Musculoskeletal Injuries are the most common cause of severe long-term pain and physical disability. Push-Ups and Pull-Ups are effective dynamic exercises that mimic high level function activities, such as those used in the military. The model developed allows for researchers to analyze the forces and moments associated with the shoulder, elbow and wrist, to further assess function in military personnel, athletes and the active population. The model also follows the guidelines set forth by the International Society of Biomechanics (ISB).

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An examination of throwing was performed in a controlled environment with the aim of identifying the control and order parameters of throwing as proposed by dynamic pattern theory. A pilot study was conducted to test the possibility that the mass of a ball, the distance thrown and the size of targets were the control parameters. Based upon the results of the pilot study, only the distance was manipulated as an independent variable in the principal study.Three-dimensional motion was recorded using three video cameras in the motion analysis laboratory and later analysed using the Peak motion analysis system (software version 5.0, 1992). Sixteen right handed adult females, aged 18 - 35 years, volunteered to participate in the principal study. Subjects were seated with their trunks secured to the back support of an adjustable chair. Ten different targets (0.6 to 6.91 m) were labelled on the floor in front of the subjects. A large area for each target was defined so that the throwing skill of subjects could be ignored as a factor in the research design. Subjects were asked to throw a 0.5 kg ball to ten different distances using their own styles which allowed them to change the pattern of throwing as the distance thrown increased.All 16 subjects selected either an overarm or an underarm throw or employed both patterns. No subject used other patterns of throwing. At the shortest distance, a greater number of subjects selected an underarm throw. As the distance thrown increased, some subjects switched to the overarm throw. At the distance of 3.36 m, there were eight subjects (50%) using each style of throwing. Alteration of the throwing pattern mainly occurred from the underarm to the overarm throw. The results suggest that the distance thrown may be one of the control parameters in the throwing movement.Furthermore, the presence of both throwing patterns for all distances ++ / thrown suggests the presence of a multiple stable state in throwing motions. Trajectories of movement become more uniform as the distance thrown increased. Variability was greatest when subjects threw to the shortest distance for both patterns. These results imply that as the distance thrown increased the stability of both throwing patterns increased. Moreover, these results also imply a phase transition within each throwing pattern, in addition to the phase shift between the pattern of throwing.No result could directly illustrate the period of the transition. This may be due to the fact that phase transition in a multistable system is the result of an external force which drives the system from one state to another. Alteration of the pattern does not occur as a result of loss of the stability of the previous state. Furthermore, the presence of both throwing patterns for all distances thrown suggests the presence of a multiple stable state in throwing motions. Trajectories of movement become more uniform as the distance thrown increased. Variability was greatest when subjects threw to the shortest distance for both patterns. These results imply that as the distance thrown increased the stability of both throwing patterns increased. Moreover, these results also imply a phase transition within each throwing pattern, in addition to the phase shift between the pattern of throwing. No result could directly illustrate the period of the transition. This may be due to the fact that phase transition in a multistable system is the result of an external force which drives the system from one state to another. Alteration of the pattern does not occur as a result of loss of the stability of the previous state. However, some of the results such as the hysteresis graph presented indirect evidence, which could imply a phase shift between throwing patterns. In addition the higher ++ / degrees of joint angle recruitment in the overarm throw suggest that the stability of the system may be better maintained in the overarm throw than in the underarm throw.Alteration of the sub-styles of throwing within the same throwing pattern seemed to occur in between the shortest and the longest distances thrown. Many of the results supported this concept, for example, data related to the relative timing, the total ROM, the releasing joint angles, the trajectories of the movement, the phase plane plots, the angle-angle plots, and relative phase. However, the presence of sub-styles in the underarm throw was not as obvious as was the case for the overarm throw.In conclusion, the changes in motor behaviour during throwing as the distance thrown increased as examined in the present study can be explained by dynamic pattern theory in some aspects. However, further investigation of the stability of the patterns and energy utilisation necessary for the execution of the underarm and overarm throw are essential to determine the most suitable order parameter and to confirm the proposed control parameter (distance thrown) identified.

The work presented in this dissertation was focused on developing an affordable, automated, upper extremity exercise system suitable for individuals with stroke and spinal cord injury (SCI). The three studies presented in this thesis demonstrated the efficacy of functional electrical stimulation-assisted exercise therapy (FES-ET). Furthermore a protocol was developed to implement FES-ET in participants homes via tele-rehabilitation. The protocol included the use of an improved version of the bionic glove, an FES device that enhanced hand grasp and release in SCI individuals in combination with a custom-built workstation that enabled task-oriented rehabilitation in the home setting, supervised over the Internet. In the course of these studies, an objective hand function assessment tool was developed to complement tele-supervised FES-ET and provide the therapist with an unbiased evaluation of the participants impairment. A major section of this dissertation is concerned with the development and testing of a novel exercise workstation named the ReJoyce (Rehabilitation Joystick for Computer Exercise), that can assess hand function electronically. The ReJoyce is an instrumented workstation that provides standardized upper extremity rehabilitation based on ADLs, in the guise of computer games played by manipulating attachments on the device. The three studies presented in this thesis focus on the scientific merits and the logistics of providing tele-supervised FES-ET with this workstation. The first study demonstrated the feasibility of treating and assessing individuals on the workstation who had recently suffered a stroke. The second study explored the relationship between the quantitative assessment of hand function with the workstation and two widely-used clinical tests. The last study involved daily, tele-supervised FES-ET or conventional exercises and therapeutic electrical stimulation (TES), maintained for 6 weeks, with SCI participants spread out over a large geographical area. FES-ET performed with the workstation resulted in statistically significant and clinically important improvements in hand function that were greater than those produced by the more conventional protocol. The results demonstrated the importance of including a range of exercises aimed at improving both strength and dexterity. It is concluded that tele-supervised FES-ET on a standardized workstation is feasible, effective and affordable in the current healthcare settin

Injury to the cervical spinal cord results in complete or partial loss of arm and hand function, severely limiting the performance of daily activities. Deficits in hand function in individuals with cervical spinal cord injury (SCI) are primarily due to a loss of descending motor pathways that are vital for fine control of the hand and fingers. In addition to these deficits, secondary plastic reorganization may create further loss of function. This thesis will explore the following questions: 1. What are the similarities and differences between cortical organization of muscles affected by a cervical SCI to those not affected by the injury?; 2. Do individuals with cervical SCI improve in hand function and cortical organization after an intensive hand training intervention?; 3. Which physical therapy intervention provides the optimal conditions by which to improve hand function following cervical SCI? In chapter 2 we compare cortical motor maps of transcranial magnetic stimulation (TMS) evoked responses of muscles rostral and caudal to the injury to those of ND individuals. The cortical maps of the biceps brachii or the thenar muscles were constructed, and compared between ND individuals and individuals with SCI. The motor threshold (MT) for the thenar muscles in individuals with SCI was significantly higher than ND individuals. The purpose of the study described in chapter 3 was to compare the functional and cortical changes associated with two different interventions: unimanual or bimanual massed practice training, both combined with somatosensory stimulation. There was a significant difference between pre- and post-intervention scores on tests measuring unimanual hand function, bimanual hand function, and sensory function. This difference was associated with a difference between pre- and post-intervention cortical map area. The purpose of the study described in chapter 4 was to compare clinical and cortical changes associated with either a delayed intervention control period or a combined intervention of massed practice training with electrical stimulation. Participants were randomly assigned to one of two groups: delayed intervention control group or immediate intervention group. Participants were also randomly assigned to one of four groups: unimanual training with somatosensory stimulation, bimanual training with somatosensory stimulation, unimanual training with functional electrical stimulation, or bimanual training with functional electrical stimulation. There was a significant difference between the control and immediate intervention group on the test measuring unimanual hand function. Participants in the bimanual group performed significantly better on the test measuring bimanual hand function. There was a significant difference between the control group and immediate intervention group in cortical map area. In chapter 5 we discuss the clinical relevance of the results of the studies described in three prior chapters. Conclusions drawn include the idea that cortical maps of muscles caudal to the level of injury in individuals with SCI have higher motor thresholds than ND participants. Individuals with tetraplegia can improve in hand function and sensation with a physical therapy intervention of massed practice training combined with somatosensory stimulation. Finally, the type of training (unimanual massed practice or bimanual massed practice) influences the type of improvements gained, however the type of electrical stimulation does not influence the clinical outcome.

This thesis analyzes the relationship between upper extremity musculoskeletal disorders and longtime computer usage. Firstly / maastricht upper extremity questionnaire is applied to Financial Control and Information Technology Departments of Turk Telekom. Results are analyzed by using spss 16.0 tool by conduction of ordinal logistic regression analysis to determine the significance between work environment and postural information and upper extremity musculoskeletal complaints. Then / development of a new tool, namely PACU (postural analysis of computer users), takes place aiming to determine the factors of disorders, by mainly focusing on work-related neck and upper limb disorders, for long time computer users of Financial Control and Information Technology Departments of Turk Telekom. Results of the PACU are analyzed by using the methods of correlation, chi square goodness of fit test, factor analysis, and ordinal logistic regression.

Have you ever attempted to rub your abdomen with one hand while tapping your head with the other? Separately these movements are easy to perform but doing them together (bilateral task) requires motor adaptation. Motor adaptation is the process through which the Central Nervous System improves upon performance. Transfer of learning is the process through which learning a motor task in one condition improves performance in another condition. The purpose of this study was to determine whether transfer of learning occurs during bilateral goal-directed reaching tasks. It was hypothesized that transfer of learning would occur from the non-dominant to the dominant arm during bilateral tasks and that position and load feedback from the arms would affect the rate of adaptation and transfer of learning. During the experiments, subjects reached with one or both their index finger(s) to eight targets while a velocity dependent force perturbation (force environment) was applied to the arm(s). Three groups of bilateral tasks were examined: (1) unilateral reaching, where one arm learned to reach in a force environment, while the other arm remained stationary and therefore did not provide movement related position or load feedback; (2) bilateral reaching single load, where both arms performed reaching movements but only one arm learned a force environment and therefore the other arm provided movement related position feedback but not load feedback; (3) bilateral reaching two loads, where both arms performed reaching movements and both learned a force environment, while providing movement related position and load feedback. The rate of adaptation of the force environment was quantified as the speed at which the perturbed index finger trajectory became straight over the course of repeated task performance. The rate of adaptation was significantly slower for the dominant arm during the unilateral reaching tasks than during the bilateral reaching single load tasks (p<0.05). This indicates that the movement related position feedback from the non-dominant arm improved significantly the motor adaptation of the dominant arm; therefore transfer of learning occurred from the non-dominant to the dominant arm. The rate of adaptation for the non-dominant arm did not differ significantly (p>0.05) between the unilateral reaching and bilateral reaching single load tasks. Results also indicated that the rate of adaptation was significantly (p<0.05) faster for both the non-dominant and the dominant arms during the bilateral reaching two loads tasks than during the bilateral reaching single load tasks. The latter results indicate that transfer of learning occurred in both directions - from the dominant to the non-dominant arm and from the non-dominant to the dominant arm - when position and load feedback was available from both arms, but only when the force environment acted in the same joint direction. This study demonstrated that transfer of learning does occur during bilateral reaching tasks and that the direction and degree of transfer of learning may be modulated by the position and load feedback that is available to the central nervous system. This information may be used by physical therapists in order to improve rehabilitation strategies for the upper extremity.

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Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

Disertacijoje apžvelgtos viršutinės galūnės segmentų replantacijų indikacijų, kontraindikacijų, terminologijos bei profilaktinio medikamentų vartojimo tendencijos, siekiant sumažinti kraujagyslinių komplikacijų skaičių po replantacijų. Darbe atlikta didžiausio Lietuvos replantologijos centro Vilniaus universiteto ligoninės Santariškių klinikų Centro filialo Plastinės ir rekonstrukcinės chirurgijos skyriaus 1983–2007 metų viršutinės galūnės segmentų replantacijų, ir jų veiksnių apžvalga bei išnagrinėtos replantacijų skaičiaus mažėjimo priežastys. Taip pat nustatyta nemedikamentinių ir medikamentinių veiksnių reikšmė replantatų prigijimui. Gautais rezultatais paneigta šiuo metu paplitusi nuomonė dėl didelės profilaktiškai vartojamų medikamentų reikšmės replantatų prigijimui. Pasiūlytos rekomendacijos dėl terminų replantologijoje naudojimo. / We overviewed indications and contraindications and their tendencies for upper extremity replantations in our dissertation. This work reviewed and analyzed 1983-2007 years material of upper extremity replantations in the oldest and largest replantation center in Lithuania – VUH Centro Affiliate Plastic and Reconstructive Surgery Department. We analyzed trends and causes of changing numbers of upper extremity replantations. We assessed clinical and social factors and determined their relationship of replantated upper extremity segments. We determined dependencies between prophylactic use of medications and replants survival ratio during the investigation period. We also analyzed different meanings of replantology terms and offered some guidelines for their proper usage.