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Macrodystrophia lipomatosa (MDL) is a rare congenital, nonhereditary anomaly characterized by overgrowth of all the mesenchymal elements, predominantly the fibroadipose tissue in a sclerotomal distribution commonly involving the median nerve territory in the upper extremity and plantar nerve territory in the lower extremity. It can be either static or progressive, with the former being the more common. MDL is usually present since birth and the affected digit/region increases in length and girth, and growth ceases after puberty. We discuss a rare case of ulnar nerve territory involvement that progressed to grow even after puberty. [ABSTRACT FROM AUTHOR]

The inclusion of health professionals who have some type of disability brings benefits, such as the increase in empathy that facilitates the relationship with patients. In this work, we present a case study on the inclusion of an undergraduate Dentistry student with upper limb agenesis. In order to improve the quality of life for people with upper limb agenesis, it is urgent to establish inclusion strategies in the educational field. This process included the use of assistive technologies to allow the manipulation of instruments used in the practice of dental clinical activities, enabling future Dentists with upper limb agenesis to have an equal education in relation to their academic peers. The case study presented in this work consists of the follow-up of G., a 23-year-old female Dentistry student. The developed adaptations were made using a low-temperature thermoplastic. The expert team that participated in this process was formed by three occupational therapists and three Dentistry professors. The process included several stages, being the last one the integration, in which training sessions were performed. The process was accessed using two main tools: quantitative questionnaires and qualitative interviews. After the proposed intervention, the volunteer presented a gradual evolution in her occupational performance with the use of most adaptations, promoting her functional training. Most adaptations allowed G. to perform the activities satisfactorily, with the precision inherent to these tasks, even with little training time. This case study demonstrates the high applicability of the proposed technologies. In order to improve the quality of life for people with upper limb agenesis, it is urgent to establish inclusion strategies in the educational field, as assessed in this study case The inclusion process of Dentistry students can include the use of assistive technology to allow the manipulation of instruments for the practice of clinical activities Our study suggests that the assistive adpatations promote a gradual evolution in the students' occupational performance, functional training and motor qualification [ABSTRACT FROM AUTHOR]

Holt-Oram syndrome comprises a rare spectrum of congenital cardiovascular and appendicular skeletal anomalies. However, only a few cases have reported lung involvement in Holt-Oram syndrome. We reported the rare case of a 1-year-old male child patient who presented with upper limb abnormalities and respiratory distress and was diagnosed with pulmonary agenesis and pulmonary arterial hypertension secondary to an atrial septal defect. [ABSTRACT FROM AUTHOR]

To examine whether accelerometry can quantitate asymmetry of upper limb activity in infants aged 3–12 months at risk for developing unilateral spastic cerebral palsy (USCP). A prospective study was performed in 50 infants with unilateral perinatal brain injury at high risk of developing USCP. Triaxial accelerometers were worn on the ipsilateral and contralesional upper limb during the Hand Assessment for Infants (HAI). Infants were grouped in three age intervals (3–5 months, 5–7.5 months and 7.5 until 12 months). Each age interval group was divided in a group with and without asymmetrical hand function based on HAI cutoff values suggestive of USCP. In a total of 82 assessments, the asymmetry index for mean upper limb activity was higher in infants with asymmetrical hand function compared to infants with symmetrical hand function in all three age groups (ranging from 41 to 51% versus − 2–6%, p < 0.01), while the total activity of both upper limbs did not differ. Upper limb accelerometry can identify asymmetrical hand function in the upper limbs in infants with unilateral perinatal brain injury from 3 months onwards and is complementary to the Hand Assessment for Infants. [ABSTRACT FROM AUTHOR]

Introduction: Despite the prevalence of congenital limb deficiencies (CLDs) occurring in around 7.9/10,000 births (Am J Med Genet A. 2011;155A:1225-1235), there is still a gap in the knowledge regarding the etiology of a large proportion of cases, and literature addressing this topic is sparser compared with other conditions. Objective: The aim of this study is to assess the literature surrounding the causes of CLDs and use this to suggest the area in which a potential gap in the information on the causes of CLDs lies. Study Design: This study is a literature review on articles published from the year 2000 onward. Methods: A search was conducted on five databases (CINAHL, Scopus, PubMed, Embase, Cochrane Library) and the ProQuest platform resulting in 18 articles to be discussed, after inclusion and exclusion criteria were applied and critical appraisals were completed. Results and Discussion: The main findings could be separated into four themes including genetics, environment, drugs, and vascular. Comparisons were made among similar literature, although within some topics, this was less effective, given the specificity and reduced volume of research. Positive correlations were seen in all studies; however, the biggest underlying factor for most causes seemed to originate from a vascular disruption. Conclusions: Future studies should focus on an underlying vascular disruption as a base for further research to attempt to find reasoning for the proportion of CLDs with an unknown cause. Further attempts should be made into creating a consensus on classifying and recording CLDs to ensure a more uniform approach to this topic worldwide, allowing comparisons to be drawn more easily. Clinical Relevance: Understanding relevant terminology is vital to ensure that families experiencing CLD receive accurate information about their child's condition. This understanding will also lead to improvements in the quality of recorded data, such as clinical notes and registry inputs. [ABSTRACT FROM AUTHOR]

Producing triggers to switch between modes of myoelectric prosthetic hands has proven to be difficult. We evaluated whether digital training methods were feasible in individuals with an upper limb defect (ULD), whether myosignals in these individuals differ from those of non-impaired individuals and whether acquired skills transfer to prosthesis use. Two groups participated in a 9-day pre-test–post-test design study with seven 45-minute training sessions. One group trained using a serious game, the other with their myosignals digitally displayed. Both groups also trained using a prosthesis. The pre- and post-tests consisted of an adapted Clothespin Relocation Test and the spherical subset of the Southampton Hand Assessment Procedure. After the post-test, the System Usability Scale (SUS) was administered. Clinically relevant performance measures and myosignal features were analysed. Four individuals with a ULD participated. SUS-scores deemed both training methods feasible. Three participants produced only a few correct triggers. Myosignals features indicated larger variability for individuals with a ULD compared to non-impaired individuals (previously published data [1]). Three participants indicated transfer of skill. Even though both training methods were deemed feasible and most participants showed transfer, seven training sessions were insufficient to learn reliable switching behaviour. Trial registration: The study was approved by the medical ethics committee of the University Medical Center Groningen (METc 2018.268). Switching between pre-programmed modes of a myoelectric prosthetic hand can be learned, however it does require training. Serious games can be considered useful training tools for trigger production in early phases of myoelectric prosthesis control training. In order to evoke transfer of skill from training to daily life both task-specificity and focus of attention during training should be taken into account. [ABSTRACT FROM AUTHOR]

Introduction: To support clinicians who treat children with upper-limb differences, we must first understand how these children are treated around the world. Study Design: A descriptive survey was carried out in this study. Objectives: The aim was to describe how treatment for children with upper-limb difference is provided in different parts of the world. Methods: A web-based survey was used to gather data. The survey was shared on the Handsmart website, through providers and members using snowball sampling. Results: Sixty-eight respondents from 18 countries, with most being occupational therapists and prosthetists, participated. All respondents reported that they provide prosthetic treatment and most fit a passive prosthesis before 1 year of age. Respondents from 13 countries reported having governmental funding for the provision of care for people with upper-limb loss. Intervention is guided by the presentation of the limb as well as availability of funding and other resources. In 12 countries, no treatment other than fitting of prostheses is provided for the children. The children who do not receive a prosthesis continue to see an occupational or physical therapist for other treatment (other devices, follow-up). Respondents stated that they would like to see clear treatment guidelines used by multidisciplinary teams to fit children and that treatment should include regular follow-up. Conclusions: Children are treated differently in various parts of the world based on different funding, family support, and therapy resources. Further studies should encompass a geographically representative sample of children's clinics. Clinical Relevance: This study provides information regarding treatment practices for children with upper-limb loss/difference in various parts of the world; prosthetic treatment is common for children, although ages for fitting vary among clinics and countries. Results will contribute by supporting clinicians to provide better treatment for children with upper-limb loss/difference. [ABSTRACT FROM AUTHOR]

To guide better prevention and treatment and to develop research priorities, this study aims to create an overview of facilitators and barriers for the development and persistence of musculoskeletal complaints (MSCs) in individuals with upper limb absence (ULA). Exploratory mixed methods design. A focus group (FG) was organized with individuals with ULA about MSCs and associated factors. An inductive approach was employed to the transcript and the studies. A scoping review was performed to systematically identify barriers and facilitators. The International Classification of Functioning, Disability, and Health was used to create an integrated overview of the results. Eleven participants participated in the FG, eight of them currently sustained or had sustained MSCs in the last year. Ten studies were included in the scoping review. The final overview consisted of 67 associated factors. Participants of the FG predominantly mentioned psychosocial factors, whereas the literature dominantly reported biomechanical factors. The extensive overview of 67 factors showed that facilitators and barriers for MSCs are heterogeneous and aids in a better understanding of the complex nature of MSCs. Several biomechanical and psychosocial factors contribute to MSCs, but the association with a prosthesis remains unclear. Musculoskeletal complaints (MSCs) are highly prevalent in the population with upper limb absence (ULA) and the overview of 67 factors could help in the prevention and treatment of MSCs. Psychosocial factors in the development and persistence of MSCs are underreported in literature, but are important contributors to MSCs according to patients. Wearing a prosthesis does not seem to be protective for the development or persistence of MSCs. Social support, especially from significant others and employers, is essential to help protect MSCs in those with ULA. [ABSTRACT FROM AUTHOR]

Introduction: Understanding repair patterns of upper-limb (UL) prosthetic devices have received little attention compared with their lower-limb counterparts. This study focuses on a retrospective analysis of anonymized UL prosthetic maintenance data to establish if there were any patterns of repairs at a regional prosthetic limb-fitting center in the United Kingdom. A secondary aim of this study is to describe the patient demographics of this center. Methods: Data containing prosthetic repair log and demographic description (n = 212) were acquired through our clinical partners and subjected to statistical analyses. Results: On average, each client visited the center 0.2 times/year for a new device and 0.9 times/year for maintenance-related activities. It is found that the repair rates are generally higher for body-powered devices (1.28 visits/device per year) compared with passive (0.94 visits/device per year) and externally powered devices (0.90 visits/device per year). In keeping with the typical UK UL-deficient population, there is a high male-to-female ratio, and higher instances of traumatic amputations were noticed for males at the center. There is a very high preponderance of congenital cases and an overall emphasis on prescribing passive devices to a majority of patients at the center. Conclusions: The data from our study are similar to previously published data from other centers and show a consistent pattern in terms of relative rates of maintenance attendances for different types of UL prostheses. Clinical Relevance: This study provides a longitudinal perspective and insights on ever-changing requirements (prostheses and related care) of the users at the level of a regional limb-fitting center. This study underscores current gaps in prosthetic device durability/reliability and opens up avenues for improvement of prosthetic services and devices. [ABSTRACT FROM AUTHOR]

Thrombocytopenia-absent radius (TAR) syndrome is a rare congenital syndrome in which thrombocytopenia and the absence of radius can be accompanied by various organ anomalies. Bilateral phocomelia is the most severe form in this clinic. Thumbs are always present. The deletion of the RNA-binding motif protein 8A (RBM8A) gene on chromosome 1q21.1 in Array Comparative Genomic Hybridization confirms the diagnosis of TAR syndrome. Thrombocytopenia, which can cause complications, tends to resolve in the first year of life. Although there are delays in motor development, mental retardation is not one of the common clinical findings of this syndrome. In the differential diagnosis of severe radial defects, TAR syndrome, Holt-Oram syndrome, Roberts syndrome, Fanconi anemia, and VACTERL association are included. The presence of key findings of each syndrome is important in the differential diagnosis. Here, we aimed to evaluate the approach to the differential diagnosis of severe radial anomalies in a patient with TAR syndrome and neuromotor retardation. [ABSTRACT FROM AUTHOR]

Background: Cubital tunnel syndrome can be caused by overtraction and dynamic compression in elbow deformities. The extent to which elbow deformities contribute to ulnar nerve strain is unknown. Here, we investigated ulnar nerve strain caused by cubitus valgus/varus deformity using fresh-frozen cadavers.Methods: We used six fresh-frozen cadaver upper extremities. A strain gauge was placed on the ulnar nerve 2 cm proximal to the medial epicondyle of the humerus. For the elbow deformity model, osteotomy was performed at the distal humerus, and plate fixation was performed to create cubitus valgus/varus deformities (10°, 20°, and 30°). Ulnar nerve strain caused by elbow flexion (0-125°) was measured in both the normal and deformity models. The strains at different elbow flexion angles within each model were compared, and the strains at elbow extension and at maximum elbow flexion were compared between the normal model and each elbow deformity model. However, in the cubitus varus model, the ulnar nerve deflected more than the measurable range of the strain gauge; elbow flexion of 60° or more were considered effective values. Statistical analysis of the strain values was performed with Friedman test, followed by the Williams' test (the Shirley‒Williams' test for non-parametric analysis).Results: In all models, ulnar nerve strain increased significantly from elbow extension to maximal flexion (control: 13.2%; cubitus valgus 10°: 13.6%; cubitus valgus 20°: 13.5%; cubitus valgus 30°: 12.2%; cubitus varus 10°: 8.3%; cubitus varus 20°: 8.2%; cubitus varus 30°: 6.3%, P < 0.001). The control and cubitus valgus models had similar values, but the cubitus varus models revealed that this deformity caused ulnar nerve relaxation.Conclusions: Ulnar nerve strain significantly increased during elbow flexion. No significant increase in strain 2 cm proximal to the medial epicondyle was observed in the cubitus valgus model. Major changes may have been observed in the measurement behind the medial epicondyle. In the cubitus varus model, the ulnar nerve was relaxed during elbow extension, but this effect was reduced by elbow flexion. [ABSTRACT FROM AUTHOR]

PURPOSE: Young adults with transversal upper limb reduction deficiency experience limitations regarding education, employment and obtaining a driver's license. Contribution of rehabilitation care within these domains has been reported to be inadequate. This study evaluates the needs and suggestions of participants in rehabilitation care. METHODS: Two online focus groups with young adults and parents met during 4 consecutive days. Health care professionals joined a face-to-face focus group. Data analysis was based on framework analysis. RESULTS: The rehabilitation team was mainly consulted for problems with residual limb or for prostheses. Young adults and their parents were mostly unaware of resources regarding education, job selection or obtaining a driver's license. Professionals stated that these subjects were addressed during periodic appointments. Young adults didn't always attend these appointments due to limited perceived benefit. To improve rehabilitation care, participants suggested methods for providing relevant information, facilitating peer contact and offering dedicated training programs to practice work-related tasks, prepare for job interviews or enhance self-confidence. CONCLUSION: Periodic appointments do not fulfil needs of young adults with transversal upper limb reduction deficiency. To improve care, rehabilitation teams should offer age-relevant information, share peer stories, and create dedicated training programs. [ABSTRACT FROM AUTHOR]

Introduction: compressive neuropathies of the upper extremity are most often associated with functional difficulties and reduced working capacity, which can be significant and very complex to treat if these lesions are not recognized and treated on time. The importance of these clinical entities is reflected in the fact that there is a possibility of simultaneous persistence of comorbidities, which may affect the final prognosis and recovery. The application of correct diagnostic and therapeutic procedures is an indispensable factor in the guidelines of treatment and achieving the expected recovery, taking into account all preexisting factors. Aim: to assess the types of diagnostic and surgical procedures to the specific type of compressive neuropathy, to gender and age distribution, and overexciting comorbidities Material and methods: we evaluated 77 cases of three types of compressive neuropathies of the upper extremity, treated at Clinic of Reconstructive and Plastic Surgery of the Clinical Center University of Sarajevo in the period from 2017 to 2021, with the evaluation of gender and age distribution, preexisting comorbidities, diagnostic and surgical procedures. Results: statistically significant difference was found in gender distribution, in terms of higher female representation, 52 (67.5%), χ2 = 14,558; p = 0.001. The mean age of the examined group of patients was 50.2 ± 14.6 years. No statistically significant difference was confirmed in the correlation of age and specific type of compressive neuropathy (p <0.05). The evaluation of existing comorbidities confirmed in most cases the association of hypertension (27 cases; 39.7%) and diabetes (10 cases, 14.7%) with Carpal tunnel syndrome, but without statistical significance. In the overall assessment of the existence of preexisting comorbidities with other types of compressive neuropathies, no statistical significance was confirmed (p <0.05). There was no statistically significant correlation between the type of preoperative diagnostic procedure (χ²=1.466; p=0.963; p=0.556) with the specific type of compressive neuropathy. The statistically significant correlation (p>0.05) was confirmed between the type of surgical procedure to the specific type of compressive neuropathy (χ² = 0.591; p = 0.0001; p=0.0001). Conclusion: compressive neuropathies of the upper extremity, with the adequate clinical diagnosis of the specific functional failure, resulted in satisfactory postoperative recovery due to defined surgical protocol of treatment, with saitsfactory postoperative results, improving the functionality and overall quality of life. [ABSTRACT FROM AUTHOR]

Background: Individual weaknesses in motor skills are a characteristic of children with congenital upper limb deficiencies. These weaknesses increase with age. In Japan, however, prosthetic prescription and subsequent rehabilitation approaches for children with upper limb deficiencies are insufficient and often delayed. This study aimed to elucidate whether rehabilitation approaches, including prostheses prescription and occupational therapy, improve these children's adaptive behaviors, especially their motor skills. Methods: The study included nine children, aged 0–6 years, with unilateral transradial or transcarpal upper limb deficiencies. We measured their adaptive behaviors and motor skills at the beginning of prosthetic therapy and after 1.5 years, using the Vineland Adaptive Behavior Scales – Second Edition. Results: The score for the motor skills domain was significantly lower than the median score of the domains at the beginning of prosthetic therapy. The motor skill weaknesses significantly improved after 1.5 years of prosthetic therapy. Conclusions: Although children with congenital upper limb deficiencies have individual weaknesses in their motor skill behavior, it was shown that these weaknesses can be improved through rehabilitation approaches, including occupational and prosthetic therapies. Issuing the appropriate prostheses and implementing the appropriate training to use the prostheses for congenital upper limb deficiencies are reasonable and meaningful interventions to improve quality of life. [ABSTRACT FROM AUTHOR]

Purpose: Rehabilitative care for children with limb difference often includes the provision and use of an artificial (or prosthetic) limb. Of key influence in this process is how parents experience and respond to their child's limb difference and prosthesis use. However, research on this is lacking. Therefore, this study aimed to explore the experiences of parenting a child with limb difference who had been provided with an artificial limb. Design: Semi-structured interviews took place with seven parents. Interview data was recorded, transcribed and analyzed using interpretative phenomenological analysis. Results: The analysis identified four themes: (1) managing the initial emotional experience through the development of coping resources; (2) opportunities through prosthesis use and its relationship with "normality"; (3) managing and making sense of social reactions toward their child; (4) the intrinsic role of support: developing a collective connection and enabling shared knowledge. Conclusions: The study highlighted salient aspects to parents' experiences and sense-making that can inform clinical support. Emotional support, the management of social responses, and the holistic co-ordination of healthcare support with peer support networks are discussed. Healthcare professionals involved in the prosthetic rehabilitation process should look to explore these meanings to help support the management of the child's prosthesis use. Understanding the sense-making of parents is important in effective service provision for children with limb difference. Service provision for children with limb difference should consider the support needs of parents. Working with limb difference charities and voluntary organizations could help services develop needed parent-to-parent support networks. [ABSTRACT FROM AUTHOR]

Supplemental digital content is available in the text. Introduction: This article presents a unique case study of an individual with congenital limb loss and long-time (>56 years) body-powered prosthesis use, who was able to control a sophisticated robotic upper-limb prosthesis using surface electromyography signals and pattern recognition (PR) algorithms. This case demonstrates that individuals with congenital limb amputation are able to learn unique strategies to intuitively control a dexterous prosthetic limb. Materials and Methods: After completing four training sessions using a virtual integration environment, a single subject participated in 12 in-laboratory clinical training sessions using the modular prosthetic limb (MPL)—a novel multiple–degree-of-freedom dexterous upper-limb prosthesis prototype. Baseline assessments were made with her body-powered prosthesis, as well as a two-site direct-control myoelectric Bebionic she had recently received. Functional assessments with the MPL were conducted during sessions 6 and 12. Outcome measures included timed box and blocks (BB) test, Assessment of Capacity for Myoelectric Control (ACMC), Jebsen-Taylor Hand Function Test (JTHFT), Trinity Amputation and Prosthesis Experience Scale, Upper Extremity Functional Scale (UEFS), and NASA Task Load Index. Results: The subject was able to control two independent wrist degrees of freedom and up to three independent hand grasps of the MPL, using an array of surface electrodes. Improvements in the BB and ACMC were observed, although the total time to complete the JTHFT stayed relatively the same from weeks 6 to 12, using the MPL. While her enpoint perceived funcitonal ability with the MPL was 58% compared with 83% with her personal myoelectric prosthesis (12 hours of use vs 4–5 weeks of use as denoted on the UEFS); the subject reported short length of training, a long-term body-powered prosthetic user with congenital limb loss was able to demonstrate objective improvements in control of a dexterous prosthetic hand over a 12-week period of in-laboratory training, achieving intuitive independent control of a variety of simultaneous individual wrist motions and grasp patterns using PR. Conclusions: This case demonstrates that even individuals with congenital amputation may be considered as candidates for upper-limb PR-controlled myoelectric prosthetic devices using surface electrodes. [ABSTRACT FROM AUTHOR]

Amniotic band syndrome can lead to a wide spectrum of congenital abnormalities including orofacial and visceral defects. It is associated with malformations in truncal, craniofacial regions and the limbs, whereas it sometimes may imitate some genetic disorders. Here, we present an atypical case mimicking amniotic band syndrome with a facio‐upper arm band that was having multiple fetal structural abnormalities including scoliosis, bilateral cleft lip and palate, upper limb abnormality, unilateral anophthalmia with contralateral microphthalmia, left hypertrophic kidney and severe ventriculomegaly. [ABSTRACT FROM AUTHOR]

Introduction: There is limited knowledge on the use of 3 D-printed transitional prostheses, as they relate to changes in function and strength. Therefore, the purpose of this study was to identify functional and strength changes after usage of 3 D-printed transitional prostheses for multiple weeks for children with upper-limb differences. Materials and methods: Gross manual dexterity was assessed using the Box and Block Test and wrist strength was measured using a dynamometer. This testing was conducted before and after a period of 24 ± 2.61 weeks of using a 3 D-printed transitional prosthesis. The 11 children (five girls and six boys; 3-15 years of age) who participated in the study, were fitted with a 3 D-printed transitional partial hand (n = 9) or an arm (n = 2) prosthesis. Results: Separate two-way repeated measures ANOVAs were performed to analyze function and strength data. There was a significant hand by time interaction for function, but not for strength. Conclusion and relevance to the study of disability and rehabilitation: The increase in manual gross dexterity suggests that the Cyborg Beast 2 3 D-printed prosthesis can be used as a transitional device to improve function in children with traumatic or congenital upper-limb differences. Implications for Rehabilitation: Children's prosthetic needs are complex due to their small size, rapid growth, and psychosocial development. Advancements in computer-aided design and additive manufacturing offer the possibility of designing and printing transitional prostheses at a very low cost, but there is limited knowledge on the function of this type of devices. The use of 3D printed transitional prostheses may improve manual gross dexterity in children after several weeks of using it. [ABSTRACT FROM AUTHOR]

Propranolol is used as the first-line treatment in essential tremor and it has also been proposed as a treatment for tremor in dystonia. However, several issues remain uncertain. For example, it is still not clear whether propranolol exerts a beneficial effect on head tremor. Moreover, no studies have investigated whether the effect of propranolol on head and upper limb tremor in essential tremor differs from that in dystonia. We aimed to assess the effects of propranolol on tremor in different body parts in essential tremor and in patients with tremor and dystonia. Twenty-nine patients with head and upper limb tremor were enrolled in the study, 14 with essential tremor, and 15 with dystonia. Participants underwent a clinical and kinematic analysis of tremor in two sessions, i.e., without (baseline) and ‘on therapy’ with propranolol. We found that head tremor was more severe in patients with dystonia, while upper limb tremor was more evident in patients with essential tremor (P < 0.05). Propranolol had no effect on head tremor in either group (all Ps > 0.05), but it did reduce upper limb tremor in patients with essential tremor. The present study demonstrates differential effects of propranolol on head and upper limb tremor in patients with essential tremor. The lack of effect on head and upper limb tremor in patients with dystonia suggests that the pathophysiological mechanisms underlying tremor in these two conditions and in different body parts may be distinct. [ABSTRACT FROM AUTHOR]

Poland's syndrome is a rare congenital malformation that is characterized by a congenital defect of the pectoralis major. It is associated with various ipsilateral upper extremity anomalies and homolateral breast hypoplasia. There have been reports of Poland's syndrome being associated with different malignancies. Here, we report two cases of Poland's syndrome associated with breast cancer (BC) and review the literature. To date, 21 cases (including our two cases) of Poland's syndrome associated with BC have been reported. The clinical characteristics of the disease are analyzed in this report. [ABSTRACT FROM AUTHOR]

Objective: Mechanical neck pain (NP) with referred pain to upper limb is a common problem and often leads to functional impairment of common activities of daily living. The present study is undertaken to study and compare the effect of gross myofascial release (MFR) of upper limb and neck alone with conventional physiotherapy against only conventional treatment in subjects with mechanical NP referred to upper limb in terms of cervical endurance, pain, range of motion, and function. Methods: Design: This was a experimental study; a total of 40 subjects clinically diagnosed with mechanical NP along with referred pain between the age group of 20 and 50 years. Intervention: Control group was given conventional treatment of hot moist pack, TENS, and stretching and strengthening exercise, and experimental group was given gross MFR of the neck and upper limb in addition to conventional therapy. Treatment was given for 6 consecutive days. Outcome measures used were pressure biofeedback to measure cervical endurance, goniometer for cervical ROM, Northwick Park NP questionnaire, and disabilities of arm, shoulder, and hand questionnaire. Results: Statistically significant change was present for pain, cervical flexure endurance, ROM, and functional abilities with P < 0.05 for both the groups except for neck flexor endurance in control group. Conclusion: Gross MFR of upper limb and neck is an effective technique for subjects with mechanical NP and has a faster rate of improvement. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the relationship between the movement abnormalities of the impaired upper limb in children with unilateral cerebral palsy (CP) and bimanual performance.Method: Twenty-three children with unilateral CP (mean age 11y 10mo [SD 2y 8mo]) underwent evaluation of bimanual performance (Assisting Hand Assessment [AHA]) and a three-dimensional movement analysis to measure deviations in the movement of their affected upper limb, and compared with 23 typically developing children (TDC) (mean age 11y 11mo [SD 2y 5mo]). Kinematic indices, such as the Global Arm Profile Score (APS), which summarizes the global movement deviation of the upper limb from the norm, and the Global Arm Variable Score (AVS), which represent movement deviations for a given joint, were calculated and correlated to AHA.Results: Values of kinematic indices were significantly higher in children with unilateral CP than in TDC. A strong correlation between Global-APS and AHA score (r=-0.75) was found. Other significant correlations were found with Global-AVS, especially in distal joints.Interpretation: Children with unilateral CP had more movement deviations than TDC. The global movement deviation of the impaired upper limb was strongly correlated with bimanual performance. The influence of distal abnormalities confirms the importance of considering these limitations in therapeutics.What This Paper Adds: Children with unilateral cerebral palsy had more movement deviations than typically developing children in unimanual tasks. A strong relationship was found between movement deviations of the impaired upper limb and bimanual performance. [ABSTRACT FROM AUTHOR]

Holt--Oram syndrome (HOS) (OMIM#142900) is a rare condition with upper extremity malformations as well as structural and conduction cardiac anomalies. There are sparse reports in the literature documenting malignancy in association with HOS. We report a pediatric patient clinically diagnosed with HOS (missing thumbs bilaterally, atrial septal defect, ventricular septal defect, and first-degree heart block), who also developed B precursor acute lymphoblastic leukemia. During induction of chemotherapy with steroids, she developed profound bradycardia without clinical symptoms. The bradycardia resolved without intervention, but this case highlights the challenges of managing chemotherapy side effects in a patient with congenital heart disease. A literature review pertinent to the associated findings in the case is also presented. [ABSTRACT FROM AUTHOR]

Key points: Experimental pain or its anticipation influence motor preparation processes as well as upcoming movement execution, but the underlying physiological mechanisms remain unknown. Our results showed that movement‐related pain modulates corticospinal excitability during motor preparation. In accordance with the pain adaptation theory, corticospinal excitability was higher when the muscle has an antagonist (vs. an agonist) role for the upcoming movement associated with pain. Anticipation of movement‐related pain also affects motor initiation and execution, with slower movement initiation (longer reaction times) and faster movement execution compared to movements that do not evoke pain. These results confirm the implementation of protective strategies during motor preparation known to be relevant for acute pain, but which may potentially have detrimental long‐term consequences and lead to the development of chronic pain. Abstract: When a movement repeatedly generates pain, we anticipate movement‐related pain and establish self‐protective strategies during motor preparation, but the underlying mechanisms remains poorly understood. The current study investigated the effect of movement‐related pain anticipation on the modulation of behaviour and corticospinal excitability during the preparation of arm movements. Participants completed an instructed‐delay reaction‐time (RT) task consisting of elbow flexions and extensions instructed by visual cues. Nociceptive laser stimulations (unconditioned stimuli) were applied to the lateral epicondyle during movement execution in a specific direction (CS+) but not in the other (CS−), depending on experimental group. During motor preparation, transcranial magnetic stimulation was used to measure corticospinal excitability in the biceps brachii (BB). RT and peak end‐point velocity were also measured. Neurophysiological results revealed an opposite modulation of corticospinal excitability in BB depending on whether it plays an agonist (i.e. flexion) or antagonist (i.e. extension) role for the CS+ movements (P < 0.001). Moreover, behavioural results showed that for the CS+ movements RT did not change relative to baseline, whereas the CS− movements were initiated more quickly (P = 0.023) and the CS+ flexion movements were faster relative to the CS− flexion movements (P < 0.001). This is consistent with the pain adaptation theory which proposes that in order to protect the body from further pain, agonist muscle activity is reduced and antagonist muscle activity is increased. If these strategies are initially relevant and lead to short‐term pain alleviation, they may potentially have detrimental long‐term consequences and lead to the development of chronic pain. [ABSTRACT FROM AUTHOR]

Robot-Assisted Therapy (RT) is an innovative approach to neurological rehabilitation that uses intensive, repetitive, interactive, and individualized practice. This systematic review aimed to investigate the effectiveness of RT on the body function and structure of people with upper limb impairments (PROSPERO registration: CRD42017054982). A search strategy conducted on seven databases identified randomized controlled studies. Methodological quality was assessed using the PEDro scale. When possible, the data were pooled, the strength of evidence was assessed using the GRADE system, and the effect sizes were assessed using Cohen coefficient. Subgroup analyses investigated the impact on the estimated effects of the following parameters: methodological quality; portion of the assessed upper limb; duration of stroke; and intervention dose and duration. Thirty-eight studies involving 1174 participants were included. Pooled estimates revealed small effects of RT on motor control and medium effects on strength compared with other intervention (OI) at a short-term follow-up. Standardized differences in means were as follows: 0.3 (95% CI 0.1 to 0.4) and 0.5 (95% CI 0.2 to 0.8). Effects at other time points and on other investigated outcomes related to body function and structure were not found (p>0.05). The strength of the current evidence was usually low quality. Subgroup analyses suggested that the methodological quality, and duration and dose of RT may influence the estimated effects. In conclusion, RT has small effects on motor control and medium effects on strength in people with limited upper limb function. Poor methodological quality, and lower treatment dose and duration may impact negatively the estimated effects. [ABSTRACT FROM AUTHOR]

Split‐hand/split‐foot malformation (SHFM) is a severe form of congenital limb deformity characterized by the absence of 1 or more digits and/or variable degree of median clefts of hands and feet. The present study describes an investigation of a consanguineous family of Pakistani origin segregating SHFM in an autosomal recessive manner. Human genome scan using SNP markers followed by whole exome sequencing revealed a frameshift deletion (c.409delA, p.Ser137Alafs*19) in the EPS15L1 gene located on chromosome 19p13.11. This is the first biallelic variant identified in the EPS15L1 gene underlying SHFM. Our findings report the first direct involvement of EPS15L1 gene in the development of human limbs. [ABSTRACT FROM AUTHOR]

Quantitative characterisation of upper limb motion allows the evaluation of the effect of pathology on functional task performance, potentially directing rehabilitation strategies. Movement patterns of the distal upper limb in healthy adults during functional tasks have not been extensively characterised. During five loaded functional tasks (drinking from a glass, pouring from a kettle, turning a handle, lifting a bag to a shelf, turning a key) the movement patterns were characterised using three-dimensional motion analysis with a minimal marker set in 16 healthy adults (10 M,6F, 27 (IQR:25-43)years). Joint angles reported include flexion/extension at the elbow and wrist, forearm supination/pronation and digits 2-5 metacarpophalangeal (MCP) joint flexion/extension. Additionally for the thumb the angle between the metacarpal of the thumb and the 2nd digit (Thumb base), the thumb MCP (Thumb MCP) and interphalangeal (Thumb IP) joint angles are presented. Durations of activities performed at self-selected comfortable speeds (3.36 (IQR:3.07,3.66)s turning a key to 6.20 (IQR:5.44,6.38)s drinking from a glass) are reported. The maximum joint angles used (median of participants' maxima) were 141° of elbow flexion, 116° forearm supination, 36° wrist extension, 56° Thumb base, 14° Thumb MCP flexion, 18° Thumb IP flexion, 85° MCP2-5 flexion. The tasks of drinking from a glass, lifting a bag to a shelf and turning a key appeared to have the least variation in performance, suggesting that these activities are better suited to be selected as standardized tasks for assessing the impact of pathology on movement than pouring from a kettle and turning a handle. [ABSTRACT FROM AUTHOR]

Clinicians and scientists interested in developmental biology have viewed preaxial polydactyly (PPD) and longitudinal preaxial ray deficiency (LPAD) as two different entities. Point mutations and duplications in the zone of polarizing activity regulatory sequence (ZRS) are associated with anterior ectopic expression of Sonic Hedgehog (SHH) in the limb bud and usually result in a PPD phenotype. However, some of these mutations/duplications also have LPAD in the phenotype. This unusual PPD-LPAD association in ZRS mutations/duplications has not been specifically reviewed in the literature. The author reviews this unusual entity and gives insights regarding its pathogenesis. [ABSTRACT FROM AUTHOR]

Background and purpose - Preaxial polydactyly of the foot is a rare malformation and clinicians are often unfamiliar with the associated malformations and syndromes. In order to give guidelines for diagnostics and referral to a clinical geneticist, we provide an overview of the presentation using a literature review and our own patient population. Patients and methods - The literature review was based on the Human Phenotype Ontology (HPO) project. From the HPO dataset, all phenotypes describing preaxial polydactyly were obtained and related diseases were identified and selected. An overview was generated in a heatmap, in which the phenotypic contribution of 12 anatomical groups to each disease is displayed. Clinical cases were obtained from our hospital database and were reviewed in terms of phenotype, genotype, heredity, and diagnosed syndromes. Results - From the HPO dataset, 21 diseases were related to preaxial polydactyly of the foot. The anatomical groups with the highest phenotypic contribution were lower limb, upper limb, and craniofacial. From our clinical database, we included 76 patients with 9 different diseases, of which 27 had a GLI3 mutation. Lower limb malformations (n = 55), upper limb malformations (n = 59), and craniofacial malformations (n = 32) were most frequently observed. Malformations in other anatomical groups were observed in 27 patients. Interpretation - Preaxial polydactyly of the foot often presents with other upper and lower limb malformations. In patients with isolated preaxial polydactyly of the foot, referral to a clinical geneticist is not mandatory. In patients with additional malformations, consultation with a clinical geneticist is recommended. When additional limb malformations are present, analysis of GLI3 is most feasible. [ABSTRACT FROM AUTHOR]

Assessments of upper limb performance should require participants to perform tasks that challenge the limits of their ability. In order to select appropriate tasks, it is important to know which joints are used to perform the movement and how reliably those movements can be measured. The purpose of this work was to quantify the reliability of upper limb and trunk joint angles in healthy adults during common activities of daily living (ADLs). Nineteen participants performed six ADLs with the right arm (applying deodorant, turning a doorknob, answering a desk telephone, placing a pushpin in a bulletin board, wiping a plate with a towel, and pouring water from a pitcher) during two separate sessions. Within- and between-session reliability was quantified using intraclass correlation coefficients (ICCs) and minimum detectable change values (MDCs). Reliability was generally better within-session than between-session. The ICCs exceeded 0.75 for 88% of the joint angles and exceeded 0.90 for 32% of the angles. All MDCs were less than 25° and 61% were also less than 10°. The MDCs represented a larger percent of the average angles for the trunk (61%) and wrist (62%) compared to the shoulder (18%) and elbow (26%). Although these results show that most angles can be measured reliably for these six ADLs, reliability varied considerably between joints. It is therefore important to select tasks for assessing of upper limb performance based on which specific joints need to be evaluated. [ABSTRACT FROM AUTHOR]

Introduction. Klippel–Feil syndrome (KFS) is a congenital anomaly resulting from fusion of cervical vertebral bodies secondary to the dysregulation of signaling pathways during somite development. It is commonly associated with scoliosis and Sprengel deformity. We present a case of KFS with commonly associated abnormalities as well as deformities that have not yet been reported in the literature. Case Presentation. A 3-year-old girl presented for further evaluation of a left upper extremity deformity following a negative genetic workup. Upon physical exam and radiographic imaging, the patient was diagnosed with KFS and associated abnormalities including cervical scoliosis, Sprengel deformity, and congenital deformity of the left upper extremity. Deformities of the left upper extremity include radioulnar synostosis, a four-rayed hand, and absent thenar musculature. The Sprengel deformity was corrected surgically with a Woodward procedure. Discussion. Congenital musculoskeletal deformities can be differentiated based upon spinal and limb embryology. The presence of extraspinal abnormalities not originating from somite differentiation may suggest a severe form of KFS. Important considerations in the workup of the KFS patient include looking for deformities of the shoulder girdle and upper extremities to identify abnormalities for intervention at a young age. [ABSTRACT FROM AUTHOR]

Abstract: Background: The Fahn‐Tolosa‐Marin Clinical Rating Scale for Tremor (FTM) has been used in large trials for essential tremor (ET), but its anchors for ratings from 0 to 4 of upper limb tremor are probably too low for patients with severe tremor (tremor amplitude >4 cm; grade 4). The Essential Tremor Rating Assessment Scale (TETRAS) is a validated clinical scale designed specifically for the assessment of ET severity. TETRAS has anchors that span a larger range of tremor amplitudes (>20 cm = grade 4), making it more suitable for assessing patients with severe ET. However, there is no direct comparison of these scales in any clinical trial. Methods: Upper limb postural and kinetic tremor items from both scales were compared using blinded, video‐recorded examinations of patients with moderate‐to‐severe ET who participated in a trial of focused ultrasound thalamotomy. Results: FTM ratings of postural and kinetic tremor correlated strongly with those of TETRAS. However, FTM exhibited a ceiling effect for severe tremor. Rest tremor, exclusive to FTM, correlated poorly with postural and kinetic tremor and had very poor test‐retest reliability. In contrast, wing‐beating postural tremor, exclusive to TETRAS, exhibited excellent test‐retest reliability and a strong correlation with kinetic and limbs‐extended‐forward postural tremor. Test‐retest reliabilities of the other TETRAS and FTM ratings were excellent, and both scales had good sensitivity to treatment effect. Conclusions: TETRAS has 2 main advantages over FTM in the assessment of tremor severity: (1) the absence of a ceiling effect in patients with severe ET, and (2) the inclusion of wing‐beating tremor. [ABSTRACT FROM AUTHOR]

There are a number of considerations that clinicians weigh when guiding patients through the decision-making processes associated with upper-limb prosthetic rehabilitation. While clinical guidance is essential to such decisions, especially for an individual's first prosthesis, many patients benefit from peer mentoring and interaction. The opportunity to speak to someone who has experienced what they are going through can be extremely valuable and appreciated. Thoughtful clinicians have also benefited from years of listening to the perspectives of their patient clientele. The intent of this article is to present two users' perspectives that canvass some of the various considerations associated with congenital deficiency versus acquired limb amputation, unilateral versus bilateral limb absence, and the perceived benefits associated with body-powered and externally powered systems. [ABSTRACT FROM AUTHOR]

Purpose: Upper limb assessments in children with hemiparesis rely on clinical measurements, which despite standardization are prone to error. Recently, 3D movement analysis using optoelectronic setups has been used to measure upper limb movement, but generalization is hindered by time and cost. Body worn inertial sensors may provide a simple, cost-effective alternative. Methods: We instrumented a subset of 30 participants in a mirror therapy clinical trial at baseline, post-treatment, and follow-up clinical assessments, with wireless inertial sensors positioned on the arms and trunk to monitor motion during reaching tasks. Results: Inertial sensor measurements distinguished paretic and non-paretic limbs with significant differences (P < 0.01) in movement duration, power, range of angular velocity, elevation, and smoothness (normalized jerk index and spectral arc length). Inertial sensor measurements correlated with functional clinical tests (Melbourne Assessment 2); movement duration and complexity (Higuchi fractal dimension) showed moderate to strong negative correlations with clinical measures of amplitude, accuracy, and fluency. Conclusion: Inertial sensor measurements reliably identify paresis and correlate with clinical measurements; they can therefore provide a complementary dimension of assessment in clinical practice and during clinical trials aimed at improving upper limb function. [ABSTRACT FROM AUTHOR]

Congenital upper limb differences are frequently associated with complex syndromes. Ultrasonography is considered as the first-line diagnostic modality, and fetal MRI can be useful to further evaluate ill-defined areas. Genetic and non-invasive prenatal testing help to identify the underlying genetic disorder. The diagnostic assessment is a multidisciplinary task that should involve early prenatal consultations with specialists involved in case management and treatment planning. Obstetricians, geneticists, radiologists, psychologists and dedicated surgeons are needed to provide good parental education, prenatal and postnatal care, and successful outcomes. The purpose of this review is to provide an overview of the clinicopathologic background, current diagnostic and imaging procedures in affected fetuses. [ABSTRACT FROM AUTHOR]

The loss of an upper limb significantly limits the functional activities of daily living. A huge emphasis is placed on the manipulation, shape, weight, and comfort of a prosthesis, to enable its use as an inherent body part. Even with technological advances, customized upper-extremity myoelectric prosthesis remain heavy and expensive. The high cost of upper-extremity prosthesis is an especially steep economic barrier for patients. Three-dimensional (3D) printing is a promising avenue for reducing the cost of prosthesis. We applied 3D-printed pressure-sensored prosthetics to a traumatic transradial amputee, and compared the hand functions with a customized myoelectric prosthesis. The 3D-printed pressure-sensored prosthetics showed low grip strength and decreased dexterity compared to the conventional myoelectric prosthesis. Although there were a few limitations, the fabrication of prosthesis with 3D printing technology can overcome previous problems such as high production cost, long fabrication period and heavy weight. [ABSTRACT FROM AUTHOR]

Impaired arm swing is a common motor symptom of Parkinson's disease (PD), and correlates with other gait impairments and increased risk of falls. Studies suggest that arm swing is not merely a passive consequence of trunk rotation during walking, but an active component of gait. Thus, techniques to enhance arm swing may improve gait characteristics. There is currently no portable device to measure arm swing and deliver immediate cues for larger movement. Here we test report pilot testing of such a device, ArmSense (patented), using a crossover repeated-measures design. Twelve people with PD walked in a video-recorded gym space at self-selected comfortable and fast speeds. After baseline, cues were given either visually using taped targets on the floor to increase step length or through vibrations at the wrist using ArmSense to increase arm swing amplitude. Uncued walking then followed, to assess retention. Subjects successfully reached cueing targets on >95% of steps. At a comfortable pace, step length increased during both visual cueing and ArmSense cueing. However, we observed increased medial-lateral trunk sway with visual cueing, possibly suggesting decreased gait stability. In contrast, no statistically significant changes in trunk sway were observed with ArmSense cues compared to baseline walking. At a fast pace, changes in gait parameters were less systematic. Even though ArmSense cues only specified changes in arm swing amplitude, we observed changes in multiple gait parameters, reflecting the active role arm swing plays in gait and suggesting a new therapeutic path to improve mobility in people with PD. [ABSTRACT FROM AUTHOR]

There are a number of considerations that clinicians weigh when guiding patients through the decision-making processes associated with upper-limb prosthetic rehabilitation. While clinical guidance is essential to such decisions, especially for an individual's first prosthesis, many patients benefit from peer mentoring and interaction. The opportunity to speak to someone who has experienced what they are going through can be extremely valuable and appreciated. Thoughtful clinicians have also benefited from years of listening to the perspectives of their patient clientele. The intent of this article is to present two users' perspectives that canvass some of the various considerations associated with congenital deficiency versus acquired limb amputation, unilateral versus bilateral limb absence, and the perceived benefits associated with body-powered and externally powered systems. [ABSTRACT FROM AUTHOR]

Assessment of upper limb function, kinematic analysis, and dystonia in patients with spastic diplegia cerebral palsy and periventricular leukomalacia. Seven children with spastic diplegia cerebral palsy and 8 controls underwent upper limb kinematics. Movement duration, average and maximum linear velocity, index of curvature, index of dystonia, and target accuracy and stability were analyzed. In the patients with spastic diplegia, Gross Motor Function and Manual Ability Classification Systems were determined, and spasticity and dystonia were rated using the Modified Ashworth and the Burke-Fahn-Marsden Dystonia scales respectively. Children with spastic diplegia demonstrated a tendency toward higher index of dystonia reflecting overflow, higher index of curvature, lower velocities, and poor target accuracy and stability. All patients showed clinical evidence of dystonia in the upper limbs. Dystonia scores correlated with the Manual Ability Classification System (r = 0.86, P = .01) and with the index of dystonia (r = 0.82, P = .02). Children with spastic diplegia cerebral palsy present dystonia in the upper limbs. This is functionally relevant and can be measured with kinematic analysis. [ABSTRACT FROM AUTHOR]

Objective: Ulnar neuropathy at the elbow (UNE) involves mechanical compression and irritation of the ulnar nerve (UN) caused by environmental and dynamic abnormalities that can however also be found in asymptomatic patients. Using high-resolution ultrasound, we aimed to assess and compare the relevance of morphological and dynamic variants of the UN and its surrounding structures (UN abnormalities) in symptomatic and asymptomatic patients.Method: UN abnormalities in patients with UNE were assessed using high-resolution ultrasound and compared against unaffected arms (patients or healthy volunteers).Results: We studied 234 arms of 117 individuals (89 with UNE and 145 control). Eighty-one percent of the arms with UNE compared to 40% of control (p=0.00001) showed UN abnormalities. While it was dislocated in 49% of arms with UNE compared to in 23% of control (p=0.004).Conclusion: The two-fold higher frequency of occurrence of UN abnormalities in arms with UNE indicates their causative or at least contributory role in such neuropathies. High-resolution ultrasound should be part of the initial evaluation of UNE in order to assess the etiology of the conflict. [ABSTRACT FROM AUTHOR]

Deep vein thrombosis (DVT) is a rare disease in patients with hemophilia A. We report a case of 22-year-old male with severe hemophilia A who presented to the emergency room with 5-day history of right arm pain that was attributed initially to bleeding event. In the absence of external signs of bleeding or hematoma and normal hemoglobin level, we suspected an underlying DVT. Doppler ultrasonography of the right upper limb revealed thrombosis of the subclavian vein and this was confirmed by CT venography. The d-dimer level was normal and investigations for prothrombotic state revealed heterozygosity for prothrombin G20210A mutation. Treatment with factor VIII and low molecular weight heparin led to successful resolution and marked improvement of his clinical condition. [ABSTRACT FROM AUTHOR]

Study design: Validation study using data from a multicenter, randomized, clinical trial (RCT). Objectives: To evaluate the reliability, validity, responsiveness, and minimal important change (MIC) of the Dutch version of the Oxford Elbow Score (OES) and the Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) in patients with a simple elbow dislocation. Background: Patient-reported outcome measures are increasingly important for assessing outcome following elbow injuries, both in daily practice and in clinical research. However measurement properties of the OES and Quick-DASH in these patients are not fully known. Methods: OES and Quick-DASH were completed four times until one year after trauma. Mayo Elbow Performance Index, pain (VAS), Short Form-36, and EuroQol-5D were completed for comparison. Data of a multicenter RCT (n = 100) were used. Internal consistency was determined using Cronbach’s alpha. Construct and longitudinal validity were assessed by determining hypothesized strength of correlation between scores or changes in scores, respectively, of (sub)scales. Finally, floor and ceiling effects, MIC, and smallest detectable change (SDC) were determined. Results: OES and Quick-DASH demonstrated adequate internal consistency (Cronbach α, 0.882 and 0.886, respectively). Construct validity and longitudinal validity of both scales were supported by >75% correctly hypothesized correlations. MIC and SDC were 8.2 and 12.0 point for OES, respectively. For Quick-DASH, these values were 11.7 and 25.0, respectively. Conclusions: OES and Quick-DASH are reliable, valid, and responsive instruments for evaluating elbow-related quality of life. The anchor-based MIC was 8.2 points for OES and 11.7 for Quick-DASH. [ABSTRACT FROM AUTHOR]

Purpose: Gait disorders in multiple sclerosis (MS) are well studied; however, no previous study has described upper limb movements during gait. However, upper limb movements have an important role during locomotion and can be altered in MS patients due to direct MS lesions or mechanisms of compensation. The aim of this study was to describe the arm movements during gait in a population of MS patients with low disability compared with a healthy control group.Methods: In this observational study we analyzed the arm movements during gait in 52 outpatients (mean age: 39.7±9.6years, female: 40%) with relapsing-remitting MS with low disability (mean EDSS: 2±1) and 25 healthy age-matched controls using a 3-dimension gait analysis.Results: MS patients walked slower, with increased mean elbow flexion and decreased amplitude of elbow flexion (ROM) compared to the control group, whereas shoulder and hand movements were similar to controls. These differences were not explained by age or disability.Conclusion: Upper limb alterations in movement during gait in MS patients with low disability can be characterized by an increase in mean elbow flexion and a decrease in amplitude (ROM) for elbow flexion/extension. This upper limb movement pattern should be considered as a new component of gait disorders in MS and may reflect subtle motor deficits or the use of compensatory mechanisms. [ABSTRACT FROM AUTHOR]

Introduction: During transition to adulthood young adults with disabilities are at risk of experiencing limitations due to changing physical and social requirements. Purpose: To determine whether young adults with transversal upper limb reduction deficiency (tULRD) have experienced limitations in various domains of participation during transition to adulthood and how they dealt with these limitations. Participants: Fifteen participants (mean age 21.4 years) with tULRD. Methods: A qualitative study was performed using a semi-structured interview based on the Rotterdam Transition Profile to identify the limitations experienced in participation domains. Results: Almost all the participants reported difficulties in finding a suitable study or job. Most young adults were convinced they were suitable for almost any study or job, but their teachers and potential employers were more reserved. Few difficulties were reported on the domains leisure activities, intimate relationships/sexuality, housing/housekeeping and transportation. Participants preferred to develop their own strategies for dealing with limitations. Various aids, adaptations and prostheses were used to overcome limitations. Rehabilitation teams were infrequently consulted for advice in solving transitional problems. Conclusion: Young adults with tULRD experience limitations mainly in choosing and finding a suitable study or job. Rehabilitation teams may play a more extensive role in supporting individuals with transitional problems. [ABSTRACT FROM AUTHOR]

Occupational Musculoskeletal System Disorders (OMSDs) are disorders that inflict a great deal of economical burden on enterprises and nations, decrease quality, productivity and cause inability to sustain livings of employees. One of the most important factor that cause OMSDs is working posture. In literature, there are various methods for determining risk levels of working postures. In this study because of its common usage, Rapid Upper Limb Assessment Method (RULA) that identfies hazard level created by working postures on employees' upper limb musculoskeletal health is selected for improving with image processing systems. It is necassary to improve RULA's performance due to complications stemming from its implementation method based on observation, lack of information on the best duration of observation, subjectivity on results and extensive analysis time etc. For compansate these requirements a modified method is proposed in this study named as Advanced RULA (ARULA). Reliability and validity analysis are implemented statistically for ARULA. As a result, ARULA is recommended as a practical tool for analyzing risk levels of working postures for tasks that contain intensive usage of upper extremity. [ABSTRACT FROM AUTHOR]

This study aimed to document and compare the decline of upper limb performance among adults with myotonic dystrophy type 1 according to phenotype and gender. A longitudinal descriptive design compared upper limb performance at baseline and follow-up of 70 women and 38 men with the late-onset or adult phenotypes. Grip strength and pinch strength as well as gross dexterity and fine dexterity were assessed. All four performance measures decreased significantly ( p  <   0.001). The decline over time was similar for individuals with the late-onset and adult-onset phenotypes, but differed according to gender. For late-onset and adult-onset phenotypes respectively, women lost less grip strength than men: 0.4 and minus 0.8 kg (2.0% and −9.4%) in women vs. minus 7.4 and minus 3.1 kg (−19.2% and −30.7%) in men. A similar situation was found for gross dexterity: minus 3.0 and minus 3.2 blocks (−4.6% and −5.9%) in women vs. minus 12.4 and minus 8.7 blocks (−19.4% and −16.6%) in men. Pinch gauge had the smallest standard deviations and was one of the only measurement tools with significant detectable changes in relation to the standard error of measurement. Given these results, health professionals and researchers should consider phenotype and gender differently when planning health services or future studies. Indeed, as their upper limb strength and dexterity differed, even if their decline was similar, the phenotypes should not be pooled. Finally, the use of the pinch gauge to assess long-term change in upper limb ability seems preferable to the three other measurements. [ABSTRACT FROM AUTHOR]

Robotic assistive devices for rehabilitation have proven to be beneficial for many individuals with impaired limbs by providing accessible, consistent and cost-effective therapy. However, it is important to acknowledge that many people need an alternative form of assistance for physical impairments, both while undergoing rehabilitation and in the common scenario of rehabilitation providing insufficient improvements. The aim of this paper is to present an intention-detecting assistive robot for upper limb motion, which may serve as a complement to rehabilitation procedures. The proposed system collects real-time data from an eye-tracker and force-sensing resistors to determine the intended movement of the arm of a user and physically assists the said movement. We show that the system is capable of moving an impaired upper limb to a desired position with average errors of less than 5 cm, and in this manner may assist motion required by various activities of daily living for someone suffering from physical impairments in their upper limbs. [ABSTRACT FROM PUBLISHER]