In the United States, more than 18 million people suffer from upper extremity injury. This population is in need of a device both to aid in the completion of activities of daily living (eating and grooming), as well as to provide daily muscular therapy. To assist persons suffering from disabling upper extremity neuromuscular diseases, this thesis concerned the redesign of a powered arm brace from a proof-of-concept design to a more functional, marketable product. The principles of Design for Manufacturability and Assembly (DFMA) were employed as part of the design methodology to create a product that could be scaled into production. Additionally, numerical analyses including Finite Element Analysis (FEA) were completed to prove the both the safety and structural integrity of the orthosis in computer simulations. The design was then successfully tested with marked improvement over the previous design, including a 58% reduction in weight, decreased manufacturing costs, and a significant improvement in functionality and comfort.

Introduction Post-stroke activity limitation secondary to upper-extremity motor impairment is common, and increasing. We do not currently have effective, globally applicable interventions to improve activity limitation. The burden of post-stroke disability is rising in low and middle-income countries, resulting in an immediate need for effective interventions that can be implemented throughout the world. Purpose This program of research was structured to address three important questions, 1) In all parts of the world, do people with stroke experience similar degrees of activity limitation secondary to upper extremity motor impairment? 2) Are there simple interventions that can be initiated by health care workers, but autonomously sustained by people with stroke, that can improve activity limitation secondary to upper extremity motor impairment? and 3) Are these interventions effective? Methods To address the first question, data from an international stroke study were used to quantify the amount of post-stroke upper extremity weakness and characterize the people. For the second question, a systematic review was conducted to identify current evidence on the effectiveness of simple, task-based practice. To address the third question a protocol was developed for an outcome study. Results Post-stroke upper extremity weakness is common throughout the world, ranging from 67.3% of those with stroke in high-income countries to 97.3% in low-income countries. There is inconclusive, but promising evidence on the effectiveness of simple, task-based practice to improve upper-extremity motor impairment. It is likely that multiple interventions are needed to address the problem and a two-by-two factorial design trial, evaluating simple, task-based practice or a motor enhancing pharmacological agent, implemented in all regions of the world, would be a novel and efficient means of addressing the question. Conclusions The answers to these questions have provided novel information that is a required next step to providing effective, globally applicable interventions for people with stroke. / Thesis / Doctor of Philosophy (PhD) / After having a stroke, more than half the people have difficulty moving their arm. This difficulty often results in difficulties doing every day tasks. Most of the information on what happens after stroke comes from developed countries and we do not know if these problems exist to the same extent in developed countries. We also do not know the most effective interventions to help improve arm function after stroke. Possible interventions could include rehabilitation strategies, drugs or a combination of both. This thesis describes the amount of arm weakness after stroke throughout the world, looks at the evidence for a simple intervention that could be used throughout the world, and describes the design of study that could look at the effectiveness of both rehabilitation and drug interventions throughout the world. This work provides information on the globally applicable interventions to improve arm function after stroke, which has not been considered in the literature to date.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Cartas al editor / Revisión por pares / Revisón por pares

Background: The prevalence of patients with end stage renal disease (ESRD) in Taiwan has risen to the first in the world in recent years. Non-traumatic lower extremity lesion is a common disease of diabetic and ESRD patients. Many studies have found that the prevalence of non-traumatic lower extremity lesion in diabetic patients with ESRD is higher than normal diabetic patients. Prevention the incidence of lower extremity lesions in patients with ESRD may prevent patients from further amputation. Objectives: This study explored the prevalence of ESRD with Non-traumatic lower extremity lesion. We focused on demography status, comorbidities, dialysis therapies and utilization of health care to define the risk factors of disease. Methods: This study conducted secondary data analysis with administrative data from Bureau of National Health Insurance (HV_CD data) for four years (2000, 2002, 2004 and 2006). In total, there were 57021, 75711, 76750, and 86902 for years 2000, 2002, 2004, and 2006, respectively. To attain the research purposes, descriptive analyses and logistic regression were performed. Result: The prevalence of ESRD with non-traumatic lower extremity lesion for the four years were 1.30%, 1.44%, 2.71% and 2.45%, respectively. ESRD patients with and without non-traumatic lower extremity lesion were significant difference between comorbidities (OR for the four years were 2.06, 1.98, 1.86 and 1.83), dialysis therapies (hemodialysis / peritoneal dialysis, OR for the four years were 17.1, 16.79, 15.12 and 9.23) and duration of dialysis (1-5 years / 5 years and more, OR was 1.39 in 2002).There were significant differences in regions of hospital organizations (compared with the north, OR were 0.67 in the center in 2000, 1.47 in the east in 2002 and 0.87 in the center in 2006), class of hospital organizations (compared with Academic Medical Centers, OR were 1.40 in Regional Hospitals, 1.50 in District Hospitals and 0.36 in Physician Clinics in 2000, 0.18 in Physician Clinics in 2002, 0.76 in Regional Hospitals, 0.78 in District Hospitals and 0.23 in Physician Clinics in 2004, 0.66 in Regional Hospitals, 0.75 in District Hospitals and 0.26 in Physician Clinics in 2006 ) and outpatient visits ( positive correlation in all years except 2000). Conclusion: The risk factors of suffering non-traumatic lower extremity lesion in ESRD patients are comorbidities, dialysis therapies and duration of dialysis. In the part of regions of hospital organizations, the east region has higher and the center region has lower probability of suffering the disease, comparing with the north region. Academic Medical Centers has the highest probability to find ESRD patients with non-traumatic lower extremity lesion. We also found the numbers of outpatient visits were increasing with the disease. Based on the results, we highly suggest that caregivers from dialysis units have to pay great attention in taking care of the ESRD patients with non-traumatic lower extremity lesion to prevent from the further amputation.

Analysis techniques specific to the proximal upper extremity have historically been overlooked in the field of ergonomics. This research effort provides a methodology that will allow the ergonomics practitioner to analyze a job and predict whether or not that job exposes workers to increased risk of proximal upper extremity disorders. Literature from the fields of physiology, biomechanics, and epidemiology was assimilated in order to understand the theories of pathogenesis of disorders in the rotator cuff and to identify the risk factors associated with proximal upper extremity disorders. A retrospective epidemiological study was conducted to identify job task variables that may contribute to the occurrence of proximal upper extremity disorders. Two proximal upper extremity constructs were proposed: a fatigue-based model and a compressive load-based model. The constructs incorporated lessons learned from the literature and results from the epidemiological study. Validation of the models was performed using data from the epidemiological study. It was determined that the fatigue-based model was a good predictor of proximal upper extremity disorders.

The aim of this study is to explain the effect of arousal on consumer’s attitude towards a direct service in terms of evaluation extremity. An important element within consumer behavior is the attitude that consumers have towards products and services. After the conceptual framework was developed through an extensive literature review on arousal, attitude and services, a hypothesis was formulated stating that: Arousal has an effect on consumer's attitude towards a direct service in terms of their evaluation extremity.  An experiment was carried out within various lectures of a university in Sweden, whereas the sampling used was a convenience sample of university students. The total amount of respondents who participated in the experiment were 154, whereof 102 were valid respondents. The experimenttriggerused to influence their level of arousal was caffeinated coffee, while the control trigger was decaffeinated coffee. The Fishbein model was used to measure attitude translated into a questionnaire which was administered at the experiment, while the three adjective scale was utilized to measure the level of arousal for control. The collected data was imported into the statistics program SPSS for analysis and discussion. Quality criteria and ethics standards were adhered to  during the entire research process. At the conclusion of the research, the hypothesis was accepted. However, it should be taken into consideration that the caffeine did not have the desired effect on the level of arousal, and the study mainly used the control questions for arousal to find a significance level. The study was deemed successful though, in that after calculating positive pretests for validity, the results showed that the aroused participants had a significantly more extreme attitude than the non-aroused participants. In that the experiment and results are original, it allows for further related research. Finally, to insure the validity of the results of this study, it is pertinent that the experiment’s results are replicated by future studies.

Osteoarthritis (OA) of the knee affects between 5.4% and 38% of older adults and this prevalence is increasing as the population ages and becomes more obese. As health costs rise, it is important to have accurate and cost-effective methods to assess knee OA and the risk for OA. One risk factor for progression of knee OA is lower extremity (LE) frontal-plane malalignment. The first goal of this thesis was to assess the suitability of knee radiographs and LE photographs for the estimation of frontal-plane LE alignment. In the first study, several versions of the femoral shaft-tibial shaft (FS-TS) angle, assessed from knee radiographs, were compared to the hip-knee-ankle (HKA) angle, assessed from full-length radiographs. We concluded that the FS-TS angle is not a recommended substitute for the HKA angle, because the association between the two measures differs depending on alignment, OA severity and the method of determining the FS-TS angle. In the second study, the hip-knee-ankle angle determined from a pelvis-to-ankle photograph (HKA-P) was assessed for its ability to estimate the HKA angle. The HKA-P angle was reliable and highly correlated to the HKA. It therefore shows promise as an accurate and cost-effective assessment tool for the estimation of LE alignment. Commonly-used grading scales for the severity of knee OA seen on a radiograph emphasize just one feature of OA; therefore the second goal of this thesis was to assess the psychometric properties of the unicompartmental osteoarthritis grade (UCOAG), a composite scale which grades several features of OA in the tibiofemoral (TF) compartment. In the third and fourth studies, the reliability, validity and sensitivity to change of the UCOAG scale was assessed and compared to two commonly-used scales (Kellgren-Lawrence and Osteoarthritis Research Society International joint space narrowing). The UCOAG scale showed moderate to excellent reliability. All three scales demonstrated comparable validity and sensitivity to change. The UCOAG is therefore recommended for the assessment of OA severity and change over time. This research provides evidence for the use of accurate and cost-effective measures to assess LE alignment using photographs, and TF OA severity using radiographs, for clinical assessment and research purposes. / Thesis (Ph.D, Rehabilitation Science) -- Queen's University, 2013-09-26 13:21:06.097

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Science in Occupational Therapy. Johannesburg, 2017 / Introduction: Lycra compression garments have been documented as beneficial in affecting spasticity in children with cerebral palsy but there is little research on the use of Lycra compression garments in adults with neurological conditions. Thus, the purpose of this study was to explore the effectiveness of Lycra compression garments on motor function and functional use of the upper limb, in patients with stroke. Methods: A randomised control design with a control or intervention group was used. Both groups received routine upper limb rehabilitation while the experimental group also received a custom Lycra compression garment worn for a minimum of six hours a day. Results: Change between an initial assessment and assessment at six weeks, was measured on the Fugl-Meyer Assessment of Motor Recovery (FMA) and The Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH). While both groups had significant improvement in upper limb movement, statistically significant differences for change in total motor function, wrist and hand movement and coordination were found when the experimental group and the control group were compared. Small differences in measurements of pain, passive range of motion, sensation and functional use of the upper limb were found between the two groups. Conclusion: Results indicate that Lycra compression garments may be beneficial in facilitating the return of movement in the upper limb in individuals with stroke. / MT2017

Background and purpose of research: The number of individuals playing rugby union is increasing every year particularly amongst adolescence at a school level. With the increase in participation an increase in injuries arises. The purpose of this study was to document the lower limb injuries previously sustained in the 2009 rugby season as well as the injuries sustained over a six week period in 2010 and to identify the risk factors associated with these injuries. Method: A prospective cohort design was used. Sixty-five participants from three high schools on the West Rand completed an injury questionnaire and participated in pre-season testing of lower limb muscle length, muscle strength and balance. Lower limb injuries were documented throughout the season. Descriptive statistics were used to describe the data and a univariate analysis was done to determine if there were any associations between various risk factors and sustaining an injury. Results: Six lower limb injuries were documented in 2010. Knee and ankle injuries accounted for 25 out of the 35 (71%) injuries sustained over the 2009 and 2010 rugby seasons. The risk factors for lower limb injuries included good flexibility of the hamstring muscle group and logistic regression also showed an association between a right lower limb injury and right sided muscle strength of the ankle dorsiflexors (p=0.04) and knee extensors (p=0.05). Conclusion: The risk factors associated with these lower limb injuries were good flexibility of the hamstring muscle group as well as right sided quadriceps and tibialis anterior muscle strength.

With American football becoming increasingly popular in the United States, more efforts have been made on technology and advancements to reduce the number of injuries sustained by athletes. However, few studies have been conducted to evaluate how the field type, field condition, and shoe type interact with each other to induce injuries. To fill in the gap in the literature, this thesis used epidemiological methods to investigate the effect of field condition and shoe type on lower extremity injuries, specifically knee and ankle injuries, using real player data from the 2008, 2009, and 2010 football seasons from The University of Iowa. Results showed that over three seasons, 189 athletes experienced approximately 38,000 football exposures in 312 days. The athletes endured 250 injuries, in which 129 (51%) occurred in the lower extremity. Of all injuries, 34 (14%) involved the knee and 30 (12%) involved the ankle. Most of the lower extremity injuries, specifically knee injuries and ankle injuries, were of the joint (non-bone) and ligament type. Practices contributed to 73% of exposures, 11% for games, and 16% for other over the three sessions studied. 65% of all exposures occurred on an artificial surface, compared to 36% of all exposures that occurred on a natural surface. Most games were played on a natural surface (56%), while most practices occurred on an artificial surface (56%). For surface condition, 89% of all exposures were categorized as a normal condition compared to the 11% categorizes as a not normal condition. Most athletes used shoes with 9-12 cleats compared to shoes with 7, more than 12, or no cleats. In addition, most athletes used shoes with a high top at the shoe opening compared to a low top and shoes with short cleat lengths compared to long cleat lengths. The field condition variable (not normal vs. normal) was the only unadjusted GLM with significant results for all lower extremity injuries (Chi-square p-value=0.0307) and ankle injuries specifically (Chi-square p-value=0.0253). When the predictor variables were adjusted for team activity (i.e., games and practices) only the playing surface model was significant for all terms, including team activity (Chi-square p-value=0.0018), surface (Chi-square p-value=0.029), and the interaction term (Chi-square p-value=0.0189). This model was further analyzed for practice and games separately, and it was found that surface was significant in predicting lower extremity injuries in a game setting (Chi-square p-value=0.005). For all lower extremity injuries, the odds of having a lower extremity injury on an artificial surface in a game setting was 2.89 times more likely than on a natural surface. For the condition, top height, and number of cleat models, only the team activity term was found significant (Chi-square p-value=0.0143, <.0001, and 0.0038, respectively). When these models were further analyzed for practice and games separately, only field condition was found to be significant in a practice setting. For all lower extremity injuries, the odds of having a lower extremity injury in a not normal condition in a practice setting was 2.04 times more likely than in a normal condition. The cleat length model was not found to be significant when adjusting for team activity. The results of this analysis provide a foundation for future studies to understand why several extrinsic risk factors may be associated with lower extremity injuries.