizures with consecutive head impact. Hence, in patients with decompressive craniectomy who are exposed to potential brain injury, we favor the use of more resistant implant as PEEK prosthesis. PMID:22898300
Adetchessi, A T; Pech-Gourg, G; Metellus, P; Fuentes, S
Improved Myoelectric Prosthesis Control Using Targeted Reinnervation Surgery: A Case Series
Targeted reinnervation is a surgical technique developed to increase the number of myoelectric input sites available to control an upper-limb prosthesis. Because signals from the nerves related to specific movements are used to control those missing degrees-of-freedom, the control of a prosthesis using this procedure is more physiologically appropriate compared to conventional control. This procedure has successfully been performed on
Laura A. Miller; Kathy A. Stubblefield; Robert D. Lipschutz; Blair A. Lock; Todd A. Kuiken
Patient-Specific Computational Modeling of Upper Extremity Arteriovenous Fistula Creation: Its Feasibility to Support Clinical Decision-Making
Introduction Inadequate flow enhancement on the one hand, and excessive flow enhancement on the other hand, remain frequent complications of arteriovenous fistula (AVF) creation, and hamper hemodialysis therapy in patients with end-stage renal disease. In an effort to reduce these, a patient-specific computational model, capable of predicting postoperative flow, has been developed. The purpose of this study was to determine the accuracy of the patient-specific model and to investigate its feasibility to support decision-making in AVF surgery. Methods Patient-specific pulse wave propagation models were created for 25 patients awaiting AVF creation. Model input parameters were obtained from clinical measurements and literature. For every patient, a radiocephalic AVF, a brachiocephalic AVF, and a brachiobasilic AVF configuration were simulated and analyzed for their postoperative flow. The most distal configuration with a predicted flow between 400 and 1500 ml/min was considered the preferred location for AVF surgery. The suggestion of the model was compared to the choice of an experienced vascular surgeon. Furthermore, predicted flows were compared to measured postoperative flows. Results Taken into account the confidence interval (25th and 75th percentile interval), overlap between predicted and measured postoperative flows was observed in 70% of the patients. Differentiation between upper and lower arm configuration was similar in 76% of the patients, whereas discrimination between two upper arm AVF configurations was more difficult. In 3 patients the surgeon created an upper arm AVF, while model based predictions allowed for lower arm AVF creation, thereby preserving proximal vessels. In one patient early thrombosis in a radiocephalic AVF was observed which might have been indicated by the low predicted postoperative flow. Conclusions Postoperative flow can be predicted relatively accurately for multiple AVF configurations by using computational modeling. This model may therefore be considered a valuable additional tool in the preoperative work-up of patients awaiting AVF creation.
Bosboom, E. Marielle H.; Kroon, Wilco; van der Linden, Wim P. M.; Planken, R. Nils; van de Vosse, Frans N.; Tordoir, Jan H. M.
Human limb-specific and non-limb-specific brain representations during kinesthetic illusory movements of the upper and lower extremities.
Sensing movements of the upper and lower extremities is important in controlling whole-body movements. We have shown that kinesthetic illusory hand movements activate motor areas and right-sided fronto-parietal cortices. We investigated whether illusions for the upper and lower extremities, i.e. right or left hand or foot, activate the somatotopical sections of motor areas, and if an illusion for each limb engages the right-sided cortices. We scanned the brain activity of 19 blindfolded right-handed participants using functional magnetic resonance imaging (fMRI) while they experienced an illusion for each limb elicited by vibrating its tendon at 110 Hz (ILLUSION). As a control, we applied identical stimuli to the skin over a nearby bone, which does not elicit illusions (VIBRATION). The illusory movement (ILLUSION vs. VIBRATION) of each immobile limb activated limb-specific sections of the contralateral motor cortex (along with somatosensory area 3a), dorsal premotor cortex (PMD), supplementary motor area (SMA), cingulate motor area (CMA), and the ipsilateral cerebellum, which normally participate in execution of movements of the corresponding limb. We found complex non-limb-specific representations in rostral parts of the bilateral SMA and CMA, and illusions for all limbs consistently engaged concentrated regions in right-sided fronto-parietal cortices and basal ganglia. This study demonstrated complete sets of brain representations related to kinesthetic processing of single-joint movements of the four human extremities. The kinesthetic function of motor areas suggests their importance in somatic perception of limb movement, and the non-limb-specific representations indicate high-order kinesthetic processing related to human somatic perception of one's own body. PMID:17553017
Naito, Eiichi; Nakashima, Tokuro; Kito, Tomonori; Aramaki, Yu; Okada, Tomohisa; Sadato, Norihiro
Oxygen uptake, heart rate, perceived exertion, and integrated electromyogram of the lower and upper extremities during level and Nordic walking on a treadmill.
The purpose of this study was to characterize responses in oxygen uptake ( VñO(2)), heart rate (HR), perceived exertion (OMNI scale) and integrated electromyogram (iEMG) readings during incremental Nordic walking (NW) and level walking (LW) on a treadmill. Ten healthy adults (four men, six women), who regularly engaged in physical activity in their daily lives, were enrolled in the study. All subjects were familiar with NW. Each subject began walking at 60 m/min for 3 minutes, with incremental increases of 10 m/min every 2 minutes up to 120 m/min VñO(2), Vñ(E) and HR were measured every 30 seconds, and the OMNI scale was used during the final 15 seconds of each exercise. EMG readings were recorded from the triceps brachii, vastus lateralis, biceps femoris, gastrocnemius, and tibialis anterior muscles. VñO(2) was significantly higher during NW than during LW, with the exception of the speed of 70 m/min (P < 0.01). VñE and HR were higher during NW than LW at all walking speeds (P < 0.05 to 0.001). OMNI scale of the upper extremities was significantly higher during NW than during LW at all speeds (P < 0.05). Furthermore, the iEMG reading for the VL was lower during NW than during LW at all walking speeds, while the iEMG reading for the BF and GA muscles were significantly lower during NW than LW at some speeds. These data suggest that the use of poles in NW attenuates muscle activity in the lower extremities during the stance and push-off phases, and decreases that of the lower extremities and increase energy expenditure of the upper body and respiratory system at certain walking speeds. PMID:23406834
Sugiyama, Koji; Kawamura, Mami; Tomita, Hisato; Katamoto, Shizuo
Oxygen uptake, heart rate, perceived exertion, and integrated electromyogram of the lower and upper extremities during level and Nordic walking on a treadmill
The purpose of this study was to characterize responses in oxygen uptake ( VñO2), heart rate (HR), perceived exertion (OMNI scale) and integrated electromyogram (iEMG) readings during incremental Nordic walking (NW) and level walking (LW) on a treadmill. Ten healthy adults (four men, six women), who regularly engaged in physical activity in their daily lives, were enrolled in the study. All subjects were familiar with NW. Each subject began walking at 60?m/min for 3?minutes, with incremental increases of 10?m/min every 2?minutes up to 120?m/min VñO2 , VñE and HR were measured every 30?seconds, and the OMNI scale was used during the final 15?seconds of each exercise. EMG readings were recorded from the triceps brachii, vastus lateralis, biceps femoris, gastrocnemius, and tibialis anterior muscles. VñO2 was significantly higher during NW than during LW, with the exception of the speed of 70?m/min (P?0.01). VñE and HR were higher during NW than LW at all walking speeds (P?0.05 to 0.001). OMNI scale of the upper extremities was significantly higher during NW than during LW at all speeds (P?0.05). Furthermore, the iEMG reading for the VL was lower during NW than during LW at all walking speeds, while the iEMG reading for the BF and GA muscles were significantly lower during NW than LW at some speeds. These data suggest that the use of poles in NW attenuates muscle activity in the lower extremities during the stance and push-off phases, and decreases that of the lower extremities and increase energy expenditure of the upper body and respiratory system at certain walking speeds.
Development and Application of Stereo Camera-Based Upper Extremity Workspace Evaluation in Patients with Neuromuscular Diseases
Background The concept of reachable workspace is closely tied to upper limb joint range of motion and functional capability. Currently, no practical and cost-effective methods are available in clinical and research settings to provide arm-function evaluation using an individuals three-dimensional (3D) reachable workspace. A method to intuitively display and effectively analyze reachable workspace would not only complement traditional upper limb functional assessments, but also provide an innovative approach to quantify and monitor upper limb function. Methodology/Principal Findings A simple stereo camera-based reachable workspace acquisition system combined with customized 3D workspace analysis algorithm was developed and compared against a sub-millimeter motion capture system. The stereo camera-based system was robust, with minimal loss of data points, and with the average hand trajectory error of about 40 mm, which resulted to ?5% error of the total arm distance. As a proof-of-concept, a pilot study was undertaken with healthy individuals (n?=?20) and a select group of patients with various neuromuscular diseases and varying degrees of shoulder girdle weakness (n?=?9). The workspace envelope surface areas generated from the 3D hand trajectory captured by the stereo camera were compared. Normalization of acquired reachable workspace surface areas to the surface area of the unit hemi-sphere allowed comparison between subjects. The healthy groups relative surface areas were 0.618Ý0.09 and 0.552Ý0.092 (right and left), while the surface areas for the individuals with neuromuscular diseases ranged from 0.03 and 0.09 (the most severely affected individual) to 0.62 and 0.50 (very mildly affected individual). Neuromuscular patients with severe arm weakness demonstrated movement largely limited to the ipsilateral lower quadrant of their reachable workspace. Conclusions/Significance The findings indicate that the proposed stereo camera-based reachable workspace analysis system is capable of distinguishing individuals with varying degrees of proximal upper limb functional impairments.
Abresch, Richard T.; Nicorici, Alina; Yan, Posu; Bajcsy, Ruzena
Pilot comparative study of unilateral and bilateral robot-assisted training on upper-extremity performance in patients with stroke.
We compared a unilateral robot-assisted training protocol (URTP) and a bilateral robot-assisted training protocol (BRTP) to study their differential effects. We recruited 21 patients with stroke who received 90-105 min of therapy 5 days/wk for 4 wk. Participants in the URTP and BRTP groups practiced forearm pronation and supination and wrist flexion and extension in a simultaneous manner with the Bi-Manu-Track. The control group received standard rehabilitation. Clinical measures included the Fugl-Meyer Assessment, the Medical Research Council instrument, grip strength, and the Modified Ashworth Scale to assess motor impairment, muscle power, muscle strength, and spasticity, respectively. The pilot study indicated that the URTP and BRTP might have differential benefits for movement improvement. URTP might be a more compelling approach to improving upper-limb motor impairment, muscle power, and strength at the distal joints than BRTP, whereas BRTP could be an optimal approach to improving proximal muscle power. PMID:22394529
Yang, Chieh-Ling; Lin, Keh-Chung; Chen, Hsieh-Ching; Wu, Ching-Yi; Chen, Chia-Ling
Evaluation of Satellite Rainfall Products for Prediction of Extreme High Flows in the Upper Blue Nile Basin
NASA Astrophysics Data System (ADS)
The upper Blue Nile River Basin is a region characterized by sparse ground based rainfall measurements both at temporal and spatial scale. Satellite rainfall products are becoming an alternative data sources for different hydrological applications. In this study we evaluated the accuracy of two high resolution satellite rainfall estimates (TMPA 3B42 V7 and CMORPH) for the prediction of high flooding events in the Blue Nile River basin and sub-watersheds. The assessment of accuracy of simulated streamflow was conducted at daily time scale for three watershed scales (Gilgel Abay =1,656 km2, Kessie = 65,000 km2 and upper Blue Nile =176,000 km2) using two watershed modeling tools (SWAT and VHM). The hydrological models were calibrated using two approaches: 1) when the satellite estimates were run using model parameters obtained from rain gauge calibrated models and 2) when the satellite rainfall estimates were run using parameter values obtained from model calibrated using the corresponding satellite rainfall data sets. The result shows that the satellite rainfall products are able to capture the general hydrograph of the basins with acceptable skill of simulation when using both lumped and distributed modelling approaches regardless of the varying watershed sizes. An encouraging result is also found for the simulation of flooding events in two of the three watersheds. The study demonstrated the satellite rainfall estimates can be considered suitable for this region for hydrological applications especially when the focus is on predicting total flows which are vital for proper watershed management practices while caution has to be taken when predicting high flooding events indicating that there is room for further improvement.
Taye, M.; Bitew, M. M.; Gebremichael, M.; Moges, S.; Willems, P.
Disability and health after replantation or revascularisation in the upper extremity in a population in southern Sweden - a retrospective long time follow up
Background Replantation in the upper extremity is a well-established microsurgical procedure. Many have reported patients satisfaction and functional measurements. The aim was to investigate the long time consequences as activity limitations in hand/arm, the general health and cold sensitivity after a replantation or revascularization in the upper extremity and to examine if sense of coherence (SOC) can be an indicator for rehabilitation focus. Methods Between 19942008, 326 patients needed replantation/revascularization in the upper extremity. 297 patients were followed up. Information was collected from the medical notes and by questionnaires [Quick-DASH (disability hand/arm), EuroQ-5D (general health), CISS (cold sensitivity) and SOC (sense of coherence)]. Severity of injury was classified with the modified Hand Injury Severity Score (MHISS). Results The patients [272 (84%) men and 54 (16%) women; median age 39 years (181 years)], where most injuries affected fingers (63%) and thumb (25%), commonly affecting the proximal phalanx (43%). The injuries were commonly related to saws (22%), machines (20%) and wood splints (20%). A direct anastomosis (30%) or vein grafts (70%) were used. The overall survival was 90%. 59% were classified as Major. Equal parts of the injuries took part during work and leisure, DASH scores at follow up were worse (p?=?0.005) in the former. Twenty percent changed work and 10% retired early. Patients with early retirement were significantly older, had a more severe injury, worse disability, quality of life and functional outcome. Median DASH score was low [11.4 (088.6)] and correlated with severity of injury. Abnormal cold sensitivity (CISS?>?50) was seen in 51/209 (24%) and they had a worse disability, quality of life, functional outcome and lower SOC. Patients with a low SOC had on the whole a worse outcome compared to patients with a high SOC and with significant differences in age, EQ-5D, Quick-DASH and CISS. Conclusions A high MHISS, abnormal cold intolerance and a low SOC seems to be factors influencing the patients outcome and might be relevant in the rehabilitation of the patients. Also, those who had to retire early had a worse disability, quality of life and functional outcome.
21 CFR 878.3590 - Ear prosthesis.
Code of Federal Regulations, 2013 CFR
... FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices ôÏ 878.3590 Ear prosthesis. (a) Identification. An ear prosthesis is a...
The Stanmore knee arthrodesis prosthesis.
Knee arthrodesis is most commonly performed for failed total knee arthroplasty. Conventional arthrodesis techniques are associated with a high incidence of complications and are unsuitable in cases with extensive bone loss. We report our medium-term results using a custom-made cemented knee arthrodesis prosthesis in 10 patients with a mean follow-up of 56.4 months (range, 15-199 months). The prosthesis was implanted as a 1- or 2-stage procedure for infected revision knee arthroplasty or tumor endoprosthesis in 9 patients and as a primary procedure in 1 patient with angiosarcoma involving the knee extensor mechanism. The average combined femoral and tibial bone deficit was 170 mm (range, 56-220 mm). Implant survivorship was 90%. All patients with retained prosthesis had no evidence of residual infection or loosening and were able to mobilize independently. One prosthesis was revised though retained following a prosthetic fracture, and 1 patient underwent above-knee amputation for uncontrolled infection. We conclude that the Stanmore knee arthrodesis prosthesis provides reliable fusion in an otherwise difficult-to-treat group of patients. PMID:21074358
Bartlett, William; Vijayan, Sridhar; Pollock, Robin; Skinner, John; Blunn, Gordon; Cannon, Steve; Briggs, Timothy
Transtibial prosthesis suspension failure during skydiving freefall: a case report.
This report describes the unusual case of an everyday-use prosthesis suspension system failure during the freefall phase of a skydiving jump. The case individual was a 53-year-old male with a left transtibial amputation secondary to trauma. He used his everyday prosthesis, a transtibial endoskeleton with push-button, plunger-releasing, pin-locking silicon liner suction suspension and a neoprene knee suspension sleeve, for a standard recreational tandem skydive. Within seconds of exiting the plane, the suspension systems failed, resulting in the complete prosthesis floating away. Several factors may have led to suspension system failure, including an inadequate seal and material design of the knee suspension sleeve and liner, lack of auxiliary suspension mechanisms, and lack of a safety cover overlying the push-button release mechanism. This is the first report, to our knowledge, to discuss prosthetic issues specifically related to skydiving. While amputees are to be encouraged to participate in this extreme sport, special modifications to everyday components may be necessary to reduce the possibility of prosthesis failure during freefall, parachute deployment, and landing. PMID:19719060
Gordon, Assaf T; Land, Rebekah M
[Analysis of arterial microporous teflon prosthesis following surgical excision].
Twenty-one prosthetic explants were analysed after being surgically excised from 19 patients whose average age at implantation was 54.8 years. The arterial prosthesis was implanted 19 times for an advanced arteriopathy (stage III and stage IV) and twice for a stage II. The average time that the implants were in place was 14.8 months (with extremes of 19 days and 4 years). Surgical reintervention was caused by thrombosis (18 cases), infection (twice) and one case of degeneration of the prosthesis. The explanted prostheses displayed an irregular capsule, an uneven filling of the wall and a fibrous proliferation adhering to the internal surface. The role of the latter appeared essential to the prevention of the invasion of the prosthesis wall by fibrous tissues. The destruction of the structure of the microporous teflon is also prevented. Furthermore, this prosthesis seemed adversely affected when creased by flexion: the reduction in the caliber of the internal lumen caused thrombosis and a detachment of the external capsule. When such a material is implanted, everything must be done to prevent twisting or damaging the prostheses. PMID:3772256
Formichi, M; Jausseran, J M; Guidoin, R; Marois, M; Bergeron, P; Gosselin, C; Courbier, R
Upper extremity compartment syndrome after minor trauma: an imperative for increased vigilance for a rare, but limb-threatening complication
Background Compartment syndrome of any extremity is a limb-threatening emergency requiring an emergent surgical management. Thus, ruling out compartment syndrome is often high on the list of priorities when treating high-energy injuries and fractures. However, even in the most seemingly benign injuries, this dangerous diagnosis must always remain on the differential and suspicion must remain high. Case presentation 23-year-old factory worker presents after a low energy entrapment injury to his left forearm. Initial work-up and evaluation noted an isolated radial head dislocation with a normal physical motor and sensory exam. However, maintaining high suspicion for compartment syndrome despite serial normal physical exams, led objective compartment pressure measurement leading to definitive diagnosis. Emergent surgical intervention via compartment fasciotomies was performed, along with closed reduction and ligament repair. At 1 year follow-up, the patient was well-healed, back to work with full range of motion and not activity limitations. Conclusion Despite a seemingly benign injury pattern, and a relatively low energy mechanism, vigilant concern for compartment syndrome following any kind of entrapment injury should initiate serial examinations and compartment pressure measurements especially in circumstances with continued swelling and inability to perform an accurate clinical assessment due to an obtunded or medicated patient.
Psychometric Properties and Administration of the Wrist/Hand Subscales of the Fugl-Meyer Assessment in Minimally-Impaired Upper Extremity Hemiparesis in Stroke
There is a need for time-efficient, valid measures of distal paretic upper extremity (UE) movement. The purposes of this study were to: (a) determine the psychometric properties of the wrist stability and mobility and hand items of the upper extremity scale of the Fugl-Meyer (w/h UE FM) as a stand alone measure of distal UE movement; and (b) provide detailed instructions on w/h UE FM administration and scoring. The UE FM and Action Research Arm Test (ARAT) were administered on 2 separate occasions to each of 29 subjects exhibiting stable, mild, UE hemiparesis (23 males; age (mean (sd)) 60.8 (12.3) years; mean time since stroke onset for subjects in the sample: 36.0 months). Fifty-eight observations were collected on each measure. w/h UE FM internal consistency levels (measured by Cronbachs alpha) were high (0.90 and 0.88 for first and second testing sessions, respectively). The intraclass correlation coefficients for the UE FM was 0.98, while the intraclass correlation coefficient for the w/h UE FM was 0.97. Concurrent validity measured by Spearmans correlation was moderately high between the w/h UE FM and ARAT (.72 p < .0001). From these data, it appears that the w/h UE FM is a promising tool to measure distal UE movement in minimally impaired stroke, although more research with a larger sample is needed. A standardized approach to UE test administration is critical to accurate score interpretation across patients and trials. Thus, the article also provides instructions and pictures for w/h UE FM administration and scoring.
Page, Stephen J.; Levine, Peter; Hade, Erinn
Penile prosthesis in the organ transplant recipient
Objectives. To determine whether pelvic organ transplant recipients are at a higher risk of developing complications after placement of a penile prosthesis relative to those receiving a penile prosthesis who did not undergo pelvic organ transplantation.Methods. Two hundred eleven men underwent placement of a penile prosthesis by a single urologist at our institution between July 1994 and March 2000. Of
David C Cuellar; Geoffrey N Sklar
Stapes prosthesis: evaluation with CT.
We used computed tomography (CT) to evaluate 44 patients who had undergone stapedectomy with insertion of a prosthesis. Several patients had poor surgical results, including recurrent conductive hearing loss, vertigo, and sensorineural hearing loss. Conductive hearing loss occurring immediately after the procedure was most often caused by anatomic limitations or surgical technique. Causes of delayed or recurrent conductive hearing loss included reparative granuloma formation, incus necrosis (at the attachment of the wire), prosthesis subluxation (most often posterior), and regrowth of otosclerosis, which occasionally is further complicated by incus dislocation. We found that CT is often diagnostic when these complications occur. Immediate sensorineural hearing loss or vertigo can be self-limited if caused by serous labyrinthitis. When delayed, these symptoms may be due to perilymph fistula. If caused by the latter, CT may not yield abnormal findings unless subluxation of the prosthesis into the vestibule has occurred. PMID:3940377
Swartz, J D; Lansman, A K; Berger, A S; Wolfson, R J; Bell, G; Popky, G L; Swartz, N G
Interfacing a haptic robotic system with complex virtual environments to treat impaired upper extremity motor function in children with cerebral palsy
Objective To investigate the ability of the New Jersey Institute of Technology Robot Assisted Virtual Rehabilitation (NJIT-RAVR) system training to elicit changes in upper extremity (UE) function in children with hemiplegia secondary to cerebral palsy. Methods Nine children (mean age 9 years, three males) participated in three pilots. Subjects trained 1 hour, 3 days a week for 3 weeks. Two groups performed this protocol as their only intervention. The third group also performed 56 hours of constraint-induced movement therapy. Results All subjects participated in a short programme of nine, 60-minute training sessions without adverse effects. As a group, subjects demonstrated statistically significant improvements in Melbourne Assessment of Unilateral Upper Limb Function Test, a composite of three timed UE tasks and several measurements of reaching kinematics. Several subjects demonstrated clinically significant improvements in active shoulder abduction and flexion as well as forearm supination. Conclusion Three small pilots of NJIT-RAVR training demonstrated measurable benefit with no complications, warranting further examination.
Sediment transport and development of banner banks and sandwaves in an extreme tidal system: Upper Bay of Fundy, Canada
NASA Astrophysics Data System (ADS)
Multibeam sonar mapping and geophysical and geological groundtruth surveys were coupled with tidal current and sediment transport model calculations to investigate the sediment transport and formation processes of the complex seabed features off the Cape Split headland in the upper Bay of Fundy. The Cape Split banner bank, composed of coarse to very coarse sand, is a southwest-northeast oriented, large tear-drop shaped sand body with superimposed sand waves that show wavelengths from 15 to 525 m and heights from 0.5 to 19 m. Isolated and chains of barchan dunes occur on top of a shadow bank to the southeast of the banner bank. The barchan dunes are composed of well-sorted medium sand and are oriented northwest-southeast. Their mean height and width are 1.5 and 55 m, respectively. A gravel bank, with an elongated elliptical shape and west-east orientation, lies in the Minas Passage erosional trough east of the headland to form the counterpart to the sandy Cape Split banner bank. The southern face is featureless but the northern face is covered by gravel megaripples. Tidal model predictions and sediment transport calculations show that the formation of the banner bank and the gravel bank are due to the development of the transient counter-clockwise and clockwise tidal eddies respectively to the west and east of the headland. The formation of barchan dunes is controlled by the nearly unidirectional flow regime in outer Scots Bay. Sand waves on the flanks of the Cape Split banner bank show opposite asymmetry and the barchan dunes are asymmetric to the northeast. The tidal current and sediment transport predictions corroborate bedform asymmetry to show that sand wave migration and net sediment transport is to southwest on the northern flank of the banner bank but to northeast on the southern bank. Long-term migration of the Scots Bay barchan dunes is to the northeast. Spring-condition tidal currents can cause frequent mobilization and high-stage transport over the banner bank and barchan dunes. Strong currents in Minas Passage can cause infrequent low-stage transport over the megarippled northern face but are not high enough to mobilize the coarser gravels on the southern face of the gravel bank.
Li, Michael Z.; Shaw, John; Todd, Brian J.; Kostylev, Vladimir E.; Wu, Yongsheng
The injury mechanisms of osteoporotic upper extremity fractures among older adults: a controlled study of 287 consecutive patients and their 108 controls.
The risk factors for falls in older adults are well known but knowledge on the direct injury mechanisms that result in various osteoporotic fractures has been very sparse. The purpose of this study was therefore to clarify the injury mechanisms of osteoporotic upper extremity fractures of older adults and to compare these mechanisms with those of the control fallers, and in this way to obtain reliable insight into the etiology and pathogenesis of upper extremity fractures and thus to enable fracture prevention. One hundred and twelve patients with a fresh fracture of the proximal humerus, 65 patients with an elbow fracture, 110 patients with a wrist fracture and 108 controls (no fracture, or a fracture other than the case fracture) were interviewed and examined between September 1995 and December 1997. The inclusion criteria of the subjects were that the patient was 50 years of age or older at the time of the accident, and that the fracture/injury had occurred as a result of low-energy trauma (typically a fall from standing height or less) within a week before the interview and examination. In 97% of patients with a proximal humerus or elbow fracture, and in all patients (100%) with a wrist fracture, the fracture was a result of a fall. In the control group this figure was 93%. In a polychotomous logistic regression analysis the intergroup differences in the fall directions (adjusted by gender, age and functional capacity) were statistically highly significant (chi 2 = 43.6, d.f. = 15, p < 0.001). Most of the patients with a proximal humerus fracture or elbow fracture reported that they had fallen 'obliquely forward' (43% and 38%) or 'to the side' (29% and 26%), whereas in the wrist fracture group the main fall direction was also 'obliquely forward' (34%) but the other fall directions (i.e., 'forward', 'to the side', 'obliquely backward' and 'backward') were quite equally represented (13-19%). The odds ratio (OR) for an obliquely forward fall resulting in a proximal humerus fracture was 3.5 [95% confidence interval (CI) 1.4-9.2), as compared with the fall directions of the controls and the 'obliquely backward' fall direction. In a logistic regression analysis the patients with a wrist fracture managed to break their fall (e.g., with an outstretched arm) more frequently than the patients in the other groups (OR 3.9; 95% CI 2.0-7.3). The patients with a proximal humerus fracture, in turn, managed to break their fall less frequently than the controls (OR 0.33; 95% CI 0.14-0.80). The same was true of the patients with an elbow fracture, although the difference was not significant (OR 0.49%; 95% CI 0.19-1.3). As objective evidence for a direct fall-induced impact on the fracture site, 68% of patients with a proximal humerus fracture revealed a fresh subcutaneous hematoma on the shoulder/upper arm, while such a hematoma was rare in the controls (2%) (p < 0.001). Correspondingly, 62% of patients with an elbow fracture showed a similar hematoma on the elbow area, while this was seen in none of the controls (p < 0.001). In patients with a wrist fracture a hand/wrist hematoma was seen in 58% of the victims, as compared with 18% of the controls (p < 0.001). The study shows that the most typical osteoporotic upper extremity fractures of older adults have their specific injury mechanisms. A great majority of these fractures occur as a result of a fall and a subsequent direct impact of the fractured site. Effective fracture prevention could be achieved by minimizing the obvious risk factors of falling and reducing the fall-induced impact force with injury site protection. PMID:11199185
Palvanen, M; Kannus, P; Parkkari, J; Pitkðjðrvi, T; Pasanen, M; Vuori, I; Jðrvinen, M
Biomechanics of the Upper Extremity in Response to Dynamic Impact Loading Indicative of a Forward Fall: An Experimental and Numerical Investigation
NASA Astrophysics Data System (ADS)
The distal radius is one of the most common fracture sites in humans, often resulting from a forward fall with more than 60 % of all fractures to the wrist requiring some form of surgical intervention. Although there is a general consensus regarding the risk factors for distal radius fractures resulting from forward falling, prevention of these injuries requires a more thorough understanding of the injury mechanisms. Therefore the overall purpose of this dissertation was to assess the response of the upper extremity to impact loading to improve the understanding of distal radius fracture mechanisms and the effectiveness of joint kinematic strategies for reducing the impact effects. Three main studies were conducted that utilized in vivo, in vitro and numerical techniques. In vitro impact testing of the distal radius revealed that fracture will occur at a mean (SD) resultant impact force and velocity of 2142.1(1228.7) N and 3.4 (0.7) m/s, respectively. Based on the failure data, multi-variate injury criteria models were produced, highlighting the dynamic and multidirectional nature of distal radius fractures The in vitro investigation was also used to develop and validate a finite element model of the distal radius. Dynamic impacts were simulated in LS-DYNARTM and the resulting z-axis force validation metrics (0.23--0.54) suggest that this is a valid model. A comparison of the experimental fracture patterns to those predicted numerically (i.e. von-Mises stress criteria) shows the finite element model is capable of accurately predicting bone failure. Finally, an in vivo fall simulation apparatus was designed and built that was found to reliably (Intraclass Correlation Coefficients > 0.6) apply multi-directional motion and upper extremity impacts indicative of forward falls. This study revealed that, to some extent, individuals are capable of selected an impact strategy that minimizes the significant injury variables that were outlined in the in vitro investigation, with very little instruction. The body of work presented here has the potential to be used to develop distal radius fracture prevention methods in an attempt to improve the health and well being of those individuals currently at the highest risk of sustaining these injuries.
Burkhart, Timothy A.
Prosthetic rehabilitation of the upper limb amputee
The loss of all or part of the arm is a catastrophic event for a patient and a significant challenge to rehabilitation professionals and prosthetic engineers. The large, upper extremity amputee population in India has, historically, been poorly served, with most having no access to support or being provided with ineffective prostheses. In recent years, the arrival of organisations like Otto Bock has made high quality service standards and devices accessible to more amputees. This review attempts to provide surgeons and other medical professionals with an overview of the multidisciplinary, multistage rehabilitation process and the solution options available. With worldwide upper extremity prosthesis rejection rates at significant levels, the review also describes some of the factors which influence the outcome. This is particularly relevant in the Indian context where the service can involve high cost investments. It is the responsibility of all contributing professionals to guide vulnerable patients through the process and try to maximise the benefit that can be obtained within the resources available.
O'Keeffe, Bernard
Experience from the in-flight calibration of the Extreme Ultraviolet Explorer (EUVE) and Upper Atmosphere Research Satellite (UARS) fixed head star trackers (FHSTs)
NASA Technical Reports Server (NTRS)
Since the original post-launch calibration of the FHSTs (Fixed Head Star Trackers) on EUVE (Extreme Ultraviolet Explorer) and UARS (Upper Atmosphere Research Satellite), the Flight Dynamics task has continued to analyze the FHST performance. The algorithm used for inflight alignment of spacecraft sensors is described and the equations for the errors in the relative alignment for the simple 2 star tracker case are shown. Simulated data and real data are used to compute the covariance of the relative alignment errors. Several methods for correcting the alignment are compared and results analyzed. The specific problems seen on orbit with UARS and EUVE are then discussed. UARS has experienced anomalous tracker performance on an FHST resulting in continuous variation in apparent tracker alignment. On EUVE, the FHST residuals from the attitude determination algorithm showed a dependence on the direction of roll during survey mode. This dependence is traced back to time tagging errors and the original post launch alignment is found to be in error due to the impact of the time tagging errors on the alignment algorithm. The methods used by the FDF (Flight Dynamics Facility) to correct for these problems is described.
Lee, Michael
Rehabilitation of the upper extremity and basic activities of daily living in the first month after ischemic stroke: an international cohort comparison study
Inpatient rehabilitation has been traditionally employed in developed countries, while in developing countries, outpatient rehabilitation is the rule. The purpose of this study was to compare the patterns of recovery of upper extremity (UE) function, global impairment and independence in activities of daily living (ADL) during the first month after ischemic stroke in inpatient (United States) and outpatient (Brazil) rehabilitation settings. This is a prospective cohort comparison study. Twenty patients from each country were selected using identical inclusion criteria. The study measures employed were the UE portion of the Fugl-Meyer scale, the Action Research Arm test, the National Institutes of Health Stroke Scale and Barthel Index. Changes from baseline to the end of treatment, efficiency and effectiveness of each treatment were compared. Both populations exhibited significant improvement between the first and second evaluations in the four outcome scales (p<0.0001). There were no differences between the two rehabilitation settings on any of the four dependent measures (p>0.05). Substantially different treatment approaches after ischemic stroke led to similar results in UE function, global impairment and ADL. Further studies in larger populations should be performed in order to confirm the present results.
Minelli, Cesar; Gondim, Francisco A.A.; Barreira, Amilton Antunes; Dromerick, Alexander W.
A "Wii" bit of fun: the effects of adding Nintendo Wii(Û) Bowling to a standard exercise regimen for residents of long-term care with upper extremity dysfunction.
The aims of this randomized, single-blind crossover trial were to investigate the effect of adding a simulated bowling video game via the Nintendo Wii(Û) gaming system to the standard exercise regimen of cognitively intact residents of long-term care (LTC) with upper extremity dysfunction and to identify individual characteristics that might predict improvement. Residents (n=34) were recruited through two LTC facilities in southwestern Ontario and were randomized into a standard exercise (SG) or standard exercise plus Wii bowling (Wii) arm. After 4 weeks of intervention, the groups were crossed over to the opposite arm. Outcomes included measures of pain intensity and bothersomeness, physical activity enjoyment, and a six-item measure of functional capacity designed specifically for residents of LTC. Results suggest that subjects improved on all outcomes from pre- to postintervention but that only enjoyment of activity showed a significant difference between the SG and Wii groups. Effect sizes (Cohen's d) ranged from small (0.30 for bothersomeness) to large (1.77 for functional capacity). Responders, defined as those subjects who reported any degree of improvement following the Wii intervention, were less likely to complain of stiffness or shoulder symptoms and were more likely to complain of hand symptoms than non-responders. Limitations in interpretation and recommendations for future research are presented. PMID:20698793
Hsu, Jason K; Thibodeau, Richard; Wong, Stephanie J; Zukiwsky, Daniel; Cecile, Sara; Walton, David M
Plasticity in the Visual System is Associated with Prosthesis Use in Phantom Limb Pain
The experience of strong phantom limb pain (PLP) in arm amputees was previously shown to be associated with structural neural plasticity in parts of the cortex that belong to dorsal and ventral visual streams. It has been speculated that this plasticity results from the extensive use of a functional prosthesis which is associated with increased visual feedback to control the artificial hand. To test this hypothesis, we reanalyzed data of cortical volumes of 21 upper limb amputees and tested the association between the amount of use of the hand prosthesis and cortical volume plasticity. On the behavioral level, we found no relation between PLP and the amount of prosthesis use for the whole patient group. However, by subdividing the patient group into patients with strong PLP and those with low to medium PLP, stronger pain was significantly associated with less prosthesis use whereas the group with low PLP did not show such an association. Most plasticity of cortical volume was identified within the dorsal stream. The more the patients that suffered from strong PLP used their prosthesis, the smaller was the volume of their posterior parietal cortex. Our data indicate a relationship between prosthesis use and cortical plasticity of the visual stream. This plasticity might present a brain adaptation process to new movement and coordination patterns needed to guide an artificial hand.
Preissler, Sandra; Dietrich, Caroline; Blume, Kathrin R.; Hofmann, Gunther O.; Miltner, Wolfgang H. R.; Weiss, Thomas
Restoration of Upper Extremity Function
Functional neuromuscular stimulation has been shown to be a viable means of Providing controlled movements in paralyzed limbs. Low levels of electrical current are effective in eliciting impulses in nerves, which then propagate to and result in a contraction of the muscle. The FNS technique encompasses many aspects of the physical and biological sciences. When properly performed, electrical stimulation can
P. Hunter Peckham
Radiography of the Upper Extremity
... de los tejidos blandos y artritis. El mÕdico le pedirà este procedimiento cuando tenga una lesiµn en ... Paciente Antes de su examen, un tÕcnico radiµlogo le explicarà el procedimiento y responderà a sus preguntas. ...
Hip painful prosthesis: surgical view
Summary Painful hip prosthesis is the most feared immediate and remote complication of a primary implant and usually represents the failure of one or more therapeutic moments. In cases of aseptic implant failure, the causes invoked may be represented by an incorrect indication, the quality of materials, local and general condition of the patient and especially from a bad joint biomechanics. In cases of septic loosening, however, the cause of failure to be found in the location of pathogens within the implant. In planning a revision is necessary to respect many important steps. They are represented by the exact identification of the causes of failure, the correct preoperative planning, by respecting the skin incisions, the proper choice of the prosthesis, planning the surgical technique, and finally by an appropriate rehabilitation program. In the evaluation of hip failure the first diagnostic step is to recognize exactly those aseptic and septic forms anyway to exclude the diagnosis of infection.
Spinarelli, Antonio; Patella, Vittorio; Conserva, Vito; Vicenti, Giovanni; Pesce, Vito; Patella, Silvio
21 CFR 888.3780 - Wrist joint polymer constrained prosthesis.
Code of Federal Regulations, 2010 CFR
...2010-04-01 false Wrist joint polymer constrained prosthesis. 888.3780...Devices Ï 888.3780 Wrist joint polymer constrained prosthesis. (a) Identification. A wrist joint polymer constrained prosthesis is a...
21 CFR 874.3695 - Mandibular implant facial prosthesis.
Code of Federal Regulations, 2010 CFR
...2010-04-01 2010-04-01 false Mandibular implant facial prosthesis. 874...Prosthetic Devices ôÏ 874.3695 Mandibular implant facial prosthesis. (a) Identification. A mandibular implant facial prosthesis is a...
21 CFR 872.3960 - Mandibular condyle prosthesis.
Code of Federal Regulations, 2010 CFR
...2009-04-01 2009-04-01 false Mandibular condyle prosthesis. 872.3960 ...Prosthetic Devices ôÏ 872.3960 Mandibular condyle prosthesis. (a) Identification. A mandibular condyle prosthesis is a device...
21 CFR 872.3960 - Mandibular condyle prosthesis.
Code of Federal Regulations, 2010 CFR
...2010-04-01 2010-04-01 false Mandibular condyle prosthesis. 872.3960 ...Prosthetic Devices ôÏ 872.3960 Mandibular condyle prosthesis. (a) Identification. A mandibular condyle prosthesis is a device...
21 CFR 874.3695 - Mandibular implant facial prosthesis.
Code of Federal Regulations, 2010 CFR
...2009-04-01 2009-04-01 false Mandibular implant facial prosthesis. 874...Prosthetic Devices ôÏ 874.3695 Mandibular implant facial prosthesis. (a) Identification. A mandibular implant facial prosthesis is a...
21 CFR 872.3970 - Interarticular disc prosthesis (interpositional implant).
Code of Federal Regulations, 2010 CFR
...prosthesis (interpositional implant). 872.3970 Section...CONTINUED) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices...prosthesis (interpositional implant). (a) Identification...prosthesis (interpositional implant) is a device that is...
21 CFR 872.3970 - Interarticular disc prosthesis (interpositional implant).
Code of Federal Regulations, 2010 CFR
...prosthesis (interpositional implant). 872.3970 Section...CONTINUED) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices...prosthesis (interpositional implant). (a) Identification...prosthesis (interpositional implant) is a device that is...
21 CFR 878.3530 - Silicone inflatable breast prosthesis.
Code of Federal Regulations, 2010 CFR
...false Silicone inflatable breast prosthesis. 878.3530...DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices...3530 Silicone inflatable breast prosthesis. (a) Identification. A silicone inflatable breast prosthesis is a...
21 CFR 878.3530 - Silicone inflatable breast prosthesis.
Code of Federal Regulations, 2010 CFR
...false Silicone inflatable breast prosthesis. 878.3530...DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices...3530 Silicone inflatable breast prosthesis. (a) Identification. A silicone inflatable breast prosthesis is a...
High resolution optoelectronic retinal prosthesis
NASA Astrophysics Data System (ADS)
Electronic retinal prostheses seek to restore sight in patients with retinal degeneration by delivering pulsed electric currents to retinal neurons via an array of microelectrodes. Most implants use inductive or optical transmission of information and power to an intraocular receiver, with decoded signals subsequently distributed to retinal electrodes through an intraocular cable. Surgical complexity could be minimized by an "integrated" prosthesis, in which both power and data are delivered directly to the stimulating array without any discrete components or cables. We present here an integrated retinal prosthesis system based on a photodiode array implant. Video frames are processed and imaged onto the retinal implant by a video goggle projection system operating at near-infrared wavelengths (~ 900 nm). Photodiodes convert light into pulsed electric current, with charge injection maximized by specially optimized series photodiode circuits. Prostheses of three different pixel densities (16 pix/mm2, 64 pix/mm2, and 256 pix/mm2) have been designed, simulated, and prototyped. Retinal tissue response to subretinal implants made of various materials has been investigated in RCS rats. The resulting prosthesis can provide sufficient charge injection for high resolution retinal stimulation without the need for implantation of any bulky discrete elements such as coils or tethers. In addition, since every pixel functions independently, pixel arrays may be placed separately in the subretinal space, providing visual stimulation to a larger field of view.
Loudin, Jim; Dinyari, Rostam; Huie, Phil; Butterwick, Alex; Peumans, Peter; Palanker, Daniel
Contact dermatitis from a prosthesis.
Patients wearing a prosthesis face a wide variety of medical problems. Skin complications have long been recognized, but their prevalence is still unknown. The most frequently reported disorders are allergic contact dermatitis (ACD), acroangiodermatitis, epidermoid cysts, epidermal hyperplasia, follicular hyperkeratosis, verrucous hyperplasia, bullous diseases, hyperhidrosis, infections, malignancies, and ulcerations. Contact dermatitis represents one-third of the dermatoses in amputees wearing prostheses. All patients who are suspected of having ACD should be patch tested with standard allergen series as well as materials from the patient's own prosthesis, topical medicaments, moisturizers, and cosmetics. We report a patient with an ACD to mixed dialkyl thiourea present in the rubber parts of his below-the-knee prosthesis. Thiourea derivates are used as accelerators in the manufacture of chloroprene rubber and as fixatives in photography and photocopy paper. Allergy to thiourea is relatively uncommon; different studies have shown a prevalence of 0.7% up to 2.4% in patch-tested patients. Thiourea derivates are often the allergic sources in ACD involving high-grade rubber products made of neoprene such as diving suits, protective goggles, knee braces, and continuous positive airway pressure masks. They are also present in the rubber material of prostheses, as in the case of our patient. PMID:18413115
Munoz, Carla A; Gaspari, Anthony; Goldner, Ronald
Women's Satisfaction with Their Breast Prosthesis: What Determines a Quality Prosthesis?
ERIC Educational Resources Information Center
The aim of this study is to determine what factors constitute a quality prosthesis and ascertain which factors affect prosthesis satisfaction. Sixty-four women who received full funding for their prosthesis and 38 women who received their hospital's usual funding were recruited. Women rated the information provided about breast prostheses very
Livingston, Patricia M.; White, Victoria M.; Roberts, Susan B.; Pritchard, Emma; Hayman, Jane; Gibbs, Anne; Hill, David J.
Towards Improved Myoelectric Prosthesis Control: High Density Surface EMG Recording After Targeted Muscle Reinnervation
The control of shoulder disarticulation prostheses remains a challenging problem. Recently, a novel method, using targeted muscle reinnervation to develop additional myoelectric control sites, has improved the control of myoelectric upper limb prosthesis in a patient with bilateral amputations at the shoulder disarticulation level. Encouraged by this achievement, we recorded high density surface electromyogram (EMG) signals from the patient's reinnervated
Ping Zhou; Madeleine M. Lowery; Julius P. A. Dewald; Todd A. Kuiken
Risk Factors for Neck and Upper Extremity Disorders among Computers Users and the Effect of Interventions: An Overview of Systematic Reviews
Background To summarize systematic reviews that 1) assessed the evidence for causal relationships between computer work and the occurrence of carpal tunnel syndrome (CTS) or upper extremity musculoskeletal disorders (UEMSDs), or 2) reported on intervention studies among computer users/or office workers. Methodology/Principal Findings PubMed, Embase, CINAHL and Web of Science were searched for reviews published between 1999 and 2010. Additional publications were provided by content area experts. The primary author extracted all data using a purpose-built form, while two of the authors evaluated the quality of the reviews using recommended standard criteria from AMSTAR; disagreements were resolved by discussion. The quality of evidence syntheses in the included reviews was assessed qualitatively for each outcome and for the interventions. Altogether, 1,349 review titles were identified, 47 reviews were retrieved for full text relevance assessment, and 17 reviews were finally included as being relevant and of sufficient quality. The degrees of focus and rigorousness of these 17 reviews were highly variable. Three reviews on risk factors for carpal tunnel syndrome were rated moderate to high quality, 8 reviews on risk factors for UEMSDs ranged from low to moderate/high quality, and 6 reviews on intervention studies were of moderate to high quality. The quality of the evidence for computer use as a risk factor for CTS was insufficient, while the evidence for computer use and UEMSDs was moderate regarding pain complaints and limited for specific musculoskeletal disorders. From the reviews on intervention studies no strong evidence based recommendations could be given. Conclusions/Significance Computer use is associated with pain complaints, but it is still not very clear if this association is causal. The evidence for specific disorders or diseases is limited. No effective interventions have yet been documented.
Andersen, Johan H.; Fallentin, Nils; Thomsen, Jane F.; Mikkelsen, Sigurd
An integrative review of outcomes in patients with acute primary upper extremity deep venous thrombosis following no treatment or treatment with anticoagulation, thrombolysis, or surgical algorithms.
Primary upper extremity deep venous thrombosis (UEDVT) is a rare condition that typically affects young patients and can cause considerable long-term morbidity. Proposed treatments have included rest, heat, elevation of the affected limb, anticoagulation, thrombolysis, surgical decompression, percutaneous transluminal angioplasty (PTA), and stenting. However, the optimal management of primary UEDVT remains controversial. This study was an integrative review of the English-language literature since 1965 on primary UEDVT, with comparison of long-term symptoms, rethrombosis, and pulmonary embolism in 4 treatment algorithms: rest, heat, and elevation alone; anticoagulation alone; surgical decompression without thrombolysis; and algorithms including thrombolysis. Forty-one studies describing 559 patients met the criteria for inclusion. Statistically significant differences were found among the 4 treatment algorithms in the incidence of residual symptoms (p < 0.000), the incidence of pulmonary embolism (p < 0.000), and the incidence of rethrombosis (p < 0.027). Residual symptoms and the severity of residual symptoms were greatest in the rest, heat, and elevation algorithm (74%), followed by the surgical (60%), anticoagulation (44%), and thrombolysis (22%) algorithms. Pulmonary embolism was also greatest in the rest, heat, and elevation algorithm (12%), followed by the anticoagulation (7%), thrombolysis (1%), and surgical algorithms (0%), while rethrombosis was greatest in the thrombolytic algorithm (7%) followed by the surgical (3%), anticoagulation (2%), and rest, heat, and elevation (0%) algorithms. These results support the current clinical practice of a staged, multidisciplinary approach to treatment of primary UEDVT that includes thrombolytic therapy and possible surgical decompression. Further studies are needed to evaluate the natural history of patients treated with thrombolysis alone, to assess the optimal timing of surgical decompression, and to determine the best use of PTA and stenting in the multidisciplinary approach. PMID:15806278
Thomas, Ildiko H; Zierler, Brenda K
Endoscopic palliation of esophageal and cardial cancer: Nd:YAG laser and prosthesis
NASA Astrophysics Data System (ADS)
From November 1, 1992 to January 31, 1997, 227 patients with inoperable esophageal and cardial carcinomas were treated with Nd:YAG laser therapy and prosthesis intubation. The retrograde technique was used in most cases. The tumor involved in 75 pts the Cardia, in 65 the middle thoracic esophagus, in 47 pts the lower thoracic esophagus, in 23 in the upper thoracic esophagus and in 17 in the cervical esophagus. The indications for palliative Nd:YAG laser and prosthesis intubation were a locally advanced or metastatic tumor in 146 pts (64.4%) and poor surgical risk in 81 pts (35.6%). The quality of palliation was evaluated according to the ability to swallow. The mean survival rate of the patients during the follow up was 22 weeks for the laser therapy and 16 weeks for the prosthesis intubation.
Norberto, Lorenzo; Ranzato, Riccardo; Marino, Saverio; Angriman, Imerio; Vella, Vincenzo; Donadi, Michele; D'Amico, D. F.
Fracture embolization of a Duromedics mitral prosthesis.
The Duromedics bileaflet pyrolitic carbon mechanical prosthesis was introduced by Hemex in 1982 and subsequently acquired by Baxter. This communication documents a case of sudden leaflet fracture of a Duromedics mitral valve 48 months after implantation, which was managed successfully by replacement with a St. Jude Medical mechanical prosthesis. The patient presented in acute distress with paroxysmal atrial tachycardia and pulmonary edema. Transesophageal echocardiography was used to diagnose the leaflet fracture. The fracture had occurred transversely, with the fragments embolizing bilaterally to the iliofemoral arteries. These were removed at a subsequent operation. Cases of such fractures of the Duromedics prosthesis have been reported, with cavitation damage being the postulated mechanism.
Baumgartner, F J; Munro, A I; Jamieson, W R
21 CFR 878.3720 - Tracheal prosthesis.
Code of Federal Regulations, 2013 CFR
... FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices ôÏ 878.3720 Tracheal prosthesis. (a) Identification. The tracheal...
21 CFR 878.3610 - Esophageal prosthesis.
Code of Federal Regulations, 2013 CFR
... FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices ôÏ 878.3610 Esophageal prosthesis. (a) Identification. An esophageal...
Custom Ocular Prosthesis: A Palliative Approach
The goal of palliative care is the achievement of the best quality of life for patients and their families. Eyes are generally the first features of the face to be noticed. Loss of an eye is a traumatic event which has a crippling effect on the psychology of the patient. Several ocular and orbital disorders require surgical intervention that may result in ocular defects. An ocular prosthesis is fabricated to restore the structure, function, and cosmetics of the defects created by such conditions. Although an implant eye prosthesis has a superior outcome, due to economic factors it may not be a feasible option for all patients. Therefore, a custom-made ocular prosthesis is a good alternative. This case report presents a palliative treatment for a patient with an enucleated eye by fabricating a custom ocular prosthesis which improved his psychological, physical, social, functional, emotional and spiritual needs.
Thakkar, Prachi; Patel, JR; Sethuraman, Rajesh; Nirmal, Narendra
Simultaneous toe-to-hand transfer and lower extremity amputations for severe upper and lower limb defects: the use of spare parts.
From 1995 to 2000, five microvascular toe-to-hand transfers were performed in three children who were simultaneously undergoing lower extremity amputations. Their ages at time of transfer ranged from 4 to 10 years and the types of lower extremity amputation included toe amputation, foot amputation and through-knee amputation. The resulting toe-to-hand transfers included three great toe-to-thumb transfers and one combined great and second toe-to-hand transfer. The toe-to-hand transfers were all successful and all the lower extremity amputations healed without complications. In all cases, improved hand function and lower extremity function was noted by the families. These unique cases represent the ultimate use of spare parts in congenital hand surgery. PMID:12074605
Chang, J; Jones, N F
Visuomotor behaviours when using a myoelectric prosthesis
Background A recent study showed that the gaze patterns of amputee users of myoelectric prostheses differ markedly from those seen in anatomically intact subjects. Gaze behaviour is a promising outcome measures for prosthesis designers, as it appears to reflect the strategies adopted by amputees to compensate for the absence of proprioceptive feedback and uncertainty/delays in the control system, factors believed to be central to the difficulty in using prostheses. The primary aim of our study was to characterise visuomotor behaviours over learning to use a trans-radial myoelectric prosthesis. Secondly, as there are logistical advantages to using anatomically intact subjects in prosthesis evaluation studies, we investigated similarities in visuomotor behaviours between anatomically intact users of a trans-radial prosthesis simulator and experienced trans-radial myoelectric prosthesis users. Methods In part 1 of the study, we investigated visuomotor behaviours during performance of a functional task (reaching, grasping and manipulating a carton) in a group of seven anatomically intact subjects over learning to use a trans-radial myoelectric prosthesis simulator (Dataset 1). Secondly, we compared their patterns of visuomotor behaviour with those of four experienced trans-radial myoelectric prosthesis users (Dataset 2). We recorded task movement time, performance on the SHAP test of hand function and gaze behaviour. Results Dataset 1 showed that while reaching and grasping the object, anatomically intact subjects using the prosthesis simulator devoted around 90% of their visual attention to either the hand or the area of the object to be grasped. This pattern of behaviour did not change with training, and similar patterns were seen in Dataset 2. Anatomically intact subjects exhibited significant increases in task duration at their first attempts to use the prosthesis simulator. At the end of training, the values had decreased and were similar to those seen in Dataset 2. Conclusions The study provides the first functional description of the gaze behaviours seen during use of a myoelectric prosthesis. Gaze behaviours were found to be relatively insensitive to practice. In addition, encouraging similarities were seen between the amputee group and the prosthesis simulator group.
Electromyography Signal Based For Intelligent Prosthesis Design
Electromyography (EMG) is widely used throughout the world for different study such as clinical diagnosis and for movement\\u000a analysis. One of the applications of EMG is in the development of myoelectric prosthesis. It is intended by all the biomechanics\\u000a engineer in order to provide better living to the amputees since the current prosthesis are limited. It is principally operated\\u000a based
Zunaidi Ibrahim; R. Nagarajan; M. Rizon; D. Hazry; D. Ruslizam; C. O. Azlin
Instruments and techniques for the analysis of wheelchair propulsion and upper extremity involvement in patients with spinal cord injuries: current concept review
Summary The correct functionality of the upper limbs is an essential condition for the autonomy of people with disabilities, especially for those in wheelchair. In this review we focused on the biomechanics of wheelchair propulsion and we described the instrumental analysis of techniques for the acquisition of wheelchair propulsion.
Dellabiancia, Fabio; Porcellini, Giuseppe; Merolla, Giovanni
Neuroma in bilateral upper limb amputation.
To evaluate the prevalence of neuroma in bilateral upper limb amputees and investigate the effect of level of amputation on their pain, 86 patients with bilateral upper limb amputation were thoroughly examined by an orthopedic surgeon. Of 172 bilateral amputated upper limbs (86 victims of war) 17.1+/-6.1 years after injury, physical examination revealed that 26.2% had moderate to severe stump pain and clinical signs suggestive of neuroma. Statistical analysis showed no relation between level of amputation, prosthesis usage, and occurrence of neuroma. Although high occurrence of neuroma among traumatic bilateral upper limb amputation had no significant effects on wearing prosthesis, its treatment can deeply influence alleviation of their pain and subsequently their quality of life. PMID:19226072
Soroush, Mansoor; Modirian, Ehsan; Soroush, Mohamadreza; Masoumi, Mahdi
Inhibitory Response Capacities of Bilateral Lower and Upper Extremities in Children with Developmental Coordination Disorder in Endogenous and Exogenous Orienting Modes
ERIC Educational Resources Information Center
This study was designed to investigate separately the inhibitory response capacity and the lateralization effect in children with developmental coordination disorder (DCD) in the endogenous and exogenous modes of orienting attention. Children with DCD on the lower extremities (DCD-LEs), along with age-matched controls, completed four tasks that
Tsai, Chia-Liang; Yu, Yi-Kai; Chen, Yung-Jung; Wu, Sheng-Kuang
Prevalence and associations of symptoms of upper extremities, repetitive strain injuries (RSI) and 'RSI-like condition'. A cross sectional study of bank workers in Northeast Brazil
Background The repetitive strain injury syndrome (RSI) is a worldwide occupational health problem affecting all types of economic activities. We investigated the prevalence and some risk factors for RSI and related conditions, namely 'symptoms of upper limbs' and 'RSI-like condition'. Methods We conducted a cross-sectional study with 395 bank workers in Recife, Northeast Brazil. Symptoms of upper limbs and 'RSI-like condition' were assessed by a simple questionnaire, which was used to screen probable cases of RSI. The diagnosis of RSI was confirmed by clinical examination. The associations of potential risk factors and the outcomes were assessed by multiple logistic regression analysis. Results We found prevalence rates of 56% for symptoms of the upper limbs and 30% for 'RSI-like condition'. The estimated prevalence of clinically confirmed cases of RSI was 22%. Female sex and occupation (as cashier or clerk) increased the risk of all conditions, but the associations were stronger for cases of RSI than for less specific diagnoses of 'RSI-like condition' and symptoms of upper limbs. Age was inversely related to the risk of symptoms of upper limbs but not to 'RSI-like' or RSI. Conclusion The variation in the magnitude of risk according to the outcome assessed suggests that previous studies using different definitions may not be immediately comparable. We propose the use of a simple instrument to screen cases of RSI in population based studies, which still needs to be validated in other populations. The high prevalence of RSI and related conditions in this population suggests the need for urgent interventions to tackle the problem, which could be directed to individuals at higher risk and to changes in the work organization and environment of the general population.
Lacerda, Eliana M; Nacul, Luis C; da S Augusto, Lia G; Olinto, Maria Teresa A; Rocha, Dyhanne C; Wanderley, Danielle C
Impedance Matching and Implementation of Planar Space-Filling Dipoles as Intraocular Implanted Antennas in a Retinal Prosthesis
In this work, an extremely compact planar meander line dipole is designed and implemented for use as an intraocular element in a retinal prosthesis. This planar meander dipole antenna exhibits a high degree of current vector alignment and is impedance matched by inducing a current phase reversal along its length. This current phase reversal is induced by a minor offset
Keyoor Gosalia; Mark S. Humayun; Gianluca Lazzi
Techniques for Evaluating the Fit of Removable and Fixed Prosthesis
The importance of an accurately fitting fixed prosthesis or a removable prosthesis is essential for the success of the restoration. Ill-fitting prosthesis may cause mechanical failures of the prosthesis, implant systems, or biologic complications of the surrounding tissue. There are several causes related to improper seating of the prosthesis. Some of which can be corrected and the others need to be repeated. Hence the clinician must carefully evaluate the adaptation of the prosthesis using the clinical techniques and combination of the available materials and evaluation methods to optimize the fit of prosthesis. This article reviews the various clinical methods that have been suggested for evaluating the fit of the fixed and removable prosthesis.
Shetty, Mallika S.; Shenoy, K. Kamalakanth
Virtual reality environment for simulating tasks with a myoelectric prosthesis: an assessment and training tool
Intuitively and efficiently controlling multiple degrees of freedom is a major hurdle in the field of upper limb prosthetics. A virtual reality myoelectric transhumeral prosthesis simulator has been developed for cost-effectively testing novel control algorithms and devices. The system acquires EMG commands and residual limb kinematics, simulates the prosthesis dynamics, and displays the combined residual limb and prosthesis movements in a virtual reality environment that includes force-based interactions with virtual objects. A virtual Box and Block Test is demonstrated. Three normally-limbed subjects performed the simulated test using a sequential and a synchronous control method. With the sequential method, subjects moved on average 6.7Ý1.9 blocks in 120 seconds, similar to the number of blocks transhumeral amputees are able to move with their physical prostheses during clinical evaluation. With the synchronous method, subjects moved 6.7Ý2.2 blocks. The virtual reality prosthesis simulator is thus a promising tool for developing and evaluating control methods, prototyping novel prostheses, and training amputees.
Lambrecht, Joris M.; Pulliam, Christopher L.; Kirsch, Robert F.
Production of porous coating on a prosthesis
Preselected surface areas of a prosthesis are covered by a blend of matching primary metallic particles and expendable particles. The particles are compressed and heated to assure that deformation and metallurgical bonding occurs between them and between the primary particles and the surface boundaries of the prosthesis. Porosity is achieved by removal of the expendable material. The result is a coating including discrete bonded particles separated by a network of interconnected voids presenting a homogeneous porous coating about the substrate. It has strength suitable for bone implant usage without intermediate adhesives, and adequate porosity to promote subsequent bone ingrowth.
Sump, Kenneth R. (Richland, WA)
The upper transition height over the Kharkiv incoherent scatter radar before, during and after the extreme minimum of the solar activity: Observational results and comparison with the IRI-2012 model
NASA Astrophysics Data System (ADS)
Variations in the diurnal minimum of upper transition height (height at which total light ions fraction is 50%) over Kharkiv, Ukraine are considered for vernal and autumnal equinoxes from 2006 to 2010. The data were obtained using the incoherent scatter radar of the Institute of ionosphere [1]. It was found that the decrease of daily F10.7 values approximately by 22 % (from 82 for spring 2006 to 67 for autumn 2007) was accompanied by a decrease in the upper transition height approximately by 19% too (from 518 km to 436 km). The linear correlation coefficient between the upper transition height and daily F10.7 was approximately 0.81. It should be noted that according to our knowledge such low values of upper transition height is the minimum ever recorded. In 2008-2009, the upper transition height over Kharkiv was up to 40 km lower than over the equator [2] and even up to 10-15 km lower than over Arecibo [3]. A comparison of the observational results with the IRI-2012 model [4] was made. It was found that the IRI-2012 model overestimates upper transition height up to 100 km in 2006, and 2010. The model also overestimates the upper transition height up to 150 km during the extreme solar minimum (2008-2009). It is clearly seen that for solar minimum under consideration latitudinal dependence of upper transition height according to observational data have decreasing character in contrast to the model dependence. Such behavior can be called latitudinal inversion of upper transition height. Strong dependence of upper transition height on Ap index was found for the conditions under consideration. It is suggested that model values for 2006 and 2010 are overestimated due to a higher geomagnetic activity during the satellite measurements (1974) underlying the model for the low level of solar activity compared with geomagnetic conditions for 2006 and 2010. Perhaps this led to the fact that the model does not show latitudinal inversion, which occurs only at very low geomagnetic activity. However, this hypothesis requires further careful checking. In 2008 and 2009, the decreasing of the upper transition height has been apparently caused by a prolonged general cooling of the thermosphere and ionosphere [5]. [1] I.F. Domnin et. al., Geomag. And Aeronomy, Intern. 53, 113 (2013). [2] R.A. Heelis et. al.,Geophys. Res. Lett. 36, L00C03, doi:10.1029/2009GL038652 (2009). [3] N. Aponte et. al., J. Geophys. Res. 118, 4465, doi:10.1002/jgra.50416 (2013). [4] V. Truhlik et al., Adv. Space. Res., Towards better description of solar activity variation in the IRI topside ion composition model, in review. [5] S.C. Solomon et. al., J. Geophys. Res. 116, doi:10.1029/2011JA016508.
Kotov, Dmytro; Truhlik, Vladimir; Richards, Philipp; Huba, Joseph; Chernogor, Leonid; Bogomaz, Oleksandr; Domnin, Igor
Implant-Retained Auricular Prosthesis: A Case Report
Extraoral implant retained prosthesis have been proven to be a predictable treatment option for maxillofacial rehabilitation. This case report describes the clinical and laboratory procedures for fabricating an auricular prosthesis. In this case report, an auricular prosthesis was fabricated for a patient who lost the left and right external ear in an electrical burn. Extraoral implants and bar-and-clip retention for the proper connection of the auricular prosthesis to implant were used. This prosthesis was acceptable to the patient because of excellent support, retentive abilities and the patients appearance.
Ozturk, A. Nilgun; Usumez, Aslihan; Tosun, Zekeriya
A running controller for a powered transfemoral prosthesis.
This paper describes a running controller for a powered knee and ankle prosthesis. The running controller was implemented on a powered prosthesis prototype and evaluated by a transfemoral amputee subject running on a treadmill at a speed of 2.25 m/s (5.0 mph). The ability of the prosthesis and controller to provide the salient features of a running gait was assessed by comparing the kinematics of running provided by the powered prosthesis to the averaged kinematics of five healthy subjects running at the same speed. This comparison indicates that the powered prosthesis and running controller are able to provide essential features of a healthy running gait. PMID:23366846
Huff, Amanda M; Lawson, Brian E; Goldfarb, Michael
New concepts biomechanical studies of a newly designed femoral prosthesis (cervicotrochanter prosthesis)
Objective. A newly designed stemless (cervico-trochanter) prosthesis was developed for the purpose of reducing the incidence of the stress-shielding effect caused by the traditional stem-type prosthesis.Design. Both mechanical test and three-dimensional finite element analysis were performed for comparing the differences of strain and stress distributions between the intact, C-T and PCA prosthetic femora.Background. The stress-shielding effect and polyethylene (PE) wear
Chun-Hsiung Shih; Weng-Pin Chen; Ching-Lung Tai; Rong-Fu Kuo; Chi-Chuan Wu; Chih-Hwa Chen
Archaeomagnetic study of five mounds from Upper Mesopotamia between 2500 and 700 BCE: Further evidence for an extremely strong geomagnetic field ca. 3000 years ago
NASA Astrophysics Data System (ADS)
The distribution of archaeomagnetic data in eastern Europe and the Near and Middle East shows a remarkable gap in Turkey. This study presents the first archaeomagnetic results from five different mounds in southeast Turkey, the northern part of Mesopotamia. The rock magnetic experiments indicate that in the majority of the samples the dominant magnetic carrier is magnetite, which is stable to heating to temperatures of 700 ¯C. In general, the demagnetization diagrams are single component and all five sets display well-defined characteristic magnetizations and clustered directions. For the period between 2500 and 700 BCE, the declinations are between 350¯ and 20¯ while inclinations are in the range of 49-64¯. The directional results are compared with the global geomagnetic field models (CALS7k.2, ARCH3k_cst.1 and CALS3k.4) and the data from the archaeomagnetic database GEOMAGIA50v2. The results are coherent with both the data and the models except for two near-contemporaneous sets dating 2000 BCE, which are offset to the east by more than 20¯ with respect to CALS7k.2. Archaeointensity measurements were made using the microwave and conventional thermal Thellier methods applied to five sets of samples (four furnaces and a mud-brick wall). These yielded comparable and intriguing results. While those from the furnaces are slightly higher than the CALS7k.2 model and in agreement with the GEOMAGIA50v2 and the Middle East data, the results from the mud-brick wall suggest a high intensity of 100.8 ?T (17.7æ1022 Am2) at 1000 BCE. This result is in excellent agreement with recent claims of extremely high intensity measured in other regions of the Middle East for this time period though less consistent with these being associated with extremely short-lived events. Finally, we discuss our new and other recently published archaeointensity results in terms of geomagnetic intensity versus climate.
Ertepinar, P.; Langereis, C. G.; Biggin, A. J.; Frangipane, M.; Matney, T.; økse, T.; Engin, A.
[Pilot prospective study of prosthesis needs at the prosthesis service of the CCTOS of Abidjan].
Studies on the dental health in Ivory Coast showed that the specific needs in prosthesis are numerous. Are there covered? What are the rates of the prosthetic consumption? It is to this question that the authors of the present work wanted brought a beginning of answer through a pilot prospective survey on the prosthetic demand to the service of prosthesis of the CCTOS of Abidjan. This survey was about 150 patients of all sex and all age come specifically for prosthetic rehabilitation, during the active period of February to April 1994. It takes out again of this survey this following results: from a general epidemiological point of view, the women are more numerous than the men, with an access frequency of 56%. Most topics are young, with an age between 20 and 30 years. The "social" rates that convenient the CCTOS attract the patients whose economic income is little important gladly or that are deprived of a health insurance. The prosthetic antecedents show that more than 65% of the topics never carried mainly a prosthesis for lack information or for lace money. Among the topics that already underwent a prosthetic treatment, prosthesis associate partial resin is the more frequently recovered in spite of an interesting rate of fixed prosthesis (37% of carriers). The clinical data reveal that aesthetic remains the main motive of the consultation, with 58% of demands and the prosthesis associate resin is in more of 70% of the cases the chosen therapeutic option. PMID:14705371
Djeredou, K B; Thiam, A; Pesson, D M; Bakou, O D; Nabe, G H; Kamagate, F S; Toure, S
Realization of a middle ear prosthesis
We present a prosthesis meant to replace the tympano-ossicular set. Such biocompatible materials as silicone elastomer and Teflon are used. The artificial eardrum consists of a plane, circular or elliptic membrane. The vibration modes of these membranes have been worked out. The influence of different parameters has been studied, in particular the aging and the sterilization. The response of the
L. Ledoux; J. Pouliquen; A. Defebvre; F. M. Vaneecloo
[Late infective mechanical aortic valve prosthesis endocarditis].
We present a case of late infective endocarditis on the mechanical aortic valve prosthesis, complicated by large paraortic abscesus. It was dificult to diagnosed this patient, because of negative blood cultures results and not diagnostic view in transthoracic echocardiogram. Transesophageal echo was performed just before cardiac surgery because of very bad patient's condition. PMID:19105103
Lisowska, Anna; Knapp, Ma?gorzata; Sobkowicz, Bozena; Hirnle, Tomasz; Musia?, W?odzimierz
Reading visual braille with a retinal prosthesis.
Retinal prostheses, which restore partial vision to patients blinded by outer retinal degeneration, are currently in clinical trial. The Argus II retinal prosthesis system was recently awarded CE approval for commercial use in Europe. While retinal prosthesis users have achieved remarkable visual improvement to the point of reading letters and short sentences, the reading process is still fairly cumbersome. This study investigates the possibility of using an epiretinal prosthesis to stimulate visual braille as a sensory substitution for reading written letters and words. The Argus II retinal prosthesis system, used in this study, includes a 10?æ?6 electrode array implanted epiretinally, a tiny video camera mounted on a pair of glasses, and a wearable computer that processes the video and determines the stimulation current of each electrode in real time. In the braille reading system, individual letters are created by a subset of dots from a 3 by 2 array of six dots. For the visual braille experiment, a grid of six electrodes was chosen out of the 10?æ?6 Argus II array. Groups of these electrodes were then directly stimulated (bypassing the camera) to create visual percepts of individual braille letters. Experiments were performed in a single subject. Single letters were stimulated in an alternative forced choice (AFC) paradigm, and short 2-4-letter words were stimulated (one letter at a time) in an open-choice reading paradigm. The subject correctly identified 89% of single letters, 80% of 2-letter, 60% of 3-letter, and 70% of 4-letter words. This work suggests that text can successfully be stimulated and read as visual braille in retinal prosthesis patients. PMID:23189036
Lauritzen, Thomas Z; Harris, Jordan; Mohand-Said, Saddek; Sahel, Jose A; Dorn, Jessy D; McClure, Kelly; Greenberg, Robert J
An archaeomagnetic study of Upper Mesopotamia and Central Anatolia between 2500 and 700 BCE. Further evidence for an extremely strong geomagnetic field ca. 3000 years ago
NASA Astrophysics Data System (ADS)
The distribution of archaeomagnetic data in eastern Europe and the Near and Middle East shows a remarkable gap in Turkey. This study presents the first archaeomagnetic results from eight different archaeological sites in Central and Southeast Turkey. We sampled furnaces, burnt mud-brick walls, and granite and ignimbrite foundation stones. The rock magnetic experiments indicate that in the majority of the samples the dominant magnetic carrier is magnetite, which is stable to heating to temperatures of 700¯ C. In general, the demagnetization diagrams are single component and all sets display well-defined characteristic magnetizations and clustered directions. For the period between 2500 and 700 BCE, the declinations are between 350¯ and 20¯ while inclinations are in the range of 49-64¯ . The directional results are compared with the global geomagnetic field models (CALS7k.2, ARCH3k_cst.1 and CALS3k.4) and the data from the archaeomagnetic database GEOMAGIA50v2. The results are coherent with both the data and the models except for two near-contemporaneous sets dating ~2000 BCE, which are offset to the east by more than 20¯ with respect to CALS7k.2. Archaeointensity measurements were made using the microwave and conventional thermal Thellier methods, as well as the multi-specimen method. These different methods yielded comparable and intriguing results. While intensities from the furnaces are slightly higher than the CALS7k.2 model and in agreement with the GEOMAGIA50v2 and the Middle East data, the results from mud-brick walls suggest a high intensity of 100.8?T (17.7 x 1022 Am2 )at ~1000 BCE. This result is in excellent agreement with recent claims of extremely high intensity measured in other regions of the Middle East for this time period though less consistent with these being associated with extremely short-lived events. Finally, we discuss our new and other recently published archaeointensity results in terms of geomagnetic intensity versus climate.
Ertepinar, Pinar; Langereis, Cor; Biggin, Andrew; de Groot, Lennart
Towards Improved Myoelectric Prosthesis Control: High Density Surface EMG Recording After Targeted Muscle Reinnervation.
The control of shoulder disarticulation prostheses remains a challenging problem. Recently, a novel method, using targeted muscle reinnervation to develop additional myoelectric control sites, has improved the control of myoelectric upper limb prosthesis in a patient with bilateral amputations at the shoulder disarticulation level [1]. Encouraged by this achievement, we recorded high density surface electromyogram (EMG) signals from the patient's reinnervated muscles as he actuated a variety of different movements. We believe that the reinnervated muscle activation patterns revealed by the high density EMG recording have the potential to further improve the myoelectric prosthesis control. As the initial stage of the study, this paper presents the experiment of high density surface EMG recording, the preliminary EMG data analysis and the framework for future investigation with advanced feature extraction and pattern recognition techniques. PMID:17281125
Zhou, Ping; Lowery, Madeleine; A Dewald, Julius; Kuiken, Todd
The use of targeted muscle reinnervation for improved myoelectric prosthesis control in a bilateral shoulder disarticulation amputee.
A novel method for the control of a myoelectric upper limb prosthesis was achieved in a patient with bilateral amputations at the shoulder disarticulation level. Four independently controlled nerve-muscle units were created by surgically anastomosing residual brachial plexus nerves to dissected and divided aspects of the pectoralis major and minor muscles. The musculocutaneous nerve was anastomosed to the upper pectoralis major; the median nerve was transferred to the middle pectoralis major region; the radial nerve was anastomosed to the lower pectoralis major region; and the ulnar nerve was transferred to the pectoralis minor muscle which was moved out to the lateral chest wall. After five months, three nerve-muscle units were successful (the musculocutaneous, median and radial nerves) in that a contraction could be seen, felt and a surface electromyogram (EMG) could be recorded. Sensory reinnervation also occurred on the chest in an area where the subcutaneous fat was removed. The patient was fitted with a new myoelectric prosthesis using the targeted muscle reinnervation. The patient could simultaneously control two degrees-of-freedom with the experimental prosthesis, the elbow and either the terminal device or wrist. Objective testing showed a doubling of blocks moved with a box and blocks test and a 26% increase in speed with a clothes pin moving test. Subjectively the patient clearly preferred the new prosthesis. He reported that it was easier and faster to use, and felt more natural. PMID:15658637
Kuiken, T A; Dumanian, G A; Lipschutz, R D; Miller, L A; Stubblefield, K A
Patient satisfaction with Mentor inflatable penile prosthesis.
Patient satisfaction with the Mentor inflatable penile prosthesis was assessed by sending a thirty-six-item questionnaire to 251 patients who had undergone implantation of the device by the senior author (D.C.M.). A total of 152 (61%) of the patients responded. Recovery time, satisfaction, reasons for dissatisfaction, perceptions of erection quality, and psychosexual parameters were evaluated. Eight-eight percent of the patients were engaging in regular sexual activity. Depending on the definition of satisfaction, 81-89 percent of the respondents reported that they were satisfied with the prosthesis. Sixty-eight percent of the survey group were satisfied with the length, width, and firmness of their prosthetic-induced erection. The majority of patients reported improvement in psychosexual functioning after implantation. Reasons for dissatisfaction included inadequate penile length, insufficient firmness, and difficulty with inflation and deflation of the penile cylinders. PMID:2038786
Whalen, R K; Merrill, D C
Ten-year experience with voice prosthesis
The E.N.T. Clinic of Tepecik Educational Hospital Izmir, Turkey, has been using voice prosthesis for 10 years. We tried using all of the prostheses sold on the market. Several scientific studies had been carried out to find the most eligible one. A total of 251 laryngectomies have been performed at our clinic since 1993: 204 Provox, 17 Blom-Singer, 5 Groningen
M. D. Ozkul; I. úukurova; ø. U?ur; A. Tatar; M. Iber; S. Kaptaner
The Penile Prosthesis Option for Erectile Dysfunction
\\u000a Erectile dysfunction (ED) treatment can be divided into three main categories. These are oral agents, intracavernosal and\\u000a intraurethral therapies, and local devices, such as vacuum and penile prosthesis. The first-line treatment for ED is oral\\u000a phosphodiesterase type 5 inhibitors (PDE5Is); second-line treatment options include any combination of intracavernosal agents,\\u000a such as papaverine, phentolamine, PGE1, or transurethral alprostadil. For this reason,
Fikret Erdemir; Andrew Harbin; Wayne J. G. Hellstrom
21 CFR 888.3770 - Wrist joint carpal trapezium polymer prosthesis.
Code of Federal Regulations, 2010 CFR
...false Wrist joint carpal trapezium polymer prosthesis. 888.3770 Section...3770 Wrist joint carpal trapezium polymer prosthesis. (a) Identification. A wrist joint carpal trapezium polymer prosthesis is a one-piece...
21 CFR 888.3170 - Elbow joint radial (hemi-elbow) polymer prosthesis.
Code of Federal Regulations, 2010 CFR
... Elbow joint radial (hemi-elbow) polymer prosthesis. 888.3170 Section 888... Elbow joint radial (hemi-elbow) polymer prosthesis. (a) Identification. An elbow joint radial (hemi-elbow) polymer prosthesis is a device intended to...
21 CFR 878.3540 - Silicone gel-filled breast prosthesis.
Code of Federal Regulations, 2010 CFR
...false Silicone gel-filled breast prosthesis. 878.3540...DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices...3540 Silicone gel-filled breast prosthesis. (a) Identification...Single-lumen silicone gel-filled breast prosthesis. A...
21 CFR 878.3540 - Silicone gel-filled breast prosthesis.
Code of Federal Regulations, 2010 CFR
...false Silicone gel-filled breast prosthesis. 878.3540...DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices...3540 Silicone gel-filled breast prosthesis. (a) Identification...Single-lumen silicone gel-filled breast prosthesis. A...
21 CFR 888.3760 - Wrist joint carpal scaphoid polymer prosthesis.
Code of Federal Regulations, 2010 CFR
...2010-04-01 false Wrist joint carpal scaphoid polymer prosthesis. 888.3760... ôÏ 888.3760 Wrist joint carpal scaphoid polymer prosthesis. (a) Identification. A wrist joint carpal scaphoid polymer prosthesis is a...
21 CFR 888.3760 - Wrist joint carpal scaphoid polymer prosthesis.
Code of Federal Regulations, 2010 CFR
...2009-04-01 false Wrist joint carpal scaphoid polymer prosthesis. 888.3760... ôÏ 888.3760 Wrist joint carpal scaphoid polymer prosthesis. (a) Identification. A wrist joint carpal scaphoid polymer prosthesis is a...
Multidisciplinary treatment for an implant retained auricular prosthesis rehabilitation.
Retention of a facial prosthesis is the most important factor in creating a useful prosthesis for the patient. This paper presents a detailed case study of an auricular defect that was rehabilitated using two types of prosthetic retention: adhesive and osseointegration. We present the patient selection criteria, the surgical considerations prior to implant placement, retention component selection, prosthetic fabrication techniques and patient management after prosthetic delivery. The osseointegrated prosthesis made a large improvement in the patient's quality of life. PMID:10500406
Wright, R F; Wazen, J J; Asher, E S; Evans, J H
[Biodegradation of silicone in voice prosthesis].
The most important problem of the useful life of vocal prostheses is bacterial and especially mycotic colonization of their surface which impaired tightness of the closing valve of the prosthesis and caused subsequent leakage of fluids and food into the airways. The objective of the present study was to prevent colonization of the silicone surface and to prolong the service life of the prosthesis. The implanted prostheses were examined under microscope after varying intervals in vivo. The silicone of the implanted prosthesis was colonized by numerous microorganisms, in particular moulds. Seventeen bacterial and mycotic strains were identified. They behave to Candida, Acinetobacter, Micrococcus, Pseudomonas, Bacillus and Chryseomonas. The results confirmed the deep degradation of silicone rubber located in islets. Plant of bacterial tissue were inoculated on two types of silicone disks. Two types of silicone were tested (Silastic Q7-4550-50ShA and Q7-4765-65) after 4, 8 and 12-week exposure. Neither of these materials was attacked by mycotic agents in vitro. Only frame print was appreciable in five hundred times magnification. The second object of the study was to recognize the main degradation factor that means a kind of microorganism. The ability of microorganisms to assimilate oligo- and polyorganosiloxans was studied. Candida albicans does not seem like a typical microorganism assimilating silicon rubber. The results of our study proved Microccus as a typical vector which assimilates silicone. PMID:11702571
SlavÚcek, A; Betka, J; NovÃk, V; Kinkal, J; Wasserbauer, R; VymazalovÃ, Z; Last'ovickovÃ, B
New concepts -- biomechanical studies of a newly designed femoral prosthesis (cervico-trochanter prosthesis).
OBJECTIVE: A newly designed stemless (cervico-trochanter) prosthesis was developed for the purpose of reducing the incidence of the stress-shielding effect caused by the traditional stem-type prosthesis. DESIGN: Both mechanical test and three-dimensional finite element analysis were performed for comparing the differences of strain and stress distributions between the intact, C-T and PCA prosthetic femora. BACKGROUND: The stress-shielding effect and polyethylene (PE) wear debris were thought to be the main factors that resulted in local bone loss after the implantation of stem-type prostheses. In this study, we developed the new C-T prosthesis, which aimed to resolve the above-mentioned problems. METHODS: Six pairs of femora taken from human male cadavers were used to compare the strain magnitudes of intact (n = 12), C-T (n= 12) and PCA (n = 4) prosthetic femora in specific positions. Failure load tests of C-T (n = 8) and PCA (n = 12) prosthetic femora were also carried out from the load-displacement curve. The analysis of variance (ANOVA) test was used for statistical analysis. In addition, three-dimensional finite element stress analyses were performed using a commercial package, ANSYS, on a Convex 3810 computer. RESULTS: Both mechanical test and finite element results showed that the C-T prosthetic femora has a lower stress-shielding tendency than the PCA prosthetic femora (P < 0.001). The C-T prosthetic femora also withstood an average bearing load of 6312 N, which is greater than that of the PCA prosthesis at 5358 N (P < 0.01). CONCLUSIONS: The C-T prosthetic femur could withstand a higher failure load than the PCA prosthesis, which effectively reduced the incidence of the stress-shielding effect. Moreover, the particular design of the C-T prosthesis also reduced localized osteolysis because of the overall coverage of the neck-trochanteric area. PMID:11415758
Shih, Chun-Hsiung; Chen, Weng-Pin; Tai, Ching-Lung; Kuo, Rong-Fu; Wu, Chi-Chuan; Chen, Chih-Hwa
Oscillation and reaction board techniques for estimating inertial properties of a below-knee prosthesis.
The purpose of this study was two-fold: (1) demonstrate a technique that can be used to directly estimate the inertial properties of a below-knee prosthesis, and (2) contrast the effects of the proposed technique and that of using intact limb inertial properties on joint kinetic estimates during walking in unilateral, transtibial amputees. An oscillation and reaction board system was validated and shown to be reliable when measuring inertial properties of known geometrical solids. When direct measurements of inertial properties of the prosthesis were used in inverse dynamics modeling of the lower extremity compared with inertial estimates based on an intact shank and foot, joint kinetics at the hip and knee were significantly lower during the swing phase of walking. Differences in joint kinetics during stance, however, were smaller than those observed during swing. Therefore, researchers focusing on the swing phase of walking should consider the impact of prosthesis inertia property estimates on study outcomes. For stance, either one of the two inertial models investigated in our study would likely lead to similar outcomes with an inverse dynamics assessment. PMID:24837164
Smith, Jeremy D; Ferris, Abbie E; Heise, Gary D; Hinrichs, Richard N; Martin, Philip E
Influence of the weight actions of the hand prosthesis on the performance of pattern recognition based myoelectric control: preliminary study.
In transradial amputees, the muscles in the residual forearm naturally employed by the unimpaired for flexing/extending the hand fingers, are the most appropriate targets, for multi-fingered prostheses control. However, once the prosthetic socket is manufactured and fitted on the residual forearm, the recorded EMG might not be originated only by the intention of performing finger movements, but also by the muscular activity needed to sustain the prosthesis itself. In this work, we preliminary show--on healthy subjects wearing a prosthetic socket emulator--that (i) variations in the weight of the prosthesis, and (ii) upper arm movements significantly influence the robustness of a traditional classifier based on k-nn algorithm. We show in simulated conditions that traditional pattern recognition systems do not allow the separation of the effects of the weight of the prosthesis because a surface recorded EMG pattern caused by the simple lifting or moving of the prosthesis is misclassified into a hand control movement. This suggests that a robust classifier should add to myoelectric signals, inertial transducers like multi-axes position, acceleration sensors or sensors able to monitor the interaction forces between the socket and the end-effector. PMID:22254633
Cipriani, Christian; Sassu, Rossella; Controzzi, Marco; Carrozza, Maria Chiara
Nerve Injuries of the Upper Extremity
... Therapist? About ASSH Hand Safety Fireworks Lawnmowers Snowblowers Pumpkin Carving Gardening Turkey Carving Removing a Ring Hand ... Therapist? About ASSH Hand Safety Fireworks Lawnmowers Snowblowers Pumpkin Carving Gardening Turkey Carving Removing a Ring Hand ...
Vascular Disorders of the Upper Extremity
... Therapist? About ASSH Hand Safety Fireworks Lawnmowers Snowblowers Pumpkin Carving Gardening Turkey Carving Removing a Ring Hand ... Therapist? About ASSH Hand Safety Fireworks Lawnmowers Snowblowers Pumpkin Carving Gardening Turkey Carving Removing a Ring Hand ...
Primary Venous Obstruction of the Upper Extremity
Three cases of primary axillary and subclavian venous obstruction presented herein demonstrated the classic findings of swelling, aching or pain, and discoloration following effort in an otherwise healthy person. The clinical diagnosis was confirmed by venography. Residual changes were frequent after treatment that included anticoagulation and thrombectomy. ImagesFigure 1.Figure 2.Figure 3.Figure 4.Figure 5.Figure 6.Figure 7.
Rowen, Marshall; Dorsey, Thomas J.; Hepps, S. A.
Vascular Disorders of the Upper Extremity
... Hand Safety Fireworks Lawnmowers Snowblowers Pumpkin Carving Gardening Turkey Carving Removing a Ring Hand and Arm Conditions ... Hand Safety Fireworks Lawnmowers Snowblowers Pumpkin Carving Gardening Turkey Carving Removing a Ring Hand and Arm Conditions ...
Use of Jonas Silicon-Silver prosthesis in erectile impotence.
Eleven patients presenting over the last three years with erectile impotence who have been treated by the insertion of the Jonas Silicon-Silver penile prosthesis are reviewed. The insertion of this prosthesis is a minor procedure. It has a simple design, low cost, no permanent erection or mechanical problems and an excellent cosmetic and functional result.
Rowe, P H; Royle, M G
Magnet-retained facial prosthesis combined with maxillary obturator.
Prosthetic rehabilitation of the midfacial defects has always perplexed prosthodontists. These defects lead to functional and esthetic deficiencies. The purpose of this clinical case report was the presentation of the prosthetic rehabilitation of an extraoral-intraoral defect using two-piece prosthesis magnetically connected. This prosthesis has dramatically improved the patient's speech, mastication, swallowing, and esthetic. PMID:23738151
Hatami, Mahnaz; Badrian, Hamid; Samanipoor, Siamak; Goiato, Marcelo Coelho
Comparison of 2 temporomandibular joint total joint prosthesis systems
Purpose: The study goal was to evaluate the comparative outcomes of patients treated with temporomandibular joint (TMJ) total joint prostheses, using either the Christensen prosthesis (TMJ Inc, Golden, CO) (CP) or the TMJ Concepts prosthesis (TMJ Concepts Inc, Camarillo, CA; formerly Techmedica Inc) (TP). Patients and Methods: Forty-five consecutive patients treated with either CP or TP total joint prostheses were
Larry M. Wolford; Douglas J. Dingwerth; Reena M. Talwar; Marcos C. Pitta
Case Study surface reconstruction from point clouds for prosthesis production
Currently, the production of a high-quality and highly aesthetic prosthesis is still mainly based on handwork and subjective comparison to get the proper shape and colour of the prosthesis, likely not by a first attempt. This article describes a case study whose goal was to investigate the possibilities of computer-aided surface reconstruction and supplementation to improve the quality and reduce
N. Vukainovi?; T. Kolek; J. Duhovnik
Clinical Results with the Bjork-Shiley Heart Valve Prosthesis.
National Technical Information Service (NTIS)
A description of the Bjork-Shiley heart valve prosthesis and its haemodynamic properties is given. An analysis of the clinical results achieved with this prosthesis over a period of 42 months with over 750 valves is presented. A selected group of these pa...
T. G. O'Donovan
[Construction of a prosthesis with wire force distribution].
The various stages and technique for the construction of a partial removable prosthesis based on the wire force distribution is possible to obtain an individual prosthesis suitable for every patient, something that is not possible with other conventional systems, such as prefabricated fittings. PMID:7005659
Pezzoli, M; Borio, P S; Toscano, E
Transitional prosthesis for a dentulous hemimaxillectomy patient
Hemimaxillectomy patients present with abrupt alterations in the physiologic processes of the maxillae, along with increased anxiety levels due to sudden impairment in esthetics, mastication, speech, deglutition and hypernasal speech. Such patients should be rehabilitated as early as possible, in the postoperative phase with the help of careful preoperative planning by the surgeon and the prosthodontist. This case report illustrates the multidisciplinary approach to rehabilitate a patient, who had undergone maxillectomy on the right side, due to carcinoma alveolus. The transitional prosthesis given in this case used Tissue conditioners, which, because of their viscoelastic nature, ensure continuous adaptation, helping peripheral seal and retention. This greatly reduces discomfort and nasal reflux and improves speech.
Singh, Ajay; Kumar, Neeraj; Singh, Vibha; Singh, S. K.
Auricular Prosthesis-A Case Report
Loss of facial organs in an individual may be developmental anomalies or acquired. The missing parts of the face ear, eyes and nose are considered as maxillofacial defects which can be rehabilitated by the prosthesis and/or cosmetic surgeries. This art of science has developed into a more reliable and predictable process due to ever increasing development of materials and equipments used in the procedure. This article describes a simple technique to rehabilitate patients with auricular defects which are both aesthetically acceptable and economical for the individual.
Ravuri, Rajyalakshmi; Bheemalingeshwarrao; Tella, Suchita; Thota, Kiran
Simplified Design Equations for Class-E Neural Prosthesis Transmitters
Extreme miniaturization of implantable electronic devices is recognized as essential for the next generation of neural prostheses, owing to the need for minimizing the damage and disruption of the surrounding neural tissue. Transcutaneous power and data transmission via a magnetic link remains the most effective means of powering and controlling implanted neural prostheses. Reduction in the size of the coil, within the neural prosthesis, demands the generation of a high-intensity radio frequency magnetic field from the extracoporeal transmitter. The Class-E power amplifier circuit topology has been recognized as a highly effective means of producing large radio frequency currents within the transmitter coil. Unfortunately, design of a Class-E circuit is most often fraught by the need to solve a complex set of equations so as to implement both the zero-voltage-switching and zero-voltage-derivative-switching conditions that are required for efficient operation. This paper presents simple explicit design equations for designing the Class-E circuit topology. Numerical design examples are presented to illustrate the design procedure.
Troyk, Philip; Hu, Zhe
Prototype to productdeveloping a commercially viable neural prosthesis
NASA Astrophysics Data System (ADS)
The Cochlear implant or 'Bionic ear' is a device that enables people who do not get sufficient benefit from a hearing aid to communicate with the hearing world. The Cochlear implant is not an amplifier, but a device that electrically stimulates the auditory nerve in a way that crudely mimics normal hearing, thus providing a hearing percept. Many recipients are able to understand running speech without the help of lipreading. Cochlear implants have reached a stage of maturity where there are now 170 000 recipients implanted worldwide. The commercial development of these devices has occurred over the last 30 years. This development has been multidisciplinary, including audiologists, engineers, both mechanical and electrical, histologists, materials scientists, physiologists, surgeons and speech pathologists. This paper will trace the development of the device we have today, from the engineering perspective. The special challenges of designing an active device that will work in the human body for a lifetime will be outlined. These challenges include biocompatibility, extreme reliability, safety, patient fitting and surgical issues. It is emphasized that the successful development of a neural prosthesis requires the partnership of academia and industry.
Seligman, Peter
Satisfaction and problems experienced with wrist movements: comparison between a common body-powered prosthesis and a new biomechatronics prosthesis.
This report compares wrist supination and pronation and flexion and extension movements with the common body-powered prosthesis and a new biomechatronics prosthesis with regard to patient satisfaction and problems experienced with the prosthesis. Fifteen subjects with traumatic transradial amputation who used both prosthetic systems participated in this study. Each subject completed two questionnaires to evaluate their satisfaction and problems experienced with the two prosthetic systems. Satisfaction and problems with the prosthetic's wrist movements were analyzed in terms of the following: supination and pronation; flexion and extension; appearance; sweating; wounds; pain; irritation; pistoning; smell; sound; durability; and the abilities to open a door, hold a cup, and pick up or place objects. This study revealed that the respondents were more satisfied with the biomechatronics wrist prosthesis with regard to supination and pronation, flexion and extension, pain, and the ability to open a door. However, satisfaction with the prosthesis showed no significant differences in terms of sweating, wounds, irritation, pistoning, smell, sound, and durability. The abilities to hold a cup and pick up or place an object were significantly better with the body-powered prosthesis. The results of the survey suggest that satisfaction and problems with wrist movements in persons with transradial amputation can be improved with a biomechatronics wrist prosthesis compared with the common body-powered prosthesis. PMID:24429510
Abd Razak, N A; Abu Osman, N A; Kamyab, M; Wan Abas, W A B; Gholizadeh, H
Extreme Rainfall Rates: An Extreme Retrieval Challenge
NASA Astrophysics Data System (ADS)
One of the greatest challenges in remote sensing, from space, or from surface-based measurements, is making accurate estimates of extremely heavy rainfall rates. These extreme rainfall rates, quite understandably, often are responsible for natural disasters that include flooding and landslides. The particular focus of this talk is to demonstrate that extreme rainfall rates can come from two distinctly different types of storms, and to show that the TRMM Precipitation Radar retrievals may have large errors in these storms. One type of extreme storm occurs more frequently in the United States than in Japan, and is characterized by very high radar reflectivity throughout the depth of the troposphere. The second type of extreme storm is characterized by a "low echo centroid", with relatively weak radar echoes in the upper troposphere, and may be more amenable to accurate rain rate retrievals. The first type of storm presents more difficulties for retrievals because of the much greater total path attenuation. Some examples of both types of storms are shown in both the United States and Japan.
Zipser, E. J.; Liu, C.; Hamada, A.; Takayabu, Y. N.
Photovoltaic Retinal Prosthesis with High Pixel Density
Retinal degenerative diseases lead to blindness due to loss of the image capturing photoreceptors, while neurons in the image processing inner retinal layers are relatively well preserved. Electronic retinal prostheses seek to restore sight by electrically stimulating surviving neurons. Most implants are powered through inductive coils, requiring complex surgical methods to implant the coil-decoder-cable-array systems, which deliver energy to stimulating electrodes via intraocular cables. We present a photovoltaic subretinal prosthesis, in which silicon photodiodes in each pixel receive power and data directly through pulsed near-infrared illumination and electrically stimulate neurons. Stimulation was produced in normal and degenerate rat retinas, with pulse durations from 0.5 to 4 ms, and threshold peak irradiances from 0.2 to 10 mW/mm2, two orders of magnitude below the ocular safety limit. Neural responses were elicited by illuminating a single 70 ?m bipolar pixel, demonstrating the possibility of a fully-integrated photovoltaic retinal prosthesis with high pixel density.
Mathieson, Keith; Loudin, James; Goetz, Georges; Huie, Philip; Wang, Lele; Kamins, Theodore I.; Galambos, Ludwig; Smith, Richard; Harris, James S.; Sher, Alexander; Palanker, Daniel
Development of the boston retinal prosthesis.
A small, hermetic, wirelessly-controlled retinal prosthesis was developed for pre-clinical studies in Yucatan mini-pigs. The device was implanted on the outside of the eye in the orbit, and it received both power and data wirelessly from external sources. The prosthesis drove a sub-retinal thin-film array of sputtered iridium oxide stimulating electrodes. The implanted device included a hermetic titanium case containing the 16-channel stimulator chip and discrete circuit components. Feedthroughs in the hermetic case connected the chip to secondary power- and data-receiving coils, which coupled to corresponding external power and data coils driven by a power amplifier. Power was delivered by a 500 KHz carrier, and data were delivered by frequency shift keying. Stimulation pulse strength, duration and frequency were programmed wirelessly from an external computer system. Through an 'outbound' telemetry channel, electrode impedances were monitored by an on-board analog to digital converter that sampled the output voltage waveforms. The final assembly was tested in vitro in physiological saline and in vivo in two mini-pigs for up to three months by measuring stimulus artifacts generated by the implant's current drivers. PMID:22255004
Rizzo, Joseph F; Shire, Douglas B; Kelly, Shawn K; Troyk, Phil; Gingerich, Marcus; McKee, Bruce; Priplata, Attila; Chen, Jinghua; Drohan, William; Doyle, Patrick; Mendoza, Oscar; Theogarajan, Luke; Cogan, Stuart; Wyatt, John L
Effects of porous coating and collar support on early load transfer for a cementless hip prosthesis.
We used a new postprocessing method with the results from a three-dimensional finite element analysis to describe the general load transfer patterns for a cementless hip arthroplasty in the early postoperative situation, and to determine the effects of porous coating [full, partial (2/3), and none] and calcar-collar support (ideal initial contact with separation allowed upon loading, no collar) on this early load transfer. No-tension interfaces were modeled over the entire bone-prosthesis interface, with an upper bound on the Coulomb-friction over coated surfaces, and zero friction over smooth surfaces to accentuate the frictional effects of the coating. The results indicate that the anteroposterior, mediolateral, and axial forces acting on each cross section of the bone were substantially different from the corresponding homeostatic (no prosthesis) forces for the fully coated device with collar support. The frontal bending moments acting on the bone were substantially less than the homeostatic values all along the prosthesis, while the sagittal bending and torsional loads were relatively similar to the homeostatic values. By far, the largest change in these loading patterns occurred with the loss of collar support, where axial loads acting on the bone were so low that over half the bone was in net tension because appreciable transfer of the compressive head force did not occur until well below the lesser trochanter. Both axial and torsional loads were transferred more distally for devices with more coating, and torsional loading of the bone was also sensitive to the degree of collar support. The frontal bending moments acting over most of the bone were insensitive to the coating or collar support. The strain energy density in the endosteal bone was most sensitive to these design variables in the proximal region, and the largest values occurred without a collar and without coating. These findings indicate that all load components acting on the proximal bone in the early postoperative situation (no bone-ingrowth or fibrous tissue at the interface) are altered by the frictional coefficient of the bone-prosthesis interface (i.e. the presence of porous coating or some other surface treatment) and the degree of collar support, while only the axial and torsional loads are altered in the distal bone. From a prosthesis design perspective this implies that surface treatments and collar support can be used to control the axial forces and the torsional moments acting all along the bone. By contrast, the distal frontal bending moment, which dominates stresses in the diaphysis, cannot be altered by these design variables. PMID:8253825
Keaveny, T M; Bartel, D L
[Obturator dislocation--a rare complication of the total hip prosthesis. Case study].
The article presents the case of a 55-year-old patient with an injury of the right leg, which was due to a falling lightly at her buttocks during squatting. Patient was transferred to hospital with complaints of severe pain and limited motion in her right hip. In view of the patient's clinical status and following radiological diagnostic work-up, she was diagnosed with femoral neck fractures, the decision was made to perform a primary total hip arthroplasty (THA) using an lateral approach in the lateral decubitus position. A good clinical and radiological outcome was achieved. Patient after 12 days without complications was released home. After 4 days being home she was transferred to hospital again with complaints of severe pain and limited motion in her operated hip. On admission, her right lower leg was lying in an extremely rotated and abducted position. However, the extremity was neurologically intact with good pedal pulses. Physical examination and an initial anteroposterior radiograph showed obturator dislocation of the hip prosthesis. The decision was made to perform an open reduction. The operative problem in this particular case was removing the head of the prosthesis from the obturator foramen without making any jatrogenic harm. PMID:22420183
Niciejewski, Krzysztof; Banachowski, Witold; Kowalczyk, Adam
Italian Biological Prosthesis Work-Group (IBPWG): proposal for a decisional model in using biological prosthesis
Introduction Indications for repair of abdominal hernia are well established and widely diffused. Controversies still exist about the indication in using the different prosthetic materials and principally about the biological ones. Material and methods In February 2012, the Italian Biological Prosthesis Work-Group (IBPWG), counting a background of 264 biologic implants, met in Bergamo (Italy) for 1-day meeting with the aim to elaborate a decisional model on biological prosthesis use in abdominal surgery. Results A diagram to simplify the decisional process in using biologics has been elaborated. Conclusion The present score represents a first attempt to combine scientific knowledge and clinical expertise in order to offer precise indications about the kind of biological mesh to use.
Design and Implementation of an Intelligent Interface for Myoelectric Controlled Prosthesis.
National Technical Information Service (NTIS)
In this paper, a discrimination system, using a neural network for electromyographic (EMG) externally controlled upper extremity prostheses is proposed. In this system, the Artificial Neural Network (ANN) is used to learn the relation between the power sp...
V. Barrero V. Grisales F. Rosas C. Sanchez J. Leon
A canine cementless total hip prosthesis model.
To evaluate a porous fiber titanium composite as a fixation method, total hip arthroplasty was performed in 13 large male mongrel dogs. In seven both acetabular and femoral composites were fixed with a porous titanium fiber composite, and in the other six the acetabulum was fixed with acrylic cement. The animals were killed one, three, and six months following implantation. At autopsy all components were fixed by bony ingrowth. There was progressive remodeling of the ingrown bone and of the bone trabeculae surrounding the prosthesis in the three- and six-month animals, with gradual thickening and development of haversian structures. Cortical osteoporosis, which did not appear to be progressive, was detected in both the one- and six-month specimens. PMID:6851333
Chen, P Q; Turner, T M; Ronnigen, H; Galante, J; Urban, R; Rostoker, W
Galvanic gold plating for fixed dental prosthesis
Metal ceramic partial fixed dental prostheses have been commonly used for the replacement of missing teeth for many years. Because of an increase in the price of gold, base metal alloys have been the choice of alloy for the fabrication of metal ceramic restorations in many dental clinics. Some major disadvantages of base metals are their corrosion and the dark coloration they may cause at the crown margins. This article describes a galvanic gold-plating technique, which is used to minimize corrosion and improve the esthetics of metal ceramic restorations fabricated with Cr-Co base metal alloys. This technique involves the deposition of a 6 ?m to 8 ?m 24 K gold layer directly onto the Cr-Co cast prosthesis framework. The technique improves metal surface properties, making them more biocompatible and usable, however, requires additional equipment and experienced laboratory technicians. Clinical studies should be performed to corroborate the long term success of this technique.
Ozcelik, Tuncer Burak; Yilmaz, Burak
Development of a micromachined epiretinal vision prosthesis
NASA Astrophysics Data System (ADS)
Microsystems engineering offers the tools to develop highly sophisticated miniaturized implants to interface with the nervous system. One challenging application field is the development of neural prostheses to restore vision in persons that have become blind by photoreceptor degeneration due to retinitis pigmentosa. The fundamental work that has been done in one approach is presented here. An epiretinal vision prosthesis has been developed that allows hybrid integration of electronics on one part of a thin and flexible substrate. Polyimide as a substrate material is proven to be non-cytotoxic. Non-hermetic encapsulation with parylene C was stable for at least 3 months in vivo. Chronic animal experiments proved spatially selective cortical activation after epiretinal stimulation with a 25-channel implant. Research results have been transferred successfully to companies that currently work on the medical device approval of these retinal vision prostheses in Europe and in the USA.
Stieglitz, Thomas
Image analysis for microelectronic retinal prosthesis.
By way of extracellular, stimulating electrodes, a microelectronic retinal prosthesis aims to render discrete, luminous spots-so-called phosphenes-in the visual field, thereby providing a phosphene image (PI) as a rudimentary remediation of profound blindness. As part thereof, a digital camera, or some other photosensitive array, captures frames, frames are analyzed, and phosphenes are actuated accordingly by way of modulated charge injections. Here, we present a method that allows the assessment of image analysis schemes for integration with a prosthetic device, that is, the means of converting the captured image (high resolution) to modulated charge injections (low resolution). We use the mutual-information function to quantify the amount of information conveyed to the PI observer (device implantee), while accounting for the statistics of visual stimuli. We demonstrate an effective scheme involving overlapping, Gaussian kernels, and discuss extensions of the method to account for shortterm visual memory in observers, and their perceptual errors of omission and commission. PMID:18232379
Hallum, L E; Cloherty, S L; Lovell, N H
Development of a micromachined epiretinal vision prosthesis.
Microsystems engineering offers the tools to develop highly sophisticated miniaturized implants to interface with the nervous system. One challenging application field is the development of neural prostheses to restore vision in persons that have become blind by photoreceptor degeneration due to retinitis pigmentosa. The fundamental work that has been done in one approach is presented here. An epiretinal vision prosthesis has been developed that allows hybrid integration of electronics on one part of a thin and flexible substrate. Polyimide as a substrate material is proven to be non-cytotoxic. Non-hermetic encapsulation with parylene C was stable for at least 3 months in vivo. Chronic animal experiments proved spatially selective cortical activation after epiretinal stimulation with a 25-channel implant. Research results have been transferred successfully to companies that currently work on the medical device approval of these retinal vision prostheses in Europe and in the USA. PMID:19850975
Stieglitz, Thomas
Self retentive partial silicone auricular prosthesis: a case report.
An auricular prosthesis may be required for a number of conditions including congenital abnormalities, malignancy and trauma, which result in disfigurement of the pinna. Whatever the cause of the absence of the pinna, it is a significant loss of a prominent part of the face for the person involved. This article describes a simple and cost effective technique for retention of a silicone partial auricular prosthesis. A Fish-bone shaped substructure (FSS) designed and fabricated using orthodontic wire and autopolymerizing acrylic resin, was embedded into the silicone elastomer of a self-retentive silicone prosthesis. The prosthesis is designed to overcome the disadvantages associated with traditionally fabricated prostheses; namely poor structural strength, inadequate retention, poor adaptation and durability over time. PMID:22852524
Patil, P G; Tagore, M; Jaiswal, N; Puri, S
21 CFR 888.3025 - Passive tendon prosthesis.
Code of Federal Regulations, 2010 CFR
...SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices ôÏ 888.3025 Passive tendon prosthesis. (a...use in the surgical reconstruction of a flexor tendon of the hand. The device is implanted for a period of 2 to 6...
21 CFR 888.3025 - Passive tendon prosthesis.
Code of Federal Regulations, 2010 CFR
...SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices ôÏ 888.3025 Passive tendon prosthesis. (a...use in the surgical reconstruction of a flexor tendon of the hand. The device is implanted for a period of 2 to 6...
21 CFR 888.3720 - Toe joint polymer constrained prosthesis.
Code of Federal Regulations, 2010 CFR
A toe joint polymer constrained prosthesis is a device made of silicone elastomer or polyester reinforced silicone elastomer intended to be implanted to replace the first metatarsophalangeal (big toe)...
21 CFR 888.3720 - Toe joint polymer constrained prosthesis.
Code of Federal Regulations, 2010 CFR
A toe joint polymer constrained prosthesis is a device made of silicone elastomer or polyester reinforced silicone elastomer intended to be implanted to replace the first metatarsophalangeal (big toe)...
[Experiences with the isoelastic prosthesis in treatment of humerus metastases].
39 patients with pathological fractures of the humerus were treated by isoelastic polyacetal endoprosthesis. Ten patients received a humeral-head-prosthesis and 32 a prosthesis of the humeral-shaft. The average survival time was nine months. Three times within the first group of twelve patients fracture of the cone of the prosthesis occurred. Therefore an additional stabilization of the contact zone between bone and prosthesis by plate-osteosynthesis was performed in the following 20 operations, preventing breakage of the material. In contrast to the conventional posterior approach to the humeral-shaft we chose a ventrolateral approach between the biceps and triceps muscle. This technique is less traumatic and leads to a shorter operation time. In patients with pathological humeral fractures a conception of treatment is demonstrated which provides an immediate stability by using endoprostheses to preserve the quality of life of oncological patients. PMID:1440999
Hertlein, H; Sch■rmann, M; Mittlmeier, T; Lob, G
21 CFR 872.3940 - Total temporomandibular joint prosthesis.
Code of Federal Regulations, 2010 CFR
... A total temporomandibular joint prosthesis is a device that is intended to be implanted in the human jaw to replace the mandibular condyle and augment the glenoid fossa to functionally reconstruct the temporomandibular joint. (b) Classification....
21 CFR 878.3800 - External aesthetic restoration prosthesis.
Code of Federal Regulations, 2013 CFR
... FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices ôÏ 878.3800 External aesthetic restoration prosthesis. (a) Identification....
21 CFR 878.3750 - External prosthesis adhesive.
Code of Federal Regulations, 2013 CFR
... FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices ôÏ 878.3750 External prosthesis adhesive. (a) Identification. An external...
[The research progress on microelectrode array (MEA) of retinal prosthesis].
This review paper presents the current research progress, challenges and future development on microelectrode array of retinal prosthesis, including epi-retinal and sub-retinal implants. PMID:21179713
Li, Tianao; Cao, Zheng; Sui, Xiaohong; Jiang, Xia; Ren, Qiushi; Chai, Xinyu
The innervation of the lower extremity comes from the lumbar and sacral plexuses. The different nerve elements of the lower extremity run more distant from each other than those of the upper extremity, and they never get to be confined to a small surface area like the trunks of the brachial plexus do. Therefore, no single peripheral block technique is
Carlo D. Franco
NSDL National Science Digital Library
This site contains facts about the most extreme places in the world: the highest and lowest places, the places of weather extremes, and the places setting water records. There are also facts about the youngest mountain in the world, the largest desert, the flattest and driest continent, and the strongest earthquake in the world.
Hearing Results After Stapedotomy With a Nitinol Piston Prosthesis
Main Outcome Measures: The operative records of the senior surgeon (B.J.G.) were retrospectively reviewed, and hearing results were obtained. The hearing results of thepatientswhoreceivedaplatinumwireprosthesiswere compared with those who received a nitinol prosthesis. Results: Results for the platinum wire prosthesis group revealed a postoperative mean (SD) air-bone gap (ABG) of 7 (6) dB, a mean (SD) ABG closure of 21 (12)
Kevin D. Brown; Bruce J. Gantz
Intraoral-extraoral combination prosthesis: improving retention using interconnecting magnets.
Osseointegrated implants have been well documented for retaining an obturator prosthesis as well as a facial prosthesis. However, when the defect extends to both the facial area and the maxilla, it is difficult to rehabilitate those defects to the satisfaction of the patient, especially in cases where implants cannot be placed on both sites. This case report describes the use of magnets to connect two prostheses, thereby increasing retention and patient comfort. PMID:24905272
Engelen, Marloes; van Heumen, Celeste C M; Merkx, Matthias A W; Meijer, Gert J
Esthetic interim acrylic resin prosthesis reinforced with metal casting.
Fabrication of an interim prosthesis is an important procedure in oral rehabilitation because it aids in determining the esthetics, phonetics, and occlusal relationship of the definitive restoration. The typical material (acrylic resin) used in interim prostheses commonly fails due to fractures. During extended oral rehabilitation with fixed partial prostheses, high strength interim prostheses are often required to protect hard and soft tissues, avoid dental mobility, and to allow the clinician and patient a chance to evaluate cosmetics and function before the placement of the definitive prosthesis. Furthermore, a satisfactory interim prosthesis can serve as a template for the construction of the definitive prosthesis. The maintenance of this prosthesis is important during treatment for protection of teeth and occlusal stability. Procedures to reinforce interim prostheses help to improve performance and esthetics in long-term treatment. Due to the low durability of acrylic resin in long-term use, the use of reinforcing materials, such as metal castings or spot-welded stainless steel matrix bands, is indicated in cases of extensive restoration and long-term treatment. This paper describes an easy technique for fabricating a fixed interim prosthesis using acrylic resin and a cast metallic reinforcement. PMID:19519710
Verri, Fellippo Ramos; Pellizzer, Eduardo Piza; Mazaro, JosÕ Vitor Quinelli; de Almeida, Erika Oliveira; Antenucci, Rosse Mary Falcµn
[A new self-retaining titanium-gold stapes prosthesis].
Various aspects of stapes surgery have been improved since its introduction in 1958 by Shea. However, fixation of the prosthesis on the long process of the incus remains difficult. Furthermore, the functional result of crimping cannot be predicted. Necrosis of the lenticular process still occurs. A new stapes prosthesis has been developed with the Kurz Co. The use of titanium allowed an innovative design: titanium has a shape memory, and a clip was constructed which uses this memory for fixation on the incus. Two new instruments were also developed to facilitate application of the prosthesis: a prosthesis inserter and a prosthesis crimper. The clip does not strangulate the incus; it is attached only to the superior and inferior surface of the incus, which are the crucial locations for mechanical transmission of the piston-like movements of the ossicular chain. Avoidance of circumferential attachment should reduce the risk of incus necrosis. Once the clip is pushed onto the incus no further crimping is necessary. The piston is of pure gold, as in this company's gold piston which has been in use for many years. In future the prosthesis may be all-titanium. PMID:10780081
aWengen, D F
Ischemic Gangrene of the Glans following Penile Prosthesis Implantation
The development of ischemic gangrene of the penis following implantation of prosthesis is unusual, and very few cases are available in the literature. As a result, no established treatment protocol is available. We report our experience within a case of gangrene of the glans following implantation of a three-component prosthesis. We present a 53-year-old male, smoker with diabetes and hypercholesterolemia, who underwent surgery for the insertion of a penile prosthesis with 3 components to correct his erectile dysfunction and severe Peyronie's disease. The procedure was carried out without incidents. During the postoperative period, the patient began to complain from penile and perineal pain. He developed avascular necrosis of the glans. The necrosed area was excised. Four weeks later, he developed fever and perineal pain arriving to the emergency room with the prosthesis extruding through the glans. He had emergency surgery to remove the prosthesis plus surgical lavage and was prescribed broad-spectrum antibiotic therapy. Four weeks later, the penis was completely revascularized and reepithelialized. Ischemic gangrene following penile prosthesis implantation takes place in patients with poor peripheral vascularisation. Diabetes mellitus has been the common denominator to all of the reported cases.
Garcia Gomez, Borja; Romero Otero, Javier; Diez Sicilia, Laura; Jimenez Alcaide, Estibaliz; Garcia-Cruz, Eduardo; Rodriguez Antolin, Alfredo
Midterm outcomes of total cervical total disc replacement with Bryan prosthesis.
Short-term results have indicated that the Bryan cervical total disc replacement (TDR) favorably compares to anterior cervical decompression and fusion, while it is associated with fewer complications and higher levels of satisfaction. The aim of the present work was to assess the safety and efficacy of the device in the treatment for cervical degenerative disc disease, at 6-year follow-up. Fifty-eighty patients have performed their 6-year follow-up visit and have been analyzed clinically and radiologically. Clinical evaluation was based on neck disability index (NDI), visual analog scale (VAS), SF-36, and range of motion (ROM) at index levels. Each measurement was taken preoperatively and at 3 months, 6 months, 1 year, 3 years, and 6 years postoperatively. Complications and re-operations were also investigated. Occurrences of heterotopic ossifications (HO) and of adjacent level degeneration were detected by radiographs at 6-year follow-up. The mean NDI and VAS scores for arm and neck were significantly reduced for all postoperative periods compared with the average preoperative values. Motion was preserved at index levels (mean ROM = 8.6¯ Ý 0.2¯ at 6 years), and 81.3 % of the segments were mobile at 6 years. HO was evident in 12/64 operated segments and not restricting the movement of the prosthesis in any case at 6-year follow-up. Six of sixty-four upper adjacent levels and 4/64 lower adjacent levels showed a slight degradation. There was 2 case of posterior migration of the prosthesis, which did not cause any clinical symptoms. No case showed evidence of subsidence, wear of the implant. At a 6-year follow-up, the cervical TDR using Bryan prosthesis displayed satisfactory clinical and radiographic outcomes without any significant complication. However, future efforts need to be directed toward the evaluation of a larger number of patients with longer follow-up. PMID:24515394
Zhang, Zhenxiang; Zhu, Wei; Zhu, Lixian; Du, Yaqing
Management of abnormal uterine bleeding in women with mechanical heart valve prosthesis and anticoagulant therapy.
In a prospective observational case series, we assessed the effects and management and outcome of oral anticoagulant associated abnormal uterine bleeding in women with mechanical heart valve prosthesis. Six women with mechanical heart valve prosthesis, who were admitted with persistent severe vaginal bleeding between 2003 and 2010, were evaluated. For each woman, detailed history, treatment received, if there was any complication and their final outcome and satisfaction were recorded. All the 6 women were parous, with their ages ranging from 27 to 50 years. They were receiving oral anticoagulant therapy for mechanical heart valve prosthesis. Of the 6 women, 4 had uterine fibroids, and the other 2 had dysfunctional uterine bleeding.Three patients with uterine fibroids underwent abdominal hysterectomy, and one underwent balloon thermal ablation of endometrium. While 1 patient with dysfunctional uterine bleeding underwent hysterectomy, the other patient desirous for further children, required levonorgestrel intra-uterine system. Two women requiring hysterectomy, developed postoperative complications, one a massive intraperitoneal haemorrhage and another a rectus sheath haematoma. At follow-up, 5 women were satisfied, and 1 woman had died suddenly at home 1 year after hysterectomy. Because of the twin problem of heart disease and anticoagulant therapy, treatment of abnormal vaginal bleeding in these women is extremely challenging. Although medical treatment yields only temporary relief, endometrial ablative procedures or levonorgestrel intra-uterine system provides more durable solution. As anticoagulant associated peri-operative haemorrhage can be potentially fatal, hysterectomy should be reserved for women with major pelvic pathologies. Proper counselling and integrated management involving gynaecologist, cardiologist, haematologist and anaesthesiologist is essential to tackle this problem. PMID:23469574
Saha, Pradip Kumar; Rakshit, Bibek Mohan; Jana, Narayan; Dutta, Sanjib; Roy, Subesha Basu; Sengupta, Gautam
Extremely compliant and highly stretchable patterned graphene
NASA Astrophysics Data System (ADS)
Graphene is intrinsically ultra-stiff in its plane. Its huge mechanical mismatch when interfacing with ultra-compliant biological tissues and elastomers (7-9 orders of magnitude difference in stiffness) poses significant challenge in its application to functional devices such as epidermal electronics and sensing prosthesis. We offer a feasible and promising solution to this significant challenge by suitably patterning graphene into a nanomesh. Through systematic coarse-grained simulations, we show that graphene nanomesh can be made extremely compliant with nearly zero stiffness up to about 20% elongation and then remain highly compliant up to about 50% elongation.
Zhu, Shuze; Huang, Yinjun; Li, Teng
21 CFR 888.3330 - Hip joint metal/metal semi-constrained, with an uncemented acetabular component, prosthesis.
Code of Federal Regulations, 2010 CFR
...semi-constrained, with an uncemented acetabular component, prosthesis. 888.3330...semi-constrained, with an uncemented acetabular component, prosthesis. (a) Identification...semi-constrained, with an uncemented acetabular component, prosthesis is a...
21 CFR 888.3330 - Hip joint metal/metal semi-constrained, with an uncemented acetabular component, prosthesis.
Code of Federal Regulations, 2010 CFR
...semi-constrained, with an uncemented acetabular component, prosthesis. 888.3330...semi-constrained, with an uncemented acetabular component, prosthesis. (a) Identification...semi-constrained, with an uncemented acetabular component, prosthesis is a...
21 CFR 888.3320 - Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis.
Code of Federal Regulations, 2010 CFR
...semi-constrained, with a cemented acetabular component, prosthesis. 888.3320...semi-constrained, with a cemented acetabular component, prosthesis. (a) Identification...semi-constrained, with a cemented acetabular component, prosthesis is a...
21 CFR 888.3320 - Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis.
Code of Federal Regulations, 2010 CFR
...semi-constrained, with a cemented acetabular component, prosthesis. 888.3320...semi-constrained, with a cemented acetabular component, prosthesis. (a) Identification...semi-constrained, with a cemented acetabular component, prosthesis is a...
Hemiarthroplasty of the shoulder joint using a custom-designed high-density nano-hydroxyapatite/polyamide prosthesis with a polyvinyl alcohol hydrogel humeral head surface in rabbits.
In this study, a novel custom-designed high-density nano-hydroxyapatite/polyamide (n-HA/PA) prosthesis with a polyvinyl alcohol (PVA) hydrogel humeral head surface was employed to repair the shoulder joint head for hemiarthroplasty in rabbits. The prosthesis was fabricated using three-dimensional computed tomography and computer-aided design and computer-aided manufacturing systems for perfect fitting. Sixteen New Zealand white rabbits underwent humeral head excision, and received the composite prostheses for hemiarthroplasty. The implant sites were free from suppuration and necrosis at all periods. The X-ray results showed that there was a clear space between the prosthesis head and the glenoid surface, and the joint capsules and surfaces of the glenoid and PVA were well preserved without any damage during the whole inspection period. A high density of bone was observed around the firmware part of the prosthesis. Histological results revealed that significant osteogenesis was surrounding the firmware part, and the joint space was clear and the cartilage of the upper joint surface was basically intact. There was no visible absorption of the joint surfaces even after 3 months of continuous functional motions. The maximum tensile strength between the prosthesis and host bone reached 2.63?MPa at the 12th week postimplantation. In conclusion, the customized prosthesis by combination of PVA and high-density n-HA/PA has excellent biocompatibility and biological fixation, and offers a promising substitute for both the cartilage and the bone of the humeral head in a rabbit model as level V evidence. PMID:24404998
Guo, Yongwen; Guo, Jun; Bai, Ding; Wang, Hang; Zheng, Xiaohui; Guo, Weihua; Tian, Weidong
[Our experience with medial unicondylar knee prosthesis].
The indications for unicondylar knee replacement for osteoarthritis are discussed. Its theoretical advantages against total knee replacement are the small size of the implants, an easier operative technique and faster rehabilitation. But some surgeons assume that tibial osteotomy has the same indications and gives the same long-term results while preserving the natural joint.52 medial resurfacing unicondylar knee prostheses have been followed for a mean time of 4 years, with a minimum of 1 year. There were 16 males and 31 females, with a mean age of 70 years (range 65 to 83 years). The indication was primary (37 cases) or post-traumatic (2 cases) osteoarthritis and necrosis of the medial femoral condyle (13 cases). The Cartier-Mansat prosthesis was most frequently used.Four prostheses were revised because of unexplained pain (1 case), aseptic loosening (2 cases) or osteoarthritic change in the opposite compartment (1 case). 48 prostheses were still in place at the time of this study. The results were studied with Hungerford's classification, giving the knee joint a maximum score of 100 points.Mean pain score was 42/50, and only 4 patients had significant pain. No abnormal laxity was seen. 45 patients had complete extension, and 3 a deficit between 5 and 10¯. 43 patients had over 90¯ flexion. Quadriceps force was always normal. Only 23 patients had a normal mechanical axis measured on a monopedal stance view, while 19 had a remaining varus deformation and 4 an overcorrection. The mean global score was 85/100, and 33 of the 39 patients with no missing item had a global score over 80/100.Objective and subjective results were very satisfactory. But we were not so pleased with the radiological appearance of the prosthesis. Malposition of both prosthetic components, including global limb malalignment, malalignment of one or both implants, incongruency of both implants or lowering of the joint space with reference to lateral compartment, were very common. The actual influence of these malpositions are not known, but is likely to be significant and the long term survival remains then questionable. A more precise operative technique could decrease the incidence of this disadvantage. PMID:24193424
Jenny, J Y; Jenny, G; Brax, M
An Harmonic Smile Resulted from the Use of Ceramic Prosthesis with Zirconia Structure: A Case Report
The rehabilitation of patients requiring an esthetic smile demands a multidisciplinary approach. This clinical report describes a treatment plan for recovery aesthetics smile of anterior teeth using ceramic prosthesis with zirconia structure. Initially, a review of aesthetic parameters, diagnostic waxing, mock-up and provisional restorations was performed. A contextual assessment of aesthetic, proportion and shape of teeth was done to recreate a natural looking for teeth in consonance with the smile line. Subsequently, based on these parameters, fixed prostheses of the upper anterior teeth using ceramic restorations with zirconia infrastructures were performed. The use of ceramic restorations with zirconia structures associated with a careful treatment plan allows the professional to integrate esthetic and function for satisfactory clinical results. How to cite the article: Tavarez RR, GonÓalves LM, Dias AP, Dias AC, Malheiros AS, Silva AC, Bandeca MC. An harmonic smile resulted from the use of ceramic prosthesis with zirconia structure: A case report. J Int Oral Health 2014;6(3):90-2.
Tavarez, Rudys Rodolfo de Jesus; Goncalves, Leticia Machado; Dias, Ana Paula; Dias, Anna Claudia Pereira; Malheiros, Adriana Santos; Silva, Alice Carvalho; Bandeca, Matheus Coelho
Proportional EMG control of ankle plantar flexion in a powered transtibial prosthesis.
The human calf muscle generates 80% of the mechanical work to walk throughout stance-phase, powered plantar flexion. Powered plantar flexion is not only important for walking energetics, but also to minimize the impact on the leading leg at heel-strike. For unilateral transtibial amputees, it has recently been shown that knee load on the leading, intact limb decreases as powered plantar flexion in the trailing prosthetic ankle increases. Not surprisingly, excessive loads on the leading, intact knee are believed to be causative of knee osteoarthritis, a leading secondary impairment in lower-extremity amputees. In this study, we hypothesize that a transtibial amputee can learn how to control a powered ankle-foot prosthesis using a volitional electromyographic (EMG) control to directly modulate ankle powered plantar flexion. We here present preliminary data, and find that an amputee participant is able to modulate toe-off angle, net ankle work and peak power across a broad range of walking speeds by volitionally modulating calf EMG activity. The modulation of these key gait parameters is shown to be comparable to the dynamical response of the same powered prosthesis controlled intrinsically (No EMG), suggesting that transtibial amputees can achieve an adequate level of powered plantar flexion controllability using direct volitional EMG control. PMID:24187210
Wang, Jing; Kannape, Oliver A; Herr, Hugh M
Spatiotemporal Interactions in Retinal Prosthesis Subjects
Purpose. Vision loss due to retinitis pigmentosa affects an estimated 15 million people worldwide. Through collaboration between Second Sight Medical Products, Inc., and the Doheny Eye Institute, six blind human subjects underwent implantation with epiretinal 4 æ 4 electrode arrays designed to directly stimulate the remaining cells of the retina, with the goal of restoring functional vision by applying spatiotemporal patterns of stimulation. To better understand spatiotemporal interactions between electrodes during synchronous and asynchronous stimulation, the authors investigated how percepts changed as a function of pulse timing across the electrodes. Methods. Pulse trains (20, 40, 80, and 160 Hz) were presented on groups of electrodes with 800, 1600, or 2400 ?m center-to-center separation. Stimulation was either synchronous (pulses were presented simultaneously across electrodes) or asynchronous (pulses were phase shifted). Using a same-different discrimination task, the authors were able to evaluate how the perceptual quality of the stimuli changed as a function of phase shifts across multiple electrodes. Results. Even after controlling for electric field interactions, subjects could discriminate between spatiotemporal pulse train patterns based on differences of phase across electrodes as small as 3 ms. These findings suggest that the quality of the percept is affected not only by electric field interactions but also by spatiotemporal interactions at the neural level. Conclusions. During multielectrode stimulation, interactions between electrodes have a significant influence on the quality of the percept. Understanding how these spatiotemporal interactions at the neural level influence percepts during multielectrode stimulation is fundamental to the successful design of a retinal prosthesis.
Greenberg, Robert J.; Fine, Ione
[Current status of cardiac valve prosthesis].
Cardiac valve replacement has been clinically applied for the final therapeutic management of valvular heart disease for the last over 20 years. Cardiac valve prostheses are mainly divided into mechanical and biological valves. As mechanical valve, tilting disc valve or bi-leaflet center opening valve made of antithrombogenic and durable pyrolytic carbon are now widely used. As biological valve, porcine aortic valve or bovine pericardial valve treated with glutaraldehyde-tanning for maintenance of cusp durability and pliability are exclusively used at the present time. However, valve related complications such as thrombus formation, embolic event, infection, hemolysis and valve sound in mechanical valve and valve failure and infection in biological valve are unavoidable clinical problems. Therefore, the cardiac valve prostheses should be selected on the basis of patients medical, social and geographical conditions. It is still necessary to develop the ideal prosthesis without the late complications in connection with decision of optimum surgical timing, and technological improvement of materials and structural design. PMID:4088196
Komatsu, S
Zirconia in fixed prosthesis. A literature review
Statement of problem: Evidence is limited on the efficacy of zirconia-based fixed dental prostheses. Objective: To carry out a literature review of the behavior of zirconium oxide dental restorations. Material and Methods: This literature review searched the Pubmed, Scopus, Medline and Cochrane Library databases using key search words zirconium oxide, zirconia, non-metal restorations, ceramic oxides, veneering ceramic, zirconia-based fixed dental prostheses. Both in vivo and in vitro studies into zirconia-based prosthodontic restoration behavior were included. Results: Clinical studies have revealed a high rate of fracture for porcelain-veneered zirconia-based restorations that varies between 6% and 15% over a 3- to 5-year period, while for ceramo-metallic restorations the fracture rate ranges between 4 and 10% over ten years. These results provoke uncertainty as to the long-term prognosis for this material in the oral medium. The cause of veneering porcelain fractures is unknown but hypothetically they could be associated with bond failure between the veneer material and the zirconia sub-structure. Key words:Veneering ceramic, zirconia-based ceramic restoration, crown, zirconia, tooth-supported fixed prosthesis.
Roman-Rodriguez, Juan L.; Ferreiroa, Alberto; Sola-Ruiz, Maria F.; Fons-Font, Antonio
Finite element modeling of retinal prosthesis mechanics
NASA Astrophysics Data System (ADS)
Epiretinal prostheses used to treat degenerative retina diseases apply stimulus via an electrode array fixed to the ganglion cell side of the retina. Mechanical pressure applied by these arrays to the retina, both during initial insertion and throughout chronic use, could cause sufficient retinal damage to reduce the device's effectiveness. In order to understand and minimize potential mechanical damage, we have used finite element analysis to model mechanical interactions between an electrode array and the retina in both acute and chronic loading configurations. Modeling indicates that an acute tacking force distributes stress primarily underneath the tack site and heel edge of the array, while more moderate chronic stresses are distributed more evenly underneath the array. Retinal damage in a canine model chronically implanted with a similar array occurred in correlating locations, and model predictions correlate well with benchtop eyewall compression tests. This model provides retinal prosthesis researchers with a tool to optimize the mechanical electrode array design, but the techniques used here represent a unique effort to combine a modifiable device and soft biological tissues in the same model and those techniques could be extended to other devices that come into mechanical contact with soft neural tissues.
Basinger, B. C.; Rowley, A. P.; Chen, K.; Humayun, M. S.; Weiland, J. D.
21 CFR 888.3810 - Wrist joint ulnar (hemi-wrist) polymer prosthesis.
Code of Federal Regulations, 2010 CFR
... 2010-04-01 false Wrist joint ulnar (hemi-wrist) polymer prosthesis...Prosthetic Devices ôÏ 888.3810 Wrist joint ulnar (hemi-wrist) polymer prosthesis. (a) Identification. A wrist joint ulnar (hemi-wrist) polymer...
21 CFR 888.3810 - Wrist joint ulnar (hemi-wrist) polymer prosthesis.
Code of Federal Regulations, 2010 CFR
... 2009-04-01 false Wrist joint ulnar (hemi-wrist) polymer prosthesis...Prosthetic Devices ôÏ 888.3810 Wrist joint ulnar (hemi-wrist) polymer prosthesis. (a) Identification. A wrist joint ulnar (hemi-wrist) polymer...
21 CFR 888.3565 - Knee joint patellofemorotibial metal/polymer porous-coated uncemented prosthesis.
Code of Federal Regulations, 2010 CFR
...joint patellofemorotibial metal/polymer porous-coated uncemented prosthesis. 888...joint patellofemorotibial metal/polymer porous-coated uncemented prosthesis. (a...joint patellofemorotibial metal/polymer porous-coated uncemented...
21 CFR 888.3360 - Hip joint femoral (hemi-hip) metallic cemented or uncemented prosthesis.
Code of Federal Regulations, 2010 CFR
...metallic cemented or uncemented prosthesis. ...A hip joint femoral (hemi-hip) metallic cemented or uncemented prosthesis is...prostheses that have a femoral component made...window-like holes in the stem of the...
21 CFR 888.3360 - Hip joint femoral (hemi-hip) metallic cemented or uncemented prosthesis.
Code of Federal Regulations, 2010 CFR
...metallic cemented or uncemented prosthesis. ...A hip joint femoral (hemi-hip) metallic cemented or uncemented prosthesis is...prostheses that have a femoral component made...window-like holes in the stem of the...
21 CFR 888.3550 - Knee joint patellofemorotibial polymer/metal/metal constrained cemented prosthesis.
Code of Federal Regulations, 2010 CFR
...false Knee joint patellofemorotibial polymer/metal/metal constrained cemented prosthesis...3550 Knee joint patellofemorotibial polymer/metal/metal constrained cemented prosthesis...Identification. A knee joint patellofemorotibial polymer/metal/metal constrained...
21 CFR 888.3220 - Finger joint metal/polymer constrained cemented prosthesis.
Code of Federal Regulations, 2010 CFR
...2010-04-01 false Finger joint metal/polymer constrained cemented prosthesis. 888... Ï 888.3220 Finger joint metal/polymer constrained cemented prosthesis. (a) Identification. A finger joint metal/polymer constrained cemented...
21 CFR 888.3520 - Knee joint femorotibial metal/polymer non-constrained cemented prosthesis.
Code of Federal Regulations, 2010 CFR
...false Knee joint femorotibial metal/polymer non-constrained cemented prosthesis...3520 Knee joint femorotibial metal/polymer non-constrained cemented prosthesis... A knee joint femorotibial metal/polymer non-constrained cemented...
21 CFR 888.3530 - Knee joint femorotibial metal/polymer semi-constrained cemented prosthesis.
Code of Federal Regulations, 2010 CFR
...false Knee joint femorotibial metal/polymer semi-constrained cemented prosthesis...3530 Knee joint femorotibial metal/polymer semi-constrained cemented prosthesis... A knee joint femorotibial metal/polymer semi-constrained cemented...
21 CFR 888.3510 - Knee joint femorotibial metal/polymer constrained cemented prosthesis.
Code of Federal Regulations, 2010 CFR
...Knee joint femorotibial metal/polymer constrained cemented prosthesis...Knee joint femorotibial metal/polymer constrained cemented prosthesis...knee joint femorotibial metal/polymer constrained cemented...solid bolt passing through a journal bearing of greater...
21 CFR 888.3510 - Knee joint femorotibial metal/polymer constrained cemented prosthesis.
Code of Federal Regulations, 2010 CFR
...Knee joint femorotibial metal/polymer constrained cemented prosthesis...Knee joint femorotibial metal/polymer constrained cemented prosthesis...knee joint femorotibial metal/polymer constrained cemented...solid bolt passing through a journal bearing of greater...
21 CFR 888.3800 - Wrist joint metal/polymer semi-constrained cemented prosthesis.
Code of Federal Regulations, 2013 CFR
...2013-04-01 false Wrist joint metal/polymer semi-constrained cemented prosthesis... ôÏ 888.3800 Wrist joint metal/polymer semi-constrained cemented prosthesis...Identification. A wrist joint metal/polymer semi-constrained...
21 CFR 888.3110 - Ankle joint metal/polymer semi-constrained cemented prosthesis.
Code of Federal Regulations, 2013 CFR
...2013-04-01 false Ankle joint metal/polymer semi-constrained cemented prosthesis... ôÏ 888.3110 Ankle joint metal/polymer semi-constrained cemented prosthesis...Identification. An ankle joint metal/polymer semi-constrained...
Motor performance benefits of matched limb imitation in prosthesis users.
Our previous work demonstrated that the action encoding parietofrontal network, which is crucial in planning and executing motor tasks, is less active in prosthesis users who imitate movements of intact actors (mismatched limb) versus prosthesis users (matched limb). Such activation could have behavioral consequences in prosthesis users rehabilitating with intact therapists. The goal was to identify behavioral effects of matched versus mismatched limb action imitation in naÿve users of prostheses. Intact subjects donned a specially adapted prosthetic device to simulate the wrist and forearm movement that transradial amputees experience. While electrogoniometry was recorded, non-amputated prosthesis users (NAPUs) observed and imitated demonstrations of a skillful motor task performed by either an intact actor or NAPU. We hypothesized that NAPUs would elicit less motion variability when performing matched versus mismatched imitation. Matched imitation resulted in a significant decrease in shoulder motion variability compared with mismatched imitation. The matched group also developed elbow motion patterns similar to the NAPU demonstrator, while the mismatched group attempted patterns similar to the intact demonstrator. This suggests a behavioral advantage to matched imitation when adapting to a prosthetic device, as it yielded more consistent movements and facilitated development of new motor patterns. Further, these results suggest that when prosthesis users are faced with the impossible task of imitating movements of an intact hand, they perform this action with greater variability and poorer technique. This work has implications on how prosthetic device operation is conveyed to persons with amputation as their clinical interactions often involve mismatched limb imitation. PMID:24643547
Cusack, William F; Patterson, Rebecca; Thach, Scott; Kistenberg, Robert S; Wheaton, Lewis A
A digital patient for computer-aided prosthesis design.
This article concerns the design of lower limb prosthesis, both below and above knee. It describes a new computer-based design framework and a digital model of the patient around which the prosthesis is designed and tested in a completely virtual environment. The virtual model of the patient is the backbone of the whole system, and it is based on a biomechanical general-purpose model customized with the patient's characteristics (e.g. anthropometric measures). The software platform adopts computer-aided and knowledge-guided approaches with the goal of replacing the current development process, mainly hand made, with a virtual one. It provides the prosthetics with a set of tools to design, configure and test the prosthesis and comprehends two main environments: the prosthesis modelling laboratory and the virtual testing laboratory. The first permits the three-dimensional model of the prosthesis to be configured and generated, while the second allows the prosthetics to virtually set up the artificial leg and simulate the patient's postures and movements, validating its functionality and configuration. General architecture and modelling/simulation tools for the platform are described as well as main aspects and results of the experimentation. PMID:24427528
Colombo, Giorgio; Facoetti, Giancarlo; Rizzi, Caterina
A digital patient for computer-aided prosthesis design
This article concerns the design of lower limb prosthesis, both below and above knee. It describes a new computer-based design framework and a digital model of the patient around which the prosthesis is designed and tested in a completely virtual environment. The virtual model of the patient is the backbone of the whole system, and it is based on a biomechanical general-purpose model customized with the patient's characteristics (e.g. anthropometric measures). The software platform adopts computer-aided and knowledge-guided approaches with the goal of replacing the current development process, mainly hand made, with a virtual one. It provides the prosthetics with a set of tools to design, configure and test the prosthesis and comprehends two main environments: the prosthesis modelling laboratory and the virtual testing laboratory. The first permits the three-dimensional model of the prosthesis to be configured and generated, while the second allows the prosthetics to virtually set up the artificial leg and simulate the patient's postures and movements, validating its functionality and configuration. General architecture and modelling/simulation tools for the platform are described as well as main aspects and results of the experimentation.
Colombo, Giorgio; Facoetti, Giancarlo; Rizzi, Caterina
Cervical disc prosthesis replacement and interbody fusion: a comparative study.
The purpose of this paper is to compare the new functional intervertebral cervical disc prosthesis replacement and the classical interbody fusion operation, including the clinical effect and maintenance of the stability and segmental motion of cervical vertebrae. Twenty-four patients with single C5-6 intervertebral disk hernias were specifically selected and divided randomly into two groups: One group underwent artificial cervical disc replacement and the other group received interbody fusion. All patients were followed up and evaluated. The operation time for the single disc replacement was (130 +/- 50) minutes and interbody fusion was (105 +/- 53) minutes. Neurological or vascular complications were not observed during or after operation. There was no prosthesis subsidence or extrusion. The JOA score of the group with prosthesis replac