Reduced elbow mobility affects the flexion or extension domain in activities of daily living

Background

Rehabilitation of patients with joint affecting diseases makes an appeal to available compensating motions. Objective information about compensatory motions is required for clinical decision-making. Our objective was to quantify resulting shoulder and arm motions from limited elbow mobility during activities of daily living in healthy controls and patients.

Methods

Ten hemophilia patients with reduced elbow motion and ten controls volunteered in a kinematic motion analysis of thorax, shoulder, arm and wrist during 5 experimental activities of daily living. In controls, the elbow range of motion was limited by an elbow brace with variable flexion and extension stops. The elbow angle of patients was not intervened. Outcome variables were minimal required elbow range of motion for successful activity of daily living completion and concurring compensatory motions.

Findings

An elbow flexion and extension domain was identified separated by a 97° to 110° interval in which none of the observed tasks could be fulfilled. A minimal average elbow flexion angle of 86° and an additional range of motion of 36° were required to finish all tasks successfully. Predominant significant compensatory motion was found in the glenohumeral joint and wrist.

Interpretation

Two functional elbow flexion domains exist, separated by a transition domain of 36°. Treatment should be focussed to bridge both domains. Limiting treatments, e.g. arthrodesis of the elbow joint within this transition range, especially in a cosmetic 90°, leads to severe disability. Limited joint range of motion requires increased compensatory motions in other joints.     

Flexor carpi ulnaris tenotomy alone does not eliminate its contribution to wrist torque

Background

Flexor carpi ulnaris muscle tenotomy and transfer to the extensor side of the wrist are common procedures used to improve wrist position and dexterity in patients with cerebral palsy. Our aim was to determine whether this muscle still influences wrist torque even after tenotomy of its distal tendon.

Methods

Intra-operatively, we determined in vivo maximal wrist torque in hemiplegic cerebral palsy patients (n = 15, mean age 17 years) in three conditions: 1) with the arm and the muscle intact; 2) after tenotomy of the flexor carpi ulnaris just proximal to the pisiform bone, with complete release from its insertion; and 3) after careful dissection of the belly of the muscle from its fascial surroundings up until approximately halfway its length.

Findings

After tenotomy of the flexor carpi ulnaris muscle, the maximal wrist torque decreased 18% whereas dissection of the muscle resulted in an additional decrease of 18%.

Interpretation

We conclude that despite the tenotomy of its distal tendon, the flexor carpi ulnaris still contributes to the flexion torque at the wrist through myofascial force transmission. Quantification of this phenomenon will help in the study of the effects of fascial dissection on the functional results of tendon transfer surgery.     

Reference chart of inspiratory muscle strength: a new tool to monitor the effect of pre-operative training

Objectives

To develop a reference chart to monitor inspiratory muscle strength during pre-operative inspiratory muscle training for patients at high risk of developing postoperative pulmonary complications awaiting coronary artery bypass graft (CABG) surgery.

Design

Secondary data analysis using patients from the intervention arm of a randomised clinical trial.

Setting

University medical centre.

Participants

Patients at high risk of developing postoperative pulmonary complications awaiting CABG surgery.

Interventions

Patients performed inspiratory muscle training seven times per week for at least 2 weeks before surgery.

Main outcome measures

Maximal inspiratory muscle strength.

Results

A new reference chart was produced using a non-linear time trend model with a normal error structure.

Conclusions

The chart is a novel tool for monitoring the progress of inspiratory muscle training for physiotherapy practice. Wider use of this chart is recommended.     

Diagnostic Accuracy of the Electromyography Parameters Associated With Anterior Knee Pain in the Diagnosis of Patellofemoral Pain Syndrome

Objective

To assess the diagnostic accuracy of the surface electromyography (sEMG) parameters associated with referred anterior knee pain in diagnosing patellofemoral pain syndrome (PFPS).

Design

Sensitivity and specificity analysis.

Setting

Physical rehabilitation center and laboratory of biomechanics and motor control.

Participants

Pain-free subjects (n=29) and participants with PFPS (n=22) selected by convenience.

Interventions

Not applicable.

Main Outcome Measure

The diagnostic accuracy was calculated for sEMG parameters’ reliability, precision, and ability to differentiate participants with and without PFPS. The selected sEMG parameter associated with anterior knee pain was considered as an index test and was compared with the reference standard for the diagnosis of PFPS. Intraclass correlation coefficient, SEM, independent t tests, sensitivity, specificity, negative and positive likelihood ratios, and negative and positive predictive values were used for the statistical analysis.

Results

The medium-frequency band (B2) parameter was reliable (intraclass correlation coefficient=.80–.90), precise (SEM=2.71–3.87 normalized unit), and able to differentiate participants with and without PFPS (P<.05). The association of B2 with anterior knee pain showed positive diagnostic accuracy values (specificity, .87; sensitivity, .70; negative likelihood ratio, .33; positive likelihood ratio, 5.63; negative predictive value, .72; and positive predictive value, .86).

Conclusions

The results provide evidence to support the use of EMG signals (B2 – frequency band of 45–96Hz) of the vastus lateralis and vastus medialis muscles with referred anterior knee pain in the diagnosis of PFPS.     

Quantitative assessment based on kinematic measures of functional impairments during upper extremity movements: A review

Background

Quantitative measures of human movement quality are important for discriminating healthy and pathological conditions and for expressing the outcomes and clinically important changes in subjects' functional state. However the most frequently used instruments for the upper extremity functional assessment are clinical scales, that previously have been standardized and validated, but have a high subjective component depending on the observer who scores the test. But they are not enough to assess motor strategies used during movements, and their use in combination with other more objective measures is necessary. The objective of the present review is to provide an overview on objective metrics found in literature with the aim of quantifying the upper extremity performance during functional tasks, regardless of the equipment or system used for registering kinematic data.

Methods

A search in Medline, Google Scholar and IEEE Xplore databases was performed following a combination of a series of keywords. The full scientific papers that fulfilled the inclusion criteria were included in the review.

Findings

A set of kinematic metrics was found in literature in relation to joint displacements, analysis of hand trajectories and velocity profiles. These metrics were classified into different categories according to the movement characteristic that was being measured.

Interpretation

These kinematic metrics provide the starting point for a proposed objective metrics for the functional assessment of the upper extremity in people with movement disorders as a consequence of neurological injuries. Potential areas of future and further research are presented in the Discussion section.     

Measurement of Hyolaryngeal Muscle Activation Using Surface Electromyography for Comparison of Two Rehabilitative Dysphagia Exercises

Objective

To investigate the effects of a resistance-based chin-to-chest (CtC) exercise on measures of hyolaryngeal muscle activation compared with a head-lift exercise.

Design

Within-subject, repeated-measures design.

Setting

Academic research laboratory.

Participants

Healthy young women (N=20) without a history of dysphagia, cervical spine conditions, neurologic disease, or head/neck cancer (mean age, 22.5y).

Interventions

All participants performed an isometric jaw-opening exercise against resistance (CtC) and an isometric head-lift exercise, both targeting activation in the hyolaryngeal (suprahyoid) muscles. The CtC exercise required jaw opening into a chin brace secured against the upper torso for a duration of 10 seconds. The isometric head-lift exercise required lifting and holding the head from a supine position for 10 seconds. The degree to which each exercise activated the suprahyoid muscles was measured using surface electromyography (sEMG).

Main Outcome Measures

Microvolts as measured from sEMG sensors placed on the skin surface above the hyolaryngeal muscles (surface of skin above geniohyoid, mylohyoid, and anterior digastric). Dependent variables included the peak microvolts during 10 seconds of sustained contraction and the difference in microvolts from rest to peak contraction for each exercise.

Results

Activation in the hyolaryngeal musculature as measured via sEMG was significantly greater when participants performed the CtC exercise compared with the head-lift exercise. Measures of peak microvolts during contraction were significantly greater for CtC (t=10.72, P<.001) compared with the head-lift exercise, and difference measures in microvolts calculated between rest and contraction for each exercise revealed a 2-fold increase in hyolaryngeal muscular activation for CtC (t=8.27, P<.001).

Conclusions

The isometric CtC exercise resulted in greater activation of the hyolaryngeal muscles compared with an isometric head-lift exercise. Results support the need for further investigations to determine whether the CtC exercise has a positive effect as a rehabilitative exercise for clinical populations with dysphagia secondary to upper esophageal sphincter dysfunction where hyolaryngeal excursion is a physiological impairment.     

Skill Training for Swallowing Rehabilitation in Patients With Parkinson's Disease

Objective

To examine the effects of skill training on swallowing in individuals with dysphagia secondary to Parkinson's disease (PD) and to explore skill retention after treatment termination.

Design

Within-subject pilot study with follow-up after 2 weeks of treatment and after a 2-week nontreatment period.

Setting

Clinic in a research institute.

Participants

Patients (N=10; mean age, 67.4y) included 3 women (mean Hoehn and Yahr score, 2.6) and 7 men (mean Hoehn and Yahr score, 2.4).

Intervention

Patients underwent 10 daily sessions of skill training therapy focused on increasing precision in muscle contraction during swallowing using visual feedback.

Main Outcome Measures

Data from the timed water swallow test, Test of Mastication and Swallowing Solids, surface electromyography (sEMG) of submental muscles, and swallowing-related quality of life questionnaire were collected at 2 baseline sessions (conducted 2wk apart) at the end of treatment and after 2 nontreatment weeks to assess skill retention.

Results

Immediately after posttreatment, the swallowing rate for liquids (P=.034), sEMG durational parameters of premotor time (P=.003), and preswallow time (P<.001) improved. A functional carryover effect was seen from dry to water swallows (P=.009). Additionally, swallowing-related quality of life improved (P=.018). Reassessment at 2 weeks after treatment termination revealed short-term retention of treatment effects.

Conclusions

A skill-based training approach produced functional, biomechanical, and swallowing-related quality of life improvements in this cohort indicating compelling evidence for the effectiveness of this novel approach for dysphagia rehabilitation in PD.     

Effects of proximal row carpectomy on wrist biomechanics: a cadaveric study

Background

Many studies show good clinical results after proximal row carpectomy. Some biomechanical consequences are documented, but to our knowledge muscle moment arm variations have not previously been quantified.

Methods

In five fresh–frozen wrist, kinematics and tendon excursions were measured using a 3D electrogoniometer and Linear Variable Differential Transformers (SOLARTRON Inc., AMETEK Advanced Measurement Technology, Inc, 801 South Illinois Avenue, Oak Ridge, TN 37831-2011, USA), respectively, in three conditions: intact wrist, after posterior capsulotomy and after proximal row carpectomy. Mean pivot point, defined as the point whose sum of the squared distances to the helical axes is minimum, wrist range of motion and mean moment arms were measured during dorso-palmar flexion, radioulnar deviation and circumduction movements.

Findings

No alteration of the range of motion was observed. On the other hand, the mean pivot point shifted proximally (6.8–9.1 mm) after proximal row carpectomy (p < 0.05) for all motions tested and most muscle moment arms decreased significantly after proximal row carpectomy.

Interpretation

The results of this study allow a better understanding of the biomechanical effects of this procedure. The important moment arm reduction and pivot point displacement suggest modifications of joint biomechanical parameters which could influence the functional outcome of PRC.     

Acute Calcific Tendinitis of the Wrist

Background

Acute calcific tendinitis, a benign and self-limiting inflammatory condition commonly seen in the shoulder, is also described in many other tendons, including those in the hand and wrist. When involving the wrist, acute calcific tendinitis is often misdiagnosed and mistaken for infection.

Objective

We present this case to increase familiarity with this condition to avoid errors in diagnosis resulting in inappropriate treatment with antibiotics or even surgery.

Case Report

A 27-year-old man presented to the Emergency Department with a 2-week history of volar wrist pain, with sudden increase in pain associated with chills and new onset swelling and redness of the wrist. Plain radiographs showed characteristic soft-tissue calcification overlying the insertion of the flexor carpi ulnaris tendon into the wrist. Treatment with ibuprofen and splinting resulted in complete symptom resolution.

Conclusion

Acute calcific tendinitis is an important consideration in the differential diagnosis of acute wrist pain. Radiographs are helpful in confirming the diagnosis when symptoms and examination findings are characteristic.     

Feasibility,safety and outcomes of playing Kinect Adventures!™ for people with Parkinson's disease: a pilot study

Objectives

To assess the feasibility, safety and outcomes of playing Microsoft Kinect Adventures™ for people with Parkinson's disease in order to guide the design of a randomised clinical trial.

Design

Single-group, blinded trial.

Setting

Rehabilitation Center of São Camilo University, Brazil.

Participants

Seven patients (six males, one female) with Parkinson's disease (Hoehn and Yahr Stages 2 and 3).

Interventions

Fourteen 60-minute sessions, three times per week, playing four games of Kinect Adventures!

Main outcome measures

The feasibility and safety outcomes were patients’ game performance and adverse events, respectively. The clinical outcomes were the 6-minute walk test, Balance Evaluation System Test, Dynamic Gait Index and Parkinson's Disease Questionnaire (PDQ-39).

Results

Patients’ scores for the four games showed improvement. The mean [standard deviation (SD)] scores in the first and last sessions of the Space Pop game were 151 (36) and 198 (29), respectively [mean (SD) difference 47 (7), 95% confidence interval 15 to 79]. There were no adverse events. Improvements were also seen in the 6-minute walk test, Balance Evaluation System Test, Dynamic Gait Index and PDQ-39 following training.

Conclusion

Kinect-based training was safe and feasible for people with Parkinson's disease (Hoehn and Yahr Stages 2 and 3). Patients improved their scores for all four games. No serious adverse events occurred during training with Kinect Adventures!, which promoted improvement in activities (balance and gait), body functions (cardiopulmonary aptitude) and participation (quality of life).     

Physiotherapy intervention practice patterns used in rehabilitation after distal radial fracture

Objectives

To identify the type and frequency of interventions used by physiotherapists in rehabilitating patients after a distal radial fracture; and, to examine whether any patient or therapist characteristics had an effect on the frequency of interventions administered.

Design

Observational study.

Setting

Four metropolitan outpatient physiotherapy departments.

Participants

14 physiotherapists reported on 160 distal radial fracture consultations.

Main outcome measures

Physiotherapists recorded the type of interventions and time spent administering interventions during each distal radial fracture consultation.

Results

A combined site response rate of 70% was achieved (160/204). The most common interventions were exercise (155/160), advice (144/160), passive joint mobilisation (88/160) and massage (60/160). Patient characteristics and physiotherapist experience had little impact on the type and frequency of interventions reported by physiotherapists.

Conclusions

Exercise and advice were the most frequently administered interventions for patients after a distal radial fracture irrespective of physiotherapist or patient factors. During rehabilitation, these interventions aim to restore wrist mobility and are consistent with both fracture management principles and a self management approach. Due to the routine use of exercise and advice there is a need for further research to provide high quality evidence that these interventions improve outcomes in patients after a distal radial fracture.     

Case Report: Endurance Electrical Stimulation Training Improves Skeletal Muscle Oxidative Capacity in Chronic Spinal Cord Injury

Objective

To describe the use of a novel neuromuscular electrical stimulation (NMES) endurance exercise protocol and its effects on skeletal muscle oxidative capacity.

Design

Case report, pre/post intervention.

Setting

University-based trial.

Participant

A 39-year-old man who suffered a motor complete spinal cord injury (C5-6, ASIA Impairment Scale grade A).

Intervention

Twenty-four weeks of endurance NMES that consisted of progressive increases in the twitch frequency, duration of sessions, and sessions per week.

Main Outcome Measure

Mitochondrial capacity was measured, in vivo, as the rate of recovery of muscle oxygen consumption using near-infrared spectroscopy.

Results

The rate of recovery of muscle oxygen consumption increased approximately 3-fold from 0.52 to 1.43, 1.46, and 1.40/min measured on 3 separate occasions during week 12 of training, and 1.57/min after 24 weeks of NMES endurance training.

Conclusion

The findings of this study suggest that NMES endurance training using twitches can increase mitochondrial capacity to comparable levels measured in nonparalyzed muscles of sedentary able-bodied controls.     

Motor Recovery of the Ipsilesional Upper Limb in Subacute Stroke

Objective

To investigate the time-related changes in motor performance of the ipsilesional upper limb in subacute poststroke patients by using clinical and kinematic assessments.

Design

Observational, longitudinal, prospective, monocentric study.

Setting

Physical medicine and rehabilitation department.

Participants

Stroke patients (n=19; mean age, 62.9y) were included less than 30 days after a first unilateral ischemic/hemorrhagic stroke. The control group was composed of age-matched, healthy volunteers (n=9; mean age, 63.1y).

Interventions

Clinical and kinematic assessments were conducted once a week during 6 weeks and 3 months after inclusion. Clinical measures consisted of Fugl-Meyer Assessment, Box and Block Test (BBT), Nine-Hole Peg Test (9HPT), and Barthel Index. We used a 3-dimensional motion recording system during a reach-to-grasp task to analyze movement smoothness, movement time, and peak velocity of the hand. Healthy controls performed both clinical (BBT and 9HPT) and kinematic evaluation within a single session.

Main Outcome Measures

BBT and 9HPT.

Results

Recovery of ipsilesional upper arm capacities increased over time and leveled off after a 6-week period of rehabilitation, corresponding to 9 weeks poststroke. At study discharge, patients demonstrated similar ipsilesional clinical scores to controls but exhibited less smooth reaching movements. We found no effect of the hemispheric side of the lesion on ipsilesional motor deficits.

Conclusions

Our findings provide evidence that ipsilesional motor capacities remain impaired at least 3 months after stroke, even if clinical tests fail to detect the impairment. Focusing on this lasting ipsilesional impairment through a more detailed kinematic analysis could be of interest to understand the specific neural network underlying ipsilesional upper-limb impairment.     

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.     

Which Neuromuscular Attributes Are Most Associated With Mobility Among Older Primary Care Patients?

Objective

To identify the neuromuscular attributes that are associated with self-reported mobility status among older primary care patients.

Design

Cohort study.

Setting

Metropolitan-based health care system.

Participants

Community-dwelling primary care patients aged ≥65 years (N=430), with self-reported modification of mobility tasks resulting from underlying health conditions.

Interventions

Not applicable.

Main Outcome Measures

Basic and Advanced Lower Extremity Function as measured by the Late Life Function and Disability Instrument.

Results

We constructed multivariable linear regression models evaluating both outcomes. For Basic Lower Extremity Function, leg strength, leg velocity, trunk extensor muscle endurance, and ankle range of motion (ROM) were statistically significant predictors (P<.001, R²=.21). For Advanced Lower Extremity Function, leg strength, leg strength asymmetry, leg velocity, trunk extensor muscle endurance, and knee flexion ROM were statistically significant predictors (P<.001, R²=.39). Sensitivity analyses conducted using multiple imputations to account for missing data confirmed these findings.

Conclusions

This analysis highlights the relevance and importance of 5 categories of neuromuscular attributes: strength, speed of movement, ROM, asymmetry, and trunk stability. It identifies novel attributes (leg velocity and trunk extensor muscle endurance) relevant to mobility and highlights that impairment profiles vary by the level of mobility assessed. These findings will inform the design of more thorough and potentially more effective disability prevention strategies.     

Posterolateral Hip Muscle Strengthening Versus Quadriceps Strengthening for Patellofemoral Pain: A Comparative Control Trial

Objective

To compare the efficacy of posterolateral hip muscle strengthening versus quadriceps strengthening in reducing pain and improving health status in persons with patellofemoral pain (PFP).

Design

Comparative control trial.

Setting

Rehabilitation facility.

Participants

Persons with a diagnosis of PFP (N=36; 18 men, 18 women).

Interventions

Patients were alternately assigned to a posterolateral hip muscle strengthening group (9 men and 9 women) or a quadriceps strengthening group (9 men and 9 women). The posterolateral hip muscle strengthening group performed hip abductor and external rotator strengthening exercises, whereas the quadriceps strengthening group performed quadriceps strengthening exercises (3 times a week for 8wk).

Main Outcome Measures

Pain (visual analog scale [VAS]) and health status (Western Ontario McMaster Universities Osteoarthritis Index [WOMAC]) were assessed at baseline, postintervention, and 6-month follow-up.

Results

Significant improvements in VAS and WOMAC scores were observed in both groups from baseline to postintervention and baseline to 6-month follow-up (P<.001). Improvements in VAS and WOMAC scores in the posterolateral hip exercise group were superior to those in the quadriceps exercise group postintervention and at 6-month follow-up (P<.05).

Conclusions

Although both intervention programs resulted in decreased pain and improved function in persons with PFP, outcomes in the posterolateral hip exercise group were superior to the quadriceps exercise group. The superior outcomes obtained in the posterolateral hip exercise group were maintained 6 months postintervention.     

Muscle parameters for musculoskeletal modelling of the human neck

Background

To study normal or pathological neuromuscular control, a musculoskeletal model of the neck has great potential but a complete and consistent anatomical dataset which comprises the muscle geometry parameters to construct such a model is not yet available.

Methods

A dissection experiment was performed on the left side of one 50th percentile male embalmed specimen. Geometrical data including muscle attachment sites were digitized using an Optotrak measurement system and laser diffraction was used to determine muscle sarcomere lengths. Bony landmarks were recorded and joint centres of rotation between different vertebrae were estimated using literature data.

Findings

A total of 34 muscle parts of the neck were divided in 129 elements per body side. Muscle attachment sites, mass, physiological cross sectional area, fibre length, tendon length and optimal fibre length for each element are supplied as digital annexes to the paper. Results are coherent with other studies and new data are provided for several smaller muscles not reported elsewhere.

Interpretation

Implementation of this dataset into a neck model is likely to improve the estimation of muscle forces and thus increase the model validity; this makes future neck models more suitable for the use as clinical tools.     

Knee joint kinematics, kinetics and muscle co-contraction in knee osteoarthritis patient gait

Background

Compared to matched controls, knee osteoarthritis patients walk with altered, kinematics, kinetics and muscle activity. Studies of osteoarthritis patient gait have focused on individual measures, and findings from these studies differ due to differences in patient levels of disability and age. Therefore, aims of this study were to examine kinematic, kinetic and muscle co-contraction gait variables within a single osteoarthritis patient group, and to determine if alterations in these variables are related to pain, symptom and function measures.

Methods

Thirty asymptomatic controls and 54 patients with radiographic evidence of knee osteoarthritis participated. Self-perceived measures of pain and symptoms, and gait (knee joint angles, moments and muscle co-contraction) were analysed and compared.

Findings

Osteoarthritis patients had greater self-perceived pain and symptoms on the questionnaires. Gait differences in the knee osteoarthritis patients were greater knee flexion at heel strike and during early stance along with reductions in the peak external knee extension moment in late stance. Co-contraction ratios highlighted greater lateral muscle activation in osteoarthritis patients, which were correlated with the magnitude of their adduction moments. Larger adduction moments were related to lower self-perceived pain and symptoms.

Interpretation

Osteoarthritis patients use predominantly lateral muscle activation during stance which may aid in stabilising the external knee adduction moment. Kinematic alterations in knee osteoarthritis patient gait occur without alterations in knee joint moments. Our results also suggest that adduction moments are lowered to reduce the patients’ pain and symptoms.     

Role of Character Strengths in Outcome After Mild Complicated to Severe Traumatic Brain Injury: A Positive Psychology Study

Objective

To examine the effects of character strengths on psychosocial outcomes after mild complicated to severe traumatic brain injury (TBI).

Design

Prospective study with consecutive enrollment.

Setting

A Midwestern rehabilitation hospital.

Participants

Persons with mild complicated to severe TBI (N=65).

Interventions

Not applicable.

Main Outcome Measures

Community Integration Measure, Disability Rating Scale, Modified Cumulative Illness Rating Scale, Positive and Negative Affect Schedule, Satisfaction with Life Scale, Values in Action Inventory of Strengths, and Wechsler Test of Adult Reading.

Results

Character virtues and strengths were moderately associated with subjective outcomes, such that there were fewer and less strong associations between character virtues/strengths and objective outcomes than subjective outcomes. Specifically, positive attributes were associated with greater life satisfaction and perceived community integration. Fewer and less strong associations were observed for objective well-being; however, character strengths and virtues showed unique value in predicting physical health and disability. Positive affectivity was not meaningfully related to objective outcomes, but it was significantly related to subjective outcomes. In contrast, negative affectivity was related to objective but not subjective outcomes.

Conclusions

Given the strength of the associations between positive aspects of character or ways of perceiving the world and positive feelings about one's current life situation, treatments focused on facilitating these virtues and strengths in persons who have experienced TBI may result in better perceived outcomes and potentially subsequently lower comorbidities.     

Improvement of hand function in children with cerebral palsy via an orthosis that provides wrist extension and thumb abduction

Background

The present study examines the hand movements of children with cerebral palsy during functional tests and compares the childrens' performance with and without the aid of an orthosis that provides wrist extension and thumb abduction.

Methods

The range of motion of the trapeziometacarpal joint was assessed for 32 participants via a reflexive markers image system. Observed motions included flexion–extension and abduction–adduction motions performed in the course of four tests for manual ability; the rest position, lateral and tripod pinches and cylindrical grasp. Muscle strength and manual ability were evaluated using dynamometry and the Jebsen–Taylor test.

Findings

The range of motion tests for the rest position, lateral and tripod pinches and cylindrical grasp demonstrated improvements from 17% to 42% (P < 0.001) for flexion/extension and from 36% to 54% for abduction/adduction (P < 0.001) with the use of the orthosis. Dynamometry measurements showed that the improvement in muscle strength obtained through use of the orthosis was 50% (P < 0.001). Improvements in the time required to perform the movements as determined using the Jebsen–Taylor test varied from 13% to 24% (P < 0.01) for the four considered tests of manual ability.

Interpretation

The orthosis improved the range of motion of the trapeziometacarpal joint, muscle strength and manual ability. The combination of the three techniques may provide the basis for a quantitative assessment of hand dysfunction/improvement in cerebral palsy that will ultimately guide health professionals in their clinical interventions.