<p>Few studies have shown the process of adaptation in muscle activity and joint angle during prolonged repetitive work. Fifteen healthy men performed 1 minute cycles of automotive-related tasks, which included a finger pull, knob turn, drill press and hose connector push. The experiment occurred on two days, separated by 24 hours. Day 1 required 61 cycles, with 5 cycles on day 2. Electromyography and kinematics of the upper extremity were analyzed at 12-minute intervals. Time to complete work cycle decreased by 6.3 s at the end of day 1 and 5.3 s on day 2. Peak EMG decreased for triceps brachii (TB), anterior deltoid (AD) and infraspinatus (IN) during work cycle, TB (finger pull), biceps brachii (BB), TB, AD, middle deltoid (MD) and IN during the hose insertion task. Peak EMG increased for MD and IN during the drill task. Mean EMG decreased for MD (work cycle), BB (hose insertion) and AD (finger pull), while MD and IN increased (drill task) and upper trapezius increased during the work cycle. EMG COV decreased for TB, AD, posterior deltoid and IN during the work cycle, TB during the finger pull task and AD during the hose insertion task. COV increased for BB during the work cycle, AD during the finger pull and for BB and lower trapezius during the drill press. Peak shoulder flexion decreased by 7.0° during the work cycle. Perceived discomfort increased by 1.2 units. This thesis found adaptations to highly repetitive but light work in only one hour, some of these changes persisted through the next day suggesting an adaptive process. This thesis is one of the first to examine adaptations to a highly repetitive simulated assembly work and has provided new insights into the evaluation of repetitive jobs as a whole and as isolated subtasks.</p> / Master of Science in Kinesiology

Yes / Assistive and robotic training devices are increasingly used for rehabilitation of the hemiparetic arm after stroke, although applications for the wrist and hand are trailing behind. Furthermore, applying a training device in domestic settings may enable an increased training dose of functional arm and hand training. The objective of this study was to assess the feasibility and potential clinical changes associated with a technology-supported arm and hand training system at home for patients with chronic stroke. Methods: A dynamic wrist and hand orthosis was combined with a remotely monitored user interface with motivational gaming environment for self-administered training at home. Twenty-four chronic stroke patients with impaired arm/hand function were recruited to use the training system at home for six weeks. Evaluation of feasibility involved training duration, usability and motivation. Clinical outcomes on arm/hand function, activity and participation were assessed before and after six weeks of training and at two-month follow-up. Results: Mean System Usability Scale score was 69 % (SD 17 %), mean Intrinsic Motivation Inventory score was 5.2 (SD 0.9) points, and mean training duration per week was 105 (SD 66) minutes. Median Fugl-Meyer score improved from 37 (IQR 30) pre-training to 41 (IQR 32) post-training and was sustained at two-month follow-up (40 (IQR 32)). The Stroke Impact Scale improved from 56.3 (SD 13.2) pre-training to 60.0 (SD 13.9) post-training, with a trend at follow-up (59.8 (SD 15.2)). No significant improvements were found on the Action Research Arm Test and Motor Activity Log. Conclusions: Remotely monitored post-stroke training at home applying gaming exercises while physically supporting the wrist and hand showed to be feasible: participants were able and motivated to use the training system independently at home. Usability shows potential, although several usability issues need further attention. Upper extremity function and quality of life improved after training, although dexterity did not. These findings indicate that home-based arm and hand training with physical support from a dynamic orthosis is a feasible tool to enable self-administered practice at home. Such an approach enables practice without dependence on therapist availability, allowing an increase in training dose with respect to treatment in supervised settings. / The SCRIPT (Supervised Care & Rehabilitation Involving Personal Telerobotics) project was partly funded by the European Commission Seventh Framework Program under grant agreement no. FP7-ICT-288698.

A 53 year-old male presented with a one-day history of a swollen arm and dull, aching pain in the right upper extremity. The patient reported commencing exercising daily over the prior week with a modified, oscillating dumbbell; commonly referred to as a Shake Weight. Imaging revealed an occlusive thrombus in the right axillary, proximal brachial and basilic veins. The patient was treated with a 24-hour tPA infusion followed by mechanical thrombectomy, balloon angioplasty, and stent placement for a residual thrombus and stenosis. The patient was discharged the following day on warfarin and aspirin. This is the first report of effort-induced thrombosis of the upper extremity following the use of a modified, oscillating dumbbell. Due to the growing popularity of modified dumbbells and the possible risk for axillary vein thrombosis, consideration should be made to caution consumers of this potential complication.

Upper extremity splinting is a popular treatment method for a range of conditions, such as rheumatoid arthritis. The intent of this treatment approach is multifaceted, but fundamentally, the provision of tools to enable and encourage patients to carry out everyday activities and to improve their quality of life is paramount. However, the aesthetic and functional limitations of wrist immobilisation splints demonstrate various weaknesses in terms of wear duration and frequency. Patient compliance is often compromised due to a number of factors, including the perceived stigma associated with assistive devices. Additive Manufacturing (AM) has proved its worth in a number of applications relating to the design of assistive devices; builds of complex, bespoke fitting geometries make AM an ideal fabrication method for upper extremity splints. However, recent advances in system technology to enable multi-material builds have been limited in this field, and a distinct need for a specialised three-dimensional (3D) Computer Aided Design (CAD) software approach is required to allow therapists to design splints for AM. Furthermore, the intent to keep practising therapists at the forefront of splint prescription is of utmost importance. This research proposes a digitised splinting approach, specifically through development of a 3D CAD software strategy to allow therapists to capture their design intent without compromising creativity. Furthermore, the approach proposes the exploration of AM build capabilities by allowing the integration of more creative features, such as aesthetically pleasing lattice structures for increased skin ventilation. The approach also proposes the integration of multiple materials to replicate and improve upon current splint design and fabrication practises. The approach therefore explores an exciting new paradigm for upper extremity splinting, the driving characteristics of which have not been proposed before as a collective medium. This research describes the feasibility of capturing therapists design intent in a 3D CAD virtual environment, whilst capturing therapists opinions of the approach with suggestions for future research and development. Results concluded that therapists were excited by the proposed transition in AM splinting, but that significant development is required elsewhere to establish a supporting infrastructure in order to make the approach a viable option in future upper extremity splinting.

Many women who have experienced breast cancer (BC) report continued impairments in upper extremity (UE) function beyond the time required for normal healing after surgical treatment. Most research supporting this has not made comparisons between survivors of breast cancer (BCS) to a sample of healthy women. This lack of comparison to a healthy cohort prevents an understanding of whether continued deficits in UE function are due to normal aging or the BC treatment. The purpose of this research was to compare quality of life (QOL) and UE function among long term breast cancer survivors and similar aged women without cancer. Both self-report and objective measurements of UE function were used to create an understanding of UE functional abilities in both populations. Data on self-reported QOL and UE function, ROM, strength, and muscular endurance were collected on 79 healthy women ages 30-69, stratified by decade. Comparisons between decades and between dominant and non-dominant limbs were made. Findings supported no effect of aging on measures, and that dominance does affect some objective measures of motion, strength, and muscular endurance. A group of 42 survivors of breast cancer (BCS) were compared to the data from healthy controls on the same measures. BCS reported lower levels of QOL and UE function, and demonstrated less motion and strength than the healthy cohort, particularly when cancer occurred on the non-dominant limb. The values of the measures, however, are not clinically relevant, and reveal that BCS 6 years after treatment recover UE function to levels similar to healthy controls. In view of a lack of clinically feasible measures of UE muscular endurance, a new test to assess this was designed and implemented: the modified Upper Body Strength and Endurance test (mUBSE). It was believed this new test would be less variable than the Functional Impairment Test – Hand and Neck, Shoulder, Arm – FIT-HaNSA. Seventeen BCS and 17 matched controls were compared on the mUBSE and FIT-HaNSA. Findings were similar for both tests. Furthermore, BCS who are 6 years post BC treatment appear to recover muscular endurance levels to normal ranges.

The wrist is one of the most complex joints in the human body. As such, the wrist joint is difficult to model due to the number of bones involved and its intricate soft tissue interactions. Many studies have attempted modeling the wrist previously; however, the majority of these studies simplify the joint into two-dimensions or idealized mechanical joints to reduce the complexity of the simulation. While these approaches still yield valuable information, the omission of a third-dimension or geometry defined movements limits the models’ usefulness in predicting joint function under non-idealized conditions. Therefore, the goal of this study was to develop a computational model of the wrist joint complex using commercially available software, whereby joint motion and behavior is dictated by highly accurate three-dimensional articular contact, ligamentous constraints, muscle loads, and external perturbations only. As such, a computational model of the human wrist was created using computed tomography (CT) images of a cadaver right upper extremity. Commercially available medical imaging software and three-dimensional computer aided design (CAD) software were used to reconstruct the osteoarticular surfaces and accurately add soft tissue constraints, as well as calculate kinematic motion simulations. The model was able to reproduce physiologic motion including flexion/extension and radial/ulnar deviation. Validation of the model was achieved by comparing predicted results from the model to the results of a published cadaveric experiment that analyzed wrist function under effects of various surgical procedures. The model was used to replicate the exact testing conditions prescribed for the experiment, and the model was able to accurately reproduce the trends and, in many instances, the magnitudes of the range of motion measurements in the study. Furthermore, the model can now be used to predict the magnitudes for the joint contact forces within the wrist as well as the tension developed in ligaments in hopes locating potential areas of concern after these surgical procedures have been conducted, including further development of arthritis in the wrist and ligament breakdown.

A estimulação somatossensitiva através da estimulação repetitiva de nervos da mão parética é uma abordagem promissora na recuperação motora do membro superior de pacientes com acidente vascular cerebral (AVC) na fase crônica e habitualmente é realizada em ambiente hospitalar. A dificuldade de comparecimento frequente de pacientes com AVC ao hospital pode prejudicar a implementação desta estratégia terapêutica em nosso meio. A reabilitação domiciliar pode ser uma alternativa interessante, além de ser menos dispendiosa do que a reabilitação hospitalar. O atual estudo teve como objetivo principal verificar a melhora em desempenho na função do membro superior parético após uma intervenção de estimulação somatossensitiva associada a treino motor, em ambiente domiciliar. Foi realizado um ensaio clínico aleatorizado, com mascaramento duplo e dois tipos de intervenção: ativa ou controle. Os pacientes do grupo ativo foram instruídos a utilizar um dispositivo de estimulação elétrica do nervo mediano, por duas horas. Os pacientes do grupo controle também foram instruídos a usar o dispositivo durante duas horas, porém sem que houvesse estimulação do nervo. Imediatamente após a utilização do dispositivo, todos os pacientes foram orientados a realizar um treino motor baseado no teste de Jebsen-Taylor. O tratamento foi realizado diariamente, ao longo de um mês. O desfecho primário foi o efeito da estimulação somatossensitiva (ativa versus controle) associada a treino motor sobre a melhora da função do membro superior parético avaliada pelo teste de Jebsen-Taylor. Os desfechos secundários foram: 1) melhora na independência funcional, avaliada pela Medida de Independência Funcional (MIF); 2) aderência às intervenções propostas, avaliada através de registros em uma agenda, e de relatos orais dos pacientes; 3) eventos adversos decorrentes dessas intervenções. O desempenho no teste de Jebsen-Taylor e na Medida de Independência Funcional (MIF) foi avaliado antes das intervenções (D0), ao seu término (D30) e quatro meses após o seu término (D150). Para a comparação da melhora em desempenho no teste de Jebsen-Taylor e da melhora em pontuação na MIF no grupo ativo e no grupo controle, foi utilizada análise de variância com medidas repetidas (ANOVAMR) com fatores grupo (ativo e controle) e tempo (D30 e D150). Foi observado um efeito significativo de grupo (F=5,02; p=0,038) na ausência de efeitos significativos de tempo ou interação grupo*tempo (p>0,05) em relação à melhora em desempenho no teste de Jebsen-Taylor. Não houve diferenças estatisticamente significantes entre os grupos em relação à pontuação na MIF após o tratamento. O grupo ativo apresentou maior aderência ao tratamento do que o grupo controle, porém esta conclusão foi baseada em informações fornecidas pelos pacientes, sem observação direta da pesquisadora. Não observamos eventos adversos relevantes. Este estudo é pioneiro por demonstrar efeitos benéficos, em longo prazo, da estimulação somatossensitiva associada a treino motor realizado em ambiente domiciliar, sem a supervisão de um terapeuta. Para a realização de estudos futuros, sugerimos algumas modificações em relação ao protocolo de estimulação somatossensitiva e treino motor, assim como combinações da técnica utilizada a outras técnicas de neuroestimulação / Somatosensory stimulation in the form of peripheral nerve stimulation is a promising strategy to improve motor function of the upper limb in chronic stroke patients and is usually administered in research laboratories. The usual difficulty in commutting to and from the hospital in a regular basis at short intervals of time is an obstacle for implementation of this therapeutic approach in our country. Home-based rehabilitation may be an interesting alternative, in addition to being less expensive than hospital-based rehabilitation. The current study aims to evaluate the improvement in performance of the paretic upper extremity after an experimental intervention consisting of somatosensory stimulation associated with motor training, performed at home. This study is a randomized, double-blind clinical trial, with two different types of interventions: active or control. Patients in the active group were instructed to use a device of electrical stimulation of the median nerve, for two hours. Patients in the control group were also instructed to use the device for two hours, and sham stimulation was administered. Immediately after the use of the device, all patients were instructed to train tasks that are part of the Jebsen-Taylor test. Treatment was performed daily, for one month. The primary outcome was improvement in performance of the paretic hand, evaluated by the Jebsen-Taylor test. Secondary outcomes were: 1) improvement in the Functional Independence Measure (FIM); 2) compliance with the proposed interventions, assessed through a daily written log, and oral reports of the patients; 3) possible adverse events from these interventions. Performance in the Jebsen-Taylor test and FIM scores were assessed before the interventions (D0), immediately after its end (D30) and four months after its end (D150). Analysis was performed with repeated- measures ANOVA (ANOVARM) with factors GROUP (active and control) and TIME (D30 and D150). Regarding Jebsen-Taylor test improvement, there was a significant effect of GROUP (F=5.02; p=0.038) in the absence of significant effects of TIME or interaction GROUP*TIME (p>0.05). There were no significant differences in FIM scores in either group after treatment. Compliance with treatment was greater in the active than in the control group, but conclusions about this finding are limited because data were collected solely based on information provided by patients. No relevant adverse events were observed. This study pioneered home-based somatosensory stimulation combined with motor training, without direct supervision of a therapist. We suggest changes to be made in the protocol in future studies, as well as investigation of effects of somatosensory stimulation combined with other neurostimulation techniques

Introdução: O ombro é a região mais acometida por lesões em atletas competitivos de esportes aquáticos, e a principal causa dessas lesões é o uso repetitivo do membro superior à cima da cabeça. Dentre as modalidades dos esportes aquáticos, o polo aquático e a natação são as modalidades que apresentam uma maior prevalência de lesão no ombro. O Déficit de Rotação Interna da Glenoumeral (GIRD) é a alteração biomecânica mais frequente em atletas \"overhead\". Vários estudos têm relacionado o GIRD com a avaliação clínica do ombro, como avaliação de amplitude de movimento e força em atletas de beisebol. Entretanto, poucos estudos têm avaliado o efeito que o GIRD exerce na articulação glenoumeral de atletas competitivos de esportes aquáticos. Objetivos: O objetivo é estudar os fatores associados ao Déficit de Rotação Interna da Glenoumeral (GIRD) e sua correlação com a avaliação funcional do ombro em atletas competitivos de esportes aquáticos. Desenho do estudo: estudo observacional com corte transversal. Amostra: Foram avaliados 44 atletas competitivos de duas modalidades de esportes aquáticos, natação e polo aquático, de ambos os sexos, com média de idade de 15 (±1,6) anos e índice de massa corpórea de 22,38 (±2,95) Kg/m². Métodos: Avaliamos o GIRD e o arco total de amplitude de movimento de rotação do ombro com a goniometria. Avaliação da funcionalidade do membro superior com \"Closed Kinetic Chain Upper Extremity Stability test\" (CKCUES). Avaliação do índice do comprimento do peitoral menor, medindo o comprimento do músculo peitoral menor com uma fita métrica. A avaliação do torque dos rotadores internos com o dinamômetro isocinético. E a avaliação da percepção de função do ombro com \"Shoulder Pain and Disability Index\" (SPADI-Br), e a Escala de Avaliação dos Resultados do Ombro do Esportista\" (EROE), traduzidos e validados para a população brasileira. Análises estatística: Foi utilizado a análise de regressão linear múltipla, considerando o GIRD como variável dependente (de saída) e a arco total de amplitude de movimento de rotação da glenoumeral, índice do comprimento do peitoral menor e pico de torque dos rotadores internos como as variáveis independentes (preditores). Análise de correlação de Pearson bilateral, considerando o GIRD como variável dependente e os escores do CKCUES, do SPADI-Br e do EROE como variáveis independentes. Resultados: Na análise de regressão linear múltipla foi encontrado uma associação significante entre o GIRD e o arco total do movimento de rotação (R² ,30). E a análise de correlação de Pearson, encontrou uma correlação pobre e no sentido negativo com o escore total do SPADI-Br (-,382). Conclusão: O único fator que se associou ao déficit de rotação interna da glenoumeral (GIRD), foi amplitude de movimento total de rotação da glenoumeral e o GIRD não se correlacionou com a avaliação funcional do ombro em atletas de esportes aquáticos. / Background: The shoulder is the region most affected by injuries in competitive athletes of aquatics sports, and the main cause of these injuries is the overuse of the upper limb in to overhead. Among the modalities of aquatics sports, water polo and swimming are the modalities that have the higher prevalence of shoulder injury. The Glenohumeral Internal Rotation Deficit (GIRD) is the most frequent biomechanical change in overhead athletes. Have been done many studies relating the GIRD with clinical shoulder evaluations, as evaluation of range of motion and strength in baseball athletes. However, few studies have assessed the effect that the GIRD exerts on the glenohumeral joint of competitive athletes of aquatics sports. Objectives: This study aims to analyze the factors associated with the Glenohumeral Internal Rotation Deficit (GIRD) and its correlation with functional assessment of the shoulder in competitive athletes of aquatics sports. Study Design: observational crosssectional study. Sample: We evaluated 44 competitive athletes from two modalities of aquatics sports, swimming and water polo, of both sex, with a mean age of 15 (± 1.6) years old and body mass index (BMI) of 22.38 (± 2 95) kg/m². Methods: We assessment the GIRD and total arc of motion of rotation with goniometry. Assessment of functionality of the upper limb with Closed Kinetic Chain Upper Extremity Stability test (CKCUES). The evaluation of the pectoralis minor length index was measuring the length of pectoralis minor with a tape measure. The assessment of the torque of internal rotators with the isokinetic dynamometer. The assessment of perception of shoulder function with Shoulder Pain and Disability Index (SPADI-Br), and Athletic Shoulder Outcome Rating Scale (ASORS) questionnaires. Statistical Analyzes: Multiple linear regression analysis, considering the GIRD as the dependent variable (output) and total arc of motion of rotation, the pectoralis minor length index, and peak torque of internal rotators as the independent variables (predictors). Bilateral Pearson correlation analysis, considering the GIRD as the dependent variable and the scores of CKCUES, the SPADI-Br and ASORS as independent variables. Results: In multiple linear regression analysis was identified a significant association between the GIRD and total arc of motion of rotation (R² .30). And Pearson correlation analysis found a poor and negative correlation with the total score of SPADI- Br (-.382). Conclusion: The total arc of motion of rotation was the only factor associated with GIRD, and the GIRD did not correlated with functional assessment of the shoulder in aquatics athletes.

This diploma thesis deals with the issue of robotic-assisted therapy, namely with the mechanical exoskeleton robotic device Armeo Spring, and it is focused on an acute stroke population. The aim of this study is to evaluate the efficiency of a robotic-assisted therapy using Armeo Spring device and to compare it with the efficiency of a common individual occupational therapy focused on improving motor function of upper extremity of patients with the acute stroke. There were 19 patients involved in the research, who were hospitalized in early rehabilitation acute beds. They were selected on the basis of entry criteria and further divided into two groups. An experimental group included 10 participants (n=10), a control group included 9 participants (n=9). The patients in the experimental group using Armeo Spring device underwent four to five 30-minutes therapies per week for three week period, the control group underwent the same amount of individual occupational therapies focused on improving motor function of a paretic upper limp. Each participant, evaluated before and after the intervention, underwent the total number of 12 therapy sessions. In the face of the determined hypothesis, following methods were used to evaluate the sample of patients: Function Independence Measure (FIM) for evaluating...

This diploma thesis deals with the issue of robotic-assisted therapy, namely with the mechanical exoskeleton robotic device Armeo Spring, and it is focused on an acute stroke population. The aim of this study is to evaluate the efficiency of a robotic-assisted therapy using Armeo Spring device and to compare it with the efficiency of a common individual occupational therapy focused on improving motor function of upper extremity of patients with the acute stroke. There were 19 patients involved in the research, who were hospitalized in early rehabilitation acute beds. They were selected on the basis of entry criteria and further divided into two groups. An experimental group included 10 participants (n=10), a control group included 9 participants (n=9). The patients in the experimental group using Armeo Spring device underwent four to five 30-minutes therapies per week for three week period, the control group underwent the same amount of individual occupational therapies focused on improving motor function of a paretic upper limp. Each participant, evaluated before and after the intervention, underwent the total number of 12 therapy sessions. In the face of the determined hypothesis, following methods were used to evaluate the sample of patients: Function Independence Measure (FIM) for evaluating...