Case history: Use of the Nintendo Wii to increase fine motor dexterity post cerebral vascular accident

2009 ◽  
Vol 8 (3) ◽  
pp. 41-46 ◽  
Author(s):  
Karen Drexler, MS, LRT/CTRS
Keyword(s):  
Therapeutic Recreation ◽  
Veterans Affairs ◽  
Fine Motor ◽  
Cerebral Vascular Accident ◽  
Nintendo Wii ◽  
Right Hand ◽  
Motor Dexterity ◽  
The Right ◽  
The Brain

Use of the low cost commercially available gaming console (Nintendo Wii) is a current trend in the rehabilitation environment. Released in 2006 by Nintendo, Veterans Affairs Medical Centers across the country are just setting one, Wii is being used as a physical, social, and cognitive tool. This case report seeks to provide evidence of its use as a rehabilitation tool for individuals who have experienced a recent stroke. By using whole body movements, the Wii sports games help in both gross motor and fine motor skills as well as in hand–eye coordination. This case study involves an older adult who is recovering from a cerebral vascular accident (CVA) and how using the Wii bowling game assisted to increase his fine motor strength and dexterity. CVA or stroke also called a “brain attack” can affect various parts of the brain. There are various signs and symptoms of CVA and these vary in each individual. Some of the signs that an individual having CVA shows are: sudden numbness or weakness of the face, arm or leg (especially on one side of the body), sudden confusion, trouble speaking, or understanding speech, sudden trouble seeing in one or both eyes, sudden trouble walking, dizziness, loss of balance or coordination, sudden severe headache with no known cause. This case study involved an older adult who experienced a CVA involving hemorrhage in the right cerebellum as revealed in a CT scan. This CVA affected the right hand of this individual. Hemorrhagic stroke occurs when a blood vessel in the brain ruptures. This lets blood to spill into nearby brain tissue, which damages the cells. Some brain cells die because their normal blood supply is cut off. Certified Therapeutic Recreation Specialist and Author of this case article utilized the Salisbury Veterans Affairs Medical Center Recreational Therapy initial intake assessment and discovered per patient’s report that he had decreased strength and fine motor dexterity in the fingers of his right hand status post CVA. This patient reported that after his stroke, he was not able to hold a utensil in his right hand. This case study speaks the use of the Nintendo Wii in assisting patient to regain use of the fingers of the hand that was affected by the CVA. This article can provide information for other Certified Therapeutic Recreation Specialists as to the use of the Nintendo Wii™ as a treatment modality. This device can demonstrate outcomes of improving fine motor dexterity for those who are recovering from a CVA.

Controlled Active Extension Programme in Association with Dynamic Splinting for Extensor Tendon Reconstruction Zones III–VIII

1998 ◽  
Vol 3 (1) ◽  
pp. 12-13
Author(s):  
Sonia Ranelli
Keyword(s):  
Extensor Tendon ◽  
Tendon Reconstruction ◽  
Right Hand ◽  
Dynamic Splinting ◽  
The Right

This case study outlines the surgical and physiotherapy management of a delayed extensor tendon reconstruction of the right hand in zones III–VIII

scholarly journals Postoptimization of the model of water supply for urban and industrial agglomeration

2018 ◽  
Vol 23 ◽  
pp. 00035
Author(s):  
Jacek Wawrzosek ◽  
Szymon Ignaciuk
Keyword(s):  
Linear Programming ◽  
Water Supply ◽  
Programming Models ◽  
Industrial Agglomeration ◽  
Infinitely Many Solutions ◽  
Nodal Solutions ◽  
Parametric Linear Programming ◽  
Right Hand ◽  
The Right

A case study of the tools used by an analyst of the economic aspects of the operation of the water supply network has been undertaken in this paper. All issues discussed here are formulated by using degenerated linear programming models ( PL ). Below, it is noted that the linear dependence of binding constraints ( CO ) distorts standard postoptimization procedures in PL. This observed fact makes postoptimization analysis mostly unhelpful for an average analyst due to problems with the int erpretation of ambiguous sensitivity reports which are obtained from popular computer packages. In standard postoptimization methods, changes to single parameters of the right-hand vector CO are analyzed or referred to parametric linear programming that unfortunately requires prior knowledge of mathematically and economically justified vectors of changes of right-hand sides CO. Therefore, it is suggested that modifications are introduced to some of the postoptimization procedures in this work. For issues in the field of hydrology, the following were presented: interpretation and methods of generating justified vectors of changes of right-hand sides of limiting conditions. And so, the procedure of generating infinitely many solutions of the dual issue based on certain vectors orthogonal to the vector of right-hand sides of constraint conditions was demonstrated. Furthermore, the same orthogonal vectors were used to obtain nodal solutions of the dua0l model and the corresponding vectors of changes of the entire right-hand sides of the constraint conditions. Then, managerial interpretation was applied to this way of proceeding. The methods presented in the work serve to improve the functioning of the system of water supply.

Hemispheric Differences in the Relationship Between Corticomotor Excitability Changes Following a Fine-Motor Task and Motor Learning

2004 ◽  
Vol 91 (4) ◽  
pp. 1570-1578 ◽  
Author(s):  
Michael I. Garry ◽  
Gary Kamen ◽  
Michael A. Nordstrom
Keyword(s):  
Motor Learning ◽  
Motor Performance ◽  
Fine Motor ◽  
Hemispheric Differences ◽  
Corticomotor Excitability ◽  
Hand Muscles ◽  
Right Hand ◽  
Left And Right ◽  
The Right ◽  
Intrinsic Hand Muscles

Motor performance induces a postexercise increase in corticomotor excitability that may be associated with motor learning. We investigated whether there are hemispheric differences in the extent and/or time course of changes in corticomotor excitability following a manipulation task (Purdue pegboard) and their relationship with motor performance. Single- and paired-pulse (3 ms) transcranial magnetic stimulation (TMS) was used to assess task-induced facilitation of the muscle evoked potential (MEP) and intracortical inhibition (ICI) for three intrinsic hand muscles acting on digits 1, 2, and 5. Fifteen right-handed subjects performed three 30-s pegboard trials with left or right hand in separate sessions. TMS was applied to contralateral motor cortex before and after performance. Number of pegs placed was higher with the right hand, and performance improved (motor learning) with both hands over the three trials. MEP facilitation following performance was short-lasting (<15 min), selective for muscles engaged in gripping the pegs, and of similar magnitude in left and right hands. ICI was reduced immediately following performance with the right hand, but not the left. The extent of MEP facilitation was positively correlated with motor learning for the right hand only. We conclude that the pegboard task induces a selective, short-lasting change in excitability of corticospinal neurons controlling intrinsic hand muscles engaged in the task. Only left hemisphere changes were related to motor learning. This asymmetry may reflect different behavioral strategies for performance improvement with left and right upper limb in this task or hemispheric differences in the control of skilled hand movements.

Embolism of the Cerebral Arteries—Softening of the Pons Varolii

1879 ◽  
Vol 24 (108) ◽  
pp. 617-622
Author(s):  
Henry Clarke
Keyword(s):  
Cerebral Arteries ◽  
The Other ◽  
Loss Of Consciousness ◽  
Right Hand ◽  
Constant Pain ◽  
The Right ◽  
The Brain

Elizabeth W., æt. 35, married, three children, one living, two dead, one at four months old, from “fits,” the other at six months, from “water on the brain.” No miscarriages. Patient states that she never had a day's illness in her life. She was committed to prison Dec. 31, 1877, and up till the commencement of her present illness, has been quite well, except that for the last few weeks she has suffered from a constant pain at the back of her neck. On February 20th, 1878, about 11.30 a.m., while sitting in her cell picking oakum, she felt a sudden numbness in the right hand and arm, and almost directly afterwards found that she was unable to speak, or move the right arm or leg. There was no loss of consciousness. She was seen within ten minutes of the attack, and had then partly recovered her speech, but still spoke thickly and indistinctly. Had regained power in the leg, but only partially in the arm. Sent to hospital.

Case Study

2014 ◽  
Vol 4 (3) ◽  
pp. 27-30
Author(s):  
Akash Shrikhande ◽  
Thierry Galvez ◽  
Nicolas Langendorfer ◽  
Krishna Jain ◽  
Rakesh Biswas
Keyword(s):  
Experiential Learning ◽  
Clinical Course ◽  
Parietal Region ◽  
Lower Zone ◽  
Left Thalamus ◽  
The Right ◽  
Contrast Ct ◽  
Supportive Management ◽  
The Brain

The authors discuss the clinical complexities surrounding an 85-year-old male complaining of left sided weakness for one month, along with cough and fever for 20 days. Findings on non-contrast CT scan of the brain showed an acute-on-chronic infarct in the right parietal region, in the territory of the right middle cerebral artery, with lacunar infarct in the left thalamus. A chest radiograph showed a heterogeneous opacity in the right lower zone, and air bronchogram with an elevated right dome of the diaphragm. The patient was diagnosed to have suffered a stroke with a subsequent right-sided pneumonia due to diaphragmatic palsy. The patient was put on ventilator and further supportive management was instituted. This article presents the clinical course of the case and the experiential learning associated with it.

scholarly journals Multiple cerebral infarction diagnosed as Eosinophilic Granulomatosis with Polyangiitis by autopsy

BMC Neurology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Kenichiro Hira ◽  
Hideki Shimura ◽  
Riyu Kamata ◽  
Masashi Takanashi ◽  
Akane Hashizume ◽  
...  
Keyword(s):  
Granulomatosis With Polyangiitis ◽  
Systemic Vasculitis ◽  
Brain Infarction ◽  
Eosinophil Infiltration ◽  
Eosinophilic Granulomatosis With Polyangiitis ◽  
Consciousness Disturbance ◽  
The Right ◽  
The Brain ◽  
Eosinophilic Granulomatosis

Abstract Background Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic vasculitis of unknown cause involving the brain and accompanied by prominent eosinophilia. Intracardiac thrombosis is a major cardiac complication of EGPA that may cause thromboembolism. Case presentation A 53-year-old man presenting with abulia (consciousness disturbance) and left upper limb paralysis was admitted to our hospital. His case was complicated by penetrating branches, small vessel infarcts, and endocardial thrombosis in the right and left ventricle. Cardiomyopathy was also observed. Sixteen days after admission, the patient died from intracranial hemorrhage. Brain autopsy revealed two major findings: 1) large hemorrhagic infarction caused by cardiac embolism; and 2) granuloma and eosinophil infiltration. Vasculitis was accompanied by eosinophil infiltration in the cortical blood vessels and granuloma. Conclusions In this case study, we report autopsy findings of brain infarction in a patient with EGPA and endocardial thrombosis. The brain infarction was caused by the cardiac embolisms and vasculitis.

scholarly journals Hemispheric antagonism in visuo-spatial neglect: A case study

1996 ◽  
Vol 2 (5) ◽  
pp. 412-418 ◽  
Author(s):  
John C. Marshall ◽  
Peter W. Halligan
Keyword(s):  
Right Hemisphere ◽  
Task Demands ◽  
Line Bisection ◽  
Spatial Neglect ◽  
Perceptual Task ◽  
Left Hand ◽  
Right Hand ◽  
The Right ◽  
Line Bisection Task

AbstractWe report a case of severe visuo-spatial neglect consequent upon right-hemisphere stroke. At the time of testing, the patient had no visual field cut and no significant hemiparesis. Conventional testing on cancellation tasks with the right hand revealed reliable left neglect, but performance was significantly improved when the left hand was used. Investigations of (manual) line bisection showed normal performance with the right hand but right neglect when the left hand was used. Right neglect was also observed on a purely perceptual version of the line bisection task. We argue that the attentional vectors of the cerebral hemispheres can be modulated by (perceptual) task-demands and by (motorie) response demands. (JINS, 1996, 2, 412–418.)

Intermanual Differences on Motor and Psychomotor Tests in Alcoholics: No Evidence for Selective Right-Hemisphere Dysfunction

1997 ◽  
Vol 84 (2) ◽  
pp. 403-414 ◽  
Author(s):  
Lauren M. Kwon ◽  
Sean B. Rourke ◽  
Igor Grant
Keyword(s):  
Right Hemisphere ◽  
Poor Performance ◽  
Fine Motor ◽  
Motor Speed ◽  
Psychomotor Tests ◽  
Chronic Alcohol Abuse ◽  
Right Hemisphere Dysfunction ◽  
Motor Dexterity ◽  
The Right

Some previous studies have suggested that alcoholics exhibit selective right-hemisphere dysfunction, based on alcoholics' poor performance on tests believed to subserve the right hemisphere. However, some of these experiments did not account adequately for differences in difficulty or novelty in putative right hemisphere tasks. This experiment was designed to evaluate and compare intermanual differences in grip strength, motor speed, fine-motor dexterity, and nonverbal problem-solving ability in 93 recently detoxified alcoholics, 54 long-term abstinent alcoholics, and 73 nonalcoholic controls. All subjects were right-handed men, matched for age and education, and both alcoholic groups had similar drinking histories. Using percent difference scores to assess intermanual differences, adjusted for demographics where appropriate, we found that, although recently detoxified alcoholics demonstrate some motor and psychomotor impairments, there is no evidence using these tests to suggest the right hemisphere is selectively more vulnerable to the effects of chronic alcohol abuse.

Effect of limb anesthesia on middle cerebral response to handgrip

1993 ◽  
Vol 264 (2) ◽  
pp. H553-H559 ◽  
Author(s):  
L. G. Jorgensen ◽  
G. Perko ◽  
G. Payne ◽  
N. H. Secher
Keyword(s):  
Blood Pressure ◽  
Regional Anesthesia ◽  
Transcranial Doppler Ultrasound ◽  
Afferent Input ◽  
Mean Flow ◽  
Pronounced Increase ◽  
Left Hand ◽  
Right Hand ◽  
The Right ◽  
The Brain

Transcranial Doppler ultrasound was used to measure middle cerebral arterial mean flow velocity (Vmean) on both sides of the brain in 12 subjects during hand contractions before and during regional anesthesia of the left arm. At rest Vmean was 49 (36-104) cm/s (median and range) and was unaffected by regional anesthesia. During right-hand contractions Vmean remained unchanged on the right side of the brain, whereas it increased 20 (4-37)% (P < 0.01) on the left side of the brain. Similarly, during left-hand contractions Vmean increased 24 (2-42)% (P < 0.01) on the right side of the brain, while it remained unchanged on the left side of the brain. Regional anesthesia did not quantitatively affect Vmean during right-hand contractions. In contrast, during left-hand contractions, both right and left Vmean tended to decrease. Increases in Vmean appeared despite a decrease in arterial carbon dioxide tension (P < 0.01). Heart rate and blood pressure responses to hand contractions were enhanced during regional anesthesia (P < 0.01), but left-hand contractions resulted in a less pronounced increase in blood pressure (P < 0.01). These data demonstrate a contralateral increase in cerebral perfusion during hand contractions that is dependent on intact afferent input from the working limb.

Case Study - Leprosy

2010 ◽  
Vol 96 (2) ◽  
pp. 92-95
Author(s):  
A M Wood ◽  
C M Wood ◽  
J Bakker-Dyos
Keyword(s):  
Clinical Diagnosis ◽  
Dry Skin ◽  
Large Lesion ◽  
Right Hand ◽  
The Uk ◽  
The Right

AbstractWe present the case of a 26 year old Indian base worker who attended the Role 2 enhanced hospital in Iraq with a case of leprosy. The patient presented four times over a 12 month period with non-specific pain in the right hand and forearm combined with a large lesion of dry skin and reduced sensation in the forearm. A clinical diagnosis of leprosy was made, which was subsequently confirmed as paucibacillary leprosy by skin smears sent to the UK. It was not possible to treat the patient locally and a recommendation made to the patient’s employer that the patient return to India to commence treatment.

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