Optimized peripheral tremor suppression could address many limitations of surgical or medicinal treatments of Essential Tremor, however it is not well understood how the tremorogenic activity is distributed among the muscles of the upper limb, and therefore how to optimize such suppression. We recorded electromyographic (EMG) activity in the 15 major superficial muscles from the shoulder to the wrist while subjects performed postural and kinetic tasks similar to activities of daily living. We calculated the power spectral density and computed the total power in the tremor band (4"12 Hz) for each muscle, from which we determined the distribution of tremorogenic activity among the 15 muscles for various conditions. Differences in distribution between conditions were quantified as Pearson correlation coefficients. All 15 muscles exhibited some tremorogenic activity. The anterior deltoid exhibited by far the most power, the wrist extensors had more power than other distal muscles, and the triceps longus showed the least power. Distributions among muscles was highly consistent across repetitions (r = 0.91 ± 0.07) and somewhat stereotyped across subjects (r = 0.58 ± 0.31). Differences in task (postural vs. kinetic), limb configuration, and subject characteristics (sex; tremor severity, onset, and duration) had little effect on distribution (r =0.84). Interestingly, the distribution of tremorogenic activity was highly correlated (r = 0.94 ± 0.08) with the distribution of voluntary activity (power between 0.5 and 4 Hz). In particular, muscles opposing gravity had the highest amount of tremorogenic activity. This may explain in part why the distribution of tremorogenic activity was stereotyped across subjects.

Limb loss has severe physical and psychological effects on individuals with upper limb amputations. Higher rates of prosthetic device abandonment has contributed to a need for prosthetic hands that are functional and comfortable for the user. Prosthetic hands have been abandoned for many reasons including weight, size, limited functionality, training time, and discomfort. An optimal prosthetic hand considers both neural control and sensory feedback. Neural control of the prosthetic is crucial to obtain accuracy and desirable functions. Popular methods of sensory feedback such as visual feedback are mentally exhausting and require constant focus from the user. Control and feedback of prosthetic devices differs based on the type of prosthetic. Passive, myoelectric, body-powered, electrocorticographic, adaptive, and sonomyographic prosthetic hand devices focus on a variety of hand movements and each utilizes different methods of control. It is also important to consider the biomaterials of prosthetic hands to enhance comfort and ease-of-use. Mechanical and AM-ULA testing ensure prosthetic hands can perform necessary movements for the user. To develop an ideal prosthetic hand, control and feedback must be considered along with comfort and functionality of the device.

Introduction Lateral elbow pain is a common disorder and affects 1-3 % of the population each year. Beside the typical characterization with pain in restricted dorsal and radial deviation of the wrist and local tenderness of the lateral epicondyle, a neurodynamic dysfunction of the radial nerve can co-exist with the tendon dysfunction.  Purpose The aim of the study was to evaluate the effects of individualized neurodynamic treatment in combination with neurodynamic self-treatment in patient with persistent lateral elbow pain with a neurodynamic dysfunction of the radial nerve on grip strength, pain, disability, and function.  Method A single subject experimental design with A-B-A design was conducted. Seven participants with lateral elbow pain and a neurodynamic dysfunction of the radial nerve were recruited for the study. Five participants completed the study which consisted of individualized neurodynamic treatment directed to the neurodynamic dysfunction in combination with home exercises which included self-mobilization with sliders and/or tensioners in combination of the strengthening- and stretching exercises. The treatment was evaluated by pain-free and maximal grip strength, the Disabilities of the Arm, Shoulder and Hand (DASH) and Patient-rated Tennis Elbow Evaluation (PRTEE) questionnaires and range of motion of the upper limb neurodynamic test (ULNT) biased n. radialis.   Results The result of this SSED shows that neurodynamic treatment with manual mobilization and self-mobilization improves the ROM of the ULNT n. radialis in all five participants. Neurodynamic treatment also improved outcomes of DASH and PRTEE in 3 of the 5 participants.  Conclusion Neurodynamic treatment including manual mobilization and self-mobilization in combination with individual strength exercises tends to improve self-rated pain and disability, function and mechanosenstivity of the radial nerve in patients with persistent lateral elbow pain.

People experiencing mobility deficiencies in their lower limbs caused by genetics, injuries, diseases, etc. struggle with their physical and mental health. The goal of this research is to design an exoskeleton that will connect the upper limb (e.g., arm extension) to the ankle joint during walking movements. We advanced the first prototype of the Workshare Upper Lower Limb (WULL) by only targeting the ankle joint as the lower limb component. We found that this change would have the biggest impact on an individual's walking movements. The benefit of this research will be found in answering the question: will harnessing the kinetic energy from a person's upper limb (e.g., arm extension or arm flexion) to transfer into the ankle joint for gait assistance reduce the lower limb muscle activation during walking movements? A series of experiments were run to test the efficacy of the wearable device. Six participants were fitted to the device and six electromyography (EMG) sensors to track the muscle activation during a comfortable walking pace. This gait analysis study used pressure insoles to calculate ground reaction forces and multiple IMUs to track the individuals' limbs and joints kinetic motion. The overall effectiveness of the device was explored based on the data collected in this study. This device decreased muscle activation of the gastrocnemii medialis and increased the anterior deltoid activation. These results support the goal of the experiment to utilize the upper limbs (anterior deltoid) to assist the lower limbs (ankle joint) during walking.

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Background: The use of outcome measures to evaluate upper extremity function after stroke is highly recommended in clinical practice and research. The Chedoke Arm and Hand Activity Inventory (CAHAI) is a recommended measure as it has strong psychometric properties and clinical utility. However, the measure has not been validated in Asia and there are also gaps in the knowledge about the psychometric properties of the CAHAI. Aim & Objectives: This thesis is dedicated to the continued evaluation of the CAHAI with two main objectives: (1) to develop a Singapore version of the CAHAI, and (2) to re-evaluate the original CAHAI using modern test theories. Method: We conducted a study to cross-culturally adapt the CAHAI and evaluated the psychometric properties in a stroke sample in Singapore. Two studies were conducted to re-evaluate the original CAHAI using modern test theories. In the first study, item response theory and Rasch measurement theory were used to evaluate the psychometric properties of the measure. Following which, both measurement theories were used to revise the CAHAI in the second study. Results: Two test items were modified for the Singapore version of the CAHAI, and the measure had good inter-rater reliability (intra-class correlation coefficient = 0.95 – 0.97) and construct validity. The evaluation of the original CAHAI using modern test theories identified three main problems: (1) the scoring scale was not working as intended, (2) local dependency, and (3) the measure was not unidimensional. Revisions to the CAHAI included collapsing the 7-category scale to four categories, deleting two test items, and developing two new shortened versions. Conclusion: The Singapore version of the CAHAI is a valid and culturally relevant outcome measure that can be used to evaluate post-stroke upper extremity function. The original CAHAI was refined into a new 11- and 5-item versions with a 4-category scale which clinicians may find easier to use. / Thesis / Doctor of Philosophy (PhD)

There are many amputees around the world who have lost a limb through conflict, disease or an accident. Upper-limb prostheses controlled using surface Electromyography (sEMG) offer a solution to help the amputees; however, their functionality is limited by the small number of movements they can perform and their slow reaction times. Pattern recognition (PR)-based EMG control has been proposed to improve the functional performance of prostheses. It is a very promising approach, offering intuitive control, fast reaction times and the ability to control a large number of degrees of freedom (DOF). However, prostheses controlled with PR systems are not available for everyday use by amputees, because there are many major challenges and practical problems that need to be addressed before clinical implementation is possible. These include lack of individual finger control, an impractically large number of EMG electrodes, and the lack of deployment protocols for EMG electrodes site selection and movement optimisation. Moreover, the inability of PR systems to handle multiple forces is a further practical problem that needs to be addressed. The main aim of this project is to investigate the research challenges mentioned above via non-invasive EMG signal acquisition, and to propose practical solutions to help amputees. In a series of experiments, the PR systems presented here were tested with EMG signals acquired from seven transradial amputees, which is unique to this project. Previous studies have been conducted using non-amputees. In this work, the challenges described are addressed and a new protocol is proposed that delivers a fast clinical deployment of multi-functional upper limb prostheses controlled by PR systems. Controlling finger movement is a step towards the restoration of lost human capabilities, and is psychologically important, as well as physically. A central thread running through this work is the assertion that no two amputees are the same, each suffering different injuries and retaining differing nerve and muscle structures. This work is very much about individualised healthcare, and aims to provide the best possible solution for each affected individual on a case-by-case basis. Therefore, the approach has been to optimise the solution (in terms of function and reliability) for each individual, as opposed to developing a generic solution, where performance is optimised against a test population. This work is unique, in that it contributes to improving the quality of life for each individual amputee by optimising function and reliability. The main four contributions of the thesis are as follows: 1- Individual finger control was achieved with high accuracy for a large number of finger movements, using six optimally placed sEMG channels. This was validated on EMG signals for ten non-amputee and six amputee subjects. Thumb movements were classified successfully with high accuracy for the first time. The outcome of this investigation will help to add more movements to the prosthesis, and reduce hardware and computational complexity. 2- A new subject-specific protocol for sEMG site selection and reliable movement subset optimisation, based on the amputee’s needs, has been proposed and validated on seven amputees. This protocol will help clinicians to perform an efficient and fast deployment of prostheses, by finding the optimal number and locations of EMG channels. It will also find a reliable subset of movements that can be achieved with high performance. 3- The relationship between the force of contraction and the statistics of EMG signals has been investigated, utilising an experimental design where visual feedback from a Myoelectric Control Interface (MCI) helped the participants to produce the correct level of force. Kurtosis values were found to decrease monotonically when the contraction level increased, thus indicating that kurtosis can be used to distinguish different forces of contractions. 4- The real practical problem of the degradation of classification performance as a result of the variation of force levels during daily use of the prosthesis has been investigated, and solved by proposing a training approach and the use of a robust feature extraction method, based on the spectrum. The recommendations of this investigation improve the practical robustness of prostheses controlled with PR systems and progress a step further towards clinical implementation and improving the quality of life of amputees. The project showed that PR systems achieved a reliable performance for a large number of amputees, taking into account real life issues such as individual finger control for high dexterity, the effect of force level variation, and optimisation of the movements and EMG channels for each individual amputee. The findings of this thesis showed that the PR systems need to be appropriately tuned before usage, such as training with multiple forces to help to reduce the effect of force variation, aiming to improve practical robustness, and also finding the optimal EMG channel for each amputee, to improve the PR system’s performance. The outcome of this research enables the implementation of PR systems in real prostheses that can be used by amputees.

Plusieurs champs de recherche ont été combinés - mettant en évidence l'utilité de l'analyse cinématique, non seulement afin d'évaluer le comportement moteur, mais aussi afin de contribuer à la compréhension de la récupération motrice post-AVC. Au travers d'analyses cinématiques, les mouvements du membre supérieur hémiplégique ont été décomposés dans le temps et l'espace, afin d'en extraire l'échelle et les composantes structurelles. Cette décomposition systématique, d'abord connue pour son bien-fondé clinique, nous a permis d'identifier les marqueurs les plus pertinents du contrôle du membre supérieur parétique : i.e., la fluidité, la rectitude et la vitesse. Subséquemment, il a été démontré que i) les changements cinématiques se stabilisent au cours de la phase de rééducation, indiquant potentiellement la nécessité de modifier la stratégie thérapeutique; ii) les patient post-AVC sont capables de percevoir la fluidité du mouvement en réalité virtuelle, cette perception étant meilleure lorsque le feedback visuel ne concerne que le point du travail du membre; iii) l'espace de travail post-AVC n'est pas isotrope pour un patient hémiplégique; iv) chez les patients post-AVC, le niveau de ‘bruit neuromoteur' est augmenté; et v) la cinématique reflète la conséquence des stratégies d'adaptation à l'augmentation du bruit, ces stratégies étant basées sur un compromis entre des modes de contrôle d'erreur en feedforward et en feedback des actions motrices. Ainsi, il peut être conclut que la décomposition du mouvement dans le temps et l'espace est un moyen simple et efficace d'appréhender contrôle moteur chez l'Homme en situation normale et âpres AVC. L'enjeu est maintenant d'implémenter ces méthodes d'analyse cinématique dans les protocoles de rééducation post-AVC quotidienne afin de développer de larges bases de données permettant, à l'aide de méthodes de modélisation, de définir des profils de récupération et ainsi personnaliser de façon optimale la rééducation à chaque patient particulier. / Multiple research fields were combined – highlighting the value of kinematic analysis, not only to evaluate motor behaviour, but also to contribute to the understanding of motor recovery post-stroke. By means of kinematics, hemiplegic upper-limb movements were unfolded in time and space, to extract the scaling and structural components of the movement. This systematic decomposition, first proven to have clinical relevance, allowed us to identify the most pertinent markers of paretic upper-limb control: i.e. smoothness, directness and velocity. Subsequently it was shown that i) change in kinematics levels off over rehabilitation, possibly indicating that treatment may profit from change; ii) people post-stroke are able to perceive movement fluency in virtual realities, whereby simple end-point displays facilitate perception; iii) the workspace post-stroke is heterogeneous; iv) stroke patients have increased levels of neuromotor noise; and v) kinematics reflect the outcome of adaptation strategies to the increased noise in relation to the automaticity of error-corrections on the trade-off between feedforward and feedback based motor control. It may thus be concluded that unfolding the movement in space and time, is a simple and powerful way to define human motor control. The challenge is to implement kinematic analysis in daily post-stroke practice to develop a large database enabling the definition of recovery profiles contributing to provide each individual patient with the right therapy at the right time.

The purpose of this Master thesis was to evaluate the effects of the Mirror program on upper- limb motor recovery, self-sufficiency and active range of wrist movement in patients after brain injury. It was included sixteen participants within maximal four months after stroke. Patients were separated into experimental and control group, both with eight members. Experimental group underwent Mirror therapy. Both group participated in a standard rehabilitation program included Physiotherapy, Occupational therapy, physical therapy and movement practice on device. Experimental group patients additionally participated in Mirror therapy program for 30 mins, four times a week, for three weeks. The Fugl-Meyer Assessment, Functional Independence Measure and goniometric measurement of active movement were used to assess recovery of upper-limb movement. Mirror therapy improve upper-limb motor recovery in patients after brain injury. This research demonstrates it with significant difference between both groups, where the experimental group have improved (0,02). I have also proved Mirror therapy, when included in occupational therapy, improves the self-sufficiency of people with neurological deficit. Comparing the data from Functional Independence Measurement, I found the difference between groups statistically...