Arm

In the last few years, the need for compact and embedded systems has expanded in all fields. With regard to this development, ARM development platform is the ideal and practical answer for planning a new product design. ARM platforms carry a generally positive result regarding speed, accuracy, adaptability, size and cost. Every new embedded design, at the back an operating system must be modified appropriately for the specifications of the embedded target. It would be a huge added advantage to have an embedded design running an OS. In particular, this paper underlines the BSP (Board Support Package) customization of Linux operating system and porting mechanism to FreeScale SabreSD an i.MX6 processor based embedded board with the help of Yocto build environment. The usual method of going for Linux Target Image Builder (LTIB) is considered old and Yocto is specifically preferred as Freescale is emphasizing on lighter and easier version. Yocto is a dream project by Freescale. Successful build of Yocto environment enables customization of kernel, through which images of OS are built and they are ported to target platform.

A new procedure for the calibration of an articulated arm coordinate measuring machine (AACMM) is presented in this paper. First, a self-calibration algorithm of four laser trackers (LTs) is developed. The spatial localization of a retroreflector target, placed in different positions within the workspace, is determined by means of a geometric multilateration system constructed from the four LTs. Next, a nonlinear optimization algorithm for the identification procedure of the AACMM is explained. An objective function based on Euclidean distances and standard deviations is developed. This function is obtained from the captured nominal data (given by the LTs used as a gauge instrument) and the data obtained by the AACMM and compares the measured and calculated coordinates of the target to obtain the identified model parameters that minimize this difference. Finally, results show that the procedure presented, using the measurements of the LTs as a gauge instrument, is very effective by ...

Background: Over fifty percent of stroke patients experience chronic arm hand performance problems, compromising independence in daily life activities and quality of life. Task-oriented training may improve arm hand performance after stroke, whereby augmented therapy may lead to a better treatment outcome. Technology-supported training holds opportunities for increasing training intensity. However, the effects of robot-supported task-oriented training with real life objects in stroke patients are not known to date. The aim of the present study was to investigate the effectiveness and added value of the Haptic Master robot combined with task-oriented arm hand training in chronic stroke patients.

Peripherally inserted central catheters (PICC) are widely used to provide central venous access, often in chronically ill patients with long-term intravenous access requirements. There are a number of significant complications related to both insertion and maintenance of PICC lines, including catheter malposition, migration, venous thrombosis, and line fracture. The incidence of these complications is likely to rise as the number of patients undergoing intravenous outpatient therapy increases, with a corresponding rise in radiologist input. This paper provides an overview of the relevant peripheral and central venous anatomy, including anatomical variations, and outlines the complications of PICC lines. Imaging examples demonstrate the range of radiological findings seen in these complications.

Objective: Patients with spinal cord injury (SCI) may complain of upper extremity (UE) pain. The purpose of this study was to determine the frequency and severity of UE pain as well as its association with functional activities. Types of treatments that SCI patients received for UE pain and the bene®ts of these treatments were also identi®ed. Study design and methods: A questionnaire of demographic variables and measures of UE pain intensity, location, treatment, and interference with functional activities was mailed to 170 persons with SCI. Data was analyzed by descriptive and comparative statistics. Results: Of the 130 persons who responded, 76 (58.5%) (38 paraplegic, 38 tetraplegic patients) reported UE pain: 71% had shoulder pain, 53% wrist pain, 43% hand pain, and 35% elbow pain. Pain interfered with transfers in 65% (36/55) of the patients who were doing them. Of ten functional activities, pain was more likely to be associated with pressure reliefs, transfers, and wheelchair mobility. Sixty-three per cent sought medical treatment for pain, and of those, 90% received either physical therapy, pharmacological treatment or massage. Although only 27% had wheelchair or home modi®cation or joint protection education, these approaches were helpful for almost all and very helpful or extremely helpful in 26.6% and 63.6% of the patients, respectively. Conclusion: UE pain is a common problem in individuals with SCI and has impact on daily activities. UE pain prevention and management programs are needed for SCI patients.

Morris DM, Uswatte G, Crago JE, Cook EW III, Taub E. The reliability of the Wolf Motor Function Test for assessing upper extremity function after stroke. Arch Phys Med Rehabil 2001;82:750-5. Objective: To examine the reliability of the Wolf Motor Function Test (WMFT) for assessing upper extremity motor function in adults with hemiplegia. Design: Interrater and test-retest reliability. Setting: A clinical research laboratory at a university medical center. Patients: A sample of convenience of 24 subjects with chronic hemiplegia (onset Ͼ1yr), showing moderate motor impairment.

Lesioning or chronic deep brain stimulation (DBS) of the nucleus ventralis intermedius results in abolition of tremor in the contralateral limbs in Parkinson's disease (PD) and also in essential tremor. Recently, chronic DBS of the subthalamic nucleus has also proved to be very effective in reducing contralateral limb tremor in PD. These targets have been less effective in controlling the complex limb tremor often seen in multiple sclerosis (MS). Consequently, other targets have been sought in cases of MS with tremor. We describe a patient with MS with disabling proximal and distal involuntary arm movements in whom we were able to obtain sustained control of contralateral arm tremor and achieve functional improvement of the affected arm by chronic DBS of the region of the zona incerta. We also highlight the important role played by local field potentials recorded from the brain, with simultaneous recording of corresponding EMGs, in target localisation.

A new study was published in the Annals of Neurology journal on using Brain Machine Interface (BMI) for improving the rehabilitation of stroke patients. The ReoGo was the machine used in this study (Figure 1). Introduction: Chronic stroke patients with severe hand weakness, respond poorly to rehabilitation efforts and BMI is the only control signal available in these patients for an active rehabilitation therapy. We evaluated efficacy of daily brain-machine-interface training to increase the hypothesized beneficial effects of physiotherapy alone in patients with severe paresis in a double blind sham-controlled design proof of concept study. Methods: 32 chronic stroke patients with severe hand weakness, were randomly assigned to two matched groups and participated in 17.8 ± 1.4 days of training rewarding desynchronization of ipsilesional oscillatory sensorimotor rhythms (SMR) with contingent online movements of hand and arm orthoses (experimental group , n=16). In the control group (sham group, n=16) movements of the orthoses occurred randomly. Both groups received identical behavioral physiotherapy immediately following BMI training or the control intervention. Upper limb motor function scores, electromyography from arm and hand muscles, placebo-expectancy effects and functional magnetic resonance imaging (MRI) blood oxygenation level dependent activity were assessed before and after intervention. Results: A significant group x time interaction in upper limb Fugl-Meyer motor (cFMA) scores was found. cFMA scores improved more in the experimental than in the control group, presenting a significant improvement of cFMA scores (3.41±0.563 points difference, p=0.018) reflecting a clinically meaningful change from no activity to some in paretic muscles. cFMA improvements in the experimental group correlated with changes in functional MRI laterality index and with paretic hand electromyography activity. Placebo-expectancy scores were comparable for both groups. Interpretation: These data indicate that contingent BCI-training combined with behavioral physiotherapy leads to motor improvement, muscular re-activation and structural and functional reorganization of the ipsilesional hemisphere.

A randomization method is developed for the calculation of covariation between multiple variables that are linked nonlinearly to a dependent variable. Covariation is a phenomenon often invoked in the study of movement coordination to capture the fact that in coordinated movement the outcome shows greater than expected consistency from the variability in the component processes. However, in most cases, the problem is that more than two variables covary in a nonlinear fashion, which makes quantification with the bivariate linear covariation and correlation coefficient inapplicable. This paper presents a generalization of the calculation of linear bivariate covariance using a variant of a randomization method that is based on the comparison between the empirically measured variability in the outcome and a covariation-free variability. The latter can be estimated by permuting data sets. A generalized correlation coefficient is derived, and it is shown how errors of estimation can be qua...

Retrospective analysis. To evaluate the efficacy of intrathecal baclofen (ITB) for upper extremity spastic hypertonia in tetraplegia of spinal origin. University of Alabama at Birmingham hospital. The medical records of 14 individuals with tetraplegia of spinal origin who underwent intrathecal baclofen pump placement were reviewed. The effects of intrathecal baclofen on spasm frequency, deep tendon reflexes, and tone (Ashworth scale) were assessed for the upper and lower extremities for a 1-year follow-up period. There were statistically significant declines in upper extremity spasm scores (1.8 points, P=0.012), reflex scores (1.4 points, P<0.0001) and Ashworth scores (0.6 points, P<0.0001) for the 1-year follow-up period. For the lower extremities, all decreases were significant (P<0.0001). There was also a statistically significant (P<0.0001) increase in intrathecal baclofen dosage requirements during the 1-year follow-up period to maintain the reductions in spasm freq...

Bex T, Chung W, Baguet A, Stegen S, Stautemas J, Achten E, Derave W. Muscle carnosine loading by beta-alanine supplementation is more pronounced in trained vs. untrained muscles. Carnosine occurs in high concentrations in human skeletal muscle and assists working capacity during high-intensity exercise. Chronic beta-alanine (BA) supplementation has consistently been shown to augment muscle carnosine concentration, but the effect of training on the carnosine loading efficiency is poorly understood. The aim of the present study was to compare muscle carnosine loading between trained and untrained arm and leg muscles. In a first study (n ϭ 17), reliability of carnosine quantification by proton magnetic resonance spectroscopy ( 1 H-MRS) was evaluated in deltoid and triceps brachii muscles. In a second study, participants (n ϭ 35; 10 nonathletes, 10 cyclists, 10 swimmers, and 5 kayakers) were supplemented with 6.4 g/day of slow-release BA for 23 days. Carnosine content was evaluated in soleus, gastrocnemius medialis, and deltoid muscles by 1 H-MRS. All the results are reported as arbitrary units. In the nonathletes, BA supplementation increased carnosine content by 47% in the arm and 33% in the leg muscles (not significant). In kayakers, the increase was more pronounced in arm (deltoid) vs. leg (soleus ϩ gastrocnemius) muscles (0.089 vs. 0.049), whereas the reverse pattern was observed in cyclists (0.065 vs. 0.084). Swimmers had significantly higher increase in carnosine in both deltoid (0.107 vs. 0.065) and gastrocnemius muscle (0.082 vs. 0.051) compared with nonathletes. We showed that 1) carnosine content can be reliably measured by 1 H-MRS in deltoid muscle, 2) carnosine loading is equally effective in arm vs. leg muscles of nonathletes, and 3) carnosine loading is more pronounced in trained vs. untrained muscles. histidine-containing dipeptides; muscle contractions; sport supplements Address for reprint requests and other correspondence: W. Derave, Watersportlaan 2, B-9000 Ghent, Belgium (e-mail: [email protected]).

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 impr...

An important goal in rehabilitation engineering is to develop technology that allows individuals with severe motor impairment to practice arm movement without continuous supervision from a rehabilitation therapist. This paper describes the development of such a system, called Therapy WREX or ("T-WREX"). The system consists of an orthosis that assists in arm movement across a large workspace, a grip sensor that detects hand grip pressure, and software that simulates functional activities. The arm orthosis is an instrumented, adult-sized version of the Wilmington Robotic Exoskeleton (WREX), which is a five degrees-of-freedom mechanism that passively counterbalances the weight of the arm using elastic bands. After providing a detailed design description of T-WREX, this paper describes two pilot studies of the system's capabilities. The first study demonstrated that individuals with chronic stroke whose arm function is compromised in a normal gravity environment can perform reaching and drawing movements while using T-WREX. The second study demonstrated that exercising the affected arm of five people with chronic stroke with T-WREX over an eight week period improved unassisted movement ability (mean change in Fugl-Meyer score was 5 points 2 SD; mean change in range of motion of reaching was 10%, 0 001). These results demonstrate the feasibility of automating upper-extremity rehabilitation therapy for people with severe stroke using passive gravity assistance, a grip sensor, and simple virtual reality software.

To understand the lesion of the terminal branches of posterior interosseous nerve (PIN), an anatomic study was carried out. Thirty adult cadaver arms were dissected and the anatomic pattern of the nerve was documented. The distance between the point at which the nerve divides into branches and the distal edge of the supinator were measured, as well as the length of each nerve branch to its muscle-entering sites. The number of branches innervating each muscle was recorded. It was found that the PIN was branching to multiple short branches and a single deep long branch after leaving the supinator muscle with great morphometric and schematic variances.

Background: Zinc carnosine (ZnC) is a health food product claimed to possess health-promoting and gastrointestinal supportive activity. Scientific evidence underlying these claims is, however, limited. Aim: To examine the effect of ZnC on various models of gut injury and repair, and in a clinical trial. Methods: In vitro studies used pro-migratory (wounded monolayer) and proliferation ([ 3 H]-thymidine incorporation) assays of human colonic (HT29), rat intestinal epithelial (RIE) and canine kidney (MDCK) epithelial cells. In vivo studies used a rat model of gastric damage (indomethacin/restraint) and a mouse model of small-intestinal (indomethacin) damage. Healthy volunteers (n = 10) undertook a randomised crossover trial comparing changes in gut permeability (lactulose:rhamnose ratios) before and after 5 days of indomethacin treatment (50 mg three times a day) with ZnC (37.5 mg twice daily) or placebo coadministration. Results: ZnC stimulated migration and proliferation of cells in a dose-dependent manner (maximum effects in both assays at 100 mmol/l using HT29 cells), causing an approximate threefold increase in migration and proliferation (both p,0.01). Oral ZnC decreased gastric (75% reduction at 5 mg/ml) and small-intestinal injury (50% reduction in villus shortening at 40 mg/ml; both p,0.01). In volunteers, indomethacin caused a threefold increase in gut permeability in the control arm; lactulose:rhamnose ratios were (mean (standard error of mean)) 0.35 (0.035) before indomethacin treatment and 0.88 (0.11) after 5 days of indomethacin treatment (p,0.01), whereas no significant increase in permeability was seen when ZnC was coadministered. Conclusion: ZnC, at concentrations likely to be found in the gut lumen, stabilises gut mucosa. Further studies are warranted.

The aim of the present study was to compare arm and leg anaerobic peak and mean power after normalisation for body mass (W/kg} and fat-free mass (W/kg FFM) of 12 female and 10 male wrestlers, members of the Polish Olympic team. Power outputs were assessed by 30 seconds leg cycling and 30 seconds arm cranking. It was determined that males had higher peak power (11.4 W/kg and 13.2 W/kg FFM for legs, 9.6 W/kg and 11.2 W/kg FFM for arms) as well as mean power (8.7 W/kg and 9.6 W/kg FFM for legs, 6.9 W/kg and 7.9 W/kg FFM for arms) than females (peak power 8.6 W/kg and 11.3 W/kg FFM for legs, and 5.9 W/kg, 7.8 W/kg FFM for arms, mean power 6.8 W/kg, 9.0 W/kg FFM for legs and 5.9 W/kg, 7.8 W/kg FFM for arms). Post-exercise maximal blood lactate concentration after 30 seconds leg cycling and 30 seconds arm cranking was also higher in male wrestlers (11.9 and 11.8 mmol/1, respectively) than in female wrestlers (10.4 and 9.1 mmol/1, respectively). However the ratios of lactate concentration to mean power expressed in W/kg FFM for males and females in leg cycling (1.18 and 1.17, respectively) and in arm cranking (1.48 and 1.50, respectively) were similar. These findings suggest that the amount of energy derived from glycolysis is not sex-dependent. Additionally it seems that the higher ratios for arms when compared to legs reflect closer relation of arm muscle energy metabolism to carbohydrate utilisation.

Low-intensity ($50% of a single repetition maximum-1 RM) resistance training combined with vascular occlusion results in increases in muscle strength and cross-sectional area Eur J Appl Physiol 86:308-331]. The mechanisms responsible for this hypertrophy and strength gain remain elusive and no study has assessed the contribution of neuromuscular adaptations to these strength gains. We examined the effect of low-intensity training (8 weeks of unilateral elbow flexion at 50% 1 RM) both with (OCC) and without vascular occlusion (CON) on neuromuscular changes in the elbow flexors of eight previously untrained men [19.5 (0.4) years]. Following training, maximal voluntary dynamic strength increased (P<0.05) in OCC (22%) and CON (23%); however, isometric maximal voluntary contraction (MVC) strength increased in OCC only (8.3%, P<0.05). Motor unit activation, assessed by interpolated twitch, was high ($98%) in OCC and CON both pre-and post-training. Evoked resting twitch torque decreased 21% in OCC (P<0.05) but was not altered in CON. Training resulted in a reduction in the twitch:MVC ratio in OCC only (29%, P<0.01). Post-activation potentiation (PAP) significantly increased by 51% in OCC (P<0.05) and was not changed in CON. We conclude that low-intensity resistance training in combination with vascular occlusion produces an adequate stimulus for increasing muscle strength and causes changes in indices of neuromuscular function, such as depressed resting twitch torque and enhanced PAP.

A new family of rehabilitation techniques, termed Constraint-Induced Movement Therapy or CI Therapy, has been developed that controlled experiments have shown is effective in producing large improvements in limb use in the real-world environment after cerebrovascular accident (CVA). The signature therapy involves constraining movements of the less-affected arm with a sling for 90% of waking hours for 2 weeks, while intensively training use of the moreaffected arm. The common therapeutic factor in all CI Therapy techniques would appear to be inducing concentrated, repetitive practice of use of the more-affected limb. A number of neuroimaging and transcranial magnetic stimulation studies have shown that the massed practice of CI Therapy produces a massive use-dependent cortical reorganization that increases the area of cortex involved in the innervation of movement of the more-affected limb. The CI Therapy approach has been used successfully to date for the upper limb of patients with chronic and subacute CVA and patients with chronic traumatic brain injury and for the lower limb of patients with CVA, incomplete spinal cord injury, and fractured hip. The approach has recently been extended to focal hand dystonia of musicians and possibly phantom limb pain.

570 patients with osteosarcoma of the extremities were treated with ®ve dierent protocols of neoadjuvant chemotherapy at Rizzoli Institute between 1983 and 1995. Surgery consisted of limb salvage in 83% rotation plasty in 5% and amputation in 12%. The 5-year event-free survival (EFS) was 60% which varied according to the protocol followed, ranging from 47.6% to 66.4%. 234 patients relapsed. The pattern of relapse was analysed. The mean relapse time was 23.8 months (range: 2±96). The ®rst site of systemic relapse was the lung in 88% (32% of these had less than three pulmonary metastases and 68% three or more), bone in 9%, lung and bone in 2% and other sites in 3%. The relapse time and the number of pulmonary metastases were strictly correlated with the ecacy of the protocol of chemotherapy used. Patients treated with the three protocols that gave a 5-year EFS of more than 60% relapsed later and had fewer pulmonary lesions than patients treated with the two protocols that gave a 5-year EFS of 47.6% and 52.5%. The rate of local recurrence was relatively low (6%). This was not correlated with the protocol or the type of surgery used: limb salvage (6.4%), rotation plasty or amputation (4.1%). However, the rate of local recurrence was very high (21.9%) in the few patients (7%) that had less than wide surgical margins. We conclude that for patients with osteosarcoma of the extremities treated with neoadjuvant chemotherapy: (a) the pattern of systemic relapse changes according to the ecacy of the protocol of chemotherapy used. This should be always considered when evaluating the preliminary results of new studies as well as in de®ning the time of follow-up; (b) limb salvage procedures are safe and do not jeopardise the outcome of the patient, provided that wide surgical margins are achieved.

Background and Objectives. Brachial plexus block is clinically useful. Although the infraclavicular approach to brachial block is the less commonly used form it may offer advantages. We describe the results with three local anesthetic mixtures used during this observational study. Methods. Three hundred and sixty patients, ASA physical status I and II, scheduled for upper extremity orthopedic surgery, were anesthetized with an infraclavicular brachial plexus block. They were divided into three groups (120 patients each) by type of 40-mE anesthetic mixture: group I had even parts of 2 % plain lidocaine and 0.5 % bupivacaine with epinephrine 1:200,000; group II had even parts of 1% plain lidocaine and 0.25 % bupivacaine with epinephrine 1:200,000; and group III had even parts of 1.5% plain lidocaine and 0.37% bupivacaine with epinephrine 1:200,000. Plexus identification was made by nerve stimulator. The observational assessments were: adequacy and latency time of the block, tourniquet tolerance, postoperative analgesia, local anesthetics doses, sedative doses, complications, and side effects. Results. In groups I, II, and III, adequacy of the block was 95, 75, and 96%, latency time was 10.4, 12.9, and 10.9 minutes, tourniquet tolerance was 99, 84, and 98%, postoperative analgesia time was 663, 331, and 502 minutes, anesthetic doses of lidocaine/bupivacaine were 5.2/1.3, 2.9/0.7 and 4.i/1.i mg/kg, respectively. Differences were noted between group II and groups I and III (P range: .0I-.0001). Sedatives in adequate blocks were midazolam with/without fentanyl (2-3 mg/50-100 I~g) in all groups. There were two complication cases with no consequences: two vascular punctures that did not hold up or delay the anesthetic or surgical procedure. There were no clinical manifestations or side effects. Conclusions. The infraclavicular approach described is effective. It produced reliable anesthesia and is associated with minimal complications and side effects. The mixture of local anesthetics used in group II is not adequate for producing reliable anesthesia. Reg Anesth Pain Med 1999: 24:411-416.

This paper represents an ongoing investigation of dexterous and natural control of upper extremity prostheses using the myoelectric signal (MES). The scheme described within uses pattern recognition to process four channels of MES, with the task of discriminating multiple classes of limb movement. The method does not require segmentation of the MES data, allowing a continuous stream of class decisions to be delivered to a prosthetic device. It is shown in this paper that, by exploiting the processing power inherent in current computing systems, substantial gains in classifier accuracy and response time are possible. Other important characteristics for prosthetic control systems are met as well. Due to the fact that the classifier learns the muscle activation patterns for each desired class for each individual, a natural control actuation results. The continuous decision stream allows complex sequences of manipulation involving multiple joints to be performed without interruption. Finally, minimal storage capacity is required, which is an important factor in embedded control systems.

Previous research has shown that changes to the body can influence the perception of distances in near space (Witt et al 2005). In this paper, we question whether changes to the body can also influence the perception of extents in extrapersonal space, namely the perception of aperture widths. In experiment 1, broad-shouldered participants visually estimated the size of apertures to be smaller than narrow-shouldered participants. In experiment 2, we questioned whether changes to the body, which included holding a ...

Retinoic acid has long been used to induce limb reductions defects in experimental animal studies. No limb malformations, however, have been reported among malformed retinoic acid-exposed human fetuses from case reports o r epidemiologic studies. We report a child and a fetus with limb reduction malformations following maternal use of isotretinoin (13-cis-retinoic acid) during the first trimester of pregnancy. The child had a unilaterally absent clavicle and nearly absent scapula, with a short humerus and short, synostotic forearm bones. He also had ventriculomegaly and developmental delay, minor dysmorphic facial features, and a short sternum with a sterno-umbilical raphe. The fetus had a unilaterally absent thumb with normal proximal bony structures. Other findings included hydrocephalus, craniofacial anomalies, thymic agenesis, supracristal ventricular septa1 defect, single umbilical artery, anal and vaginal atresia, and urethral agenesis with dysplastic, multicystic kidneys. Although the limb malformations were quite dissimilar, a number of anomalies that are frequently found among isotretinoin-exposed fetuseslinfants were present in both cases. This increases the probability that retinoic acid caused these limb defects, but a causal association cannot be conclusively drawn on the basis of these two retrospective case reports.

The importance of proximal-to-distal sequencing in human performance throwing has been reported previously. However, a comprehensive comparison of the proximal-to-distal sequence in team-handball throwing in athletes with different training experience and competition is lacking. Therefore, the aim of the study was to compare the ball velocity and proximal-todistal sequence in the team-handball standing throw with run-up of players of different skill (less experienced, experienced, and elite). Twenty-four male team-handball players (n ¼ 8 for each group) performed five standing throws with run-up with maximal ball velocity and accuracy. Kinematics and ball trajectories were recorded with a Vicon motion capture system and joint movements were calculated. A specific proximal-to-distal sequence, where elbow flexion occurred before shoulder internal rotation, was found in all three groups. These results are in line with previous studies in team-handball. Furthermore, the results of the present study suggest that in the team-handball standing throw with run-up, increased playing experience is associated with an increase in ball velocity as well as a delayed start to trunk flexion.

Survivors of spinal cord injury need to reorganize their residual body movements for interacting with assistive devices and performing activities that used to be easy and natural. To investigate movement reorganization, we asked subjects with high-level spinal cord injury (SCI) and unimpaired subjects to control a cursor on a screen by performing upper-body motions. While this task would be normally accomplished by operating a computer mouse, here shoulder motions were mapped into the cursor position. Both the control and the SCI subjects were rapidly able to reorganize their movements and to successfully control the cursor. The majority of the subjects in both groups were successful in reducing the movements that were not effective at producing cursor motions. This is inconsistent with the hypothesis that the control system is merely concerned with the accurate acquisition of the targets and is unconcerned with motions that are not relevant to this goal. In contrast, our findings suggest that subjects can learn to reorganize coordination so as to increase the correspondence between the subspace of their upper-body motions with the plane in which the controlled cursor moves. This is effectively equivalent to constructing an inverse internal model of the map from body motions to cursor motions, established by the experiment. These results are relevant to the development of interfaces for assistive devices that optimize the use of residual voluntary control and enhance the learning process in disabled users, searching for an easily learnable map between their body motor space and control space of the device.

Background: Scoliosis is present in 3-5% of the children in the adolescent age group, with a higher incidence in females. Treatment of adolescent idiopathic scoliosis is mainly dependent on the progression of the scoliotic curve. There is a close relationship between curve progression and rapid (spinal) growth of the patient during puberty. However, until present time no conclusive method was found for predicting the timing and magnitude of the pubertal growth spurt in total body height, or the curve progression of the idiopathic scoliosis. The goal of this study is to determine the predictive value of several maturity indicators that reflect growth or remaining growth potential, in order to predict timing of the peak growth velocity of total body height in the individual patient with adolescent idiopathic scoliosis. Furthermore, different parameters are evaluated for their correlation with curve progression in the individual scoliosis patient.

We developed a neural network model to simulate temporal coordination of human reaching and grasping under variable initial grip apertures and perturbations of object size and object location/orientation. The proposed model computes reach-grasp trajectories by continuously updating vector positioning commands. The model hypotheses are: (1) Hand/wrist transport, grip aperture, and hand orientation control modules are coupled by a gating signal that fosters synchronous completion of the three sub-goals. Coupling from transport and orientation velocities to aperture control causes maximum grip apertures that scale with these velocities and exceed object size. (3) Part of the aperture trajectory is attributable to an aperture-reducing passive biomechanical effect that is stronger for larger apertures. (4) Discrepancies between internal representations of targets partially inhibit the gating signal, leading to movement time increases that compensate for perturbations. Simulations of the model replicate key features of human reach/grasp kinematics observed under three experimental protocols. Our results indicate that no precomputation of component movement times is necessary for online temporal coordination of the components of reaching and grasping.

Objective: To evaluate the validity of the Prosthetic Upper Extremity Functional Index (PUFI), a parent-and older childreport measure that evaluates the extent of Prosthetic limb use, ease of task performance with and without the prosthesis, and its usefulness. Design: Evaluation of discriminant validity (the PUFI's ability to detect differences between children), construct validity (between the parent-report PUFI and University of New Brunswick Test of Prosthetic Function [UNB Test]), and criterion validity (comparison of parent-report PUFI responses with an assessor's scores of a child's performance of PUFI activities). Setting: Four pediatric amputee clinics. Participants: Thirty-eight children, ages 3 to 18 years, with unilateral upper-extremity amputation and a prosthesis. Interventions: Not applicable. Main Outcome Measures: The PUFI and the UNB Test. Results: The PUFI differentiated between children in high and low UNB Test score categories, and between younger and older children's functional abilities. The extent of correlation between PUFI ratings and UNB skill of performance scores was moderate for "ease of performance" and "usefulness of prosthesis" categories (rϾ.47, PϽ.05). The level of agreement between parent report and observational assessment of PUFI skills was acceptable (weighted range, .44-.65). Conclusions: The PUFI showed acceptable validity and showed promise in identifying prosthetic skill and use in children of different ages and abilities.

Handball is a sport with high anaerobic demands in lower body as has been indicated by Wingate test (WT) performed with the legs, but there are no data available concerning power production during a WT performed with the arms in handball players (HndP). Therefore, the purpose of this study was to explore the arm anaerobic profile of HndP during a WT. Twenty-one elite HndP and 9 physical education students (CON), performed a 30-s arm WT. Power production and muscle oxygenation were recorded. Peak power (PP) as well as mean power (MP) was higher (P = .017 and 0.03, and ES = 1.00 and 0.86, respectively) for HndP (HndP PP: 7.6 +/- 0.8 W x kg(-1); CON PP: 6.7 +/- 1.1 W x kg(-1); HndP MP 5.3 +/- 0.6 W x kg(-1); CON MP 4.7 +/- 0.9 W x kg(-1)) with no significant difference in fatigue index between the two groups. Muscle oxygen saturation (StO2) declined approximately 30% with exercise with no differences between groups. During recovery the HndP group had higher StO2 (P = .01, ES= 3.04), to...

Among various three-dimensional (3D) scanning anthropometric surveys, the inconsistent arm postures for scanning may lead to incompatible measurement results. Therefore, this study aims to investigate the effect of arm posture on the scan-derived measurements. The two arm postures in concern are the one with palms facing inward and the one with palms facing backward. The experimental results reveal that the two postures do not differ from each other in obtaining the scan-derived measurements for most body dimensions except for those related to the upper torso. Besides, the scan-derived measurements can be more precise between the two postures than the manual measurements. Further, it was found that being scanned with palms facing backward can contribute to the smaller difference between the scan-derived measurements and the manual measurements and the better image quality. Overall, the arm posture with palms facing backward is considered as the preferred posture for 3D whole body scanning.

OBJECTIVE. We investigated the effect of constraint-induced therapy (CIT) plus eye patching (EP), CIT alone, and conventional treatment on functional performance, eye movement, and trunk-arm kinematics in stroke patients with neglect syndrome.

The capability of performing functional radiosurgery lesions in the brain using a dedicated linear accelerator (LINAC) have not yet been demonstrated. This study evaluates modern LINAC technology for the creation of a sharp, small and functionally eloquent lesion in the thalamus. Three patients underwent thalamotomy using a dedicated linear accelerator to radiosurgery, 2 females and 1 male, ages were 52, 53, and 73 years. Two patients presented with unilateral poststroke central pain and 1 with unilateral upper extremity pain secondary to metastatic infiltration of the brachial plexus. Maximal doses varied from 150 to 200 Gy, delivered by a 5-mm diameter collimator and 5 to 8 noncoplanar arcs evenly distributed. All patients gained substantial relief of their pain. They were able to reduce their medications and improve their activity levels. The patient with end-stage metastatic disease died of his malignancy 2 weeks after the treatment. One patient presented with recurrence of the pain 4 months after the treatment. No clinical complications were noticed. A dedicated linear accelerator is able to perform a precise and circumscribed lesion in the thalamus for pain control. Moreover, it proved to be safe, because no complications were observed. For patients using chronic anticoagulant therapy or with severe disabilities caused by cardiac, pulmonary or malignant diseases, this technique represents an alternative of treatment to radiofrequency thalamotomy.

The requirement for high accuracy in dynamic positioning of remotely operated vehicles (ROV), especially when tasks close to underwater structures have to be performed, demands high precision of sensor systems. Taut-wire and passive arm systems can satisfy this demand in measuring ROVs positions and orientations relative to a structure. However, the main drawback of these sensor systems is that additional forces act on ROVs due to the mechanical connection. In order to solve this problem, an adaptive PD controller is proposed and designed for dynamic positioning of ROVs working in close proximity of structures. Invoking the adaptation law, these additional forces caused by the passive arm and umbilical, and even by the uncertainties in gravity and buoyancy can be identified and compensated. By choosing an adequate Lyapunov candidate function, the system's stability is proven. The effectiveness of this design control method is demonstrated by means of numerical simulations and experiments.

Article abstract-Spasticity is a disorder of excess muscle tone associated with CNS disease. We hypothesized that botulinum toxin, a neuromuscular blocking agent, would reduce tone in spastic muscles after stroke. This randomized, double-blind, placebo-controlled, multicenter clinical trial evaluated the safety and efficacy of botulinum toxin type A (BTXA) in the treatment of chronic upper limb spasticity after stroke. Thirty-nine patients received IM injections of a total dose of either 75, 150, or 300 units of BTXA or placebo into the biceps, flexor carpi radialis, and flexor carpi ulnaris muscles. At baseline, patients demonstrated a mean wrist flexor tone of 2.9 and elbow flexor tone of 2.6 on the Ashworth Scale (0 to 4). Treatment with the 300-unit BTXA dose resulted in a statistically and clinically significant mean decrease in wrist flexor tone of 1.2 (p = 0.028), 1.1 ( p = 0.044), and 1.2 ( p = 0.026) points and elbow flexor tone of 1.2 ( p = 0.0241, 1.2 ( p = 0.028), and 1.1 ( p = 0.199) at weeks 2,4, and 6 postinjection. In the placebo group, tone reduction at the wrist was 0.3,0.2, and 0.0 and at the elbow was 0.3, 0.3, and 0.6 a t weeks 2,4, and 6 postinjection. BTXA groups reported significant

The purpose of this study was to compare linear periodization (LP), daily undulating periodization (DUP), and reverse linear periodization (RLP) for gains in local muscular endurance and strength. Sixty subjects (30 men, 30 women) were randomly assigned to LP, DUP, or RLP groups. Maximal repetitions at 50% of the subject's body weight were recorded for leg extensions as a pretest, midtest, and posttest. Training involved 3 sets (leg extensions) 2 days per week. The LP group performed sets of 25 repetition maximum (RM), 20RM, and 15RM changing every 5 weeks. The RLP group progressed in reverse order (15RM, 20RM, 25RM), changing every 5 weeks. The DUP group adjusted training variables between each workout (25RM, 20RM, 15RM repeated for the 15 weeks). Volume and intensity were equated for each training program. No significant differences were measured in endurance gains between groups (RLP ϭ 73%, LP ϭ 56%, DUP ϭ 55%; p ϭ 0.58). But effect sizes (ES) demonstrated that the RLP treatment (ES ϭ 0.27) was more effective than the LP treatment (control) and the DUP treatment (ES ϭ Ϫ0.02) at increasing muscular endurance. Therefore, it was concluded that making gradual increases in volume and gradual decreases in intensity was the most effective program for increasing muscular endurance. A comparison of linear and daily undulating periodized programs with equated volume and intensity for local muscular endurance.

Purpose: To compare the functional outcome of successful microsurgical replantation versus amputation closure for single fingertip amputations. Methods: Forty-six fingertip amputations in 46 patients (23 were replanted successfully, 23 had amputation closure) were included in this study. Thumb amputations were excluded. Grip strength and active range of motion of the proximal interphalangeal joint were evaluated. The patients were questioned about their symptoms of pain, paresthesia, and cold intolerance. The Disabilities of the Arm, Shoulder, and Hand questionnaire was given and the disability/symptom score was evaluated. Patients' satisfaction with the surgical result was assessed. Time spent in the hospital and time off from work were reviewed. Results: Active range of motion of the proximal interphalangeal joint was greater in the successful replantation group. Although the existence of paresthesia and cold intolerance were not statistically different between the 2 groups, pain in the affected fingers was more frequent in the amputation closure group. The average Disabilities of the Arm, Shoulder, and Hand score of the successful replantation group was statistically better. All patients in the successful replantation group were highly or fairly satisfied with the surgical results, whereas 14 patients in the amputation closure group were highly or fairly satisfied. The time spent in the hospital and the time off from work for the successful replantation group were longer. Conclusions: Successful replantation of single fingertip amputations can result in minimal pain, better functional outcome, better appearance, and higher patient satisfaction. We recommend attempting fingertip replantation not only to obtain the best appearance but also to gain better functional outcome. If the patient requests the simple surgery and earlier return to work amputation closure is an accepted method despite the disadvantage of digital shortening and the risk for a painful stump. (

The role of arm swing in running has been minimally described, and the contributions of arm motion to lower extremity joint kinematics and external force generation are unknown. These contributions may have implications in the design of musculoskeletal models for computer simulations of running, since previous models have usually not included articulating arm segments. 3D stance phase lower extremity joint angles and ground reaction forces (GRFs) were determined for seven subjects running normally, and running under two conditions of arm restraint. When arm swing was suppressed, the peak vertical GRF decreased by 10–13% bodyweight, and the peak lateral GRF increased by 4–6% bodyweight. Changes in peak joint angles on the order of 1–5 deg were observed for hip flexion, hip adduction, knee flexion, knee adduction, and ankle abduction. The effect sizes (ES) were small to moderate (ES&lt;0.8) for most of the peak GRF differences, but large (ES&gt;0.8) for most of the peak joint angle di...