Developing and assessing a new web-based tapping test for measuring distal movement in Parkinson’s disease: a Distal Finger Tapping test

Disability in Parkinson’s disease (PD) is measured by standardised scales including the MDS-UPDRS, which are subject to high inter and intra-rater variability and fail to capture subtle motor impairment. The BRadykinesia Akinesia INcoordination (BRAIN) test is a validated keyboard tapping test, evaluating proximal upper-limb motor impairment. Here, a new Distal Finger Tapping (DFT) test was developed to assess distal upper-limb function. Kinetic parameters of the test include kinesia score (KS20, key taps over 20 s), akinesia time (AT20, mean dwell-time on each key) and incoordination score (IS20, variance of travelling time between key taps). To develop and evaluate a new keyboard-tapping test for objective and remote distal motor function in PD patients. The DFT and BRAIN tests were assessed in 55 PD patients and 65 controls. Test scores were compared between groups and correlated with the MDS-UPDRS-III finger tapping sub-scores. Nine additional PD patients were recruited for monitoring motor fluctuations. All three parameters discriminated effectively between PD patients and controls, with KS20 performing best, yielding 79% sensitivity for 85% specificity; area under the receiver operating characteristic curve (AUC) = 0.90. A combination of DFT and BRAIN tests improved discrimination (AUC = 0.95). Among three parameters, KS20 showed a moderate correlation with the MDS-UPDRS finger-tapping sub-score (Pearson’s r = − 0.40, p = 0.002). Further, the DFT test detected subtle changes in motor fluctuation states which were not reflected clearly by the MDS-UPDRS-III finger tapping sub-scores. The DFT test is an online tool for assessing distal movements in PD, with future scope for longitudinal monitoring of motor complications.

Stroke - shoulder pain and upper limb function

Introduction: Stroke causes disability and pain, especially shoulder pain. Often, shoulder pain, has a not completely known mechanism and evolution.1,2 Objectives: Assess shoulder pain and its impact in upper limb function, in patients who had suffered a stroke within 6 months. Methods: Observational study. Included patients at discharge from an inpatient rehabilitation centre, from November 2019 until February 2020. Assessment was done using validated Portuguese versions of the Brief Pain Inventory (BPI) and Fugl Meyer Assessment Scale (FMAS). Results: Of 32 patients screened, 26 fulfilled the inclusion criteria, 7 were females (26,9 %), with mean age of 60,7±10 years. Mean values of BPI Severity and Interference were 3,2±1,6 and 2,4±1,8, respectively. The mean values of the FMAS Motor Function and Passive Articular Movement were 38,8±23,2 and 20,3±2,3, respectively. Analysing the association between both subscales of BPI and both Subscales of FMAS negative correlations were found to be statistically significant with a confidence interval of 95% but there was no correlation between BPI Severity and FMAS motor function. Six patients (23%) received a local injection for shoulder pain. Analysing both groups, BPI Severity and both subscales of FMAS showed a statistically significant difference (p values of 0,0083, 0,0031 and 0,0056, respectively) for a Wilcoxon/Kruskal-Wallis test with a confidence interval of 95%. Discussion/Conclusions: Patients with voluntary upper limb movements after a stroke tend to have less shoulder pain. Local injection was an effective intervention for shoulder pain. The greatest limitation of this study is the small sample size.

Low-Frequency rTMS over Contralesional M1 Increases Ipsilesional Cortical Excitability and Motor Function with Decreased Interhemispheric Asymmetry in Subacute Stroke: A Randomized Controlled Study

Objective. To determine the long-term effects of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) over the contralesional M1 preceding motor task practice on the interhemispheric asymmetry of the cortical excitability and the functional recovery in subacute stroke patients with mild to moderate arm paresis. Methods. Twenty-four subacute stroke patients were randomly allocated to either the experimental or control group. The experimental group underwent rTMS over the contralesional M1 (1 Hz), immediately followed by 30 minutes of motor task practice (10 sessions within 2 weeks). The controls received sham rTMS and the same task practice. Following the 2-week intervention period, the task practice was continued twice weekly for another 10 weeks in both groups. Outcomes were evaluated at baseline (T0), at the end of the 2-week stimulation period (T1), and at 12-week follow-up (T2). Results. The MEP (paretic hand) and interhemispheric asymmetry, Fugl-Meyer motor assessment, Action Research Arm Test, and box and block test scores improved more in the experimental group than controls at T1 ( p < 0.05 ). The beneficial effects were largely maintained at T2. Conclusion. LF-rTMS over the contralesional M1 preceding motor task practice was effective in enhancing the ipsilesional cortical excitability and upper limb function with reducing interhemispheric asymmetry in subacute stroke patients with mild to moderate arm paresis. Significance. Adding LF-rTMS prior to motor task practice may reduce interhemispheric asymmetry of cortical excitabilities and promote upper limb function recovery in subacute stroke with mild to moderate arm paresis.

Mirror Therapy Rehabilitation in Stroke: A Scoping Review of Upper Limb Recovery and Brain Activities

Background. Mirror therapy (MT) has been used as a treatment for various neurological disorders. Recent application of electroencephalogram (EEG) to the MT study allows researchers to gain insight into the changes in brain activity during the therapy. Objective. This scoping review is aimed at mapping existing evidence and identifying knowledge gaps about the effects of MT on upper limb recovery and its application for individuals with chronic stroke. Methods and Materials. A scoping review through a systematic literature search was conducted using PubMed, CINAHL, PsycINFO, and Scopus databases. Twenty articles published between 2010 and 2020 met the inclusion criteria. The efficacy of MT on upper limb recovery and brain activity during MT were discussed according to the International Classification of Functioning, Disability and Health (ICF). Results. A majority of the studies indicated positive effects of MT on upper limb recovery from the body structure/functional domain. All studies used EEG to indicate brain activation during MT. Conclusion. MT is a promising intervention for improving upper limb function for individuals with chronic stroke. This review also highlights the need to incorporate EEG into the MT study to capture brain activity and understand the mechanism underlying the therapy.

Effectiveness of Post-Operative Exercises on Upper Limb Function among Clients with Modified Radical Mastectomy at selected Cancer Hospitals, Hyderabad, Telangana, India

Objective: The study was conducted to assess the Effectiveness of Post-Operative Exercises on Upper Limb Function among Clients with Modified Radical Mastectomy at selected Cancer Hospitals, Hyderabad, Telangana. Study objectives were to (i) Assess the upper limb function among the clients with Modified Radical Mastectomy before the intervention. (ii) Demonstrate post-operative upper limb function exercises to the clients with breast cancer posted for Modified Radical Mastectomy. (iii) Assess the effectiveness of post-operative exercises on upper limb function among clients with Modified Radical Mastectomy. (iv) Find out the association between the upper limb function among clients with Modified Radical Mastectomy and selected variables. Methodology: Quantitative evaluative research approach was used for this study. The study was conducted at selected cancer hospitals, Hyderabad, Telangana. Pre-test post-test group only design adopted. The sample comprised of 30, 15 sample taken as experimental group,15 sample taken as experimental group. Sample was selected by purposive sampling technique. The data was collected by observational checklist. Results: The results revealed that pretest mean score was 64.03 and after intervention the post-test mean score was 57.16 there was a significant difference between the pre-test and post test scores from day 1 to day 5 of the clients at the level of p= 0.05, computed ‘t’ value is more than table value hence null hypothesis was rejected. The obtained’ value was 8.15, found greater than ‘t’ table value. Conclusion: The study concluded that most of the sample was improved upper limb function from day 1to day 5. There is a significant difference between pretest and post- test scores, The findings point out that demonstration of teaching programme would improve the upper limb function of clients with Modified Radical Mastectomy.

Occupational Therapy Assessment for Upper Limb Rehabilitation: A Multisensor-Based Approach

Most post-stroke patients experience varying degrees of impairment in upper limb function and fine motor skills. Occupational therapy (OT) with other rehabilitation trainings is beneficial in improving the strength and dexterity of the impaired upper limb. An accurate upper limb assessment should be conducted before prescribing upper limb OT programs. In this paper, we present a novel multisensor method for the assessment of upper limb movements that uses kinematics and physiological sensors to capture the movement of the limbs and the surface electromyogram (sEMG). These sensors are Kinect, inertial measurement unit (IMU), Xsens, and sEMG. The key assessment features of the proposed model are as follows: (1) classification of OT exercises into four classes, (2) evaluation of the quality and completion of the OT exercises, and (3) evaluation of the relationship between upper limb mobility and muscle strength in patients. According to experimental results, the overall accuracy for OT-based motion classification is 82.2%. In addition, the fusing of Kinect and Xsens data reveals that muscle strength is highly correlated with the data with a correlation coefficient (CC) of 0.88. As a result of this research, occupational therapy specialists will be able to provide early support discharge, which could alleviate the problem of the great stress that the healthcare system is experiencing today.

Efficacy of Action Observation for Upper Limb Motor Deficit in Acute Stroke Participants

Introduction: Action Observation (AO) is a multisensory approach encompassing motor, somatosensory and cognitive rehabilitation. Several Studies have proved the effects of action observation on recovery of motor functions in chronic stroke survivors. However, the effect of action observation strategy on acute stroke participants remains unclear. The objective of this study was to find out the effectiveness of action observation to improve upper limb function in acute stroke. Methods: 28 acute stoke participants were selected based on inclusion and exclusion criteria and randomly assigned into two groups based on computer generated randomization. Action observation training group (AO) received action observation training and conventional group received conventional physiotherapy. Both the groups received 45 minutes session per day for the total duration of 10 days. Results: Upper limb functions were measured using Fugl Myer upper limb component (FMA) and action research arm test (ARAT)at the baseline and after the intervention. Compared with the conventional training group, AO group showed significant improvement in ARAT but no significant difference between the groups in FMA. Conclusion: In conclusion Action observation treatment may become a useful strategy in rehabilitation of acute stroke participants.

Treatment Outcome of Tardy Ulnar Nerve Palsy Associated with Traumatic Cubitus Valgus by Supracondylar Shortening Wedge Rotary Osteotomy and Ulnar Nerve in Situ Tension Release

Background Tardy ulnar nerve palsy is a common late complication of traumatic cubitus valgus. At present, the treatment of tardy ulnar nerve palsy associated with traumatic cubitus valgus is still controversial, whether these two problems can be corrected safely and effectively in one operation is still unclear. To investigate the supracondylar shortening wedge rotary osteotomy combined with in situ tension release of the ulnar nerve in the treatment of tardy ulnar nerve palsy associated with traumatic cubitus valgus. Methods Between 2012 and 2019, 16 patients who had traumatic cubitus valgus deformities with tardy ulnar nerve palsy were treated with simultaneous supracondylar shortening wedge rotary osteotomy and ulnar nerve in situ tension release. we compared a series of indicators of preoperative and postoperative follow-up for at least 24 months, (1) elbow range of motion; (2) the radiographic correction of the preoperative and postoperative humerus-elbow-wrist angles; (3) the static two-point discrimination and grip strength; and (4) the preoperative and postoperative DASH scores of upper limb function. The minimum follow-up was 24 months postoperative (mean, 33 months; range, 24ཞ44 months). Results The mean ROM was improved from 107 ° preoperatively to 122 ° postoperatively (P = 0.001). The mean preoperative elbow wrist angle was 24.6 °, and the mean postoperative humerus-elbow wrist angle was 12.1 ° (P < 0.001). The average grip strength and static two-point discrimination improved from 28 kg force and 8 mm to 21 kg force and 4.0 mm (P < 0.001 and P < 0.001, respectively). The ulnar nerve symptoms were improved in all patients except one. The mean HASH score improved from 29 to 16 (P < 0.001). Conclusion Supracondylar shortening wedge rotary osteotomy combined with in situ tension release of ulnar nerve is an effective method for the treatment of traumatic cubitus valgus with tardy ulnar nerve palsy, which restored the normal biomechanical characteristics of the affected limb and improved the elbow joint function.