scholarly journals Preliminary Examination of the Ability of a New Wearable Device to Capture Functional Hand Activity After Stroke

Stroke ◽  
2019 ◽  
Vol 50 (12) ◽  
pp. 3643-3646 ◽  
Author(s):  
Lisa A. Simpson ◽  
Amanda Mow ◽  
Carlo Menon ◽  
Janice J. Eng
Keyword(s):  
Upper Limb ◽  
Optimal Dose ◽  
Wearable Device ◽  
Reach To Grasp ◽  
Scaling Properties ◽  
Preliminary Examination ◽  
Consistent Manner ◽  
The Mean ◽  
Mean Differences ◽  
The Impact

Background and Purpose— A reliable measure of movement repetitions is required to assist in determining the optimal dose for maximizing upper limb recovery after stroke. This study investigated the ability of a new wearable device to capture reach-to-grasp repetitions in individuals with stroke. Methods— Eight individuals with stroke wore an instrumented wrist bracelet while completing 12 upper limb activities. Participants completed 5 and 10 repetitions of each activity on 2 separate sessions (time 1 and time 2) and completed clinical assessments (Fugl-Meyer Upper Extremity Assessment and Action Research Arm Test). Mean reach-to-grasp counts (ie, hand counts) were compared across activities. Scaling properties were assessed by the ratio of 10 repetitions to 5 repetitions for the activities (ie, expected value of 2). Bland-Altman diagrams were used to examine agreement between time 1 and time 2 counts. Results— The wrist bracelet averaged 0 to 0.6 hand counts per repetition for the arm-only and hand-only activities and averaged 1 to 2 counts per repetition of the reach-to-grasp activities. The mean ratio of 10 repetition to 5 repetition counts was ≈2 for all of the reach-to-grasp activities. Mean differences from time 1 to time 2 were <0.3 counts/repetition for all activities except one. Conclusions— These preliminary results provide evidence that the wrist bracelet is able to capture hand counts over a variety of tasks in a consistent manner. This wrist bracelet could be further developed as a tool to record dose of upper limb practice for research or clinical practice, as well as providing motivation and accountability to patients participating in treatments requiring upper limb movement repetitions. Currently, there are limitations in interpreting the impact of impairment and common compensatory movements on hand counts, and it would be valuable for future studies to explore these effects.

scholarly journals Clinicians’ perceptions of a potential wearable device for capturing upper limb activity post-stroke: a qualitative focus group study

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Lisa A. Simpson ◽  
Carlo Menon ◽  
Antony J. Hodgson ◽  
W. Ben Mortenson ◽  
Janice J. Eng
Keyword(s):  
Upper Limb ◽  
Physical Therapists ◽  
Optimal Dose ◽  
Wearable Devices ◽  
Wearable Device ◽  
Reach To Grasp ◽  
Focus Group Study ◽  
Self Monitoring ◽  
Homework Adherence ◽  
Therapy Sessions

Abstract Background There is growing interest in the use of wearable devices that track upper limb activity after stroke to help determine and motivate the optimal dose of upper limb practice. The purpose of this study was to explore clinicians’ perceptions of a prospective wearable device that captures upper limb activity to assist in the design of devices for use in rehabilitation practice. Methods Four focus groups with 18 clinicians (occupational and physical therapists with stroke practice experience from a hospital or private practice setting) were conducted. Data were analyzed thematically. Results Our analysis revealed three themes: (1) “Quantity and quality is ideal” emphasized how an ideal device would capture both quantity and quality of movement; (2) “Most useful outside therapy sessions” described how therapists foresaw using the device outside of therapy sessions to monitor homework adherence, provide self-monitoring of use, motivate greater use and provide biofeedback on movement quality; (3) “User-friendly please” advocated for the creation of a device that was easy to use and customizable, which reflected the client-centered nature of their treatment. Conclusions Findings from this study suggest that clinicians support the development of wearable devices that capture upper limb activity outside of therapy for individuals with some reach to grasp ability. Devices that are easy to use and capture both quality and quantity may result in greater uptake in the clinical setting. Future studies examining acceptability of wearable devices for tracking upper limb activity from the perspective of individuals with stroke are needed.

scholarly journals Effect of post-stroke spasticity on voluntary movement of the upper limb

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Hadar Lackritz ◽  
Yisrael Parmet ◽  
Silvi Frenkel-Toledo ◽  
Melanie C. Baniña ◽  
Nachum Soroker ◽  
...  
Keyword(s):  
Upper Limb ◽  
Target Location ◽  
Distance Measure ◽  
Movement Time ◽  
Motor Impairment ◽  
Reach To Grasp ◽  
Motion Patterns ◽  
Post Stroke ◽  
The Impact ◽  
Elbow Motion

Abstract Background Hemiparesis following stroke is often accompanied by spasticity. Spasticity is one factor among the multiple components of the upper motor neuron syndrome that contributes to movement impairment. However, the specific contribution of spasticity is difficult to isolate and quantify. We propose a new method of quantification and evaluation of the impact of spasticity on the quality of movement following stroke. Methods Spasticity was assessed using the Tonic Stretch Reflex Threshold (TSRT). TSRT was analyzed in relation to stochastic models of motion to quantify the deviation of the hemiparetic upper limb motion from the normal motion patterns during a reaching task. Specifically, we assessed the impact of spasticity in the elbow flexors on reaching motion patterns using two distinct measures of the ‘distance’ between pathological and normal movement, (a) the bidirectional Kullback–Liebler divergence (BKLD) and (b) Hellinger’s distance (HD). These measures differ in their sensitivity to different confounding variables. Motor impairment was assessed clinically by the Fugl-Meyer assessment scale for the upper extremity (FMA-UE). Forty-two first-event stroke patients in the subacute phase and 13 healthy controls of similar age participated in the study. Elbow motion was analyzed in the context of repeated reach-to-grasp movements towards four differently located targets. Log-BKLD and HD along with movement time, final elbow extension angle, mean elbow velocity, peak elbow velocity, and the number of velocity peaks of the elbow motion were computed. Results Upper limb kinematics in patients with lower FMA-UE scores (greater impairment) showed greater deviation from normality when the distance between impaired and normal elbow motion was analyzed either with the BKLD or HD measures. The severity of spasticity, reflected by the TSRT, was related to the distance between impaired and normal elbow motion analyzed with either distance measure. Mean elbow velocity differed between targets, however HD was not sensitive to target location. This may point at effects of spasticity on motion quality that go beyond effects on velocity. Conclusions The two methods for analyzing pathological movement post-stroke provide new options for studying the relationship between spasticity and movement quality under different spatiotemporal constraints.

scholarly journals Reproducibility and inter-observer agreement of Greulich-Pyle protocol to estimate skeletal age among female adolescent soccer players

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Yuri V. Faustino-da-Silva ◽  
Diogo V. Martinho ◽  
Manuel J. Coelho-e-Silva ◽  
João Valente-dos-Santos ◽  
Jorge Conde ◽  
...  
Keyword(s):  
Female Adolescent ◽  
Skeletal Age ◽  
Observer Agreement ◽  
Soccer Players ◽  
Biological Maturation ◽  
Reproducible Method ◽  
The Mean ◽  
Mean Differences ◽  
The Impact

Abstract Background Skeletal age (SA) is considered the best method of assessing biological maturation. The aim of this study was to determine intra-observer (reproducibility) and inter-observer agreement of SA values obtained via the Greulich-Pyle (GP) method. In addition, the variation in calculated SAs by alternative GP protocols was examined. Methods The sample was composed of 100 Portuguese female soccer players aged 12.0–16.7 years. SAs were determined using the GP method by two observers (OB1: experience < 100 exams using GP; OB2: experience > 2000 exams using several methods). The radiographs were examined using alternative GP protocols: (wholeGP) the plate was matched to the atlas as an overall approach; (30-boneGP) bone-by-bone inspections of 30-bones; (GPpmb) bone-by-bone inspections of the pre-mature bones only. For the 30-boneGP and GPpmb approaches, SA was calculated via the mean (M) and the median (Md). Results Reproducibility ranged 82–100% and 88–100% for OB1 and OB2, respectively. Inter-observer agreement (100 participants multiplied by 30 bones) was 92.1%. For specific bones, agreement rates less than 90% were found for scaphoid (81%), medial phalange V (83%), trapezium (84%) and metacarpal V (87%). Differences in wholeGP SAs obtained by the two observers were moderate (d-cohen was 0.79). Mean differences between observers when using bone-by bone SAs were trivial (30-boneGP: d-cohen less than 0.05; GPpmb: d-cohen less than 0.10). The impact of using the mean or the median was negligible, particularly when analyses did not include bones scored as mature. Conclusion The GP appeared to be a reasonably reproducible method to assess SA and inter-observer agreement was acceptable. There is evidence to support a recommendation of only scoring pre-mature bones during later adolescence. Further research is required to examine whether these findings are consistent in younger girls and in boys.

Effect of bodyweight on VerifyNow Aspirin platelet function test: a retrospective review

2020 ◽  
pp. neurintsurg-2020-016842
Author(s):  
Melissa Sandler ◽  
Cuong Hoang ◽  
Hannah Y Mak ◽  
Michael R Levitt
Keyword(s):  
Stent Thrombosis ◽  
Retrospective Review ◽  
Platelet Reactivity ◽  
Thrombotic Event ◽  
Optimal Dose ◽  
Platelet Inhibition ◽  
Platelet Function Test ◽  
Assay Result ◽  
The Mean ◽  
The Impact

BackgroundAntiplatelet therapy is used to prevent stent thrombosis in intracranial stents, but the optimal dose of aspirin is unknown. This study sought to determine whether the degree of platelet inhibition with aspirin is affected by bodyweight as observed through a platelet reactivity assay.MethodsThis is a retrospective review of patients who underwent neurovascular stent placement and had a VerifyNow Aspirin assay result. The primary outcome was the correlation between the VerifyNow Aspirin result, bodyweight, and the initial dose of aspirin. Secondary outcomes included the impact of the VerifyNow P2Y12 result and of weight on the incidence of bleeding or a thrombotic event.ResultsOf the 142 included patients, 62.7% weighed ≥70 kg and 88.7% were initiated on aspirin 300–325 mg daily. 83.8% achieved a therapeutic VerifyNow Aspirin result. There was minimal correlation between the VerifyNow Aspirin result, bodyweight, and aspirin dose (R2=0.02). Between patients who weighed <70 kg versus ≥70 kg, there was no difference in the mean aspirin reaction units (ARU) (449 vs 435, p=0.32) or in the incidence of bleeding (28% vs 17.1%, p=0.14) or a thrombotic event (4% vs 5.3%, p=0.59). No patient experienced stent thrombosis and eight patients experienced in-stent stenosis. In a multivariate analysis, only the VerifyNow P2Y12 result predicted the development of either bleeding or a thrombotic event (p<0.01).ConclusionsBodyweight did not influence the likelihood of obtaining a therapeutic VerifyNow Aspirin result. The clinical utility of obtaining VerifyNow Aspirin assays for this patient population is unknown.

SCALING PROPERTIES OF FIRST RETURN TIME ON WEIGHTED TRANSFRACTALS (1,3)-FLOWERS

Fractals ◽  
2018 ◽  
Vol 26 (06) ◽  
pp. 1850095 ◽  
Author(s):  
MEIFENG DAI ◽  
HUIJIA CHI ◽  
XIANBIN WU ◽  
YUE ZONG ◽  
WENJING FENG ◽  
...  
Keyword(s):  
Complex Networks ◽  
Real Life ◽  
Probability Generating Function ◽  
Return Time ◽  
Exact Probability ◽  
Scaling Properties ◽  
Mean And Variance ◽  
The Mean ◽  
First Return Time ◽  
The Impact

Complex networks are omnipresent in science and in our real life, and have been the focus of intense interest. It is vital to research the impact of their characters on the dynamic progress occurring on complex networks for weight-dependent walk. In this paper, we first consider the weight-dependent walk on one kind of transfractal (or fractal) which is named the weighted transfractal [Formula: see text]-flowers. And we pay attention to the first return time (FRT). We mainly calculate the mean and variance of FRT for a prescribed hub (i.e. the most concerned nodes) in virtue of exact probability generating function and its properties. Then, we obtain the mean and the secondary moment of the first return time. Finally, using the relationship among the variance, mean and the secondary moment, we obtain the variance of FRT and the scaling properties of the mean and variance of FRT on weighted transfractals [Formula: see text]-flowers.

scholarly journals Validation of a Human Pose Tracking Algorithm for Measuring Upper Limb Joints: Comparison With Photography-based Goniometry

2022 ◽  
Author(s):  
Qingtang Zhu ◽  
Jingyuan Fan ◽  
Fanbin Gu ◽  
Lulu Lv ◽  
Zhejin Zhang ◽  
...  
Keyword(s):  
Upper Limb ◽  
Digital Camera ◽  
Correlation Coefficients ◽  
Tracking Algorithm ◽  
Shoulder Abduction ◽  
Intra Class Correlation ◽  
Pose Tracking ◽  
Rgb Images ◽  
The Mean ◽  
Mean Differences

Abstract Background: Range of motion (ROM) measurements are essential for diagnosing and evaluating upper extremity conditions. Clinical goniometry is the most commonly used methods but it is time-consuming and skill-demanding. Recent advances in human tracking algorithm suggest potential for automatic angle measuring from RGB images. It provides an attractive alternative for at-distance measuring. However, the reliability of this method has not been fully established. The purpose of this study is to evaluate if the results of algorithm are as reliable as human raters in upper limb movements.Methods: Thirty healthy young adults (20 males, 10 females) participated in this study. Participants were asked to performed a 6-motion task including movement of shoulder, elbow and wrist. Images of movements were capture by commercial digital camera. Each movement was measured by a pose tracking algorithm and compared with the surgeon-measurement results. The mean differences between the two measurements were compared. Pearson correlation coefficients were used to determine the relationship. Reliability was investigated by the intra-class correlation coefficients.Results: Comparing this algorithm-based method with manual measurement, the mean differences were less than 3 degrees in 5 motions (shoulder abduction: 0.51; shoulder elevation: 2.87; elbow flexion:0.38; elbow extension:0.65; wrist extension: 0.78) except wrist flexion. All the intra-class correlation coefficients were larger than 0.60. The Pearson coefficients also showed high correlations between the two measurements (p<0.001). Conclusions: Our results indicated that pose estimation is a reliable method to measure the shoulder and elbow angles, supporting RGB images for measuring joint ROM. Our results proved the possibility that patients can assess their ROM by photos taken by a digital camera.Trial registration: This study was registered in the Clinical Trials Center of The First Affiliated Hospital, Sun Yat-sen University (2021-387).

scholarly journals Bridging the Gap between Theory and Practice; the Active Role of Inpatient Pharmacists in Therapeutic Drug Monitoring

Pharmacy ◽  
2019 ◽  
Vol 7 (1) ◽  
pp. 20 ◽  
Author(s):  
Abrar Alhameed ◽  
Sara Khansa ◽  
Hani Hasan ◽  
Sherine Ismail ◽  
Mohammed Aseeri
Keyword(s):  
Statistical Significance ◽  
Optimal Dose ◽  
Active Role ◽  
Mean Difference ◽  
Theory And Practice ◽  
Therapeutic Drug ◽  
Retrospective Assessment ◽  
The Mean ◽  
Mean Differences

Many hospitals face barriers in the implementation of TDM services, this study aimed to evaluate a pharmacist-led TDM service to optimize patients’ outcomes. Adult patients who were administered vancomycin, gentamicin, or amikacin were included. The pre-phase included a retrospective assessment of patients and the intervention phase consisted of an educational program. The post-phase assessed patients based on TDM services provided by inpatient pharmacists on a 24-h, 7-day basis for 3 months. The primary outcome was to assess the mean difference in proportion of correct initial doses of prescribing orders. Secondary outcomes included assessing the mean differences in proportions of correct dose adjustments and correct drug sampling time. Seventy-five patients in each phase were eligible. Patients who received optimal initial dosing in the post-phase showed a higher statistical significance, mean difference of 0.31, [95% CI (0.181–0.4438), p < 0.0001]. Patients in the post-phase received more optimal dose adjustments, mean difference of 0.1, [95% CI (−0.560–0.260), p = 0.2113]. Drug levels were ordered more correctly in the post-phase, mean difference of 0.03, [95% CI (−0.129–0.189), p = 0.7110]. This study demonstrated the important role of TDM services led by pharmacists in optimizing the initial dosing for these antibiotics.

scholarly journals Differences in Lipid Measurements by Antiretroviral Regimen Exposure in Cohorts from Asia and Australia

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Amit C. Achhra ◽  
Janaki Amin ◽  
Jennifer Hoy ◽  
Junko Tanuma ◽  
Thira Sirisanthana ◽  
...  
Keyword(s):  
Protease Inhibitor ◽  
High Density Lipoprotein ◽  
Total Cholesterol ◽  
High Density Lipoprotein Cholesterol ◽  
Density Lipoprotein ◽  
Antiretroviral Drugs ◽  
Reverse Transcriptases ◽  
The Mean ◽  
Mean Differences ◽  
The Impact

We explored the mean differences in routinely measured lipids (total cholesterol, triglycerides, and high-density lipoprotein cholesterol) according to exposure to different combination antiretroviral regimens in Asian (n=2051) and Australian (predominantly Caucasian,n=794) cohorts. The regimen was defined as at least 3 antiretroviral drugs with at least 2 nucleoside-reverse transcriptases (NRTIs) and either of at least one protease inhibitor (PI) or non-nucleoside-reverse transcriptases (NNRTIs). We categorised cART regimens as: NRTIs as tenofovir based or not; NNRTIs as nevirapine or efavirenz (but not both); and PI as atazanavir based or not. We found that the impact of various antiretroviral regimens on lipids in Asian and Australian cohorts was only different by cohort for total cholesterol (Pfor interaction between regimen and cohort: <0.001) but not in case of other lipids (Pfor interaction: >0.05). The differences in total cholesterol were however small and unlikely to be of clinical significance. Overall, tenofovir with nevirapine or atazanavir was associated with the most favorable lipids, while the PI regimens without tenofovir and atazanavir were associated with least favorable lipids. We conclude that the impact of various ART regimens on lipids is largely similar in Asian and Australian cohorts and that the newer drugs such as tenofovir and atazanavir are likely to provide similar benefit in terms of lipid profiles in both populations.

scholarly journals Optimal dose of perineural dexmedetomidine to prolong analgesia after brachial plexus blockade: a systematic review and Meta-analysis of 57 randomized clinical trials

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hai Cai ◽  
Xing Fan ◽  
Pengjiu Feng ◽  
Xiaogang Wang ◽  
Yubo Xie
Keyword(s):  
Clinical Trials ◽  
Brachial Plexus ◽  
Upper Limb ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Optimal Dose ◽  
Adult Patients ◽  
Cochrane Library ◽  
Upper Limb Surgery ◽  
The Mean

Abstract Background and Objectives Peripheral injection of dexmedetomidine (DEX) has been widely used in regional anesthesia to prolong the duration of analgesia. However, the optimal perineural dose of DEX is still uncertain. It is important to elucidate this characteristic because DEX may cause dose-dependent complications. The aim of this meta-analysis was to determine the optimal dose of perineural DEX for prolonged analgesia after brachial plexus block (BPB) in adult patients undergoing upper limb surgery. Method A search strategy was created to identify suitable randomized clinical trials (RCTs) in Embase, PubMed and The Cochrane Library from inception date to Jan, 2021. All adult patients undergoing upper limb surgery under BPB were eligible. The RCTs comparing DEX as an adjuvant to local anesthetic (LA) with LA alone for BPB were included. The primary outcome was duration of analgesia for perineural DEX. Secondary outcomes included visual analog scale (VAS) in 12 and 24 h, consumption of analgesics in 24 h, and adverse events. Results Fifty-seven RCTs, including 3332 patients, were identified. The subgroup analyses and regression analyses revealed that perineural DEX dose of 30-50 μg is an appropriate dosage. With short−/intermediate-acting LAs, the mean difference (95% confidence interval [CI]) of analgesia duration with less than and more than 60 μg doses was 220.31 (153.13–287.48) minutes and 68.01 (36.37–99.66) minutes, respectively. With long-acting LAs, the mean differences (95% CI) with less than and more than 60 μg doses were 332.45 (288.43–376.48) minutes and 284.85 (220.31–349.39) minutes. Conclusion 30-50 μg DEX as adjuvant can provides a longer analgesic time compared to LA alone and it did not increase the risk of bradycardia and hypotension.

Asteroid and Comet Impact Speeds upon Mars: Significance for Panspermia and the Supply of Organics

1997 ◽  
Vol 161 ◽  
pp. 197-201 ◽  
Author(s):  
Duncan Steel
Keyword(s):  
Probability Distributions ◽  
Regions Of Interest ◽  
Significant Fraction ◽  
Organic Chemicals ◽  
Impact Speed ◽  
The Mean ◽  
The Impact

AbstractWhilst lithopanspermia depends upon massive impacts occurring at a speed above some limit, the intact delivery of organic chemicals or other volatiles to a planet requires the impact speed to be below some other limit such that a significant fraction of that material escapes destruction. Thus the two opposite ends of the impact speed distributions are the regions of interest in the bioastronomical context, whereas much modelling work on impacts delivers, or makes use of, only the mean speed. Here the probability distributions of impact speeds upon Mars are calculated for (i) the orbital distribution of known asteroids; and (ii) the expected distribution of near-parabolic cometary orbits. It is found that cometary impacts are far more likely to eject rocks from Mars (over 99 percent of the cometary impacts are at speeds above 20 km/sec, but at most 5 percent of the asteroidal impacts); paradoxically, the objects impacting at speeds low enough to make organic/volatile survival possible (the asteroids) are those which are depleted in such species.

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