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.

Stroke is the primary cause of adult disability. To support this large population in recovery, robotic technologies are being developed to assist in the delivery of rehabilitation. A partially observable Markov decision process (POMDP) system was designed for a rehabilitation robotic device that guides stroke patients through an upper-limb reaching task. The performance of the POMDP system was evaluated by comparing the decisions made by the POMDP system with those of a human therapist. Overall, the therapist agreed with the POMDP decisions approximately 65% of the time. The therapist thought the POMDP decisions were believable and could envision this system being used in both the clinic and home. The patient would use this system as the primary method of rehabilitation. Limitations of the current system have been identified which require improvement in future research stages. This research has shown that POMDPs have promising potential to facilitate upper extremity rehabilitation.

Stroke is the major cause of permanent adult disability worldwide. Often stroke affects the motor control of the upper limb, leading to difficulties in performing activities of daily living. Many hours are spent in resource-intensive therapy to regain functionality of the upper limb. In order to decrease the burden to therapists and increase access to rehabilitation, an upper limb rehabilitation robotic device was developed. Observations from therapists and an international survey of stroke therapists were conducted to understand general requirements of an upper limb rehabilitation device. These requirements were the basis of the mechanical design portion of the prototype. The prototype was evaluated with stroke therapists in a focus group. Although more iterations of design, testing and evaluation are needed, this project is a step in developing a lower cost, portable device to increase access to upper limb stroke rehabilitation.

Stroke is the major cause of permanent adult disability worldwide. Often stroke affects the motor control of the upper limb, leading to difficulties in performing activities of daily living. Many hours are spent in resource-intensive therapy to regain functionality of the upper limb. In order to decrease the burden to therapists and increase access to rehabilitation, an upper limb rehabilitation robotic device was developed. Observations from therapists and an international survey of stroke therapists were conducted to understand general requirements of an upper limb rehabilitation device. These requirements were the basis of the mechanical design portion of the prototype. The prototype was evaluated with stroke therapists in a focus group. Although more iterations of design, testing and evaluation are needed, this project is a step in developing a lower cost, portable device to increase access to upper limb stroke rehabilitation.

Upper limb function is important for individuals with tetraplegia because upper limb function supports global function for these individuals. As a result, a great deal of time and effort has been devoted to the restoration of upper limb function. Appropriate outcome measures that can be used to characterize the neurological status of the upper limb have been one of the current barriers in substantiating the efficacy of interventions. Techniques and protocols to evaluate changes in upper limb neurological status have not been applied to the SCI population adequately. The objectives of this thesis were to develop a measure; which is called the Graded Redefined Assessment of Strength Sensibility and Prehension (GRASSP). Development of the scoring approach, testing for reliability and construct validity, and determining impairment and function relationships specific to the upper limb neurological were established. The GRASSP is a clinical measure of upper limb impairment which incorporates the construct of “sensorimotor upper limb function”; comprised of three domains which include five subtests. The GRASSP was designed to capture information on upper limb neurological impairment for individuals with tetraplegia. The GRASSP defines neurological status with numerical values, which represent the deficits in a predictive pattern, is reliable and valid as an assessment technique, and the scores can be used to determine relationships between impairment and functional capability of the upper limb. The GRASSP is recommended for use in the very early acute phases after injury to approximately one year post injury. Use of the GRASSP is recommended when a change in neurological status is being assessed.

Stroke is the primary cause of adult disability. To support this large population in recovery, robotic technologies are being developed to assist in the delivery of rehabilitation. A partially observable Markov decision process (POMDP) system was designed for a rehabilitation robotic device that guides stroke patients through an upper-limb reaching task. The performance of the POMDP system was evaluated by comparing the decisions made by the POMDP system with those of a human therapist. Overall, the therapist agreed with the POMDP decisions approximately 65% of the time. The therapist thought the POMDP decisions were believable and could envision this system being used in both the clinic and home. The patient would use this system as the primary method of rehabilitation. Limitations of the current system have been identified which require improvement in future research stages. This research has shown that POMDPs have promising potential to facilitate upper extremity rehabilitation.

Upper limb function is important for individuals with tetraplegia because upper limb function supports global function for these individuals. As a result, a great deal of time and effort has been devoted to the restoration of upper limb function. Appropriate outcome measures that can be used to characterize the neurological status of the upper limb have been one of the current barriers in substantiating the efficacy of interventions. Techniques and protocols to evaluate changes in upper limb neurological status have not been applied to the SCI population adequately. The objectives of this thesis were to develop a measure; which is called the Graded Redefined Assessment of Strength Sensibility and Prehension (GRASSP). Development of the scoring approach, testing for reliability and construct validity, and determining impairment and function relationships specific to the upper limb neurological were established. The GRASSP is a clinical measure of upper limb impairment which incorporates the construct of “sensorimotor upper limb function”; comprised of three domains which include five subtests. The GRASSP was designed to capture information on upper limb neurological impairment for individuals with tetraplegia. The GRASSP defines neurological status with numerical values, which represent the deficits in a predictive pattern, is reliable and valid as an assessment technique, and the scores can be used to determine relationships between impairment and functional capability of the upper limb. The GRASSP is recommended for use in the very early acute phases after injury to approximately one year post injury. Use of the GRASSP is recommended when a change in neurological status is being assessed.

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.