Humans possess the ability to generate an incredible degree of complex, highly skilled, and coordinated movements. Although much is known about the anatomical and physiological components of upper limb movement, the exact means by which these different areas coordinate is still far from understood. The ability to perform symmetrical, bimanual tasks with ease suggest a default coupling between mirror motor regions – a default coupling that is perceptible in unilateral movements. During intended unimanual movement in the upper limbs, bilateral changes to motor cortex output occur. The purpose of this study was to investigate the neural underpinnings of these bilateral changes and investigate the involvement of intracortical inhibitory circuits. Previous studies have shown that transcallosal connections between cortical representations of the intrinsic muscles of the hands are relatively sparser than the more proximal muscles of the upper limbs. It was hypothesized that differential responses in overall motor output or intracortical inhibition to ipsilateral muscle activation between the FDI and ECR could infer the involvement of transcallosal pathways; although interhemispheric transfer was not directly investigated in this thesis. Two studies used focal transcranial magnetic stimulation (TMS), specifically paired-pulse protocols, to investigate changes in short-interval intracortical inhibition (SICI) and long-interval intracortical inhibition (LICI) in response to contraction of contralateral homologous muscle groups to the inactive test muscle. Also, the response to activation of a non-homologous, but spatially close, muscle was investigated. Lastly, two muscle groups were investigated, a distal, intrinsic muscle of the hand (first dorsal interosseous) and a relatively more proximal muscle of the upper limb (extensor carpi radialis). These studies revealed that at low levels of force generation, unilateral isometric contractions facilitate ipsilateral mirror motor representations and reduce local GABA¬A receptor mediated inhibition. Notably, while similar facilitation occurred in both the distal and proximal effectors, decreases in SICI were much more robust in the ECR. Findings from this thesis provides insight into the neural mechanisms governing bilateral changes with unilateral movement and is important in the guiding the focus of future research.

[Truncated abstract] In cricket, the bowler propels a ball using a straight arm (permitted minimal extension) in an overhead fashion to a batsman situated approximately 20m away, who attempts to strike the ball in order to score runs for their team. Cricket bowling can be generalised by two types of bowlers; fast bowlers, who primarily use high ball speed, and spin bowlers that attempt to impart spin on the ball causing it to bounce in different directions. There has been numerous studies investigating the kinematics of fast bowling in cricket, but there is a paucity of objective literature on the spin bowling action due to the complex rotations of the upper limb necessary to develop ball velocity and rotation. One primary reason is that three dimensional (3D) analysis of upper limb movement is difficult due to the high degrees of freedom and ranges of motion of the associated joints. Furthermore, existing methods do not allow measurement of the kinematics of this highly dynamic task to be performed in an ecologically sound environment. The complexity is further compounded as the upper limb does not perform regular cyclical movements like the lower limb does with gait. Therefore, this makes it difficult to determine what

Impairments of upper limb function can negatively impact an individual???s ability to carry out everyday tasks. Children with cerebral palsy can have limitations of upper limb movement due to physiological and structural changes in their body. Current treatment regimes for children with upper limb involvement of cerebral palsy are assessed using a variety of qualitative assessment tools. These measures rely on subjective input from the assessor, and can be insensitive to significant functional improvements. Research methods in upper limb motion analysis are developing towards use as clinical tools. To date, there is a paucity of knowledge on the quantitative measures of range of motion (ROM) and function of upper limbs in healthy children. There is also lack of agreement on repeatable functional tasks of the upper limb for 3D measurement. The identification of a repeatable task in healthy children would facilitate the use of upper limb 3D motion analysis to guide clinical practice and improve patient outcomes. This thesis aims to describe upper limb joint range of movement in each degree of freedom and present normative three dimensional kinematic data of upper limb movement in healthy children during a repeatable upper limb functional task. This will provide a basis for comparison to children with movement disorders for future research and clinical practice. The UNSW kinematic upper limb model was found to successfully measure three dimensional upper limb anatomical and functional movements in healthy children. Normative kinematic data are reported for anatomical movements and two functional tasks. The results of the studies undertaken showed that differences in dominant and non-dominant limbs were present during anatomical and functional movements. Joint angles measured were found to be repeatable in healthy children. The results suggest that methods used were reliable for investigating upper limb kinematics. Functional movement time-series data were found to be repeatable for the group with the exception of wrist flexion/extension during the hand to mouth movement for both the dominant and non-dominant limbs. These findings improve current knowledge on upper limb kinematics in healthy children. This knowledge can assist the investigation of movement disorders in children to facilitate clinical decision making.

Impairments of upper limb function can negatively impact an individual???s ability to carry out everyday tasks. Children with cerebral palsy can have limitations of upper limb movement due to physiological and structural changes in their body. Current treatment regimes for children with upper limb involvement of cerebral palsy are assessed using a variety of qualitative assessment tools. These measures rely on subjective input from the assessor, and can be insensitive to significant functional improvements. Research methods in upper limb motion analysis are developing towards use as clinical tools. To date, there is a paucity of knowledge on the quantitative measures of range of motion (ROM) and function of upper limbs in healthy children. There is also lack of agreement on repeatable functional tasks of the upper limb for 3D measurement. The identification of a repeatable task in healthy children would facilitate the use of upper limb 3D motion analysis to guide clinical practice and improve patient outcomes. This thesis aims to describe upper limb joint range of movement in each degree of freedom and present normative three dimensional kinematic data of upper limb movement in healthy children during a repeatable upper limb functional task. This will provide a basis for comparison to children with movement disorders for future research and clinical practice. The UNSW kinematic upper limb model was found to successfully measure three dimensional upper limb anatomical and functional movements in healthy children. Normative kinematic data are reported for anatomical movements and two functional tasks. The results of the studies undertaken showed that differences in dominant and non-dominant limbs were present during anatomical and functional movements. Joint angles measured were found to be repeatable in healthy children. The results suggest that methods used were reliable for investigating upper limb kinematics. Functional movement time-series data were found to be repeatable for the group with the exception of wrist flexion/extension during the hand to mouth movement for both the dominant and non-dominant limbs. These findings improve current knowledge on upper limb kinematics in healthy children. This knowledge can assist the investigation of movement disorders in children to facilitate clinical decision making.

Impairments of upper limb function can negatively impact an individual???s ability to carry out everyday tasks. Children with cerebral palsy can have limitations of upper limb movement due to physiological and structural changes in their body. Current treatment regimes for children with upper limb involvement of cerebral palsy are assessed using a variety of qualitative assessment tools. These measures rely on subjective input from the assessor, and can be insensitive to significant functional improvements. Research methods in upper limb motion analysis are developing towards use as clinical tools. To date, there is a paucity of knowledge on the quantitative measures of range of motion (ROM) and function of upper limbs in healthy children. There is also lack of agreement on repeatable functional tasks of the upper limb for 3D measurement. The identification of a repeatable task in healthy children would facilitate the use of upper limb 3D motion analysis to guide clinical practice and improve patient outcomes. This thesis aims to describe upper limb joint range of movement in each degree of freedom and present normative three dimensional kinematic data of upper limb movement in healthy children during a repeatable upper limb functional task. This will provide a basis for comparison to children with movement disorders for future research and clinical practice. The UNSW kinematic upper limb model was found to successfully measure three dimensional upper limb anatomical and functional movements in healthy children. Normative kinematic data are reported for anatomical movements and two functional tasks. The results of the studies undertaken showed that differences in dominant and non-dominant limbs were present during anatomical and functional movements. Joint angles measured were found to be repeatable in healthy children. The results suggest that methods used were reliable for investigating upper limb kinematics. Functional movement time-series data were found to be repeatable for the group with the exception of wrist flexion/extension during the hand to mouth movement for both the dominant and non-dominant limbs. These findings improve current knowledge on upper limb kinematics in healthy children. This knowledge can assist the investigation of movement disorders in children to facilitate clinical decision making.

Orientador: Antonio Guilhermo Borges Neto / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas. / Made available in DSpace on 2018-08-12T03:50:01Z (GMT). No. of bitstreams: 1 Oliveira_Robertade_D.pdf: 4460655 bytes, checksum: f3f50fd7e512e461cbe4b77ba1053ad9 (MD5) Previous issue date: 2008 / Resumo: O acidente vascular cerebral (AVC) é reconhecido como uma das maiores causas de morbidade e mortalidade. Seqüelas decorrentes deste evento podem levar à incapacidade motora e déficits de leves a severos. Para classificar melhor a disfunção sensitivo-motora, o equilíbrio e as habilidades para as atividades de vida diária (AVD's), escalas de avaliações quantitativas e qualitativas estão sendo amplamente utilizadas. O objetivo do Artigo 1 foi verificar a correlação existente entre a Escala de Fugl-Meyer (FM), Escala de Equilíbrio de Berg (EEB) e Índice de Barthel (IB). Foram recrutados 20 pacientes com diagnóstico de AVC crônico, que passaram pelas avaliações por cerca de uma hora. Os resultados demonstraram que a FM se correlaciona positivamente com o IB e a EEB, mostrando que, quando utilizadas em conjunto, classificam de forma esclarecedora o quadro físico geral do paciente com AVC. Após o AVC, o comprometimento da função do membro superior é a seqüela mais comum, podendo ser permanente. Os movimentos de alcance feitos com o membro superior hemiparético são freqüentemente acompanhados por movimentos compensatórios de tronco e cintura-escapular. O uso da terapia de restrição de tronco visa evitar a movimentação compensatória de tronco, propiciando o desenvolvimento de padrões motores mais próximos do normal no braço afetado. Através do uso de escalas de mensuração clínica, foram observados os benefícios da terapia de restrição de tronco em 11 sujeitos com seqüela de AVC que passaram por 20 sessões de treinamento (Artigo 2). Em um segundo estudo (Artigo 3), 20 sujeitos foram recrutados e divididos em dois grupos de treinamento (20 sessões): Grupo com Tronco Restrito (GTR - treinamento de alcance com o tronco restrito) e o Grupo com Tronco Livre (GTL - treinamento de alcance sem restrição de tronco, enfatizando o uso da orientação verbal). O objetivo foi verificar os benefícios a longo prazo do treinamento de alcance tarefa-específica associado à terapia de restrição de tronco, utilizando como instrumentos de medida as escalas clínicas (Escala Modificada de Ashworth, FM, IB e EEB) e a avaliação cinemática do movimento (deslocamento, velocidade, angulação). As avaliações foram divididas em três momentos: a primeira foi realizada na admissão (PRÉ); a segunda, no final do período total de treinamento (PÓS) e a terceira, três meses após o término do tratamento (RET). O treinamento tarefa-específica associado à terapia de restrição de tronco (GTR) mostrou-se eficaz a longo prazo para a melhora dos movimentos articulares ativos de ombro e cotovelo, além de propiciar melhora no planejamento interno do movimento. Em contrapartida, o uso contínuo da restrição provocou dependência aos pacientes e não foi eficaz na redução dos graus adicionais de liberdade (tronco) a longo prazo. Apesar do treinamento baseado em orientações verbais (GTL) ter sido mais eficaz na retenção do tronco, não houve melhora significativa nas amplitudes articulares voluntárias de membro superior. Acredita-se que os pacientes que passaram por este tipo de tratamento ficaram mais atentos ao recrutamento anormal de graus adicionais de liberdade e não exploraram de forma efetiva as combinações multiarticulares presentes membro superior. / Abstract: Stroke is recognized as one of the major causes of morbidity and mortality. Sequels deriving from this event may lead to motor disability and from mild to severe deficits. In order to better classify sensory-motor dysfunction, balance and ability to perform activities of daily living (ADL), quantitative and qualitative evaluation scales have been used. The aim of Article 1 was to verify the correlation between the Fugl-Meyer Assessment Scale (FM), Berg Balance Scale (BBS) and Barthel Index (BI). Twenty chronic stroke patients were submitted to an evaluation that spent approximately one hour. The results demonstrated that the FM was positively correlated with the BBS and BI, showing that when they are employed together, make it possible to design the general clinical performance of the stroke patient. After stroke, upper limb function impairment is the most common sequel that could lead to permanent dysfunction. Reaching movements made with hemiparetic upper limbs are often followed by compensatory trunk and shoulder-girdle movements. The use of the trunk restraint therapy aims at avoiding the compensatory trunk movement providing the development of normal motor patterns in the affected upper limb. The benefits of the trunk restraint therapy could be observed through the clinical measures scales in eleven stroke subjects that performed twenty training sessions (Article 2). In another study (Article 3), twenty patients were recruited and divided into two training groups (20 sessions): Trunk restraint group (TRG - reaching training with trunk restraint) and trunk free group (TFG - reaching training without trunk restraint, providing emphasis in the verbal cue). The aim was to verify the long term benefits of the task-specific training with trunk restraint using the clinical scales (Modified Ashworth Scale, FM, BI and BBS) and the kinematic analysis (displacement, velocity, angles) like evaluation tools. The evaluations were performed in three phases: the first, in admission time (PRE test); the second, after the end of the treatment (POST test); and the third, three months after the completed treatment (retention test - RET test). Task-specific training associated with the trunk restraint therapy (TRG) proved to be a long-term effective treatment in the enhancement of shoulder and elbow active joint range, as well as in the improvement of the internal planning of the movement. However, the continuous use of restraint may have caused dependence to the patients and was not efficient in long term reduction of the additional degrees of freedom (trunk). Although the verbal cue training (TFG) was more effective in the trunk retention, there was no significant improvement in the upper limb joint ranges. Therefore patients who sustained this type of treatment developed more attention in the abnormal recruitment of the additional degrees of freedom, and did not efficiently explore the multi-joint combinations presented in the upper limb. / Doutorado / Ciencias Biomedicas / Doutor em Ciências Médicas

Background: Numerous multidimensional assessment tools have been developed to measure frailty; however, the clinical feasibility of these tools is limited. We previously developed and validated an upper-extremity function (UEF) assessment method that incorporates wearable motion sensors. The purpose of the current study was to: 1) cross-sectionally validate the UEF method in a larger sample in comparison with the Fried index; 2) develop a UEF frailty index to predict frailty categories including non-frail, pre-frail, and frail based on UEF parameters and demographic information, using the Fried index as the gold standard; and 3) develop a UEF continuous score (points scores for each UEF parameter and a total frailty score) based on UEF parameters and demographic information, using the Fried index as the gold standard. Methods: We performed a cross-sectional validation and index development study within the Banner Medical Center, Tucson, and Banner Sun Health Research Institute, Sun City, Arizona. Community-dwelling and outpatient older adults (>= 60 years; n = 352; 132 non-frail, 175 pre-frail, and 45 frail based on Fried criteria) were recruited. For the UEF test, each participant performed a 20-s elbow flexion, within which they repetitively and rapidly flexed and extended their dominant elbow. Using elbow motion outcomes two UEF indexes were developed (categorical and score). The Fried index was measured as the gold standard. Results: For the categorical index, speed of elbow flexion, elbow range of motion, elbow moment, number of flexion, speed variability and reduction within 20 s, as well as body mass index (BMI) were included as the pre-frailty/frailty predictor parameters. Results from 10-fold cross-validation showed receiver operator characteristic area under the curve of 0.77 +/- 0.07 and 0.80 +/- 0.12 for predicting Fried pre-frailty and frailty, respectively. UEF score (0.1 to 1.0) was developed using similar UEF parameters. Conclusions: We present an objective, sensor-based frailty assessment tool based on physical frailty features including slowness, weakness, exhaustion (muscle fatigue), and flexibility of upper-extremity movements. Within the current study, the method was validated cross-sectionally using the Fried index as the gold standard and the UEF categorical index and UEF frailty score were developed for research purposes and potentially for future clinical use.

Background Efficient shoulder movement depends on the ability of central nervous system to integrate sensory information and to create an appropriate motor command. Various daily encountered factors can potentially compromise the execution of the command, such as fatigue. This study explored how fatigue influences shoulder movements during upper limb reaching. Methods Forty healthy participants were randomly assigned to one of two groups: Control or Fatigue Group. All participants completed an upper limb reaching task at baseline and post-experimental, during which they reached four targets located at 90° of shoulder abduction, 90° external rotation at 90° abduction, 120° scaption, and 120° flexion in a virtual reality environment. Following the baseline phase, the Fatigue Group completed a shoulder fatigue protocol, while Controls took a 10-minute break. Thereafter, the reaching task was repeated. Upper limb kinematic (joint angles and excursions) and spatiotemporal (speed and accuracy) data were collected during the reaching task. Electromyographic activity of the anterior and middle deltoids were also collected to characterize fatigue. Two-way repeated-measures ANOVA were performed to determine the effects of Time, Group and of the interaction between these factors. Results The Fatigue group showed decreased mean median power frequency and increased electromyographic amplitudes of the anterior deltoid (p < 0.05) following the fatigue protocol. Less glenohumeral elevation, increased trunk flexion and rotation and sternoclavicular elevation were also observed in the Fatigue group (Group x Time interaction, p < 0.05). The Control group improved their movement speed and accuracy in post-experimental phase, while the Fatigue group showed a decrease of movement speed and no accuracy improvement (Group x Time interaction, p < 0.05). Conclusion In a fatigued state, changes in movement strategy were observed during the reaching task, including increased trunk and sternoclavicular movements and less glenohumeral movement. Performance was altered as shown by the lack of accuracy improvement over time and a decrease in movement speed in the Fatigue group.

Seventy percent of stroke survivors experience loss of upper limb function after stroke and rehabilitative therapy is the only option to reduce impairments. However, uncertainty remains as to the optimal dose of therapy that should be prescribed. It has been suggested to report multiple parameters of dose, to increase standardization within the field, and to gain a better understanding of the dose-response relationship. This study investigated the automatic quantification of multiple dose parameters in a rat model of ischemic stroke, with rehabilitation paradigms whereby rats repeatedly grasp for food pellets to train their forelimb function. Starting 7 days post-stroke, groups of rats received 4, 8, or 12 rehabilitative training sessions for 10 days, practicing either high-quality (precision practice) or less skilled (mass practice) reaching movements. Pellet consumption was measured after each session and various metrics were analyzed using deep learning-based software (DeepLabCut, DLC) to represent parameters of dose intensity (number of reaches, paw path length) and session density (time on task). Functional outcome was assessed with the Montoya staircase task. Computer algorithms were validated against human analysis, demonstrating reach detection accuracy and reliability >80%. Interestingly, the number of training sessions did not alter the accumulated movement practice across rehabilitation, in either task. However, the number of sessions inversely affected training intensity, resulting in more forelimb use per session in rats with 4 sessions compared to 12 sessions. We found strong positive correlations between the number of reaches, time on task, paw path length, and pellets consumed in the precision practice, but only between reaches and pellets consumed in mass practice. This work demonstrates the quantification of multiple dose parameters using deep learning software and shows subtle differences between the two commonly used forelimb training tasks. Moreover, our data suggest that rehabilitative training at a frequency that is too high may negatively impact performance per session.

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