The Upper Limb Tension Test: Inter-tester Reliability for Assessing the Onset of Passive Resistance R 1

Abstract

The aim of this trial was to assess the inter-tester reliability of the Upper Limb Tension Test (ULTT). The onset of passive resistance (R1) of the left elbow was determined by four experienced manual therapists in a group of asymptomatic subjects. A recording of the degrees of elbow extension was obtained using a goniometer, having first positioned the upper extremity in a bracket maintaining 110 degrees of shoulder abduction and 10 degrees of shoulder extension. Each rater then moved the subjects' left shoulder into full external rotation and the forearm into full supination with the wrist and fingers in a neutral position. Data was collected four consecutive days. The data was analyzed by a two-way analysis of variance. The means of the readings among the four raters was found to be significantly different. It was concluded that the ULTT has a low inter-tester reliability when R1 is compared. Several suggestions are made for future research projects in this area.     

Remind to move – A novel treatment on hemiplegic arm functions in children with unilateral cerebral palsy: A randomized cross-over study

Objective: To investigate the effects of ‘remind to move’ treatment on hemiplegic arm function in children with unilateral cerebral palsy (CP). Methodology: Twelve students with unilateral CP aged 6–18 were recruited from a special school and randomly assigned into two groups. Participants in the experimental group underwent a 3-week sensory cueing treatment followed by a 3-week sham treatment. Participants in the waitlist group completed the sham treatment first followed by the sensory-cueing treatment. There was a 4-week washout period between treatments. Results: Both functional hand use and arm impairment level significantxly improved after the 3-week sensory cueing treatment for the combined sample between groups. However, no significant carryover effects were found for either treatment. Conclusion: Three weeks of ‘remind to move’ treatment is useful in improving hemiplegic arm function and quantity of hand use in children with unilateral CP but the long-term carryover effect requires further investigation.     

Safety and immediate effects of Hybrid Assistive Limb in children with cerebral palsy: A pilot study

PurposeEarly intervention is effective for developing motor ability and preventing contractures and deformities in patients with cerebral palsy (CP). Gait training using the newly developed Hybrid Assistive Limb (HAL) shows promise as an intervention to prevent deterioration in walking ability and deformities in pediatric CP patients. The purpose of this pilot study was to examine the safety and immediate effects on walking ability after gait training using the HAL in pediatric CP patients.MethodsNineteen patients (six females, 13 males; mean age 8.5 years; mean height 120.5 cm; mean weight 23.2 kg) were enrolled. The Gross Motor Functional Classification Scale level was I in two patients, II in two, III in eight, and IV in seven. The HAL was used for a single session of gait training. The primary outcome was safety of the HAL for use in pediatric CP patients. The secondary outcome was the immediate effect after gait training with HAL, evaluated by passive range of motion (ROM) and gait parameters, including gait speed (m/s), step length (cm), and cadence (step/min).ResultsAll 19 patients were able to carry out the gait training without any severe adverse events. Significant improvements were observed for mean internal/external rotation and abduction angles of the hip joint, and ankle dorsiflexion angles (n = 19). Significant improvements were observed for mean gait speed and step length based on expansion of the hip flexion-extension range (n = 11).ConclusionGait training using the HAL is safe and can produce immediate improvements in ROM and walking ability in pediatric patients with CP.     

Hybrid Assistive Limb® for sporadic inclusion body myositis: A case series

We evaluated the efficacy of rehabilitation therapy with Hybrid Assistive Limb® (HAL; hereafter HAL therapy) in three patients diagnosed with sporadic inclusion body myositis (sIBM) who were hospitalized to undergo HAL therapy. Among them, one patient participated in eight courses and the other two in two courses of HAL therapy between 2017 and 2020. We determined the mean rate of improvement in two-minute walking distance and 6 m walking speed at the time of hospital discharge. After HAL therapy, we confirmed the patients’ desire to continue the use of HAL. In one patient, we observed improvements of 146.0% and 120.0% in two-minute walk and 6 m walking speed, respectively, after the first course of HAL therapy; these values are 133.7% and 130% after the eighth course of HAL therapy. These values exceeded 90% in the other two patients after the second course of HAL therapy. HAL therapy maintained both quantity and quality of ambulation and showed positive psychological effects on patient conditions because it reduces exercise load and facilitates safety. While HAL therapy might be effective in maintaining and improving ambulation in patients with sIBM, we should consider to discontinue HAL therapy as it increased risk of falling.     

Outcomes of a Clinic-Based Pediatric Constraint-Induced Movement Therapy Program

ABSTRACT

A single-group pre- and post-test design was used to evaluate functional outcomes of a constraint-induced movement therapy (CIMT) protocol implemented in an outpatient therapy center. The participants were 29 children with hemiplegia, ages 1.6–19.1 years old. The less-involved upper limb was placed in a cast that was worn 24 hr a day, 7 days a week. Individual therapy sessions took place 5 days/week. Children received 3 or 6 hr therapy sessions for 16–19 days followed by 2–5 days in which bimanual tasks were performed. Outcomes were assessed at baseline and following CIMT. Statistically significant gains were made on the Melbourne Assessment of Unilateral Upper Limb Function, Quality of Upper Extremity Skills Test (except the Protective Extension subtest), Assisting Hand Assessment, and the Canadian Occupational Performance Measure. The effect sizes varied from 0.46 to 0.70 indicating a moderate effect size. The results support the effectiveness of CIMT provided through a center-based program.     

旷置螺钉孔技术在钢板内固定治疗四肢骨干骨折的临床应用

目的：探讨旷置螺钉孔对钢板螺丝钉内固定系统稳定性和骨折愈合的影响。方法：回顾性分析2010年3月-2012年3月收治的60例四肢骨干骨折患者的临床资料,根据是否主动旷置螺钉孔分为旷置组和非旷置组,每组各30例。分析比较两组患者总的疗效,包括：骨痂出现时间、骨折愈合时间（临床愈合、骨性愈合）、内固定失效率（骨不连发生率、钢板断裂发生率）、临床疗效等方面进行比较分析。结果：两组总疗效比较,旷置组优于非旷置组。临床疗效优良率：旷置组为93.3%,非旷置组为80%,两组比较差异有统计学意义（P〈0.05）。术后出现骨痂时间：旷置组为（9.16±1.70）周,非旷置组为（11.20±1.60）周,两组比较差异有统计学意义（P〈0.05）;临床愈合时间：旷置组为（12.82±2.68）周,非旷置组为（15.36±3.66）周,两组比较差异有统计学意义（P〈0.05）;骨性愈合时间：旷置组为（4.51±1.46）个月,非旷置组为（7.06±1.21）个月,两组比较差异有统计学意义（P〈0.05）;术后旷置组骨不连发生率为0,非旷置组为3.3%;旷置组钢板断裂发生率为0,非旷置组为3.3%。结论：合理使用旷置螺钉孔技术对钢板螺丝钉内固定系统稳定性没有显著性影响,符合生物学固定原则;同时,由于有效保护骨折断端的血运,促进了骨折的愈合,减少骨不连、钢板断裂现象,是一种简单可行的操作技术,值得基层医院推广。