Posts Tagged Upper-limbs
Occupational therapists usually assess hand function through standardised tests, however, there is no consensus on how the scores assigned to hand dexterity can accurately measure hand function required for daily activities and few studies evaluate the movement patterns of the upper limbs during hand function tests. This study aimed to evaluate the differences in muscle activation patterns during the performance of three hand dexterity tests.
Twenty university students underwent a surface electromyographic (sEMG) assessment of eight upper limb muscles during the performance of the box and blocks test (BBT), nine-hole peg test (9HPT), and functional dexterity test (FDT). The description and comparison of each muscle activity during the test performance, gender differences, and the correlation between individual muscles’ sEMG activity were analysed through appropriate statistics.
Increased activity of proximal muscles was found during the performance of BBT (p < .001). While a higher activation of the distal muscles occurred during the FDT and 9HPT performance, no differences were found between them. Comparisons of the sEMG activity revealed a significant increase in the muscle activation among women (p = .05). Strong and positive correlations (r > .5; p < .05) were observed between proximal and distal sEMG activities, suggesting a coordinate pattern of muscle activation during hand function tests.
The results suggested the existence of differences in the muscle activation pattern during the performance of hand function evaluations. Occupational therapists should be aware of unique muscle requirements and its impact on the results of dexterity tests during hand function evaluation.
Hand and upper extremity function is essential to humans as it allows for the performance of a wide range of self-care, productive, and leisure activities (Chan & Spencer, 2004). Due to its importance, impairments in the upper extremities lead to restrictions on activity performance and impacts participation in social activities and engagements in meaningful occupations, ultimately affecting overall wellbeing and quality of life (van de Ven-Stevens et al., 2016).
Treating patients with hand and upper limb injuries is a common situation for occupational therapists; hand and wrist lesions account for approximately 20% of all cases seen in hospital emergency departments (Dias & Garcia-Elias, 2006), with most patients presenting further limitations to upper extremity function due to a restricted range of motion, pain, oedema, and muscle weakness caused by the trauma (Ydreborg, Engstrand, Steinvall, & Larsson, 2015). In addition to acute situations, restricted hand function also represents one of the leading causes of limited participation in daily activities by patients with chronic diseases, such as rheumatoid arthritis (Andrade, Brandão, Pinto, & Lanna, 2016) and stroke (Dawson, Binns, Hunt, Lemsky, & Polatajko, 2013).
Although the cause of injury varies in different countries (Che Daud, Yau, Barnett, Judd, Jones, & Muhammad Nawawi, 2016), the majority of the upper limb trauma affects working adults aged between 20 years and 64 years (de Putter et al., 2016), thereby causing a significant economic impact. Studies completed in the past decade have estimated the healthcare and productivity costs of upper limb lesions to be US$ 410–740 million per year (de Putter et al., 2012 ; de Putter et al., 2016), with increased absenteeism and early retirement age observed among patients (Shi et al., 2014 ; Tiippana-Kinnunen et al., 2013).
Assessment procedures that allow occupational therapists to obtain accurate and reliable information regarding patients’ hand function are essential for setting realistic goals and measuring patients’ progression during the rehabilitation of upper limb injuries (Carrasco-Lopez et al., 2016). Amongst the several resources available, standardised manual tests are extensively used during the evaluations of hand function to assess the upper limb coordination and skill through a series of tasks involving the manipulation of objects in established patterns (Ekstrand et al., 2016; Srikesavan et al., 2015 ; van de Ven-Stevens et al., 2016).
Despite focusing on the measurements of body functions and structures, standardised dexterity tests provide valid and reliable data that aids therapists in understanding the impact of hand injuries on patients’ activities of daily life. Commonly used standardised tests have high inter-rater and test-retest reliability, usually with an intraclass correlation coefficient (ICC) greater than 0.85 (Aaron and Jansen, 2003; Desrosiers et al., 1994 ; Earhart et al., 2011).
However, given the existence of multiple standardised dexterity tests and an even greater variety of structured tasks involved in each assessment, there is no consensus on which test is more suitable for evaluating the entire function of upper extremities (van de Ven-Stevens et al., 2016). Moreover, there is an increasing concern regarding the way by which the scores assigned to hand dexterity can accurately measure hand function required for daily activities (Rallon and Chen, 2008; Rand and Eng, 2010 ; van de Ven-Stevens et al., 2016).
The study of muscle activation through surface electromyography (sEMG) allows a real-time, noninvasive assessment of the activation pattern of muscles during the activity performance (Gurney et al., 2016). Although sEMG has been used to evaluate the muscle activation patterns in several self-care (Meijer et al., 2014), productivity (Almeida et al., 2013 ; Ferrigno et al., 2009), and leisure activities (Donoso Brown, McCoy, Fechko, Price, Gilbertson, & Moritz, 2014), few studies have analysed the different recruitment of muscle fibres during the performances of different hand function tests (Brorsson et al., 2014 ; Calder et al., 2011).
Considering the lack of studies describing the muscle activities of the upper extremities in standardised hand assessments, this study aimed to evaluate and compare the differences in muscle activation patterns during the performance of the box and blocks test (BBT), nine-hole peg test (9HPT), and functional dexterity test (FDT)—the three hand dexterity tests used by occupational therapists during hand function evaluation.
[REVIEW] On the assessment of coordination between upper extremities: towards a common language between rehabilitation engineers, clinicians and neuroscientists – Full Text
Well-developed coordination of the upper extremities is critical for function in everyday life. Interlimb coordination is an intuitive, yet subjective concept that refers to spatio-temporal relationships between kinematic, kinetic and physiological variables of two or more limbs executing a motor task with a common goal. While both the clinical and neuroscience communities agree on the relevance of assessing and quantifying interlimb coordination, rehabilitation engineers struggle to translate the knowledge and needs of clinicians and neuroscientists into technological devices for the impaired. The use of ambiguous definitions in the scientific literature, and lack of common agreement on what should be measured, present large barriers to advancements in this area. Here, we present the different definitions and approaches to assess and quantify interlimb coordination in the clinic, in motor control studies, and by state-of-the-art robotic devices. We then propose a taxonomy of interlimb activities and give recommendations for future neuroscience-based robotic- and sensor-based assessments of upper limb function that are applicable to the everyday clinical practice. We believe this is the first step towards our long-term goal of unifying different fields and help the generation of more consistent and effective tools for neurorehabilitation.
This work was developed as part of the project “State of the Art Robot-Supported assessments (STARS)” in the frame of the COST Action TD1006 “European Network on Robotics for NeuroRehabilitation” . The goal of STARS is to give neurorehabilitation clinical practitioners and scientists recommendations for the development, implementation, and administration of different indices of robotic assessments, grounded on scientific evidence.
Well-coordinated movements are a characteristic feature of well-developed motor behavior. From neuroscientists to clinicians, quantifying coordination of an individual is of critical importance. Not only does this help in understanding the neurophysiological components of movement (neuroscience field), but it can also help us identify and assess underlying neurological problems of a patient with movement disorders, and guide therapeutic interventions (clinical field).
The term ‘coordination’ is so strongly ingrained in our common language that we do not typically stop to think about the key underlying features that characterize good and bad coordination–even though we can all distinguish the well-coordinated movements of a trained dancer from those of a novice. What exactly is meant by coordination? And how should it be measured? Addressing these questions is particularly difficult when considering such an abstract concept, which encompasses many different aspects that are not straightforward to define formally.
Indeed, coordinated movements are multidimensional and require the organization of multiple subsystems, e.g., eye-hand coordination , intersegmental coordination , intralimb coordination , interlimb coordination . Given the multiple connotations and associations to the word coordination, in this paper, we attempt to summarize how coordination between upper extremities-a form of interlimb coordination-is interpreted and measured by clinicians, neuroscientists and rehabilitation engineers.
As the reader will see in the following pages, the descriptors of interlimb coordination and how it is assessed vary considerably from field to field, and even within a field. This lack of a common language and standard terminology is a huge barrier to relate the observations from different fields, hindering the understanding and discussion needed to move forward. Further, such definitions are critical for engineers working in translational neurorehabilitation, who harness knowledge from basic and clinical neuroscience to produce technological tools (e.g., robotic devices, instrumented tools) to aid clinicians in their everyday practice. The lack of a common understanding has fostered the use of dozens of ad-hoc algorithms and assessment tools (see section 3), most of which have had limited transfer to everyday clinical applications.
Our long-term goal is to standardize the administration of robotic-and sensor-based assessments of sensory-motor function. Towards this end, we present a summary of different ways in which interlimb coordination has been studied and quantified. We start by presenting a general overview of why the study of coordination between upper limbs is relevant for clinicians and behavioral neuroscientists. We then present a summary of how interlimb coordination is typically assessed in clinical environments and during related motor control experiments. This is followed by a proposal of categorization of interlimb tasks and different outcome measures that are applicable to each task. We believe that the growing scientific community in translational neurorehabilitation research would benefit from this condensed review. …
Continue —> On the assessment of coordination between upper extremities: towards a common language between rehabilitation engineers, clinicians and neuroscientists | Journal of NeuroEngineering and Rehabilitation | Full Text
[Systematic Review] Integration of emerging motion capture technologies and videogames for human upper-limb telerehabilitation – Full Text PDF
Integrating emerging technologies has shown to have the potential to improve access to rehabilitation services and the adherence for physical therapy when they are applied into telemedicine environments.
This systematic review aims to explore telerehabilitation systems that use motion capture and video games for upper-limb rehabilitation purposes. Motion capture was focused on the information fusion from inertial sensors and other technologies. The search was limited to 2010-2013, from which 667 papers were obtained; afterwards,
duplicate papers were removed, thus, reducing the sample to 57 papers with full text availability. Finally, only 3 of them were selected by approaching the subject of this study.
We conclude that the fusion information from inertial sensors and other motion capture technologies appears to be a new tendency in remote monitoring of motor rehabilitation process. However, the combination of them with active video games in physiotherapy programs is only an emerging research area with promising results.
A mirror therapy-based AO protocol significantly contributes to motor learning of the affected in patients in the chronic stage after stroke…