Kinematic analysis of upper extremity movement during drinking in hemiplegic subjects

Background

It is necessary to analyze the kinematic properties of a paralyzed extremity to quantitatively determine the degree of impairment of hemiplegic people during functional activities of daily living (ADL) such as a drinking task. This study aimed to identify the kinematic differences between 16 hemiplegic and 32 able-bodied participants in relation to the task phases when drinking with a cup and the kinematic strategy used during motion with respect to the gravity direction.

Methods

The subjects performed a drinking task that was divided into five phases according to Murphy's phase definition: reaching, forward transport, drinking, backward transport, and returning. We found that the groups differed in terms of the movement times and the joint angles and angular velocities of the shoulder, elbow, and wrist joints.

Findings

Compared to the control group, the hemiplegic participants had a larger shoulder abduction angle of at most 17.1° during all the phases, a larger shoulder flexion angle of 7.6° during the reaching phase, and a smaller shoulder flexion angle of 6.4° during the backward transporting phase. Because of these shoulder joint patterns, a smaller elbow pronation peak angle of at most 13.1° and a larger wrist extension peak angle of 12.0° were found in the motions of the hemiplegic participants, as compensation to complete the drinking task. The movement in the gravity direction during the backward transporting phase resulted in a 15.9% larger peak angular velocity for elbow extension in the hemiplegic participants compared to that of the control group.

Interpretation

These quantitative kinematic patterns help provide an understanding of the movements of an affected extremity and can be useful in designing rehabilitation robots to assist hemiplegic people with ADL.     

Characteristics of the scapula movement during shoulder elevation depend on posture

[Purpose] This study aimed to clarify the differences in scapular movement during flexion and abduction of the shoulder joint with different postures. [Participants and Methods] This study included 15 male participants. Their shoulder flexion and abduction and angles of the scapular upward rotation, scapular anterior tilt, scapular external rotation, and thoracic spine flexion were measured. Measurements were taken in three positions: the control, thoracic spine flexion, and thoracic spine extension positions using a three-dimensional motion capture system. [Results] In the shoulder flexion, the amount of change in the scapular external rotation was significantly greater in the thoracic flexion than in the thoracic extension. In shoulder abduction, the amount of change in the scapular anterior tilt and external rotation was significantly greater in the thoracic flexion than in the thoracic extension. A comparison of the scapular angles in shoulder flexion and abduction showed that the upward rotation, posterior tilt, and external rotation were significantly greater in abduction than flexion. [Conclusion] To avoid posture-induced incoordination of the scapula and thorax movement during shoulder elevation, postural adjustment of the thoracic spine based on the movements is necessary for the shoulder joint exercises.     

Range of Motion in Older Women

This study had three purposes: to compare the active neck and upper extremity range of motion (ROM) in healthy older women with expected estimates; to consider if right and left side measures were similar; and to determine the degree of ROM loss with advancing age. Sixty-one older women, living independently in the community, were measured at the neck, shoulder, elbow, forearm, and wrist on the right and left sides using a standard protocol. ROM was less than expected by 14_ to 30_ for neck lateral flexion (26.00_ ?8.72_ on right; 26.41_ ?7.67_ on left), shoulder abduction (154.62_D 21.37_ on right; 150.25_ ?21.65_ on left), shoulder flexion (158.23_ ?19.55_ on right; 159.20_ ?8.73_ on left), shoulder internal rotation (52.92_ ?8.99_ on right; 53.74_ ?9.94_ on left), and shoulder external rotation (76.05_ ?16.31_ on right; 72.44_ ?15.37 on left). Some differences were noted between right and left side ROM. Linear regression for age and range suggested that range decreased with age by an average of approximately 1_ per year in right shoulder abduction, right shoulder flexion, and right and left shoulder external rotation.     

Light resistance and stretching exercise in elderly women: effect upon flexibility

Decreased range of motion (ROM) due to disuse limits the older adult's ability to perform daily activities. The flexibility of five joints of 46 women (aged 65 to 89 years) was measured by goniometer before and after a 25-week exercise program. Three groups were formed: a control group who did no exercise (C) (n = 13), a group who exercised with light weights (EW) (n = 17), and a group who exercised with no weights (EN) (n = 16). Subjects who exercised (EN and EW) gained significantly greater ROM in ankle plantar flexion, shoulder flexion, shoulder abduction, and left neck rotation than C subjects. No significant differences were found between groups in hip flexion, right neck rotation, wrist flexion or extension, or ankle dorsiflexion. The only difference between exercise treatments was that the EN group gained significantly more ROM in shoulder abduction than the EW. The use of arm weights may have limited shoulder ROM during exercise, resulting in less improvement for shoulder abduction. Comparison with data from other studies suggests age-related loss in flexibility at the shoulder joint. Exercise generally increased shoulder ROM and may be capable of reversing loss in flexibility due to disuse.     

Throwing kinematics and elbow varus torque relative to ball size in junior baseball players

[Purpose] The purpose of this study was to investigate changes in the shoulder and elbow joint angles, upper limb angular velocities, and elbow varus torque when throwing balls of two different sizes. [Participants and Methods] The pitching motion of 26 junior baseball players was analyzed using an optical motion capture system. The balls used were a standard baseball and a small ball of equal weight. Shoulder external rotation/abduction and elbow flexion were measured. The maximum values of shoulder joint internal rotation, elbow joint extension, wrist flexion angular velocity, and elbow joint varus torque were also evaluated. The ball velocity was determined as an index of pitching performance. [Results] The shoulder external rotation and elbow flexion angles were higher when pitching with a small ball. The joint angular velocity was also significantly higher when pitching with a small ball for all items examined. The ball speed was significantly higher with the small ball. The maximum varus torque of the elbow joint divided by the ball velocity was significantly lower for the small ball. [Conclusion] For a junior baseball player with a small hand length, using a small ball enables pitching with low stress on the elbow joint.     

Muscular endurance and wheelchair propulsion in children with cerebral palsy or myelomeningocele.

Bivariate correlations between muscular endurance or resistance used during six-repetition maximum (6-RM) for eight upper body exercises (shoulder flexion, extension, abduction, internal and external rotation, elbow flexion, extension and shoulder flexion/elbow extension (bench press), 50-meter dash, and 12-minute wheelchair propulsion tests were examined in six children with diagnoses of cerebral palsy or myelomeningocele. Correlations were determined before and after resistance training. Before training, only elbow extension correlated significantly with the 12-minute test. Following training, significant correlations (p less than or equal to 0.05) were found between all 6-RM exercises and 12-minute test scores. Additionally, significant correlations were found between all 6-RM exercises (except elbow flexion, which approached significance) and 50-meter dash scores. The results of this clinical case investigation indicate that the relationship between muscular endurance (6-RM) and wheelchair propulsion improves as muscular endurance increases.     

The effect of zaltoprofen on physiotherapy for limited shoulder movement in breast cancer patients: a single-blinded before-after trial

OBJECTIVE: To determine the efficacy of oral administration of zaltoprofen on shoulder range of motion (ROM) exercises for breast cancer patients after surgery. DESIGN: Single-blind, before-after trial. SETTING: Rehabilitation facility in a Japanese university hospital. PARTICIPANTS: Forty breast cancer patients (age range, 37-72y) with limited shoulder movement after surgery. INTERVENTION: Single session of physiotherapy (PT) with or without oral administration of zaltoprofen. MAIN OUTCOME MEASURES: Active shoulder ROM in flexion, abduction, and external rotation, as well as subjective pain score during shoulder movements. RESULTS: Active shoulder movements after ingesting a zaltoprofen tablet significantly improved in flexion, abduction (P<.001), and external rotation (P<.005). PT treatment improved flexion and abduction ROM in both the zaltoprofen and control groups and led to significantly larger flexion and abduction movements in the zaltoprofen group than in the control group (P<.01). There were no differences in pain scores between groups, but 2 patients who did not receive zaltoprofen complained of increased pain just after ROM exercises. CONCLUSION: Zaltoprofen taken orally before ROM exercises for painful shoulder after breast cancer surgery may enhance the effects of PT.     

肩胛骨松解法治疗慢性肩周炎的康复疗效

目的：探讨肩胛骨松解法结合关节松动术在治疗慢性肩周炎中的康复疗效。方法：对已确诊的慢性肩周炎患者60例随机分为A、B2组各30例，均接受关节松动术治疗方案，A组并增加肩胛骨松解法，治疗前后比较2组患者肩关节疼痛程度及ROM改善情况。结果：治疗20d后，疼痛视觉模拟评分2组与治疗前比较均显著降低（P〈0．01），2组间比较，A组下降更明显（P〈0．01）；ROM评定，2组肩关节角度均有较大提高，但A组肩关节前屈、后伸、外旋及外展、内旋的活动范围均明显大于B组（P〈0．01）；复发率比较，2组间差异无显著性意义。结论：肩胛骨松解法结合关节松动术治疗慢性肩周炎效果显著，尤其在疼痛的改善、肩关节活动范围的提高方面明显优于单纯关节松动术。     

Ranges of active joint motion for the shoulder,elbow, and wrist in healthy adults

Purpose: The aim of this study was to show highly reliable normal values and three-dimensional characteristics for final range of motion during active movements of the upper extremity joints, and to develop a database from healthy participants, with the advantage of this database lying in the methods of defining shoulder axial rotation angle and of compensating for soft tissue artifacts. Methods: We used an electromagnetic tracking system (FASTRAK) to measure three-dimensional motions of the shoulder (thoracohumeral), elbow/forearm, and wrist in 20 healthy adults (age range: 18–34 years) during active joint motion tasks of the upper extremity. Results: Joint angles of the upper extremity at the final position of joint motion tasks were determined. Highly reliable data for shoulder axial rotation angle were obtained, using a new definition of joint angle and regression analysis to compensate for estimation errors. Conclusions: These results should be useful in setting goals for the treatment of upper extremity joint functions in the fields of rehabilitation, orthopedics, and sports medicine.

Implications for Rehabilitation

• Complex joint motions that occur naturally (unconsciously) about some axes should be taken into account in interventions for range of joint motion (ROM).

• The data obtained through this study simultaneously indicating multiple interrelated angles can be used as reference values for maximum active ROM.

• ROM in the directions of motion involved in the various tasks (for example, elevation angle during shoulder flexion) may have a role to play in evaluating and setting goals for patients with impaired ROM of the arm joints.

     

不同检查者和不同检查工具对关节活动度检查的影响

目的观察不同检查者和不同检查工具对关节活动度(ROM)检查的影响。方法对104名健康青年人进行肩前屈、后伸、外展、内旋、外旋ROM测定,每位受试者接受2位检查者用通用量角器和方盘量角器检查,对比受试者主动活动与被动活动、左侧与右侧、同一检查者用通用量角器与方盘量角器的ROM值,以及不同检查者用通用量角器、方盘量角器的ROM值。结果无论用哪一种量角器,受试者主动ROM均小于被动ROM,有显著差异,但左右两侧ROM无显著差异。使用通用量角器和方盘量角器相比,肩前屈ROM无显著差异,肩后伸、外展、内旋、外旋ROM有显著差异。不同检查者用方盘量角器测量ROM值无显著差异,用通用量角器测量肩内旋ROM值无显著差异,肩前屈、后伸、内旋、外旋ROM值有显著差异。结论方盘量角器测量ROM的可重复性较高。为确保ROM检查结果的可比性,应由同一位检查者使用同一种检查工具对患者进行ROM检查。     

Normal functional range of motion of upper limb joints during performance of three feeding activities

This study was designed to quantify the range of upper limb joint motion required during the performance of a specific type of functional activity. Ten able-bodied men were studied as they performed three feeding tasks--eating with a spoon, eating with a fork, and drinking from a handled cup. Three shoulder joint rotations, one elbow joint rotation, one forearm joint rotation, and three wrist joint rotations were quantified simultaneously using a three-dimensional measurement system. It was found that the required ranges of motion for the feeding tasks were 5 degrees to 45 degrees shoulder flexion, 5 degrees to 35 degrees shoulder abduction, 5 degrees to 25 degrees shoulder internal rotation, 70 degrees to 130 degrees elbow flexion, from 40 degrees forearm pronation to 60 degrees forearm supination, from 10 degrees wrist flexion to 25 degrees wrist extension, and from 20 degrees wrist ulnar deviation to 5 degrees wrist radial deviation. Wrist rotation was also measured, but it was found to be negligible.     

A study of the external forces and moments at the shoulder and elbow while performing every day tasks

OBJECTIVES: To establish a database of upper limb kinematics and kinetics to support the development of a biomechanical model of the shoulder and elbow. DESIGN: Ten unimpaired subjects were studied when performing 10 different tasks of every day living. BACKGROUND: The development of biomechanical models of the upper limb to support the design of total joint replacements requires data on the commonly performed activities. Unlike the lower limb, this involves the selection of the tasks believed to be the most common. METHODS: Kinematic data were collected using four video cameras to track the movements of reflective markers attached to the upper limb and trunk. The rigid body kinematics was then analysed and the external forces and moments at the shoulder and elbow were calculated using inverse dynamics. RESULTS: The greatest ranges of motion at the shoulder occurred during reaching and lifting tasks as did the greatest shoulder moment (14.3 Nm flexion). The greatest elbow flexion occurred while reaching the back of the head but the greatest moment (5.8 Nm) occurred while lifting a block to head height. CONCLUSIONS: A database of ranges of motion and external forces and moments has been established to support the development of biomechanical models of the upper limb. RELEVANCE: The development of biomechanical models to support the design of upper limb joint replacements requires detailed knowledge of the types and magnitudes of forces and moments at the joints.     

Virtual reality games for rehabilitation of upper extremities in stroke patients

IntroductionStroke is one of the main causes of physical disability in which doing frequent and early exercise is imperative for rehabilitation. Virtual reality gaming has a high potential in rehabilitation leading to increased performance of patients. This study aimed to develop, validate and examine virtual reality games in chronic stroke patients.MethodsThis was a single before-after study. To determine the movements and content of games, 9 physiotherapists and 11 game designers were asked to participate in a questionnaire-based survey. Then, to evaluate the impact of games on rehabilitation, patients (N = 10; mean age = 52 ± 4.38) with chronic stroke were asked to play the games three times a week for four weeks. Outcomes included measurement of the ability to perform shoulder, elbow and wrist movements was performed using goniometric instrument, Modified Motor Assessment Scale (MMAS) was used to assess the functional ability of patients and muscle spasticity, and brunnstrom's stages of recovery test was also used to assess spastic and involuntary muscle movement.ResultsGames have positive effects on the horizontal abduction of shoulder (16.26 ± 23.94, P = 0.02), horizontal adduction of shoulder (59.24 ± 74.76, P = 0.00), supination of wrist (10.68 ± 53.52, P = 0.02), elbow flexion (0.1 ± 1.5, P = 0.00), and wrist flexion (0.06 ± 1.34, P = 0.03). However, they had no effects on the flexion of shoulder, flexion of elbow, extension of elbow, and extension of wrist (p-value> 0.05).ConclusionsThe results showed that games improve the range of motion of the participants in terms of horizontal abduction and abduction of the shoulder, elbow flexion, and supination and flexion of the wrist. Due to the small sample size in this study, we recommend more studies with larger samples and a control group.     

Quantitative in vivo studies of median nerve sliding in response to wrist, elbow, shoulder and neck movements

Objective. To examine median nerve sliding in response to upper limb movements in vivo. To determine whether the median nerve can be unloaded.

Design. Exploratory study in healthy subjects.

Background. Impaired sliding may lead to neuropathic symptoms. In vivo results for neural dynamics in normal subjects are essential to understand changes in upper limb disorders.

Methods. Ultrasound imaging of the median nerve during 40° wrist extension, 80° shoulder abduction, 90° elbow extension, and 35° contralateral neck side flexion. Frame by frame cross-correlation of image sequences to measure nerve sliding and strain.

Results. Nerve excursion in the forearm and upper arm ranged from 0.3 mm for neck side flexion to 10.4 mm for elbow extension. Additional strain in the forearm for wrist extension was 1.1% (SEM, 0.2%), for shoulder abduction 1.0% (SEM, 0.2%), and for neck side flexion 0.1% (SEM, 0.1%). With the limb flexed, sliding was delayed and sometimes the nerve or the nerve fascicles had a wavy appearance.

Conclusion. The median nerve is unloaded when the shoulder is adducted or elbow flexed. When the arm is extended (90° shoulder abduction, 60° wrist extension, and elbow straight) the total additional strain in the forearm will be 2.5–3.0%. Even in this position the strain is likely to be below levels that impair blood flow or conduction. Therefore, the median nerve appears well designed to cope with changes in bed length caused by limb movements.Relevance

These results will provide baseline data that can be used to examine entrapment neuropathies.     

膏摩治疗配合等速训练治疗肩周炎的疗效观察

目的:观察膏摩结合等速训练治疗肩周炎的临床疗效。方法:将60名肩周炎患者随机分为观察组和对照组各30例,2组均采用膏摩治疗,观察组加用等速肌力训练。观察2组患者治疗前后肩关节前屈、后伸,外展角度、力矩峰值及VAS评分变化。结果:治疗3周后,2组患者肩关节前屈、后伸、外展角度及力矩峰值均较治疗前明显提高(P0.05),且观察组更优于对照组(P0.05);2组VAS评分均较治疗前明显下降(P0.05),且观察组更低于对照组(P0.05)。结论:膏摩治疗配合等速训练能够更好的减轻肩周炎患者的疼痛,增加肩关节活动度,增加肌力,并藉此改善患者上肢运动功能。     

Active Shoulder Range of Motion in Persons Aged 60 Years and Older

The purpose of this study was to present active shoulder range of motion (ROM) measurements obtained from healthy personsaged 60 years and older. One hundred two volunteers participated this study. The right shoulder of these subjects was examined for active shoulder flexion, abduction, internal and external rotation. Measurements were recorded from a full round plastic goniometer. Results showed that the mean active shoulder ROM was significantly different (p < .0001) than the known American Academy of Orthopaedic Surgeons' standard for this age group. From the sixth through ninth decade ROM decreased linearly, statistically significant for abduction and external rotation by some decades. Additionally, women had statistically significant greater ROM than men for flexion, abduction and internal rotation. From a clinical perspective it is apparent that individuals sixty years of age and older have less active shoulder ROM than the known standard. These findings should prove useful to clinicians when evaluating and rehabilitating patients with shoulder dysfunctions.     

Test-Retest Reliability and Face Validity of a Modified Neural Tissue Provocation Test in Patients with Cervicobrachial Pain Syndrome

Abstract

The Neural Tissue Provocation Test (NTPT) via median nerve is used to assess the compliance and mechanosensitivity of neural tissues in the upper limb. However, the standard requires 90° of shoulder abduction, a position that may be unsuitable for patients with cervicobrachial pain, who often present with limited range of shoulder abduction. This study, therefore, examined the test-retest reliability of pain responses to a modified testing procedure in 12 subjects with unilateral cervicobrachial pain syndrome (CBPS). The test was performed on the symptomatic and asymptomatic arm with the cervical spine in neutral position. The angles of elbow extension at the onset of pain/pain threshold (P1) and at the limitation of elbow extension due to pain/pain tolerance (P2) were measured using an external trigger and an electrogoniometer. Results showed that the onsets of P1 and P2 were sufficiently reliable across trials to warrant clinical use of this test (ICC_3,1 ≥ 0.925). The elbow extension angles associated with pain threshold and pain tolerance were significantly lower in the symptomatic arm compared to the asymptomatic arm (p=0.003). In the majority of subjects, their exact symptoms were reproduced in the symptomatic arm and normal sensory responses occurred on the other side. The difference between sides in the elbow extension angle associated with pain responses, the type of pain responses, and the available elbow extension range of motion suggest that this modified version of the NTPT via median nerve has face validity for the assessment of the presence of heightened mechanosensitivity of neural tissues in patients with CBPS.