Improving Upper Extremity Strength, Function, and Trunk Stability Using Wide-Pulse Functional Electrical Stimulation in Combination With Functional Task-Specific Practice

Objectives: To evaluate upper extremity (UE) function, strength, and dynamic sitting balance in individuals with spinal cord injury (SCI) who received an intensive outpatient therapy program focused on UE training augmented with wide pulse/high frequency functional electrical stimulation (WPHF-FES). Methods: This prospective case series was conducted in an outpatient (OP) clinic in an SCI-specific rehabilitation hospital. Participants were a convenience sample (N = 50) of individuals with tetraplegia receiving OP therapy focused on UE recovery. Individuals participated in 60 minutes of UE functional task-specific practice (FTP) in combination with WPHF-FES 5 times/week for an average of 72 sessions. The primary outcome for this analysis was the Capabilities of Upper Extremity Test (CUE-T). Secondary outcomes include UE motor score (UEMS) and the modified functional reach (MFR). Results: Fifty individuals (13 motor complete; 37 motor incomplete SCI) completed an OP UE training program incorporating WPHF-FES and were included in this analysis. On average, participants demonstrated significant improvements in the total CUE-T score of 14.1 (SD = 10.0, p < .0001) points; significant changes were also noted in UEMS and MFR, improving an average of 4.6 (SD = 5.2, p < .0001) points and 13.6 (SD = 15.8, p < .0001) cm, respectively. Conclusion: Individuals with tetraplegia demonstrated significant improvements in UE strength, function, and dynamic sitting trunk balance after receiving UE training augmented with WPHF-FES. Future comparative effectiveness studies need to be completed to guide efficacious treatment interventions in OP therapy.

Reduced Movement Variability and Kinematics Changes During a Hand to Head Movement are Associated with Improved Outcome Following Superior Capsular Reconstruction (232)

Objectives: Patients with irreparable rotator cuff tears (RCT) exhibit functional limitations including limited ability to perform functional tasks such as combing their hair. One viable treatment is superior capsular reconstruction (SCR). SCR has been shown to restore stability of the glenohumeral (GH) joint in cadavers1, but its effect on in vivo scapular and humeral motion is unknown. The aims of this study were to determine the effect of SCR on in vivo scapular and humeral kinematics during a functional hand to head motion and to identify associations between shoulder kinematics and patient-reported outcomes (PROs). We hypothesized that moving the hand to the back of the head would be accomplished by using more GH based movement including rotation and abduction, and less scapular motion after SCR, and there would be a positive correlation between kinematics changes and improved PROs. Methods: Ten patients (8M, 2F, age 63 ± 7 years) with irreparable RCT provided informed consent to participate in this prospective IRB-approved study. American Shoulder and Elbow Surgeon (ASES), Disability of the Arm Shoulder and Hand (DASH), and Western Ontario Rotator Cuff Index (WORC) surveys were completed before (PRE) and 1-year (1YR-POST) after SCR. Participants were seated and instructed to move their hand from their lap to the back of their head while synchronized biplane radiographs of the shoulder were collected PRE and 1YR-POST at 50 images/s for 3 separate trials. Six degree of freedom GH and scapular kinematics were determined with sub-millimeter accuracy by matching subject-specific CT-based bone models of the humerus and scapula to the synchronized radiographs using a validated volumetric tracking technique3. The contributions of humeral abduction, plane of elevation and internal/external (I/E) rotation relative to the scapula, as well as scapular upward rotation, protraction, and tilt, were calculated for each subject before and after SCR. Differences in rotational contributions from PRE to POST were evaluated using a paired t-test. Variability in rotational contributions was characterized by the inter-subject standard deviation in rotational component contributions to the movement. Correlations among changes in the contribution of each rotation component and between the contribution of each rotation component and PROs were evaluated with Pearson’s correlation coefficients. Significance was set at p < 0.05 for all tests. Results: No differences in contribution to motion were identified in any of the rotational components from PRE to POST (all p > 0.15, Figure 1). Inter-subject variability in rotational contributions to the movement decreased in 5 of the 6 rotational components from PRE to 1YR-POST (Table 1; Figure 1). The PRE to 1YR POST change in contribution from GH abduction was positively correlated to the change in contribution from GH I/E rotation (Figure 2, R = 0.8, p = 0.001) and negatively correlated to the change in contribution from scapular protraction (Figure 2, R = -0.94, p = 0.001). ASES scores were negatively correlated with abduction contribution PRE (R = -0.65, p = 0.043), and positively correlated with plane of elevation PRE (R = 0.685, p = 0.03). Changes in the plane of elevation contribution were also positively correlated with changes in ASES scores (R = 0.635, p = 0.048). Conclusions: This is the first study to report GH and scapular kinematics when performing the functional task of placing the hand to the back of the head. Changes in contributions to the motion were inconsistent across subjects, making it difficult to find differences from PRE to POST. However, inter-subject variation was reduced following surgery, suggesting the participants’ movement strategy converged toward a more similar and possibly more efficient movement pattern following SCR. Increased contributions of glenohumeral rotation and abduction were offset by decreased scapular protraction and indicates SCR affects the contributions from these three rotations, partially supporting our first hypothesis. In addition, increased GH plane of elevation contribution following surgery was associated with improved ASES scores supporting our second hypothesis. This may be consistent with improved glenohumeral kinematics and efficiency of movement during a functional task following SCR. Future work will investigate GH and scapular kinematics in healthy individuals performing the hand to head movement to determine if movement strategy is closer to healthy after SCR.

Rare location of Universal tumor

Lipomas are one of the most common benign mesenchymal tumor in human. Lipoma occurring in the tongue is rare as tongue has paucity of normal adipose tissue. Here we present an unusual case of lipoma presented in the tongue, and removal of which comforted patient by regaining of the functional task of tongue. Fifty two year’s old Muslim women presented with painless swelling on right lateral border of tongue for 5 years for which excision was done and histopathology evaluation was performed. The histopathology was consistent with the diagnosis of Lingual Lipoma. Existence of lipoma in the tongue is very rare, which can be managed by simple excision. Histopathology is the gold standard in the diagnosis.

Application of the Challenge Point Framework During Treatment of Speech Sound Disorders

Purpose The purpose of this article is to provide trial-by-trial practice performance data in relation to learning (outcome probe data) as collected from 18 treatment sessions provided to children with severe speech sound disorders. The data illustrate the practice–learning paradox: Specific, perfect practice performance is not required for speech production learning. Method We detailed how nine student speech-language pathologists (SSLPs) implemented and modified the motor learning practice conditions to reach a proposed challenge point during speech practice. Eleven participants diagnosed with a severe speech sound disorder received high-intensity speech therapy 3 times per week for 6 weeks. SSLPs implemented treatment procedures with the goal of achieving at least 100 practice trials while manipulating practice parameters to maintain practice at the challenge point. Specifically, child performance was monitored for accuracy in five-trial increments, and practice parameters were changed to increase functional task difficulty when the child's performance was high (four or five correct responses) or to decrease functional task difficulty when the child's performance was low (fewer than four correct responses). The practice stimulus, type and amount of feedback, structure of practice, or level of support might be changed to ensure practice at the challenge point. Results On average, the children achieved 102 practice trials per session at a level of 58% correct responses. Fast achievement of connected speech with the lowest amount of support was associated with high scores on generalization probes. Even with high levels of error during practice, the children improved percent consonants correct with maintenance of learning 3 months posttreatment. Conclusion The results of this study show that it may not be necessary to overpractice or maintain a high degree of performance accuracy during treatment sessions to achieve transfer and retention of speech production learning.

Determination of the Strongest Factor and Component in a Relationship between Lower-Extremity Assessment Protocol and Patient-Oriented Outcomes in Individuals with Anterior Cruciate Ligament Reconstruction: A Pilot Study

Although the Lower-Extremity Assessment Protocol (LEAP) assesses multidimensional aspects of a patient with anterior cruciate ligament (ACL) injury, there is a need to reduce the dimensionality of LEAP items to effectively assess patients. Therefore, the present study aimed to establish the validity of LEAP and to determine associated factors and components in a relationship between LEAP and the International Knee Documentation Committee (IKDC) questionnaire. Fifteen patients who had ACL reconstruction more than 1 year and less than 5 years earlier were recruited. Patients performed LEAP, including muscular strength, fatigue index, static balance, drop landing, and functional hopping assessment. They also completed the IKDC questionnaire and the Tegner Activity Score. Factor analysis and stepwise regression analysis were performed. The 14 components of LEAP were categorized into four factors (functional task, muscle strength, neuromuscular control, and fatigue), which accounted for 83.8% of the cumulative variance by factor analysis. In the stepwise regression analysis, the functional task (R2 = 0.43, p = 0.008) in factors and single-leg hop (R2 = 0.49, p = 0.004) in components were associated with patient-oriented outcomes, respectively. In conclusion, the functional task and single-leg hop may be used for providing valuable information about knee joints to patients and clinicians.