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Background: Functional Magnetic resonance imaging (fMRI) measures the small fluctuation of blood flow happening during task-fMRI in brain regions. Objective: This research investigated these active, imagery and passive movements in volunteers design to permit a comparison of their capabilities in activating the brain areas. Material and Methods: In this applied research, the activity of the motor cortex during the right-wrist movement was evaluated in 10 normal volunteers under active, passive, and imagery conditions. T2* weighted, three-dimensional functional images were acquired using a BOLD sensitive gradient-echo EPI (echo planar imaging) sequence with echo time (TE) of 30 ms and repetition time (TR) of 2000 ms. The functional data, which included 248 volumes per subject and condition, were acquired using the blocked design paradigm. The images were analyzed by the SPM12 toolbox, MATLAB software. Results: The findings determined a significant increase in signal intensity of the motor cortex while performing the test compared to the rest time (p< 0.05). It was also observed that the active areas in hand representation of the motor cortex are different in terms of locations and the number of voxels in different wrist directions. Moreover, the findings showed that the position of active centers in the brain is different in active, passive, and imagery conditions. Conclusion: Results confirm that primary motor cortex neurons play an essential role in the processing of complex information and are designed to control the direction of movement. It seems that the findings of this study can be applied for rehabilitation studies.

To assess whether ankle tape applied by a Sport and Exercise Physiotherapist (SEP) or self-applied by the athlete results in a change in proprioception and whether it is maintained during a netball session.Randomised controlled trial.Australian Institute of Sport.53 pre-elite netball athletes.Athlete proprioception was assessed using the Active Movement Extent Discrimination Apparatus (AMEDA) on four occasions for each taping condition: 1) pre-tape, 2) post-tape, 3) post-netball4) post-netball no-tape.Mixed effect linear models were used for analysis. A significant increase in proprioception was observed when self-tape: 0.022 (95% CI: [-0.000 - 0.044], p = 0.05), and SEP tape: 0.034 (95% CI: [0.012-0.055], p 0.01), were initially applied. These improvements were maintained during a netball session for both, self-taping: 0.01 (95% CI: [-0.01 - 0.02], p = 0.45) and SEP-taping:0.01 (95% CI: [-0.02 - 0.01], p = 0.56). Results also indicate there was no significant difference between taping conditions (β = -0.001, 95% CI: [-0.02 - 0.02], p = 0.90).Proprioception improves and is maintained during a netball session with either SEP or self-applied taping.

Introduction Approaches to rehabilitation following rotator cuff repair are variable but typically include 4-6 weeks of immobilisation followed by a gradual introduction of movement and activity. However, research has questioned whether such an approach is optimal. The aim of this study was to undertake an updated survey to understand whether practice has evolved in line with contemporary research. Methods An electronic survey was developed describing three case scenarios (medium-sized rotator cuff repair [2 cm], large-sized rotator cuff repair [4 cm] and large-sized rotator cuff repair with biceps tenodesis). Clinicians involved with rehabilitation following rotator cuff repair were invited to participate. Results 129 responses were received (United Kingdom = 87, other regions [ORs] = 42). Respondents would most commonly recommend four to six weeks of immobilisation for all case scenarios. Passive movement would commence during this period, with active movement recommended from four to six weeks. Resisted exercise would commence between seven to 12 weeks along with return to driving. There were some minor differences in recommendations between respondents from the United Kingdom and ORs, including a greater proportion from the United Kingdom recommending sling immobilisation rather than abduction brace immobilisation. Conclusion For many respondents to this survey, rehabilitation for the three case scenarios was similar and has not evolved in line with contemporary research evidence. The reasons behind this need to be explored and incorporated into the design of future research evaluating rehabilitation following rotator cuff repair.

Background and objective: Flexor tendon injuries of the hand are common, especially in zone II. Various pharmacologic agents have been used to improve the outcome of primary tendon repair. One must select an option that accomplishes an excellent total active movement of the repaired tendon. This study aimed to find out the effect of hyaluronic acid injections in the restoration of normal gliding and power of the repaired tendon. Methods: An interventional study of 47 cases of zone II flexor tendon injury managed from May 2017 to May 2018. The data were assembled in a questionnaire. Standardized photographs for pre-, intra-, and postoperative were taken. Hyaluronic acid injections were used in selected cases. Results: Sharp injury (34 cases, equal to 72%) was found to be the commonest mechanism of flexor tendon injury. Male predominance was noticed (38 cases out of 47) due to their working nature. The hyaluronic acid injection was delivered to selected cases (10 cases, equal to 21%) based on preoperative evaluation. Eighty percent of repairs regained total active movement uneventfully. Few complications happened which responded to conservative management. The P value of total active movement in relation to hyaluronic acid injection was 0.036, which is considered statistically significant. Conclusion: This study shows that intraoperative injection of high molecular weight of hyaluronic acid improves the outcome of flexor tendon repair, presumably by decreasing the chance of adhesion.

The aim of this study was to investigate the effects of early active movement on the area repaired with three different suture techniques used in extensor tendon injuries in zone IV.A total of nine cadaver's 35 extensor tendons from 9 intact upper extremities were used in this study. The proximal and distal borders of the extensor tendons in zone IV were marked. The distance between the proximal and distal border was measured with a 0.5 mm precision tape measure and the mid-point was marked. Intertendinous connections were dissected and loop sutures were prepared for each extensor digitorum. Afterwards, force was applied to each digit along the tendon axis from the loops inserted into the extensor tendons, to measure the extensor forces required to extend the MCP joints to 0˚ with a hand scale. The flexor tendons of the digits were dissected at zone III, and loop sutures were prepared individually for the tendons to enable independent flexion for each digit. The force required to fully flex the digits was measured with a hand scale. The extensor tendons were incised transversely and repaired at the mid-point in zone IV with three different suture techniques (double Kessler, double figure of eight, running interlocking horizontal mattress (RIHM)). The extenxor tendon lengths in zone IV were re-measured for all digits after suturing. The predetermined forces required for full flexion and extension of the digits were applied to the repaired digits. After force was applied 20 times to each tendon, the gap formation was checked. Totally 200 flexion and 200 extension movements were applied to each finger with the help of a hand-held scale. Formation of 2-mm gap was failure criteria. At the end of the movements the extent of the gaps was recorded. In the absence of insufficiency at the repair site, 50 additional flexion and extension movements with double the previously recorded forces were applied to the tendons.There was a significant shortening of the extensor tendons after repair independent from the used suture technique. No significant gap formation was detected in all three suture techniques.All three suturing techniques are reliable for early active movements following the zone IV extensor tendon repairs. Therefore, surgeons can choose one of those three suture techniques to repair extensor tendon injuries in zone IV.ZIEL: Diese Studie untersucht an Leichenpräparaten die Auswirkungen der früh-aktiven Nachbehandlung von Strecksehnenverletzungen der Finger in Zone IV unter Verwendung dreier verschiedener Nahttechniken.Die Untersuchung erfolgte an 35 Extensor-digitorum(ED)-Sehnen an 9 intakten Leichenarmen. Distaler und proximaler Rand der Strecksehnen sowie deren Mitte in Zone IV wurden markiert und die Länge der Strecksehnen in Zone IV gemessen. Nach Durchtrennung der Connexus intertendinei wurden die Strecksehnen mit einer Naht armiert und die Kraft gemessen, die erforderlich war, um eine Streckung der Fingergrundgelenke von 0° zu erzielen. Die Beugesehnen wurden in Zone III freipräpariert, mit einer Naht armiert und anschließend die Kraft gemessen, die es bedurfte, um eine volle Beugung des Fingers zu bewerkstelligen. Die ED-Sehnen wurden mittig in Zone IV durchtrennt und mittels dreier verschiedener Nahttechniken (doppelte Kessler-Naht, doppelte Figure-of-eight-Naht, Running-interlocking-horizontal-Mattress-Naht) repariert. Danach erfolgte eine erneute Bestimmung der ED-Sehnenlänge in Zone IV. Die zuvor bestimmte Kraft, notwendig für eine volle Beugung und Streckung der Finger, wurde abwechselnd appliziert. Nach 20 Applikationen wurde untersucht, ob es zu einer Diastase der genähten Sehnen kam. Insgesamt wurden 200 Fingerbeugungen und -streckungen unter Verwendung der vorbestimmten Kraft durchgeführt und danach der Abstand zwischen den Sehnenstümpfen gemessen, wobei ein Spalt von 2 mm als Versagen der Naht gewertet wurde. Zeigte sich keine Nahtinsuffizient, erfolgten weitere 50 Bewegungszyklen unter Applikation der doppelten Kraft.Unabhängig von der angewandten Nahttechnik kam es bei allen ED-Sehnen durch die Naht zu einer signifikanten Verkürzung ihrer Länge in Zone IV. Eine signifikante Spaltbildung oder gar ein Versagen der Sehnennähte wurde nicht beobachtet.Alle 3 verwendeten Sehnennähte eignen sich für eine früh-aktive Nachbehandlung von Strecksehnendurchtrennungen in Zone IV. Entsprechend können Handchirurgen jene wählen, mit denen sie die meiste Erfahrung haben.

To assess the effect of early active shoulder movement after rotator cuff repair, compared to delayed active shoulder movement, on clinical outcomes, rotator cuff integrity, and return to work.Intervention systematic review.We searched 14 databases in November 2017 and updated the search in December 2018 and February 2020.We included comparative studies that assessed the effect of early active shoulder movement versus delayed active shoulder movement following rotator cuff repair.Means and SDs were used to calculate weighted mean differences and 95% confidence intervals for outcomes of interest. The sensitivity analysis included only randomized controlled trials and was performed when heterogeneity among studies was statistically significant.Eight studies with a total of 756 participants (early active shoulder movement, n = 379; delayed active shoulder movement, n = 377) were included. There was high-certainty evidence favoring early active movement for forward flexion (6 weeks), abduction (6 weeks), and external rotation (6 weeks and 3 and 6 months) postsurgery. There was moderate-certainty evidence of worse Western Ontario Rotator Cuff Index score (6 weeks) for the early active movement group, and no difference in rotator cuff integrity between the early and delayed active movement groups. There were no group differences for all other outcomes.Patients who commenced active shoulder movement early after rotator cuff repair had greater shoulder range of motion and worse shoulder-specific quality of life after surgery than patients who delayed active shoulder movement. However, the group differences did not appear to be clinically important, and rotator cuff integrity was similar.

We examined the effect of pretest familiarization with ipsilateral or contralateral limbs on the performance in a proprioception test conducted afterwards. Sixty adults were randomly assigned to six different familiarization-session patterns. Ankle proprioception was tested using active movement extent discrimination assessment. The results reflected a beneficial effect of familiarization session on performance in the subsequent proprioception test (ES = 0.777). However, no significant difference was found between proprioceptive acuity scores when familiarization and test happened with either ipsilateral or contralateral limbs (ES= 0.361), or between the tested left and right foot no matter which side was familiarized (ES = 0.343). These results suggest that proprioceptive information from the familiarization session facilitates the subsequent proprioception test and is equally available to both hemispheres without loss of quality.

Objective: To evaluate the feasibility and effectiveness of a wearable robotic device in guiding isometric torque generation and passive-active movement training for ankle motor recovery in children with acute brain injury. Participants/setting: Ten inpatient children with acute brain injury being treated in a rehabilitation hospital. Design: Daily robot-guided ankle passive-active movement therapy for 15 sessions, including isometric torque generation under real-time feedback, stretch-ing, and active movement training with motivating games using a wearable ankle rehabilitation robot. Main measures: Ankle biomechanical improvements induced by each training session including ankle range of motion (ROM), muscle strength, and clinical (Fugl-Meyer Lower-Extremity (FMLE), Pediatric Balance Scale (PBS)) and biomechanical (ankle ROM and muscle strength) outcomes over 15 training sessions. Results: As training progressed, improvements in biomechanical performance measures followed logarithmic curves. Each training session increased median dorsiflexion active range of motion (AROM) 2.73° (standard deviation (SD) 1.14), dorsiflexion strength 0.87 Nm (SD 0.90), and plantarflexion strength 0.60 Nm (SD 1.19). After 15 training sessions the median FMLE score had increased from 14.0 (SD 10.11) to 23.0 (SD 11.4), PBS had increased from 33.0 (SD 19.99) to 50.0 (SD 23.13) (p

Background Positive signs are essential for the diagnosis of functional neurological disorders (FND). The author described a new positive sign to diagnose functional weakness (FW), “paradoxical wrist flexion”, and tested its validity. Methods The test comprised Medical Research Council (MRC) examinations of wrist flexion in two different limb positions, one with the wrist maximally flexed (wrist flexion in the flexed position; WFfl) and the other with the wrist in the neutral position (wrist flexion in the extended position; WFex). In “organic” weakness (OW), WFfl should be stronger than WFex according to the dynamic theory. Paradoxical wrist flexion was judged positive when the MRC score for WFfl was lower than that for WFex. A higher MRC score for WFfl than WFex was considered an “organic sign” for wrist flexion. We retrospectively enrolled patients with FND or other “organic” neurological disorders, who presented with wrist flexor weakness with an MRC score of 4. Results Twenty-four patients with FW and 40 patients with OW were enrolled. Paradoxical wrist flexion was positive in 16 patients with FW and in no patients with OW, i.e. 67% sensitivity and 100% specificity. The “organic sign” for wrist flexion was positive in no patients with FW and in 35 patients with OW, i.e. 88% sensitivity and 100% specificity. Conclusions Paradoxical wrist flexion is useful for the detection of nonorganic paresis. The background theory is that an active movement is more severely affected in FW than a passive movement when maintaining a limb position., Highlights • A new sign to diagnose functional weakness, “paradoxical wrist flexion”, is reported. • It compares the Medical Research Council scale of wrist flexion in two postures. • The sensitivity to diagnose functional weakness was 67% with 100% specificity. • The sensitivity of the “organic sign” was 88% with 100% specificity.

Background Muscle Force (MF) and amplitude of active movement (AAM) are progressively affected in amyotrophic lateral sclerosis (ALS). These measurements are correlated with mobility but influence it in a distinct manner. Objective To determine the influence of MF and AAM on the mobility of the subjects with ALS. Methods The formula for identifying the covariables and scale of mobility of the Amyotrophic Lateral Sclerosis Assessment Questionnaire were applied to 23 subjects with ALS. The MF data of the knee and ankle flexors and extensors were collected in the most affected limb. In conjunction, the AAM of hip and knee flexion were captured. Multiple linear regressions were used, considering alpha ≤0.05. Results MF and AAM interfered in mobility and are responsible for 63.6% of the variation in mobility. The variable that explained this variation was the AAM of hip flexion. The stage of disease was considered a covariable. Conclusion AAM of hip flexion is a safe predictor of mobility in ALS. Retarding loss of this AAM may maintain these subjects functional for a longer time. It was not possible to use MF of the muscles evaluated to predict mobility.

Proprioception, the sense of limb position and motion, is essential for generating accurate movements. Limb position sense has typically been studied under static conditions (i.e., the fixed position of a limb in space), with less known about dynamic position sense (i.e., limb position during movement). Here we investigated how a person's estimate of hand position varies when using spatial or temporal information to judge the unseen hand's location during reaching. We assessed the acuity of dynamic position sense in two directions, orthogonal to hand movement, which only requires spatial information, and in line with hand movement, which has both spatial and temporal components. Our results showed that people have better proprioceptive acuity in the orthogonal condition where only spatial information is used. We then assessed whether cerebellar damage impairs proprioceptive acuity in both tasks during passive and active movement. Cerebellar patients showed reduced acuity in both tasks and in both movement conditions relative to age-matched controls. However, patients' deficits were most apparent when judgments of active movement relied on temporal information. Furthermore, both cerebellar patient and control performance correlated with the trial-to-trial variability of their active movements: subjects are worse at the proprioceptive tasks when movements are variable. Our results suggest that, during active movements, proprioceptive acuity may be reliant on the motor system's ability to predict motor output. Therefore, the resultant proprioceptive deficits occurring after cerebellar damage may be related to a more general impairment in movement prediction.

Muscle spindles provide critical information about movement position and velocity. They have been shown to act as stretch receptors in passive muscle, however, during active movements their behavior is less clear. In particular, spindle responses have been shown to be out-of-phase or phase advanced with respect to their expected muscle length-sensitivity. Whether this apparent discrepancy of spindle responses between passive and active movements is due to fusimotor (γ-drive) remains unresolved, since the activity of fusimotor neurons during voluntary non-locomotor movements are largely unknown. We developed a computational model to predict fusimotor activity and to investigate whether fusimotor activity could explain the empirically observed phase advance of spindle responses. The model links a biomechanical wrist model to length- and γ-drive-dependent transfer functions of type Ia and type II muscle spindle activity. Our simulations of two wrist-movement tasks suggest that (i) experimentally observed type Ia and type II activity profiles can to a large part be explained by appropriate, i.e. strongly modulated and task-dependent, γ-drive. That (ii) the empirically observed phase advance of type Ia or of type II profiles during active movement can be similarly explained by appropriate γ-drive. In summary, the simulation predicts that a highly task-modulated activation of the γ-system is instrumental in producing a large part of the empirically observed muscle spindle activity for voluntary wrist movements.

The wide-awake approach to flexor tendon repair has decreased our rupture and tenolysis rates and permitted us to get consistently good results in cooperative patients. The wide-awake surgery allows the repair of gaps of the surgical repair site revealed with intraoperative active movement testing of the repair We are now doing midrange active movement after primary tendon repair. After tenolysis, full-range active motion is possible even before skin closure. We no longer perform flexor tendon repair with the tourniquet, sedation, and muscle paralysis of general or block (Bier or axillary) anesthesia.

This study tested whether proprioceptive discrimination of movement is a global, general ability, or an attribute that is specific to the joint tested. 40 right-handed, healthy, young adults (19 men, 21 women; M age = 20.4 yr., SD = 1.7) volunteered. A battery of versions of the Active Movement Extent Discrimination Apparatus (AMEDA) were employed to generate the stimuli for movements of different extents at the ankle, knee, spine, shoulder, and finger; discrimination accuracy scores were derived from participants' responses. No significant correlations were found between the discrimination scores from the five sites (all rs ≤ .21, all ps ≥ .20). This finding extends a previous report of non-significantly correlated proprioception test scores at two lower limb sites, and the findings taken together suggest that rather than proprioception being a global, general ability, sensitivity to the proprioception that underlies movement control is site-specific.

10% of the points for the Constant-Murley score (CMS) are allocated for the capacity for internal rotation (IR), measured as unassisted active movement of the dorsum of the hand or the thumb to reach different anatomical landmarks. However, there is little information about the validity of this method and no three-dimensional measurement of the degree of IR that is necessary to reach these landmarks.Sixteen volunteers with healthy shoulders were recruited. The degree of IR was defined using the following landmarks as described in the CMS: (1) lateral aspect of thigh, (2) buttock, (3) sacroiliac joint, (4) level of waist, (5) vertebra T12, (6) interscapular. The validity of IR measurement was assessed by simultaneous 3D motion analysis.Using the thumb as pointer, there were significant increases in IR from 39.3° at position 1 to 80.4° at position 2, followed by 105.1°, 108.6°, 110.1°, and 125.3° at position 3-6. Taking the dorsum of the hand as pointer, there were significant increases in IR between all positions, starting from 71.2° (position 1) and followed by 99.3°, 104.1°, 110.3°, 115.2°, and 119.7° at positions 2 to 6. Comparing the two measurement methods, a significant difference was found for the amount of IR between positions 1 and 2.Measurement of IR as described in the CMS is a suitable method. However, there was an increase of only 10° in IR between positions 3 and 5, which may be hard to measure with a standard goniometer in clinical practice.

Numerous studies have reported large disparities between short cortico-muscle conduction latencies and long recorded delays between cortical firing and evoked muscle activity. Using methods such as spike- and stimulus-triggered averaging of electromyographic (EMG) activity, previous studies have shown that the time delay between corticomotoneuronal (CM) cell firing and onset of facilitation of forelimb muscle activity ranges from 6.7 to 9.8 ms, depending on the muscle group tested. In contrast, numerous studies have reported delays of 60-122 ms between cortical cell firing onset and either EMG or movement onset during motor tasks. To further investigate this disparity, we simulated rapid active movement by applying frequency-modulated stimulus trains to M1 cortical sites in a rhesus macaque performing a movement task. This yielded corresponding EMG modulations, the latency of which could be measured relative to the stimulus modulations. The overall mean delay from stimulus frequency modulation to EMG modulation was 11.5 ± 5.6 ms, matching closely the conduction time through the cortico-muscle pathway (12.6 ± 2.0 ms) derived from poststimulus facilitation peaks computed at the same sites. We conclude that, during active movement, the delay between modulated M1 cortical output and its impact on muscle activity approaches the physical cortico-muscle conduction time.

Halocynthia roretzi, a solitary ascidian, can swell and deflate its solid, leather-like tunic largely, but it is not clear whether the tunic deforms actively. Cellulose Iβ, which is predominant in higher plants, is also present in the tunic as a highly crystalline form. The elastic modulus of its whisker crystalline is considerably high. Substantial amounts of chitin sulfate-like, water-soluble polysaccharide were also present. These polysaccharides alone would barely cause tunic deformation. If the tunic's flexible deformation is self-controlled, it would have another element in addition to the polysaccharide, and it would be an ideal model for designing a novel material. The hypothesis of this study was that the H. roretzi tunic has a nervous system, myocytes, and elastic fibers controlling its flexible deformation. Using acetylcholine and touch as stimuli, the tunic samples were found to deform at acetylcholine concentrations ≥20 µM, indicating the existence of a nervous system, and to have mechanosensitivity. The Bodian, Kluver-Barrera, acetylcholinesterase, immunohistochemical (α-smooth muscle actin), and Elastica-Masson staining methods indicated the presence of a nervous system, myocytes, a region rich in α-smooth muscle actin, and elastic fibers, validating the hypothesis. The self-controlled system in the tunic is useful to understand the properties of the tunic and to design a novel actively deforming material.

Between 1972 and 1982 45 patients with tears of the rotator cuff have been operated in our clinic. 41 of these patients could be controlled at an average of 3.5 years after the operation. According to the applied repair technique the observed patients were divided into three groups. The results were analysed in regard to this classification. A very good and good active movement was achieved in 2/3 of the cases.

In the developing brain the majority of neurons migrate from their birthplace to their final destination. This active movement is essential for the formation of cortical layers and nuclei. The impairment of migration does not affect the viability of neurons but often results in abnormal differentiation. The proper migration of neurons requires the orchestrated activities of multiple cellular and molecular events, such as pathway selection, the activation of specific receptors and channels, and the assembly and disassembly of cytoskeletal components. The migration of neurons is very vulnerable to exposure to environmental toxins, such as alcohol. In this article, we will focus on recent developments in the migration of cerebellar granule cells. First, we will describe when, where and how granule cells migrate through different cortical layers to reach their final destination. Second, we will present how internal programs control the sequential changes in granule cell migration. Third, we will review the roles of external guidance cues and transmembrane signals in granule cell migration. Finally, we will reveal mechanisms by which alcohol exposure impairs granule cell migration.

Background and PurposePassive stretching is widely used to increase muscle flexibility, but it has been shown that this process does not produce long-term changes in the viscoelastic properties of muscle as originally thought. The authors tested a method of lengthening hamstring muscles called “Awareness Through Movement” (ATM) that does not use passive stretching. Subjects. Thirty-three subjects who were randomly assigned to ATM and control groups met the screening criteria and completed the intervention phase of the study. Methods. The ATM group went through a process of learning complex active movements designed to increase length in the hamstring muscles. Hamstring muscle length was measured before and after intervention using the Active Knee Extension Test. Results. The ATM group gained significantly more hamstring muscle length (+7.04°) compared with the control group (+1.15°). Discussion and Conclusions. The results suggest that muscle length can be increased through a process of active movement that does not involve stretching. Further research is needed to investigate this finding.

We assessed functional results after treatment of phalangeal fractures in severely injured hands. Our aim was to quantify digital functional loss with (combinations of) risk factors of unsatisfactory function. Patients who had multiple phalangeal fractures necessitating operation in a 10-year time period were tested, using measurements of total active movement. Seventy-eight patients with 228 phalangeal fractures were available for follow-up. In 88 fingers, the fractures ended in amputation and were excluded from the study. In the resulting 140 fractures, 74 (53%) had a good result (movement >180degrees for fingers 2-5, and >98degrees for the thumb), and 66 (47%) in an unsatisfactory result. Associated soft tissue injury, level of injury, and arthrodesis were risk factors for diminished function. Intra-articular fractures and multiple fractures within the same finger predisposed to arthrodesis. Despite the extensive and severe injuries more than half had good results, which is comparable with reports describing hand injuries with less extensive trauma.

We present the results of two-stage flexor tendon grafting to the hand followed by early active mobilisation. Twenty-six digits from 22 patients were assessed over a 10-year period between 1991 and 2001. Using the LaSalle and Strickland assessment for surgical outcome, we found that 20 digits (77%) achieved excellent or good results. Two ruptured (8%) and one developed adhesions (4%). We think that our results are achieved through meticulous attention to surgical technique with the use of mid-lateral incisions for surgical access, strong bony fixation of the graft that allows a good interface between tendon and distal phalanx, and a closely supervised early active mobilisation regimen after the repair.

Displaced three - and four - part fractures of the humeral head are at high risk for a poor functional outcome after internal fixation. Primary prosthetic replacement can restore the pretraumatic anatomy and early mobilisation is possible. Functional outcome after hemiarthroplasty of the shoulder joint after trauma however is poor, regardless the type of implant used. However, a stable, painless joint is obtained at a "one time surgery". In our institute from April 1996 until January 2001 fifty-eight primary OrTra-prostheses were implanted. In 43 patients we could perform the follow up. The patients revealed a mean range of active movement from about flex./ext. 54 degrees/0/40 with abd./add. 67 degrees/0/20 degrees. Most important for the patients was the achieved painfree shoulder in 86% (ASES index) of all cases.

We report a case of fixation of a radial head fracture with PLLA screw and pin (FIXSORB®). A49-year-old male fell and sustained a fracture of the right radial head by direct injury. The radiological finding was classified as Mason type 3. We removed the radial head, fixated two fragments of the head of radial head with two PLLA pins, and fixated it to the shaft of the radius with one PLLA screw. In addition, one PLLA pin was used for the prevention of rotation. The elbow was immobilized in a splint for two weeks. Active movement was begun after two weeks. One year after the injury, his only symptom was a slight limitation of pronation. Extension-flexsion was full range of motion (zero to 140 degrees), as was supination (90 degrees). Pronation was 35 degrees. The JOA score was 98.

Objective There are limited data on improvements of active limb movement and function following treatment with botulinum toxin in chronic spastic paresis. We report the effect of repeated injections of abobotulinumtoxinA (aboBoNT-A) on these parameters from two Phase III multicenter open-label (OL) trials in adults with spasticity post-stroke/traumatic brain injury; one trial in upper limb spasticity, the other in lower limb spasticity. These are extensions to respective double-blind studies (DB) in which adults received a single aboBoNT-A injection (Gracies et al. Lancet Neurol 2015; Esquenazi et al. AAPM&R 2016). Material/Patients and methods Subjects (18–78 years) received aboBoNT-A (500 to 1500U) over a year (injections ≥ 12 weeks apart) in their affected limb. Active movement was assessed by active range of motion (XA) against elbow, wrist and finger flexors or active ankle dorsiflexion. Active function was assessed by Modified Frenchay Scale (MFS) (upper limb) or the 10-meter walking speed test (lower limb). Results for cycle 4 week 4 of the OL phase are presented. Results Eighty-one subjects received 5 injections in their UL and 139 subjects in their LL. XA improved in the upper limb across injection cycles, with active finger extension (most frequently injected muscle group) increasing by a mean (SD) of +38.0 (53.4)°. The overall increase in MFS was +0.40 (0.75), an improvement that was more pronounced with 1500U (500U in shoulder muscles): +0.62 (0.48) vs. +0.30 (0.83) for 1000U. Active ankle dorsiflexion improved by +6.5(10.9)° with knee extended. Comfortable walking speed improved by +0.088 (0.144) (mean increase of 25% from baseline of DB phase). Discussion/Conclusion Improvement in active movement and function in subjects with chronic upper or lower limb spasticity was observed following repeat injections of aboBoNT-A over a year. A more pronounced efficacy with 1500U versus 1000U aboBoNT-A for active function in the upper limb may suggest the importance of shoulder muscle injections.

A muscle hernia of the lower extremity can occur when the overlying fascia has become weakened. Often it is diagnosed clinically as a soft bulge on active movement and can be confirmed by ultrasound or MRI. If conservative treatment is not effective, surgical fascial reinforcement is required for either cosmetic reasons or clinically symptomatic patients. We are presenting a case of symptomatic, bilateral lower extremity hernias.

The purpose of this study was to determine the early growth scheme and development stages of the red porgy, Pagrus pagrus larvae through the transition from endogenous and exogenous food sources using as main criterion the body length gained at each development stage. The initial period of the species´ larval life can be divided into three phases: a) an initial phase characterised by no motility (0-24 h time after hatching; TAH); b) a phase characterised by active movement and exploitation of the endogenous food reserves (24 h to 96 TAH); and c) a phase characterised by the transition from endogenous to exogenous food (96 to 168 TAH). It was observed that there does not exist an overlapping period between phases b and c and therefore, there exists a gap of 24-36 hours during which the larvae have exhausted their internal food reserves (oil globule and yolk sac) while the digestive tract is not ready to digest external food items (rotifers). We observed a massive larval mortality reaching almost 85% between days 3 and 7 after hatching., No disponible

We evaluated vertex-parietal P37, N50, and contralateral N37 somatosensory evoked potentials (SEPs) to posterior tibial nerve stimulation during weak (20 to 30%) and strong (80 to 90%) ipsilateral gastrocnemius-soleus contraction. The results were compared with data obtained during full relaxation. P37 and N50 were attenuated significantly during weak contraction and then abolished during strong contraction, whereas the contralateral N37 was not. The N37 potential spreads over the vertex and over the ipsilateral parietal region during strong contraction. The Cz'-F3 montage was not appropriate for detecting these SEP patterns. These findings suggest that thalamic or cortical gating mechanisms affect specific cortical responses. P37 and N50 could reflect the arrival of the afferent volley into the motor areas from thalamic and cortical (subareas 1 and 2 of S1) projections. N37 could be generated in subarea 3b. Differential analysis of N37 and P37 is required in clinical practice, mainly in those conditions that involve the motor system and in those conditions in which tonic muscular activity is increased.

During development, cerebellar neurons migrate from their birthplaces (the cerebellar plate ventricular zone and the upper rhombic lip) to their final destinations (the cerebellar cortexes and deep cerebellar nuclei). The active movement of cerebellar neurons is essential for the formation of neuronal cytoarchitecture and their proper differentiation. In this chapter, we focus on recent findings from studies that investigated (1) when, where, and how cerebellar neurons migrate from their origin to their resident destinations, (2) the mechanisms underlying the migration of cerebellar neurons, and (3) how the exposure to toxic materials, such as alcohol, affects the migration of cerebellar neurons.

Context Individuals with and without functional ankle instability have been tested for deficits in lower limb proprioception with varied results. Objective To determine whether a new protocol for testing participants' joint position sense during stepping is reliable and can detect differences between participants with unstable and stable ankles. Design Descriptive laboratory study. Setting University clinical laboratory. Patients or Other Participants Sample of convenience involving 21 young adult university students and staff. Ankle stability was categorized by score on the Cumberland Ankle Instability Tool; 13 had functional ankle instability, 8 had healthy ankles. Intervention(s) Test-retest of ankle joint position sense when stepping onto and across the Active Movement Extent Discrimination Apparatus twice, separated by an interim test, standing still on the apparatus and moving only 1 ankle into inversion. Main Outcome Measure(s) Difference in scores between groups with stable and unstable ankles and between test repeats. Results Participants with unstable ankles were worse at differentiating between inversion angles underfoot in both testing protocols. On repeated testing with the stepping protocol, performance of the group with unstable ankles was improved (Cohen d = 1.06, P = .006), whereas scores in the stable ankle group did not change in the second test (Cohen d = 0.04, P = .899). Despite this improvement, the unstable group remained worse at differentiating inversion angles on the stepping retest (Cohen d = 0.99, P = .020). Conclusions The deficits on proprioceptive tests shown by individuals with functional ankle instability improved with repeated exposure to the test situation. The learning effect may be the result of systematic exposure to ankle-angle variation that led to movement-specific learning or increased confidence when stepping across the apparatus.

The current study introduces a novel rehabilitation robot for treatment of impaired ankle in children with cerebral palsy (CP). The treatment consisted of passive stretching under intelligent control and active movement training with motivating game-playing using the portable robot. After 18 sessions of training (3 sessions/week for 6 weeks), we found significant improvement in 12 children with CP in terms of improved passive and active ranges of motion, selective motor control and mobility functions. The positive outcomes of this study along with the improvements in motor control and functional activities suggest that robotic rehabilitation provides a useful and convenient option of treatment in clinic or patient home for more accessible and frequent rehabilitation.

Background Wide-awake flexor tendon repair in tourniquet-free unsedated patients permits intraoperative Total Active Movement examination (iTAMe) of the freshly repaired flexor tendon. This technique has permitted the intraoperative observation of tendon repair gapping induced by active movement when the core suture is tied too loosely. The gap can be repaired intraoperatively to decrease postoperative tendon repair rupture rates. The authors record their rupture rate in the first 15 years of experience with iTAMe. Methods This was a retrospective chart review of 102 consecutive patients with wide-awake flexor tendon repair (no tourniquet, no sedation, and pure locally injected lidocaine with epinephrine anesthesia) in which iTAMe was performed by two hand surgeons in two Canadian cities between 1998 and 2008. Intraoperative gapping and postoperative rupture were analyzed. Results The authors observed intraoperative bunching and gap formation with active movement in flexor tendon repair testing (iTAMe) in seven patients. In all seven cases, they redid the repair and repeated iTAMe to confirm gapping was eliminated before closing the skin, and those seven patients did not rupture postoperatively. In 68 patients with known outcomes, four of 122 tendons ruptured (tendon rupture rate, 3.3 percent) in three of 68 patients (patient rupture rate, 4.4 percent). All three patients who ruptured had accidental jerk forced rupture. All those patients who did what we asked them did not rupture. Conclusions Tendons can gap with active movement if the core suture is tied too loosely. Gapping can be recognized intraoperatively with iTAMe and repaired to decrease postoperative rupture.

This paper introduces a newly designed dynamic traction splint for the management of digital intea-articular fractures. These fractures, particularly when involving comminution of the joint surface, often result in limitation of hand function due to joint stiffness, tendon adhesion, and chronic pain. Fourteen patients with intea-articular fractures were studied. Thirteen cases involved the proximal interphalangeal joint of the finger and one case involved the interphalangeal joint of the thumb. The splint, a compact, lateral-hinge type, was designed to apply dynamic traction to the fracture. Follow-up at 7 months (range 2 to 19 months) demonstrated functional, pain-free movement. The mean total arc of active motion was 80° in the proximal interphalangeal joints of the fingers and 60° in the interphalangeal joint of the thumb. Radiologic examination demonstrated remodeling of the articular surfaces with maintenance of joint space. The results, when compared with those of other treatment methods, support the use of this splint and treatment program for the management of difficult intea-articular fractures.

A portable ankle rehabilitation robot with intelligent stretching and game-based active movement training was used to treat the spastic impaired ankle of children with cerebral palsy over six weeks. The subject’s calf muscles and Achilles tendon properties were evaluated before and after treatment using ultrasonography and biomechanical measures. It was found that there were decreased Achilles tendon resting length (2.5%), increased cross-sectional area (5.5%), increased stiffness (22.9%), increased Young’s modulus (13.8%), decreased soleus muscle fascicular stiffness (53.7%), and decreased medial gastrocnemius fascicular stiffness (46.1%).

Objectives: The tendon transfer operation is the most preferred surgical method for chronic extensor pollicis longus (EPL) tendon rupture repair. The key factor in these operations is tension setting of the tendon transfer. In this article, we retrospectively reviewed our extensor indicis proprius (EIP) to EPL transfer cases for chronic EPL ruptures. Methods: Five patients were operated on for chronic rupture of the EPL tendon between December of 2011 and April of 2014. The EIP tendon was transferred to the EPL tendon using the wide-awake approach in order to optimally set the tension. Results: All five patients were able to extend their thumbs. No second operation was needed for tension adjusting. No complications were encountered postoperatively and during the follow-up period. Conclusion: Tendon transfers using the wide-awake approach provides the benefit of improved tendon tension setting with active movement and minimal risks of complication. [Hand Microsurg 2015; 4(2.000): 39-43]

This is a prospective follow up of 190 consecutive cases of volar plate avulsion fractures. A standard management regimen of immediate, active movement was followed in all cases and physiotherapy was rarely required. Of the 190 patients, 162 were followed up for at least one year. An excellent or good outcome was achieved in 98 per cent. Patients presenting more than three weeks from injury had a worse outcome. The size and displacement of the avulsed fragment did not affect the outcome. For the stable joint, early active mobilisation with minimal or no splintage provides a good result.

Autocorrelation histograms were used to study the nature of spike activity in neurons recorded bilaterally from the visual and parietal areas of the cortex and hippocampal field CA1 in rabbits in free behavior during exposure to emotionally significant stimuli. Active movement orientational-investigative reactions to stimuli were associated with grouping of discharges and periodicity in the spike activity of most neurons in the cortex and hippocampus, this being dominated by the theta frequency (predominantly 4-5 Hz in the cortex and 4-5 and 6-7 Hz in the hippocampus). As compared with active movement reactions, freezing in response to stimulation was associated with increased numbers of neurons with uniform discharge distributions, while the spike activity of neurons with discharge periodicity showed increases in the intensity of the delta frequency (predominantly from 2 to 4 Hz), while theta intensity decreased. The number of neurons with periodic frequency in the delta range was greater in freezing than in the baseline state of calmly sitting rabbits.

156 American Journal of Obstetrics & Gynecology Optimal timing of cord clamping is a subject that has garnered much interest recently. Potential benefits of delayed cord clamping, occurring some 30-60 seconds after birth rather than the usual 15-20 seconds after birth, include increases in newborns’ blood volume and hemoglobin level In December, 2012, the American Congress of Obstetricians and Gynecologists, with the assistance and subsequent endorsement of the American Academy of Pediatrics, issued a Committee Opinion that recommended delayed cord-clamping for preterm infants— though not for term infants. This guidance was based on systematic reviews of the available data, which revealed that intraventricular hemorrhage was reduced by nearly 50% in preterm infants when cord clamping was delayed and the neonate was held at a level below that of the placenta. A reduced need for transfusion was noted as well. While term infants had increased levels of hemoglobin and ferritin when clamping was delayed, they also had an increase in hyperbilirubinemia. One issue raised in this opinion was the relative lack of data on cord milking, or the active movement of cord contents toward the infant. Journal Club members discussed a new study by Upadhyay and colleagues, which sheds important light on a relatively new practice.

Live eosinophils when mixed with Acridine Orange solution and viewed microscopically using u.v. light show very intense colours of their granules (yellow, orange and red) and green nuclear staining. Their active movement, translocation of granules and degranulation can be observed in vitro. Using this method, live eosinophils can be easily differentiated and enumerated.

Three research goats were accomplished during this third year. (1) Analysis of data indicated that the responsiveness of primary somatosensory (SI) cortical neurons is unattended if when behavioral conditions become unpredictable. This observation fits with the hypothesis that during stereotyped behavior, neuronal responsiveness is gated so that the CNS may partially engage in other activities. (2) SI cortical neurons that respond to vibratory go-cues for wrist movement with the greatest fidelity have their activity modulated just prior to movement onset. This observation fits with the hypothesis that prior to active movement, sensory inputs that are no longer behaviorally relevant are gated so as not to interfere with monitoring movement parameters by the primate CNS. (3) SI cortical neurons that may bind together other SI neurons with their rhythmic activity have this activity disrupted at go-cue onset and just prior to movement onset. This observation fits with the hypothesis that prior to behaviorally significant events, the activity of these neurons that may tonically gate other SI neurons is suppressed to allow the monitoring sensory events and the initiation of movements.

The aim of the study was to obtain an overall view of the extent of variation in hand size and joint mobility in professional pianists. Twenty dimensions of hand size, 17 ranges of active movement and 11 features of passive joint mobility were tested on both hands of 127 male pianists aged between 17 and 63 and 111 female pianists aged between 16 and 64. The male hand showed significantly higher mean values than the female hand in all absolute hand-size variables with the exception of fingertip prominence 3–5. The lateral differences were numerically slight, although occasionally significant; the variability of hand-shape dimensions, except in the case of finger-tip prominence, was less than 10%. All mean values of finger spans with the thumb were greater in men than in women. The same tendency prevailed in the case of finger spans without the thumb, although the differences were only occasionally significant. Five of the 20 finger spans were on average significantly greater on the left than on the right....

Sixty-five knees were subjected to a kinematic analysis using the instant-centre technique in order to determine the effect of deficiency of the anterior cruciate ligament on the biomechanics of active movement in the knee. The instant-centre pathway in acute ruptures of the anterior cruciate ligament was found to have a specific abnormality. This corresponded with a positive pivot-shift sign, but was present even when that sign was not clinically detectable. Primary repair using a transosseous wire suture did not usually abolish the biomechanical abnormality. The data provide a possible explanation for the doubtful prognosis of primary repair of this ligament and encourage clinical and biomechanical evaluation of alternative procedures such as primary augmented repair.

Active and passive muscle tension is discussed in relation to finger flexor and extensor tendons. Minimising active tension required to produce finger movement is seen as an important part of post-operative finger mobilisation following flexor tendon repair in which active movement is used. It is argued that “minimal active tension” in the flexors is equal to, or just exceeds, the passive tension in the extensors. A method of measuring passive tension in finger tendons has been described. In 24 volunteers, it has been used to determine that if the metacarpo-phalangeal joints are held flexed, there is least “minimal active tension” in the flexor tendons when the wrist is splinted in extension.

Use of the Pavlik harness for the treatment of congenital dislocation of the hip of a infant under three months old, has the following two objections, 1) functional reduction may not be obtained because active movement of limbs are still poorley developed, 2) the immature hip joint may be damaged, so as to cause growth disturbance of upper femoral epiphysis.In spite of these objections, from our investigation of 82 joints which were treated in infant under three months old with a Pavlik harness, 68 of them (83%) were successfully reduced and femoral head of these reduced hip were mostly well developed, and fairly good results were obtained.

✓ Recordings of electrical activity in the cerebellar cortex and deep nuclei were obtained from three patients with congenital athetosis, prior to therapeutic ablation of the dentate nucleus. Recordings from microelectrodes were carried out during the stereotaxic procedure with the patient under light fluthane anesthesia. Macroelectrodes were also implanted within the cerebellar nuclear and cortical regions; records from these electrodes were obtained with the patient fully awake during a 2-week evaluation period. Two major areas of electrical activity were defined in the cortical gray and nuclear gray, separated by an area of relative electrical silence corresponding to the cerebellar white matter. The electrical activity from the nuclear gray was characteristically of a higher frequency and voltage; thus, the limits of the nuclear region can be defined by contrast with the relatively silent white matter. The recorded electrical activity was not influenced by either sleep or active movement of the extremities.

The question of cell contacts and cell movements is examined with a view to providing a working hypothesis for some of the cellular phenomena seen in morphogenesis and in the infiltration and metastasis of cancer. No attempt is made to review the vast relevant literature, but examination of some of the data emphasizes the existence of a common pattern in many systems, whenever moving cells come into contact with each other. Initially there is random contact, followed by a secondary phase during which like cells tend to stay apposed whereas unlike cells separate. These secondary movements are expressed in the descriptive terminology of Holtfreter as positive and negative affinities respectively. It is suggested that the active movement of two cells apart from each other is not limited by the strength of the adhesions between them as is generally accepted, but that the restraint to movement is the cohesive strength of the individual cell surfaces. Developing this argument, it is proposed that after initial contact between cells, negative affinity is manifest when the surfaces of one or both of the cells are weakened to a level below that of the cellular propulsive forces. Various mechanisms whereby this weakening may be carried out include enzymatic surface autolysis, and the development of structural heterogeneities. On the other hand, positive affinity between cells may represent either failure of surface weakening processes and/or cessation or diminuation of propulsive cellular movement. It is emphasized that the proposed hypothesis is to be regarded as a basis for future experiments rather than a concrete theory.

The effects of active movement involvement with visual perception in children were studied in two situations. In Exp. I 15 elementary school children were assigned to each of the three experimental conditions. In all conditions subjects were presented with a standard visual length. In Condition I (visual) they viewed the distance between two stops on a rail. In Condition II (active movement) the subject moved his arm through the viewed length. In Condition III (passive movement) the experimenter moved the subject's arm passively through the viewed length. The experimenter then adjusted a visual variable (in the absence of the standard) until the subject judged it to be as long as the standard. The active movement condition was significantly more accurate than the other two conditions which did not differ significantly. In Exp. II 12 elementary school children were assigned to visual, active movement, and passive movement conditions. Stimulus and test materials were six-sided random forms. Results closely paralleled findings for Exp. I, significantly more errors being made in the visual and passive movement conditions. The implications of the results for understanding intersensory facilitation effects and perceptual learning are discussed and I argue that the results make feasible a mechanism of specific intersensory connections via the motor cortex in intersensory facilitation.

1. The pigeon exhibits peculiar rhythmic movements in some cases while in the state of narcosis. These movements are seen as bilaterally symmetrical flexion of the hind limbs, depression of the tail, and flapping of the wings. The wing movements commence with rapid flapping—these members being in a state of extension and abduction—and are then succeeded by a state in which the flapping is replaced by a state of flexion and adduction. This movement is bilaterally symmetrical; it is rhythmic—the manifestations of the phenomenon being separated by intervals of rest; and it is probably connected with the normal movements of flight. 2. Three different types of movement may occur in the rabbit when in a state of narcosis. 3. Of these the first is the hop. The hind limbs describe rhythmic movements which are bilaterally symmetrical. There is flexion at all three joints, succeeded by extension. The movements of the hind limbs are simultaneous, and the rhythm lies between 1·2 and 2·0 beats per second. Records of the movements of the isolated quadriceps extensor cruris demonstrate active movement synchronous with the hopping movements in the limbs. These contractions are commonly separated by short intervals of rest at the level of relaxation. 4. The second type of movement to occur in the rabbit is the scratch. In its main features this phenomenon corresponds very closely with the similar phenomenon already described as taking place in the guinea-pig. Peculiarly well marked in the case of the rabbit are the movements of the head and neck, face, and ears. Analysis of the movements of the scratch shews that the “beats” are of irregular form and rhythm. This variation of rhythm may lie between 0·75 and 4·5 beats per second. The differences in the form and rhythm of the beats may be due to the complication of the movements of the scratch with concurrent hopping movements. 5. The third type of movement exhibited by the hind limbs may be described as a simple act of flexion. Here the one hind limb performs a short movement of flexion. There is no maintenance of the flexion, and during its exhibition the contralateral hind limb performs a synchronous act of extension. The flexions occur usually upon the one side only at any one time. They may occur in groups, but then appear to have no rhythmic relationship. When they occur close together there is a summation of the “residual flexion” which is present in each single act. 6. The three types of movement in the rabbit may be compounded in different combinations during the phenomena seen under narcosis. The movements of the scratch may be preceded by the movements either of progression or of flexion. In the former case the hopping movements are abolished at the point of initiation of the scratch in the hind limb which goes into extension. But the other hind limb sometimes shews the persistence of the hopping movements superposed upon the maintained flexion of the scratch. In this case the maintained flexion may commence as a very slow rise. The flexion movements in a similar manner may precede the movements of the scratch. In this case the flexion is seen upon the same side as that upon which the scratching first appears. Two or three flexion movements may be grouped together. These shew the summation of the “residual flexion,” and finally there is complete mergence with the maintained flexion of the scratch, which then appears as at its full extent.