A espasticidade é uma das alterações decorrentes do Acidente Vascular Encefálico (AVE) que causa limitação no tônus muscular podendo gerar graves comprometimentos funcionais nos membros superiores. Pela característica do tecido neurológico lesado, frequentemente ocorre a cronificação das sequelas e incapacidades e atuar na minimização desses comprometimentos é objetivo dos profissionais da saúde. No entanto, há dificuldades na escolha da intervenção, análise de sua eficácia e aprimoramento dos estudos na área da reabilitação decorrentes da limitação nas estratégias de avaliação, sendo que nessa área as escalas são utilizadas com frequência. Dessa forma, esse estudo buscou desenvolver e validar a utilização clínica de um instrumento de medida da resistência isométrica ao estiramento passivo do grupo muscular flexor do punho em adultos e idosos com espasticidade decorrente do AVE. Foi desenvolvido um instrumento portátil capaz de medir a resistência da musculatura com um torquímetro. Foram realizados testes para analisar a validade, confiabilidade, sensibilidade e praticabilidade. Os testes foram feitos com os sujeitos sentados e com o antebraço e mão fixados no aparelho em seis diferentes posições do arco do movimento do punho, sendo que a articulação permaneceu estável por 20 segundos em cada posição. Foi realizada a avaliação de 108 sujeitos. A avaliação unilateral foi realizada em 21 sujeitos sem lesão neurológica e 27 sujeitos com AVE. A avaliação bilateral por dois examinadores foi realizada em 60 sujeitos, sendo 19 sem lesão e 41 com lesão neurológica. O instrumento mostrou-se capaz de mensurar as diferenças da resistência da musculatura em cinco das seis posições sendo relevante salientar que o instrumento foi sensível para apresentar a diferença entre população normal e com lesão e posteriormente apresentando a diferença entre lado comprometido e não comprometido. Os testes inter-examinadores mostraram boa correlação, no entanto, considerou-se a distribuição da segunda avaliação mais uniforme, sugerindo que se deve padronizar o uso para que o examinador realize a sequência de avaliação do arco do movimento por, no mínimo, duas vezes. Evidenciou-se ainda que o instrumento foi sensível para graduar a intensidade da sequela utilizando-se da comparação entre o lado não comprometido e o comprometido, sempre que a sequela seja apenas do hemicorpo visto que a graduação atribuída pela Escala Modificada de Ashworth possibilitou identificar correlação com as resistências apenas na avaliação grau 3, sendo que nos demais graus, não houve evidência estatística, corroborando com os também apresentados na literatura. Sugere-se, como continuidade do estudo, correlacionar os dados obtidos da avaliação da resistência estática à dinâmica. Esse instrumento desenvolvido pode ser utilizado para avaliação dos efeitos de órteses posicionadoras de punho, contribuindo assim, para o aprimoramento das estratégias de reabilitação. / Spasticity is one of the changes resulting from stroke which causes limitation in muscle tone and may cause severe functional impairment of the upper limbs. For the feature damaged neurological tissue often occurs chronicity of disabilities and act on these commitments is minimization objective of health professionals. However, there are difficulties in the choice of intervention, analysis and improvement of its effectiveness studies in rehabilitation due to limitations in assessment strategies, and this area scales are frequently used. Thus, this study sought to develop and validate the clinical use of an instrument for measuring isometric resistance to passive stretching of the wrist flexor muscle group in adult and elderly patients with spasticity due to stroke. We developed a portable instrument capable of measuring the muscular strength of a torquemeter. Tests were conducted to examine the validity, reliability, sensitivity and practicability. Tests were performed with the subjects seated with the forearm and hand set in the apparatus in six different positions of the arc of movement of the wrist, and the joint remained stable for 20 seconds at each position. Our evaluation of 108 subjects. The evaluation was performed unilaterally in 21 subjects without neurological injury and 27 subjects with stroke. A bilateral assessment by two examiners was performed in 60 subjects, 19 with and 41 without injury neurological injury. The instrument was able to measure differences in muscle strength in five of the six positions is important to note that the instrument was sensitive to show the difference between normal population and with injury and presents the difference between the affected and non-affected. The tests showed good inter-rater correlation, however, was considered a distribution more uniform the second evaluation, suggesting that it should use to standardize the examiner performs the evaluation sequence of the arc of movement by at least twice . It is further demonstrated that the instrument was sensitive to grade the intensity of the sequel using comparing the committed and uncommitted side where the sequel of the hemisphere is only seen that the graduation given by the Modified Ashworth Scale possible to identify a correlation with resistance only in the evaluation grade 3, and in the remaining degrees, there was no statistical evidence, corroborating also presented in the literature. It is suggested, as a continuation of the study, correlate data obtained from the evaluation of the resistance to static dynamic. This tool developed can be used to assess the effects of splint of wrist, thus contributing to the improvement of rehabilitation strategies.

Although tremor is one of the most common movement disorders, there are few effective tremor-suppressing options available to patients. One potential tremor-suppression device involves a wearable gyrostabilizer similar to those used to stabilize cameras. However, we do not currently know how to design a gyrostabilizer to suppress tremor in an optimal manner. To address this gap, we present a systematic investigation of how gyrostabilizer parameters affect tremor suppression in a single degree of freedom (DOF). A simple model of the hand with a single DOF at the wrist and a gyroscope mounted on the back of the hand was used to focus on the most basic effects. After demonstrating that a linearized version of the non-linear equations of motion provides an adequate approximation, we simulated the frequency response of the system (hand + gyroscope) to a tremorogenic input torque at the wrist. By varying system parameters one at a time, we determined the effect of individual parameters on the frequency response of the system. To minimize the bandwidth without adding significant inertia about the wrist joint, the inertia and spin speed of the flywheel should be as high as design constraints allow, whereas the distance from the wrist joint axis to the gyroscope, the precession stiffness, and the precession damping should be kept as low as possible. The results demonstrate the potential of gyroscopic tremor suppression and can serve as the foundation for further investigations of gyroscopic tremor suppression in the upper limb.

This thesis analyzes the wrist joint of the human hand by using a realistic threedimensional wrist model. Load distributions among carpal bones, forces on ligaments and joints were examined by using three-dimensional model. Wrist injuries and required surgical operations were examined with the model. The most crucial point of the study was that, using three-dimensional model of the wrist, hand surgeons would be able to predict results of surgical operation. Surgery planning may be done and mechanical results may be Evaluated on the wrist model.

The human wrist is a vital joint in daily life, and it is subject to injuries and disease. Currently, severe wrist disease is normally treated with wrist arthrodesis, which is normally reliable but results in a fixed wrist incapable of allowing wrist motion. Another method of treating a nonfunctional or severely painful wrist is wrist arthroplasty where the wrist joint is replaced with an implant that allows wrist movement. As of yet, a suitable wrist implant has not been developed, especially for the case of the post-traumatic, young male wrist, and most current wrist implants fail from failure of the bone-implant interface. Through simulation and literature review, it is concluded that implants that restrict axial rotation are bound to fail overtime. With this conclusion, a new wrist implant prototype is designed that incorporates state of the art materials, fluid film lubrication, proper kinematics, a suitable range of motion, and more. This implant contributes several improvements to the field of wrist arthroplasty. / text

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / Orthopaedic Surgery / Master / Master of Philosophy

Thesis (M.S.)--University of Delaware, 2008. / Principal faculty advisor: Thomas W. Kaminski, Dept. of Health, Nutrition, & Exercise Sciences. Includes bibliographical references.

Thesis (M.S.)--Virginia Polytechnic Institute and State University, 1991. / Vita. Abstract. Includes bibliographical references (leaves 139-150). Also available via the Internet.

Le poignet, complexe articulaire situé entre l'avant-bras et la main, est sujet aux traumatismes. Par exemple, une chute sur le poignet suite à la pratique d'un sport de glisse ou tout simplement dans un accident de la vie quotidienne peut entraîner une lésion du ligament scapho-lunaire. Cette lésion, difficile à diagnostiquer sur une simple radiographie, évolue toujours vers l'arthrose du poignet. Si le diagnostic est fait pendant la phase aigue, proche du traumatisme, la réparation du ligament ou des techniques conservatrices sur parties molles sont possibles. Si la lésion n'est pas détectée à temps, celle-ci engendre une instabilité du carpe évoluant vers l'arthrose.. A ce stade, des techniques plus radicales incluant des arthrodèses partielles ou totales sont bien connues. Cependant, ces techniques de fusion des os engendrent une perte conséquente de mobilité du poignet. L'objectif de la thèse est de définir une méthode de conception et le dimensionnement d'un implant dont le but est de rétablir la cinématique du carpe après une lésion ligamentaire. Ce dispositif devra remplacer la partie dorsale du ligament scapho-lunaire lorsque celui-ci n'est plus réparable et avant apparition de l'arthrose. / ScaphoLunate interosseous ligament (SLIL) lesion can occur when falling on an outstretched, pronated hand and lead to carpal instability. If SLIL tears are detected early, the ligament can be repaired. However, if the ligament is left untreated, SLIL instability can evolve into carpal arthritis called ScaphoLunate Advanced Collapse (SLAC). Well-known SLAC treatments include arthrodeses. These techniques modify the carpal kinematics and involve a range of motion (ROM) loss. Different prostheses are proposed for patients with arthritis. However, these prostheses do not make an acceptable compromise between the ROM allowed and their mechanical strength. This thesis presents an implant to replace the dorsal part of SLIL when the ligament is not repairable and before the apparition of SLAC. The implant must restore normal kinematics and the mechanical behavior of the carpus. Each step of its design is presented. Kinematic constraints of the implant were derived from measured bone displacements. Using a 3D best-fit method, their mean values and uncertainties were determined. The mechanical behavior of the implant was defined by SLIL stiffness and elongation. Strain energy of the native ligament was a characteristic relevant to the implant behavior design. Surgical and anatomical constraints lead to a small amount of space availaible; hence, the design was driven by strain energy distribution. Using an material capability index, the choice of suitable material is discussed. Finally, the implant design and its method are presented, which satisfy all previous constraints. FEA of the most critical case of kinematic constraints was performed to validate the proposed implant design.

abstract: During the downswing all golfers must roll their forearms and twist the club handle in order to square the club face into impact. Anecdotally some instructors say that rapidly twisting the handle and quickly closing the club face is the best technique while others disagree and suggest the opposite. World class golfers have swings with a range of club handle twist velocities (HTV) from very slow to very fast and either method appears to create a successful swing. The purpose of this research was to discover the relationship between HTV at impact and selected body and club biomechanical characteristics during a driver swing. Three-dimensional motion analysis methods were used to capture the swings of 94 tour professionals. Pearson product-moment correlation was used to determine if a correlation existed between HTV and selected biomechanical characteristics. The total group was also divided into two sub-groups of 32, one group with the fastest HTV (Hi-HTV) and the other with the slowest HTV (Lo-HTV). Single factor ANOVAs were completed for HTV and each selected biomechanical parameter. No significant differences were found between the Hi-HTV and Lo-HTV groups for both clubhead speed and driving accuracy. Lead forearm supination velocity at impact was found to be significantly different between groups with the Hi-HTV group having a higher velocity. Lead wrist extension velocity at impact, while not being significantly different between groups was found to be positive in both groups, meaning that the lead wrist is extending at impact. Lead wrist ulnar deviation, lead wrist release and trail elbow extension velocities at maximum were not significantly different between groups. Pelvis rotation, thorax rotation, pelvis side bend and pelvis rotation at impact were all significantly different between groups, with the Lo-HTV group being more side bent tor the trail side and more open at impact. These results suggest that world class golfers can successfully use either the low or high HTV technique for a successful swing. From an instructional perspective it is important to be aware of the body posture and wrist/forearm motion differences between the two techniques so as to be consistent when teaching either method. / Dissertation/Thesis / Doctoral Dissertation Exercise Science 2014