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Lateral elbow tendinopathy (LET) is a common upper limb pathology in people involved in manual occupations. The upper extremity functional index (UEFI) was specifically designed to evaluate functional limitations in patients with upper limb pathology. The UEFI was developed in English and has been translated into several languages, including Greek. However, it has been assessed only in patients with shoulder pathology. Thus, the aim of this study was to pilot-test the Greek version of the UEFI (GV-UEFI) questionnaire and assess its measurement properties in patients with LET. Thirty patients with LET were recruited and asked to fill in the GV-UEFI twice and the disabilities of arm, shoulder, and hand questionnaire (DASH) once. The internal consistency and test–retest reliability were examined using Cronbach’s alpha and the intraclass correlation coefficient (ICC). The standard error of measurement (SEM) and the minimum detectable change (MDC) were calculated and possible ground or ceiling effects were also examined. Convergent validity was evaluated with the Greek DASH using Pearson’s correlation. Lastly, the unidimensionality of the scale was examined through principal component analysis to verify construct validity. Internal consistency was high for the GV-UEFI (Cronbach’s a = 0.98) and test–retest reliability was excellent (ICC = 0.98). The SEM was 2.95 and the MDC was 6.85. Test–retest reliability of each item was good (ICC > 0.87). The correlation analysis demonstrated a strong correlation between the GV-UEFI and the DASH. No floor or ceiling effects were found. Principal component analysis verified the construct validity and the unidimensionality of the scale. The GV-UEFI was successfully tested in patients with LET. It seems that the GV-UEFI can be used reliably in Greek-speaking patients with LET. However, the measurement properties of this scale should be examined in a larger sample of LET patients.

Objective To clarify the efficacy of functional magnetic stimulation (FMS) in improving hemiplegic upper extremity function in patients with sub-acute stroke. Methods In this randomized controlled trial, 40 sub-acute stroke patients with hemiplegia were recruited from inpatient wards in the Department of Rehabilitation and randomly assigned to two groups. In the FMS group, magnetic stimulation was applied to extensor muscle groups of the affected upper extremity. In the low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) group, stimulation was applied to the contralesional primary motor cortex. All patients received occupational therapy. Hand and upper extremity motor function was evaluated using the Fugl–Meyer Assessment for upper extremity (FMA-UE), and the Barthel Index (BI) evaluated daily living abilities. Results The FMA-UE and BI scores were significantly increased in both groups following stimulation. Furthermore, a significant between-group difference was observed in both FMA-UE and BI scores after 2 weeks of therapy. In the FMS group, 6 of 19 patients regained wrist and finger extension abilities, but only 2 patients regained equivalent motor skills in the LF-rTMS group Conclusions FMS improves paretic upper extremity function and leads to better recovery of motor activity than LF-rTMS. FMS may be a novel modality to improve motor function.

Hemispheric dominance has been used to understand the influence of central and peripheral neural damage on the motor function of individuals with stroke, cerebral palsy, and limb loss. It has been well established that greater activation occurs in the contralateral hemisphere to the side of the body used to perform the task. However, there is currently a large variability in calculation procedures for brain laterality when using functional near-infrared spectroscopy (fNIRS) as a non-invasive neuroimaging tool. In this study, we used fNIRS to measure brain activity over the left and right sensorimotor cortices while participants (n = 20, healthy and uninjured) performed left and right-hand movement tasks. Then, we analyzed the fNIRS data using two different processing pipelines (block averaging or general linear model [GLM]), two different criteria of processing for negative values (include all beta values or include only positive beta values), and three different laterality index (LI) formulas. The LI values produced using the block averaging analysis indicated an expected contralateral dominance with some instances of bilateral dominance, which agreed with the expected contralateral activation. However, the inclusion criteria nor the LI formulas altered the outcome. The LI values produced using the GLM analysis displayed a robust left hemisphere dominance regardless of the hand performing the task, which disagreed with the expected contralateral activation but did provide instances of correctly identifying brain laterality. In conclusion, both analysis pipelines were able to correctly determine brain laterality, but processes to account for negative beta values were recommended especially when utilizing the GLM analysis to determine brain laterality.

The objectives of this study were: (a) to determine asymmetries, both lower limb (LL) and upper limb (UL), in Chilean older adults, and (b) to relate asymmetries to FA in both LL and UL. Forty-one older adults voluntarily participated in this study (mean ± standard deviation [SD]: age 72.0 ± 8.0 years, LL asymmetries 13.78 ± 14.87%, UL asymmetries 10.70 ± 8.85%, FA 40.35 ± 16.26 points). The variables were: (1) asymmetries of LL and UL, assessed through a force platform and handgrip, respectively; (2) FA, assessed through the Latin American Group for Maturity (GDLAM) and the GDLAM index of autonomy (GI) protocol. The relationship between the variables was performed through Spearman’s correlation. The analysis showed that 39% of the participants presented asymmetries above 15% in the LL. Likewise, this 39% of older adults presented a lower FA than their peers with asymmetries below 15% in the LL (≤15%: 35.64 ± 12.26 points vs. >15%: 47.69 ± 19.23 points, p = 0.003). The analysis showed a small correlation between LL and GI asymmetries (r = 0.27, p = 0.07) and a small but negative correlation between UL and GI (r = −0.21). The mean values of asymmetries of both LL and UL are within ‘normal’ parameters. However, several older adults were identified as being at risk. In parallel, older adults who presented a higher level of asymmetries in LL showed a lower level of FA.

Background and Purpose. Patients requiring prolonged mechanical ventilation (PMV) are frequently deconditioned because of respiratory failure precipitated by the underlying disease, the adverse effects of medications, and a period of prolonged immobilization. The effects of 6 weeks of physical training on the strength of respiratory and limb muscles, on ventilator-free time, and on functional status in patients requiring PMV were examined. Subjects. Thirty-nine patients with PMV were initially enrolled in the study and were assigned to either a treatment group (n=20) or a control group (n=19). Three subjects in the treatment group and 4 subjects in the control group died during the 6-week intervention period and thus their data were excluded from the final analysis. Methods. Subjects in the treatment group received physical training 5 days a week for 6 weeks. Strength of respiratory and limb muscles, ventilator-free time, and functional status, which was measured by the Barthel Index of Activities of Daily Living (BI) and Functional Independence Measure (FIM), were examined at baseline and at the third and sixth weeks of the study period. Results. Respiratory and limb muscle strength improved significantly at the third and sixth weeks in the treatment group compared with baseline measurements. Total BI and FIM scores increased significantly in the treatment group and remained unchanged in the control group. Effect sizes of the BI and FIM scores were 2.02 and 1.93, respectively, at the sixth week. Discussion and Conclusion. The results show that a 6-week physical training program may improve limb muscle strength and ventilator-free time and thus improve functional outcomes in patients requiring PMV. [Chiang LL, Wang LY, Wu CP, et al. Effects of physical training on functional status in patients with prolonged mechanical ventilation. Phys Ther. 2006;86:1271–1281.]

Background Impaired dexterity of the weaker upper extremity is common post stroke and it is recommended that these individuals practice many repetitions of movement to regain function. However, stroke rehabilitation methods do not achieve the required intensity to be effective. Touchscreen tablet technology may be used as a motivating tool for self-training impaired dexterity of the weaker upper extremity post stroke. Methods/Design Rehab-let is a self-training protocol utilizing game apps on a touchscreen for practicing movement of the weaker upper extremity. We will conduct a pilot randomized controlled trial to assess Rehab-let compared to traditional self-training to improve dexterity of the weaker hand, and to increase self-training time and satisfaction in individuals with subacute stroke. Forty individuals with stroke undergoing subacute rehabilitation will be randomly allocated to Rehab-let or a traditional self-training program using therapeutic aids such as balls, blocks and pegs. All participants will be requested to perform self-training for 60 minutes a day, 5 times a week for 4 weeks. Dexterity assessed by The Nine Hole Peg Test is the main outcome measure. Assessments will be administered pre and post the self-training intervention by assessors blind to the group allocation. Discussion The outcomes of this study will inform the design of a fully powered randomized controlled trial to evaluate the effectiveness of Rehab-let. If found to be effective, Rehab-let can be used during subacute rehabilitation to increase treatment intensity and improve dexterity. Potentially, Rehab-let can also be used after discharge and might be ideal for individuals with mild stroke who are often not referred to formal rehabilitation. Trial Registration Current Controlled Trials NCT02136433 registered on 17 September 2014.

Background This study assessed surgical accuracy and functional outcomes using hand-held accelerometer-based navigation following total knee arthroplasty (TKA). Question: (1) Does hand-held navigation (the iAssist system) improve surgical accuracy (assessed with five parameters commonly used to evaluate surgical alignment: the hip-knee-ankle angle (HKA), femoral coronal angle (FCA), tibial coronal angle (TCA), femoral sagittal angle (FSA), and tibial slope angle (TSA)) compared to conventional instruments in TKA? (2) Which surgical alignment parameters among HKA, FCA, TCA, FSA, and TSA can obtain the most advantage from the iAssist system? (3) Does the iAssist system lead to better functional outcomes at two years of follow-up after TKA? Methods This parallel-group double-blinded randomized controlled trial recruited 60 patients (30 patients each in the iAssist and conventional group) with osteoarthritis who underwent primary TKA by a single surgeon at Siriraj Hospital. There was no loss to follow-up in the study. All procedures in both groups were performed using similar surgical exposure, prosthesis implant, perioperative and postoperative protocols. Participants in the iAssist group received the iAssist system as an assistive technique, while those in the conventional group only had conventional instruments. Surgical alignments (HKA, FCA, TCA, FSA, and TSA) were recorded using CT scan at six weeks post-operation. Functional outcomes were assessed with knee ROM, KSS, and EQ-5D at 6 months, 1 year and 2 years post-operation. Baseline characteristics including age, sex, the affected knee side, and body mass index were comparable between the two groups, similar to preoperative ROM, KSS, and EQ-5D. Results The mean operative time was relatively longer in the iAssist than the conventional group, although not statistically significant (88.1 ± 13.7 versus 83.4 ± 21.3; p  = 0.314). Among the surgical alignment parameters evaluated, FCA was the only radiographic parameter with a statistically significant difference between the two groups and was closer to 90º in the iAssist group (89.4 ± 2.2 in the iAssist versus 87.2 ± 2.1 in the conventional group; p  = 0.003). Also, there was a higher proportion of outliers in the conventional than the iAssist group (23.3% versus 10%; p  = 0.086). Nonetheless, HKA and TCA did not differ between the two groups ( p  = 0.25 and 0.096, respectively), although the percentages of outliers were higher in the conventional than the iAssist group (HKA: 26.7% vs. 13.3%; p  = 0.101 and TCA: 6.7% versus 0%; p  = 0.078). Likewise, we observed other radiographic parameters had no significant group differences, including FSA and TSA. Furthermore, at two years post-operation, we found no differences between the iAssist and the conventional group in knee ROM (106.7 ± 14.6 versus 108.2 ± 12.7; p  = 0.324), KSS (82.5 ± 6.4 versus 83.8 ± 3.4; p  = 0.324), and EQ-5D (0.9 ± 0.2 versus 1.0 ± 0.1; p = 0.217). All functional outcomes were also comparable at 6 months and 12 months of follow-up postoperatively. Conclusion The iAssist technology increase surgical precision by allowing for a more precise FCA with fewer outliers than conventional equipment. iAssist had longer operative time. Functional outcomes and quality of life were not different. Level of evidence: I

Twelve moderately to severely involved chronic stroke survivors (>12 mo) were randomized to one of two treatments: robotics and motor learning (ROB-ML) or functional neuromuscular stimulation and motor learning (FNS-ML). Treatment was 5 h/d, 5 d/wk for 12 wk. ROB-ML group had 1.5 h per session devoted to robotics shoulder and elbow (S/E) training. FNS-ML had 1.5 h per session devoted to functional neuromuscular stimulation (surface electrodes) for wrist and hand (W/H) flexors/extensors. The primary outcome measure was the functional measure Arm Motor Ability Test (AMAT). Secondary measures were AMAT-S/E and AMAT-W/H, Fugl-Meyer (FM) upper-limb coordination, and the motor control measures of target accuracy (TA) and smoothness of movement (SM). ROB-ML produced significant gains in AMAT, AMAT-S/E, FM upper-limb coordination, TA, and SM. FNS-ML produced significant gains in AMAT-W/H and FM upper-limb coordination.

Background Breast cancer surgery frequently causes deficiencies in shoulder functioning. The study pourpode is to identify risk factors for prolonged pain, reduction in function, and decrease in range of motion (ROM) in BC patients. Methods A prospective cohort study was designed in a private hospital; between October 2018 and April 2019 with a follow-up of 6 months. Patients following BC surgery, were divided by arm morbidities, and the different risk facrors were evaluated using univariate analysis and logistic regression. Results A total of 157 patients were included in the study. Risk factors for functional disabilities included; pain levels during hospitalization NPRS 1.2 (±0.8) compared to patients with no disabilities 0.5 ± 0.7 ( p  = .006), the size of tumors more than 1.4 ± 0.8 cm. compared with no morbidities 0.8 ± 0.9 cm. ( p  = .046), and breast reconstructions ( p  = .030). Risk factors for prolonged pain includes mastectomy ( p  = .006), breast reconstruction ( p  = .011), more than three dissected lymph nodes ( p  = .002), the presence of preoperative pain ( p  < .001), in-hospital pain ( p  < .001), axillary web syndrome ( p  < .001) and lymphedema ( p  < .001). Risk factors for decreased ROM were more than three dissected lymph nodes ( p  = .027), radiation ( p  = .018), and the size of dissected tissue ( p  = .035). Postoperative physical therapy appears to reduce the incidence of prolonged pain ( p  = .013) and regular physical activity may reduce long term functional disabilities ( p  = .021). Conclusions Upper arm morbidity following BC treatments affect up to 70% of the patients. Identifying the different risk and beneficial factors may improve awareness among physicians to refer patients to early rehabilitation programs and thus avoid chronic morbidity and improve the course of recovery. Trial registration The study was registered in Clinical trial with the ID number: NCT03389204 .

Background Greater body segment mass due to obesity has shown to impair gross and fine motor functions and reduce balance control. While recent studies suggest that obesity may be linked with altered brain functions involved in fine motor tasks, this association is not well investigated. Objective The purpose of this study was to examine the neural correlates of motor performance in non-obese and obese adults during force control of two upper extremity muscles. Methods Nine non-obese and eight obese young adults performed intermittent handgrip and elbow flexion exertions at 30 % of their respective muscle strengths for 4 min. Functional near infrared spectroscopy was employed to measure neural activity in the prefrontal cortex bilaterally, joint steadiness was computed using force fluctuations, and ratings of perceived exertions (RPEs) were obtained to assess perceived effort. Results Obesity was associated with higher force fluctuations and lower prefrontal cortex activation during handgrip exertions, while RPE scores remained similar across both groups. No obesity-related differences in neural activity, force fluctuation, or RPE scores were observed during elbow flexion exertions. Conclusion The study is one of the first to examine obesity-related differences on prefrontal cortex activation during force control of the upper extremity musculature. The study findings indicate that the neural correlates of motor activity in the obese may be muscle-specific. Future work is warranted to extend the investigation to monitoring multiple motor-function related cortical regions and examining obesity differences with different task parameters (e.g., longer duration, increased precision demands, larger muscles, etc.).