Posts Tagged UE

[ARTICLE in Press] Upper Extremity Functional Index – Journal of Physiotherapy

Article Outline

  1. Summary
  2. Commentary
  3. References



Description: The Upper Extremity Functional Index (UEFI) is a 20-item, region-specific, patient-reported outcome measure developed by Paul Stratford and colleagues in 2001.1 The UEFI is used to measure upper extremity function in individuals with hand and upper extremity disorders. Patients rate their function on a 0 to 4 Likert scale, where 0 indicates extreme difficulty and 4 indicates no difficulty performing the task. This translates into a maximum possible score of 80, which indicates excellent function.2 The UEFI takes about 5 minutes to complete, and is easy to administer and score with minimal training. The total score is computed by adding up individual item scores.

Validity and reliability: The UEFI has been validated in a variety of populations like post-surgical patients with shoulder, elbow, wrist and hand conditions.1, 2, 3 The UEFI has demonstrated construct validity through moderate correlations with the Patient-Specific Functional Scale (0.59, 95% CI 0.48 to 0.67),2 and stronger correlations with UEFS (0.82) in a sample that consisted of upper extremity musculoskeletal conditions.1 The UEFI is able to distinguish improved patients from stable patients (AUC 0.88, 95% CI 0.81 to 0.94) with a sensitivity of 0.73 and a specificity of 0.92, and had a minimally important difference of 8.50 in a sample of shoulder, elbow, wrist and forearm musculoskeletal conditions.2 In the shoulder disorder population, UEFI has demonstrated moderate correlations with the Western Ontario Rotator Cuff Index (Spearman’s Rho = 0.78) and Rotator cuff Quality of life questionnaire (Spearman’s Rho = 0.67).3 The known group validity of the UEFI has been established through its ability to differentiate subgroups based on work status (p < 0.05).4 The UEFI has demonstrated acceptable sensitivity to change in a shoulder disorder population (SRM = 1.54).3 A Rasch analysis revealed misfit and multidimensionality in the original version of the UEFI, and a 15-item Rasch validated version has been proposed to provide a better fit to the Rasch model.5 The UEFI has been cross-culturally adapted into multiple languages (Turkish,6 French Canadian,7 Spanish8) and has shown consistent measurement properties to the original English version.

Studies have determined test re-test reliability and found it to be excellent (ICC 0.94, 95% CI 0.92 to 0.95) in a sample with shoulder, elbow, wrist and hand musculoskeletal conditions;4 ICC 0.95 in a sample of upper extremity musculoskeletal conditions,1 and ICC 0.85 (95% CI: 0.73, 0.92) in a sample with shoulder, elbow, wrist and forearm musculoskeletal conditions.2 It has also exhibited excellent internal consistency (Cronbach’s alpha 0.94).1The minimum clinically important difference value for the UEFI was 8/80 (shoulder, elbow, wrist and hand musculoskeletal conditions).4


The UEFI measures function related to upper extremity injuries and disorders.9 Although used and studied less than the DASH, it has demonstrated strong clinical measurement properties in multiple clinical populations. Clinicians should be aware that 20-item and 15-item versions exist. Further studies are required to clarify the optimal items and performance in additional clinical or cultural contexts.


  1. Stratford, P.W. et al. Physiother Can200153259–267
  2. Hefford, C. et al. J Orthop Sports Phys Ther20124256–65
  3. Razmjou, H. et al. BMC Musculoskelet Disord2006726
  4. Chesworth, B.M. et al. Physiother Can201466243–253
  5. Hamilton, C.B. et al. Phys Ther2013931507–1519
  6. Aytar, A. et al. J Back Musculoskelet Rehabil201528489–495
  7. Hamasaki, T. et al. J Hand Ther201427247–252
  8. Cuesta-Vargas, A.I. et al. Health Qual Life Outcomes201311126
  9. Hong, I. et al. Int J Rehabil Res2017401–10

via Upper Extremity Functional Index – Journal of Physiotherapy


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[VIDEO] Henry Hoffman Q&A Video Series: Why SaeboStim Micro? – YouTube

Published on Oct 16, 2017

Saebo, Inc. is a medical device company primarily engaged in the discovery, development and commercialization of affordable and novel clinical solutions designed to improve mobility and function in individuals suffering from neurological and orthopedic conditions. With a vast network of Saebo-trained clinicians spanning six continents, Saebo has helped over 100,000 clients around the globe achieve a new level of independence.
In 2001, two occupational therapists had one simple, but powerful goal – to provide neurological clients access to transformative and life changing products.
At the time, treatment options for improving arm and hand function were limited. The technology that did exist was expensive and inaccessible for home use. With inadequate therapy options often leading to unfavorable outcomes, health professionals routinely told their clients that they have “reached a plateau” or “no further gains can be made”. The founders believed that it was not the clients who had plateaued, but rather their treatment options had plateaued.
Saebo’s commitment – “No Plateau in Sight” – was inspired by this mentality; and the accessible, revolutionary solutions began.
Saebo’s revolutionary product offering was based on the latest advances in rehabilitation research. From the SaeboFlex which allows clients to incorporate their hand functionally in therapy or at home, to the SaeboMAS, an unweighting device used to assist the arm during daily living tasks and exercise training, “innovation” and “affordability” can now be used in the same sentence.
Over the last ten years, Saebo has grown into a leading global provider of rehabilitative products created through the unrelenting leadership and the strong network of clinicians around the world. As we celebrate our history and helping more than 100,000 clients regain function, we are growing this commitment to affordability and accessibility even further by making our newest, most innovative products more accessible than ever.


via Henry Hoffman Q&A Video Series: Why SaeboStim Micro? – YouTube

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[Poster] Randomized Trial on the Effects of Attentional Focus on Motor Training of the Upper Extremity Using Robotics With Individuals After Chronic Stroke


  • Participants improved on motor outcomes after engaging in high-repetition robotics arm training.
  • There were no differences between external focus or internal focus of attention on retention of motor skills after 4 weeks of arm training.
  • Individuals with moderate-to-severe arm impairment may not experience the advantages of an external focus during motor training found in healthy individuals.
  • Attentional focus is most likely not an active ingredient for retention of trained motor skills for individuals with moderate-to-severe arm impairment.



To compare the long-term effects of external focus (EF) and internal focus (IF) of attention after 4 weeks of arm training.


Randomized, repeated-measures, mixed analysis of variance.


Outpatient clinic.


Individuals with stroke and moderate-to-severe arm impairment living in the community (N=33; withdrawals: n=3).


Four-week arm training protocol on a robotic device (12 sessions).

Main Outcome Measures

Joint independence, Fugl-Meyer Assessment, and Wolf Motor Function Test measured at baseline, discharge, and 4-week follow-up.


There were no between-group effects for attentional focus. Participants in both groups improved significantly on all outcome measures from baseline to discharge and maintained those changes at 4-week follow-up regardless of group assignment (joint independence EF condition: F1.6,45.4=17.74; P<.0005; partial η2=.39; joint independence IF condition: F2,56=18.66; P<.0005; partial η2=.40; Fugl-Meyer Assessment: F2,56=27.83; P<.0005; partial η2=.50; Wolf Motor Function Test: F2,56=14.05; P<.0005; partial η2=.35).


There were no differences in retention of motor skills between EF and IF participants 4 weeks after arm training, suggesting that individuals with moderate-to-severe arm impairment may not experience the advantages of an EF found in healthy individuals. Attentional focus is most likely not an active ingredient for retention of trained motor skills for individuals with moderate-to-severe arm impairment, whereas dosage and intensity of practice appear to be pivotal. Future studies should investigate the long-term effects of attentional focus for individuals with mild arm impairment.


via Randomized Trial on the Effects of Attentional Focus on Motor Training of the Upper Extremity Using Robotics With Individuals After Chronic Stroke – ScienceDirect

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[Abstract] Efficacy and safety of NABOTA in post-stroke upper limb spasticity: A phase 3 multicenter, double-blinded, randomized controlled trial


A phase III clinical trial was performed for a novel botulinum toxin A, NABOTA, on post-stroke upper limb spasticity.

NABOTA demonstrated non-inferiority on efficacy and safety compared to onabotulinum toxin A (Botox).

NABOTA may serve as an alternative for treatment of post-stroke upper limb spasticity using botulinum toxin A.


Botulinum toxin A is widely used in the clinics to reduce spasticity and improve upper limb function for post-stroke patients. Efficacy and safety of a new botulinum toxin type A, NABOTA (DWP450) in post-stroke upper limb spasticity was evaluated in comparison with Botox (onabotulinum toxin A). A total of 197 patients with post-stroke upper limb spasticity were included in this study and randomly assigned to NABOTA group (n = 99) or Botox group (n = 98). Wrist flexors with modified Ashworth Scale (MAS) grade 2 or greater, and elbow flexors, thumb flexors and finger flexors with MAS 1 or greater were injected with either drug. The primary outcome was the change of wrist flexor MAS between baseline and 4 weeks post-injection. MAS of each injected muscle, Disability Assessment Scale (DAS), and Caregiver Burden Scale were also assessed at baseline and 4, 8, and 12 weeks after the injection. Global Assessment Scale (GAS) was evaluated on the last visit at 12 weeks. The change of MAS for wrist flexor between baseline and 4 weeks post-injection was − 1.44 ± 0.72 in the NABOTA group and − 1.46 ± 0.77 in the Botox group. The difference of change between both groups was 0.0129 (95% confidence interval − 0.2062–0.2319), within the non-inferiority margin of 0.45. Both groups showed significant improvements regarding MAS of all injected muscles, DAS, and Caregiver Burden Scale at all follow-up periods. There were no significant differences in all secondary outcome measures between the two groups. NABOTA demonstrated non-inferior efficacy and safety for improving upper limb spasticity in stroke patients compared to Botox.


via Efficacy and safety of NABOTA in post-stroke upper limb spasticity: A phase 3 multicenter, double-blinded, randomized controlled trial – ScienceDirect

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[Abstract] Motor imagery: a systematic review of its effectiveness in the rehabilitation of the upper limb following a stroke.



Motor imagery or mental practice of movement is a relatively new intervention that is being used on an increasingly more frequently basis in the treatment of stroke patients. It consists in the person evoking a movement or gesture in order to learn or improve its execution. Neuroimaging studies have shown that imagining movements activates neuronal patterns that are similar to those produced when they are actually performed.


A systematic review was conducted between January and June 2017 in the Web of Science, PubMed, CINHAL, PEDro and Scopus databases to select clinical trials carried out with stroke patients in whom this technique was used as rehabilitation. Thirteen randomised clinical trials were included. The characteristics of the studies and the measures of results were summarised and the evidence of their outcomes was described.


Most of the studies found significant differences in terms of improved motor rehabilitation of the upper limb among the subjects in the experimental groups. Only one of the studies failed to show any evidence of its effectiveness in isolation. None of them made any reference to its effectiveness in improving sensory alterations.


Motor imagery, combined with conventional therapy (physiotherapy or occupational therapy), seems to have positive effects on the motor rehabilitation of the upper limb following a stroke. Further research is needed to improve the heterogeneity of the interventions and to evaluate their effectiveness in the long term.


via [Motor imagery: a systematic review of its effectiveness in the rehabilitation of the upper limb following a stroke]. – PubMed – NCBI

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[ARTICLE] Soft robotic devices for hand rehabilitation and assistance: a narrative review – Full Text



The debilitating effects on hand function from a number of a neurologic disorders has given rise to the development of rehabilitative robotic devices aimed at restoring hand function in these patients. To combat the shortcomings of previous traditional robotics, soft robotics are rapidly emerging as an alternative due to their inherent safety, less complex designs, and increased potential for portability and efficacy. While several groups have begun designing devices, there are few devices that have progressed enough to provide clinical evidence of their design’s therapeutic abilities. Therefore, a global review of devices that have been previously attempted could facilitate the development of new and improved devices in the next step towards obtaining clinical proof of the rehabilitative effects of soft robotics in hand dysfunction.


A literature search was performed in SportDiscus, Pubmed, Scopus, and Web of Science for articles related to the design of soft robotic devices for hand rehabilitation. A framework of the key design elements of the devices was developed to ease the comparison of the various approaches to building them. This framework includes an analysis of the trends in portability, safety features, user intent detection methods, actuation systems, total DOF, number of independent actuators, device weight, evaluation metrics, and modes of rehabilitation.


In this study, a total of 62 articles representing 44 unique devices were identified and summarized according to the framework we developed to compare different design aspects. By far, the most common type of device was that which used a pneumatic actuator to guide finger flexion/extension. However, the remainder of our framework elements yielded more heterogeneous results. Consequently, those results are summarized and the advantages and disadvantages of many design choices as well as their rationales were highlighted.


The past 3 years has seen a rapid increase in the development of soft robotic devices for hand rehabilitative applications. These mostly preclinical research prototypes display a wide range of technical solutions which have been highlighted in the framework developed in this analysis. More work needs to be done in actuator design, safety, and implementation in order for these devices to progress to clinical trials. It is our goal that this review will guide future developers through the various design considerations in order to develop better devices for patients with hand impairments.


Imagine tying your shoes or putting on a pair of pants while having limited use of your hands. Now imagine the impact on your daily life if that limitation was permanent. The ability to perform activities of daily living (ADL) is highly dependent on hand function, leaving those suffering with hand impairments less capable of executing ADLs and with a reduced quality of life. Unfortunately, the hand is often the last part of the body to receive rehabilitation.

According to a 2015 National Health Interview Survey, there were approximately 4.7 million adults in the United States that found it “Very difficult to or cannot grasp or handle small objects” [1]. Hand impairments are commonly observed in neurological and musculoskeletal diseases such as arthritis, Cerebral Palsy, Parkinson’s Disease, and stroke. A summary of motor impairment prevalence associated with these diseases may be seen in Table 1. Fortunately, physical rehabilitation has been shown to promote motor recovery through repetitive isolated movements [25]. This is largely due to neuroplasticity – the ability for the brain to reorganize itself by establishing new neural connections. Occupational and physical therapists thus attempt to take advantage of neuroplasticity in order to re-map motor function in the brain through repeated exercise. Currently, however, there is no consensus on the best mode and dosing to facilitate neuroplasticity [6]. Additionally, recovery success relies heavily on a patient’s ability to attend therapy, which can be deterred by the frequency, duration, or cost of the therapy. Robotic devices could enhance access to repeated exercise. As such, they have been developed and investigated for their utilization as an adjunctive therapy to improve patient access, compliance and subsequent outcomes of rehabilitation efforts. An overview of the designs with comparisons between the different approaches will help future development of these tools. […]


Continue —>  Soft robotic devices for hand rehabilitation and assistance: a narrative review

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[Abstract] Motor skill changes and neurophysiologic adaptation to recovery-oriented virtual rehabilitation of hand function in a person with subacute stroke: a case study.



The complexity of upper extremity (UE) behavior requires recovery of near normal neuromuscular function to minimize residual disability following a stroke. This requirement places a premium on spontaneous recovery and neuroplastic adaptation to rehabilitation by the lesioned hemisphere. Motor skill learning is frequently cited as a requirement for neuroplasticity. Studies examining the links between training, motor learning, neuroplasticity, and improvements in hand motor function are indicated.


This case study describes a patient with slow recovering hand and finger movement (Total Upper Extremity Fugl-Meyer examination score = 25/66, Wrist and Hand items = 2/24 on poststroke day 37) following a stroke. The patient received an intensive eight-session intervention utilizing simulated activities that focused on the recovery of finger extension, finger individuation, and pinch-grasp force modulation.


Over the eight sessions, the patient demonstrated improvements on untrained transfer tasks, which suggest that motor learning had occurred, as well a dramatic increase in hand function and corresponding expansion of the cortical motor map area representing several key muscles of the paretic hand. Recovery of hand function and motor map expansion continued after discharge through the three-month retention testing.


This case study describes a neuroplasticity based intervention for UE hemiparesis and a model for examining the relationship between training, motor skill acquisition, neuroplasticity, and motor function changes. Implications for rehabilitation Intensive hand and finger rehabilitation activities can be added to an in-patient rehabilitation program for persons with subacute stroke. Targeted training of the thumb may have an impact on activity level function in persons with upper extremity hemiparesis. Untrained transfer tasks can be utilized to confirm that training tasks have elicited motor learning. Changes in cortical motor maps can be used to document changes in brain function which can be used to evaluate changes in motor behavior persons with subacute stroke.


via Motor skill changes and neurophysiologic adaptation to recovery-oriented virtual rehabilitation of hand function in a person with subacute stroke: … – PubMed – NCBI

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[Abstract] Mirror therapy for motor function of the upper extremity in patients with stroke: A meta-analysis.



To evaluate the mean treatment effect of mirror therapy on motor function of the upper extremity in patients with stroke.


Electronic databases, including the Cochrane Library, PubMed, MEDLINE, Embase and CNKSystematic, were searched for relevant studies published in English between 1 January 2007 and 22 June 2017.


Randomized controlled trials and pilot randomized controlled trials that compared mirror therapy/mirror box therapy with other rehabilitation approaches were selected.


Two authors independently evaluated the searched studies based on the inclusion/exclusion criteria and appraised the quality of included studies according to the criteria of the updated version 5.1.0 of the Cochrane Handbook for Systematic Review of Interventions.


Eleven trials, with a total of 347 patients, were included in the meta-analysis. A moderate effect of mirror therapy (standardized mean difference 0.51, 95% confidence interval (CI) 0.29, 0.73) on motor function of the upper extremity was found. However, a high degree of heterogeneity (χ2 = 25.65, p = 0.004; I2 = 61%) was observed. The heterogeneity decreased a great deal (χ2 = 6.26, p = 0.62; I2 = 0%) after 2 trials were excluded though sensitivity analysis.


Although the included studies had high heterogeneity, meta-analysis provided some evidence that mirror therapy may significantly improve motor function of the upper limb in patients with stroke. Further well-designed studies are needed.

PMID: 29077129


DOI: 10.2340/16501977-2287
Free full text

via Mirror therapy for motor function of the upper extremity in patients with stroke: A meta-analysis. – PubMed – NCBI

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[Abstract] Rehabilitation Interventions for Upper Limb Function in the First Four Weeks Following Stroke: A Systematic Review and Meta-Analysis of the Evidence



To investigate the therapeutic interventions reported in the research literature and synthesize their effectiveness in improving upper limb (UL) function in the first 4 weeks poststroke.

Data Sources

Electronic databases and trial registries were searched from inception until June 2016, in addition to searching systematic reviews by hand.

Study Selection

Randomized controlled trials (RCTs), controlled trials, and interventional studies with pre/posttest design were included for adults within 4 weeks of any type of stroke with UL impairment. Participants all received an intervention of any physiotherapeutic or occupational therapeutic technique designed to address impairment or activity of the affected UL, which could be compared with usual care, sham, or another technique.

Data Extraction

Two reviewers independently assessed eligibility of full texts, and methodological quality of included studies was assessed using the Cochrane Risk of Bias Tool.

Data Synthesis

A total of 104 trials (83 RCTs, 21 nonrandomized studies) were included (N=5225 participants). Meta-analyses of RCTs only (20 comparisons) and narrative syntheses were completed. Key findings included significant positive effects for modified constraint-induced movement therapy (mCIMT) (standardized mean difference [SMD]=1.09; 95% confidence interval [CI], .21–1.97) and task-specific training (SMD=.37; 95% CI, .05–.68). Evidence was found to support supplementary use of biofeedback and electrical stimulation. Use of Bobath therapy was not supported.


Use of mCIMT and task-specific training was supported, as was supplementary use of biofeedback and electrical simulation, within the acute phase poststroke. Further high-quality studies into the initial 4 weeks poststroke are needed to determine therapies for targeted functional UL outcomes.


via Rehabilitation Interventions for Upper Limb Function in the First Four Weeks Following Stroke: A Systematic Review and Meta-Analysis of the Evidence – Archives of Physical Medicine and Rehabilitation

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[Abstract] Efficacy of Short-Term Robot-Assisted Rehabilitation in Patients With Hand Paralysis After Stroke: A Randomized Clinical Trial

Background: We evaluated the effectiveness of robot-assisted motion and activity in additional to physiotherapy (PT) and occupational therapy (OT) on stroke patients with hand paralysis.

Methods:A randomized controlled trial was conducted. Thirty-two patients, 34.4% female (mean ± SD age: 68.9 ± 11.6 years), with hand paralysis after stroke participated. The experimental group received 30 minutes of passive mobilization of the hand through the robotic device Gloreha (Brescia, Italy), and the control group received an additional 30 minutes of PT and OT for 3 consecutive weeks (3 d/wk) in addition to traditional rehabilitation. Outcomes included the National Institutes of Health Stroke Scale (NIHSS), Modified Ashworth Scale, Barthel Index (BI), Motricity Index (MI), short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH), and the visual analog scale (VAS) measurements. All measures were collected at baseline and end of the intervention (3 weeks).

Results: A significant effect of time interaction existed for NIHSS, BI, MI, and QuickDASH, after stroke immediately after the interventions (all, P < .001). The experimental group had a greater reduction in pain compared with the control group at the end of the intervention, a reduction of 11.3 mm compared with 3.7 mm, using the 100-mm VAS scale.

Conclusions: In the treatment of pain and spasticity in hand paralysis after stroke, robot-assisted mobilization performed in conjunction with traditional PT and OT is as effective as traditional rehabilitation.

via Efficacy of Short-Term Robot-Assisted Rehabilitation in Patients With Hand Paralysis After Stroke: A Randomized Clinical Trial – Jorge H. Villafañe, Giovanni Taveggia, Silvia Galeri, Luciano Bissolotti, Chiara Mullè, Grace Imperio, Kristin Valdes, Alberto Borboni, Stefano Negrini, 2018

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