Remote self-measurement of wrist range of motion performed on normal wrists by a minimally trained individual using the iPhone level application only demonstrated good reliability in measuring wrist flexion and extension

Little information exists about three-dimensional (3-D) deformity patterns of malunited distal radius fractures including axial deformity. The current study aimed to clarify the 3-D deformity pattern of malunited distal radius fractures and reveal the influence of osseous deformities, including axial rotation deformity, on wrist and forearm motion. The deformity of 20 dorsally tilted malunions were evaluated using 3-D computer models created from CT data, and correlations between deformity components and range of motion were assessed. The 3-D deformity analysis showed that axial malalignment in pronation, which showed a correlation with the degree of radial tilt deformity, was very common. A radial tilt deformity of > 5° was observed in only 45% of cases. Although the range of wrist flexion and extension showed a correlation with dorsal tilt deformity, the range of forearm pronation and supination did not correlate with distal radius deformities.

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Range of Motion after the Sauvé–Kapandji and Darrach Procedures without Extensor Tendon Rupture

Journal of Wrist Surgery ◽

10.1055/s-0040-1721452 ◽

2020 ◽

Author(s):

Tomoyuki Kato ◽

Taku Suzuki ◽

Makoto Kameyama ◽

Masato Okazaki ◽

Yasushi Morisawa ◽

...

Keyword(s):

Range Of Motion ◽

Tendon Rupture ◽

Extensor Tendon ◽

Distal Radioulnar Joint ◽

Wrist Flexion ◽

Level Of Evidence ◽

Radioulnar Joint ◽

The Mean ◽

Therapeutic Study ◽

Loss Of Motion

Abstract Background Previous study demonstrated that distal radioulnar joint (DRUJ) plays a biomechanical role in extension and flexion of the wrist and suggested that fixation of the DRUJ could lead to loss of motion of the wrist. Little is known about the pre- and postoperative range of motion (ROM) after the Sauvé–Kapandji (S-K) and Darrach procedures without tendon rupture. To understand the accurate ROM of the wrist after the S-K and Darrach procedures, enrollment of patients without subcutaneous extensor tendon rupture is needed. Purpose This study aimed to investigate the pre- and postoperative ROM after the S-K and Darrach procedures without subcutaneous extensor tendon rupture in patients with rheumatoid arthritis (RA) and osteoarthritis (OA). Methods This retrospective study included 36 patients who underwent the S-K procedure and 10 patients who underwent the Darrach procedure for distal radioulnar joint disorders without extensor tendon rupture. Pre- and postoperative ROMs after the S-K and Darrach procedures were assessed 1 year after the surgery. Results In the S-K procedure, the mean postoperative ROM of the wrist flexion (40 degrees) was significantly lower than the mean preoperative ROM (49 degrees). In wrist extension, there were no significant differences between the mean preoperative ROM (51 degrees) and postoperative ROM (51 degrees). In the Darrach procedure, the mean postoperative ROM of the wrist flexion and extension increased compared with the mean preoperative ROM; however, there were no significant differences. Conclusion In the S-K procedure, preoperative ROM of the wrist flexion decreased postoperatively. This study provides information about the accurate ROM after the S-K and Darrach procedures. Level of Evidence This is a Level IV, therapeutic study.

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Feasibility of an iPhone-based application for knee joint goniometry during gait in a stroke patient (Preprint)

10.2196/preprints.12472 ◽

2018 ◽

Author(s):

Claudia Nava ◽

Patrizio Sale ◽

Vittorio Leggero ◽

Simona Ferrante ◽

Cira Fundaro' ◽

...

Keyword(s):

Range Of Motion ◽

Stroke Patient ◽

Reference Method ◽

Flexion Angle ◽

Good Reliability ◽

Rater Reliability ◽

Maximum Extension ◽

Angle Measurements ◽

Hemiparetic Gait ◽

Flexion Extension

BACKGROUND In recent years, different smartphone apps have been validated for joint goniometry, but none for goniometric assessment of gait after stroke. OBJECTIVE The aims of our work were to assess:1) to assess intra-rater reliability of an image-based goniometric app – DrGoniometer- in the measurement of the extension, flexion angles and range of motion of the knee during the hemiparetic gait of a stroke patient; (2) its validity comparing to the reference method (electrogoniometer) for flexion-extension excursion measurements; and the intra-rater agreement in the choice of the video frames. METHODS An left-hemiparetic inpatient following haemorrhagic stroke was filmed using the app while walking on a linear path. An electrogoniometer was fixed on the medial face of the affected knee in order to record the dynamic goniometry during gait. Twenty-one raters, blinded to measurements, were recruited to rate knee angle measurements from video acquired with DrGoniometer. Each rater repeated the same procedure twice, the second one at least one day after the first measure. RESULTS Results showed that flexion angle measurements are reliable (ICC95%=0.66, 0.34;0.85; SEM=4°), and adequately precise (CV=14%). Extension angles measurements demonstrated moderate reliability and higher degree of variation (ICC=0.51, 0.09;0.77; SEM 4°; CV=53%). ROM values were: ICC=0.23 (-0.21;0.60); CV=20%. Accuracy of DrGoniometer compared to the electrogoniometer was 7.3±4.7°. The selection of maximum extension frame revealed an accordance of 58% and 72% within a range of ±5 or ±10 frames, respectively; while the best flexion frame reported 86% of agreement for both range of 5 and 10 frames. CONCLUSIONS The results demonstrated moderate to good reliability concerning the maximum extension and flexion angles, while assessing ROM DrGoniometer showed poor intra-rater reliability. Flexion angle measurements seemed to be reliable according to ICC and SEM values and more precise with a limited dispersion of results DrGoniometer revealed a good accuracy in the measurement of range of motion. The agreement of the maximal extension frame was anyway adequate within 5 frames (59%) and noticeably increased within 10 frames (72%). In conclusion, DrGoniometer was found to be a valid and reliable method for assessing knee angles during hemiparetic gait. Further studies are necessary to investigate inter-rater reliability and confirm our results.

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Detection of effort maximality in adults performing isokinetic wrist flexion and extension

Isokinetics and Exercise Science ◽

10.3233/ies-200274 ◽

2021 ◽

pp. 1-7

Author(s):

Mercè Torra ◽

Eduard Pujol ◽

Anna Maiques ◽

Salvador Quintana ◽

Roser Garreta ◽

...

Keyword(s):

High Velocity ◽

Healthy Male ◽

Wrist Flexion ◽

Low Velocity ◽

Wrist Extensor ◽

Submaximal Effort ◽

The Difference ◽

Muscle Groups ◽

Maximal Effort ◽

Flexion And Extension

BACKGROUND: The difference between isokinetic eccentric to concentric strength ratios at high and low velocities (DEC) is a powerful tool for identifying submaximal effort in other muscle groups but its efficiency in terms of the wrist extensors (WE) and flexors (WF) isokinetic effort has hitherto not been studied. OBJECTIVE: The objective of the present study is to examine the usefulness of the DEC for identifying suboptimal wrist extensor and flexor isokinetic efforts. METHODS: Twenty healthy male volunteers aged 20–40 years (28.5 ± 3.2) were recruited. Participants were instructed to exert maximal and feigned efforts, using a range of motion of 20∘ in concentric (C) and eccentric (E) WE and WF modes at two velocities: 10 and 40∘/s. E/C ratios (E/CR) where then calculated and finally DEC by subtracting low velocity E/CR from high velocity ones. RESULTS: Feigned maximal effort DEC values were significantly higher than their maximal effort counterparts, both for WF and WE. For both actions, a DEC cutoff level to detect submaximal effort could be defined. The sensitivity of the DEC was 71.43% and 62.5% for WE ad WF respectively. The specificity was 100% in both cases. CONCLUSION: The DEC may be a valuable parameter for detecting feigned maximal WF and WE isokinetic effort in healthy adults.

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Traumatic Brachial Plexus Palsy in Children: Long-Term Outcome and Strategy of Reconstruction

Journal of Reconstructive Microsurgery ◽

10.1055/s-0041-1726029 ◽

2021 ◽

Author(s):

Tarek A. El-Gammal ◽

Amr El-Sayed ◽

Mohamed M. Kotb ◽

Waleed Riad Saleh ◽

Yasser Farouk Ragheb ◽

...

Keyword(s):

Brachial Plexus ◽

External Rotation ◽

Hand Function ◽

Functional Restoration ◽

Shoulder Abduction ◽

Wrist Flexion ◽

Term Outcome ◽

Long Term Outcome ◽

Age At Surgery ◽

Flexion And Extension

Abstract Background Traumatic brachial plexus injuries in children represent a definite spectrum of injuries between adult and neonatal brachial plexus injuries. Their characteristics have been scarcely reported in the literature. The priority of functional restoration is not clear. Materials and Methods In total, 52 children with surgically treated traumatic brachial plexus injuries, excluding Erb's palsy, were reviewed after a minimum follow-up of 2 years. All children except nine were males, with an average age at surgery of 8 years. Forty-five children had exclusive supraclavicular plexus injuries. Twenty-one of them (46%) had two or more root avulsions. Seven children (13.5%) had infraclavicular plexus injuries. Time from trauma to surgery varied from 1 to 15 months (mean = 4.7 months). Extraplexal neurotization was the most common surgical technique used. Results Shoulder abduction and external rotation were restored to an average of 83 and 26 degrees, respectively. Elbow flexion and extension were restored to grade ≥3 in 96 and 91.5% of cases, respectively. Finger flexion and extension were restored to grade ≥4 in 29 and 32% of cases, respectively. Wrist flexion and extension were restored to grade ≥4 in 21 and 27% of cases, respectively. Results of neurotization were superior to those of neurolysis and nerve grafting. Among the 24 children with insensate hands, 20 (83.3%) recovered S3 sensation, 3 recovered S2, and 1 recovered S1. No case complained of neuropathic pain. Functional recovery correlated negatively but insignificantly with the age at surgery and time from injury to surgery. Conclusion Brachial plexus injuries in children are associated with a high incidence root avulsions and no pain. Neurotization is frequently required and the outcome is not significantly affected by the delay in surgery. In total plexus injuries, some useful hand function can be restored, and management should follow that of obstetric palsy and be focused on innervating the medial cord.

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Joint-Specific Play Controller for Upper Extremity Therapy: Feasibility Study in Children With Wrist Impairment

Physical Therapy ◽

10.2522/ptj.20150493 ◽

2016 ◽

Vol 96 (11) ◽

pp. 1773-1781

Author(s):

Bethany J. Wilcox ◽

Megan M. Wilkins ◽

Benjamin Basseches ◽

Joel B. Schwartz ◽

Karen Kerman ◽

...

Keyword(s):

Upper Extremity ◽

Computer Games ◽

Average Frequency ◽

Cross Sectional Study ◽

Wrist Flexion ◽

Motor Impairments ◽

Cross Sectional ◽

Play Activity ◽

Play Session ◽

Flexion And Extension

Abstract Background Challenges with any therapeutic program for children include the level of the child's engagement or adherence. Capitalizing on one of the primary learning avenues of children, play, the approach described in this article is to develop therapeutic toy and game controllers that require specific and repetitive joint movements to trigger toy/game activation. Objective The goal of this study was to evaluate a specially designed wrist flexion and extension play controller in a cohort of children with upper extremity motor impairments (UEMIs). The aim was to understand the relationship among controller play activity, measures of wrist and forearm range of motion (ROM) and spasticity, and ratings of fun and difficulty. Design This was a cross-sectional study of 21 children (12 male, 9 female; 4–12 years of age) with UEMIs. Methods All children participated in a structured in-clinic play session during which measurements of spasticity and ROM were collected. The children were fitted with the controller and played with 2 toys and 2 computer games for 5 minutes each. Wrist flexion and extension motion during play was recorded and analyzed. In addition, children rated the fun and difficulty of play. Results Flexion and extension goal movements were repeatedly achieved by children during the play session at an average frequency of 0.27 Hz. At this frequency, 15 minutes of play per day would result in approximately 1,700 targeted joint motions per week. Play activity was associated with ROM measures, specifically supination, but toy perception ratings of enjoyment and difficulty were not correlated with clinical measures. Limitations The reported results may not be representative of children with more severe UEMIs. Conclusions These outcomes indicate that the therapeutic controllers elicited repetitive goal movements and were adaptable, enjoyable, and challenging for children of varying ages and UEMIs.

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Patient Self-Assessed Passive Range of Motion of the Knee Cannot Replace Health Professional Measurements

The Journal of Knee Surgery ◽

10.1055/s-0037-1598174 ◽

2017 ◽

Vol 30 (08) ◽

pp. 829-834

Author(s):

Frank Madsen ◽

Anders Odgaard ◽

Jens Borgbjerg

Keyword(s):

Range Of Motion ◽

Knee Extension ◽

Flexion Contracture ◽

Patient Assessment ◽

Limits Of Agreement ◽

Self Assessment ◽

Knee Motion ◽

Bland Altman Method ◽

Flexion And Extension ◽

Patient Self Assessment

AbstractThe purpose of this study was to investigate whether patients can accurately self-assess their knee passive range of motion (PROM). A picture-based questionnaire for patient self-assessment of knee PROM was developed and posted to patients. The self-assessed PROM from 58 patients was compared with surgeon-assessed PROM using a short-arm goniometer. Agreement between the measurement methods was calculated with the Bland-Altman method. We calculated the sensitivity and specificity of patient-assessed PROM in dichotomously detecting knee motion impairment in both flexion (≤ 100 degrees) and extension (≥ 10-degree flexion contracture). Surgeon- and patient-assessed knee PROM showed a mean difference (95% limits of agreement) of −2.1 degrees (−42.5 to 38.3 degrees) for flexion and −8.1 degrees (−28.8 to 12.7 degrees) for extension. The sensitivity of patient self-assessed PROM in identifying knee flexion and extension impairments was 86 and 100%, respectively, whereas its specificity was 84 and 43%, respectively. Although wide limits of agreement were observed between surgeon- and patient-assessed knee PROM, the picture-based questionnaire for patient assessment of knee ROM was found to be a valid tool for dichotomously detecting knee motion impairment in flexion (≤ 100 degrees). However, the specificity of the questionnaire for detection of knee extension impairments (≥ 10-degree flexion contracture) was low, which limits is practical utility for this purpose.

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Validity and reliability of a wearable-controlled serious game and goniometer for telemonitoring of wrist fracture rehabilitation

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-021-01657-5 ◽

2021 ◽

Author(s):

Henriëtte A. W. Meijer ◽

Maurits Graafland ◽

Miryam C. Obdeijn ◽

Marlies P. Schijven ◽

J. Carel Goslings

Keyword(s):

Range Of Motion ◽

Intraclass Correlation ◽

Internal Validity ◽

Wrist Fracture ◽

Serious Game ◽

Reference Standard ◽

Validity And Reliability ◽

Good Reliability ◽

Rater Reliability ◽

Flexion Extension

Abstract Purpose To determine the validity of wrist range of motion (ROM) measurements by the wearable-controlled ReValidate! wrist-rehabilitation game, which simultaneously acts as a digital goniometer. Furthermore, to establish the reliability of the game by contrasting ROM measurements to those found by medical experts using a universal goniometer. Methods As the universal goniometer is considered the reference standard, inter-rater reliability between surgeons was first determined. Internal validity of the game ROM measurements was determined in a test–retest setting with healthy volunteers. The reliability of the game was tested in 34 patients with a restricted range of motion, in whom the ROM was measured by experts as well as digitally. Intraclass-correlation coefficients (ICCs) were determined and outcomes were analyzed using Bland–Altman plots. Results Inter-rater reliability between experts using a universal goniometer was poor, with ICCs of 0.002, 0.160 and 0.520. Internal validity testing of the game found ICCs of − 0.693, 0.376 and 0.863, thus ranging from poor to good. Reliability testing of the game compared to medical expert measurements, found that mean differences were small for the flexion–extension arc and the radial deviation-ulnar deviation arc. Conclusion The ReValidate! game is a reliable home-monitoring device digitally measuring ROM in the wrist. Interestingly, the test–retest reliability of the serious game was found to be considerably higher than the inter-rater reliability of the reference standard, being healthcare professionals using a universal goniometer. Trial registration number (internal hospital registration only) MEC-AMC W17_003 #17.015.

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Assessment of Muscle Activity and Joint Angles in Small-Handed Pianists: A Pilot Study on the 7/8-Sized Keyboard versus the Full-Sized Keyboard

Medical Problems of Performing Artists ◽

10.21091/mppa.2006.1002 ◽

2006 ◽

Vol 21 (1) ◽

pp. 3-9

Author(s):

B G Wristen ◽

M C Jung ◽

A K G Wismer ◽

M S Hallbeck

Keyword(s):

Pilot Study ◽

Research Question ◽

Wrist Flexion ◽

Joint Angles ◽

Ulnar Deviation ◽

Surface Electrodes ◽

Musical Excerpt ◽

Muscle Loading ◽

Maximal Angle ◽

Flexion And Extension

This pilot study examined whether the use of a 7/8 keyboard contributed to the physical ease of small-handed pianists as compared with the conventional piano keyboard. A secondary research question focused on the progression of physical ease in pianists making the transition from one keyboard to the other. For the purposes of this study, a hand span of 8 inches or less was used to define a “small-handed” pianist. The goal was to measure muscle loading and hand span during performance of a specified musical excerpt. For data collection, each of the two participants was connected to an 8-channel electromyography system via surface electrodes, which were attached to the upper back/shoulder, parts of the hand and arm, and masseter muscle of the jaw. Subjects also were fitted with electrogoniometers to capture how the span from the first metacarpophalangeal (MCP) joint to the fifth MCP joint moves according to performance demands, as well as wrist flexion and extension and radial and ulnar deviation. We found that small-handed pianists preferred the smaller keyboard and were able to transition between it and the conventional keyboard. The maximal angle of hand span while playing a difficult piece was about 5º smaller radially and 10º smaller ulnarly for the 7/8 keyboard, leading to perceived ease and better performance as rated by the pianists.

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The surface electromyography analysis of the non-plegic upper limb of hemiplegic subjects

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2010000400016 ◽

2010 ◽

Vol 68 (4) ◽

pp. 562-566 ◽

Cited By ~ 2

Author(s):

Heloyse U Kuriki ◽

Raquel N. de Azevedo ◽

Augusto C. de Carvalho ◽

Fábio Mícolis de Azevedo ◽

Rúben F Negrão-Filho ◽

...

Keyword(s):

Control Group ◽

Electromyographic Activity ◽

Healthy Individuals ◽

Wrist Flexion ◽

Functional Changes ◽

Normal Individuals ◽

Flexor Muscles ◽

Stroke Group ◽

Dominant Member ◽

Flexion And Extension

Many authors have studied physical and functional changes in individuals post-stroke, but there are few studies that assess changes in the non-plegic side of hemiplegic subjects. This study aimed to compare the electromyographic activity in the forearm muscles of spastic patients and clinically healthy individuals, to determine if there is difference between the non-plegic side of hemiplegics and the dominant member of normal individuals. 22 hemiplegic subjects and 15 clinically healthy subjects were submitted to electromyography of the flexor and extensor carpi ulnaris muscles during wrist flexion and extension. The flexor muscles activation of stroke group (average 464.6 u.n) was significantly higher than the same muscles in control group (mean: 106.3 u.n.) during the wrist flexion, what shows that the non affected side does not present activation in the standart of normality found in the control group.

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