Hand function and fine motor activities

Background/aim We previously reported the feasibility of RecoverNow (a mobile tablet-based post-stroke communication therapy in acute care). RecoverNow has since expanded to include fine motor and cognitive therapies. Our objectives were to gain a better understanding of patient experiences and recovery goals using mobile tablets. Methods Speech-language pathologists or occupational therapists identified patients with stroke and communication, fine motor, or cognitive/perceptual deficits. Patients were provided with iPads individually programmed with applications based on assessment results, and instructed to use it at least 1 h/day. At discharge, patients completed a 19-question quantitative and open-ended engagement survey addressing intervention timing, mobile device/apps, recovery goals, and therapy duration. Results Over a six-month period, we enrolled 33 participants (three did not complete the survey). Median time from stroke to initiation of tablet-based therapy was six days. Patients engaged in therapy on average 59.6 min/day and preferred communication and hand function therapies. Most patients (63.3%) agreed that therapy was commenced at a reasonable time, although half expressed an interest in starting sooner, 66.7% reported that using the device 1 h/day was enough, 64.3% would use it after discharge, and 60.7% would use it for eight weeks. Sixty-seven percent of patients expressed a need for family/friend/caregiver to help them use it. Conclusion Our results suggest that stroke patients are interested in mobile tablet-based therapy in acute care. Patients in the acute setting prefer to focus on communication and hand therapies, are willing to begin within days of their stroke and may require assistance with the tablets.

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High-frequency submaximal stimulation over muscle evokes centrally generated forces in human upper limb skeletal muscles

Journal of Applied Physiology ◽

10.1152/japplphysiol.90939.2008 ◽

2009 ◽

Vol 106 (2) ◽

pp. 370-377 ◽

Cited By ~ 24

Author(s):

Jean-Sébastien Blouin ◽

Lee D. Walsh ◽

Peter Nickolls ◽

Simon C. Gandevia

Keyword(s):

Upper Limb ◽

High Frequency ◽

Biceps Brachii ◽

Fine Motor ◽

Nerve Blocks ◽

Ia Afferents ◽

Lower Limb Muscles ◽

Peripheral Mechanism ◽

Central Origin ◽

Motor Activities

Control of posture and movement requires control of the output from motoneurons. Motoneurons of human lower limb muscles exhibit sustained, submaximal activity to high-frequency electrical trains, which has been hypothesized to be partly triggered by monosynaptic Ia afferents. The possibility to trigger such behavior in upper limb motoneurons and the potential unique role of Ia afferents to trigger such behavior remain unclear. Subjects ( n = 9) received high-frequency trains of electrical stimuli over biceps brachii and flexor pollicis longus (FPL). We chose to study the FPL muscle because it has weak monosynaptic Ia afferent connectivity and it is involved in fine motor control of the thumb. Two types of stimulus trains (100-Hz bursts and triangular ramps) were tested at five intensities below painful levels. All subjects exhibited enhanced torque in biceps and FPL muscles after both types of high-frequency train. Torques also persisted after stimulation, particularly for the highest stimulus intensity. To separate the evoked torques that resulted from a peripheral mechanism (e.g., muscle potentiation) and that which resulted from a central origin, we studied FPL responses to high-frequency trains after complete combined nerve blocks of the median and radial nerves ( n = 2). During the blocks, high-frequency trains over the FPL did not yield torque enhancements or persisting torques. These results suggest that enhanced contractions of central origin can be elicited in motoneurons innervating the upper limb, despite weak monosynaptic Ia connections for FPL. Their presence in a recently evolved human muscle (FPL) indicates that these enhanced contractions may have a broad role in controlling tonic postural outputs of hand muscles and that they may be available even for fine motor activities involving the thumb.

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Dexteria app. therapy versus conventional hand therapy in stroke

Journal of Enabling Technologies ◽

10.1108/jet-05-2020-0023 ◽

2020 ◽

Vol 14 (4) ◽

pp. 221-231

Author(s):

Neha Sawant ◽

Meruna Bose ◽

Shrutika Parab

Keyword(s):

Peer Review ◽

Conventional Therapy ◽

Therapy Group ◽

Hand Function ◽

Functional Independence ◽

Wilcoxon Test ◽

Fine Motor ◽

Hand Therapy ◽

Content Type ◽

Advanced Therapy

Purpose Hand impairment post-stroke is a very common and important rehabilitation goal for functional independence. Advanced therapy options such as an app. therapy provides repetitive training, which may be beneficial for improving fine motor function. This study aims to evaluate the effect of app-based therapy compared to conventional hand therapy in improving dexterity in individuals with stroke. Methodology In total, 39 individuals within the first year of stroke with Brunnstrom stage of hand recovery IV to VI were randomly divided into three groups. All three groups received 60 min of therapy for 21 sessions over a period of 30 days. Group A received conventional hand therapy; Group B received app. therapy, while Group C received conventional therapy along with the app. therapy. All participants were assessed on the Nine-Hole Peg Test and Jebsen–Taylor Hand Function Test at the beginning and after completion of 21 sessions of intervention. Kruskal–Wallis (H) test and Wilcoxon test were used for statistical analysis. Results All three groups improved on hand function post-treatment. However, Group C demonstrated significant improvement with 16%–58% increase in hand function performance on outcome measures (p < 0.05). Findings Findings of the present study demonstrate improvement in dexterity with the app. therapy and combination therapy, in comparison to conventional therapy alone in individuals with stroke. Originality This experimental study focuses the first time on a structured protocol using an enabling technology adjunct to conventional physical therapy to improve hand function in individuals with stroke, which opens up the further scope in Neurorehabilitation. Peer review The peer review history for this article is available at: https://publons.com/publon/10.1108/ILT-04-2020-0144/

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Utilizing a Combination of Interactive Technology and Traditional Fine-Motor Activities to Improve Fine-Motor Development in Kindergarten Students

American Journal of Occupational Therapy ◽

10.5014/ajot.2020.74s1-po1132 ◽

2020 ◽

Vol 74 (4_Supplement_1) ◽

pp. 7411515347p1

Author(s):

Chelsey Lyons

Keyword(s):

Motor Development ◽

Kindergarten Students ◽

Interactive Technology ◽

Fine Motor ◽

Motor Activities

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Fine Motor Activities in Head Start and Kindergarten Classrooms

American Journal of Occupational Therapy ◽

10.5014/ajot.57.5.550 ◽

2003 ◽

Vol 57 (5) ◽

pp. 550-557 ◽

Cited By ~ 83

Author(s):

D. Marr ◽

S. Cermak ◽

E. S. Cohn ◽

A. Henderson

Keyword(s):

Head Start ◽

Fine Motor ◽

Motor Activities

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The Impact of Musical Training on Hand Biomechanics in String Musicians

Hand ◽

10.1177/1558944718772388 ◽

2018 ◽

Vol 14 (6) ◽

pp. 823-829 ◽

Cited By ~ 1

Author(s):

Stacey L. Gorniak ◽

Evan D. Collins ◽

Kimberly Goldie Staines ◽

Forrest A. Brooks ◽

Ricardo V. Young

Keyword(s):

Muscle Strength ◽

Force Control ◽

Musical Training ◽

Hand Function ◽

The Body ◽

Cortical Reorganization ◽

Fine Motor ◽

Professional Musicians ◽

Hand Biomechanics ◽

The Impact

Background: The effects of musical training on the body in professional musicians remain an understudied area, particularly in reference to understanding and managing orthopedic/neuromuscular deviations and injuries in this population. The purpose of this study was to evaluate hand/finger fine motor function in musicians via physical examination as well as laboratory-based evaluations. Methods: Thirteen healthy noninjured young elite string musicians participated in this study. Performance of musicians was compared with healthy age-matched, sex-matched, and handedness-matched nonmusician controls. Results: Musicians exhibited decreased intrinsic muscle strength compared with controls; however, no change in extrinsic muscle strength was found between groups. No between-group differences in overall force control were found; however, Group × Hand (right vs left) interactions were found in force control. Conclusions: These data suggest that musicians are a unique population with respect to: (1) fine motor control of the hand; and (2) exhibit changes in differential hand use. This suggests cortical reorganization of string musicians, such that this population should be studied separately from typical healthy controls with respect to hand function.

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A pediatric robotic thumb exoskeleton for at-home rehabilitation

International Journal of Intelligent Computing and Cybernetics ◽

10.1108/ijicc-10-2013-0043 ◽

2014 ◽

Vol 7 (3) ◽

pp. 233-252 ◽

Cited By ~ 16

Author(s):

Patrick Aubin ◽

Kelsey Petersen ◽

Hani Sallum ◽

Conor Walsh ◽

Annette Correia ◽

...

Keyword(s):

Activities Of Daily Living ◽

Daily Living ◽

Degrees Of Freedom ◽

Hand Function ◽

Maximum Efficiency ◽

Fine Motor ◽

Content Type ◽

Flexion Extension ◽

Linear Force ◽

At Home

Purpose – Pediatric disorders, such as cerebral palsy and stroke, can result in thumb-in-palm deformity greatly limiting hand function. This not only limits children's ability to perform activities of daily living but also limits important motor skill development. Specifically, the isolated orthosis for thumb actuation (IOTA) is 2 degrees of freedom (DOF) thumb exoskeleton that can actuate the carpometacarpal (CMC) and metacarpophalangeal (MCP) joints through ranges of motion required for activities of daily living. The paper aims to discuss these issues. Design/methodology/approach – IOTA consists of a lightweight hand-mounted mechanism that can be secured and aligned to individual wearers. The mechanism is actuated via flexible cables that connect to a portable control box. Embedded encoders and bend sensors monitor the 2 DOF of the thumb and flexion/extension of the wrist. A linear force characterization was performed to test the mechanical efficiency of the cable-drive transmission and the output torque at the exoskeletal CMC and MCP joints was measured. Findings – Using this platform, a number of control modes can be implemented that will enable the device to be controlled by a patient to assist with opposition grasp and fine motor control. Linear force and torque studies showed a maximum efficiency of 44 percent, resulting in a torque of 2.39±1.06 in.-lbf and 0.69±0.31 in.-lbf at the CMC and MCP joints, respectively. Practical implications – The authors envision this at-home device augmenting the current in-clinic and at-home therapy, enabling telerehabilitation protocols. Originality/value – This paper presents the design and characterization of a novel device specifically designed for pediatric grasp telerehabilitation to facilitate improved functionality and somatosensory learning.

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Intelligence Functioning and Associated Factors in Children with Cerebral Palsy

European Psychiatry ◽

10.1016/j.eurpsy.2017.02.202 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S307-S307

Author(s):

S. Türkoglu ◽

G. Türkoğlu ◽

C. Celik ◽

H. Ucan

Keyword(s):

Cerebral Palsy ◽

Motor Function ◽

Intelligence Testing ◽

Hand Function ◽

Intellectual Functioning ◽

Speech Disorders ◽

Fine Motor ◽

Function Type ◽

Gross Motor ◽

Gross Motor Function

ObjectivesCerebral palsy (CP) is described as a primary disorder of posture and movement; however, intellectual impairment is prevalent in children with CP.AimThe aim of the present study was to examine the association with intellectual level and gross motor function, hand function, type of CP, and the presence of co-morbid disorders in these children.MethodsA total of 107 children with CP were included in the study. Intellectual functions of the children were determined by clinical assessment, adaptive function of daily life, and individualized standardized intelligence testing. Gross motor function and hand function of the patients were classified using the gross motor function classification system and the bimanual fine motor function measurements.ResultsThe mean age of the patients were 8.10 ± 3.43 years (age: 2–16 years). During clinical typing, we observed that 80.4% of the patients were spastic, 11.2% were mixed, 4.7% were dyskinetic, and 3.7% were ataxic. No significant relationship was determined between the type of CP and intellectual functioning (P > 0.05). Intellectual functioning was found to be significantly correlated negatively with both gross motor function and hand functions level (P < 0.001). The factors related to intellectual functioning were neonatal convulsion (x2 = 12.97, P = 0.002), epilepsy (x2 = 29.221, P < 0.001), and speech disorders (x2 = 23.29, P < 0.001).ConclusionsThere is an association between intellectual functioning in children with CP and the degree of motor impairment, neonatal convulsion, epilepsy, and speech disorders. Intelligence assessment should be an essential part of CP evaluation.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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